Beyond obesity: the hidden burden of metabolic abnormalities

Abstract Background Metabolic syndrome (MetS) and its components are often attributed to obesity, nevertheless, many individuals without severe obesity also present with metabolic disturbances. Therefore, understanding the metabolic risk profile in adults with only moderate adiposity may considerably improve early prevention and screening strategies. Purpose To compare the prevalence and predictors of metabolic abnormalities between obese and non-obese adults. Methods A total of 9891 adults were evaluated using standardized clinical and biochemical measurements. MetS was defined according to modified NCEP ATP III (2005) criteria. Participants were classified as non-obese (body mass index (BMI) 30 kg/m²) or obese (BMI ≥ 30 kg/m²). Group comparisons used standard statistical tests and independent predictors of MetS were identified by running multivariable logistic regression. Results Non-obese participants comprised 38.5% of the sample. Despite lower BMI and waist circumference, metabolic abnormalities were common: • 76.2% met MetS criteria, • 85.6% had hypertension, • 38.5% had left ventricular hypertrophy (LVH), and • 13.2% had diabetes (all p 0.001 vs obese). In adjusted models, BMI, waist circumference, triglycerides, C-reactive protein (CRP), age, and sex were independent predictors of MetS (p 0.01). Each unit increase in BMI increased the odds by 6% with triglycerides being the strongest predictor (OR = 3.81, 95% CI 3.43–4.25). Further interaction effects showed that CRP and BMI amplified each other’s impact on metabolic risk, particularly in individuals with moderate BMI (p = 0.018). Conclusions Metabolic syndrome and its complications are highly prevalent even among non-obese adults. Moreover, the observed interaction between inflammation and adiposity reflects how inflammatory processes may amplify metabolic disturbances, even in those with only moderate excess weight. Consequently, our findings support using inflammatory markers alongside adiposity when assessing metabolic risk.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.