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Influence of visceral adiposity on cardiovascular risk in patients with systemic sclerosis

  • Observational Research
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Abstract

Systemic sclerosis (SSc) is an autoimmune disease characterized by systemic inflammation, endothelial dysfunction, generalized fibrosis and high cardiovascular mortality. The evaluation of cardiovascular risk through the visceral adiposity index (VAI) has been helpful due to its direct relationship to the body and visceral fat percentage. We evaluated the influence of body composition and anthropometrics on cardiovascular risk as measured by VAI in healthy controls (HC) and SSc. An analytical cross-sectional study of 66 participants (33 SSc and 33 HC), mean age 52.7 ± 10, 95% women, was conducted from August 2020 to January 2021. Inclusion criteria in cases were consecutive patients with SSc (ACR/EULAR 2013), 63.6% were diffuse cutaneous (dcSS) subtype, and 36.4 were limited cutaneous (lcSS) subtype. HC was matched by age and gender. Serum lipid profiles and InBody anthropometrics were analyzed and compared. We performed descriptive statistics, bivariate analysis with Student’s t, or Mann–Whitney U, correlation and chi-square according to the variable type and distribution. Total cholesterol was significantly higher in SSc than HC (345 vs 194, p = < 0.001). The BMI was higher in HC (26.2 vs 28.9, p < 0.001). Kilograms of muscle (19.8 vs 28.9, p < 0.001) and total fat (23.4 vs 28.9, p < 0.001) were lower in SSc patients compared to HC. VAI was similar when BMI < 25, but significantly higher when BMI > 25 in SSc than in HC (3 vs 1.9, p = 0.030). The increase in BMI at overweight or obese in SSc is associated with a significant increase in cardiovascular risk.

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Data availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

Abbreviations

VAI:

Visceral adiposity index

BMI:

Body mass index

TG:

Triglyceride

SSc:

Systemic sclerosis

HC:

Healthy controls

HDL:

High-density lipoprotein-cholesterol

W:

Waist

WHR:

Waist-to-hip ratio

References

  1. Sanz I, Martínez F, Guillén-del-Castillo A, Roque A, Cuéllar H, Pizzi M, Fernandez A, Callejas E, Orozco O, Fonollosa V, Simeón C (2018) Subclinical cardiovascular disease and systemic sclerosis: a comparison between risk charts, quantification of coronary calcium and carotid ultrasonography. Autoimmun Rev 17(9):900–905. https://doi.org/10.1016/j.autrev.2018.03.015

    Article  Google Scholar 

  2. Cen X, Feng S, Wei S, Yan L, Sun L (2020) Systemic sclerosis and risk of cardiovascular disease: a PRISMA-compliant systemic review and meta-analysis of cohort studies. Medicine (Baltimore) 99(47):e23009. https://doi.org/10.1097/MD.0000000000023009

    Article  PubMed  Google Scholar 

  3. Ota Y, Kuwana M (2020) Endothelial cells and endothelial progenitor cells in the pathogenesis of systemic sclerosis. Eur J Rheumatol 7(Suppl 3):S139–S146. https://doi.org/10.5152/eurjrheum.2019.19158

    Article  PubMed  Google Scholar 

  4. Frech T, Machin D, Murtaugh M, Stoddard G, Bloom S, Phibbs J, Donato A (2018) Implications of endothelial shear stress on systemic sclerosis vasculopathy and treatment. Clin Exp Rheumatol 36 Suppl 113(4):175–182

    PubMed  Google Scholar 

  5. Ferreira F, Segheto W, Da Silva D, Pereira P, Longo G (2018) Visceral adiposity index associated with behavioral and inflammatory parameters in adults: a population-based study. Nutr Hosp 35(2):326–331. https://doi.org/10.20960/nh.1325

    Article  PubMed  Google Scholar 

  6. Ejtahed HS, Kelishadi R, Hasani-Ranjbar S, Angoorani P, Motlagh ME, Shafiee G, Ziaodini H, Taheri M, Qorbani M, Heshmat R (2019) Discriminatory ability of visceral adiposity index as an indicator for modeling cardio-metabolic risk factors in pediatric population: the CASPIAN-V study. J Cardiovasc Thorac Res 11(4):280–286. https://doi.org/10.15171/jcvtr.2019.46

    Article  PubMed  PubMed Central  Google Scholar 

  7. Saqlain M, Akhtar Z, Karamat R, Munawar S, Iqbal M, Fiaz M, Zafar MM, Saeed S, Nasir MF, Naqvi SMS, Raja GK (2019) Body mass index versus other adiposity traits: best predictor of cardiometabolic risk. Iran J Public Health 48(12):2224–2231

    PubMed  PubMed Central  Google Scholar 

  8. Kouli GM, Panagiotakos DB, Kyrou I, Georgousopoulou EN, Chrysohoou C, Tsigos C, Tousoulis D, Pitsavos C (2017) Visceral adiposity index and 10-year cardiovascular disease incidence: the ATTICA study. Nutr Metab Cardiovasc Dis 27(10):881–889. https://doi.org/10.1016/j.numecd.2017.06.015

