Precision Screening for MetS: The Role of Derived Lipid Indicators in Chinese Populations

BackgroundTraditional obesity assessment using body mass index (BMI) fails to adequately capture fat distribution, particularly central obesity, which is closely linked to metabolic dysfunction and obesity-related complications. Alternative obesity indices that better reflecting fat distribution and body composition have shown promise, yet large-scale population-based data remain limited. This study evaluates the ranges, temporal trends, and associated factors of novel obesity indexes in a nationally representative cohort of middle-aged and older Chinese adults.MethodsUsing data from the China Health and Retirement Longitudinal Study (CHARLS), we analyzed 17,708 adults in 2011 and followed 5,078 participants over 5 years nationally. Six obesity indexes: waist-to-height ratio (WHtR), lipid accumulation product (LAP), visceral adiposity index (VAI), body shape index (ABSI), Chinese visceral adiposity index (CVAI), and weight-adjusted waist index (WWI), were evaluated for ranges, temporal trends, and associated factors using logistic regression and generalized estimating equations (GEE). Associated factors included demographic, socioeconomic, lifestyle, and medical variables.ResultsThe national ranges were as follows: VAI (−1.805 to 6.615), ABSI (0.071 to 0.095), WHtR (0.462 to 0.622), CVAI (48.993 to 147.057), WWI (10.264 to 12.144), and LAP (−3.158 to 80.818). Significant associated factors were grouped into demographic (age, sex, urban/rural residence), medical (diabetes, and hypertension), and lifestyle factors (smoking, and drinking), with varying impacts across indexes. Over the five-year period, WHtR, CVAI, and LAP increased significantly (β = 0.00489, β = 4.51607, β = 6.37441; all p < 0.001), while ABSI decreased (β = −0.00048, p < 0.001). Interaction effects showed that diabetic participants experienced reductions in VAI, WHtR, CVAI, and LAP, indication a time-dependent change. In contrast, chronic kidney disease (CKD) and hypertension had stable effects on obesity indices, with no significant changes over time.ConclusionThis study provides nationally representative baseline ranges, temporal changes and influencing factors of novel obesity indexes among middle-aged and older Chinese adults. These findings underscore the potential of these obesity indices to guide clinical interventions aimed at controlling and preventing obesity-related health issues.

Introduction: Obesity has been established as a significant risk factor for rapid kidney function decline (RKFD) and chronic kidney disease (CKD). However, the comparative prognostic value of various obesity-related indices in predicting RKFD and CKD remains inadequately elucidated. The objective of this study was to explore the correlations between ten obesity-related indices: body mass index (BMI), Chinese visceral adiposity index (CVAI), waist-to-height ratio, visceral adiposity index (VAI), body roundness index (BRI), a body shape index (ABSI), lipid accumulation product (LAP), waist triglyceride index (WTI), relative fat mass (RFM), and conicity index (C-index) and RKFD and CKD. Methods: This retrospective longitudinal cohort study leveraged data sourced from the China Health and Retirement Longitudinal Study (CHARLS). Multivariate logistic regression models with covariate adjustment were employed to assess independent associations between obesity-related indices and clinical outcomes. Restricted cubic spline (RCS) regression analyses were performed to characterize potential nonlinear relationships. Predictive performance was quantified through receiver operating characteristic (ROC) curve analysis, with area under the curve (AUC) comparisons. Results: A total of 1,620 participants were enrolled in this study. Among them, 109 participants developed RKFD, and 60 progressed to CKD. Adjusted logistic regression revealed significant positive associations between CVAI, VAI, LAP, WTI, and RKFD risk, while BRI and C-index demonstrated per standard deviation increases associated with CKD progression. RCS curve analysis demonstrated that CVAI and LAP exhibited a nonlinear relationship with the risk of RKFD, while VAI and WTI had a linear relationship. Moreover, the C-index had a nonlinear relationship with the risk of CKD, whereas BRI had a linear relationship. ROC analysis revealed WTI as the superior RKFD predictor and ABSI as the optimal CKD progression indicator among the evaluated obesity-related indices. Conclusion: This study comprehensively investigated the associations between ten obesity-related indices and both RKFD and CKD. Our findings indicated that CVAI, VAI, LAP, and WTI were associated with RKFD, with WTI exhibiting the highest predictive value. Furthermore, BRI and C-index were associated with CKD, with ABSI demonstrating the highest predictive value for the progression to CKD.

