Elevated Visceral Adiposity Index is Associated with Reproductive Endocrine Characteristics, and Adverse Pregnancy Outcomes in Chinese Women with Polycystic Ovary Syndrome

To evaluate the visceral adiposity index (VAI) as a metabolic and reproductive risk marker in Chinese women with polycystic ovary syndrome (PCOS).

Secondary analysis of 956 women with PCOS from the PCOSAct trial. VAI was calculated from waist circumference, BMI, triglycerides, and HDL-C. Associations with anthropometric, metabolic, endocrine, and pregnancy outcomes were assessed using regression models. Predictive performance for insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) was evaluated via ROC analysis.

Elevated VAI was positively associated with age, BMI, blood pressure, dysglycemia, dyslipidemia, FT, hepatic enzymes, and prevalence of IR, MetS, and NAFLD (all P-trend < 0.05). VAI was negatively correlated with QUICKI, HDL, SHBG, gonadotropins and AMH (all P-trend < 0.01). In fully adjusted models, the highest VAI quartile had an increased risk of IR (OR: 4.58, 95% CI: 1.53-6.02, P-trend = 0.002) compared to the lowest quartile. VAI predicted IR (AUC = 0.74) and NAFLD (AUC = 0.71) with moderate accuracy. Higher VAI quartiles were dose-dependently associated with reduced reproductive success (P-trend < 0.01).

VAI is a practical, non-invasive tool for identifying metabolic dysfunction and predicting adverse pregnancy outcomes in women with PCOS, supporting its use for risk stratification and early intervention.