Abstract
<title>Abstract</title> <p>Background Diabetes mellitus (DM) is a major contributor to global morbidity and mortality, particularly in developing regions. Effective identification of high-risk individuals is crucial for targeted prevention and resource allocation. This population-based study aimed to compare the association and discriminative performance of novel visceral adiposity indices—Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI), and Waist-triglyceride Index (WTI)—with traditional measures (Body Mass Index [BMI] and Waist Circumference [WC]), in detecting diabetes. Methods Data from 17,945 participants in the Iran 2021 WHO STEPwise approach to Noncommunicable Disease Risk Factor Surveillance (STEPS) survey were analysed. Associations with diabetes were examined in multivariable logistic regression models. Discriminative performance was assessed using receiver operating characteristic curve (ROC) analysis. Stratified analyses were performed by sex, age group, and place of residence Results All indices were significantly associated with diabetes. LAP and WC showed the highest discriminatory ability, with similar areas under the curve (AUC) (0.70, 95% CIs: 0.69–0.71) followed by WTI (0.67, 95% CI: 0.67–0.68), BMI (0.66, 95% CI: 0.65–0.67), and VAI (0.65, 95% CI: 0.64–0.66). Discriminative ability was consistently higher in female, rural residents, and participants younger than 60 years old. LAP outperformed BMI, but did not differ significantly from WC. Conclusion LAP and WC exhibited superior discrimination for diabetes compared to BMI. Given their accessibility, these indices may enhance diabetes risk stratification. Prospective studies are warranted to evaluate their predictive utility.</p>