Higher Metabolic Score for Visceral Fat Is Associated With Incident Stroke in Middle Aged and Older Chinese Adults

Q: What are the key findings of this study?

Higher metabolic score for visceral fat (METS-VF Q4 vs Q1) was associated with an increased risk of incident stroke in Chinese adults.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Incident stroke (n=5031). Intervention: Highest quartile of Metabolic Score for Visceral Fat (METS-VF ≥ 7.08) vs. Lowest quartile of METS-VF (≤ 6.34). Primary outcome: Incident stroke (HR 1.83, 95% CI 1.36–2.47, p=<0.001).

Q: What does this research mean for the field?

A higher metabolic score for visceral fat (METS-VF) is linearly associated with an increased risk of incident stroke in middle-aged and older Chinese adults. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between the metabolic score for visceral fat (METS-VF) and the risk of incident stroke in a nationally representative prospective cohort of Chinese adults.

Ziyang Chen; Jiajun Hu; Junjie Zhong; Yubo Hou; yan zheng; Fuxin Lin; Lingyun Zhuo; Dezhi Kang

doi:10.21203/rs.3.rs-11225750/v1

November 12, 2026Open Access

Higher Metabolic Score for Visceral Fat Is Associated With Incident Stroke in Middle Aged and Older Chinese Adults

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Key result

Higher metabolic score for visceral fat is linked to ~83% higher incident stroke risk.

HR 1.83
95% CI 1.36–2.47
P<0.001
n=5,031

Why the study?

Visceral adiposity is associated with increased cardiovascular risk, but evidence linking the metabolic score for visceral fat (METS-VF) to incident stroke in large prospective cohorts remained limited.

Is a higher Metabolic Score for Visceral Fat (METS-VF) associated with an increased risk of incident stroke in middle-aged and older Chinese adults without prior stroke?

Key Points

To evaluate the association between the metabolic score for visceral fat (METS-VF) and the risk of incident stroke in a nationally representative prospective cohort of Chinese adults.
Analyzed 5,031 participants aged 45 years or older without a history of stroke from the China Health and Retirement Longitudinal Study (CHARLS) across four waves of follow-up (2011 to 2018).
Calculated METS-VF combining sex, age, waist-to-height ratio, and METS-IR (derived from fasting glucose, fasting triglycerides, body mass index, and high-density lipoprotein cholesterol).
Evaluated incident stroke risk using Cox proportional hazards regression, restricted cubic splines, receiver operating characteristic curve analysis, and decision curve analysis.
Over a median follow-up of approximately 7 years, 479 incident stroke events were recorded among the 5,031 participants.
Participants in the highest METS-VF quartile had a significantly greater risk of incident stroke compared with those in the lowest quartile (HR = 1.83; 95% CI: 1.36–2.47; P < 0.001).
Restricted cubic spline analysis showed a linear relationship with stroke risk (P for overall < 0.001; P for nonlinearity = 0.614), and adding METS-VF improved model discrimination (AUC: 0.675 vs 0.630; ΔAUC = 0.045, P < 0.001).

Study Design

Type

Cohort (n=5,031)

Multicenter

Yes

Structured PICO

Is a higher Metabolic Score for Visceral Fat (METS-VF) associated with an increased risk of incident stroke in middle-aged and older Chinese adults without prior stroke?

P

Population

5,031 middle-aged and older Chinese adults (mean age 58.7 years, 54.6% female) without a prior history of stroke, followed for a median of approximately 7 years.

E

Exposure

Higher Metabolic Score for Visceral Fat (METS-VF), analyzed continuously (per 1-SD increase) and by quartiles (highest quartile Q4: METS-VF ≥ 7.08; Q3: 6.75–7.08; Q2: 6.34–6.75).

C

Comparator

Lowest quartile of Metabolic Score for Visceral Fat (Q1: METS-VF ≤ 6.34).

