ABC | Volume 112, Nº3, March 2019

Original Article Indicators of Abdominal Adiposity and Carotid Intima-Media Thickness: Results from the Longitudinal Study of Adult Health (ELSA-Brazil) Michaela Eickemberg, 1, 2 Leila Denise Alves Ferreira Amorim, 1 Maria da Conceição Chagas de Almeida, 3 Estela Maria Leão de Aquino, 1 Maria de Jesus Mendes da Fonseca, 4 Itamar de Souza Santos, 5 Dora Chor, 4 Maria de Fátima Sander Diniz, 6 Sandhi Maria Barreto, 6 Sheila Maria Alvim de Matos 1 Universidade Federal da Bahia, 1 Salvador, BA – Brazil Escola Bahiana de Medicina e Saúde Pública, 2 Salvador, BA – Brazil Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), 3 Salvador, BA – Brazil Escola Nacional de Saúde Pública – Fiocruz, 4 Rio de Janeiro, RJ – Brazil Universidade de São Paulo, 5 São Paulo, SP – Brazil Universidade Federal de Minas Gerais, 6 Belo Horizonte, MG – Brazil Mailing Address: Michaela Eickemberg • Rua Basílio da Gama, 316. Postal Code 40110-040, Canela, Salvador, BA – Brazil E-mail: mieickemberg@yahoo.com.br , mieickemberg@gmail.com Manuscript received April 11, 2018, revised manuscript July 23, 2018, accepted July 23, 2018 DOI: 10.5935/abc.20180273 Abstract Background: Abdominal adiposity is a risk factor for cardiovascular disease. Objective: To determine the magnitude of the association between abdominal adiposity, according to five different indicators, and the carotid intima-media thickness (CIMT). Methods: Data from 8,449 participants aged 35 to 74 years from the ELSA-Brazil study were used. The effect of waist circumference (WC), waist-to-hip ratio (WHR), conicity index (C index), lipid accumulation product (LAP) and visceral adiposity index (VAI) on CIMT were evaluated. Data were stratified by gender and analyzed using multivariate linear and logistic regressions. A significance level of 5% was considered. Results: Participants with CIMT > P75 showed a higher frequency of abdominal adiposity (men >72% and women >66%) compared to those with CIMT < P75. Abdominal adiposity was associated with the mean CIMT, mainly through WC in men (0.04; 95%CI: 0.033; 0.058). The abdominal adiposity identified by the WC, WHR, LAP, and VAI indicators in women showed an effect of 0.02 mm on the CIMT (WC: 0.025, 95%CI: 0.016, 0.035; WHR: 0.026, 95%CI: 0.016, 0.035; LAP: 0.024, 95%CI: 0.014; 0.034; VAI: 0.020, 95%CI: 0.010, 0.031). In the multiple logistic regression, the abdominal adiposity diagnosed by WC showed an important effect on the CIMT in both genders (men: OR = 1.47, 95%CI: 1.22-1.77, women: OR = 1.38; 95%CI: 1.17-1.64). Conclusion: Abdominal adiposity, identified through WC, WHR, LAP, and VAI, was associated with CIMT in both genders, mainly for the traditional anthropometric indicator, WC. (Arq Bras Cardiol. 2019; 112(3):220-227) Keywords: Cardiovascular Diseases; Risk Factors; Metabolism; Metabolic Syndrome; Abdominal Obesity; Atherosclerosis; Carotid Intima-Media Thickness. Introduction Abdominal obesity is a traditional risk factor for cardiovascular diseases. 1 In Brazil, the prevalence of abdominal obesity, estimated by the National Health Survey (Pesquisa Nacional de Saúde), according to the cut-off points for waist circumference (WC) of the World Health Organization, 2 was 52.1% for women and 21.8% for men in 2013. 3 Several mechanisms have attempted to explain how abdominal adiposity becomes a risk factor for cardiovascular disease. It is a consensus that abdominal adipose tissue has complexmetabolic functions and produces numerous mediators that trigger specific, dynamic and inflammatory reactions. 4 Atherosclerotic lesions increase the risk for cardiovascular diseases. The carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and a predictor of myocardial infarction and cerebrovascular accident. 5 The association between abdominal adiposity and subclinical atherosclerosis has been documented in different populations. 6,7 However, even though the CIMT is associated with abdominal adiposity, it is yet to be fully established how much this adiposity, measured by different clinical and other unusual indicators, is associated with subclinical atherosclerosis. Studies have suggested that WC, waist-to-hip ratio (WHR) and visceral adiposity index (VAI) may predict subclinical atherosclerosis. 6,8,9 Most studies on this subject were performed in Europe, Asia and the United States, and use the WC and WHR to define abdominal adiposity and its association with cardiovascular diseases. Indicators that provide indirect information on lipid overaccumulation and visceral fat function associated with cardiovascular events, such 220