The aim of this study was to investigate the efficacy of 13 obesity- and lipid-related indices in screening and predicting activities of daily living (ADL) disability, as well as to determine the optimal cutoffs for these indices in the middle-aged and elderly population in China. This study was based on cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS), which included 4,784 participants aged 45 years and older. Thirteen obesity- and lipid-related indices, including body mass index (BMI), waist circumference (WC), the waist-height ratio (WHtR), the visceral adiposity index (VAI), the body shape index (ABSI), the body roundness index (BRI), the lipid accumulation product (LAP), the conicity index (CI), the Chinese visceral adiposity index (CVAI), the triglyceride-glucose (TyG) index and its correlation index (TyG-BMI, TyG-WC, TyG-WHtR), were analyzed. Unadjusted and adjusted correlations between these indices and ADL disability were assessed via logistic regression analyses, and the area under the curve (AUC) of each index as a predictor of ADL ability was calculated via receiver operating characteristic (ROC) curves to compare the predictive efficacy and determine the optimal cutoff value. After adjustment for confounders, all 13 obesity- and lipid-related indices were independently associated with the risk of ADL disability (p < 0.05). All 13 indices had predictive value for ADL disability according to the ROC analysis (all AUCs > 0.7). The LAP index exhibited the highest predictive efficacy in men (AUC = 0.793, 95% CI: 0.704-0.882, and optimal cutoff = 35.669), and BMI was optimal in women (AUC = 0.721, 95% CI: 0.678-0.765, and optimal cutoff = 26.142). The TyG-BMI performed well in both sexes (men AUC = 0.790, female AUC = 0.720). The risk of ADL disability increased significantly with each unit increase in obesity and lipid indices. All 13 obesity- and lipid-related indices were effective predictors of ADL disability risk in Chinese middle-aged and older adults. LAP and BMI emerged as the best predictors of ADL disability in men and women, respectively. These indices can serve as simple screening tools to identify the risk of ADL disability and facilitate early intervention.

Introduction: Previous studies have reported a significant relationship between the baseline Chinese visceral adipose index (CVAI) and the risk of new-onset hypertension (NOH). However, the long-term effect of the CVAI and the risk of NOH remains uncertain. This study aimed to investigate the association between the cumulative CVAI and the risk of NOH. Methods: Data were obtained from the China Health and Retirement Longitudinal Study from 2011 to 2020. In total, 2,836 Chinese participants ≥45 years were included. Multivariable logistic regression analysis as well as restricted cubic spline regression analysis were performed to assess the association of the cumulative CVAI, visceral adiposity index (VAI), and lipid accumulation product (LAP) with the risk of NOH. Furthermore, receiver operating characteristic (ROC) curve analysis was used to determine the area under the ROC curves between the risk of NOH and the adiposity indices to compare the predictive powers of the cumulative CVAI, VAI, and LAP for NOH. Results: During the 5-year follow-up period, 433 cases of NOH were recorded. The cumulative CVAI, VAI, and LAP were positively associated with the risk of NOH. After adjusting for potential confounders, as compared to the lowest quartile of the cumulative CVAI, VAI, and LAP, the participants in the highest quartile had a significantly higher risk for NOH (odds ratio = 1.74, 1.46, and 1.95; 95% confidence interval = 1.25–2.42, 1.05–2.03, and 1.39–2.75, respectively). ROC analysis revealed that the cumulative CVAI had the highest relationship with the risk of NOH. Conclusion: The cumulative CVAI was positively associated with an increased risk of NOH in middle-aged and elderly Chinese populations. In addition, the performance of the cumulative CVAI to predict NOH was superior to other visceral obesity indices. Monitoring long-term changes to the CVAI may assist with early identification of individuals at high risk of NOH.

