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Normal weight adiposity in a Swedish population: how well is cardiovascular risk associated with excess body fat captured by BMI?

Journal article
Authors Christina Berg
Elisabeth Strandhagen
Kirsten Mehlig
Sreevidya Subramoney
Lauren Lissner
Lena Björck
Published in Obesity Science & Practice
Volume 1
Issue 1
Pages 50-58
Publication year 2015
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Health and Care Sciences
Department of Food and Nutrition, and Sport Science
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 50-58
Language en
Keywords Normal weight obesity, metabolically obese, BMI, body fat
Subject categories Domestic science and nutrition, Public Health, Global Health, Social Medicine and Epidemiology


Objective The aim of this study was to examine how well body mass index (BMI) reflects cardiovascular risk associated with excess adiposity in a Swedish population by examining the association between body fat, BMI and cardiovascular risk factors. Methods A total of 3,010 adults participated. Normal weight adiposity was defined as the combination of BMI<25 kg/m2 and percentage body fat ≥35% for women and ≥25% for men. Associations with blood pressure, blood lipids, apolipoproteins and C-reactive protein were analysed in age-adjusted regression models. Results The majority of the individuals with overweight and obesity were correctly classified to adiposity, while a wide range of body fat was observed among the normal weight subjects. In total, 9% of the participants were categorised as normal weight with adiposity. Compared with the normal weight leanness group, participants with normal weight adiposity had higher levels of serum triglycerides, low-density lipoprotein cholesterol, C-reactive protein, apolipoptotein B and the apolipoprotein B/A-I ratio. In normal weight men, adiposity was also associated with higher blood pressure and lower high-density lipoprotein cholesterol. Conclusions Higher percentage of body fat was associated with less favourable risk factor profile even in subjects who were normal weight. Thus, it might be relevant to screen for metabolic risk factors in the upper end of the normal weight category.

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