INTRODUCTION:

Globally, diabetes is one of the most common chronic diseases affecting 5.0% of the world's population and doubling every generation.¹ Type 2 diabetes accounts for up to 95.0% of this total.²

Patients suffering from type 2 diabetes mellitus (T2DM) have a 2 to 4 fold risk of cardiovascular disease (CVD) compared to the general population. In T2DM, several CVD risk factors have been identified, including obesity, smoking, hypertension, hyperglycemia, proteinuria, sedentary lifestyle, and dyslipidemia. These complications are a major burden to the patient, his relatives, and on the health care system. In patients with type 2 diabetes, atherosclerosis is more common and mortality is higher after CVD events than among non-diabetic persons.^3-5

The incidence of type 2 diabetes is rising as a consequence of lifestyle patterns contributing to obesity.^6,7 Index of central obesity, a ratio of waist circumference (WC) and height is a better and novel parameter to measure central obesity both in males as well as in females.⁸ Obesity has become the major risk factor for the development of cardiovascular disease, diabetes and dyslipidemia. Nowadays obesity and an increase in fat tissue, especially abdominal obesity are the major problems of public health in the worldwide that will lead to chronic cardiovascular abnormalities.⁹ To explore a more accurate tool for diagnosis, and therapeutics as well new risk biomarkers are required. Hence it is essential to find out the simple and effective measure for the assessment of obesity in order to identify the cardiovascular risk and to guide appropriate management. The ankle brachial index (ABI) is a simple diagnostic test that is non-invasive and has been validated in the detection of stenosis in > 50.0% of arteries in the lower limbs.¹⁰ Several anthropometric measurements and indices have been developed for the assessment of obesity and to predict cardiovascular complications. However a better obesity measure to predict cardiovascular complications is still contentious. There are several other obesity measures in which WC has been proposed as the best measures, with exceptional correlation with abdominal imaging and high association with CVD risk factors, particularly diabetes.^11-13

Visceral adiposity index (VAI)⁽¹⁴⁾has been correlated with body mass index (BMI), waist/hip ratio (WHR), WC, and hip circumference (HC) and showed a good correlation with all the parameters used to assess the adiposity.¹⁵ Since it is based on simple anthropometric calculations, VAI would be an easy tool for the assessment of CVD and might be useful in routine clinical practice. The purpose of the study is that since the incidence of T2DM in India is constantly rising, it is essential to identify high-risk patients before diabetic complications develop. It is important to tailor effective treatments for these patients to reduce CVD mortality by identifying a simple, effective, and better cardiometabolic risk predictor among the VAI, body adiposity index (BAI), WHR, waist/height ratio (WHtR), BMI, and their association with CVD risk factors.

MATERIALS AND METHODS:

Ethical statement:

The study and informed consent were approved by the Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Ethics Review Board, Patna- Bihar, India registered with Drug Controller Government of India, New Delhi (no. ECR/480/Inst/BR/2014).

Study design and subjects:

It is an observational cross-sectional study carried out at Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna- Bihar, India. Data collection was done between August 2014 to May 2015. A total of 181 type 2 diabetes mellitus subjects (98 males and 83 females) were enrolled for the study. Patients were enrolled according to the Inclusion criteria (patients with fasting blood sugar level ≥ 126 mg/dL, known diabetic patients, and age more than 30 years). Alcoholics, smokers, subjects with hepatic, and renal disorders, and those on lipid-lowering agents were excluded from the study. After taking a detailed medical history, a detailed physical examination was also conducted for all participants and the data were recorded. To analyze the data patients were divided into two groups based on BMI (normal weight as Group 1 with BMI < 25 kg/m², n = 94; and overweight as Group 2 with BMI ≥ 25 kg/m², n = 87). All comparisons and correlations were made between these two groups on a gender basis.

Data collection and measurements:

All the demographic information was collected from the patients. Body weight was measured on a calibrated weighing balance, to the nearest 0.1 kg. Height was measured using a wall-mounted height measurement scale, to the nearest 0.5 cm. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the subjects were measured in supine posture using a sphygmomanometer. Blood pressure was based on the average of two readings. Waist and hip circumferences were measured by using a measurement tape. Patients were instructed to wear light and single-piece cloths during the HC and WC measurements. Waist circumferences were measured according to the WHO standard protocol (at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest after the normal expiration). Hip circumference was measured at the widest margin of the buttocks. All anthropometric indices were measured once.

