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Abstract
Aim: This study aimed to explore the relationship between visceral fat and obesity-related metabolic diseases, validate the obesity criteria from the European Association for the Study of Obesity (EASO) in the Chinese population, and propose new standards for identifying visceral fat using simple anthropometric indicators.
Methods: This cross-sectional study involved 3,371 participants aged 26-76 years in Pinggu District, Beijing. Anthropometric measurements and metabolic indicators were assessed, and visceral fat area (VFA) was calculated from non-contrast abdominal computed tomography scans. The McNemar test was used to compare the diagnostic accuracy of the EASO criteria and body mass index (BMI) for identifying visceral obesity. The correlation between anthropometric indicators and VFA was analysed using Spearman’s correlation coefficient. Receiver operating characteristic curves were used to compare the diagnostic efficacy and thresholds of anthropometric indicators with the EASO criteria.
Results: Among 3,371 participants, 61.2% were diagnosed with visceral obesity. Metabolic disease prevalence was higher in individuals with visceral obesity, suggesting that visceral fat accumulation is a sensitive marker for identifying metabolic diseases. The EASO criteria showed higher sensitivity and lower specificity than BMI alone for diagnosing visceral obesity. Waist circumference (WC) and waist-to-height ratio correlated strongly with VFA. BMI combined with WC was the most effective tool for diagnosing visceral obesity in the Chinese population.
Conclusion: Visceral fat accumulation is associated with metabolic diseases, and the EASO criteria are superior to BMI in identifying visceral obesity. BMI combined with WC is effective for diagnosing visceral obesity in the Chinese population.
Keywords
European association for the study of obesity
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obesity
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clinical obesity
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visceral obesity
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body mass index
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Bingying Yang, Yingying Luo, Xianghai Zhou, Fang Zhang, Yufeng Li, Linong Ji.
Validation of EASO criteria and development of a new diagnostic tool for visceral obesity in Chinese adults.
Metabolism and Target Organ Damage, 2025, 5(3): 40 DOI:10.20517/mtod.2025.70
| [1] |
Ralston MR,Lees ZJ.Beyond body mass index: exploring the role of visceral adipose tissue in intensive care unit outcomes.BJA Open2025;14:100391 PMCID:PMC11986990
|
| [2] |
Goossens GH.The metabolic phenotype in obesity: fat mass, body fat distribution, and adipose tissue function.Obes Facts2017;10:207-15 PMCID:PMC5644968
|
| [3] |
Nielsen S,Johnson CM,Jensen MD.Splanchnic lipolysis in human obesity.J Clin Invest2004;113:1582-8 PMCID:PMC419492
|
| [4] |
Emamat H,Farhadi A,Ghasemi M.The association between the visceral to subcutaneous abdominal fat ratio and the risk of cardiovascular diseases: a systematic review.BMC Public Health2024;24:1827 PMCID:PMC11232263
|
| [5] |
Cheng C,Shi K.Associations between abdominal obesity indices with hypertension in type 2 diabetes mellitus: Chinese visceral adiposity index.J Endocrinol Invest2024;47:547-55
|
| [6] |
Silveira EA,Noll M,de Oliveira C.Visceral obesity and incident cancer and cardiovascular disease: an integrative review of the epidemiological evidence.Obes Rev2021;22:e13088 PMCID:PMC7757158
|
| [7] |
Fang H,Cheng X.How to best assess abdominal obesity.Curr Opin Clin Nutr Metab Care2018;21:360-5 PMCID:PMC6299450
|
| [8] |
Kong M,Zhou Y.Assessing visceral obesity and abdominal adipose tissue distribution in healthy populations based on computed tomography: a large multicenter cross-sectional study.Front Nutr2022;9:871697 PMCID:PMC9082940
|
| [9] |
Busetto L,Frühbeck G.A new framework for the diagnosis, staging and management of obesity in adults.Nat Med2024;30:2395-9
|
| [10] |
Yusuf S, Hawken S, Ounpuu S, et al; INTERHEART Study Investigators. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366:1640-9.
