2654-P: The Clinical Outcomes of Preclinical and Clinical Obesity across Multiple Cohorts

Introduction and Objective: The Lancet Diabetes & Endocrinology Commission proposed a new definition of clinical obesity, based on excess adiposity with organ dysfunction or activity limitation; however, its prognostic value across populations remains uncertain. Methods: We applied the Commission’s criteria to define clinical obesity in the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), and the National Health and Nutrition Examination Survey (NHANES). Participants were categorized into four groups according to obesity and organ dysfunction status: non-obesity without dysfunction, non-obesity with dysfunction, pre-clinical obesity, and clinical obesity. The prevalence of clinical obesity was estimated by subtracting the prevalence of organ dysfunction in the non-obese comparator group. Cox proportional hazards models estimated risks of all-cause and cardiovascular mortality and events. Results: Clinical obesity prevalence was 2.50% in CHARLS, 6.18% in ELSA, and 9.08% in NHANES and was lower among older adults and men. Compared with non-obesity without dysfunctions, clinical obesity increased the cardiovascular risk. Relative to preclinical obesity, clinical obesity was associated with increased cardiovascular event risk in CHARLS (HR 2.50, 95% CI 1.32-4.71) and ELSA (HR 1.80, 95% CI 1.02-3.16), and with higher all-cause (HR 1.88, 95% CI 1.23-2.87) and cardiovascular mortality (HR 3.14, 95% CI 1.51-6.53) in NHANES. Conclusion: Under a strict diagnostic algorithm, clinical obesity was less prevalent in older adults and men, warranting re-evaluate its discriminatory performance in these groups. Nevertheless, clinical obesity robustly predicted cardiovascular and mortality risk, supporting its high prognostic value. Disclosure Q. Huang: None. S. Li: None. L. Ji: None. X. Zou: None. Funding National Natural Science Foundation of China (82500988 to Qi Huang), the Special Funds of the National Natural Science Foundation of China (T2341011 to Xiantong Zou), Beijing Nova Cross Program of Science and Technology (20250484806, to Xiantong Zou), Peking University People’s Hospital Research and Development Funds (grant numbers RZ2024-03to Xiantong Zou)