ABI was measured by using a stethoscope and sphygmomanometer. The patient was allowed to rest in the supine position for 5-10 minutes. A blood pressure (BP) cuff was placed just an inch above the medial malleolus and inflated till the posterior tibial pulse disappeared and slowly deflated until the pulse reappeared and the systolic pressure was recorded. The same was repeated by palpating the dorsalis pedis and recorded and the highest of the posterior tibial and dorsalis pedis was considered as the systolic pressure of legs. Similarly, systolic pressure in the arms was recorded by placing the BP cuff just above the ante cubital fossa and the systolic pressure was recorded by palpating the brachial artery in both arms.

Biochemical measurement:

All the Biochemical measurements were made in the morning. Fasting blood sugar (FBS) levels, Postprandial blood sugar (PPBS) levels and total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C) were measured in Clinical Biochemistry Laboratory, by using Merck microlab 300 auto analyzer and Lab diagnostic kit. Glycosylated hemoglobin (HbA1c) was estimated by using the Afnion auto analyzer Alere Diagnostic Cartridge in the Clinical Biochemistry Laboratory, RMRIMS, Patna. Patients were requested to be fasting for at least 8 hours (whole night) for the estimation of FBS. This was followed by food intake which consisted of carbohydrates, proteins, and fats. However, foods with high glycemic index were avoided. The patients were told not to eat, drink (other than water), smoke, or chew gum or candy following the meal until the blood was withdrawn, after 2 hours for the estimation of PPBS.

Anthropometric indices:

Based on these measurements, the following body mass-related indices (BMI, WHR, WHtR, VAI (14) and BAI (15)) were calculated.

Statistical analysis:

Statistical analysis was done by using SPSS version 22. An independent-sample test was used for comparative analysis, made between groups and between males and females. Pearson’s correlation was used to find out the correlation between anthropometric indices and cardiovascular risk factors. A p values of <0.05 was considered to show significant differences.

RESULTS:

In Table 1, the basic characteristics of the study population, stratified by gender and also by BMI are shown. A total of 54.1% (n = 98) of the subjects were males, and the mean age of the study population was 54.1 years, with a mean BMI of 25.0 kg/m². Females tended to have higher mean HC, WHtR, BAI, VAI (all P < 0.001), and WC, but lower mean height (P < 0.001), weight (P < 0.05), and WHR. As for CVD risk factors, females had a higher mean FBS, PPBS, HbA1c, and all components of the lipid profile, but lower SBP and DBP (P < 0.05). Group 2 (BMI ≥ 25) patients had higher weight, WC, HC, BMI, WHtR, and BAI (all P < 0.001) in comparison to group 1 (BMI < 25), and no significant differences were observed with other parameters.

Male diabetic patients showed significantly higher mean values (all P < 0.001) in the group 2 category, whereas height, WHR, and VAI failed to show significant differences. Female diabetic patients showed significantly higher mean values in group 2 (all P < 0.001) except VAI, which was significantly higher in the group 1 category. Height and WHR failed to show significant differences. CVD risk factors obtained from male diabetic patients are presented. Mean diastolic blood pressure (DBP) was significantly higher in group 2 (P < 0.05) when compared with group 1. Mean values of TC, TG, LDL-C and VLDL-C were observed significantly higher when compared to group 2 (Table 2).

Male patients in group 1 had significantly higher mean values of height and weight (P < 0.001) whereas female patients had significantly higher WHtR (P < 0.05), BAI and VAI (P < 0.001) with comparison to male patients. Male patients in group 2 had a significantly higher mean value of height (P < 0.001) and weight (P < 0.05) when compared with the female group. Mean values of BMI and VAI (P < 0.05), WHtR, and BAI (P < 0.001) were significantly higher in female patients when compared with the male group. Mean values of TC and LDL-C were significantly higher (P < 0.05) in females when compared with males in group 1 patients, whereas the mean value of DBP was significantly higher (P < 0.05) in males when compared with females in group 2 patients (Table 2).