|
| [11] |
Ashwell M.Waist to height ratio is a simple and effective obesity screening tool for cardiovascular risk factors: analysis of data from the British National Diet And Nutrition Survey of adults aged 19-64 years.Obes Facts2009;2:97-103 PMCID:PMC6444829
|
| [12] |
Rubino F,Eckel RH.Definition and diagnostic criteria of clinical obesity.Lancet Diabetes Endocrinol2025;13:221-62 PMCID:PMC11870235
|
| [13] |
Zhou X,Zhang X.Independent markers of nonalcoholic fatty liver disease in a gentrifying population-based Chinese cohort.Diabetes Metab Res Rev2019;35:e3156 PMCID:PMC6606362
|
| [14] |
Zhang F,Zhao Y,Ji L.Is visceral abdominal fat area a better indicator for hyperglycemic risk?.J Diabetes Investig2020;11:888-95 PMCID:PMC7378436
|
| [15] |
Examination Committee of Criteria for ‘Obesity Disease’ in Japan; Japan Society for the Study of Obesity. New criteria for ‘obesity disease’ in Japan.Circ J2002;66:987-92
|
| [16] |
Zheng J,Xu H.Normal-weight visceral obesity promotes a higher 10-year atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus-a multicenter study in China.Cardiovasc Diabetol2023;22:137 PMCID:PMC10262529
|
| [17] |
Li X,Yasumasu T.Visceral fat area, waist circumference and metabolic risk factors in abdominally obese Chinese adults.Biomed Environ Sci2012;25:141-8
|
| [18] |
Grundy SM, Cleeman JI, Daniels SR, et al; American Heart Association, National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112:2735-52.
|
| [19] |
Lu Y, Zhang H, Lu J, et al; China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project Collaborative Group. Prevalence of dyslipidemia and availability of lipid-lowering medications among primary health care settings in China. JAMA Netw Open. 2021;4:e2127573. PMCID:PMC8482054
|
| [20] |
Atef HM,Ahmed NA,El-refaie AM.Assessment of hepatic steatosis of potential living donor before liver transplantation using liver/spleen CT attenuation ratio compared to liver biopsy.Egypt J Radiol Nucl Med2023;54:1165
|
| [21] |
Speliotes EK,Hoffmann U.Liver fat is reproducibly measured using computed tomography in the Framingham heart study.J Gastroenterol Hepatol2008;23:894-9 PMCID:PMC3057524
|
| [22] |
Iwasaki M,Hayashi M.Noninvasive evaluation of graft steatosis in living donor liver transplantation.Transplantation2004;78:1501-5
|
| [23] |
Liu L,Zhang G.Visceral adipose tissue is more strongly associated with insulin resistance than subcutaneous adipose tissue in Chinese subjects with pre-diabetes.Curr Med Res Opin2018;34:123-9
|
| [24] |
Lee YH,Min S,Kwon H.Impact of visceral obesity on the risk of incident metabolic syndrome in metabolically healthy normal weight and overweight groups: a longitudinal cohort study in Korea.Korean J Fam Med2020;41:229-36 PMCID:PMC7385301
|
| [25] |
Lear SA,Kohli S,Frohlich JJ.Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT).Am J Clin Nutr2007;86:353-9
|
| [26] |
Gadekar T,Basu I,Mukherji S.Correlation of visceral body fat with waist-hip ratio, waist circumference and body mass index in healthy adults: a cross sectional study.Med J Armed Forces India2020;76:41-6 PMCID:PMC6994756
|
| [27] |
Parente EB,Harjutsalo V,Forsblom C.Waist-height ratio and waist are the best estimators of visceral fat in type 1 diabetes.Sci Rep2020;10:18575 PMCID:PMC7596092
|
| [28] |
Tuglo LS.Comparison of adiposity anthropometric indices and their associations with visceral fat levels determined by bioelectrical impedance analysis among diabetic patients.Sci Rep2022;12:17824 PMCID:PMC9592612
|
| [29] |
Verma M,Sahoo SS,Rohilla R.Correlation between the percentage of body fat and surrogate indices of obesity among adult population in rural block of Haryana.J Family Med Prim Care2016;5:154-9 PMCID:PMC4943124
|