A Comparative Evaluation of Adiposity Indices for Predicting Visceral Adipose Tissue Magnitude: Insights from NHANES 2011–2018

<b><i>Background and Aims:</i></b> Visceral adipose tissue (VAT) is a key cardiometabolic risk factor. This study evaluates the association between VAT and adiposity indices and identifies reliable predictors of increased VAT. <b><i>Methods:</i></b> This cross-sectional study utilized data from 4696 participants in the National Health and Nutrition Examination Survey 2011-2018. VAT was measured via dual-energy X-ray absorptiometry. Adiposity indices included body mass index (BMI), waist circumference (WC), lipid accumulation product, visceral adiposity index, body shape index, body roundness index, and metabolic score for visceral fat (METS-VF). Correlation analysis, receiver operating characteristic curve analysis, and multivariate adaptive regression splines (MARS) modeling evaluated the performance of indices and identified key predictors of VAT. <b><i>Results:</i></b> All adiposity indices were significantly correlated with VAT (<i>P</i> < 0.001). Among them, METS-VF demonstrated the highest predictive performance for increased VAT (>130 cm²) followed by WC. Optimal cutoff values for METS-VF were 7.1 [areas under the curve (AUC): 0.887, 95% confidence interval (CI): 0.873-0.899] in men and 7.5 (AUC: 0.904, 95% CI: 0.891-0.916) in women. For WC, the cutoff values were 99.5 cm (AUC: 0.866, 95% CI: 0.851-0.879) in men and 96 cm (AUC: 0.883, 95% CI: 0.869-0.896) in women. MARS modeling identified race, age, WC, BMI, glucose, high-density lipoprotein cholesterol, and triglycerides as significant predictors of VAT, achieving an <i>R</i>² of 75.2%. <b><i>Conclusion:</i></b> METS-VF demonstrated the highest predictive value among the indices evaluated for predicting increased VAT. It may serve as a valuable tool in assessing visceral obesity and associated cardiometabolic risks.