Original Article EXPLORING VISCERAL ADIPOSITY INDEX AS A PREDICTOR OF VISCERAL ADIPOSITY DYSFUNCTION AND EVALUATING ITS PERFORMANCE IN PREDICTING HEPATIC INSULIN RESISTANCE IN INDIAN TYPE 2 DIABETICS KAUSHAL Y. PATHAK*, ANOOKH MOHANAN, SHIVANI ACHARYA, DIVYESH MANDAVIA, HEMANT R. JADHAV 1,3,4 Clinical Research Department, Torrent Pharmaceuticals Limited, Village-Bhat, Dist. Gandhinagar, India, 2 Techno-Commercial Department, Torrent Pharmaceuticals Limited, Village Bhat, Dist. Gandhinagar, India, 5 Received: 04 May 2016 Revised and Accepted: 20 Jun 2016 Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Rajasthan 333031, India Email: kaushalpath@gmail.com ABSTRACT Objective: Visceral adiposity index (VAI) is a simple clinical algorithm developed as a surrogate marker for characterizing visceral adiposity dysfunction (VAD). This study aimed to explore an optimal VAI cut off value for predicting VAD as reflected quantitatively by magnetic resonance imaging (MRI) and to evaluate its merit in predicting the severity of the cardiometabolic risk (CMR) in type 2 diabetic patients of India. Methods: Data was collected from 81 diabetics and 48 healthy participants, who underwent metabolic assessments. VAI derived using BMI, waist circumference (WC), triglycerides (TG) and HDLc, was studied against visceral fat area measuring ≥ 130 cm 2 by MRI as it is associated with higher CMR through raised VAD. Optimal VAI cutoff was determined using the area under the receiver operator characteristic curve (AUROC). Diabetic participants were divided into VAD absent, and VAD present groups based on derived VAI cut off to study associated difference in their metabolic profile. Results: Diabetic group had significantly deranged metabolic profile compared to the healthy control group. Most of the diabetic group participants had a visceral fat area between 101 and 200 cm 2 . From the ROC curve analysis (AUROC = 0.761), VAI cut-off of 2.0 predicted VAD with sensitivity and specificity of 73.21% and 71.23% respectively. Diabetic participants with VAI values more than 2, had significantly (p<0.05) higher WC, visceral fat, fasting insulin, HOMA-IR (Homeostatic model assessment for insulin resistance), TG (p<0.01), non-HDLc and apolipoprotein B/A1 ratio values. Age adjusted partial correlation analysis showed a significant (p<0.01) positive correlation between VAI and HOMA-IR. Conclusion: VAI was useful in predicting VAD and identifying the severity of CMR within type 2 diabetics. VAI can replace imaging procedures with the advantages of reduced economic burden and can be used as screening tool for surveillance of CMR in Indian population. © 2016 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license ( Keywords: Cardiometabolic risk, Magnetic resonance imaging, Receiver operating curve http://creativecommons.org/licenses/by/4.0/ ) INTRODUCTION Metabolic diseases such as diabetes and cardiovascular disease (CVD) are extremely prevalent in obese patients than among normal-weight individuals. Obesity is a remarkably heterogeneous condition, and not every obese patient is characterized by co- morbidities. In this regard, increased accumulation of visceral fat leading to visceral adipose dysfunction (VAD) is a major link with a cluster of diabetogenic, atherogenic, prothrombic and pro- inflammatory metabolic abnormalities [1]. VAD causes release of various cytokines and hormones, such as adiponectin, leptin, tumor necrosis factor, resistin and interleukin 6. Due to its anatomic location and peculiar metabolic, hyperlipolytic activity, the expanded visceral adipose depot is considered to be an independent component of cardiometabolic risk (CMR) [1]. It is well established that type 2 diabetes significantly increases the risk of CVD and that merely treating hyperglycemia do not eliminate all the excess cardiovascular risk [2]. Gastaldelli et al. explored metabolic effects of visceral fat accumulation in type 2 diabetes using two specialized techniques viz. magnetic resonance imaging (MRI) and euglycemic insulin clamp and reported that visceral fat had a significant negative impact over glycemic control through a decrease in peripheral insulin sensitivity and an enhancement of gluconeogenesis. Further, while ethnicity, gender, age, duration of diabetes, and obesity (as body mass index) together explained only 25% of HbA1c variability; the inclusion of visceral fat in the model raised the explicable HbA1c variability to 45%. According to this model, HbA1c is predicted to be 0.8% higher for each 50-cm 2 India is a global leader in diabetes, currently with second largest pool of diabetes in the world. Asian Indian phenotype is uniquely predisposed to develop diabetes and represents the population with increased abdominal adiposity (especially visceral adiposity) predisposing them to higher CMR compared to Caucasians at the same levels of BMI [5]. Excess of fat in the abdominal region is reported to be a better predictor of risk factors (dyslipidemia, glucose intolerance, and hyperinsulinemia) than the total amount of adipose tissue [6]. Indian diabetes federation (IDF) recommends CT and MRI for assessing visceral fat accumulation, where MRI is considered to be the gold standard in estimating visceral fat values non-invasively [7,8]. The association between CMR factors and visceral fat values measured using these techniques is stronger than the associations observed with waist to hip ratio and waist circumference [6]. increment in the visceral fat area. Thus, an accurate measurement of visceral fat is an important part of clinical phenotyping and has rather direct consequences for the metabolic control of patients with type 2 diabetes [3]. Since then, with advancement in imaging techniques such as computed tomography (CT) and MRI, it is clearly demonstrated that obese diabetic patients with raised metabolic abnormalities like high insulin resistance and atherogenic dyslipidemia associated with an excess visceral adiposity are predisposed to higher CVD risk [4]. Using CT and MRI techniques, diagnostic thresholds have been established. Presently, the visceral fat threshold is 100 cm 2 below which disturbances of glucose, insulin and lipid metabolism are uncommon. Secondly, a level of 130 cm 2 Although CT or MRI is precise, they have certain limitations. CT imaging exposes the subject to ionizing radiation while MRI is not done routinely in clinical practice as the setup is not available at all centers and further high cost involved in scan acquisition, and analysis restricts its use in research setting. However, MRI is a safe, accurate and precise imaging modality for measuring visceral often detects the metabolic abnormalities representing an increased risk group [9-11]. International Journal of Pharmacy and Pharmaceutical Sciences ISSN- 0975-1491 Vol 8, Issue 8, 2016