March 3, 2026

Body Fat and Cardiometabolic Disease Burden and All-Cause Mortality in Adults With Normal Body Mass Index

Key Points

Higher body fat levels are linked to an increased burden of cardiometabolic disease and all-cause mortality in adults with a normal body mass index.
The analysis shows that even within a normal body mass index range, excess body fat can significantly impact health outcomes.

Structured PICO

Does higher body fat percentage increase cardiometabolic disease burden and all-cause mortality in adults with normal body mass index?

Population

20,613 adults 20 to 65 years of age (including 6,424 with normal BMI 18.5-24.9 kg/m2) from the US National Health and Nutrition Examination Survey (NHANES) from 1999-2006 and 2011-2018.

Intervention

Higher body fat percentage (BF%) measured by dual x-ray absorptiometry (DXA)

Comparator

Lower body fat percentage (BF%) tertiles

Outcome

Metabolic disorders (insulin resistance, metabolic syndrome, dyslipidemia, type 2 diabetes mellitus, and hypertension) and all-cause mortalityhard clinical

Higher body fat percentage identifies increased cardiometabolic and mortality risk even among individuals with a normal BMI, highlighting the limitations of BMI alone for risk stratification.

Abstract

OBJECTIVE: To test the hypothesis that body adiposity measured by dual x-ray absorptiometry is associated with metabolic disorders and all-cause mortality in normal-weight individuals. METHODS: Adults 20 to 65 years of age with normal body mass index (BMI) and dual x-ray absorptiometry examination in the US National Health and Nutrition Examination Survey from 1999-2006 and 2011-2018 were evaluated. Follow-up was until December 2019. Weighted logistic regression and Cox proportional hazard models were performed to test the association between body fat percentage (BF%) and metabolic disorders (ie, insulin resistance, metabolic syndrome, dyslipidemia, type 2 diabetes mellitus, and hypertension) and mortality. Models were adjusted for potential confounders while considering complex survey design and were further stratified by sex and BF% as tertiles in normal-weight individuals. RESULTS: Included in this study sample were 20,613 individuals of whom 6424 were normal weight by BMI (18.5-24.9 kg/m CONCLUSION: Even in these normal weight subjects, increases in body adiposity are significantly associated with increased cardiometabolic disease burden and mortality.

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Cite This Study

Chen et al. (Sun,) studied this question.

synapsesocial.com/papers/69a7654fbadf0bb9e87d8aed https://doi.org/https://doi.org/10.1016/j.mayocp.2025.06.022

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