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Background Waist circumference (WC), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) are considered surrogate indicators of abdominal fat deposition, but the longitudinal association of these indices with cardiovascular (CV) events in adults with type 2 diabetes (T2D) remains unclear. Our study aimed to examine the associations between abdominal obesity indices and incident CV events among people with T2D and to compare their predictive performance in risk assessment. Methods The present study included 2328 individuals with T2D from the Xinjiang Multi-Ethnic Cohort. Multivariable Cox regression analyses were applied to assess the associations between abdominal obesity indices and CV events. Harrell's concordance statistic (C-statistic), net reclassification improvement (NRI) index, and integrated discrimination improvement (IDI) index were utilized to evaluate the predictive performance of each abdominal obesity index. Results At a median follow-up period of 59 months, 289 participants experienced CV events. After multivariable adjustment, each 1-SD increase in WC, VAI, LAP, and CVAI was associated with a higher risk of CV events in people with T2D, with adjusted hazard ratios (HRs) being 1.57 [95% CI (confidence interval): 1.39–1.78], 1.11 (95% CI 1.06–1.16), 1.46 (95% CI 1.36–1.57), and 1.78 (95% CI 1.57–2.01), respectively. In subgroup analyses, these positive associations appeared to be stronger among participants with body mass index (BMI) < 25 kg/m 2 compared to overweight/obese participants. As for the predictive performance, CVAI had the largest C-statistic (0.700, 95% CI 0.672–0.728) compared to VAI, LAP, WC, and BMI (C-statistic: 0.535 to 0.670, all P for comparison < 0.05). When the abdominal obesity index was added to the basic risk model, the CVAI index also showed the greatest incremental risk stratification (C-statistic: 0.751 vs. 0.701, P  < 0.001; IDI: 4.3%, P  < 0.001; NRI: 26.6%, P  < 0.001). Conclusions This study provided additional evidence that all abdominal obesity indices were associated with the risk of CV events and highlighted that CVAI might be a valuable abdominal obesity indicator for identifying the high risk of CV events in Chinese populations with T2D. These results suggest that proactive assessment of abdominal obesity could be helpful for the effective clinical management of the diabetic population.

Stroke is a leading cause of global morbidity and mortality, with risk factors like visceral adiposity and inflammation playing significant roles. This study introduces the Visceral Adiposity Inflammatory Index (VAII), combining the Visceral Adiposity Index (VAI) and high-sensitivity C-reactive protein (CRP), to better predict stroke risk. Analyzing data from 8415 participants in the China Health and Retirement Longitudinal Study over 9 years, the study found that higher VAII levels were strongly associated with increased stroke incidence, with a hazard ratio of 1.91 for the highest quartile. VAII outperformed VAI and CRP alone in predictive accuracy, enhancing traditional risk models as shown by improved Net Reclassification Index and Integrated Discrimination Improvement Index. Furthermore, blood pressure and the triglyceride-glucose index were identified as mediators in the VAII-stroke relationship. These findings underscore VAII as a promising tool for stroke risk assessment, suggesting that public health interventions targeting VAII reduction could help mitigate stroke risk.

The visceral adiposity index (VAI) is an indicator of visceral fat dysfunction associated with atherosclerotic cardiovascular disease (ASCVD). Neck circumference (NC) is a common anthropometric measure of upper-body fat. This study evaluated the association between NC and VAI in a rural Thai population using data from the Health Outcomes and Risk Factors in Rural Communities in Thailand (HARRIT) study (2017–2022). Elevated VAI was defined as > 2.98, while a large NC was considered ≥ 35 cm in men and ≥ 32 cm in women. Multivariable linear and logistic regression analyses were used to assess the relationship between NC and VAI. The study included 2,160 adults with a mean age of 55.6 years, 65.5% of whom were women. The average NC was 33.6 cm, and 63.4% of participants had a large NC. The mean VAI was 6.3, with 75.5% classified as having an elevated VAI. A large NC was significantly associated with a higher VAI (adjusted β = 2.31, 95% confidence interval [CI]: 1.91–2.71). Participants with a large NC had a 26% higher prevalence of elevated VAI (adjusted prevalence ratio [APR] = 1.26, 95% CI: 1.19–1.33). For individuals under 60, the APR was 1.33 (95% CI: 1.23–1.44); for those aged 60 and above, it was 1.17 (95% CI: 1.09–1.26). In conclusion, NC is positively associated with VAI among rural Thai adults. This highlights the need for further research to explore the relationship between NC and ASCVD outcomes and to establish sex- and age-specific NC cutoffs.

