Sex differences in the association between visceral adipose tissue and atherosclerosis in type 2 diabetes patients with normal bodyweight: A study in a Chinese population

AIMS/INTRODUCTION: To investigate the impact of visceral adipose tissue (VAT) on atherosclerosis in type 2 diabetes patients with normal bodyweight (OB[−]) in the Chinese population, and to further assess the sex–age differences between them. MATERIALS AND METHODS: A total of 8,839 type 2 diabetes patients from two of the National Metabolic Management Centers in China were included in this study. Participants were classified into four groups by visceral fat area (VFA; cm(2)) and body mass index (BMI; kg/m(2)): VFA < 100 and BMI < 23.9 (VA[−]OB[−]), VFA < 100 and BMI ≥ 23.9 (VA[−]OB[+]), VFA ≥ 100 and BMI < 23.9 (VA[+]OB[−]), VFA ≥ 100 and BMI ≥ 23.9 (VA[+]OB[+]). Atherosclerosis was defined by brachial‐ankle pulse wave velocity (baPWV; cm/s), and we analyzed the association between VFA, BMI and the tertiles of baPWV values. RESULTS: The VA(+)OB(−) prevalence was 3.7% among these participants. Patients with VA(+)OB(−) had the highest baPWV value (P < 0.001) and the highest proportion of the tertile 3 of baPWV (P < 0.001) among four groups, and were significantly associated with baPWV (standardized β = 0.026, P = 0.008). VFA was significantly related to tertile 2 to tertile 3 of baPWV in (OB[−]) type 2 diabetes patients, when compared with tertile 1 of baPWV, respectively. In sex–age stratified analysis, the association of VFA and the tertiles of baPWV showed sex differences. For the 55 years age stratification analysis, there was no age difference in the relationship between VFA and baPWV in (OB[−]) patients. CONCLUSION: Increased VAT was an independent risk factor for atherosclerosis in female type 2 diabetes patients with normal weight.