Chinese Visceral Adipose Index Shows Superior Diagnostic Performance in Predicting the Risk of Metabolic Dysfunction Associated Fatty Liver Disease in Early Postmenopausal Chinese Women

Figures & data

Table 1 Baseline Characteristics of the Study Population

Parameters	Lean Subjects (BMI<23.0 kg/m^2)			Overweight/Obese Subjects (BMI≥23.0 kg/m^2)
	MAFLD (+) (n=51)	MAFLD (-) (n=1143)	P-value	MAFLD (+) (n=407)	MAFLD (-) (n=913)	P-value
Age (years)	52.10±2.25	51.43±2.40	0.052	51.07±2.18	51.26±2.45	0.183
BMI (kg/m^2)	22.01±0.86	21.09±1.36	<0.001	26.79±2.69	25.35±1.94	<0.001
WC (cm)	75.51±4.26	71.63±4.80	<0.001	84.17±6.96	79.76±5.55	<0.001
WHR	0.85 [0.83,0.88]	0.80 [0.78,0.84]	<0.001	0.87 [0.85,0.90]	0.84 [0.81,0.87]	<0.001
WHtR	0.47 [0.45,0.50]	0.45 [0.43,0.47]	<0.001	0.52 [0.50,0.55]	0.50 [0.48,0.52]	<0.001
BAI	26.36 [25.24,27.68]	26.01 [24.60,27.39]	0.101	29.71 [27.91,31.77]	29.02 [27.58,30.86]	<0.001
CVAI	79.72 [71.24,88.51]	53.33 [40.58,66.12]	<0.001	97.95 [82.10,114.23]	83.03 [71.31,95.08]	<0.001
FBG (mmol/L)	5.84 [5.40,7.09]	5.09 [4.84,5.37]	<0.001	5.38 [4.99,5.98]	5.24 [4.98,5.58]	<0.001
Diabetes (n, %)	16 (31.4)	28 (2.4)	<0.001	68 (16.7)	33 (3.6)	<0.001
SBP (mmHg)	122.82±14.01	113.15±14.63	<0.001	124.06±15.96	118.93±15.27	<0.001
DBP (mmHg)	74.96±9.24	69.24±9.65	<0.001	76.30±10.44	73.21±10.21	<0.001
Hypertension (n, %)	7 (13.7)	53 (4.6)	0.011	62 (15.2)	83 (9.1)	0.002
TG (mmol/L)	2.13 [1.52,2.99]	1.03 [0.77,1.50]	<0.001	1.58 [1.12,2.08]	1.22 [0.86,1.72]	<0.001
TC (mmol/L)	5.47 [4.60,5.85]	5.25 [4.67,5.79]	0.596	5.03 [4.43,5.76]	5.13 [4.56,5.71]	0.384
LDL-C (mmol/L)	3.41 [2.89,3.93]	3.32 [2.79,3.84]	0.594	3.04 [2.54,3.61]	3.29 [2.77,3.86]	<0.001
HDL-C (mmol/L)	1.15 [1.04,1.37]	1.56 [1.31,1.84]	<0.001	1.33 [1.11,1.64]	1.41 [1.21,1.66]	<0.001
AST (IU/L)	18.00 [16.00,21.00]	18.00 [15.00,21.00]	0.262	19.00 [18.00,21.00]	18.75 [16.00,21.00]	<0.001
ALT (IU/L)	22.00 [15.00,33.00]	16.00 [12.00,23.00]	<0.001	34.00 [26.00,40.00]	20.00 [14.00,31.00]	<0.001
UA (μmol/L)	329.79±88.72	285.81±61.05	<0.001	337.27±91.46	315.48±68.56	<0.001
WBC (×10^9/L)	5.80 [5.02,6.59]	5.08 [4.37,5.90]	<0.001	6.00 [5.10,6.82]	5.39 [4.65,6.27]	<0.001
NE(×10^9/L)	2.95 [2.44,3.53]	2.69 [2.17,3.30]	0.012	3.27 [2.78,3.80]	2.84 [2.38,3.49]	<0.001

Notes: Continuous data are expressed as mean ± standard deviation or median (interquartile range) according to normal distribution test of data, and categorical data are described as numbers (percentages). P-values were determined using the Chi-square test, independent t-test, or the Mann–Whitney U-test.

Abbreviations: MAFLD, metabolic dysfunction-associated fatty liver disease; BMI, body mass index; WC, waist circumference; WHR, waist-hip ratio; WHtR, waist-height ratio; BAI, body adiposity index; CVAI, Chinese visceral adipose index; FBG, fasting blood glucose; SBP, systolic blood pressure; DBP, diastolic blood pressure; TG, triglyceride; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; AST, aspartate aminotransferase; ALT, alanine aminotransferase; UA, uric acid; WBC, white blood cell; NE, neutrophil.

Table 2 Association Between Six Obesity Indices and Risk of MAFLD in the Lean and Obese Subjects

Obesity Indices (Per SD Increase)	Lean Subjects		Overweight/Obese Subjects
	Univariable	Multivariable	Univariable	Multivariable
BMI	2.80 (1.81–4.33)	2.38 (1.40–4.05) ***	1.86 (1.65–2.11)	1.65 (1.44–1.89) ***
WC	2.24 (1.68–3.00)	1.92 (1.32–2.78) ***	2.08 (1.82–2.37)	1.85 (1.61–2.14) ***
WHR	2.72 (2.01–3.67)	2.37 (1.61–3.50) *	2.30 (2.00–2.64)	2.09 (1.80–2.43) **
WHtR	2.59 (1.94–3.46)	2.24 (1.56–3.23) ***	2.00 (1.75–2.28)	1.75 (1.52–2.01) ***
BAI	1.30 (0.98–1.73)	1.27 (0.91–1.77)	1.33 (1.17–1.51)	1.20 (1.04–1.38) *
CVAI	4.98 (3.43–7.22)	5.73 (2.84–11.54) ***	2.21 (1.93–2.54)	2.26 (1.90–2.70) ***

Notes: Adjusted for diabetes, hypertension, LDLC, HDLC, TG, AST, ALT WBC, NE, and UA. ***P<0.001; **P<0.01; *P<0.05.

Figure 1 Dose-response relationship between obesity indices and the risk of MAFLD in the lean and overweight/obese group of early postmenopausal women after adjusting for parameters such as diabetes, hypertension, LDLC, HDLC, TG, AST, ALT WBC, NE, and UA. The solid line represents obesity index values when OR is equal to 1. The red line represents mean OR values. The area between the dashed lines represents the 95% confidence interval (CI) values of OR.

Table 3 Cut-off Points and AUC (95% CI) Values of Different Obesity Indices for Predicting MAFLD in Early Postmenopausal Women

	AUC (95% CI)	Sensitivity (%)	Specificity (%)	Youden Index	Cut-Off Value
BMI	0.803(0.782–0.823)	0.852	0.613	0.465	23.48
WC	0.799(0.778–0.819)	0.718	0.712	0.430	78.5
WHR	0.750(0.727–0.774)	0.666	0.691	0.357	0.845
WHtR	0.800(0.780–0.821)	0.799	0.664	0.463	0.486
BAI	0.703(0.677–0.729)	0.651	0.349	0.302	28.27
CVAI	0.820(0.801–0.839)	0.828	0.660	0.488	75.82

Figure 2 ROC curves to estimate the predictive value of obesity indices for MAFLD among lean subjects.

Figure 3 ROC curves to estimate the predictive value of the obesity indices for MAFLD in obese subjects.