Although obesity is a known risk for hyperuricemia (HUA), the associations between adiposity indices and incident HUA and whether sex-specific differences exist is still unknown. We aimed to investigate theassociations between adiposity indices and incident HUA in a longitudinal study. Data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011-2012 and 2015-2016 were used to conduct a cohort study. Participants aged ≥45 years without HUA at baseline were included in this study. Adiposity indices, including body mass index (BMI), waist circumference (WC), waist-to-height ratio body roundness index (BRI), conicity index (CI), lipid accumulation product (LAP) index, waist-to-height ratio (WHtR), visceral adiposity index (VAI), and Chinese visceral adiposity index (CVAI), were calculated. Logistic analysis was used to analyze the association between adiposity indices and incident HUA risk stratified by gender. Receiver operating characteristic curve analysis was performed to evaluate the power of predictions for incident HUA. Of 5,873 participants aged 59.0 ± 8.7 years enrolled in this study, 578 (9.8%) participants developed HUA during the 4-year follow-up period. After adjusting for confounding variables, LAP, VAI, and CVAI showed significant association with incident HUA. BMI, WC, WHtR, BRI, and CI were significantly associated with incident HUA in women but not in men. LAP had the highest area under the curve (AUC) (0.612) followed by CVAI (0.596) in men, while CVAI had the highest AUC (0.707) followed by LAP (0.691) in women. All indices showed better predictive ability in women than in men. Our findings indicated that adiposity indices were effective predictors of incident HUA and showed better predictive power in women than men. In clinical practice, adiposity indices could be used to assess and prevent incident HUA among Chinese middle-aged and older adults.

To predict the optimal cut-off values for screening and predicting metabolic syndrome(MetS) in a middle-aged and elderly Chinese population using 13 obesity and lipid-related indicators, and to identify the most suitable predictors. The data for this cross-sectional investigation came from the China Health and Retirement Longitudinal Study (CHARLS), including 9457 middle-aged and elderly people aged 45-98 years old. We examined 13 indicators, including waist circumference (WC), body mass index (BMI), waist-height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product index (LAP), conicity index (CI), Chinese visceral adiposity index (CVAI), triglyceride-glucose index (TyG-index) and their combined indices (TyG-BMI, TyG-WC, TyG-WHtR). The receiver operating characteristic curve (ROC) was used to determine the usefulness of indicators for screening for MetS in the elderly and to determine their cut-off values, sensitivity, specificity, and area under the curve (AUC). Association analysis of 13 obesity-related indicators with MetS was performed using binary logistic regression analysis. A total of 9457 middle-aged and elderly Chinese were included in this study, and the overall prevalence of the study population was 41.87% according to the diagnostic criteria of NCEP ATP III. According to age and gender, the percentage of males diagnosed with MetS was 30.67% (45-54 years old: 30.95%, 55-64 years old: 41.02%, 65-74 years old: 21.19%, ≥ 75 years old: 6.84%). The percentage of females diagnosed with MetS was 51.38% (45-54 years old: 31.95%, 55-64 years old: 39.52%, 65-74 years old: 20.43%, ≥ 75 years old: 8.10%). The predictive power of Tyg-related parameters was more prominent in both sexes. In addition, LAP and CVAI are also good at predicting MetS. ABSI had a poor prediction ability. Among the middle-aged and elderly population in China, after adjusting for confounding factors, all the indicators except ABSI had good predictive power. The predictive power of Tyg-related parameters was more prominent in both sexes. In addition, LAP and CVAI are also good at predicting MetS.

BackgroundVisceral 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.ObjectiveThis study aimed to investigate the longitudinal associations of LAP, VAI, and CVAI with incident DR in Chinese patients with diabetes.MethodsThis 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.ResultsThe 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).ConclusionsVisceral 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.