In the correlation statistical analysis between anthropometric measures, anthropometric indices, and CVD risk factors with obesity indices of Group 1 and Group 2 subjects, nearly all the clinical parameters shows significant correlation with various obesity indices, wheres as the ABI shows significant correlation with BAI and VAI (Table 3).

Table 1. Anthropometric characteristics, biochemical parameters, and cardiovascular risk factors of total subjects according to sex and body mass index (BMI < 25 kg/m²as Group 1and BMI ≥ 25 kg/m²as Group 2).

	Sex			BMI
Characteristics	Male (n = 98) Mean ± SD	Female (n = 83) Mean ± SD	P-value	Group 1 (n = 94) Mean ± SD	Group 2 (n = 87) Mean ± SD	P-value
Age (years)	54.8 ± 9.7	53.3 ± 10.1	0.311	54.3 ± 9.7	53.95 ± 10.2	0.811
Duration of disease (yrs)	3.8 ± 3.9	4.4 ± 4.6	0.349	4.2 ± 4.6	4.01 ± 3.9	0.810
Height (cm)	163.1 ± 6.9	150.7 ± 6.1	0.0001^a	159.8 ± 9.1	154.8 ± 8.1	0.0001^a
Weight (kg)	63.2 ± 9.3	59.9 ± 10.1	0.02^a	56.5 ± 8.6	67.3 ± 7.8	0.0001^a
WC (inches)	35.3 ± 3.3	36.1 ± 4.2	0.136	33.9 ± 2.8	37.5 ± 3.7	0.0001^a
HC (inches)	38.2 ± 2.8	39.8 ± 3.6	0.001^a	37.3 ± 2.6	40.7 ± 3.1	0.0001^a
BMI (kg/m²)	23.8 ± 3.3	26.4 ± 4.2	0.0001^a	22.1 ± 2.3	28.1 ± 2.8	0.0001^a
WHR	0.9 ± 0.1	0.9 ± 0.1	0.052	0.9 ± 0.1	0.9 ± 0.1	0.199
WHtR	0.2 ± 0.02	0.2 ± 0.02	0.0001^a	0.2 ± 0.01	0.2 ± 0.3	0.0001^a
BAI	0.4 ± 1.7	3.6 ± 2.3	0.0001^a	0.5 ± 1.9	3.3 ± 2.5	0.0001^a
VAI	1.9 ± 1.2	2.9 ± 1.9	0.0001^a	2.5 ± 2.1	2.2 ± 1.02	0.278
HbA1c(%)	8.3 ± 2.4	8.9 ± 2.3	0.073	8.6 ± 2.2	8.5 ± 2.5	0.677
FBS (mg/dL)	177 ± 73	193 ± 68	0.144	186 ± 71	183 ± 71	0.727
PPBS (mg/dL)	272 ± 106	282 ± 89	0.524	84 ± 10	276 ± 99	0.908
SBP (mmHg)	135 ± 19	130 ± 13	0.032^a	131 ± 18	134 ± 16	0.341
DBP (mmHg)	87 ± 11	83 ± 9	0.012^a	84 ± 10	86 ± 10	0.219
TC (mg/dL)	138 ± 42	146 ± 36	0.210	143 ± 42	140 ± 36	0.522
HDL-C (mg/dL)	38 ± 10	40 ± 12	0.438	38 ± 12	39 ± 10	0.477
TG (mg/dL)	131 ± 80	138 ± 100	0.600	141 ± 112	127 ± 56	0.269
LDL-C (mg/dL)	78 ± 29	86 ± 31	0.070	82 ± 32	81 ± 28	0.767
VLDL-C (mg/dL)	27 ± 16	28 ± 20	0.535	29 ± 22	25 ± 11	0.174
ABI	1.1 ± 0.1	1.1 ± 0.1	0.120	1.1 ± 0.1	1.1 ± 0.1	0.319

Data are mean ± SD values. An independent-sample t - test was used to examine significant changes.

