Meal Frequency, Visceral Adiposity Index, and Atherogenic Index of Plasma in Adults with Overweight and Obesity
DOI:
https://doi.org/10.58600/eurjther3150Keywords:
atherogenic index of plasma, cardiometabolic risk, meal frequency, obesity, overweight, visceral adiposity indexAbstract
Objective: This study aimed to evaluate whether daily main meal count and snack frequency are independently associated with the Visceral adiposity index (VAI) and atherogenic index of plasma (AIP) in overweight and obese adults without known chronic disease or pharmacotherapy.
Methods: This cross-sectional study included 347 adults aged 18–65 years with BMI ≥25 kg/m² who presented for a first cardiological assessment. Participants with diagnosed chronic disease or regular medication use were excluded. Meal frequency was recorded by structured interview as daily main meal count and snack frequency. VAI was calculated using sex-specific formulas incorporating waist circumference, BMI, triglycerides, and HDL-cholesterol. AIP was calculated as log₁₀ (triglycerides/HDL-cholesterol), using molar concentrations.
Results: The mean age of participants was 40.8 ± 11.7 years, and 53.3% were female. Participants with obesity had significantly higher AIP and VAI values than overweight participants. In unadjusted analyses, main meal count was positively correlated with AIP, whereas snack frequency was inversely correlated with both AIP and VAI. Participants reporting one snack per day had lower AIP and VAI values than those reporting no snacks. However, neither main meal count nor snack frequency remained independently associated with AIP or VAI in the multivariable models. The AIP model was adjusted for age, sex, BMI, smoking status, and regular exercise, whereas the primary VAI model was constructed without BMI because BMI is a component of the VAI formula. Higher age, male sex, BMI, and lack of regular exercise were the main independent correlates of AIP. In the primary BMI-free VAI model, higher age and lack of regular exercise were independently associated with VAI, while meal-frequency variables remained non-significant. A BMI-adjusted sensitivity model yielded the same conclusion regarding meal-frequency variables.
Conclusion: In medication-free overweight and obese adults without known chronic disease, meal frequency alone was not independently associated with AIP or VAI after adjustment for demographic, anthropometric, and lifestyle-related factors. These findings suggest that simple eating-occasion counts may be less informative than overall dietary quality, meal composition, timing, and physical activity in cardiometabolic risk assessment.
References
[1] Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, Lear SA, Ndumele CE, Neeland IJ, Sanders P, St-Onge MP, American Heart Association Council on Lifestyle and Cardiometabolic Health, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, Stroke Council (2021) Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 143(21):e984–e1010. https://doi.org/10.1161/CIR.0000000000000973
[2] Kivimäki M, Strandberg T, Pentti J, Nyberg ST, Frank P, Jokela M, Ervasti J, Suominen SB, Vahtera J, Sipilä PN, Lindbohm JV, Ferrie JE (2022) Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. Lancet Diabetes Endocrinol. 10(4):253–263. https://doi.org/10.1016/S2213-8587(22)00033-X
[3] Neeland IJ, Ross R, Després JP, Matsuzawa Y, Yamashita S, Shai I, Seidell J, Magni P, Santos RD, Arsenault B, Cuevas A, Hu FB, Griffin B, Zambon A, Barter P, Fruchart JC, Eckel RH (2019) Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 7(9):715–725. https://doi.org/10.1016/S2213-8587(19)30084-1
[4] Abdollahi S, Kazemi A, de Souza RJ, Clark CCT, Soltani S (2021) The effect of meal frequency on biochemical cardiometabolic factors: a systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 40(5):3170–3181. https://doi.org/10.1016/j.clnu.2020.12.038
[5] St-Onge MP, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton PM, Varady K (2017) Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 135(9):e96–e121. https://doi.org/10.1161/CIR.0000000000000476
[6] Amato MC, Giordano C (2014) Visceral adiposity index: an indicator of adipose tissue dysfunction. Int J Endocrinol. 2014:730827. https://doi.org/10.1155/2014/730827
[7] Quirino-Vela L, Mayoral-Chávez M, Pérez-Cervera Y, Ildefonso-García O, Cruz-Altamirano E, Ruiz-García M, Alpuche J (2025) Cardiometabolic risk assessment by anthropometric and biochemical indices in Mexican population. Front Endocrinol (Lausanne). 16:1588469. https://doi.org/10.3389/fendo.2025.1588469
[8] Bozorgmanesh M, Hadaegh F, Khalili D, Azizi F (2012) Prognostic significance of the complex “Visceral Adiposity Index” vs. simple anthropometric measures: Tehran lipid and glucose study. Cardiovasc Diabetol. 11:20. https://doi.org/10.1186/1475-2840-11-20
[9] Lioy B, Webb RJ, Amirabdollahian F (2023) The association between the Atherogenic Index of Plasma and cardiometabolic risk factors: a review. Healthcare (Basel). 11(7):966. https://doi.org/10.3390/healthcare11070966
[10] Hamzeh B, Pasdar Y, Mirzaei N, Faramani RS, Najafi F, Shakiba E, Darbandi M (2021) Visceral adiposity index and atherogenic index of plasma as useful predictors of risk of cardiovascular diseases: evidence from a cohort study in Iran. Lipids Health Dis. 20(1):82. https://doi.org/10.1186/s12944-021-01505-w
[11] World Health Organization (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. WHO Technical Report Series 894. World Health Organization, Geneva.