BackgroundEstimate glucose disposal rate (eGDR), Chinese visceral adiposity index (CVAI), triglyceride-glucose (TyG), TyG-body mass index (TyG-BMI), metabolic score for insulin resistance (METS-IR), and atherogenic index of plasma (AIP) are considered surrogate indexes of insulin resistance (IR). There is a lack of studies comparing the predictive values of different IR surrogate indexes for stroke risk among individuals with abnormal glucose metabolism. This study aimed to investigate the relationships between six IR surrogate indexes and stroke risk in individuals with abnormal glucose metabolism, evaluate their predictive abilities for stroke risk.MethodsData from the China Health and Retirement Longitudinal Study (CHARLS) were analysed in this study. Multivariate logistic regression models were applied to analyse the relationships of IR surrogate indexes with stroke risk. The dose-response relationships between IR surrogate indexes and stroke risk were explored using restricted cubic splines. The areas under the curve (AUCs) of IR surrogate indexes were calculated by receiver operating characteristic (ROC) analysis.ResultsAfter adjusting for potential confounders, we observed that each standard deviation (SD) increase in eGDR was associated with a reduced risk of stroke, with an adjusted odds ratio (OR) of 0.746 [95% confidence interval (CI): 0.661–0.842]. In contrast, each SD increase in CVAI, TyG, TyG-BMI, METS-IR, and AIP were associated with an increased risk of stroke, with adjusted ORs (95% CIs) of 1.232 (1.106–1.373), 1.246 (1.050–1.479), 1.186 (1.022–1.376), 1.222 (1.069–1.396), and 1.193 (1.050–1.355), respectively. Dose-response analyses showed that eGDR, CVAI, TyG-BMI and METS-IR were linearly associated with stroke risk (Pnonlinear ≥ 0.05), whereas TyG and AIP were nonlinearly associated with stroke risk (Pnonlinear < 0.05). According to ROC analysis, The AUC of eGDR for predicting stroke risk in the overall population with abnormal glucose metabolism (AUC: 0.612, 95% CI: 0.584–0.640) was significantly higher than that of other indexes.ConclusionThe six IR surrogate indexes were closely associated with high risk of stroke in individuals with abnormal glucose metabolism. The eGDR showed promising potential in predicting stroke risk in Chinese middle-aged and elderly populations with abnormal glucose metabolism.

Objective: This cohort study was designed to investigate the associations between Chinese visceral adiposity index (CVAI) and Cardiometabolic multimorbidity (CMM) among middle-aged and elderly Chinese population. Design and method: A national cohort study that consisted of 6419 participants was conducted during a median follow-up time of 4 years. Three obesity- and lipid-related indices, including visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP) were recorded. Our study used multivariate adjusted Cox proportional hazard models, sensitivity analysis and restricted cubic spline analysis to investigate the associations of the Chinese visceral adiposity index with Cardiometabolic multimorbidity. Results were reported in log-relative hazard ratios and associated 95% CIs. Results: Of the 6686 participants included in the analysis, 6419 participants did not develop CMM and incident CMM occurred in 267 participants during the study period. Using multivariable-adjusted restricted cubic spline analyses, it was found that there was a significant nonlinear relationship between the levels of CVAI and the incidence of cardiometabolic multimorbidity (P&lt;0.0001). The risk of CMM gradually increased when the CVAI increased, and rapid upward after exceeding 91.2. After adjustment of multiple covariates, a U-shaped association between CVAI and CMM was evident in all participants. The HR of CVAI gradually increases and is positively correlated with the increase of CVAI. Conclusions: The CVAI are independent predictors of CMM in the middle-aged and elderly Chinese population. Higher CVAI is positively associated with CMM risk.

PurposeWe aimed to evaluate the performance of Chinese visceral adiposity index (CVAI), visceral adiposity index (VAI), lipid accumulation product (LAP), triglyceride glucose (TyG) as indices in screening abnormal glucose tolerance (AGT) in Chinese women with polycystic ovary syndrome (PCOS), using the oral glucose tolerance test (OGTT) as a reference test. In addition, we essentially compared the abilities of these indices with body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG).Materials and methodsAll 1113 PCOS patients evaluated in this study underwent OGTTs. The 2-h post-oral glucose load (2 h-PG) level was used to categorize subjects into two groups: those having AGT or normal glucose tolerance (NGT) levels.ResultsA statistically significant positive correlation between levels of 2 h-PG and FPG, BMI, WC, LAP, VAI, CVAI, TyG, (P < 0.05), was observed. The strongest correlation was found between the levels of 2 h-PG and CVAI (r = 0.47). The CVAI provided the highest area under the receiver-operating characteristic curve (AUC) for AGT, followed by LAP, BMI, TyG, VAI, WC, and FPG. The CVAI of 32.61 (with AUC: 0.76, sensitivity: 73%, specificity: 70%, positive preductive value (PPV): 0.41, negative predictive value (NPV): 0.90) was found to be the cut-off point for AGT in Chinese women with PCOS.ConclusionsCVAI may not reliably detect AGT in Chinese women with PCOS. However, it is suitable as a first screening indicator to guide physicians to ordering OGTT.

