Normal-weight central obesity and cardiometabolic risk among adolescents and young adults in 70 countries

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Normal-weight central obesity and cardiometabolic risk (n=60618). Intervention: Normal-weight central obesity (waist-to-height ratio >= 0.5 with normal BMI) vs. Normal BMI and no central obesity. Primary outcome: Hypertension (aOR 1.28, 95% CI 1.15-1.41).

Q: What does this research mean for the field?

Normal-weight central obesity affects nearly one in five adolescents and young adults globally and is associated with significantly increased odds of hypertension, diabetes, and elevated cholesterol. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Setognal Birara Aychiluhm; Allen Guy Ross; Vivian Isaac; Subash Thapa; Kedir Yimam Ahmed

doi:10.1038/s41598-026-77815-9

October 30, 2026Scientific ReportsOpen Access

Normal-weight central obesity and cardiometabolic risk among adolescents and young adults in 70 countries

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Key result

Normal-weight central obesity in youth linked to ~28% higher odds of hypertension.

aOR 1.28
95% CI 1.15-1.41
n=60,618

Why the study?

Body mass index does not capture central adiposity, which raises cardiometabolic risk even at normal BMI, motivating an estimation of the prevalence and cardiometabolic associations of central obesity and normal-weight central obesity in adolescents and young adults across 70 countries.

What is the global prevalence of central obesity and normal-weight central obesity among adolescents and young adults, and is normal-weight central obesity associated with increased odds of hypertension, diabetes, and elevated cholesterol compared to normal BMI without central obesity?

Key Points

To estimate the global prevalence of central obesity and normal-weight central obesity and determine their associations with cardiometabolic risk in adolescents and young adults across 70 countries.
Cross-sectional study analyzing World Health Organization STEPS survey data collected from 2010 to 2023 across 70 countries, including 60,618 participants aged 15–29 years.
Central obesity was defined as a waist-to-height ratio ≥ 0.5, and normal-weight central obesity was defined as central obesity occurring alongside a normal body mass index.
Prevalence was pooled using random-effects meta-analysis, and associations with cardiometabolic outcomes were assessed using multilevel logistic regression models.
Pooled prevalence among participants was 42.1% (95% CI 37.9–46.2; I2 = 98.9%) for central obesity and 18.8% (95% CI 16.5–21.0; I2 = 94.0%) for normal-weight central obesity.
Compared with individuals with normal body mass index and no central obesity, normal-weight central obesity was associated with higher odds of hypertension (aOR 1.28, 95% CI 1.15–1.41), diabetes (aOR 1.36, 95% CI 1.08–1.71), and elevated cholesterol (aOR 1.90, 95% CI 1.70–2.13).

Study Design

Type

Cross-Sectional (n=60,618)

Multicenter

Yes

Structured PICO

What is the global prevalence of central obesity and normal-weight central obesity among adolescents and young adults, and is normal-weight central obesity associated with increased odds of hypertension, diabetes, and elevated cholesterol compared to normal BMI without central obesity?

P

Population

60,618 non-pregnant adolescents and young adults aged 15-29 years (48.9% female) across 70 countries from nationally representative WHO STEPS cross-sectional surveys (2010-2023).

E

Exposure

Central obesity (defined as waist-to-height ratio [WHtR] ≥ 0.5) and normal-weight central obesity (defined as central obesity [WHtR ≥ 0.5] with a normal BMI or BMI-for-age).

C

Comparator

Normal BMI and no central obesity (WHtR < 0.5).

O

Outcome

Pooled prevalence of central obesity and normal-weight central obesity, and their associations with major cardiometabolic outcomes: hypertension (SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or current use of antihypertensive medication), diabetes (fasting blood glucose ≥ 126 mg/dL [≥ 7 mmol/L] or use of glucose-lowering medication), and elevated total cholesterol (total cholesterol ≥ 190 mg/dL [≥ 5.0 mmol/L] or use of lipid-lowering medications).surrogate

Main Result

Odds Ratio: 1.28 (95% CI 1.15–1.41)

Nearly one in five adolescents and young adults globally have normal-weight central obesity, which is significantly associated with higher odds of hypertension, diabetes, and elevated cholesterol, supporting the addition of waist-to-height ratio to routine BMI screening in young populations.

Limitations

Substantial between-country heterogeneity in pooled prevalence estimates (I2 = 98.9% for central obesity and 94.0% for normal-weight central obesity)
Primary sampling unit identifiers were not consistently available in the harmonised dataset, so each observation was treated as an individual primary sampling unit
Prespecified survey thresholds for hypertension and high total cholesterol served as operational survey classifications rather than clinical diagnostic criteria
Cross-sectional household survey design
Substantial between-country heterogeneity in prevalence estimates (I² = 98.9% for central obesity and 94.0% for normal-weight central obesity)
Thresholds for hypertension and high total cholesterol served as operational survey classifications rather than clinical diagnostic criteria
Analyses were based on complete cases for each outcome, excluding participants with missing data on the relevant outcome, exposure, or survey weight

Implication

Normal-weight central obesity may signal cardiometabolic risk despite normal BMI; leaves open its addition to youth screening pending longitudinal data.

Abstract

Body mass index (BMI) does not capture central adiposity, which raises cardiometabolic risk even at normal BMI. We estimated the prevalence of central obesity and normal-weight central obesity, and their cardiometabolic associations, among adolescents and young adults (15–29 years) in 70 countries using WHO STEPS data (2010–2023; n = 60,618). Central obesity was defined as a waist-to-height ratio ≥ 0.5, and normal-weight central obesity as central obesity with a normal BMI. Prevalence estimates were pooled using a random-effects meta-analysis; multilevel logistic regression examined associated factors and cardiometabolic associations. Pooled prevalence was 42.1% (95% CI 37.9–46.2) for central obesity and 18.8% (95% CI 16.5–21.0) for normal-weight central obesity, with substantial between-country heterogeneity (I 2 = 98.9 and 94.0%, respectively). Compared with normal BMI and no central obesity, normal-weight central obesity was associated with higher odds of hypertension (aOR 1.28, 95% CI 1.15–1.41), diabetes (aOR 1.36, 95% CI 1.08–1.71), and elevated cholesterol (aOR 1.90, 95% CI 1.70–2.13). More than two in five young people had central obesity, including nearly one in five with normal BMI; this phenotype was associated with cardiometabolic risk across income settings. Adding waist-based measures to BMI screening could help identify at-risk young people.

Discussion

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Cite This Study

Aychiluhm et al. (2026) conducted a cross-sectional in Normal-weight central obesity and cardiometabolic risk (n=60,618). Normal-weight central obesity (waist-to-height ratio >= 0.5 with normal BMI) vs. Normal BMI and no central obesity was evaluated on Hypertension (aOR 1.28, 95% CI 1.15-1.41). Normal-weight central obesity had a 18.8% global prevalence in youth and was associated with higher odds of hypertension (aOR 1.28), diabetes (aOR 1.36), and elevated cholesterol (aOR 1.90).

synapsesocial.com/papers/6ae682bde432e7a5c4ef372a https://doi.org/10.1038/s41598-026-77815-9

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Normal-weight central obesity and cardiometabolic risk among adolescents and young adults in 70 countries

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Normal-weight central obesity and cardiometabolic risk among adolescents and young adults in 70 countries

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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