Abdominal obesity leads to earlier and higher CKM syndrome risk than general obesity: a cross-sectional NHANES study

Aim Obesity is an upstream driver for the progression of cardiovascular-kidney-metabolic (CKM) syndrome risk. However, the associations of general or abdominal overweight/obesity with different risk stratifications of CKM syndrome remain unclear. This study examined the associations of distinct phenotypic patterns—isolated or coexisting general and abdominal overweight/obesity—with the risk of CKM syndrome. Methods This cross-sectional analysis used data from the NHANES 2005-2020 cycles. General and abdominal overweight/obesity were defined using race-specific BMI cut-offs and WHtR cut-offs (0.5/0.6), respectively, to construct four mutually exclusive exposure phenotypes. Multivariable logistic regression assessed associations with CKM syndrome. Results Among 18,099 adult participants, coexisting overweight significantly increased the risk of progression from the CKM low-risk to high-risk stage (OR=2.11,95% CI:1.58-2.80), from stage 2 to 3-4 combined (OR=1.04,95%CI:1.01-1.06), and from stage 2-to-3 (OR=1.02,95%CI:1.01-1.03). Abdominal obesity alone significantly increased the risk of progression from the CKM low-risk to high-risk stage (OR=1.73,95%CI:1.42-2.12), from stage 1-to-2 (OR=1.36,95%CI:1.02-1.79), from stage 2-to-3 (OR=1.05,95%CI:1.02-1.08), from stage 1 to 2-4 combined (OR=1.04,95%CI:1.02-1.07), and from stage 2 to 3-4 combined (OR=1.07,95%CI:1.04-1.10). In contrast, coexisting obesity did not further increase this risk. No type of overweight or obesity was significantly associated with the risk of progression from CKM stage 3-to-4. These associations were stronger in younger individuals, those living alone, and certain racial/ethnic groups. Conclusion Abdominal obesity is a more critical CKM risk phenotype than general obesity, and its associated risk begins to manifest as early as the overweight stage, with coexisting obesity conferring no significant additional CKM risk. Early identification and intervention targeting abdominal obesity are essential for preserving CKM health.