Researchers at UTHealth Houston have found that body mass index (BMI) alone may not be enough to determine the risk of cardiometabolic disease in adults. The study, led by the Border Health Research Cohort at UTHealth Houston School of Public Health and published in JAMA Network Open, examined how excess fat tissue, known as adiposity, relates to health conditions such as heart disease and diabetes.
Cardiometabolic disease includes a group of health issues like heart disease and diabetes that are often linked to factors such as being overweight or having high blood pressure or blood sugar. According to Joseph Mccormick, MD, co-principal investigator and professor at UTHealth Houston School of Public Health, “When you have excess adiposity, even if you're not obese, you're still at risk for cardiometabolic disease. This adipose tissue is a big driver of the elements that make up what we call cardiometabolic disease.”
The study was conducted with 1,465 adult participants from Cameron County, an area with high rates of cardiometabolic disease among adults. Researchers used both waist circumference measurements and a metric typically used for bone density—which can also measure total body fat—to analyze adiposity.
Findings showed that more than 96% of participants classified as obese had excess body fat according to both methods. However, waist circumference measurements indicated that 17% of those who were not obese still had excess adiposity. The bone density-based metric revealed this number could be as high as 58%.
Kari North, PhD, director of the Border Health Research Center and professor at the School of Public Health, said: "Patients often visit their doctor, get weighed, and are told that with a BMI of 25 or lower they are at very low risk of cardiometabolic disease. However, our findings show that some of these individuals actually have excess adiposity, placing them at significant risk for Type 2 diabetes, high cholesterol, and hypertension.”
The research suggests clinicians should consider measuring adiposity alongside BMI when assessing patient risk for cardiometabolic diseases. According to the team’s data, men with a waist circumference over 40.1 inches and women over 34.6 inches are more likely to have excess adiposity.
Mccormick added: “BMI is a very good marker because 98% of the people who have BMIs of 30 or more have excess adiposity. But that's not enough. We already know that the second highest risk of diabetes and cardiovascular disease in adults is related to excess adiposity, particularly around the abdomen.”
The Border Health Research Cohort has been active since its founding by McCormick and remains one of the largest studies on Mexican-American health in the United States.
Other co-principal investigators included Susan Fisher-Hoch, MD; Jennifer E. Below, PhD; Alexandra B. Palmer, PhD; Penny Gordon-Larsen, PhD; and Rashedeh Roshani.
