Research Article: Visceral fat area and visceral-to-subcutaneous fat ratio are more strongly associated with residual cholesterol than conventional anthropometric indices in adults with type 2 diabetes
Abstract:
Residual cholesterol (RC) is linked to cardiovascular risk, yet the optimal adiposity indices to capture this burden in type 2 diabetes (T2D) remain unclear. We compared associations of general and central adiposity indices with RC in a real-world T2D cohort.
This cross-sectional study included 1,135 adults with T2D at a Chinese Metabolic Management Centre (2022–2025). We assessed BMI, weight, waist circumference (WC), waist-to-height ratio (WHtR), visceral fat area (VFA), subcutaneous fat area (SFA), and VFA/SFA ratio. Linear regression estimated ? coefficients for RC per 1-SD increase in indices, adjusted for age, sex, HbA1c, eGFR, blood pressure, smoking, and drinking. Nonlinearity was assessed using generalized additive models and piecewise regression.
Across RC quartiles, patients with higher RC were more often male and current smokers and had higher BMI, WC, VFA, SFA, WHtR and VFA/SFA. In unadjusted models, all adiposity indices were positively associated with RC, but after full adjustment only VFA (? 0.1102, 95% CI 0.0186–0.2018) and VFA/SFA (? 0.1882, 95% CI 0.1010–0.2753) remained independently related to RC. When modelled in original units and quartiles, the highest VFA quartile was associated with 0.383 mmol/L (95% CI 0.131–0.636) higher RC and the highest VFA/SFA quartile with 0.562 mmol/L (95% CI 0.316–0.808) higher RC compared with the lowest quartile in fully adjusted models. A non-linear association between VFA/SFA and RC was observed, with an inflection around 0.72: below this threshold, higher VFA/SFA was strongly associated with higher RC (? 1.61, 95% CI 0.91–2.30), whereas no clear association was seen above it. Subgroup analyses showed broadly consistent associations across age, sex, BMI and HbA1c strata, without significant interactions.
In T2D, indices of visceral fat accumulation—particularly VFA and VFA/SFA—are more strongly associated with RC than BMI, WC, or WHtR. A VFA/SFA ratio near 0.7–0.8 may mark a critical range where visceral fat predominance is most strongly linked to RC elevation. Detailed visceral adiposity assessment may help refine RC-related risk stratification beyond traditional measures.
Introduction:
Residual cholesterol (RC) is linked to cardiovascular risk, yet the optimal adiposity indices to capture this burden in type 2 diabetes (T2D) remain unclear. We compared associations of general and central adiposity indices with RC in a real-world T2D cohort.
Read more