Prevalence, Geographic Distribution, and Socioeconomic Disparities of Normal-Weight Central Obesity: An Analysis of 46,493 Adults

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Normal-weight central obesity (NWCO) (n=46493). Intervention: Normal weight (BMI 18.5–24.9 kg/m2) across sociodemographic, geographic, and wealth strata vs. Lowest wealth quintile / male sex / reference sociodemographic strata. Primary outcome: Prevalence of normal-weight central obesity (NWCO, defined as BMI 18.5–24.9 kg/m2 with waist circumference ≥80 cm in women or ≥90 cm in men) (Prevalence 35.1%; RII 1.93 across wealth rank, 95% CI 34.4-35.9).

Q: What does this research mean for the field?

Normal-weight central obesity affects over one-third of normal-BMI Peruvian adults, with substantially higher prevalence in women, older individuals, and wealthier socioeconomic groups. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lily Mabel Portal-Valqui; Adriana Mishell Yoplac-Oyarce; Kevin Cusma-Regalado; Jhosmer Ballena-Caicedo; Fiorella Elvira Zuzunaga-Montoya; Rossmery Leonor Poemape Mestanza; Marcos Francisco Garavito Castillo; Víctor Juan Vera-Ponce

doi:10.14740/jem1639

October 1, 2026Journal of Endocrinology and MetabolismOpen Access

Prevalence, Geographic Distribution, and Socioeconomic Disparities of Normal-Weight Central Obesity: An Analysis of 46,493 Adults

View Full Paper

Ask AI

Bookmark

Share

Key result

Normal-weight central obesity affects ~35% of normal-BMI Peruvian adults, predominantly women and wealthier groups.

Prevalence 35.1%; RII 1.93 across wealth rank
95% CI 34.4-35.9
n=46,493

Why the study?

Normal-weight central obesity is a metabolically adverse phenotype often overlooked when using BMI alone, and its prevalence, geographic distribution, socioeconomic inequalities, and temporal trends from 2018 to 2024 among Peruvian adults required characterization.

Key Points

To evaluate the prevalence, geographic distribution, socioeconomic inequalities, and temporal trends of normal-weight central obesity among Peruvian adults from 2018 to 2024.
Analytical cross-sectional analysis using national ENDES 2018–2024 survey data with directly measured anthropometrics in 46,493 normal-weight adults aged ≥ 18 years (BMI 18.5–24.9 kg/m2).
Normal-weight central obesity was defined as a waist circumference ≥ 80 cm in women or ≥ 90 cm in men (with ATP III cutoffs of ≥ 88 cm and ≥ 102 cm used in sensitivity analyses).
Analyses accounted for complex survey design, quantifying socioeconomic inequality with the Slope Index of Inequality, Relative Index of Inequality, and concentration index, alongside spatial autocorrelation (Moran's I) and linear regression for temporal trends.
Among 46,493 normal-weight adults, 15,907 had normal-weight central obesity, representing a prevalence of 35.1% (95% CI: 34.4–35.9%), which was higher in women (58.9%) than men (14.2%) and peaked in adults aged ≥ 60 years (48.9%).
Prevalence rose across wealth quintiles from 26.7% in the lowest to 46.4% in the highest quintile (Slope Index of Inequality = 0.23, 95% CI: 0.204–0.256; Relative Index of Inequality = 1.93, 95% CI: 1.80–2.07; concentration index = 0.100).
Prevalence ranged from 24.0% to 41.9% across departments without statistically significant spatial autocorrelation (Moran's I = 0.167, P = 0.070), and temporal trends remained stable overall (−0.46 percentage points per year, P = 0.172).

Study Design

Type

Cross-Sectional (n=46,493)

Multicenter

Yes

Structured PICO

P

Population

46,493 Peruvian adults aged ≥18 years with normal BMI (18.5–24.9 kg/m2) and directly measured anthropometrics surveyed in ENDES between 2018 and 2024.

O

Outcome

Prevalence of normal-weight central obesity (NWCO), defined as BMI 18.5-24.9 kg/m2 with waist circumference >= 80 cm in women or >= 90 cm in men (IDF criteria for Latin American populations).surrogate

Main Result

Effect estimate: Prevalence 35.1%; RII 1.93 across wealth rank (95% CI 34.4-35.9)

