Guerra Valencia Jamee, Hernández-Vásquez Akram, Mayta-Tristán Percy, Saavedra-Garcia Lorena, Vargas-Fernández Rodrigo
Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru.
Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
Lancet Reg Health Am. 2025 Aug 29;50:101217. doi: 10.1016/j.lana.2025.101217. eCollection 2025 Oct.
Traditional obesity classification based on body mass index (BMI) fails to capture body fat distribution or clinical dysfunction, and may therefore fail to identify people at highest cardiometabolic risk. The Lancet Diabetes & Endocrinology Commission recently proposed a new framework distinguishing preclinical from clinical obesity based on excessive adiposity and clinical dysfunction. We aimed to estimate the prevalence of clinical and preclinical obesity in Peruvian adults using the Commission's criteria and adapted regional cutoffs, and to generate ethnicity-specific reference curves for waist circumference (WC) and waist-to-height ratio (WHtR).
This cross-sectional analysis used nationally representative data from 2021 to 2023 Peruvian Demographic and Health Surveys (ENDES), including 84,622 adults aged ≥20 years. Clinical obesity was defined as excess body fat (BMI, WC, or WHtR) plus diabetes or hypertension diagnosis. Preclinical obesity was defined as excess body fat without clinical dysfunction. Age-adjusted prevalence estimates were calculated using four anthropometric criteria and stratified by sex. Ethnicity-specific WC and WHtR reference curves were generated using GAMLSS models, stratified by age and sex.
A total of 84,622 participants were included in the study. Among these participants, mean age was 44.1 (range: 20-97) years, and 48,300 participants (51.7%) were female. Clinical obesity age-adjusted prevalence ranged from 15.7% to 22.1%, and preclinical obesity from 28.7% to 53.8%, depending on cutoffs used. Up to 13.5% of individuals with normal BMI and 21% of those overweight met criteria for clinical obesity. Women showed the highest prevalence estimates of preclinical obesity, ranging from 33.4% to 65.8%, whereas men reached their highest prevalence (41.3%) when the International Diabetes Federation (IDF) cutoffs were applied. In the case of clinical obesity, women had higher prevalence estimates of clinical obesity when applying the Lancet Commission approach (18.7%) and the Peruvian national guidelines (21.4%). Men showed higher prevalence estimates when using the cutoffs proposed by the Latin American Consortium of Studies in Obesity (LASO) (16.8%) and the IDF (22.8%). Reference curves showed that Quechua-Aymara individuals had lower WC and WHtR values compared to Afro-Peruvian and other groups at the 97th percentile, in both men and women.
Reliance on BMI alone underestimates a large proportion of clinically relevant cases. Incorporating WC-measurements and clinical dysfunction into diagnostic frameworks could improve identification, prevention, and policy responses to obesity in Peru and similar settings.
The authors received no financial support.
基于体重指数（BMI）的传统肥胖分类未能反映体脂分布或临床功能障碍，因此可能无法识别心血管代谢风险最高的人群。《柳叶刀糖尿病与内分泌学委员会》最近提出了一个新框架，根据过度肥胖和临床功能障碍将临床前肥胖与临床肥胖区分开来。我们旨在使用该委员会的标准和调整后的区域临界值来估计秘鲁成年人中临床肥胖和临床前肥胖的患病率，并生成针对不同种族的腰围（WC）和腰高比（WHtR）参考曲线。
这项横断面分析使用了2021年至2023年秘鲁人口与健康调查（ENDES）具有全国代表性的数据，包括84622名年龄≥20岁的成年人。临床肥胖定义为身体脂肪过多（BMI、WC或WHtR）加上糖尿病或高血压诊断。临床前肥胖定义为没有临床功能障碍的身体脂肪过多。使用四种人体测量标准计算年龄调整后的患病率估计值，并按性别分层。使用GAMLSS模型生成针对不同种族的WC和WHtR参考曲线，按年龄和性别分层。
共有84622名参与者纳入研究。在这些参与者中，平均年龄为44.1岁（范围：20 - 97岁），48300名参与者（51.7%）为女性。根据所使用的临界值，临床肥胖的年龄调整患病率在15.7%至22.1%之间，临床前肥胖在28.7%至53.8%之间。BMI正常的个体中高达13.5%以及超重个体中21%符合临床肥胖标准。女性的临床前肥胖患病率估计最高，在33.4%至65.8%之间，而男性在应用国际糖尿病联盟（IDF）临界值时达到最高患病率（41.3%）。在临床肥胖方面，采用《柳叶刀委员会》方法（18.7%）和秘鲁国家指南（21.4%）时，女性的临床肥胖患病率估计较高。男性在使用拉丁美洲肥胖研究联盟（LASO）提出的临界值（16.8%）和IDF临界值（22.8%）时患病率估计较高。参考曲线显示，在第97百分位数时，克丘亚 - 艾马拉族个体的WC和WHtR值低于非裔秘鲁人和其他群体，男女皆是如此。
仅依靠BMI会低估很大一部分具有临床相关性的病例。将WC测量和临床功能障碍纳入诊断框架可以改善秘鲁及类似环境中对肥胖的识别、预防和政策应对。
作者未获得资金支持。
