The visceral fat area to skeletal muscle mass ratio (VSR) is significantly associated with the risk of cardiometabolic diseases in a young and middle-aged Chinese natural population: a cross-sectional study

Background: Growing evidence has revealed that using BMI for assessment of obesity and cardiometabolic risk has some limitations. Visceral adiposity and skeletal muscle loss may be both correlated with cardiometabolic outcomes. This study aimed to explore the associations between the visceral fat area to skeletal muscle mass ratio (VSR) and the risk of several cardiometabolic diseases including metabolic associated fatty liver disease (MAFLD), hyperglycemia, hypertension, dyslipidemia and hyperuricemia in a young and middle-aged Chinese natural population and further elucidate the differences of these associations between male and female. Methods: A total of 5158 participants were included in this study. Body composition, anthropometrical and biochemical measurements were performed. The associations between VSR and cardiometabolic diseases were analyzed. Results: Both in male and female, VSR was positively associated with the five cardiometabolic diseases and with the increase of VSR by one quartile, the ORs increased significantly for all the five cardiometabolic diseases (P trend<0.001). With regard to the highest versus the lowest quartile of VSR, the ORs for MAFLD, hyperglycemia, hypertension, dyslipidemia and hyperuricemia were 17.23 (95% CI, 12.52-23.71), 15.47 (95% CI, 7.1-33.72), 5.12 (95% CI, 3.88-6.76), 3.16 (95% CI, 2.33-4.28) and 1.89 (95% CI, 1.42-2.51) in male, respectively. In female, the corresponding ORs were 41.15 (95% CI, 25.80-65.63), 21.62 (95% CI, 7.87-59.36), 9.64 (95% CI, 6.88-13.53), 9.34 (95% CI, 6.63-13.14) and 6.58 (95% CI, 3.45-12.56). The results of restricted cubic splines showed there were significant positive non-linear relationships between VSR and the risk of MAFLD, dyslipidemia, hyperglycemia and hypertension in both genders (P for non-linearity <0.05). The risk was relatively flat until when VSR reached 3.078 cm2/kg in men and 4.750 cm2/kg in women and started to increase rapidly afterwards. In men, however, the risk slowed down after VSR value got to around 4 cm2/kg and the curve became flat and even tended to decline. Conclusions: VSR was positively associated with cardiometabolic diseases regardless of gender. As VSR increased, the risk of cardiometabolic diseases was significantly higher in women than in men. Women should be more alert to the risk of cardiometabolic diseases caused by the increase of VSR.