Psoriasis is associated with visceral adiposity and metabolic dysfunction. Conventional indicators, including body mass index (BMI) and waist circumference (WC), are inadequate with regards to assessment of visceral fat metabolism. Emerging indices, such as metabolic score for insulin resistance (METS-IR) or visceral fat (METS-VF), may be better suited to evaluate visceral adipose metabolism, however, their comparative predictive value for psoriasis remains unclear. To compare associations between traditional and emerging obesity indicators and risk of psoriasis, and identify optimal predictors. Data from 8,770 participants in the NHANES were analysed. Associations between obesity indicators and psoriasis risk were evaluated using weighted logistic regression. Model performance was assessed by receiver operating characteristic (ROC) area under the curve (AUC), with 95% confidence intervals and pairwise comparisons adjusted using DeLong's test. Subgroup analyses and restricted cubic splines (RCS) were used to explore heterogeneity and dose response for the best indicator. Threshold effects were examined using piecewise linear regression. Psoriasis patients showed significantly higher BMI, WC, and METS-VF. All three indicators were positively associated with risk of psoriasis, with METS-VF demonstrating the highest AUC. RCS analysis demonstrated a linear dose-response relationship between METS-VF and psoriasis risk, while piecewise regression further identified a critical threshold of 6.6. The optimal cutoff value was 6.17, yielding a sensitivity of 69.2% and specificity of 42.8%. Subgroup analysis showed stronger associations in individuals ≤45 years, with moderate income, hypertension and without diabetes (significant interaction: p=0.022). Compared to traditional obesity indices, METS-VF demonstrates a significant and consistent association with risk of psoriasis, which is modulated, in particular, by diabetes status.
Qin et al. (2026) studied this question.