Development and Validation of Equations to Estimate Visceral Adipose Tissue in Military Men

Abstract

Introduction It has been suggested that visceral adipose tissue (VAT) is associated with several non-communicable chronic diseases, but measuring it is difficult. Thus, anthropometry could be used because is easily applied in clinical practice. Objectives The present study aimed to develop and validate VAT estimation equations (Eq) in military men. Methods The sample consisted of 409 (mean age, 36.5 ± 6.7 years) military men in the Brazilian Army (BA) divided into an equation group (EG) ( n = 270; mean age, 37.0 ± 6.3 years) and a validation group (VG) ( n =139; mean age, 36.0 ± 7.2 years). Anthropometric, hemodynamic and DXA body composition evaluations ( GE iLunar ) were performed. The Student’s t test, Pearson’s correlation, and stepwise general linear regression were applied. Bland-Altman graphics were used to assess the concordance between VAT by Eq and by DXA. The level of significance was 95% ( p < 0.05). Results Age, waist circumference (WC), hip circumference and body mass index presented the main significant positive correlations with the VAT-DXA. Four Eq were created Eq1 ( r 2 = 0.793), Eq2 ( r 2 = 0.810), Eq3 ( r 2 = 0.817), and Eq 4 ( r 2 = 0.823) ( p < 0.05). No differences were observed between VAT by DXA and VAT by Eq ( p = 0.982, p = 0.970, p = 0.495 and p = 0.698). Bland-Altman analysis also presented good concordance as the bias was close to zero and was not statistically significant. Conclusion Eq2 (age*13.0 + WC*60.0 - 4975,.5) was more suitable because it is easier to apply, has a higher predictive power (81.0%), less bias (1.86) and validation yielded average VAT values close to those found in DXA. It may still be considered a valuable tool for other extensive epidemiological studies in military men in the BA and can be used in adult men. Evidence Level I: Development of diagnostic criteria on consecutive patients (with universally applied reference ‘‘gold’’ standard).

Anthropometric measures, predicted visceral adipose tissue and biomarkers of chronic inflammation

“…Interestingly, we found predicted VAT accounted for more variance in seven of the examined blood‐based biomarkers related to systemic inflammation in men and nine in women when compared to BMI, WC, WHR and WHtR. In particular, equations by da Rosa et al, 11 Eastwood et al, 12 Goel et al 13 and So et al 15 demonstrated potential use as tools to characterise metabolic health. This suggests a role for equations in assessing VAT levels and that these might be used to identify high‐risk subjects in clinical care and health‐related research.…”

“…Predicted visceral adipose tissue was defined using a selection of 10 existing equations based on a range of anthropometric measures and other variables (Table 1). 9–15 …”

“…These equations have been validated against various imaging modalities and have been shown to strongly correlate with VAT levels. [9][10][11][12][13][14][15] Indices that estimate VAT have the potential to enhance clinical care and epidemiological research by providing additional non-invasive tools to characterise metabolic, cardiovascular and oncologic health risks. 8 However, few studies have compared predicted VAT equations with commonly assessed anthropometric measures and examined them in the context of inflammatory biomarkers.…”

“…Consequently, a number of equations that simultaneously integrate anthropometric measures and other variables have been developed to estimate VAT. These equations have been validated against various imaging modalities and have been shown to strongly correlate with VAT levels 9–15 . Indices that estimate VAT have the potential to enhance clinical care and epidemiological research by providing additional non‐invasive tools to characterise metabolic, cardiovascular and oncologic health risks 8 .…”