[12] World Health Organization (2011) Waist circumference and waist–hip ratio: report of a WHO expert consultation, Geneva, 8–11 December 2008. World Health Organization, Geneva.
[13] Ben-Noun L, Sohar E, Laor A (2001) Neck circumference as a simple screening measure for identifying overweight and obese patients. Obes Res. 9(8):470–477. https://doi.org/10.1038/oby.2001.61
[14] Dobiásová M, Frohlich J (2001) The plasma parameter log(TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma. Clin Biochem. 34(7):583–588. https://doi.org/10.1016/S0009-9120(01)00263-6
[15] Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, Galluzzo A (2010) Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 33(4):920–922. https://doi.org/10.2337/dc09-1825
[16] Blazey P, Habibi A, Hassen N, Friedman D, Khan KM, Ardern CL (2023) The effects of eating frequency on changes in body composition and cardiometabolic health in adults: a systematic review with meta-analysis of randomized trials. Int J Behav Nutr Phys Act. 20(1):133. https://doi.org/10.1186/s12966-023-01532-z
[17] Liu HY, Eso AA, Cook N, O’Neill HM, Albarqouni L (2024) Meal timing and anthropometric and metabolic outcomes: a systematic review and meta-analysis. JAMA Netw Open. 7(11):e2442163. https://doi.org/10.1001/jamanetworkopen.2024.42163
[18] Karpe F, Pinnick KE (2015) Biology of upper-body and lower-body adipose tissue—link to whole-body phenotypes. Nat Rev Endocrinol. 11(2):90–100. https://doi.org/10.1038/nrendo.2014.185
[19] Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, Baker P, Lawrence M, Rebholz CM, Srour B, Touvier M, Jacka FN, O’Neil A, Segasby T, Marx W (2024) Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. 384:e077310. https://doi.org/10.1136/bmj-2023-077310
[20] Tramunt B, Smati S, Grandgeorge N, Lenfant F, Arnal JF, Montagner A, Gourdy P (2020) Sex differences in metabolic regulation and diabetes susceptibility. Diabetologia. 63(3):453–461. https://doi.org/10.1007/s00125-019-05040-3
[21] Mann S, Beedie C, Jimenez A (2014) Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations. Sports Med. 44(2):211–221. https://doi.org/10.1007/s40279-013-0110-5
[22] Wewege MA, Thom JM, Rye KA, Parmenter BJ (2018) Aerobic, resistance or combined training: a systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome. Atherosclerosis. 274:162–171. https://doi.org/10.1016/j.atherosclerosis.2018.05.002
[23] Tamosiunas A, Luksiene D, Kranciukaite-Butylkiniene D, Radisauskas R, Sopagiene D, Bobak M (2023) Predictive importance of the visceral adiposity index and atherogenic index of plasma of all-cause and cardiovascular disease mortality in middle-aged and elderly Lithuanian population. Front Public Health. 11:1150563. https://doi.org/10.3389/fpubh.2023.1150563
[24] Zhang J, Li M, Wang T, Tian W, Ju J, Xu H (2025) Association between visceral adiposity index and all-cause and cardiovascular mortality in the non-elderly adults. Front Endocrinol (Lausanne). 16:1523731. https://doi.org/10.3389/fendo.2025.1523731
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