1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Public Health, Yonsei University Graduate School, Seoul, Korea
Copyright © 2020 The Korean Society for Preventive Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
The authors have no conflicts of interest associated with the material presented in this paper.
FUNDING
This study was supported by a grant (HI13C0715) from the Korea Health Technology R&D Project, funded by the Ministry of Health and Welfare of the Republic of Korea.
AUTHOR CONTRIBUTIONS
Conceptualization: JB, HCK. Data curation: JB, HCK, JSS, YWJ. Formal analysis: JB, HCK. Funding acquisition: HCK. Methodology: JB, HCK, SJJ, JSS, YWJ. Visualization: JB, HCK, ES. Writing - original draft: JB, HCK. Writing - review & editing: SJJ, JSS, YWJ, ES.
Abdominal adiposity index |
Men (n=1366) |
Women (n=2480) |
|||||||
---|---|---|---|---|---|---|---|---|---|
Range | n | n (%) of NAFLD | OR (95% CI)1 | Range | n | n (%) of NAFLD | OR (95% CI)1 | ||
VFA | |||||||||
Q1 | <82.3 | 341 | 15 (4.4) | 1.00 (reference) | <59.6 | 620 | 6 (1.0) | 1.00 (reference) | |
Q2 | 82.3-111.8 | 342 | 67 (19.6) | 2.59 (1.36, 4.95) | 59.6-83.3 | 620 | 28 (4.5) | 2.99 (1.19, 7.51) | |
Q3 | 111.9-146.4 | 340 | 141 (41.5) | 4.73 (2.45, 9.16) | 83.4-110.0 | 620 | 78 (12.6) | 6.65 (2.72, 16.23) | |
Q4 | ≥146.5 | 343 | 222 (64.7) | 6.14 (2.96, 12.73) | ≥110.1 | 620 | 266 (42.9) | 17.84 (7.12, 44.71) | |
p for trend | <0.001 | <0.001 | |||||||
continuous (per 10 cm2) | 1.13 (1.07, 1.18) | 1.26 (1.20, 1.32) | |||||||
SFA | |||||||||
Q1 | <105.2 | 341 | 28 (8.2) | 1.00 (reference) | <131.4 | 620 | 44 (7.1) | 1.00 (reference) | |
Q2 | 105.2-135.9 | 342 | 78 (22.8) | 1.37 (0.79, 2.38) | 131.4-164.3 | 620 | 66 (10.7) | 0.54 (0.34, 0.88) | |
Q3 | 136.0-174.9 | 341 | 139 (40.8) | 1.66 (0.93, 2.97) | 164.4-203.9 | 620 | 108 (17.4) | 0.50 (0.31, 0.81) | |
Q4 | ≥175.0 | 342 | 200 (58.5) | 1.26 (0.64, 2.48) | ≥204.0 | 620 | 160 (25.8) | 0.21 (0.12, 0.38) | |
p for trend | 0.592 | <0.001 | |||||||
continuous (per 10 cm2) | 0.99 (0.94, 1.04) | 0.89 (0.86, 0.92) | |||||||
VSR | |||||||||
Q1 | <0.61 | 341 | 98 (28.7) | 1.00 (reference) | <0.39 | 620 | 33 (5.3) | 1.00 (reference) | |
Q2 | 0.61-0.79 | 342 | 103 (30.1) | 1.39 (0.88, 2.20) | 0.39-0.48 | 620 | 53 (8.6) | 1.39 (0.81, 2.38) | |
Q3 | 0.80-1.03 | 341 | 115 (33.7) | 1.91 (1.20, 3.03) | 0.49-0.64 | 620 | 88 (14.2) | 3.06 (1.83, 5.12) | |
Q4 | ≥1.04 | 342 | 129 (37.7) | 1.99 (1.22, 3.26) | ≥0.65 | 620 | 204 (32.9) | 6.73 (4.10, 11.03) | |
p for trend | 0.003 | <0.001 | |||||||
continuous (per 0.1 SD) | 1.03 (1.01, 1.05) | 1.07 (1.06, 1.09) |
NAFLD, non-alcoholic fatty liver disease; OR, odds ratio; CI, confidence interval; VFA, visceral fat area; SFA, subcutaneous fat area; VSR, visceral-to-subcutaneous fat ratio.
1 Adjusted for age, drinking status, smoking status, hypertension, diabetes mellitus, body mass index, and waist circumference.
