Abstract
BACKGROUND: Obesity is a well-recognized risk factor for stroke, and this study aims to explore the association between a novel obesity parameter, the metabolic score for visceral fat (MetS-VF), and stroke in middle-aged and elderly adults. METHODS: The first wave (2011) national data of the China Health and Retirement Longitudinal Study (CHARLS) was used as the baseline, and the occurrence of stroke events was then ascertained in the subsequent three consecutive waves of national follow-up surveys (2013, 2015, and 2018). Restricted cubic spline (RCS) and multivariable Cox regression were constructed to examine the association between MetS-VF and incident stroke, with the corresponding hazard ratios (HRs) and 95% confidence intervals recorded. RESULTS: The study included 7,962 middle-aged and elderly participants from the CHARLS project who were free of stroke at baseline. During an average follow-up period of 6.42 years, a total of 518 participants (6.51%) experienced a stroke, including 252 males and 266 females. After adjusting for confounding factors, the results of the multivariable Cox regression analysis showed that the risk of stroke increased linearly with increasing levels of MetS-VF [HR: 1.47, 1.23–1.76; P for nonlinearity = 0.734]. Notably, drinking status may modify the association between MetS-VF and stroke; compared to individuals without alcohol consumption habits, those with alcohol consumption habits had a higher risk of future stroke events. CONCLUSIONS: In this prospective cohort study based on middle-aged and elderly Chinese individuals, our research reveals a significant association between the novel obesity parameter MetS-VF and incident stroke. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12883-026-04754-3.