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 - Report - MDSpire

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

  • By

  • Zichen Rao

  • Liangyan Hua

  • Yiwei Mo

  • Zhenghao Wu

  • Ziru Fang

  • Chunyan Zhu

  • Lifang Cheng

  • Yiming Zhang

  • May 29, 2026

  • 0 min

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Association of Visceral Fat Area and Residual Cholesterol in Type 2 Diabetes

Overview

This study identifies visceral fat area (VFA) and the visceral-to-subcutaneous fat ratio (VFA/SFA) as significant predictors of residual cholesterol (RC) in adults with type 2 diabetes (T2D). Traditional anthropometric measures like BMI and waist circumference were less effective in capturing this association.

Background

Residual cholesterol is a critical marker of cardiovascular risk, particularly in individuals with T2D, who often experience elevated levels despite achieving LDL-C targets. Understanding the relationship between adiposity indices and RC can enhance risk stratification and management strategies in this population. Traditional measures of obesity may not adequately reflect visceral fat accumulation, which is linked to increased cardiometabolic risk.

Data Highlights

Adiposity Indexβ Coefficient (95% CI)
VFA0.1102 (0.0186–0.2018)
VFA/SFA0.1882 (0.1010–0.2753)
Highest VFA Quartile0.383 mmol/L (0.131–0.636)
Highest VFA/SFA Quartile0.562 mmol/L (0.316–0.808)

Key Findings

  • Higher residual cholesterol levels were associated with increased visceral fat area and visceral-to-subcutaneous fat ratio.
  • After adjustment, only VFA and VFA/SFA remained significantly associated with residual cholesterol.
  • A VFA/SFA ratio near 0.7–0.8 may indicate a critical threshold for elevated residual cholesterol.
  • Subgroup analyses showed consistent associations across various demographics including age, sex, and BMI.
  • Traditional measures like BMI and waist circumference were less effective in predicting residual cholesterol compared to visceral fat indices.

Clinical Implications

Healthcare professionals should consider incorporating visceral fat measurements into routine assessments for patients with type 2 diabetes to better evaluate cardiovascular risk. This approach may enhance the identification of individuals at higher risk for residual cholesterol-related complications.

Conclusion

The study underscores the importance of visceral fat assessment in understanding residual cholesterol levels in type 2 diabetes, suggesting that traditional anthropometric measures may not suffice for effective risk stratification.

Related Resources & Content

  1. Frontiers in Endocrinology, 2026 -- Comparison of the association and discriminatory ability of CVAI, LAP, CI, and AVI for type 2 diabetes in Chinese adults aged ≥ 50 years: a sex-specific analysis
  2. The Journal of Clinical Endocrinology & Metabolism, 2025 -- Links Between Regional Fat Distribution and Cardiovascular Disease Risk and Mortality in Type 2 Diabetes Patients
  3. The Journal of Clinical Endocrinology & Metabolism, 2025 -- The Role of Mesenteric Fat Mass in Visceral Fat Accumulation and Glucose Metabolism
  4. ACC/AHA Issue Updated Guideline for Managing Lipids, Cholesterol, 2026 -- American College of Cardiology
  5. Obesity Surgery — Impact of Type 2 Diabetes Mellitus on Subclinical Atherosclerosis in Individuals with Severe Obesity
  6. What is ‘remnant cholesterol’?
  7. Association of remnant cholesterol with cardiovascular disease events in patients with diabetes
  8. ACC/AHA Issue Updated Guideline for Managing Lipids, Cholesterol - American College of Cardiology
  9. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 | Diabetes Care | American Diabetes Association
  10. Cumulative remnant cholesterol and major adverse cardiovascular events among adults with type 2 diabetes - PubMed
  11. Pemafibrate to Reduce Cardiovascular Outcomes by Reducing Triglycerides in Patients With Diabetes - American College of Cardiology
  12. Identifying and assessing overweight, obesity and central adiposity | Overweight and obesity management | Guidance | NICE
  13. The association between the visceral to subcutaneous abdominal fat ratio and the risk of cardiovascular diseases: a systematic review | BMC Public Health | Full Text
  14. Association between visceral adiposity index and cardiovascular disease: A systematic review and meta-analysis - ScienceDirect
  15. Visceral adipose tissue area and proportion provide distinct reflections of cardiometabolic outcomes in weight loss; pooled analysis of MRI-assessed CENTRAL and DIRECT PLUS dietary randomized controlled trials - PMC

Original Source(s)

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

  • by Zichen Rao, Liangyan Hua, Yiwei Mo, Zhenghao Wu, Ziru Fang, Chunyan Zhu, Lifang Cheng, Yiming Zhang

  • May 29, 2026

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