O

Outcome

Incident stroke (defined as self-reported physician-diagnosed stroke or current stroke treatment reported during follow-up) over a median follow-up of approximately 7 years (mean 6.7 ± 1.4 years, 2011 to 2018).hard clinical

Main Result

Hazard Ratio: 1.83 (95% CI 1.36–2.47)

Absolute Event Rate: 14.79% vs 5.41%

p-value: p=<0.001

Higher Metabolic Score for Visceral Fat (METS-VF) is linearly associated with an increased risk of incident stroke and modestly improves stroke risk discrimination in middle-aged and older Chinese adults.

Limitations

Incremental predictive value and generalizability require further external validation in independent cohorts
Moderate discriminatory performance of the predictive models (AUC 0.675)
Potential selection bias due to differences in baseline metabolic conditions (hypertension, diabetes, dyslipidemia) between included and excluded participants
Stroke diagnosis relied on self-reported physician diagnosis or treatment during follow-up
Potential selection bias due to exclusion of 6,548 participants with missing information for METS-VF or ADL assessment, with observed baseline differences in metabolic conditions (hypertension, diabetes, dyslipidemia) between included and excluded participants
Incremental predictive value and generalizability require further validation in independent cohorts

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Answers are grounded in this paper and cite their sources.

Implication

METS-VF may refine stroke risk assessment in Chinese adults; extends visceral adiposity data but leaves clinical adoption open pending validation.

Abstract

Background : Visceral adiposity has been associated with increased cardiovascular risk; however, evidence regarding its relationship with incident stroke in large prospective cohorts remains limited. The metabolic score for visceral fat (METS-VF), which integrates anthropometric and metabolic parameters, has been proposed as a comprehensive indicator of visceral adiposity and metabolic dysfunction. This study investigated the association between METS-VF and incident stroke in a nationally representative cohort of Chinese adults. Methods : We included 5,031 participants without a history of stroke from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards regression, restricted cubic spline analyses, receiver operating characteristic curves, and decision curve analyses were performed to evaluate the association between METS-VF and stroke risk, as well as its incremental predictive performance. Results : During a median follow-up of approximately 7 years, 479 incident stroke events were identified. Compared with participants in the lowest METS-VF quartile, those in the highest quartile had a higher risk of stroke (HR = 1.83; 95% CI: 1.36–2.47; P < 0.001). Restricted cubic spline analysis demonstrated a positive association between METS-VF and stroke risk (P for overall < 0.001) without significant departure from linearity (P for nonlinearity = 0.614). Adding METS-VF improved discrimination compared with the basic model (AUC: 0.675 vs 0.630; ΔAUC=0.045, P<0.001), and DCA suggested potential net benefit across part of the evaluated threshold-probability range. Mediation analysis showed no significant indirect effect of ADL-L. Conclusion : Higher METS-VF was associated with an increased risk of incident stroke among middle-aged and older Chinese adults. METS-VF may serve as a complementary metabolic marker for risk stratification of individuals at higher risk of stroke, although its incremental predictive value and generalizability require further validation in independent cohorts.

Discussion

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Cite This Study

Chen et al. (2026) conducted a cohort in Incident stroke (n=5,031). Highest quartile of Metabolic Score for Visceral Fat (METS-VF ≥ 7.08) vs. Lowest quartile of METS-VF (≤ 6.34) was evaluated on Incident stroke (HR 1.83, 95% CI 1.36–2.47, p=<0.001). Higher metabolic score for visceral fat (METS-VF Q4 vs Q1) was associated with an increased risk of incident stroke in Chinese adults.

synapsesocial.com/papers/6af73ada9badce7b6084db26 https://doi.org/10.21203/rs.3.rs-11225750/v1

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Higher Metabolic Score for Visceral Fat Is Associated With Incident Stroke in Middle Aged and Older Chinese Adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Higher Metabolic Score for Visceral Fat Is Associated With Incident Stroke in Middle Aged and Older Chinese Adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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