Cardiometabolic multimorbidity (CMM) has emerged as a prominent public health concern. Hypertensive patients are prone to develop comorbidities. Moreover, the accumulation of visceral adipose tissue is the main cause for the development of cardiometabolic diseases. The cardiometabolic index (CMI), lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese visceral adiposity index (CVAI) not only assess adipose tissue mass but also reflect adipose tissue dysfunction. So far, no study has been reported to evaluate the association of CMI, LAP, VAI, and CVAI with CMM risk in hypertensive patients. Therefore, this study aimed to assess the association between these adiposity indicators and the risk of CMM among Chinese hypertensive patients. In this cross-sectional study, a total of 229,287 hypertensive patients aged 35 years and older were included from the National Basic Public Health Service Project. All participants underwent a face-to-face questionnaire survey, physical examination, and the collection of fasting venous blood samples. Multivariable logistic regression models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Receiver operating characteristic curve was utilized to evaluate the identification ability for CMM. After adjusting for confounders, each 1-standard deviation increase in CMI, LAP, VAI, and CVAI was associated with a 14%, 8%, 12%, and 54% increased risk of CMM, respectively. When comparing the highest quartile of these indicators with the lowest quartile, individuals in the highest quartile of CMM, LAP, VAI, and CVAI had a 1.39-fold (95% CI 1.30, 1.48), 1.28-fold (95% CI 1.19, 1.37), 1.37-fold (95% CI 1.29, 1.46), and 2.56-fold (95% CI 2.34, 2.79) increased risk of CMM after adjusting for potential confounders. Notably, a nonlinear association was observed for CMI, LAP, and VAI with the risk of CMM (all P nonlinearity < 0.001). CVAI exhibited the highest area under the receiver operating characteristic curve (AUC) among all the included adiposity indices in this analysis. This study indicated the significant positive association of CMI, LAP, VAI, and CVAI with the risk of CMM in hypertensive patients. Among these indicators, CVAI demonstrated the most robust performance in predicting CMM risk and may serve as a valuable tool for identifying CMM risk in Chinese hypertensive patients.

Predicting post-stroke depression in middle-aged and older adults in china using obesity-related index: A cohort study.

There is insufficient attention to hypogonadism in Chinese males with type 2 diabetes mellitus (T2DM). We evaluated the relationship between Combined obesity- and lipid-related indices [Visceral Adiposity Index (VAI), Chinese Visceral Adiposity Index (CVAI), Triglyceride Glucose Index (TyG) and Lipid Accumulation Product (LAP)] with total testosterone (TT) and analyzed the predictive capability of the respective cut-off values. We recruited 958 hospitalized male patients with T2DM at the Affiliated Hospital of Qingdao University, collected baseline data and four calculated indices, and obtained their dominance ratio (OR) and corresponding 95% confidence intervals (CI) with TT by multivariate logistic regression. Receiver operating characteristic (ROC) curves were then used to determine cutoff values in predicting hypogonadism (TT< 12 nmol/L), and we also analyzed the combinations between the different indices. VAI, CVAI, TyG, and LAP all have satisfactory predictive capabilities. The test capability (sensitivity and specificity) of all four indices was better or not worse than that of body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR) and waist circumference (WC). All four indices were effective predictors of hypogonadism at their respective cutoff values (VAI ≥ 2.284, CVAI ≥ 145.779, TyG ≥ 4.308, and LAP ≥ 59.850). Of these, LAP had the largest area under the curve (AUC, AUC = 0.852, Std. Error = 0.014, 95% CI = 0.818-0.873). However, the predictive capability of the combined indices was not significantly improved over the individual indices. VAI, CVAI, TyG, and LAP are sensitive indices for predicting hypogonadism in Chinese male patients with T2DM. Considering the need for concise and accurate indices in clinical practice, we suggest LAP as a commonly used index.

