To compare the performance of triglyceride-glucose index combined with body mass index (TyG-BMI) and waist-to-height ratio (WHtR) in the diagnosis of visceral fat area (VFA) in overweight and obese people, and to explore their gender differences, so as to provide a simple and accurate assessment tool for clinical screening of central obesity and metabolic risk.

A total of 117 overweight and obese patients were enrolled. The quartiles of VFA (113.60 cm², 146.30 cm², 190.10 cm²)were used as the cut-off values and divided into four groups: S1 to S4. Anthropometric, serological and insulin resistance-related composite indicators were collected. Pearson correlation analysis was used to evaluate the correlation between each indicator and VFA. ROC curve analysis was used to compare the efficacy of each indicator in diagnosing high VFA, and gender subgroup analysis was performed. Clinical decision curve analysis (DCA) was used to evaluate the net clinical benefit of each index, and the positive predictive value (PPV) and negative predictive value (NPV) were calculated.

The body weight (107.07±17.40 vs 80.34±10.28 ), waist circumference (116.31±12.13 vs 97.60±8.81), waist-to-height ratio (0.69±0.07 vs 0.59±0.05) and TyG-BMI (340.34±45.48 vs 265.30±31.29) in group S4 were higher than those in group S1. Blood pressure (135.83±16.50 vs 125.27±18.74), liver function (24.90 vs 22.45) and fatty liver (355.34±42.39 vs 293.20±36.42) were higher than those in S1 group (P<0.05). Correlation analysis showed that TyG-BMI (r=0.559 ) and waist-to-height ratio (r=0.587) were positively correlated with VFA (P<0.05). Gender subgroup analysis showed that the cut-off values of TyG-BMI and waist-to-height ratio at different VFA cut-off points. There were gender differences. The cut-off point of TyG-BMI was 298.12-315.89 in males and 263.76-283.88 in females. The cut-off point of waist-to-height ratio was 0.62-0.65 in males and 0.58-0.63 in females. DCA showed that TyG-BMI had the greatest net clinical benefit, which was better than waist-to-height ratio, waist circumference and BMI. Taking VFA ≥100 cm² as the gold standard, PPV reached 97.7 % when TyG-BMI > 298.64, which was higher than waist-to-height ratio >0.62 (94.5%), waist circumference >103.7 cm (93.8%) and BMI >31.11 (94.8%). However, the NPV of the four indicators was low (24.7%-37.5%), suggesting that the exclusion ability was limited.

TyG-BMI and WHtR can be used as indicators of VFA in overweight and obese people, but there are gender differences. When TyG-BMI >282.73 (male >298.12) and WHtR >0.58 (male 0.62 ), It can be used as an early warning index for abnormal accumulation of visceral fat.it is preliminarily suggested that there may be significant visceral fat accumulation in individuals, which is worthy of further examination and dynamic observation of VFA.TyG-BMI has the best clinical net benefit and diagnostic efficacy in screening visceral obesity, and can be used as a convenient screening tool for high-risk groups, but negative results need to be further evaluated in combination with other indicators.