Linking metabolic score for visceral fat to heart failure: insights from national health and nutrition examination survey 2003-2018

Abstract

Background: Visceral fat has become increasingly recognized as a key modifiable risk factor in the development of heart failure (HF). This study aims to investigate the link between the Metabolic Score for Visceral Fat (METS-VF) and the prevalence of HF, and evaluate whether METS-VF could improve the detection of HF in the general population.

Methods: 24,681 subjects from the 2003-2018 National Health and Nutrition Examination Survey were included in the analysis. HF was determined according to self-reported medical history.

Results: The overall prevalence of HF was found to be 2.91%. After adjusting for relevant confounders, each one-standard-deviation increase in METS-VF was associated with a 75.4% higher risk of prevalent HF. Participants with METS-VF values in the highest quartile had a 2.731-fold greater risk of prevalent HF than those in the lowest quartile. The relationship between METS-VF and HF appeared nearly linear based on smooth-curve modeling, and subgroup analyses confirmed this association across different demographic groups. When METS-VF was added to standard cardiovascular risk factors, there was a slight improvement in HF discrimination (AUC: 0.867 vs. 0.873, P = 0.003). Reclassification metrics also highlighted the incremental value of including METS-VF.

Conclusion: The findings of this study demonstrated a strong, linear relationship between METS-VF and the prevalence of HF, suggesting that METS-VF could be an adjunctive tool for improving HF screening in the general population.

Keywords: General population; Heart failure; Insulin resistance; Metabolic score for visceral fat; NHANES; Visceral adiposity.

Fig. 1

Flow chart of the subject’s enrollment Abbreviations: National Health and Nutrition Examination Survey; METS-VF: Metabolic Score for Visceral Fat; HF: heart failure

Fig. 2

Smooth curve fitting illustrating the linear relationship between METS-VF and prevalent HF The model was adjusted for age, sex, race, current smoking, heavy alcohol consumption, PIR, BMI, WC, SBP, FPG, TC, eGFR, anti-hypertensive, anti-diabetic, and lipid-lowering therapy. The solid line represents the estimated risk of prevalent HF, while the dotted lines indicate the pointwise 95% confidence intervals. The association remained linear across the entire range of METS-VF Abbreviations: METS-VF: Metabolic Score for Visceral Fat; HF: heart failure; PIR: poverty-to-income ratio; BMI: body mass index; WC: waist circumference; SBP: systolic blood pressure; FPG: fasting plasma glucose; TC: total cholesterol; eGFR: estimated glomerular filtration rate

Fig. 3

Subgroup analysis of the correlation between METS-VF and prevalent HF The multivariate logistic model was adjusted for all variables in Model 2 of Table 2, except for the variable used to define each subgroup. The association remained consistent across subgroups of sex, age, race, PIR, obesity, hypertension, and diabetes Abbreviations: METS-VF: Metabolic Score for Visceral Fat; HF: heart failure; PIR: poverty-to-income ratio