Addressing diagnostic gaps in metabolic syndrome: A sex-based evaluation of indices in Türkiye

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.