Association between different visceral fat distribution metrics and risk of abdominal wall hernia

Obesity increases the risk of abdominal wall hernia (AWH). Body mass index (BMI) is widely used to define obesity, but it does not reflect fat distribution, especially visceral fat. Therefore, relying solely on BMI may be insufficient for assessing the relationship between obesity and AWH. This study examined the associations of visceral fat area (VFA) and waist circumference (WC) with AWH. A total of 417 participants were included in this study, including 209 patients with AWH and 208 healthy controls. VFA and WC were measured by bioelectrical impedance analysis. Multivariable logistic regression, smooth curve fitting, and subgroup analyses were used to evaluate the associations between VFA, WC, and AWH. Additionally, receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Compared with the controls, AWH patients had significantly higher VFA and WC ( P < 0.001). After adjustment for potential confounders, both VFA and WC were strongly and positively associated with AWH risk, with evidence of nonlinear relationships. Subgroup analysis demonstrated that the correlation remained consistent across various populations ( P -interraction > 0.05). ROC analysis indicated good diagnostic value for both indices (area under the curve: VFA = 0.726; WC = 0.727). Our findings that increased VFA and WC are associated with a higher risk of AWH contribute to our understanding of the relationship between visceral fat distribution and AWH. This finding further supports that keeping VFA and WC within healthy ranges may help prevent AWH. However, inference is limited by the cross‑sectional, single‑center design and incomplete data on hernia type, defect size, and certain risk factors. Confirmation in multi-center prospective cohorts is needed.