Association Between Metabolic Score for Visceral Fat and Liver Fibrosis Risk in Non-Viral Hepatitis Populations: NHANES 2017–2020

Background Visceral adiposity dysfunction has been recognized as an independent risk factor for liver fibrosis, and early identification may improve prognosis. This study aimed to investigate the association of metabolic score for visceral fat (METS-VF) and other visceral adiposity metabolic indices (METS-IR, VAI, CMI, LAP) with liver fibrosis in U.S. non-viral hepatitis populations. Methods Using data from the National Health and Nutrition Examination Survey (NHANES 2017–March 2020), we conducted weighted multivariable logistic regression and trend analyses to evaluate the associations of visceral adiposity metabolic indices with overall, significant and advanced fibrosis. In addition, restricted cubic spline (RCS) model was used to examine potential nonlinear relationships. Receiver operating characteristic (ROC) curves were further used to assess the diagnostic performance of these indices. Finally, subgroup analyses were performed to evaluate potential variations of association between METS-VF and fibrosis across different population strata. Results A total of 3,490 participants were included in this study. Among all visceral adiposity metabolic indices, METS-VF showed the strongest association with liver fibrosis, demonstrating superior predictive performance. Participants in the highest METS-VF quartile had 7.81-fold greater odds of fibrosis (adjusted OR 7.812, 95% CI: 2.421–25.207), with an AUC of 0.748 (95% CI: 0.696–0.796). This association exhibited a severity-dependent pattern, with the odds ratio increasing to 23.44 for advanced fibrosis. Subgroup analyses revealed higher association between METS-VF and fibrosis among individuals who were married or living with partner or had hypertension or diabetes. Conclusions METS-VF demonstrated significant association with liver fibrosis and superior predictive performance compared to FIB-4 and other visceral adiposity metabolic indices, suggesting its clinical utility for liver fibrosis screening in non-viral hepatitis populations