METS-VF as a novel predictor of gallstones in U.S. adults: a cross-sectional analysis (NHANES 2017–2020)

Abstract

Background and Aims: Obesity is a well-established risk factor for gallstone formation, but traditional anthropometric measures (e.g., BMI, waist circumference) inadequately assess metabolically active visceral adiposity. The novel Metabolic Score for Visceral Fat (METS-VF) may better capture obesity-related metabolic dysfunction. We aimed to investigate the association between METS-VF and gallstone prevalence and compare its predictive performance against conventional obesity indices (WC, LAP, VAI) in a U.S. national cohort. Methods: This cross-sectional study analyzed nationally representative data from 3,010 US adults in NHANES 2017–2020 (aged 20–85 years, 51.3% male, multi-ethnic population). We employed weighted multivariable logistic regression to examine the METS-VF-gallstones association, with restricted cubic splines testing nonlinearity. Predictive performance of METS-VF versus traditional indices (WC/LAP/VAI) was compared using ROC curves and XGBoost machine learning. Results: Among 3,010 U.S. adults (mean age 47.8 ± 17.0 years, 51.3% male) in the NHANES 2017–2020 cohort, multivariable analysis revealed METS-VF as the strongest independent predictor of gallstones (adjusted OR = 2.02, 95%CI:1.20–3.40). Notably, METS-VF demonstrated significantly superior discriminative ability with the highest AUC of 0.712 (95%CI:0.684–0.739) compared to conventional indices (WC:0.635, LAP:0.609, VAI:0.530; all P < 0.05). Conclusion: The cross-sectional analysis demonstrates a significant association between METS-VF and gallstone prevalence (OR = 2.02, 95% CI:1.20–3.40), with relatively better predictive performance compared to conventional adiposity indices (AUC = 0.712). Its simple calculation using routine clinical measurements makes it ideally suited for implementation in primary care screening programs targeting high-risk populations with visceral adiposity. While these findings position METS-VF as a promising screening marker, its etiological role requires verification through longitudinal studies.