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Visceral Adiposity and Inflammation Index as Predictors of Stroke Risk in Middle and Older Age: A Cohort Study Across

Huang Luwen¹, Yang Linyi¹, Li Linlin¹

¹Department of Neurology, Suining Central Hospital, Suining, Sichuan Province, China.

Brain and Behavior

|December 23, 2025

Insights

The visceral adiposity and inflammation index (VAII) is linked to increased stroke risk, particularly in individuals with elevated blood pressure. This association is nonlinear and more pronounced in women and middle-aged adults.

Area of Science:

Cardiovascular Epidemiology
Metabolic Syndrome Research
Biomarker Discovery for Stroke Risk

Background:

The visceral adiposity and inflammation index (VAII) combines visceral adiposity index (VAI) and high-sensitivity C-reactive protein (hs-CRP).
Both VAI and hs-CRP are independently associated with increased stroke risk.
Understanding the combined impact of visceral adiposity and inflammation on stroke is crucial for risk stratification.

Purpose of the Study:

To investigate the association between the visceral adiposity and inflammation index (VAII) and stroke risk.
To examine how this association varies across different blood pressure statuses, sexes, and age groups.
To explore the nonlinear relationship between VAII and stroke incidence.

Main Methods:

Analysis of data from 8883 participants in the China Health and Retirement Longitudinal Study.
Categorization of VAII levels into quartiles to assess stroke incidence.
Application of restricted cubic spline analysis to evaluate nonlinear associations, with sensitivity analyses for robustness.

Main Results:

A 1-SD increase in VAII was associated with a 4.8% higher stroke risk (HR = 1.048).
Stroke risk significantly increased across VAII quartiles, with the highest quartile showing over double the risk of the lowest (HR = 2.138).
Stronger associations were observed in women, adults aged 40-60, and individuals with elevated blood pressure or hypertension, with nonlinear patterns noted.

Conclusions:

A significant nonlinear relationship exists between VAII and stroke risk.
The VAII-stroke association is particularly evident in individuals with elevated blood pressure and hypertension.
Nonlinear associations were consistent across sexes and age groups, highlighting VAII's broad relevance in stroke risk assessment.

Read full analysis

Abstract

Objective:

The visceral adiposity and inflammation index (VAII) is a composite index that combines the visceral adiposity index (VAI) and high-sensitivity C-reactive protein (hs-CRP), both of which are associated with stroke risk. This study aimed to investigate the association between VAII and stroke risk, with a particular focus on different blood pressure (BP) statuses, sexes, and age groups.

Methods:

Data from 8883 participants in the China Health and Retirement Longitudinal Study were analyzed. VAII levels were categorized into quartiles, and stroke incidence was assessed. Restricted cubic spline analysis was used to assess the association between VAII and stroke risk on the basis of sex, age, and BP status. Sensitivity analyses, including complete-case analysis, multiple imputation, and calculation of the E-value, were conducted to assess the robustness of the findings.

Results:

During a median follow-up of 9 years, 827 participants (9.31%) developed stroke. In fully adjusted models, a 1-SD increase in VAII was associated with higher stroke risk (HR = 1.048, 95% CI: 1.009-1.089). Stroke incidence increases across VAII quartiles, with Q4 showing more than twice the risk of Q1 (HR = 2.138, 95% CI: 1.720-2.658). Associations were evident in elevated BP (Q4 vs. Q1: HR = 2.034) and hypertension groups (Q3: HR = 1.906; Q4: HR = 1.713), but not in normal BP. Stronger associations appeared in women and in adults aged 40-60 years. Restricted cubic splines indicated nonlinear relationships. Sensitivity analyses supported the robustness of these findings.

Conclusion:

Our study revealed a significant nonlinear relationship between VAII and the risk of stroke. The association between VAII and stroke was nonlinear in individuals with elevated BP and hypertension. Additionally, a nonlinear relationship was observed between VAII and stroke risk in both males and females, as well as in middle-aged and older adults.

Keywords:

CHARLS hypertension nonlinear association stroke visceral adiposity and inflammation index

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