Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality

Overview

Journal Ann Intern Med

Specialty General Medicine

Date 2015 Nov 10

PMID 26551006

Citations 227

Authors

Karine R Sahakyan

Virend K Somers

Juan P Rodriguez-Escudero

David O Hodge

Rickey E Carter

Ondrej Sochor

Thais Coutinho

Michael D Jensen

Veronique L Roger

Prachi Singh

Francisco Lopez-Jimenez

Affiliations

Soon will be listed here.

Abstract

Background: The relationship between central obesity and survival in community-dwelling adults with normal body mass index (BMI) is not well-known.

Objective: To examine total and cardiovascular mortality risks associated with central obesity and normal BMI.

Design: Stratified multistage probability design.

Setting: NHANES III (Third National Health and Nutrition Examination Survey).

Participants: 15,184 adults (52.3% women) aged 18 to 90 years.

Measurements: Multivariable Cox proportional hazards models were used to evaluate the relationship of obesity patterns defined by BMI and waist-to-hip ratio (WHR) and total and cardiovascular mortality risk after adjustment for confounding factors.

Results: Persons with normal-weight central obesity had the worst long-term survival. For example, a man with a normal BMI (22 kg/m2) and central obesity had greater total mortality risk than one with similar BMI but no central obesity (hazard ratio [HR], 1.87 [95% CI, 1.53 to 2.29]), and this man had twice the mortality risk of participants who were overweight or obese according to BMI only (HR, 2.24 [CI, 1.52 to 3.32] and 2.42 [CI, 1.30 to 4.53], respectively). Women with normal-weight central obesity also had a higher mortality risk than those with similar BMI but no central obesity (HR, 1.48 [CI, 1.35 to 1.62]) and those who were obese according to BMI only (HR, 1.32 [CI, 1.15 to 1.51]). Expected survival estimates were consistently lower for those with central obesity when age and BMI were controlled for.

Limitations: Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report.

Conclusion: Normal-weight central obesity defined by WHR is associated with higher mortality than BMI-defined obesity, particularly in the absence of central fat distribution.

Primary Funding Source: National Institutes of Health, American Heart Association, European Regional Development Fund, and Czech Ministry of Health.

Citing Articles

Association of Mammographic Features and Major Adverse Cardiac Events in Postmenopausal Women: A 10-Year Retrospective Cohort Study.

Hu Y, Wang Z, Huang Z, Hu Y, Wang X Int J Womens Health. 2025; 17:553-560.

PMID: 40046870 PMC: 11881771. DOI: 10.2147/IJWH.S502790.

Integrative multi-omics analysis reveals molecular signatures of central obesity in children.

Zhao C, An X, Xiao L, Chen J, Huang D, Chen L Pediatr Res. 2025; .

PMID: 40044886 DOI: 10.1038/s41390-025-03958-6.

Central obesity is a burden even in normal weight adolescents of a non-metropolitan Indian City: A case for alarm and action for prevention and control.

Nawab T, Khan Z, Khan I, Ansari M J Family Med Prim Care. 2025; 14(1):283-289.

PMID: 39989545 PMC: 11844957. DOI: 10.4103/jfmpc.jfmpc_967_24.

Normal-weight central obesity and cardiometabolic disorders among Aboriginal and Torres Strait Islander Australians.

Ahmed K, Mondal U, Huda M, Aychiluhm S, Newman J, Thapa S BMC Med. 2025; 23(1):106.

PMID: 39984922 PMC: 11846202. DOI: 10.1186/s12916-025-03942-1.

The effects of high intensity exercise on pregnancy outcomes and complications during pregnancy: a meta-analysis of randomized controlled trials.

Liu X, Guo X, Jie R, Tang Y Eur J Appl Physiol. 2025; .

PMID: 39976761 DOI: 10.1007/s00421-025-05730-4.