Abdominal adiposity index |
AUC |
Improved AUC |
IDI |
Category-based NRI1 |
Category-free NRI |
|||||
---|---|---|---|---|---|---|---|---|---|---|
Index | Index | p-value | Index | p-value | Index | p-value | Index | p-value | ||
Men | ||||||||||
Base model2 | 0.813 | |||||||||
WC3 | 0.842 | Reference | Reference | Reference | Reference | |||||
WC+VFA | 0.855 | 0.013 | <0.001 | 0.024 | <0.001 | 0.050 | 0.018 | 0.296 | <0.001 | |
WC+SFA | 0.843 | 0.001 | 0.434 | 0.002 | 0.160 | △0.002 | 0.835 | 0.074 | 0.201 | |
WC+VSR | 0.851 | 0.009 | 0.007 | 0.017 | <0.001 | 0.050 | 0.012 | 0.262 | <0.001 | |
Women | ||||||||||
Base model2 | 0.807 | |||||||||
WC3 | 0.818 | Reference | Reference | Reference | Reference | |||||
WC+VFA | 0.862 | 0.044 | <0.001 | 0.075 | <0.001 | 0.181 | <0.001 | 0.620 | <0.001 | |
WC+SFA | 0.836 | 0.017 | <0.001 | 0.040 | <0.001 | 0.113 | <0.001 | 0.412 | <0.001 | |
WC+VSR | 0.865 | 0.046 | <0.001 | 0.089 | <0.001 | 0.207 | <0.001 | 0.654 | <0.001 |
NAFLD, non-alcoholic fatty liver disease; AUC, area under the receiver operating characteristic curve; IDI, integrated discrimination improvement; NRI, net reclassification improvement; WC, waist circumference; VFA, visceral fat area; SFA, subcutaneous fat area; VSR, visceral-to-subcutaneous fat ratio; △, negative number.
1 For the category-based NRI, risk cut-offs of 20% and 50% were used.
2 The base model is adjusted for age and body mass index.
3 The WC-based model is adjusted for age, body mass index, and WC.
Characteristics | Men (n=1366) |
Women (n=2480) |
|||||
---|---|---|---|---|---|---|---|
NAFLD absent (n=921) | NAFLD present (n=445) | p for difference | NAFLD absent (n=2102) | NAFLD present (n=378) | p for difference | ||
Age (y) | |||||||
30-39 | 224 (24.3) | 114 (25.6) | 0.089 | 314 (14.9) | 21 (5.6) | <0.001 | |
40-49 | 139 (15.1) | 86 (19.3) | 390 (18.6) | 31 (8.2) | |||
50-59 | 331 (35.9) | 153 (34.4) | 1018 (48.4) | 214 (56.6) | |||
60-64 | 227 (24.7) | 92 (20.7) | 380 (18.1) | 112 (29.6) | |||
Alcohol drinking status | |||||||
Never or past drinker | 139 (15.1) | 57 (12.8) | 0.259 | 685 (32.6) | 143 (37.8) | 0.047 | |
Current drinker | 782 (84.9) | 388 (87.2) | 1417 (67.4) | 235 (62.2) | |||
Cigarette smoking status | |||||||
Never or past smoker | 630 (68.4) | 277 (62.2) | 0.024 | 2037 (96.9) | 374 (98.9) | 0.027 | |
Current smoker | 291 (31.6) | 168 (37.8) | 65 (3.1) | 4 (1.1) | |||
Hypertension | |||||||
No | 673 (73.1) | 213 (47.9) | <0.001 | 1753 (83.4) | 202 (53.4) | <0.001 | |
Yes | 248 (26.9) | 232 (52.1) | 349 (16.6) | 176 (46.6) | |||
Diabetes mellitus | |||||||
No | 880 (95.5) | 316 (71.0) | <0.001 | 2045 (97.3) | 252 (66.7) | <0.001 | |
Yes | 41 (4.5) | 129 (29.0) | 57 (2.7) | 126 (33.3) | |||
BMI (kg/m2) | |||||||
Normal (<23.0) | 350 (38.0) | 23 (5.2) | <0.001 | 1170 (55.7) | 60 (15.9) | <0.001 | |
Overweight (23.0-24.9) | 282 (30.6) | 79 (17.7) | 529 (25.2) | 77 (20.4) | |||
Obese (≥25.0) | 289 (31.4) | 343 (77.1) | 403 (19.2) | 241 (63.8) | |||
Abdominal adiposity index | |||||||
WC (cm) | 83.8±6.5 | 92.9±7.0 | <0.001 | 76.6±7.3 | 85.9±8.3 | <0.001 | |
VFA (cm2) | 100.6±40.0 | 152.1±47.2 | <0.001 | 81.0±33.4 | 136.3±44.3 | <0.001 | |
SFA (cm2) | 127.2±46.5 | 180.0±63.4 | <0.001 | 165.0±54.1 | 203.3±67.4 | <0.001 | |
VSR | 0.84±0.34 | 0.92±0.38 | <0.001 | 0.51±0.20 | 0.73±0.31 | <0.001 |
Abdominal adiposity index | Men (n=1366) |
Women (n=2480) |
|||||||
---|---|---|---|---|---|---|---|---|---|
Range | n | n (%) of NAFLD | OR (95% CI) |
Range | n | n (%) of NAFLD | OR (95% CI) |
||
VFA | |||||||||
Q1 | <82.3 | 341 | 15 (4.4) | 1.00 (reference) | <59.6 | 620 | 6 (1.0) | 1.00 (reference) | |