BackgroundGiven the established link between obesity and hyperuricemia (HUA), the research want to investigate the relationship between different obesity indices and HUA, and further analyze which obesity index can better predict HUA.MethodsThe data were obtained from a longitudinal study involving middle-aged and elderly populations in Dalian, China. The research encompassed individuals who exhibited typical uric acid levels initially and tracked their progress over a three-year period. 8 obesity indices were evaluated retrospectively. Subgroup analyses were conducted to identify susceptible populations. Restricted cubic splines (RCS) were utilized to model the dose-response relationships between obesity indices and HUA. Receiver operating characteristic (ROC) curves were applied to visualize and compare the predictive value of both traditional and new obesity indices for HUA.ResultsAmong 4,112 individuals with normal baseline uric acid levels, 950 developed HUA. Significant associations with HUA were observed for body mass index (BMI), waist circumference (WC), body roundness index (BRI), cardiometabolic index (CMI), visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), and abdominal volume index (AVI). Subgroup analysis indicated that all obesity indices proved more effective in assessing the onset of HUA in women without Metabolic Syndrome (MetS). Further analysis using RCS revealed non-linear dose-response relationships between LAP, CMI, VAI, and HUA in males, with similar non-linear relationships observed for all indices in females. The results from the ROC curves indicate that LAP may serve as a better predictor of HUA in males, and CVAI may serve as a better predictor in females.ConclusionHUA is closely associated with obesity indices. Among females, CVAI emerges as the preferred predictive index for HUA. In males, LAP emerges as the preferred predictive index for HUA.

BackgroundNormal-weight maintenance hemodialysis (MHD) patients with abdominal obesity exhibited a more proatherogenic profile than overweight and obesity patients with abdominal obesity, highlighting the importance of early identification of metabolically unhealthy nonobese (MUNO) in this population. Visceral fat accumulation plays a crucial role in the development of MUNO. Lipid accumulation product (LAP), visceral adiposity index (VAI) have been proved as reliable visceral obesity markers. The Chinese visceral adiposity index (CVAI) and a body shape index (ABSI) are newly discovered indexes of visceral obesity and have been reported to be associated with multiple metabolic disorders. There are limited studies investigating the associations between different visceral obesity indices and risk of MUNO, especially in hemodialysis patients. Moreover, no general agreement has been reached to date regarding which of these obesity indices performs best in identifying MUNO. We aimed to investigate the prevalence of MUNO in MHD patients and compare the associations between different adiposity indices (CVAI, ABSI,VAI, LAP, body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHtR)) with MUNO risk in this population.MethodsWe conducted a multi-center cross-sectional study in Guizhou Province, Southwest China. 1302 nonobese adult MHD patients were included in our study. MUNO was defined as being nonobese and having the presence of > = 2 components of metabolic syndrome (MetS). Nonobese was defined as BMI less than 25 kg/m2. VAI, LAP, CVAI, ABSI, BMI, WC and WHtR were calculated. Logistic regression analyses and receiver operator curve (ROC) analyses were performed.Results65.6% participants were metabolically unhealthy. The ROC curve analysis demonstrated that of the seven obesity indices tested, the VAI (AUC 0.84 for women and 0.79 for men) followed by LAP (AUC 0.78 for women and 0.72 for men) had the highest diagnostic accuracy for MUNO phenotype while ABSI exhibited the lowest AUC value for identifying MUNO phenotypeConclusionsMetabolically unhealthy is highly prevalent in nonobese MHD patients. VAI and LAP outperformed CVAI in discriminating MUNO in MHD patients. Though ABSI could be a weak predictor of MUNO, it is not better than WHtR, WC and BMI.