VAI Calculator – Visceral Adiposity Index
Enter sex, age, waist circumference, weight and height (or the BMI directly) and the lipid values, and choose the units used by your laboratory - the index is calculated automatically.
Result
VAI: —
Interpretation following Amato et al., 2011: —
How to interpret the VAI
The VAI was scaled so that it equals 1 in healthy non-obese subjects with normal fat distribution and normal triglyceride and HDL levels. Higher values indicate a less favourable combination of waist circumference, BMI, triglycerides and HDL cholesterol. In a follow-up study of 1,764 primary care patients in Sicily, Amato et al. determined age-specific cut-offs that best identified patients with metabolic syndrome (NCEP-ATP III criteria). Patients above the cut-off were divided into tertiles of the VAI and labelled as having mild, moderate or severe visceral adipose dysfunction (VAD):
| Age (years) | No VAD | Mild VAD | Moderate VAD | Severe VAD |
|---|---|---|---|---|
| < 30 | ≤ 2.52 | > 2.52 and < 2.58 | ≥ 2.58 and < 2.73 | ≥ 2.73 |
| 30–41 | ≤ 2.23 | > 2.23 and < 2.53 | ≥ 2.53 and < 3.12 | ≥ 3.12 |
| 42–51 | ≤ 1.92 | > 1.92 and < 2.16 | ≥ 2.16 and < 2.77 | ≥ 2.77 |
| 52–65 | ≤ 1.93 | > 1.93 and < 2.32 | ≥ 2.32 and < 3.25 | ≥ 3.25 |
| ≥ 66 | ≤ 2.00 | > 2.00 and < 2.41 | ≥ 2.41 and < 3.17 | ≥ 3.17 |
Frequency of metabolic syndrome and of previous cardio- and cerebrovascular events in the four groups of the same study:
| No VAD | Mild VAD | Moderate VAD | Severe VAD | |
|---|---|---|---|---|
| Patients | 1,362 | 126 | 141 | 135 |
| Metabolic syndrome | 4.6% | 31.7% | 36.9% | 65.2% |
| Coronary heart disease or myocardial infarction | 1.0% | 5.6% | 7.1% | 10.4% |
| TIA or ischemic stroke | 1.5% | 7.1% | 9.9% | 11.1% |
In logistic regression models that also included age, sex, metabolic syndrome, diabetes and high blood pressure, moderate VAD (odds ratio 5.35, 95% CI 1.92–14.87) and severe VAD (odds ratio 7.46, 95% CI 2.64–21.05) were independently associated with coronary heart disease or myocardial infarction. Mild (2.73, 1.12–6.65), moderate (4.20, 1.86–9.45) and severe VAD (5.10, 2.14–12.17) were independently associated with TIA or ischemic stroke. The study was cross-sectional, so these are associations with past events, not predicted risks.
What is the VAI?
The visceral adiposity index (VAI) is a sex-specific index based on waist circumference, BMI, triglycerides and HDL cholesterol. It is intended as an indirect marker of visceral fat function ("visceral adipose dysfunction") and insulin sensitivity. It was developed by Marco C. Amato and colleagues at the University of Palermo, Italy, and published in Diabetes Care in 2010.
The data came from the AlkaMeSy study, a database of 13,195 primary care patients from Alcamo in western Sicily. A model of adipose distribution based on waist circumference and BMI was first derived from 315 healthy subjects with a BMI between 20 and 30 kg/m² and then corrected for fat function by adding triglycerides and HDL cholesterol. In 26 metabolically healthy patients, the adipose distribution model correlated with visceral fat on MRI (volume: Rs = 0.744), but not with subcutaneous fat. In 74 patients who underwent a euglycemic-hyperinsulinemic clamp, the VAI showed an inverse correlation with insulin sensitivity (Rs = −0.721), while waist circumference and BMI did not. In 1,498 primary care patients, the VAI was independently associated with cardiovascular (odds ratio 2.45, 95% CI 1.52–3.95) and cerebrovascular events (odds ratio 1.63, 95% CI 1.06–2.50).
The age-specific cut-offs were published in 2011 (Amato et al., Lipids in Health and Disease), based on 1,764 primary care patients (585 men and 1,179 women, aged 16 to 99 years). The area under the ROC curve for identifying metabolic syndrome ranged from 0.783 (age ≥ 66 years) to 0.997 (age < 30 years).
Later studies
In the Tehran Lipid and Glucose Study, 5,964 adults without diabetes were followed for incident type 2 diabetes. Diabetes risk was 4.5 times higher (95% CI 3.0–6.9) in the highest than in the lowest VAI quintile, and the VAI improved the prediction of diabetes compared with the metabolic syndrome alone. However, the simpler waist-to-height ratio predicted diabetes better than the VAI (Bozorgmanesh et al., 2011).
