Fang Zihan, Yuan Jun, Qiu Jieshan, Liu Qi, He Ran, Zheng Danna, Jin Juan, He Qiang
Cardiorenal Med. 2025 Jul 21:1-30. doi: 10.1159/000547533.
Background A newly recognized condition, the cardiovascular-kidney-metabolic (CKM) syndrome,integrated disease spectrum encompassing interlinked renal, cardiovascular, and metabolic dysfunction. Visceral adiposity plays a pivotal role in driving this multisystem deterioration. Although surrogate markers such as the visceral adiposity index (VAI), metabolic score for visceral fat (METS-VF), body roundness index (BRI), and weight-adjusted waist index (WWI) have been proposed to estimate visceral fat burden, their relationship with advanced CKM syndrome remains poorly defined.This study sought to thoroughly examine the links between these indices and advanced CKM risk, and to evaluate their ability to predict such risk. Methods In this study, we performed a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, which included 22,019 adults aged 20 years and older. We calculated four indices of visceral fat accumulation (VAI, METS-VF, BRI, WWI) and assessed their associations with advanced CKM syndrome through weighted multivariable logistic regression, restricted cubic spline (RCS) modeling, and receiver operating characteristic (ROC) curve analysis. Subgroup analyses were also conducted to ensure the robustness of the findings, adjusting for demographic and lifestyle factors. Results Advanced CKM syndrome was present in 17.4% of participants. All four indices were significantly associated with advanced CKM (all P < 0.05), with METS-VF showing the strongest association (OR = 1.87, 95% CI: 1.51-2.30). Both METS-VF and VAI demonstrated a non-linear increase in risk for advanced CKM, whereas BRI and WWI showed a positive linear relationship with the risk. Subgroup analyses provided additional evidence, confirming that these associations remained consistent across multiple population subgroups. In ROC analysis, METS-VF demonstrated the highest predictive accuracy (AUC = 0.79), followed by WWI (AUC = 0.73), outperforming traditional markers such as body mass index (BMI) and waist circumference (WC). Conclusions Elevated VAI, METS-VF, BRI, and WWI levels have been significantly linked to advanced CKM syndrome. METS-VF and WWI, as simple and non-invasive markers, show strong predictive capacity and may serve as effective tools for early detection and intervention in clinical settings.
背景 一种新认识的病症，即心血管-肾脏-代谢（CKM）综合征，是一种综合疾病谱，涵盖相互关联的肾脏、心血管和代谢功能障碍。内脏肥胖在推动这种多系统恶化中起关键作用。尽管已提出诸如内脏肥胖指数（VAI）、内脏脂肪代谢评分（METS-VF）、身体圆润指数（BRI）和体重调整腰围指数（WWI）等替代标志物来估计内脏脂肪负担，但它们与晚期CKM综合征的关系仍不清楚。本研究旨在全面研究这些指标与晚期CKM风险之间的联系，并评估它们预测此类风险的能力。
方法 在本研究中，我们使用1999年至2018年美国国家健康和营养检查调查（NHANES）的数据进行了横断面分析，该数据包括22,019名20岁及以上的成年人。我们计算了四个内脏脂肪堆积指标（VAI、METS-VF、BRI、WWI），并通过加权多变量逻辑回归、受限立方样条（RCS）建模和受试者工作特征（ROC）曲线分析评估了它们与晚期CKM综合征的关联。还进行了亚组分析以确保研究结果的稳健性，并对人口统计学和生活方式因素进行了调整。
结果 17.4%的参与者存在晚期CKM综合征。所有四个指标均与晚期CKM显著相关（所有P<0.05），其中METS-VF显示出最强的关联（OR = 1.87，95%CI：1.51-2.30）。METS-VF和VAI均显示晚期CKM风险呈非线性增加，而BRI和WWI与风险呈正线性关系。亚组分析提供了额外的证据，证实这些关联在多个人口亚组中保持一致。在ROC分析中，METS-VF显示出最高的预测准确性（AUC = 0.79），其次是WWI（AUC = 0.73），优于传统标志物如体重指数（BMI）和腰围（WC）。
结论 VAI、METS-VF、BRI和WWI水平升高与晚期CKM综合征显著相关。METS-VF和WWI作为简单且无创的标志物，显示出强大的预测能力，可作为临床环境中早期检测和干预的有效工具。
