Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Metabolic score for visceral fat is correlated with all-cause and cardiovascular mortality among individuals with non-alcoholic fatty liver disease,” published in the April 2025 issue of the BMC Gastroenterology by Xie et al.

This study investigates the prognostic significance of the metabolic score for visceral fat (METS-VF) in predicting both all-cause and cardiovascular disease-related mortality among individuals with non-alcoholic fatty liver disease (NAFLD). METS-VF, a recently developed index of visceral adiposity derived from metabolic parameters, has emerged as a reliable marker of visceral obesity, which is known to be a key contributor to NAFLD pathophysiology and related complications. Given the growing global burden of NAFLD, identifying robust and accessible predictors of long-term outcomes is critical for improving risk stratification and clinical management.

Data were derived from the National Health and Nutrition Examination Survey (NHANES), encompassing 6,759 participants diagnosed with NAFLD between 1999 and 2018. METS-VF scores were calculated at baseline, and participants were followed for a median duration of 9.3 years to assess all-cause and CVD-specific mortality. Multivariate Cox proportional hazards models were employed to evaluate the independent association between METS-VF and mortality outcomes, with adjustments for confounding variables. Restricted cubic spline analysis was used to characterize the dose-response relationship. Additionally, subgroup analyses and time-dependent receiver operating characteristic curve analyses were performed to evaluate the predictive performance of METS-VF compared with other obesity and insulin resistance-related indices.

During the follow-up period, 1,254 participants (18.6%) died from all causes, and 418 (6.2%) succumbed to CVD-related causes. Elevated METS-VF was significantly associated with increased mortality risk. Specifically, restricted cubic spline analysis revealed a non-linear positive correlation between METS-VF and mortality, with a notable inflection point at a METS-VF value of 7.436. Beyond this threshold, the hazard ratios for CVD and all-cause mortality increased markedly (HR for CVD mortality: 4.15, 95% CI: 2.31–7.44; HR for all-cause mortality: 5.27, 95% CI: 3.75–7.42; both p < 0.001). Subgroup analysis indicated a stronger association between METS-VF and all-cause mortality among individuals without diabetes. Predictive accuracy, as reflected by AUC values, remained consistently high across multiple time points, with AUCs ranging from 0.740 to 0.774, outperforming other commonly used obesity and insulin resistance metrics.

METS-VF is a robust, independent predictor of both all-cause and cardiovascular mortality in patients with NAFLD. Its non-linear relationship with mortality risk and superior predictive performance underscores its clinical utility as a screening and prognostic tool in this population, particularly in individuals without diabetes.

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03833-y