Formula
Men: VAI = [WC / (39.68 + 1.88 × BMI)] × (TG / 1.03) × (1.31 / HDL)
Women: VAI = [WC / (36.58 + 1.89 × BMI)] × (TG / 0.81) × (1.52 / HDL)
WC = waist circumference [cm], BMI [kg/m²], TG = triglycerides [mmol/l], HDL = HDL cholesterol [mmol/l]. BMI = weight [kg] / height [m]². If the BMI is already known, it can be entered directly.
Example: a 50-year-old man with a waist circumference of 100 cm, BMI 28 kg/m², triglycerides 2.0 mmol/l and HDL cholesterol 1.0 mmol/l has VAI = [100 / (39.68 + 1.88 × 28)] × (2.0 / 1.03) × (1.31 / 1.0) = 1.083 × 1.942 × 1.31 = 2.76. In the age group 42–51 years, this corresponds to moderate visceral adipose dysfunction (≥ 2.16 and < 2.77).
Limitations
- The VAI and its cut-offs were developed in a Caucasian population from a single town in Sicily. The authors describe the cut-offs as applying to this population; they may differ in other ethnic groups.
- The cut-offs were chosen to identify metabolic syndrome, which itself includes waist circumference, triglycerides and HDL cholesterol. The division into mild, moderate and severe dysfunction is based on tertiles and was described by the authors as arbitrary.
- Both studies were retrospective and cross-sectional, so the associations with cardio- and cerebrovascular events do not show that the VAI predicts future events. The authors state that the VAI is not a diagnostic tool for cardiovascular or cerebrovascular events.
- In an Iranian cohort, the waist-to-height ratio predicted type 2 diabetes better than the VAI.
- The VAI is a continuous variable. Values just above and just below a cut-off differ little, although they fall into different groups.
- Triglycerides and HDL cholesterol are affected by lipid-lowering drugs, alcohol, acute illness and fasting status; the original publications do not state whether fasting samples were required.
Frequently asked questions
What is a normal VAI?
The equations were scaled so that the VAI equals 1 in healthy non-obese subjects with normal fat distribution and normal triglyceride and HDL levels (Amato et al., 2010). The cut-offs above which visceral adipose dysfunction was assumed range from 1.92 to 2.52, depending on age (Amato et al., 2011).
How do I convert units for the VAI?
The calculator converts units automatically. Manually: triglycerides mg/dl ÷ 88.57 = mmol/l (e.g. 150 mg/dl ≈ 1.69 mmol/l); HDL cholesterol mg/dl ÷ 38.67 = mmol/l (e.g. 50 mg/dl ≈ 1.29 mmol/l). Waist circumference must be entered in cm and BMI in kg/m².
Why are the cut-offs age-specific?
Amato et al. divided their cohort into age quintiles and determined the best cut-off for identifying metabolic syndrome separately in each group: 2.52 (under 30 years), 2.23 (30 to under 42), 1.92 (42 to under 52), 1.93 (52 to under 66) and 2.00 (66 years and older). The cohort included patients aged 16 to 99 years, so no cut-offs are available for younger patients.
Is the cut-off "below" or "at or below" the value?
The 2011 publication defines patients with a VAI "less than or equal to" the age-specific cut-off as having no visceral adipose dysfunction, and mild dysfunction as a VAI above the cut-off. This calculator follows that definition for all age groups. The VAI is rounded to two decimals before it is compared with the cut-offs, which are also given with two decimals.
Where should the waist circumference be measured?
In the study that defined the cut-offs, waist circumference was measured at the midpoint between the lower rib and the iliac crest (Amato et al., 2011).
Related calculators
Reference
Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, Galluzzo A; AlkaMeSy Study Group. Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care. 2010;33(4):920–922. doi:10.2337/dc09-1825
Amato MC, Giordano C, Pitrone M, Galluzzo A. Cut-off points of the visceral adiposity index (VAI) identifying a visceral adipose dysfunction associated with cardiometabolic risk in a Caucasian Sicilian population. Lipids Health Dis. 2011;10:183. doi:10.1186/1476-511X-10-183
Bozorgmanesh M, Hadaegh F, Azizi F. Predictive performance of the visceral adiposity index for a visceral adiposity-related risk: type 2 diabetes. Lipids Health Dis. 2011;10:88. doi:10.1186/1476-511X-10-88
Written and medically reviewed by Frederic Eberhardt, MD. Last reviewed: 8 November 2026