Why the study?
BMI may classify some adults as normal weight even when excess abdominal adiposity is present, potentially masking an unfavorable cardiometabolic profile.
Does normal-weight central obesity increase the odds of prevalent hypertension compared to normal weight without central obesity in US adults?
Cross-Sectional (n=9,867)
Yes
Does normal-weight central obesity increase the odds of prevalent hypertension compared to normal weight without central obesity in US adults?
Normal-weight adults with central obesity have more than double the odds of prevalent hypertension and nearly double the odds of low HDL-C compared to normal-weight adults without central obesity, highlighting the clinical utility of measuring waist circumference alongside BMI.
May warrant waist circumference assessment in normal-weight adults; leaves open prospective validation before guiding risk stratification.
Body Mess Index (BMI) may classify some adults as normal weight even when excess abdominal adiposity is present, potentially masking an unfavorable cardiometabolic profile. We investigated this discordance by examining four BMI–waist circumference phenotypes in 9,867 adults participating in NHANES 2015–2018. Hypertension was the primary outcome, with diabetes and low HDL-C evaluated as secondary outcomes. Associations were estimated using logistic regression that incorporated the NHANES survey design and sequential adjustment for demographic, socioeconomic, and lifestyle characteristics. Relative to adults with normal BMI and normal waist circumference, those with normal-weight central obesity had greater odds of hypertension after full adjustment (OR 2.12, 95% CI 1.13–4.00). Higher odds of low HDL-C were also observed in this phenotype, whereas the association with diabetes was not statistically significant. These results suggest that BMI and waist circumference capture different aspects of adiposity and that considering both measures may better identify normal-weight adults with elevated cardiometabolic burden.
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Juntao He (2026) conducted a cross-sectional in Hypertension and cardiometabolic risk across BMI-waist circumference phenotypes (n=9,867). Normal-weight central obesity (BMI 18.5 to <25.0 kg/m² with waist circumference ≥102 cm in men or ≥88 cm in women) vs. Normal weight without central obesity (BMI 18.5 to <25.0 kg/m² with normal waist circumference) was evaluated on Prevalent hypertension (mean SBP ≥130 mmHg, mean DBP ≥80 mmHg, or current antihypertensive medication use) (OR 2.12, 95% CI 1.13-4.00, p=0.024).
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