Comparison of novel visceral adiposity indices with body mass index for identification of prevalent diabetes: findings from the 2021 Iran STEPS survey

Abstract

Diabetes mellitus (DM) is a major contributor to global morbidity and mortality, particularly in developing regions. Effective identification of high-risk individuals is crucial for targeted prevention and resource allocation. This population-based study aimed to compare the association and discriminatory performance of novel visceral adiposity indices—Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI), and Waist-triglyceride Index (WTI)—and Waist Circumference (WC) with Body Mass Index (BMI) in detecting prevalent diabetes. Data from 17,945 participants in the Iran 2021 WHO STEPwise approach to Noncommunicable Disease Risk Factor Surveillance (STEPS) survey were analyzed. Associations with diabetes were examined via multivariable logistic regression models. Comparisons of discriminatory performance were carried out using receiver operating characteristic curves and Somers’ D. Stratified analyses were performed by sex, age group, and place of residence. All indices were significantly associated with diabetes. Addition of LAP and WTI to the base predictive model yielded a significantly higher discriminatory ability (AUC = 0.816, 95% CIs: 0.805–0.827 and AUC = 0.815, 95% CI: 0.804–0.826, respectively) compared to BMI. All anthropometric indices outperformed the base model in discriminating prevalent diabetes. LAP and WTI exhibited better discrimination of prevalent diabetes than BMI. Given their accessibility, these indices may provide additional information beyond BMI for diabetes discrimination. Prospective studies are warranted to evaluate the indices’ predictive utility.