Visceral adiposity index as a predictor of metabolic dysfunction-associated steatotic liver disease: a cross-sectional study

BACKGROUND: The association between visceral adiposity index (VAI) and metabolic dysfunction-associated steatotic liver disease (MASLD) remains unestablished. Our study sought to investigate the potential relationship between VAI and MASLD risk. METHODS: This study employed data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). Weighted multivariable regression models, subgroup analyses, and machine learning algorithms were used to evaluate associations and predictive performance. RESULTS: Higher VAI tertiles correlated with increased MASLD risk (adjusted OR for T3 vs. T1: 7.08, 95% CI: 4.35-11.5; P-trend=0.003). Machine learning models demonstrated robust predictive accuracy, with random forest (AUC=0.869) and gradient boosting machine (AUC=0.868) outperforming non-invasive scores. However, lipid accumulation product (LAP, AUC=0.834) and fatty liver index (FLI, AUC=0.833) achieved superior diagnostic performance compared to VAI (AUC=0.736), while maintaining clinical interpretability through simplicity and routine parameter availability. CONCLUSIONS: While VAI demonstrated significant positive associations with MASLD risk, non-invasive scores like LAP and FLI emerged as superior diagnostic tools, balancing accuracy with clinical practicality.