{"doi":"10.31083/ijvnr39830","title":"Visceral Adiposity Index and Cancer Prevalence in U.S. Adults: A Cross-Sectional Analysis of NHANES 1999–2020","abstract":"<jats:p>Objective: Visceral adiposity has been implicated in carcinogenesis through chronic inflammation, insulin resistance, and lipid dysregulation, whereas body mass index (BMI) does not capture fat distribution. The Visceral Adiposity Index (VAI)—combining waist circumference, BMI, triglycerides, and high-density lipoprotein-cholesterol (HDL-C)—serves as a surrogate of visceral fat function, but its value for cancer risk prediction is unclear. We aimed to evaluate the association between VAI and cancer prevalence in U.S. adults using NHANES 1999–2020, assess independence from BMI, characterize subgroup and dose–response patterns, and conduct prespecified exploratory site-specific analyses. Methods: A total of 20,699 adults aged ≥20 years were included after excluding participants with missing data. The primary outcome was a self-reported history of physician-diagnosed cancer, with the exclusion of non-melanoma skin cancers—such as basal cell carcinoma and squamous cell carcinoma—due to their typically indolent behavior and minimal epidemiological impact. Importantly, melanoma cases were included in the analysis. VAI was analyzed both as a continuous variable and in quartile-based categories (&lt;1.0, 1.0–&lt;2.0, 2.0–&lt;3.0, and ≥3.0). Weighted logistic regression models were constructed with progressive adjustment for demographic, lifestyle, and metabolic covariates (e.g., hypertension, diabetes). Restricted cubic spline (RCS) analyses were performed to assess the dose–response relationship between VAI and cancer, and interaction analyses were conducted across subgroups defined by sex, age, BMI, and hypertension status. Results: In the unadjusted model, each one-unit increase in VAI was associated with significantly higher odds of cancer (OR = 1.019; 95% CI: 1.003–1.035; p = 0.019). Participants in the highest VAI category (≥3.0) had approximately threefold increased odds of cancer compared to those in the lowest category (&lt;1.0) (OR = 3.04; p &lt; 0.001). After stepwise adjustment for demographic and lifestyle factors, the association attenuated; in our prespecified primary model that excluded BMI and hyperlipidemia to avoid overadjustment, the association remained statistically significant (OR = 1.024; 95% CI: 1.004–1.045; p = 0.021), indicating that higher VAI was independently associated with cancer prevalence. RCS analysis suggested a weak, approximately linear increase in cancer prevalence odds with increasing VAI, without a clear threshold effect; the overall association was statistically significant (p = 0.0428), and the test for nonlinearity showed borderline significance (p = 0.0540). Subgroup analyses showed a consistent pattern across most strata, except for a borderline significant interaction by hypertension status (p = 0.044), with a stronger association in individuals without hypertension. In pre-specified site-specific analyses, no individual cancer type demonstrated an independent positive association with VAI after full adjustment; intermediate VAI levels were inversely associated with cervical cancer, a counterintuitive finding that warrants cautious interpretation given limited case counts. Conclusions: Higher VAI levels were associated with increased cancer prevalence; however, the strength of the association diminished after controlling for traditional obesity metrics. These findings suggest that VAI may offer limited independent predictive value for cancer risk beyond BMI. Further prospective and mechanistic studies are warranted to establish causal relationships and evaluate the utility of VAI in identifying high-risk subpopulations.</jats:p>","journal":"International Journal for Vitamin and Nutrition Research","year":2026,"id":613469,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":290332,"name":"Mu Yang","orcid":null,"position":1,"is_corresponding":false},{"id":952981,"name":"Weiheng Zhao","orcid":"0000-0002-5726-6892","position":2,"is_corresponding":false},{"id":1580481,"name":"Jingyao Tu","orcid":null,"position":3,"is_corresponding":false},{"id":692316,"name":"Xianglin Yuan","orcid":"0000-0003-4653-5388","position":4,"is_corresponding":false},{"id":1344721,"name":"Xinyi Chen","orcid":"0000-0003-3321-2483","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Visceral Adiposity Index and Cancer Prevalence in U.S. Adults: A Cross-Sectional Analysis of NHANES 1999–2020","abstract":"<jats:p>Objective: Visceral adiposity has been implicated in carcinogenesis through chronic inflammation, insulin resistance, and lipid dysregulation, whereas body mass index (BMI) does not capture