Visceral adiposity index is associated with insulin resistance, impaired insulin secretion, and β-cell dysfunction in subjects at risk for type 2 diabetes

•The Visceral Adiposity Index (VAI) is useful to assess dysfunctional adipose tissue.•The VAI is associated with insulin resistance (IR).•The VAI is associated with impaired first and late-insulin secretion.•The VAI is associated with decreased β-cell function.•In a Mexican population at risk for type 2 diabetes, a VAI of 2.23 had the best sensitivity for identifying insulin resistance and a VAI of 3 had the best sensitivity for identifying β-cell dysfunction.•The VAI could be useful to evaluate IR and β-cell dysfunction in primary prevention in Mexican subjects at risk for type 2 diabetes. Increased visceral adiposity, insulin resistance, and β-cell dysfunction predispose to type 2 diabetes (T2D). The Visceral Adiposity Index (VAI) is an indicator of visceral fat function obtained from the association between BMI, Triglycerides, HDL-C, and waist circumference, and is a reliable tool to assess the cardiometabolic risk, however, its association with insulin resistance and decreased β-cell function in primary prevention for T2D has not been fully yielded. This is a retrospective cross-sectional study that included 354 asymptomatic subjects, without any known chronic disease, with at least two risk factors for T2D that underwent an oral glucose tolerance test. Patients with newly diagnosed T2D were excluded from the analysis. Participants were 51 ± 8 years old, 72.2% were women, had a mean body mass index of 29.9 ± 6.5 kg/m2 and a median VAI of 3.00. The homeostasis model assessment of insulin resistance (HOMA-IR) (r = 0.324), Matsuda index (r = -0.325), first-phase insulin secretion (S1PhOGTT) (r = 0.138), second-phase insulin secretion (S2PhOGTT) (r = 0.137), HOMA-B (r = 0.224), and disposition index (r = -0.165) were significantly correlated with the VAI. After multiple linear regression analysis, the VAI was independently associated with HOMA-IR (β = 0.305), Matsuda Index (β = -0.303), S1PhOGTT (β = 0.143), S2PhOGTT (β = 0.140), HOMA-B (β = 0.204), and the disposition index (β = -0.146). Likewise, a VAI of 2.23 had a sensitivity/specificity of 81.9% and 41.5%, respectively, for identifying a HOMA-IR ≥ 2.5; and a VAI of 3.00 had a sensitivity/specificity of 61.3% and 41.8%, respectively, for identifying a disposition index ≤1.24. The VAI was independently associated with insulin resistance, impaired insulin secretion and β-cell dysfunction in subjects at risk for developing T2D.