^aP < 0.05 was considered statistically significant.

ABI, Ankle brachial index; BAI, Body adiposity index.

BMI, Body mass index; DBP, Diastolic blood pressure; FBS, Fasting blood sugar; HbA1c, Glycosylated haemoglobin; HC, Hip circumference; HDL-C, High-density lipoprotein cholesterol; LDL-C, Low-density lipoprotein cholesterol; PPBS, Postprandial blood sugar; SBP, Systolic blood pressure; TC, Total cholesterol; TG, Triglyceride; VAI, Visceral adiposity index; VLDL-C, Very low-density lipoprotein cholesterol; WC, Waist circumference; WHR, Waist to hip ratio; WHtR, Waist to height ratio.

Table 2. Comparison of anthropometric measures, anthropometric indices, and cardiovascular risk factors in Group 1 and Group 2, between male and female subjects.

	Group 1			Group 2			P-value Group 1 vs Group 2
Characteristics	Male (n = 63) Mean ± SD	Female (n = 31) Mean ± SD	P-value	Male (n = 35) Mean ± SD	Female (n = 52) Mean ± SD	P-value	Between males	Between females
Anthropometric measures
Height (cm)	163.0 ± 7.3	151.3 ± 6.2	0.0001^a	161.4 ± 8.9	150.4 ± 6.1	0.0001^a	0.070	0.523
Weight (kg)	59.3 ± 8.2	51.0 ± 6.4	0.0001^a	70.5 ± 6.5	65.2 ± 8.0	0.002^a	0.0001^a	0.0001^a
WC (inches)	34.2 ± 2.9	33.4 ± 2.6	0.196	37.2 ± 3.1	37.7 ± 4.1	0.540	0.0001^a	0.0001^a
HC (inches)	37.2 ± 2.7	37.4 ± 2.2	0.749	40.0 ± 2.0	41.2 ± 3.6	0.063	0.0001^a	0.0001^a
Anthropometric indices
BMI (kg/m²)	22.0 ± 2.5	22.2 ± 1.8	0.680	27.01 ± 1.6	28.8 ± 3.1	0.002^a	0.0001^a	0.0001^a
WHR	0.1 ± 90.1	0.9 ± 0.04	0.062	0.9 ± 0.1	0.9 ± 0.1	0.283	0.316	0.101
WHtR	0.2 ± 0.01	0.2 ± 0.01	0.003^a	0.2 ± 0.01	0.3 ± 0.02	0.0001^a	0.0001^a	0.0001^a
BAI	-0.2 ± 1.5	2.1 ± 1.3	0.0001^a	1.5 ± 1.4	4.4 ± 2.3	0.0001^a	0.0001^a	0.0001^a
VAI	1.9 ± 1.4	3.6 ± 2.7	0.0001^a	1.8 ± 0.8	2.5 ± 1.1	0.006^a	0.780	0.007^a
Cardiovascular risk factors
HbA1c (%)	8.4 ± 2.2	9.3 ± 2.2	0.069	8.2 ± 2.7	8.7 ± 2.3	0.315	0.723	0.315
FBS (mg/dL)	181 ± 73	196 ± 67	0.352	170 ± 74	191 ± 69	0.180	0.464	0.744
PPBS (mg/dL)	275 ± 103	282 ± 90	0.774	267 ± 112	282 ± 90	0.493	0.702	0.995
SBP (mmHg)	133 ± 20	127 ± 12	0.136	138 ± 18	131 ± 14	0.400	0.232	0.274
DBP (mmHg)	85 ± 10	82 ± 8	0.180	90 ± 12	84 ± 9	0.005^a	0.042^a	0.537
TC (mg/dL)	137 ± 44	156 ± 35	0.035^a	141 ± 37	139 ± 35	0.853	0.668	0.036
HDL-C (mg/dL)	38 ± 11	39 ± 13	0.731	39 ± 8	40 ± 12	0.597	0.719	0.709
TG (mg/dL)	128 ± 88	168 ± 15	0.110	136 ± 64	120 ± 49	0.208	0.664	0.036^a
LDL-C (mg/dL)	76 ± 29	94 ± 34	0.008^a	81 ± 27	81 ± 28	0.972	0.420	0.049^a
VLDL-C(mg/dL)	26 ± 18	34 ± 29	0.114	27 ± 13	25 ± 10	0.405	0.949	0.031^a
ABI	1.03 ± 0.1	1.03 ± 0.1	0.047^a	1.1 ± 0.1	1.1 ± 0.1	0.511	0.701	0.070

Data are mean ± SD values. An independent-sample t - test was used to examine significant changes.