    Article  PubMed  Google Scholar 

  9. Nguyen AD, McMahan ZH, Volkmann ER (2022) Micronutrient deficiencies in systemic sclerosis: a scoping review. Open Access Rheumatol 14:309–327. https://doi.org/10.2147/OARRR.S354736

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Baron M, Hudson M, Steele R, Canadian Scleroderma Research Group (2009) Malnutrition is common in systemic sclerosis: results from the Canadian scleroderma research group database. J Rheumatol 36(12):2737–2743. https://doi.org/10.3899/jrheum.090694

    Article  PubMed  Google Scholar 

  11. Gopinath B, Kifley A, Flood VM, Mitchell P (2018) Physical activity as a determinant of successful aging over ten years. Sci Rep 8(1):10522. https://doi.org/10.1038/s41598-018-28526-3

    Article  CAS  ADS  PubMed  PubMed Central  Google Scholar 

  12. Amato MC, Giordano C, Pitrone M, Galluzzo A (2011) Cut-off points of the visceral adiposity index (VAI) identifying a visceral adipose dysfunction associated with cardiometabolic risk in a Caucasian Sicilian population. Lipids Health Dis 10:183. https://doi.org/10.1186/1476-511X-10-183

    Article  PubMed  PubMed Central  Google Scholar 

  13. Toms TE, Panoulas VF, Kitas GD (2011) Dyslipidaemia in rheumatological autoimmune diseases. Open Cardiovasc Med J 5:64–75. https://doi.org/10.2174/1874192401105010064

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Borba EF, Borges CT, Bonfá E (2005) Lipoprotein profile in limited systemic sclerosis. Rheumatol Int 25:379–383. https://doi.org/10.1007/s00296-004-0580-8

    Article  CAS  PubMed  Google Scholar 

  15. Ferraz-Amaro I, Delgado-Frías E, Hernández-Hernández V, Sánchez-Pérez H, de Armas-Rillo L, Armas-González E, Machado JD, Diaz-González F (2021) HDL cholesterol efflux capacity and lipid profile in patients with systemic sclerosis. Arthritis Res Ther 23(1):62. https://doi.org/10.1186/s13075-021-02443-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Shamah-Levy T, Romero-Martínez M, Barrientos-Gutiérrez T, Cuevas-Nasu L, Bautista-Arredondo S, Colchero MA, Gaona-Pineda EB, Lazcano-Ponce E, Martínez-Barnetche J, Alpuche-Arana C, Rivera-Dommarco J (2022) Encuesta Nacional de Salud y Nutrición 2021 sobre Covid-19. Resultados nacionales. Cuernavaca, México: Instituto Nacional de Salud Pública. https://www.insp.mx/resources/images/stories/2022/docs/220801_Ensa21_digital_29julio.pdf

  17. Renaud A, Jirka A, Durant C, Connault J, Espitia O, Takoudju C, Agard C (2023) Atteinte digestive de la sclérodermie systémique [Gastrointestinal tract involvement in systemic sclerosis]. Rev Med Interne. https://doi.org/10.1016/j.revmed.2023.05.003

    Article  PubMed  Google Scholar 

  18. Bratoiu I, Burlui AM, Cardoneanu A, Macovei LA, Richter P, Rusu-Zota G, Rezus C, Badescu MC, Szalontay A, Rezus E (2022) The involvement of smooth muscle, striated muscle, and the myocardium in scleroderma: a review. Int J Mol Sci 23(19):12011. https://doi.org/10.3390/ijms231912011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Sobolewski P, Maślińska M, Wieczorek M, Łagun Z, Malewska A, Roszkiewicz M, Nitskovich R, Szymańska E, Walecka I (2019) Systemic sclerosis - multidisciplinary disease: clinical features and treatment. Reumatologia 57(4):221–233. https://doi.org/10.5114/reum.2019.87619

    Article  PubMed  PubMed Central  Google Scholar 

  20. Paik JJ (2018) Muscle disease in scleroderma. Curr Opin Rheumatol 30(6):576–580. https://doi.org/10.1097/BOR.0000000000000552

    Article  PubMed  Google Scholar 

  21. Pettersson H, Boström C, Bringby F, Walle-Hansen R, Jacobsson L, Svenungsson E, Nordin A, Alexanderson H (2019) Muscle endurance, strength, and active range of motion in patients with different subphenotypes in systemic sclerosis: a cross-sectional cohort study. Scand J Rheumatol 48(2):141–148. https://doi.org/10.1080/03009742.2018.1477990

    Article  CAS  PubMed  Google Scholar 

  22. Khanna D, Khanna S, Khanna P, Kahar P, Patel BM (2022) Obesity: a Chronic low-grade inflammation and its markers. Cureus 14(2):e22711. https://doi.org/10.7759/cureus.22711

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gigante A, Iannazzo F, Navarini L, Sgariglia MC, Margiotta DPE, Vaiarello V, Foti F, Afeltra A, Cianci R, Rosato E (2021) Metabolic syndrome and adipokine levels in systemic lupus erythematosus and systemic sclerosis. Clin Rheumatol 40(10):4253–4258. https://doi.org/10.1007/s10067-021-05731-6

