Abstract
BACKGROUND: The metabolic score for visceral fat (METS-VF) integrates metabolic and anthropometric indices to assess visceral fat burden; however, its relationship with frailty remains underexplored. This study aimed to assess the relationship between the METS-VF and frailty in overweight and obese adults. METHODS: We analyzed data from 6598 overweight/obese individuals (representing 38.8 million U.S. adults) from the 2007-2020 National Health and Nutrition Examination Survey (NHANES). Frailty was determined via a 49-item frailty index. METS-VF was estimated on the basis of insulin resistance, lipid profile, waist-to-height ratio, age, and sex. Associations were evaluated via multivariate logistic regression, restricted cubic splines, and subgroup analyses. Receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were used to compare the predictive performance of the METS-VF with that of the metabolic score for insulin resistance (METS-IR), waist circumference (WC), and body mass index (BMI) for frailty. RESULTS: The prevalence of frailty was 13.1%. Each unit increase in the METS-VF was associated with more than a fivefold greater odds of frailty (adjusted odds ratio (OR) = 4.95; 95% CI: 3.35-7.32; P < 0.001). Compared with those in the lowest quartile, participants in Q4 had 3.39-fold greater odds of frailty (95% CI: 2.29-5.01; P < 0.001; P for trend < 0.001). ROC analysis revealed that the METS-VF had superior predictive performance for frailty (AUC = 0.685) compared with the METS-IR, WC, and BMI. DCA further indicated that METS-VF provided greater net clinical benefit across the threshold probability range of 0.15-0.35. CONCLUSION: The METS-VF was strongly associated with frailty in overweight/obese adults and was superior to the METS-IR, WC, and BMI in predicting frailty. These findings suggest that METS-VF may be useful for the early identification of high-risk populations, although causal inference cannot be made owing to the cross-sectional design.