Normal weight obesity: A risk factor for cardiometabolic dysregulation and cardiovascular mortality

Abel Romero-Corral, Virend K. Somers, Justo Sierra-Johnson, Yoel Korenfeld, Simona Boarin, Josef Korinek, Michael D. Jensen, Gianfranco Parati, Francisco Lopez-Jimenez

Research output: Contribution to journalArticlepeer-review

340 Scopus citations


Aims We hypothesized that subjects with a normal body mass index (BMI), but high body fat (BF) content [normal weight obesity (NWO)], have a higher prevalence of cardiometabolic dysregulation and are at higher risk for cardiovascular (CV) mortality. Methods and results We analysed 6171 subjects >20 years of age from the Third National Health and Nutrition Examination Survey (NHANES III) and the NHANES III mortality study, whose BMI was within the normal range (18.5-24.9 kg/m2), and who underwent a complete evaluation that included body composition assessment, blood measurements, and assessment of CV risk factors. Survival information was available for >99 of the subjects after a median follow-up of 8.8 years. We divided our sample using sex-specific tertiles of BF. The highest tertile of BF (>23.1 in men and >33.3 in women) was labelled as NWO. When compared with the low BF group, the prevalence of metabolic syndrome in subjects with NWO was four-fold higher (16.6 vs. 4.8, P < 0.0001). Subjects with NWO also had higher prevalence of dyslipidaemia, hypertension (men), and CV disease (women). After adjustment, women with NWO showed a significant 2.2-fold increased risk for CV mortality (HR = 2.2; 95 CI, 1.03-4.67) in comparison to the low BF group. Conclusion Normal weight obesity, defined as the combination of normal BMI and high BF content, is associated with a high prevalence of cardiometabolic dysregulation, metabolic syndrome, and CV risk factors. In women, NWO is independently associated with increased risk for CV mortality.

Original languageEnglish (US)
Pages (from-to)737-746
Number of pages10
JournalEuropean heart journal
Issue number6
StatePublished - Mar 2010


  • Body fat
  • Cardiovascular mortality
  • Cardiovascular risk factor
  • Metabolic syndrome
  • Mortality
  • Normal weight obesity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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