Addressing diagnostic gaps in metabolic syndrome: A sex-based evaluation of indices in Türkiye
Abstract
Background: Metabolic syndrome (MetS) is a major public health concern, and the performance of metabolic and anthropometric indices may vary by sex. This study evaluates the diagnostic performance of six indices in identifying MetS among adults in Türkiye, aiming to evaluate sex-based screening strategies to improve diagnostic precision.
Methods: A cross-sectional study was conducted between September and December 2025 with 610 participants (421 women, 189 men) at an internal medicine clinic in Eskişehir. MetS was defined by NCEP ATP III criteria. Six indices—body mass index (BMI), waist-to-height ratio (WHtR), visceral adiposity index (VAI), abdominal volume index (AVI), triglyceride-glucose index (TyG), and waist-to-triglyceride index (WTI)— were evaluated. Binary logistic regression was employed to confirm each index as a significant predictor of MetS. Subsequently, diagnostic accuracy was assessed using ROC analysis and AUC comparisons via the DeLong method.
Results: Mean ages were 50.1±16.3 years for women and 49.0±17.1 for men, with metabolic syndrome identified in 49.2% and 47.6% of the participants, respectively. In women, TyG (AUC:0.898) showed the highest diagnostic accuracy without a significant difference compared to VAI (AUC:0.878) (p = 0.139). In men, WHtR performed best (AUC:0.859), with no significant differences compared to VAI (AUC: 0.786) (p = 0.092), TyG (AUC:0.829) (p = 0.469), or WTI (AUC:0.821) (p = 0.315). BMI demonstrated the lowest predictive performance in both women (AUC:0.781) and men (AUC:0.769).
Conclusions: BMI showed poor performance in both sexes. While metabolic indices such as TyG and VAI are essential for achieving diagnostic accuracy in women, anthropometric measures like WHtR remain reliable for men. These findings support sex-specific screening approaches for MetS, particularly in women whose risk may be underestimated by traditional anthropometric measures, enabling more equitable and precise metabolic risk management.
Key messages: • BMI was found to be the least effective screening tool for metabolic syndrome in both sexes; its limited diagnostic performance suggests more precise indices may improve routine screening.
• In women, anthropometric measures alone may be insufficient to predict metabolic syndrome; incorporating metabolic indices might improve detection and reduce disparities in risk detection.
Related
- Continuous Diagnostic Indices from BanffNET Automated Lesion Scores for Kidney Transplant Pathology: Development and Evaluation of a Diagnostic Prediction Model
- Comparison of Metabolic Dysfunction‐Associated Steatotic Liver Disease Between Individuals With Werner Syndrome and Those With Insulin‐Resistant Type 2 Diabetes: Hepatic Steatosis and Fibrosis Indices
- Age‐ and Sex‐Specific Optimal Cutoffs for Obesity Indices for Early Detection of Metabolic Syndrome Risk in Taiwanese Adults
- Beyond BMI: Associations of Body-Shape Indices with CBC-Derived Systemic Inflammatory Indices in Adults with Metabolic Syndrome: A Cross-Sectional Study
- Atherogenic lipid indices and metabolic syndrome in polycystic ovary syndrome: a comparative cross-sectional study.
BibTeX
@article{akbay2026addressing,
title = {{Addressing diagnostic gaps in metabolic syndrome: A sex-based evaluation of indices in Türkiye}},
author = {F Akbay and S Sert and B Karagöz and Ö Arslangiray and S Metintaş and M F Önsüz and P Yıldız and M Şahin Tekin},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1142},
url = {https://doi.org/10.1093/eurpub/ckag169.1142},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Addressing diagnostic gaps in metabolic syndrome: A sex-based evaluation of indices in Türkiye
AU - F Akbay
AU - S Sert
AU - B Karagöz
AU - Ö Arslangiray
AU - S Metintaş
AU - M F Önsüz
AU - P Yıldız
AU - M Şahin Tekin
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1142
UR - https://doi.org/10.1093/eurpub/ckag169.1142
AB - Background: Metabolic syndrome (MetS) is a major public health concern, and the performance of metabolic and anthropometric indices may vary by sex. This study evaluates the diagnostic performance of six indices in identifying MetS among adults in Türkiye, aiming to evaluate sex-based screening strategies to improve diagnostic precision. Methods: A cross-sectional study was conducted between September and December 2025 with 610 participants (421 women, 189 men) at an internal medicine clinic in Eskişehir. MetS was defined by NCEP ATP III criteria. Six indices—body mass index (BMI), waist-to-height ratio (WHtR), visceral adiposity index (VAI), abdominal volume index (AVI), triglyceride-glucose index (TyG), and waist-to-triglyceride index (WTI)— were evaluated. Binary logistic regression was employed to confirm each index as a significant predictor of MetS. Subsequently, diagnostic accuracy was assessed using ROC analysis and AUC comparisons via the DeLong method. Results: Mean ages were 50.1±16.3 years for women and 49.0±17.1 for men, with metabolic syndrome identified in 49.2% and 47.6% of the participants, respectively. In women, TyG (AUC:0.898) showed the highest diagnostic accuracy without a significant difference compared to VAI (AUC:0.878) (p = 0.139). In men, WHtR performed best (AUC:0.859), with no significant differences compared to VAI (AUC: 0.786) (p = 0.092), TyG (AUC:0.829) (p = 0.469), or WTI (AUC:0.821) (p = 0.315). BMI demonstrated the lowest predictive performance in both women (AUC:0.781) and men (AUC:0.769). Conclusions: BMI showed poor performance in both sexes. While metabolic indices such as TyG and VAI are essential for achieving diagnostic accuracy in women, anthropometric measures like WHtR remain reliable for men. These findings support sex-specific screening approaches for MetS, particularly in women whose risk may be underestimated by traditional anthropometric measures, enabling more equitable and precise metabolic risk management. Key messages: • BMI was found to be the least effective screening tool for metabolic syndrome in both sexes; its limited diagnostic performance suggests more precise indices may improve routine screening. • In women, anthropometric measures alone may be insufficient to predict metabolic syndrome; incorporating metabolic indices might improve detection and reduce disparities in risk detection.
SN - 1101-1262
SN - 1464-360X
ER -