title: Visceral adiposity index and risks of cardiovascular events and mortality in prevalent hemodialysis patients.
abstract: BACKGROUND
  The visceral adiposity index (VAI) is a newly-derived measure of visceral adiposity with well-validated predictive power for cardiovascular (CV) outcomes in the general population. However, this predictability has not been investigated in hemodialysis patients, and whether VAI is superior to waist circumference (WC) and waist-to-height ratio (WHtR) in predicting CV outcomes and survival in hemodialysis patients remains unknown.
  
  
  METHODS
  We performed a prospective study including 464 prevalent hemodialysis patients. The composite outcome was the occurrence of death and CV events during follow-up. Using multivariate Cox regression analysis, VAI, WC and WHtR were tested for the predictive power of outcomes. To evaluate the predictive performance of the VAI, WC and WHtR, time-dependent receiver operating characteristic curve (ROC) analysis was performed.
  
  
  RESULTS
  VAI, WC and WHtR positively correlated with each other. Patients with a higher VAI (tertile 3 vs. tertile 1, adjusted hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.12-2.42; tertile 2 vs. tertile 1, adjusted HR, 1.52; 95% CI, 1.1-2.18) had more composite outcomes. VAI had a similar predictive power of all-cause mortality to WC and WHtR, but superior predictive power of composite and CV outcomes to WC when analyzed by a stepwise forward likelihood ratio test. In time-dependent ROC analysis, VAI, WC and WHtR showed similar predictive performance for outcomes.
  
  
  CONCLUSIONS
  VAI is an optimal method to measure visceral adiposity to assess long-term CV outcomes and all-cause mortality in prevalent hemodialysis patients. VAI may provide a superior predictive power of CV outcomes to WC and WHtR.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01457625.
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Division of Nephrology, #21 Nan-Ya South Rd, Section 2, Banciao District, New Taipei City, Taiwan. alexander220tw@yahoo.com.|Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. alexander220tw@yahoo.com.
authors.forename: Hung-Yuan
authors.initials: HY
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Division of Nephrology, #21 Nan-Ya South Rd, Section 2, Banciao District, New Taipei City, Taiwan. yenling.chiu@gmail.com.|Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. yenling.chiu@gmail.com.
authors.forename: Yen-Ling
authors.initials: YL
authors.lastname: Chiu
authors.affiliation: Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan. grace.yifangchuang@gmail.com.
authors.forename: Yi-Fang
authors.initials: YF
authors.lastname: Chuang
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Division of Nephrology, #21 Nan-Ya South Rd, Section 2, Banciao District, New Taipei City, Taiwan. shihping999@yahoo.com.tw.|Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. shihping999@yahoo.com.tw.
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Hsu
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Division of Nephrology, #21 Nan-Ya South Rd, Section 2, Banciao District, New Taipei City, Taiwan. dragonwang57@gmail.com.|Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. dragonwang57@gmail.com.
authors.forename: Mei-Fen
authors.initials: MF
authors.lastname: Pai
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Division of Nephrology, #21 Nan-Ya South Rd, Section 2, Banciao District, New Taipei City, Taiwan. yangjuyeh@gmail.com.|Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. yangjuyeh@gmail.com.
authors.forename: Ju-Yeh
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Division of Nephrology, #21 Nan-Ya South Rd, Section 2, Banciao District, New Taipei City, Taiwan. taan70@yahoo.com.tw.|Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. taan70@yahoo.com.tw.
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Peng
mesh_terms: D050154:Adiposity / Q000502:physiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods; D012306:Risk