Elevated Visceral Adiposity Index is Associated with Reproductive Endocrine Characteristics, and Adverse Pregnancy Outcomes in Chinese Women with Polycystic Ovary Syndrome

Objective: To evaluate the visceral adiposity index (VAI) as a metabolic and reproductive risk marker in Chinese women with polycystic ovary syndrome (PCOS). Methods: Secondary analysis of 956 women with PCOS from the PCOSAct trial. VAI was calculated from waist circumference, BMI, triglycerides, and HDL-C. Associations with anthropometric, metabolic, endocrine, and pregnancy outcomes were assessed using regression models. Predictive performance for insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) was evaluated via ROC analysis. Results: Elevated VAI was positively associated with age, BMI, blood pressure, dysglycemia, dyslipidemia, FT, hepatic enzymes, and prevalence of IR, MetS, and NAFLD (all P -trend < 0.05). VAI was negatively correlated with QUICKI, HDL, SHBG, gonadotropins and AMH (all P -trend < 0.01). In fully adjusted models, the highest VAI quartile had an increased risk of IR (OR: 4.58, 95% CI: 1.53– 6.02, P -trend = 0.002) compared to the lowest quartile. VAI predicted IR (AUC = 0.74) and NAFLD (AUC = 0.71) with moderate accuracy. Higher VAI quartiles were dose-dependently associated with reduced reproductive success ( P -trend < 0.01). Conclusion: VAI is a practical, non-invasive tool for identifying metabolic dysfunction and predicting adverse pregnancy outcomes in women with PCOS, supporting its use for risk stratification and early intervention.