The age-adjusted visceral adiposity index (AVAI) is a novel marker reflecting visceral fat-related metabolic risk. However, its relationship with chronic kidney disease (CKD) remains unclear. This study aims to evaluate the association between AVAI and CKD prevalence in U.S. adults. We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018, including 7,760 participants aged 20 years and older. Logistic regression models were used to examine the association between AVAI and CKD, with adjustments for demographic, lifestyle, and clinical factors. Restricted cubic spline and threshold effect analyses were applied to explore the potential nonlinear patterns, and subgroup analyses assessed the potential effect modifiers. Receiver operating characteristic (ROC) curves compared the predictive performance of AVAI and the traditional visceral adiposity index (VAI). AVAI was significantly associated with higher CKD prevalence after adjustment, with each 1-unit increase corresponding to a 47% higher risk of CKD (OR = 1.47, 95% CI: 1.36-1.59). A nonlinear association was observed, with a threshold at AVAI = -6.5, beyond which CKD risk increased steeply. Subgroup analysis showed a stronger association in older adults. ROC analysis indicated that AVAI had better discriminatory ability for CKD (AUC = 0.7581) than VAI (AUC = 0.5685). These findings suggest that AVAI is a promising, practical tool for identifying individuals at high risk of CKD in the general population.

Background The effects of visceral adiposity on decreased lung function have drawn much attention. Recently, the visceral adiposity index (VAI) has been proposed as a visceral fat distribution and dysfunction marker. However, the relationship between the VAI and lung function has not been investigated. The objective of the study was to analyze the association between the VAI and lung function and evaluate the potential of VAI as a predictor of lung function. Methods We collected data from a population-based study of 1786 subjects aged 40 years or older. All subjects completed a questionnaire and underwent anthropometric measurements and laboratory tests. Linear and logistic regression models were developed to assess the association between the VAI and lung function. Results The VAI was inversely related to FVC%predicted in men and negatively associated with both FVC%predicted and FEV1%predicted in women. In the linear regression analysis, the decrease in FVC%predicted associated with each 10% increase in the VAI was 1.127% in men and 1.943% in women; the decrease in FEV1%predicted associated with each 10%increase in the VAI was 0.663% in men and 1.738% in women. Further regression analysis revealed that the VAI was positively correlated with FVC and FEV1 impairment in women. Conclusions We were the first to show a clear correlation between the VAI and lung function impairment in the Chinese population. The VAI could be a simple and reliable approach in daily practice, and individuals, especially women with a high VAI, should receive additional screening and preventive interventions for respiratory disease.

Objective This study aimed to evaluate the prognostic value of the Chinese Visceral Adiposity Index (CVAI) for all-cause mortality in the high-risk population with coexisting type 2 diabetes mellitus (T2DM), heart failure (HF), and chronic kidney disease (CKD). Results Over a median 26-month follow-up among 442 patients, 194 deaths occurred. The highest CVAI tertile (T3) exhibited a significantly elevated mortality risk (adjusted hazard ratio [HR] = 2.806, 95% confidence interval [CI] 1.848–4.261, P  < 0.001), demonstrating a linear dose-response relationship. CVAI provided significant incremental predictive value beyond left ventricular ejection fraction (LVEF) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Subgroup analysis revealed a significant association in patients with LVEF < 40% but not in those with LVEF ≥ 40% (P for interaction = 0.049).

Visceral adipose tissue plays an active role in the pathogenesis of type 2 diabetes and vascular dysfunction. The lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese VAI (CVAI) have been proposed as simple and validated surrogate indices for measuring visceral adipose tissue. However, the evidence from prospective studies on the associations between these novel indices of visceral obesity and diabetic retinopathy (DR) remains scant. This study aimed to investigate the longitudinal associations of LAP, VAI, and CVAI with incident DR in Chinese patients with diabetes. This was a prospective cohort study conducted in Guangzhou in southern China. We collected baseline data between November 2017 and July 2020, while on-site follow-up visits were conducted annually until January 2022. The study participants consisted of 1403 patients with a clinical diagnosis of diabetes, referred from primary care, who were free of DR at baseline. The LAP, VAI, and CVAI levels were calculated by sex-specific equations based on anthropometric and biochemical parameters. DR was assessed using 7-field color stereoscopic fundus photographs and graded according to the modified Airlie House Classification scheme. Time-dependent Cox proportional hazard models were constructed to estimate the hazard ratios with 95% CIs. Restricted cubic spline curves were fitted to examine the dose-response relationship between the 3 indices of visceral obesity and new-onset DR. Subgroup analyses were performed to investigate the potential effect modifiers. The mean age of study participants was 64.5 (SD 7.6) years, and over half (816/1403, 58.2%) were female. During a median follow-up of 2.13 years, 406 DR events were observed. A 1-SD increment in LAP, VAI, or CVAI was consistently associated with increased risk for new-onset DR, with a multivariable‑adjusted hazard ratio of 1.24 (95% CI 1.09-1.41; P=.001), 1.22 (95% CI 1.09-1.36; P<.001), and 1.48 (95% CI 1.19-1.85; P=.001), respectively. Similar patterns were observed across tertiles in LAP (P for trend=.001), VAI (P for trend<.001), and CVAI (P for trend=.009). Patients in the highest tertile of LAP, VAI, and CVAI had an 84%, 86%, and 82% higher hazard of DR, respectively, compared to those in the lowest tertile. A nonlinear dose-response relationship with incident DR was noted for LAP and VAI (both P for nonlinearity<.05), but not for CVAI (P for nonlinearity=.51). We did not detect the presence of effect modification by age, sex, duration of diabetes, BMI, or comorbidity (all P for interaction>.10). Visceral obesity, as measured by LAP, VAI, or CVAI, is independently associated with increased risk for new-onset DR in Chinese patients with diabetes. Our findings may suggest the necessity of incorporating regular monitoring of visceral obesity indices into routine clinical practice to enhance population-based prevention for DR.

Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine illnesses, often accompanied by visceral adiposity and metabolic syndrome (MetS). Visceral adiposity is an accurate predictor of MetS and cardiometabolic risk. This study aims to evaluate different anthropometric indices that can be used in PCOS and MetS risk assessment. A total of 66 women with PCOS (50%) and 66 controls (50%) were included, and clinical and biochemical parameters were evaluated. The body mass index (BMI), body shape index (ABSI), body roundness index (BRI), dysfunctional adiposity index (DAI), lipid accumulation (LAP) index, and visceral adiposity index (VAI) were calculated. The means of all indices were higher in the PCOS group (p < 0.05). The marker with the lowest discriminatory ability for PCOS and MetS was ABSI (AUC = 0.762 and AUC = 0.714, respectively, p = 0.000). According to the multivariate logistic regression model, the VAI and WC are strong predictors of PCOS (AUC, 98%; accuracy, 92%; sensitivity, 92%; and specificity, 91%), and WC, LAP index, and BRI are strong predictors of MetS (AUC, 0.95%; accuracy, 86%; sensitivity, 83%; and specificity, 88%). The use of different anthropometric indices in the detection of PCOS and MetS may allow for early diagnosis and treatment, and are simple and cost-effective.

Background Benign prostatic hyperplasia (BPH) and its related lower urinary tract symptoms (LUTS) are commonly observed among aging males and have a substantial effect on quality of life. Metabolic syndrome, with a specific focus on obesity, is believed to play a role in the development of BPH. This study intends to explore the relationship between several obesity-related metrics, including the Chinese Visceral Adiposity Index (CVAI), and LUTS/BPH within a national cohort of Chinese men. Methods Data from the China Health and Retirement Longitudinal Study (CHARLS) 2015 were analyzed, encompassing a sample of 5,735 male participants aged 45 and older. Eight obesity-related indices—namely Body mass index (BMI), Waist-height ratio (WHtR), Triglyceride-glucose.BMI (TyG.BMI), TyG. Waist circumference (TyG.WC), TyG.WHtR, CVAI, Visceral adiposity index (VAI), and A body shape index (ABSI)—were examined. Logistic regression models, adjusted for potential confounders, were utilized to evaluate the associations between these indices and LUTS or BPH. The predictive capabilities of these indices were further assessed using receiver operating curves (ROC). Results Among the participants, 718 (12.5%) were diagnosed with LUTS/BPH. All obesity-related indices were significantly higher in the LUTS/BPH group compared to the healthy group. CVAI demonstrated the highest predictive ability for LUTS/BPH, with an area under the curve (AUC) of 0.58. The study highlighted a nonlinear relationship between LUTS/BPH and several obesity-related indices, including CVAI. Conclusions This study underscores the significant association between visceral fat, as measured by CVAI, and the risk of LUTS/BPH in Chinese men. CVAI emerged as the most effective predictor among the indices evaluated, suggesting its potential utility in identifying individuals at risk for LUTS/BPH. Further prospective studies are needed to confirm these findings and elucidate the underlying mechanisms.

Metabolic syndrome (MetS), is a non-communicable disorder caused by impaired management and storage of energy, primarily associated with unhealthy diets, sedentary lifestyles and stress. It is diagnosed when any three of the following conditions are observed, obesity (primary factor), hyperglycemia, low HDL, hypertriglyceridemia, and hypertension (ATP III guidelines). MetS affects approximately 14-34 % of the global population, highlighting significant public health concern. If left untreated, it leads to the development of other serious metabolic diseases like atherosclerosis, diabetes, PCOS, NAFLD, NASH, thyroid, cancer, sleep disturbance, osteoarthritis, anxiety, and depression. Despite ongoing research, no first-line drug currently exists for the comprehensive management of MetS. Its multifactorial nature often requires lifelong polytherapy with lifestyle intervention, raising concern over chronic drug use, drug-drug interactions, increasing morbidity and mortality. Therefore, there is a need highlighting the requirement of a single and targeted pharmacotherapy which offers a safer and more specific therapeutic approach. This review aims to identify and analyse ten key molecular targets in managing the pathogenesis of Metabolic Syndrome (MetS). These targets can further pave the way for a targeted and safer approach in the treatment of MetS. See also the graphical abstract(Fig. 1).