^aP < 0.05 was considered statistically significant.

ABI, Ankle brachial index; BAI, Body adiposity index; BMI, Body mass index; DBP, Diastolic blood pressure; FBS, Fasting blood sugar; HbA1c, Glycosylated haemoglobin; HC, Hip circumference; HDL-C, High density lipoprotein cholesterol; LDL-C, Low density lipoprotein cholesterol; PPBS, Postprandial blood sugar; SBP, Systolic blood pressure; TC, Total cholesterol; TG, Triglyceride; VAI, Visceral adiposity index; VLDL-C, Very low density lipoprotein cholesterol; WC, Waist circumference; WHR, Waist to hip ratio; WHtR, Waist to height ratio.

Table 3. Correlation between anthropometric measures, anthropometric indices, and CVD risk factors with obesity indices of Group 1 and Group 2 subjects.

	Group 1					Group 2
	BMI	BAI	VAI	WHR	WHtR	BMI	BAI	VAI	WHR	WHtR
Height	- 0.050	- 0.741^**	- 0.305^**	0.215^*	- 0.371^**	- 0.323^**	- 0.725^**	- 0.148	0.291^**	- 0.344^**
P-value	0.631	< 0.001	0.003	0.038	< 0.001	0.002	< 0.001	0.172	0.006	< 0.001
Weight	0.662^**	- 0.212^**	- 0.110	0.277^**	0.172	0.511^**	-0.145^**	0.080	0.354^**	0.221^*
P-value	< 0.001	0.040	0.292	0.007	0.098	< 0.001	0.181	0.461	< 0.001	0.040
WC	0.647^**	0.266^**	0.030	0.589^**	0.770^**	0.505^**	0.345^**	0.359^**	0.644^**	0.854^**
P-value	< 0.001	0.010	0.771	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
HC	0.659^**	0.516^**	0.032	- 0.082	0.581^**	0.591^**	0.720^**	0.065	- 0.101	0.689^**
P-value	< 0.001	< 0.001	0.760	0.435	< 0.001	< 0.001	< 0.001	0.548	0.350	< 0.001
BMI		0.485^**	0.171	0.176	0.644^**		0.635^**	0.256^*	0.092	0.645^**
P-value		< 0.001	0.099	0.090	< 0.001		< 0.001	0.017	0.399	< 0.001
BAI			0.295^**	- 0.241^*	0.721^**			0.138	- 0.275^**	0.710^**
P-value			0.004	0.019	< 0.001			0.202	0.010	< 0.001
VAI				- 0.001	0.253^*				0.432^**	0.413^**
P-value				0.990	0.014				< 0.001	< 0.001
WHR					0.444^**					0.454^**
P-value					< 0.001					< 0.001
ABI	-0.102	-0.331^**	-0.226^*	0.198	- 0.184	-0.015	0.029	0.073	- 0.082	- 0.025
P-value	0.327	<0.001	0.028	0.056	0.075	0.893	0.788	0.499	0.450	0.819
TC	0.113	0.081	0.462^**	0.054	0.094	0.104	0.197	0.321^**	0.172	0.313^**
P-value	0.279	0.439	< 0.001	0.602	0.369	0.339	0.068	0.002	0.110	0.003
HDL-C	0.024	- 0.095	- 0.208^*	- 0.004	- 0.091	- 0.086	0.005	- 0.244^*	- 0.102	- 0.052
P-value	0.817	0.365	0.044	0.970	0.385	0.429	0.963	0.022	0.349	0.631
TG	0.200	0.143	0.894^**	0.053	0.166	0.070	- 0.123	0.694^**	0.294^**	0.076
P-value	0.054	0.169	< 0.001	0.614	0.109	0.518	0.257	< 0.001	0.006	0.384
LDL-C	0.162	0.288^**	0.563^**	0.084	0.326^**	0.169	0.243*	0.315^**	0.094	0.281^**
P-value	0.119	0.005	< 0.001	0.420	0.001	0.118	0.023	0.003	0.388	0.008
VLDL-C	0.204	0.138	0.889^**	0.078	0.176	0.122	- 0.062	0.669^**	0.260^*	0.114
P-value	0.051	0.190	< 0.001	0.458	0.094	0.262	0.589	< 0.001	0.016	0.297
HbA1c	- 0.216^*	- 0.049	0.037	- 0.038	- 0.113	0.019	- 0.137	0.249^*	0.241^*	0.040
P-value	0.036	0.640	0.722	0.715	0.277	0.862	0.207	0.020	0.025	0.048
FBS	- 0.088	- 0.113	0.058	- 0.051	- 0.148	0.041	- 0.077	0.320^**	0.229^*	0.090
P-value	0.400	0.279	0.576	0.626	0.155	0.705	0.478	0.003	0.033	0.405
PPBS	- 0.102	- 0.147	0.077	0.061	- 0.111	0.070	- 0.061	0.374^**	0.294^**	0.129
	0.330	0.159	0.460	0.558	0.286	0.519	0.577	< 0.001	0.006	0.233