fat distribution. The Visceral Adiposity Index (VAI)—combining waist circumference, BMI, triglycerides, and high-density lipoprotein-cholesterol (HDL-C)—serves as a surrogate of visceral fat function, but its value for cancer risk prediction is unclear. We aimed to evaluate the association between VAI and cancer prevalence in U.S. adults using NHANES 1999–2020, assess independence from BMI, characterize subgroup and dose–response patterns, and conduct prespecified exploratory site-specific analyses. Methods: A total of 20,699 adults aged ≥20 years were included after excluding participants with missing data. The primary outcome was a self-reported history of physician-diagnosed cancer, with the exclusion of non-melanoma skin cancers—such as basal cell carcinoma and squamous cell carcinoma—due to their typically indolent behavior and minimal epidemiological impact. Importantly, melanoma cases were included in the analysis. VAI was analyzed both as a continuous variable and in quartile-based categories (&lt;1.0, 1.0–&lt;2.0, 2.0–&lt;3.0, and ≥3.0). Weighted logistic regression models were constructed with progressive adjustment for demographic, lifestyle, and metabolic covariates (e.g., hypertension, diabetes). Restricted cubic spline (RCS) analyses were performed to assess the dose–response relationship between VAI and cancer, and interaction analyses were conducted across subgroups defined by sex, age, BMI, and hypertension status. Results: In the unadjusted model, each one-unit increase in VAI was associated with significantly higher odds of cancer (OR = 1.019; 95% CI: 1.003–1.035; p = 0.019). Participants in the highest VAI category (≥3.0) had approximately threefold increased odds of cancer compared to those in the lowest category (&lt;1.0) (OR = 3.04; p &lt; 0.001). After stepwise adjustment for demographic and lifestyle factors, the association attenuated; in our prespecified primary model that excluded BMI and hyperlipidemia to avoid overadjustment, the association remained statistically significant (OR = 1.024; 95% CI: 1.004–1.045; p = 0.021), indicating that higher VAI was independently associated with cancer prevalence. RCS analysis suggested a weak, approximately linear increase in cancer prevalence odds with increasing VAI, without a clear threshold effect; the overall association was statistically significant (p = 0.0428), and the test for nonlinearity showed borderline significance (p = 0.0540). Subgroup analyses showed a consistent pattern across most strata, except for a borderline significant interaction by hypertension status (p = 0.044), with a stronger association in individuals without hypertension. In pre-specified site-specific analyses, no individual cancer type demonstrated an independent positive association with VAI after full adjustment; intermediate VAI levels were inversely associated with cervical cancer, a counterintuitive finding that warrants cautious interpretation given limited case counts. Conclusions: Higher VAI levels were associated with increased cancer prevalence; however, the strength of the association diminished after controlling for traditional obesity metrics. These findings suggest that VAI may offer limited independent predictive value for cancer risk beyond BMI. Further prospective and mechanistic studies are warranted to establish causal relationships and evaluate the utility of VAI in identifying high-risk subpopulations.</jats:p>","is_dataset_classified":null,"base_score":0.0,"endowment":0.0,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"21097893","pmcid":null,"openalex_id":"https://openalex.org/W7167644408","authors":[],"funders":[{"funder_name":"China Postdoctoral Science Foundation","grant_id":"2024M761057","title":null}],"total_grants":1,"fwci":0.0,"citation_percentile":0.7772629,"influential_citations":0,"citation_trend":[],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://storage.imrpress.com/IMR/2070394928366592000/application/1664-2821-96-3-39830.pdf","host_type":"journal"},{"url":"https://storage.imrpress.com/IMR/2070394928366592000/application/1664-2821-96-3-39830.pdf","host_type":"publisher"},{"url":"https://www.imrpress.com/journal/IJVNR/96/3/10.31083/IJVNR39830","host_type":"publisher"},{"url":"https://doi.org/10.31083/ijvnr39830","host_type":"journal"}],"fields_of_study":["Cancer Risks and Factors","Nutrition and Health in Aging","Inflammatory Biomarkers in Disease Prognosis"],"mesh_terms":[],"keywords":["Body mass index","Epidemiology","Logistic regression","Waist","Cancer","Odds ratio","National Health and Nutrition Examination Survey","Obesity","Metabolic syndrome"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-02T08:13:32.694424Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}