Higher visceral fat area is inversely associated with ketosis in Chinese patients with type 2 diabetes mellitus: a cross-sectional study.

BACKGROUND: The relationship between visceral fat area (VFA) and ketosis remains a subject of debate, with a paucity of research specifically addressing this association in individuals with type 2 diabetes mellitus (T2DM). This research seeks to investigate the connection between VFA and ketosis among Chinese patients diagnosed with T2DM. METHODS: A cross-sectional study was performed, encompassing 1,058 patients with T2DM from real-world clinical environments. Body composition and visceral obesity were assessed through bioelectrical impedance analysis. The clinical characteristics of patients across varying quartiles of VFA were compared, and the relationships between VFA quartiles, visceral obesity, and ketosis were investigated. RESULTS: After adjusting for age, gender and diabetes duration, ketosis prevalence appeared to gradually decrease across ascending VFA quartiles, with rates of 15.5%, 11.5%, 9.1% and 5.3% respectively, presenting a statistically significant trend (P < 0.001). Higher VFA categories tended to correlate with higher MASLD prevalence and elevated C-peptide levels (P < 0.001 for trend). Multivariate binary logistic regression indicated a potential inverse link between visceral obesity (OR = 0.409, 95%CI: 0.251-0.644, P<0.001), VFA quartile and ketosis occurrence among T2DM patients (P = 0.022 for trend). CONCLUSIONS: Higher visceral fat mass was associated with a lower prevalence of ketosis. Evaluation of visceral fat status can provide reference for personalized diet and medication management. Attention should be paid to ketosis in patients with low visceral fat.