Research Progress on the Role of Visceral Fat Area in the Occurrence and Progression of Diabetic Complications

糖尿病慢性并发症是患者致残、致死的首要因素，内脏脂肪过量蓄积与糖尿病并发症进展密切相关。内脏脂肪面积(VFA)可精准反映内脏脂肪堆积程度，相较于体重指数、腰围等指标，更适用于代谢风险评估，在亚裔“瘦胖表型”人群中评估价值尤为突出。本文综述了VFA的检测方法与国内诊断临界值，归纳其介导糖尿病并发症的核心病理机制，阐述了VFA升高在糖尿病并发症中的作用机制与病理过程。现阶段主要依靠生活方式干预、药物、代谢手术开展综合防控，但亚裔人群专项研究、作用靶点挖掘、简易筛查技术及靶向药物研发仍有待完善。VFA是糖尿病并发症防治的重要靶点，临床需将其纳入常规评估体系，对内脏脂肪超标患者实施个体化干预，尽早阻断病理损伤通路，以此延缓并发症发生发展，改善糖尿病患者生存质量与远期预后。Chronic diabetic complications are the leading cause of disability and death in diabetic patients, and excessive visceral fat accumulation is strongly associated with the progression of these complications. Visceral fat area (VFA) precisely quantifies visceral fat deposition. Compared with metrics including body mass index and waist circumference, VFA is superior for evaluating metabolic risks, and its predictive value stands out markedly among Asian individuals with the “thin-fat phenotype”. This article reviews the measurement modalities and domestic diagnostic cut-off values of VFA, summarizes the core pathological mechanisms by which VFA drives diabetic complications, and illustrates the functional pathways and pathological cascades triggered by elevated VFA in diabetic complications. Current comprehensive prevention and management strategies centre on lifestyle modification, pharmacotherapy and metabolic surgery. However, targeted research specific to Asian populations, discovery of therapeutic targets, development of convenient screening tools and innovation of targeted medications remain insufficiently established. VFA represents a critical therapeutic target for preventing and treating diabetic complications. Clinically, VFA should be integrated into routine assessment workflows. Individualized interventions ought to be delivered to patients with excess visceral fat to block pathological injury pathways at an early stage. This strategy can delay the initiation and advancement of complications, and ultimately enhance the quality of life and long-term prognosis of patients with diabetes.