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Daily Dose: The BMI vs Body Fat Debate


Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On July 12, 2023, we reported on a study published in Frontiers Nutrition that examined the prevalence of excessive adiposity among normal-weight individuals, and their cardiometabolic risk.

The study

Researchers designed their study to identify the prevalence of metabolically obese normal weight individuals (NWO) in a sample of the Israeli population and to investigate the relationship between NWO, NW lean (NWL), and cardiometabolic risk. They recruited study participants from an Israeli nutrition clinic between 2015 and 2021 for the cross-sectional study. Candidates were required to be age 20 years or older and no BMI value was specified. Investigators recorded values for weight, abdominal circumference (ABC), and BMI. They utilized dual X-ray absorptiometry (DEXA) to measure body composition. The researchers tapped medical records for serum markers of glycemic control, lipids, liver enzymes, and blood count.

Investigators applied multivariate linear regressions to assess associations between cardiometabolic markers in NWL vs NWO participants, stratified by gender, and adjusted to age and BMI. Using nonlinear regression, they also analyzed the relationship between BMI and BF%.

The findings

The final cohort numbered 3001 participants of which approximately half were men and half women (51.9% and 48.1%, respectively).

When compared to NWL participants, NWO men and women had higher triglycerides and elevated LDL-C and total cholesterol for men only. Among NWO participants, abdominal circumference was prevalent in 60% of the women, but in only 4% of the men.

A note from authors

"Higher adiposity, even within normal weight, increases cardiometabolic risk, and abdominal waist circumference misclassified obesity in normal-weight individuals. This study highlights the need for a body composition evaluation to determine cardiometabolic risk for adults with normal body weight."

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