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. 2025 Apr 10;25(1):238.
doi: 10.1186/s12876-025-03833-y.

Metabolic score for visceral fat is correlated with all-cause and cardiovascular mortality among individuals with non-alcoholic fatty liver disease

Chunming Xie #  1 , Xianpei Chen #  2 , Jiakun Zhang  1 , Xueqing Jiang  2 , Jing Xu  3 , Hao Lin  4
Affiliations

Metabolic score for visceral fat is correlated with all-cause and cardiovascular mortality among individuals with non-alcoholic fatty liver disease

Chunming Xie et al. BMC Gastroenterol. .

Abstract

Background: Metabolic score for visceral fat (METS-VF) as an effective marker of visceral obesity has been correlated with non-alcoholic fatty liver disease (NAFLD). This study aims to explore the correlation between METS-VF and both all-cause mortality and cardiovascular disease (CVD)-related mortality among individuals with NAFLD.

Methods: A cohort of 6,759 subjects diagnosed with NAFLD was selected from the NHANES during the period from 1999 to 2018. Within this cohort, the prognostic utility of METS-VF for predicting CVD-related and all-cause mortality was assessed.

Results: There was a total of 1254 all-cause deaths (18.6%) and 418 CVD-related deaths (6.2%) at a median follow-up for 9.3 years. Multivariate Cox regression analysis and restricted cubic splines analysis indicated that METS-VF can exhibit a positive non-linearly correlation with CVD mortality (HR: 4.15, 95% CI: 2.31-7.44, p < 0.001) and all-cause mortality (HR: 5.27, 95% CI: 3.75-7.42, p < 0.001), with an identified inflection point at 7.436. Subgroup analyses further revealed a stronger correlation between METS-VF and all-cause mortality among subjects without diabetes. Furthermore, the areas under the curve (AUC) for 1-, 3-, 5-, and 10-year survival rates were 0.756, 0.740, 0.747 and 0.746 for all-cause mortality, and 0.774, 0.751, 0.746 and 0.758 for CVD mortality, respectively, which performs better than the other obesity and IR related index.

Conclusion: Elevated METS-VF independently contributes to an increased risk of both all-cause and CVD mortality in individuals with NAFLD.

Clinical trial number: Not applicable.

Keywords: Insulin resistance; METS-VF; NAFLD; Obesity; Visceral obesity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The National Center for Health Statistics Ethics Review Board has approved the implementation of NHANES, and every participant signed informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the sample selection from the 1999–2018 NHANES
Fig. 2
Fig. 2
Kaplan–Meier curves depicting survival rate and the number (%) of a NAFLD population stratified by METS-VF groups. A. All-cause mortality. B. CVD mortality
Fig. 3
Fig. 3
Dose-response curve of METS-VF and all-cause mortality (A) and CVD mortality (B) using restricted cubic splines
Fig. 4
Fig. 4
Exploratory stratified analysis of the associations between METS-VF and All-cause(A) or CVD mortality(B)
Fig. 5
Fig. 5
Time-dependent ROC curves and time-dependent AUC values of the METS-VF for predicting all-cause mortality (A, B) and CVD mortality (C, D)
See this image and copyright information in PMC

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