Key result
Metabolically unhealthy normal weight shows no significant association with undiagnosed diabetes versus healthy normal weight.
Why the study?
BMI reliability as a sole indicator of metabolic health is controversial, and a subset of normal-BMI individuals has obesity-related metabolic risks, prompting evaluation of undiagnosed diabetes in metabolically unhealthy normal-weight adults.
Does the Metabolically Unhealthy Normal Weight phenotype predict undiagnosed diabetes in normal-weight adults compared to the Metabolically Healthy Normal Weight phenotype?
Cross-Sectional (n=60,000,000)
Does the Metabolically Unhealthy Normal Weight phenotype predict undiagnosed diabetes in normal-weight adults compared to the Metabolically Healthy Normal Weight phenotype?
Effect estimate: OR 2.35 (95% CI 0.57–9.68)
Absolute Event Rate: 4.84% vs 1.28%
p-value: p=0.2
Normal-weight adults with metabolic risk factors or of Asian descent have a significantly higher risk of undiagnosed diabetes, highlighting the limitations of relying solely on BMI for screening.
May support diabetes screening by metabolic phenotype beyond BMI in normal-weight adults; hypothesis-generating and requires prospective validation.
Background/Objectives: Although body mass index (BMI) is a conventional screening tool for type 2 diabetes mellitus (T2D), its reliability as a sole indicator of metabolic health is controversial, and the metabolic profile of a subset of individuals with normal BMI is indicative of obesity-related complications. This study aimed to estimate the prevalence and predictors of undiagnosed diabetes among Metabolically Unhealthy Normal Weight (MUNW) adults. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2017–March 2020 were analyzed. Normal weight adults (BMI 18.5–24.9 kg/m2) were categorized into Metabolically Healthy (MHNW) and Unhealthy (MUNW) phenotypes based on the presence of ≥2 metabolic risk factors, including elevated blood pressure, triglycerides, waist circumference, or low HDL cholesterol. The primary outcome was undiagnosed diabetes, defined as HbA1c ≥ 6.5% or Fasting Plasma Glucose ≥ 126 mg/dL. Results: The study population represented approximately 60 million US adults. The prevalence of undiagnosed diabetes was nearly four times higher in the MUNW group (4.84%) compared to the MHNW group (1.28%). In multivariable logistic regression analysis, age and race emerged as significant predictors. Notably, Asian adults exhibited a significantly higher risk of undiagnosed diabetes (OR 6.10; 95% CI: 1.32–28.2) compared to White adults, independent of metabolic phenotype. Conclusions: Reliance solely on BMI may overlook undiagnosed diabetes in normal-weight adults, particularly those with metabolic clustering or of Asian descent. These findings underscore the importance of multidimensional risk assessment integration into preventive care, optimizing clinical management.
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Pál et al. (2026) conducted a cross-sectional in Normal-weight (BMI 18.5–24.9 kg/m2) US adults categorized by metabolic health status (n=60,000,000). Metabolically Unhealthy Normal Weight phenotype (≥2 metabolic risk factors) vs. Metabolically Healthy Normal Weight phenotype (0 or 1 metabolic risk factors) was evaluated on Prevalence of undiagnosed diabetes defined by HbA1c ≥ 6.5% or fasting plasma glucose ≥ 126 mg/dL (OR 2.35, 95% CI 0.57–9.68, p=0.2). Metabolically Unhealthy Normal Weight adults had nearly four times higher prevalence of undiagnosed diabetes (4.84%) compared to healthy normal weight adults (1.28%) with an adjusted OR of 2.35 (95% CI 0.57–9.68).
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