Metabolic Score for Visceral Fat (METS-VF), a novel estimator of intra-abdominal fat content and cardio-metabolic health

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2020-05, Vol.39 (5), p.1613-1621
• Main Authors: Bello-Chavolla, Omar Yaxmehen, Antonio-Villa, Neftali Eduardo, Vargas-Vázquez, Arsenio, Viveros-Ruiz, Tannia Leticia, Almeda-Valdes, Paloma, Gomez-Velasco, Donaji, Mehta, Roopa, Elias-López, Daniel, Cruz-Bautista, Ivette, Roldán-Valadez, Ernesto, Martagón, Alexandro J., Aguilar-Salinas, Carlos A.
• Format: Article
• Language: English
• Subjects: Cardiometabolic risk; DXA; Intra-abdominal fat; METS-VF; MRI; Visceral adiposity
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2019.07.012

Intra-abdominal and visceral fat (VAT) are risk factors for the development of cardio-metabolic comorbidities; however its clinical assessment is limited by technology and required expertise for its assessment. We aimed to develop a novel score (METS-VF) to estimate VAT by combining the non-insulin-based METS-IR index, waist-height ratio (WHtr), age and sex. We developed METS-VF in a sample of 366 individuals with Dual X-ray absorptiometry (DXA). METS-VF was modeled using non-linear regression and validated in two replication cohorts with DXA (n = 184, with n = 118 who also had MRI) and bio-electrical impedance (n = 991). We also assessed METS-VF to predict incident type 2 diabetes (T2D) and arterial hypertension independent of body-mass index (BMI) in our Metabolic Syndrome Cohort (n = 6144). We defined METS-VF as: 4.466 + 0.011*(Ln(METS-IR))3 + 3.239*(Ln(WHtr))3 + 0.319*(Sex) + 0.594*(Ln(Age)). METS-VF showed better performance compared to other VAT surrogates using either DXA (AUC 0.896 95% CI 0.847–0.945) or MRI (AUC 0.842 95% CI 0.771–0.913) as gold standards. We identified a METS-VF cut-off point >7.18 in healthy patients which has 100% sensitivity (95% CI 76.8–100) and 87.2% specificity (95% CI 79.1–93.0) to identify increased VAT (>100 cm2). METS-VF also had adequate performance in subjects with metabolically-healthy obesity. Finally, in our metabolic syndrome cohort, subjects in the upper quintiles of METS-VF (>7.2) had 3.8 and 2.0-fold higher risk of incident T2D and hypertension, respectively (p