Correlation coefficient values are presented in the first row, whereas P - values are presented in the second row of each variable.

Significance of correlations: *at the 0.05 level, **at the 0.01 level.

ABI, Ankle brachial index; BAI, Body adiposity index; BMI, Body mass index; FBS, Fasting blood sugar; HbA1c, Glycosylated haemoglobin; HC, Hip circumference; HDL-C, High-density lipoprotein cholesterol; LDL-C, Low-density lipoprotein cholesterol; PPBS, Postprandial blood sugar; SBP, TC, Total cholesterol; TG, Triglyceride; VAI, Visceral adiposity index; VLDL-C, Very low-density lipoprotein cholesterol; WC, Waist circumference; WHR, Waist to hip ratio; WHtR, Waist to height ratio.

DISCUSSION:

In the present scenario, diabetes is considered as a major health issue. Because of its widespread prevalence and potentially debilitating impact, T2DM has become an international and national priority area of health concern. Rural areas experience an approximately 17.0% higher diabetes prevalence rate in comparison to urban areas.¹⁶The burden of diabetes in rural communities is further compounded by high rates of obesity and sedentary lifestyles. Jackson CL, et al.,¹⁷found that the prevalence of obesity was 23.0% for rural adults compared to 20.5% of their urban counterparts. The present study is, to our knowledge, one of the very few, that has undertaken a comprehensive comparison across two groups according to BMI.

The height and weight of male diabetics were significantly higher than female diabetic patients. On the other hand, HC, BMI, WHtR, BAI, and VAI were found significantly more in female patients. Larger thighs and HC in women could reflect increased subcutaneous fat mass in gluteal and femoral areas, which have been reported to show low lipolytic activity and high lipoprotein lipase activity, thus contributing to fatty acid uptake and storage.^18,19Obesity, both general and central, had a greater influence on the risk of T2DM in women than men, consistent with previous evidence,²⁰ and also proved that the genetic effects determine sex differences in body composition in various findings,²¹ whereas hormonal factors,⁽²²⁾have been invoked to account for the weaker association between obesity and T2DM in men. However, the reasons for these gender-specific effects are still not clear.

Concerning group comparison, body weight, WC, HC, WHtR, and BAI were observed significantly higher in group 2 patients. Most of the anthropometric measures were found significantly higher in group 2 patients of both genders. Bergman RN, et al.,²³have shown the role of BAI, compared to other anthropometric indices of adiposity (BMI, WC, and WHR), in the body fat assessment.^24,25Another study by Talaei M. et al,²⁶on the Iranian population for seven years, showed that waist-to-height ratio (WHtR) and BMI were better than BAI in the prediction of T2DM especially in the overweight population. Further concluded by Schulze MB, et al,²⁷in a study on approximately 36,368 individuals of both sexes, it was observed that BAI was associated more with DM risk compared with BMI, while WC was shown to be the strongest predictor.

