Association of the Chinese visceral adiposity index with incident cardio-renal-metabolic multimorbidity: a 9-year nationwide cohort study

Background The Chinese Visceral Adiposity Index (CVAI) is an improved surrogate marker of visceral adiposity, yet prospective evidence linking CVAI to cardio-renal-metabolic multimorbidity (CRMM) is limited. Objective To evaluate the predictive performance of CVAI for CRMM and its association with incident CRMM risk. Methods A total of 5,929 participants were included. Discrimination and reclassification were assessed using ROC curves, NRI, and IDI. Kaplan–Meier and Cox models evaluated CRMM risk across CVAI quartiles, and mediation analyses examined the role of insulin resistance (TyG) and systemic inflammation (hs-CRP). Results Over a median follow-up of 9 years, 871 participants developed incident CRMM (14.7%). CVAI showed superior predictive performance compared with other adiposity indices (AUC: 0.638; NRI: 0.370, P < 0.001; IDI: 0.003, P < 0.001). Higher CVAI was independently associated with increased CRMM risk (Q4 vs. Q1: adjusted HR 2.329, 95% CI 1.887–2.874; P < 0.001). Mediation analysis indicated that insulin resistance mediated 22.6% of the association, whereas systemic inflammation contributed modestly (3.5%). Conclusion CVAI is a superior predictor of incident CRMM. Higher CVAI levels are independently associated with increased long-term risk of CRMM, supporting the clinical utility of CVAI for early risk stratification of CRMM.MediationKM