Comparative diagnostic performance of lipid and adiposity-related indices in identifying metabolic syndrome among university-affiliated adults in Indonesia

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities associated with increased risk of cardiovascular disease and type 2 diabetes mellitus. MetS is accompanied by distinct alterations in adiposity and lipid metabolism, prompting the use of composite indices to improve early identification. However, the comparative discriminative performance of such indices varies across populations and between sexes. This study aimed to evaluate and compare the discriminative ability of lipid and adiposity indices including lipid accumulation product (LAP), visceral adiposity index (VAI), triglyceride/high-density lipoprotein (TG/HDL), TG–glucose index (TyG), and modified cardiometabolic index (MCMI) for identifying MetS in adults. A cross-sectional study was conducted among 317 adult participants aged ≥ 30 years. Anthropometric measurements and biochemical parameters were collected using standardized procedures. MetS was defined using Asia-Pacific waist-circumference thresholds combined with National Cholesterol Education Program Adult Treatment Panel III criteria for the remaining four components; a sensitivity analysis using original ATP III wait-circumference thresholds was also performed. Receiver operating characteristic curve analysis was conducted to assess the discriminative ability of each index. The area under the curve (AUC) was calculated, and optimal cutoff values were determined using Youden’s index. All indices demonstrated strong discrimination for MetS. Among men, AUC values ranged from 0.88 (Tg/HDL, VAI, LAP) to 0.91 (MCMI), with no significant differences across indices overall (p = 0.063), and pairwise comparisons with Bonferroni correction likewise showed no statistically significant differences between individual indices. Tg/HDL showed the most favorable Youden’s index (0.71). Among women, discrimination was similarly high (AUC 0.87–0.92), with MCMI showing the numerically highest AUC (0.92; Youden’s index, 0.72); pairwise comparisons with Bonferroni correction showed no statistically significant differences between individual indices, and differences across indices were not significant overall (p = 0.215). Sensitivity ranged from 73% to 93% and specificity from 75% to 89% across indices and sexes. All evaluated indices demonstrated strong discriminative ability for MetS, with broadly comparable performance between sexes. MCMI showed the numerically highest accuracy in both men and women, although pairwise differences between indices were not statistically significant after correction for multiple testing. These findings support further evaluation of these indices as potential adjunct tools for identifying individuals at elevated cardiometabolic risk, pending external validation. Not applicable.