Simple adiposity indices for identifying visceral adiposity and associated fatty liver and atherosclerotic plaque in a health examination cohort

Abstract Visceral adipose tissue (VAT) is strongly linked to cardiometabolic risk, yet direct measurement is not routinely feasible in health examination settings. The comparative performance of routine anthropometric indices, triglyceride-glucose (TyG)-derived metrics, and formula-based adiposity indices for identifying VAT, as well as their clinical relevance to fatty liver and atherosclerotic plaque, remains incompletely defined. We analysed 821 adults who underwent routine health examinations. Spearman correlation analysis was used to compare anthropometric, metabolic and TyG-derived variables with measured VAT. Receiver operating characteristic analysis was used to compare lipid accumulation product (LAP), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), metabolic score for insulin resistance (METS-IR) and metabolic score for visceral fat (METS-VF) for identifying high VAT. Logistic regression was used to assess fatty liver and atherosclerotic plaque. VAT was strongly associated with fatty liver than plaque, with stepwise prevalence increases across VAT quartiles. For fatty liver, LAP, METS-IR, METS-VF, BRI, and VAI showed good model discrimination; for plaque, BRI, ABSI, and METS-VF remained positive after age/sex adjustment, but discrimination was modest. TyG-WC, TyG-WWI, and WC best reflected measured VAT, while METS-VF, LAP, BRI, and METS-IR effectively identified high VAT, supporting preliminary risk stratification and targeted liver/vascular assessment.