Q2 | 82.3-111.8 | 342 | 67 (19.6) | 2.59 (1.36, 4.95) | 59.6-83.3 | 620 | 28 (4.5) | 2.99 (1.19, 7.51) | |
Q3 | 111.9-146.4 | 340 | 141 (41.5) | 4.73 (2.45, 9.16) | 83.4-110.0 | 620 | 78 (12.6) | 6.65 (2.72, 16.23) | |
Q4 | ≥146.5 | 343 | 222 (64.7) | 6.14 (2.96, 12.73) | ≥110.1 | 620 | 266 (42.9) | 17.84 (7.12, 44.71) | |
p for trend | <0.001 | <0.001 | |||||||
continuous (per 10 cm2) | 1.13 (1.07, 1.18) | 1.26 (1.20, 1.32) | |||||||
SFA | |||||||||
Q1 | <105.2 | 341 | 28 (8.2) | 1.00 (reference) | <131.4 | 620 | 44 (7.1) | 1.00 (reference) | |
Q2 | 105.2-135.9 | 342 | 78 (22.8) | 1.37 (0.79, 2.38) | 131.4-164.3 | 620 | 66 (10.7) | 0.54 (0.34, 0.88) | |
Q3 | 136.0-174.9 | 341 | 139 (40.8) | 1.66 (0.93, 2.97) | 164.4-203.9 | 620 | 108 (17.4) | 0.50 (0.31, 0.81) | |
Q4 | ≥175.0 | 342 | 200 (58.5) | 1.26 (0.64, 2.48) | ≥204.0 | 620 | 160 (25.8) | 0.21 (0.12, 0.38) | |
p for trend | 0.592 | <0.001 | |||||||
continuous (per 10 cm2) | 0.99 (0.94, 1.04) | 0.89 (0.86, 0.92) | |||||||
VSR | |||||||||
Q1 | <0.61 | 341 | 98 (28.7) | 1.00 (reference) | <0.39 | 620 | 33 (5.3) | 1.00 (reference) | |
Q2 | 0.61-0.79 | 342 | 103 (30.1) | 1.39 (0.88, 2.20) | 0.39-0.48 | 620 | 53 (8.6) | 1.39 (0.81, 2.38) | |
Q3 | 0.80-1.03 | 341 | 115 (33.7) | 1.91 (1.20, 3.03) | 0.49-0.64 | 620 | 88 (14.2) | 3.06 (1.83, 5.12) | |
Q4 | ≥1.04 | 342 | 129 (37.7) | 1.99 (1.22, 3.26) | ≥0.65 | 620 | 204 (32.9) | 6.73 (4.10, 11.03) | |
p for trend | 0.003 | <0.001 | |||||||
continuous (per 0.1 SD) | 1.03 (1.01, 1.05) | 1.07 (1.06, 1.09) |
Abdominal adiposity index | AUC |
Improved AUC |
IDI |
Category-based NRI |
Category-free NRI |
|||||
---|---|---|---|---|---|---|---|---|---|---|
Index | Index | p-value | Index | p-value | Index | p-value | Index | p-value | ||
Men | ||||||||||
Base model |
0.813 | |||||||||
WC |
0.842 | Reference | Reference | Reference | Reference | |||||
WC+VFA | 0.855 | 0.013 | <0.001 | 0.024 | <0.001 | 0.050 | 0.018 | 0.296 | <0.001 | |
WC+SFA | 0.843 | 0.001 | 0.434 | 0.002 | 0.160 | △0.002 | 0.835 | 0.074 | 0.201 | |
WC+VSR | 0.851 | 0.009 | 0.007 | 0.017 | <0.001 | 0.050 | 0.012 | 0.262 | <0.001 | |
Women | ||||||||||
Base model |
0.807 | |||||||||
WC |
0.818 | Reference | Reference | Reference | Reference | |||||
WC+VFA | 0.862 | 0.044 | <0.001 | 0.075 | <0.001 | 0.181 | <0.001 | 0.620 | <0.001 | |
WC+SFA | 0.836 | 0.017 | <0.001 | 0.040 | <0.001 | 0.113 | <0.001 | 0.412 | <0.001 | |
WC+VSR | 0.865 | 0.046 | <0.001 | 0.089 | <0.001 | 0.207 | <0.001 | 0.654 | <0.001 |
Values are presented as number (%) or mean±standard deviation. NAFLD, non-alcoholic fatty liver disease; BMI, body mass index; WC, waist circumference; VFA, visceral fat area; SFA, subcutaneous fat area; VSR, visceral-to-subcutaneous fat ratio.
NAFLD, non-alcoholic fatty liver disease; OR, odds ratio; CI, confidence interval; VFA, visceral fat area; SFA, subcutaneous fat area; VSR, visceral-to-subcutaneous fat ratio. Adjusted for age, drinking status, smoking status, hypertension, diabetes mellitus, body mass index, and waist circumference.
NAFLD, non-alcoholic fatty liver disease; AUC, area under the receiver operating characteristic curve; IDI, integrated discrimination improvement; NRI, net reclassification improvement; WC, waist circumference; VFA, visceral fat area; SFA, subcutaneous fat area; VSR, visceral-to-subcutaneous fat ratio; △, negative number. For the category-based NRI, risk cut-offs of 20% and 50% were used. The base model is adjusted for age and body mass index. The WC-based model is adjusted for age, body mass index, and WC.