Impact of increased visceral adiposity with normal weight on the progression of arterial stiffness in Japanese patients with type 2 diabetes

Objective: Normal-weight abdominal obesity has been reported to be associated with poor mortality. We aimed to investigate the impact of increased visceral adiposity with normal weight (OB(-) VA(+)) on the progression of arterial stiffness in patients with type 2 diabetes. Methods: This was a cross-sectional study of 414 patients with type 2 diabetes (mean age 64 +/- 12 years; 40.3% female). Visceral fat area (VFA, cm(2)) was measured by a dual bioelectrical impedance analyzer. Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV, cm/s). Patients were divided into four groups by VFA and body mass index (BMI, kg/m(2)) as the following: BMI< 25 kg/m(2) and VFA< 100 cm(2) (obesity (OB)(-) visceral adiposity (VA)(-)), BMI= 25 kg/m(2) and VFA< 100 cm(2) (OB(+) VA(-)), BMI< 25 kg/m(2) and VFA= 100 cm(2) (OB(-) VA(+)), and BMI= 25 kg/m(2) and VFA= 100 cm(2) (OB(+) VA(+)). Multivariate linear regression analysis was done to determine the impact of OB(-) VA(+) on arterial stiffness. Results: Among the patients, 7.2% were OB(-) VA(+) with higher baPWV levels (1956 +/- 444 cm/s) than those with OB(+) VA(-) (1671 +/- 416 cm/s, p= 0.014), those with OB(+) VA(+) (1744 +/- 317 cm/s, p= 0.048), and those with OB(-) VA(-) (1620 +/- 397 cm/s, p= 0.024). In multivariate linear regression analysis, OB(-) VA(+) remained independently associated with baPWV (standardized beta 0.184, p= 0.001). Conclusions: This study provides evidence for the burden of arterial stiffness in OB(-) VA(+) patients with type 2 diabetes; therefore, evaluation of visceral adiposity is of clinical relevance for the better management of nonobese individuals as well as obese populations.