Limitations

Cross-sectional design precludes assessment of causal relationships or the longitudinal natural history of NWCO.
Waist circumference cannot distinguish visceral adipose tissue from abdominal subcutaneous fat.
Lack of direct body composition measures and key clinical or behavioral covariates such as menopausal status, parity, detailed diet, and objectively measured physical activity.
Use of IDF waist circumference cutoffs not specifically validated for the Peruvian population or adjusted for altitude, potentially introducing misclassification.
Departmental-level spatial analysis may mask within-department heterogeneity and is subject to ecological fallacy.
Repeated cross-sectional survey design where participants were not followed across years, precluding longitudinal within-person trajectory assessment
IDF waist circumference thresholds have not been specifically validated in the Peruvian adult population
2020-2021 survey rounds were affected by the COVID-19 pandemic, requiring cautious interpretation of fieldwork comparability
Complete-case analysis was used without multiple imputation for missing data

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

More than one-third of Peruvian adults with a normal BMI have central obesity (particularly women and those in higher socioeconomic strata), underscoring the need to routinely measure waist circumference in clinical assessments rather than relying on BMI alone.

Abstract

Background: Normal-weight central obesity (NWCO) represents a metabolically adverse phenotype that is often overlooked when nutritional status is assessed using body mass index (BMI) alone. This study aimed to determine the prevalence of NWCO among Peruvian adults, characterize its geographic distribution using spatial autocorrelation, assess socioeconomic inequalities, and analyze temporal trends from 2018 to 2024. Methods: An analytical cross-sectional study using ENDES 2018–2024 data with directly measured anthropometric information was conducted. Adults aged ≥18 years with normal weight (BMI 18.5–24.9 kg/m2) were included. NWCO was defined as waist circumference ≥ 80 cm in women or ≥ 90 cm in men. Prevalences were estimated accounting for the complex survey design; socioeconomic inequalities were assessed using the Slope Index of Inequality (SII), Relative Index of Inequality (RII), and concentration index; temporal trends were evaluated using linear regression; spatial autocorrelation was examined using global Moran’s I and local indicators of spatial association (LISA); and an ATP III-based sensitivity analysis was performed using waist circumference cutoffs of ≥ 88 cm in women and ≥ 102 cm in men. Results: Among 46,493 adults with normal weight, 15,907 (35.1%; 95% confidence interval (CI): 34.4–35.9%) had NWCO. Prevalence was higher in women (58.9%) than in men (14.2%) and increased with age (25.0% in 18–29 years vs. 48.9% in ≥ 60 years). A positive socioeconomic gradient was observed: 26.7% in the lowest wealth quintile to 46.4% in the highest wealth quintile (SII = 0.23; RII = 1.93; concentration index = 0.100). At the departmental level, NWCO prevalence among adults with normal BMI ranged from 24.0% in Huancavelica to 41.9% in Tacna. Global Moran’s I was 0.167 (P = 0.070), and no significant LISA clusters were identified. No statistically significant temporal change was observed overall (−0.46 percentage points per year (pp/year), P = 0.172), among men (−0.21 pp/year, P = 0.356), or among women (−0.63 pp/year, P = 0.101). In sensitivity analyses using ATP III cutoffs, NWCO prevalence was substantially lower (8.0%; 95% CI: 7.6–8.4%) but remained concentrated among women and higher wealth groups. Conclusions: More than one-third of Peruvian adults with normal weight have central obesity, with a female predominance, concentration in higher socioeconomic strata, and marked geographic heterogeneity without statistically significant spatial clustering after correction of the departmental estimand. These findings support incorporating waist circumference measurement into routine adult clinical assessment, including primary care visits, even when BMI is within the normal range.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Portal-Valqui et al. (2026) conducted a cross-sectional in Normal-weight central obesity (NWCO) (n=46,493). Normal weight (BMI 18.5–24.9 kg/m2) across sociodemographic, geographic, and wealth strata vs. Lowest wealth quintile / male sex / reference sociodemographic strata was evaluated on Prevalence of normal-weight central obesity (NWCO, defined as BMI 18.5–24.9 kg/m2 with waist circumference ≥80 cm in women or ≥90 cm in men) (Prevalence 35.1%; RII 1.93 across wealth rank, 95% CI 34.4-35.9). Normal-weight central obesity affected 35.1% (95% CI 34.4–35.9%) of normal-BMI Peruvian adults, with higher prevalence in women (58.9% vs 14.2%) and the richest wealth quintile (46.4% vs 26.7%).

synapsesocial.com/papers/6af0e999de503f37741409ce https://doi.org/10.14740/jem1639

View Full Paper

Ask AI

Bookmark

Share

Prevalence, Geographic Distribution, and Socioeconomic Disparities of Normal-Weight Central Obesity: An Analysis of 46,493 Adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prevalence, Geographic Distribution, and Socioeconomic Disparities of Normal-Weight Central Obesity: An Analysis of 46,493 Adults

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading