Obesity measures and heart disease risks— the risks of overtraining and being underweight

Purpose: Obesity and abnormal fat distribution are major components of the Cardiovascular–Kidney–Metabolic (CKM) syndrome and are strongly associated with cardiovascular disease (CVD). However, the comparative performance of different anthropometric measures and the modifying role of physical activity remain incompletely defined. We aimed to examine the associations between body mass index (BMI), body fat percentage (BFP), waist-to-height ratio (WHtR), physical activity, and prevalent CVD in a large population-based cohort.Materials and methods: We conducted a cross-sectional analysis of UK Biobank participants aged 40–69 years. After excluding individuals with missing data, N = 489909 participants were included. Prevalent CVD was defined as a history of angina, myocardial infarction, or stroke at baseline assessment. Multivariable logistic regression models were used to evaluate associations between anthropometric measures and CVD, adjusting for age, sex, smoking status, and major comorbidities. Physical activity was analyzed by type and duration. Results are reported as odds ratios (OR) with 95% confidence intervals (CI).Results: BMI showed a U-shaped association with CVD, with higher prevalence observed at both low (<18.5 kg/m²) and high (>25 kg/m²) values. WHtR was positively associated with CVD across its range, whereas BFP provided little additional predictive value after adjustment. Moderate physical activity was associated with lower odds of CVD, while very high volumes of vigorous activity showed no additional benefit and were associated with slightly higher CVD prevalence.