Cardiovascular risk factors were assessed in group 1 and group 2 concerning gender. After comparison, the high level of TC, LDL-C, and low ABI was observed more in females. Several studies ^28,29indicated that the risk of CVD in diabetic females is higher than the risk in diabetic males. In this study, statistically significant greater differences in the cardiovascular risk factors were observed in women than in men. This can be interpreted that important risk factors for micro- and macrovascular complications were more prominent in diabetic women than diabetic men. In all comparisons with females concerning obese diabetic males, the DBP was found significantly higher. In other studies, SBP was the best predictor of CVD in men at any age and DBP in men < 60 years old.⁽³⁰⁾The result of our study is similar to a study conducted in Lebanon in which the frequencies of obesity and low HDL-C were significantly higher in diabetic females.⁽³¹⁾In support of our study findings, data obtained from the available literature suggest that increasing BMI results in decreasing HDL-C levels and increasing TG levels.^32,33These studies, however, were conducted in general populations rather than selected groups of patients with obesity. These observations are also supported by the results of a study conducted in adult Peruvians (n = 1518), where the authors found a very strong negative correlation between VAI, BMI, and HDL-C, as well as a positive correlation with TG; however, this was irrespective of gender.³⁴

Interestingly, the group 1 patients who have BMI < 25 had statistically significantly higher mean serum levels of TC, TG, LDL-C, and VLDL-C compared with patients of group 2. These findings were not related to lipid-lowering treatment. Similar unexpected results were obtained in another study, where higher serum levels of TC, LDL-C, and TG were found in overweight people compared with the obese.³⁵

The primary difficulty of this study was to assess the diagnostic ability of various anthropometric measures and indices in type 2 diabetic patients within two categories of BMI i.e. normal weight and overweight diabetic patients. In correlation study, among all the anthropometric indices studied, the VAI is the one that showed the greatest number of correlations with the highest value when correlated with various characteristics of type 2 diabetic patients. VAI in particular showed a very strong correlation with HDL and LDL cholesterol which in general thought to be considered a strong prognostic determinant of cardiovascular risk factors. The utility of VAI in type 2 diabetic patients only not restricted to assessing the cardiovascular risk due to prolonged hyperglycemia but it’s also useful to predict the residual cardiovascular risk when all other parameters like glucose, lipid, and other clinical parameters look in normal condition.³⁶In some studies, positive correlations were seen between anthropometric parameters and lipid profiles in healthy volunteers.³⁷The present study examined the correlations between obesity indices and various anthropometric measures and lipid profiles in T2DM. Positive correlations were seen in both groups of patients, whereas inverse correlations were seen between height and HDL-C in type 2 diabetics in both groups of patients. The limitation of the study includes its small sample size. Other potential and perhaps the most important factors, such as nutritional status, were also not assessed. More subjects in both genders in urban and rural areas in different parts of the country should be studied in the future.

CONCLUSION:

The present study is, to our knowledge, one of the very few, that has undertaken a comprehensive comparison across two groups according to BMI in patients with T2DM. Various findings in this study highlight the complex correlation of obesity in males and females. In conclusion, among all the obesity indices VAI would be a reliable assessment tool for the evaluation of cardiovascular risk in T2DM, still further need for more clinical studies are still required for more precise decision-making to justify the prognostic role of VAI in cardiovascular risk. Epidemiological studies should evaluate whether obesity indices could be combined with other markers to provide efficient screening tests for cardiovascular risk in T2DM.

ACKNOWLEDGEMENTS:

We are very thankful to Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna- Bihar, India for providing access and support to conduct this study.

CONFLICT OF INTEREST:

There is no conflict of interest.

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Received on 06.08.2024 Revised on 14.10.2024

Accepted on 29.12.2024 Published on 28.01.2025

Available online from February 27, 2025

Research J. Pharmacy and Technology. 2025;18(2):878-884.

DOI: 10.52711/0974-360X.2025.00129

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