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. 2020 May;39(5):1613-1621.
doi: 10.1016/j.clnu.2019.07.012. Epub 2019 Jul 30.

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

Omar Yaxmehen Bello-Chavolla  1 , Neftali Eduardo Antonio-Villa  1 , Arsenio Vargas-Vázquez  1 , Tannia Leticia Viveros-Ruiz  2 , Paloma Almeda-Valdes  3 , Donaji Gomez-Velasco  2 , Roopa Mehta  3 , Daniel Elias-López  3 , Ivette Cruz-Bautista  2 , Ernesto Roldán-Valadez  4 , Alexandro J Martagón  5 , Carlos A Aguilar-Salinas  6
Affiliations

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

Omar Yaxmehen Bello-Chavolla et al. Clin Nutr. 2020 May.

Abstract

Background & aims: 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.

Methods: 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).

Results: 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 < 0.001). This effect was independent of BMI for both outcomes.

Conclusion: METS-VF is a novel surrogate to estimate VAT, which has better performance compared to other surrogate VAT indexes and is predictive of incident T2D and hypertension. METS-VF could be a useful tool to assess cardio-metabolic risk in primary care practice and research settings.

Keywords: Cardiometabolic risk; DXA; Intra-abdominal fat; METS-VF; MRI; Visceral adiposity.

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