References

Romero-Corral A, Somers V, Sierra-Johnson J, Korenfeld Y, Boarin S, Korinek J . Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J. 2009; 31(6):737-46. PMC: 2838679. DOI: 10.1093/eurheartj/ehp487. View

Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi M, Commerford P . Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005; 366(9497):1640-9. DOI: 10.1016/S0140-6736(05)67663-5. View

Flegal K, Kit B, Orpana H, Graubard B . Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013; 309(1):71-82. PMC: 4855514. DOI: 10.1001/jama.2012.113905. View

Kahn H, Bullard K, Barker L, Imperatore G . Differences between adiposity indicators for predicting all-cause mortality in a representative sample of United States non-elderly adults. PLoS One. 2012; 7(11):e50428. PMC: 3511554. DOI: 10.1371/journal.pone.0050428. View

Jensen M, Ryan D, Apovian C, Ard J, Comuzzie A, Donato K . 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2013; 129(25 Suppl 2):S102-38. PMC: 5819889. DOI: 10.1161/01.cir.0000437739.71477.ee. View

Makuch R . Adjusted survival curve estimation using covariates. J Chronic Dis. 1982; 35(6):437-43. DOI: 10.1016/0021-9681(82)90058-3. View

Cerhan J, Moore S, Jacobs E, Kitahara C, Rosenberg P, Adami H . A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin Proc. 2014; 89(3):335-45. PMC: 4104704. DOI: 10.1016/j.mayocp.2013.11.011. View

Flegal K, Graubard B . Estimates of excess deaths associated with body mass index and other anthropometric variables. Am J Clin Nutr. 2009; 89(4):1213-9. PMC: 2667465. DOI: 10.3945/ajcn.2008.26698. View

Cornier M, Despres J, Davis N, Grossniklaus D, Klein S, Lamarche B . Assessing adiposity: a scientific statement from the American Heart Association. Circulation. 2011; 124(18):1996-2019. DOI: 10.1161/CIR.0b013e318233bc6a. View

10.

Grundy S . Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab. 2004; 89(6):2595-600. DOI: 10.1210/jc.2004-0372. View

11.

Okorodudu D, Jumean M, Montori V, Romero-Corral A, Somers V, Erwin P . Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis. Int J Obes (Lond). 2010; 34(5):791-9. DOI: 10.1038/ijo.2010.5. View

12.

Despres J . Intra-abdominal obesity: an untreated risk factor for Type 2 diabetes and cardiovascular disease. J Endocrinol Invest. 2006; 29(3 Suppl):77-82. View

13.

Wormser D, Kaptoge S, Di Angelantonio E, Wood A, Pennells L, Thompson A . Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011; 377(9771):1085-95. PMC: 3145074. DOI: 10.1016/S0140-6736(11)60105-0. View

14.

Coutinho T, Goel K, Correa de Sa D, Carter R, Hodge D, Kragelund C . Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of "normal weight central obesity". J Am Coll Cardiol. 2013; 61(5):553-60. DOI: 10.1016/j.jacc.2012.10.035. View

15.

Reis J, Macera C, Araneta M, Lindsay S, Marshall S, Wingard D . Comparison of overall obesity and body fat distribution in predicting risk of mortality. Obesity (Silver Spring). 2009; 17(6):1232-9. DOI: 10.1038/oby.2008.664. View

16.

Van Gaal L, Mertens I, De Block C . Mechanisms linking obesity with cardiovascular disease. Nature. 2006; 444(7121):875-80. DOI: 10.1038/nature05487. View

17.

Seidell J, Bjorntorp P, Sjostrom L, SANNERSTEDT R, Krotkiewski M, Kvist H . Regional distribution of muscle and fat mass in men--new insight into the risk of abdominal obesity using computed tomography. Int J Obes. 1989; 13(3):289-303. View

18.

Navab M, Anantharamaiah G, Fogelman A . The role of high-density lipoprotein in inflammation. Trends Cardiovasc Med. 2005; 15(4):158-61. DOI: 10.1016/j.tcm.2005.05.008. View

19.

Manolopoulos K, Karpe F, Frayn K . Gluteofemoral body fat as a determinant of metabolic health. Int J Obes (Lond). 2010; 34(6):949-59. DOI: 10.1038/ijo.2009.286. View

20.

Ashwell M, Mayhew L, Richardson J, Rickayzen B . Waist-to-height ratio is more predictive of years of life lost than body mass index. PLoS One. 2014; 9(9):e103483. PMC: 4157748. DOI: 10.1371/journal.pone.0103483. View