Body Composition

Association Between the Chinese Visceral Adiposity Index-Frailty Index (CVAI-FI) and the Incidence of New-Onset Stroke in Individuals with Cardiovascular-Kidney-Metabolic Syndrome Stage 0-3: Evidence From a National Population-Based Study.

Zhao E, Xie H, Dong B, Zhang C • Global heart • 2026

PubMed 42921540 DOI 10.5334/gh.1597
TL;DR

The CVAI-FI index (Chinese Visceral Adiposity Index multiplied by Frailty Index) provides enhanced stroke risk stratification across CKM syndrome stages 0-3, with quantifiable improvements in discrimination and reclassification, and cumulative exposure further strengthens predictive accuracy.

Key Findings

Results

Among 6,772 CKM stage 0-3 participants aged ≥45 years in CHARLS, 447 (6.6%) developed new-onset stroke during follow-up.

  • Data came from the China Health and Retirement Longitudinal Study (2011-2020).
  • Participants with CKM stage 4 or baseline stroke were excluded.
  • A cumulative exposure analysis was done in 4,170 participants with measurements from Waves 1 (2011) and 3 (2015).
Results

CVAI-FI showed a significant dose-response association with incident stroke.

  • Restricted cubic splines gave a P for nonlinearity <0.001.
  • Each one-SD increment in CVAI-FI corresponded to 31% higher stroke risk (OR 1.31, 95% CI 1.20-1.43).
  • Multivariable logistic regression adjusted for sociodemographic, behavioral, and clinical confounders.
Results

Cumulative CVAI-FI discriminated stroke better than standalone CVAI, FI, or baseline CVAI-FI.

  • AUC was 0.675 for cumulative CVAI-FI, versus 0.616 for CVAI, 0.609 for FI, and 0.641 for baseline CVAI-FI (all P < 0.001).
  • Model performance was assessed with ROC curves.
Results

CVAI-FI significantly improved reclassification and discrimination metrics.

  • IDI improvements ranged from 0.018 to 0.020.
  • NRI improvement was 0.032.
  • Incremental value was determined through NRI and IDI.
Results

The association between CVAI-FI and stroke was robust across subgroups, with stronger effects in some groups.

  • Individuals with secondary education or above had a stronger association (OR 1.83).
  • Individuals without hypertension had a stronger association (OR 1.51).
Methods

The CVAI-FI index was constructed by combining a visceral adiposity measure and a deficit-accumulation frailty measure.

  • CVAI was calculated using age, BMI, waist circumference, triglycerides, and HDL-C.
  • FI incorporated 32 health deficits following standardized methodology.
  • CVAI-FI was derived as the product of CVAI and FI.
Conclusions

The authors conclude that CVAI-FI supports stroke risk stratification within CKM syndrome frameworks for identifying high-risk individuals.

  • Enhanced stratification was seen across CKM stages 0-3.
  • Cumulative exposure assessment further strengthened predictive accuracy.

What This Means

This study looked at whether combining a measure of belly (visceral) fat with a measure of frailty could better predict who will have a stroke. Researchers used data from nearly 6,800 middle-aged and older Chinese adults who had early-to-moderate stages (0-3) of cardiovascular-kidney-metabolic syndrome, a cluster of linked heart, kidney, and metabolic problems. About 6.6% of them had a stroke during the roughly nine-year follow-up. The combined index, called CVAI-FI, was linked to stroke risk in a dose-response way: each one standard-deviation increase corresponded to 31% higher odds of stroke. It predicted stroke better than either the fat measure or the frailty measure alone, and tracking the index across two time points (2011 and 2015) predicted better still. The link appeared in many subgroups, and was stronger among people with more education and those without hypertension. This research suggests that a simple index built from routine measurements might help identify people at higher stroke risk earlier in the course of CKM syndrome. However, the study is observational, so it shows association rather than cause, and the predictive accuracy (AUC of about 0.68) was modest.

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Citation

Zhao E, Xie H, Dong B, Zhang C. (2026). Association Between the Chinese Visceral Adiposity Index-Frailty Index (CVAI-FI) and the Incidence of New-Onset Stroke in Individuals with Cardiovascular-Kidney-Metabolic Syndrome Stage 0-3: Evidence From a National Population-Based Study.. Global heart. https://doi.org/10.5334/gh.1597