Correlation Of Lipid Metabolic Indexes With Abdominal Fat Distribution In Patients With Type 2 Diabetes Mellitus

ObjectiveThe aim of this study is to analyse the characteristics and patterns of abdominal fat distribution in patients with primary type 2 diabetes mellitus(T2DM),to investigate the correlation between lipid metabolism-related indicators and visceral obesity,to summarise the characteristics and risk factors of lipid metabolism in visceral obese people with BMI<30kg/m~2,and to provide clinicians with information on the disease characteristics of these patients,in order to draw attention to the them and provide a basis for early detection,diagnosis and treatment of the disease.MethodsA total of 344 patients with primary T2DM who were hospitalized at China-Japan Union Hospital of Jilin University from January 2021 to July 2022 were retrospectively selected for the study.The basic data of the study subjects were recorded in detail:gender,age(years),height(m),weight(kg),BMI,systolic blood pressure(mm Hg),diastolic blood pressure(mm Hg),history of smoking,history of alcohol consumption and past history;glucose metabolism indexes:glycated haemoglobin(Hb A1C),fasting blood glucose(FPG),2-hour postprandial blood glucose(2h PG),fasting insulin(FINS),postprandial insulin(2h PG),and glucose metabolism indexes.2 h insulin(2h INS),fasting C-peptide(FCP),2 h postprandial C-peptide(2h CP);lipid metabolism indicators:triglycerides(TG),total cholesterol(CHOL),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),small and dense low-density cholesterol(sd LDL-C),apolipoprotein A1(Apo A1),apolipoprotein B(Apo B),lipoprotein a(Lp(a)),apolipoprotein E(Apo E)and blood free fatty acid profiles(FFAs);visceral fat area(VFA),subcutaneous fat area(SFA).The ratio of visceral fat area to subcutaneous fat area(V/S)was used to express the distribution of abdominal fat,and the V/S ratios were grouped according to quartiles to compare the differences in general clinical data and glucolipid metabolism-related indexes of patients with different abdominal fat distribution;according to the diagnostic criteria proposed by the Japanese Society of Obesity,the study subjects were divided into normal group(VFA<100cm~2)and visceral obesity group(VFA≥100cm~2),compared the differences in general clinical data and glucolipid metabolism-related indexes between the two groups,used Spearman correlation analysis to correlate the variables with significant differences with the VFA of visceral obese patients,drew ROC curves to assess the predictive value of some lipid metabolism indexes for the diagnosis of visceral obesity,and analyzed the risk factors for visceral obesity in patients with primary T2DM by multivariate logistic regression.The risk factors of those with BMI<30 kg/m~2and VFA≥100cm~2namely“invisible obesity”were also analysed.Statistical analysis was performed using SPSS 25.0,and P<0.05 was statistically significant.Results1.In patients with primary T2DM with different levels of abdominal fat distribution(V/S),the differences between gender and sd LDL-C levels were statistically significant when compared between the different V/S groups(p=0.001and 0.047,respectively);the results of ordered multivariate logistic regression analysis indicated gender differences in abdominal fat distribution.2.Age,gender,height,weight,BMI,systolic blood pressure,diastolic blood pressure,combined fatty liver,VFA,SFA,FINS,FCP,2h INS,2h CP,HOMA-IR,HOMA-IS,TG,HDL-C,sd LDL-C,TG/HDL-C,Apo A1,Apo B/Apo A1,Apo E,lauric acid,myristic oleic acid,myristic acid,palmitoleic acid,palmitic acid,linolenic acid,linoleic acid,oleic acid,stearic acid,eicosatrienoic acid,eicosadienoic acid,eicosapentaenoic acid,docosapentaenoic acid,docosatetraenoic acid,erucic acid,behenic acid,ligno-taric acid,trienes/tetraenes,total saturated fatty acids,total monounsaturated fatty acids,total polyunsaturated fatty acids,total omega 6 and total fatty acid levels were statistically significant(all p<0.05)in patients in the VFA normal group(VFA<100cm~2)and visceral obesity group(VFA≥100cm~2);age distribution was negatively correlated with VFA(r=-0.227,p=0.012);height,weight,BMI,SFA and FCP were positively correlated with VFA(r is 0.253,0.535,0.483,0.581,0.186,all p<0.05,respectively);multivariate logistic regression analysis showed that male(OR=2.969),age(OR=1.034),BMI(OR=1.454)and serum lauric acid(OR=1.052)were risk factors for visceral obesity patients(p<0.05).3.The best threshold value for TG/HDL-C to predict visceral obesity in patients was 2.32,with a sensitivity of 68.9%and specificity of 53.2%;the best threshold value for serum lauric acid to predict visceral obesity in patients was 16.5,with a sensitivity of 49.2%and specificity of 71.6%.4.In the BMI<30kg/m2 population,gender,weight,BMI,combined fatty liver,VFA,SFA,FINS,FCP,2h INS,HOMA-IR,HOMA-IS,TG,sd LDL-C,TG/LDL-C,Apo B/Apo A1,Apo E,lauric acid,myristic oleic acid,linolenic acid,linoleic acid,stearic acid,eicosatrienoic acid,eicosanoic acid,erucic acid,neuronic acid and triene/tetraene levels were statistically significant(all p<0.05)between patients in the VFA normal group(VFA<100cm~2)and visceral obesity group(VFA≥100cm~2);weight,BMI and SFA were positively correlated with VFA(r is 0.373,0.373,0.484,all p<0.05,respectively);BMI(OR=1.246,p=0.032)was risk factor for visceral obesity patients.Conclusion1.There is gender dimorphism in the distribution of abdominal fat in patients with primary T2DM,with men tending to accumulate more visceral fat.2.Male,age,BMI and serum lauric acid are risk factors for visceral obesity in patients with primary diagnosis of T2DM.3.TG/HDL-C and serum lauric acid have some predictive value for the diagnosis of visceral obesity.4.BMI is risk factor for“invisible obesity”in patients with primary T2DM and should be monitored in the clinical setting.