Ma Miaomiao, Lv Deliang, Wu Xiaobing, Chen Yuqing, Dai Shimiao, Luo Yutian, Yang Hui, Xie Wei, Xie Fengzhu, Shang Qinggang, Zhang Ziyang, Zhao Zhiguang, Zhou Ji-Chang
Shenzhen Center for Chronic Disease Control, Shenzhen, China.
School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, China.
PLoS One. 2025 Jan 8;20(1):e0316346. doi: 10.1371/journal.pone.0316346. eCollection 2025.
The increased risks for cardiovascular comorbidities and cardiovascular diseases (CVD) in populations with normal weight obesity (NWO) have not been well-identified. We aimed to study their associations in an adult population in South China.
Based on the CVD prevalence of 4% in Shenzhen and a calculated sample size of 6,000, a cross-sectional study with a multi-stage stratified cluster sampling method was conducted in Shenzhen City. The cardiovascular comorbidities being studied were abdominal obesity (AO), diabetes, hypertension, dyslipidemia, metabolic syndrome, and chronic kidney disease, while the CVD events were occurrences of myocardial infarction and strokes. Questionnaire surveys, physical examinations, and laboratory tests were performed. NWO was defined as a condition with the highest tertile of body fat percentage (BF%) among the normal body mass index (BMI) range (18.5-23.9 kg/m2). Continuous data were reported as mean [standard deviation (SD)] and categorical data as percentages (%). CVD comorbidities and CVD events and their detection rates in different groups were compared using ANONA analysis and Chi-squared test. Spearman's correlation coefficients between BF% and cardiometabolic abnormalities were calculated by partial correlation analysis. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for BF%, CVD comorbidities, and CVD events, adjusted for multiple confounders.
Among the total 6,240 subjects who completed the study and had BMI and BF% data available, 3,086 had normal BMI. The prevalence of NWO was 16.36%, with 13.15% for men and 19.54% for women. With confounders adjusted, the risks of AO (OR = 6.05, 95%CI = 3.40-10.75), essential hypertension (OR = 1.56, 95%CI = 1.09-2.22), dyslipidemia (OR = 1.85, 95%CI = 1.49-2.29), and metabolic syndrome (OR = 4.61, 95%CI = 2.32-9.18) were significantly increased in the populations with NWO compared with the population without NWO (P < 0.05). BF% was not significantly associated with the risk of CVD events in the total (OR = 1.56, 95%CI = 0.83-2.93), male (OR = 1.00, 95%CI = 0.44-2.30), and female populations (OR = 2.53, 95%CI = 0.91-7.06).
NWO was found to be positively associated with CVD comorbidities but not with CVD events. The current study provides a ground to conduct further studies on whether body fat affects the risk of occurrence of CVD events and the underlying mechanisms in the future.
体重正常的肥胖（NWO）人群中心血管合并症和心血管疾病（CVD）风险增加的情况尚未得到充分明确。我们旨在研究中国南方成年人群中它们之间的关联。
基于深圳市4%的CVD患病率以及计算得出的6000例样本量，在深圳市采用多阶段分层整群抽样方法进行了一项横断面研究。所研究的心血管合并症包括腹型肥胖（AO）、糖尿病、高血压、血脂异常、代谢综合征和慢性肾脏病，而CVD事件为心肌梗死和中风的发生情况。进行了问卷调查、体格检查和实验室检测。NWO被定义为在正常体重指数（BMI）范围（18.5 - 23.9 kg/m²）内体脂百分比（BF%）处于最高三分位数的情况。连续数据以均值[标准差（SD）]报告，分类数据以百分比（%）报告。使用方差分析和卡方检验比较不同组中CVD合并症、CVD事件及其检出率。通过偏相关分析计算BF%与心血管代谢异常之间的Spearman相关系数。使用多变量逻辑回归模型估计经多种混杂因素调整后的BF%、CVD合并症和CVD事件的比值比（OR）和95%置信区间（CI）。
在完成研究且有BMI和BF%数据的总共6240名受试者中，3086人BMI正常。NWO的患病率为16.36%，男性为13.15%，女性为19.54%。在调整混杂因素后，与无NWO的人群相比，NWO人群中AO（OR = 6.05，95%CI = 3.40 - 10.75）、原发性高血压（OR = 1.56，95%CI = 1.09 - 2.22）、血脂异常（OR = 1.85，95%CI = 1.49 - 2.29）和代谢综合征（OR = 4.61，95%CI = 2.32 - 9.18）的风险显著增加（P < 0.05）。BF%与总体人群（OR = 1.56，95%CI = 0.8
