Visceral adiposity as a predictor of new-onset diabetes in patients with primary aldosteronism: a cohort study

Background: Patients with primary aldosteronism (PA) exhibit a high prevalence of diabetes mellitus (DM). However, the relationship between visceral adipose tissue (VAT) and new-onset diabetes mellitus (NODM) in PA patients remains unclear. Objectives: To explore the association between VAT and the risk of NODM in PA patients. Design: This is a prospective cohort study spanning 10 years (2010-2020). Methods: A total of 342 PA patients were enrolled prospectively. Abdominal adiposity indexes, including VAT area, VAT ratio, subcutaneous adipose tissue (SAT) area, and SAT ratio, were measured using a computed tomography-based software at diagnosis. Results: Of 342 PA patients (46.2% male, mean age 50.8 +/- 11.2 years), 35 (10.2%) developed NODM over a mean follow-up of 7.4 years. A positive nonlinear association between NODM risk and Log (VAT ratio) >= -0.72 was observed (high-VAT group). High VAT (odds ratio (OR), 6.09; p = 0.005), older age (OR, 1.09; p < 0.001), higher body mass index (OR, 1.24; p < 0.001), higher waist-to-hip ratio (OR, 1.11, p < 0.001), lower baseline aldosterone (OR, 0.99, p = 0.011), higher diastolic blood pressure (OR, 1.05, p = 0.012), and lower systolic blood pressure (OR, 0.98, p = 0.045) as risk factors for high VAT. Adrenalectomy did not significantly associate with reduced NODM risk (OR, 0.49; p = 0.292). Conclusion: Our findings highlight that 10.2% of PA patients develop NODM over a mean follow-up of 7.4 years, with high VAT increasing the risk. Baseline VAT is a key determinant of NODM development in PA patients, regardless of targeted treatments.