Key result
LAP outperforms METS-IR in predicting MetS, with LAP optimal in women and VAI in men.
Why the study?
While insulin resistance underpins metabolic syndrome pathogenesis, practical screening biomarkers remain limited and METS-IR, LAP, and VAI require comparative validation.
Do LAP and VAI outperform METS-IR for predicting metabolic syndrome in Northern Chinese adults?
Cross-Sectional (n=2,821)
No
Do LAP and VAI outperform METS-IR for predicting metabolic syndrome in Northern Chinese adults?
Effect estimate: AUC 0.904 (95% CI 0.888-0.920)
Absolute Event Rate: 0.904% vs 0.85%
p-value: p=<0.001
LAP and VAI are superior, sex-specific predictors of metabolic syndrome compared to METS-IR, with LAP performing best overall and in women, and VAI performing best in men.
LAP and VAI should not yet guide metabolic syndrome screening; leaves open prospective validation against METS-IR.
BACKGROUND: Metabolic syndrome (MetS) significantly elevates the risk of diabetes and cardiovascular disease. While insulin resistance (IR) underpins MetS pathogenesis, practical biomarkers for population screening remain limited. The metabolic score for IR (METS-IR), lipid accumulation product (LAP) and visceral adiposity index (VAI) are highly sensitive and specific biomarkers of IR, which require comparative validation. OBJECTIVE: To compare LAP, VAI, and METS-IR index for predicting MetS with sex-stratified analysis. METHODS: The physiological characteristics and blood biochemistry data collected from 2821 patients during an annual health check-up were analyzed. Participants were assigned to MetS group (≥3 MetS conditions), pre-Mets group (1-2 Mets components) or control group (0 component) based on IDF/AHA/NHLBI 2009 criteria and were further stratified by sex. The predictive value and clinical usefulness of the LAP, VAI, and METS-IR were evaluated by receiver operating characteristic (ROC) curve and decision curve analysis (DCA). RESULTS: LAP, VAI, and METS-IR levels were significantly elevated in the MetS group (P < 0.05) and strongly correlated with MetS components. ROC analysis revealed LAP as the superior predictor in the total cohort (AUC: 0.904 [95% CI: 0.888-0.920]) and females (AUC: 0.949 [95% CI: 0.921-0.976]), while VAI performed best in males (AUC: 0.863 [95% CI: 0.840-0.886]). DCA confirmed the superior clinical utility of LAP and VAI over METS-IR across subgroups. CONCLUSION: This large-scale validation establishes LAP and VAI as superior, sex-specific predictors of MetS compared to METS-IR. LAP is optimal overall and in women, while VAI is optimal in men. Their reliance on standard clinical measurements establishes them as practical tools for metabolic risk stratification.
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Liu et al. (2025) conducted a cross-sectional in Metabolic Syndrome (n=2,821). Lipid accumulation product (LAP) vs. METS-IR was evaluated on Prediction of Metabolic Syndrome (AUC) (AUC 0.904, 95% CI 0.888-0.920, p=<0.001). Lipid accumulation product (LAP) demonstrated superior predictive performance for metabolic syndrome compared to METS-IR in the total cohort (AUC 0.904 vs 0.850), with LAP performing optimally in women and VAI optimally in men.
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