ABC | Volume 112, Nº3, March 2019

Original Article Eickemberg et al Abdominal adiposity and C-IMT in the ELSA-Brasil Arq Bras Cardiol. 2019; 112(3):220-227 Table 2 – Multivariate linear regression analysis between abdominal adiposity, measured by five indicators alone, and CIMT, according to gender. ELSA-Brazil 2008-2010 Male Female n = 3,737 n = 4,712 β (SE) 95%CI β (SE) 95%CI Waist circumference 0.045 (0.006) 0.033;0.058 0.025 (0.004) 0.016;0.035 Waist-to-hip ratio 0.032 (0.006) 0.019;0.045 0.026 (0.004) 0.016;0.035 Conicity index 0.016 (0.006) 0.003;0.029 0.011 (0.004) 0.002;0.020 Lipid accumulation product 0.030 (0.006) 0.016;0.043 0.024 (0.004) 0.014;0.034 Visceral adiposity index 0.022 (0.007) 0.007;0.037 0.020 (0.005) 0.010;0.031 The models were adjusted for age, ethnicity/skin color, level of schooling, smoking status, HDL-cholesterol, LDL-cholesterol and arterial hypertension. Table 3 – Odds ratio and respective 95% confidence intervals for the association between abdominal adiposity, diagnosed by five indicators alone, with CIMT, according to gender. ELSA-Brazil 2008-2010 Male Female n = 3,737 n = 4,712 OR (95%CI) OR (95%CI) Waist circumference 1.47 (1.22;1.77) 1.38 (1.17;1.64) Waist-to-hip ratio 1.37 (1.12;1.67) 1.33 (1.13;1.57) Conicity index 1.02 (0.83;1.24) 1.12 (0.95;1.32) Lipid accumulation product 1.39 (1.13;1.69) 1.28 (1.08;1.53) Visceral adiposity index 1.42 (1.13;1.77) 1.31 (1.08;1.59) The models were adjusted for age, ethnicity/skin color, level of schooling, smoking status, HDL-cholesterol, LDL-cholesterol and arterial hypertension. indirect measures of this component, but they show good correlation with visceral fat and are accessible to the overall population. 27 The WC was the indicator most strongly associated with CIMT. Similar to our data, other studies have also found an association betweenWC and CIMT in healthy 45- to 65‑year‑old Dutch adults, hospitalized Irish adults, and hospitalized subjects aged 21-83 years in China. 7,30,31 WC is described as an indicator of abdominal adiposity with a greater capacity to predict metabolic alterations and cardiovascular diseases, being one of the measures that most closely approximates to visceral fat measured by imaging tests. 27 In this study, WHR also showed an important association with CIMT between men and women. Large epidemiological studies have described the strongest associations not only between adiposity diagnosed by WHR and CIMT, but also with the prevalence of myocardial infarction, incidence of coronary artery disease, high coronary risk and coronary events. 6,32,33 However , evidence shows that the gluteofemural region consists mainly of subcutaneous adipose tissue. This tissue does not seem to play an important role in the pathogenesis of cardiovascular disease. By including hip measurement, WHR reflects the effect of total adiposity as a risk factor for atherosclerosis and other cardiovascular outcomes. 32 Thus, WHR can be useful as a simple and consistent indicator by reflecting the combination of total and abdominal adiposity. The C index was the indicator that showed the lowest effect of abdominal adiposity on the CIMT in this study. No studies were found that investigated this indicator in relation to subclinical atherosclerosis. Previous publications have observed the association of this indicator with high coronary risk in Brazilians from the Northeast region 34 and metabolic alterations in Indian civil servants. 35 Although the C index is not a new indicator, it remains little explored and there is no consensus on ideal cutoff points for the Brazilian population. As it considers weight and height, similar to theWHR, it may be useful to demonstrate the combination of total and abdominal adiposities on cardiovascular outcomes. One hypothesis for the absence of association in this study is the large percentage of participants of white ethnicity/skin color, since the performance of this indicator as a discriminator of coronary risk works better in black populations. 34 VAI is an indicator originally proposed to identify the distribution and function of adipose tissue, indirectly expressing cardiovascular risk. Due to the inclusion of physical and metabolic parameters (anthropometric measures and biochemical tests), this indicator may reflect the altered production of adipocytokines, increase in lipolysis and free fatty acids in plasma. 10 Evidence indicates that VAI was independently associated with cardiovascular (OR = 2.45, 95%CI: 1.52, 3.95) and cerebrovascular events (OR = 1.63, 95%CI: 1.06, 2.50) in 224