    Article  PubMed  PubMed Central  Google Scholar 

  24. Iannone F, Praino E, Rotondo C, Natuzzi D, Bizzoca R, Lacarpia N, Fornaro M, Cacciapaglia F (2021) Body mass index and adipokines/cytokines dysregulation in systemic sclerosis. Clin Exp Immunol 206(2):153–160. https://doi.org/10.1111/cei.13651

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Li CW, Yu K, Shyh-Chang N et al (2022) Pathogenesis of sarcopenia and the relationship with fat mass: descriptive review. J Cachexia Sarcopenia Muscle 13(2):781–794. https://doi.org/10.1002/jcsm.12901

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Cao Q, Yu S, Xiong W, Li Y, Li H, Li J, Li F (2018) Waist-hip ratio as a predictor of myocardial infarction risk: a systematic review and meta-analysis. Medicine (Baltimore) 97(30):e11639. https://doi.org/10.1097/MD.0000000000011639

    Article  PubMed  Google Scholar 

  27. Palacio AC, Díaz-Torrente X, Quintiliano-Scarpelli D (2022) Higher abdominal adiposity is associated with lower muscle strength in Chilean adults. Front Nutr 9:812928. https://doi.org/10.3389/fnut.2022.812928

    Article  PubMed  PubMed Central  Google Scholar 

  28. Roubenoff R (2004) Sarcopenic obesity: the confluence of two epidemics. Obes Res 12(6):887–888. https://doi.org/10.1038/oby.2004.107

    Article  PubMed  Google Scholar 

  29. Cruz-Domínguez MP, García-Collinot G, Saavedra MA, Montes-Cortes DH, Morales-Aguilar R, Carranza-Muleiro RA, Vera-Lastra OL, Jara LJ (2017) Malnutrition is an independent risk factor for mortality in Mexican patients with systemic sclerosis: a cohort study. Rheumatol Int 37(7):1101–1109. https://doi.org/10.1007/s00296-017-3753-y

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank all the participants in this study for their time and willingness to share their experiences. Their contributions have been invaluable in helping us to understand the topic and draw meaningful conclusions.

Funding

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Benemérita Universidad Autónoma de Puebla, Campus Puebla, Puebla, Puebla, Mexico

    Gabriela Martínez-Díaz & Michelle Arrucha-Cozaya

  2. Direction of Education and Research, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Mexico City, Mexico

    María Pilar Cruz-Domínguez

  3. Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Mexico City, Mexico

    Berenice López Zamora

  4. Postgraduate studies section and research, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico

    Berenice López Zamora & Kybaná Aurora Gil-Galindo

  5. Internal Medicine Resident, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Mexico City, Mexico

    Jordan Ramirez-Facio

  6. Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, IMSS; Universidad Nacional Autónoma de México, Mexico City, Mexico

    Gabriela Medina & Miguel Angel Saavedra-Salinas

  7. Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico

    María Pilar Cruz-Domínguez, Gabriela Medina, Ricardo Xavier Munguía-Cruz, Olga Lidia Vera-Lastra & Ana Lilia Peralta-Amaro

  8. Internal Medicine Department, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Mexico City, Mexico

    Olga Lidia Vera-Lastra & Ana Lilia Peralta-Amaro

  9. Laboratory Department, Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Mexico City, Mexico

    Óscar Iván Florez-Durante

Authors
  1. Gabriela Martínez-Díaz
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  7. Miguel Angel Saavedra-Salinas
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  8. Michelle Arrucha-Cozaya
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  11. Óscar Iván Florez-Durante
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  12. Kybaná Aurora Gil-Galindo
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Contributions

All authors meet the ICMJE criteria for authorship. GMD, MCD, and BLZ contributed to methodology, validation, and formal analysis; GMD, MCD, JFR, and RMC were involved in investigation and writing—original draft; MSS and OFD contributed to visualization, resources, and review; APA MAC, and OVL were involved in editing, project administration, conceptualization, and critical review; and KGG contributed to resources and formal analysis of diet. The final manuscript has been revised critically and approved by all the authors, who are fully responsible for the integrity and accuracy of all aspects of the work.

Corresponding author

Correspondence to María Pilar Cruz-Domínguez.

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Conflict of interest

The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript.

Ethical approval

Our study was carried out according to the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Local Research Ethics Committee of our hospital (Comité Local de Ética e Investigación en Salud 3501 IMSS, No. R-2020-3501-077), on April 20, 2020. All patients gave full written informed consent. All authors had access to the study data.

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Congress abstract publications: This data was accepted as a poster discussion in LI Mexican Congress of Rheumatology. Colegio Mexicano de Reumatología (2023) LI congreso mexicano de Reumatología. Reumatol Clin 19 (Supl Congr 1):45–67. https://www.reumatologiaclinica.org/es-vol-19-num-sc1-sumario-X1699258X23X00C10.

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Martínez-Díaz, G., Cruz-Domínguez, M.P., López Zamora, B. et al. Influence of visceral adiposity on cardiovascular risk in patients with systemic sclerosis. Rheumatol Int 44, 621–630 (2024). https://doi.org/10.1007/s00296-023-05421-3

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