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Prevalence and Correlates of 2 Phenotypes Among the US Population (NHANES 1999-2004)

Rachel P. Wildman, PhD; Paul Muntner, PhD; Kristi Reynolds, PhD; Aileen P. McGinn, PhD; Swapnil Rajpathak, MD, DrPH; Judith Wylie-Rosett, EdD; MaryFran R. Sowers, PhD

Arch Intern Med. 2008;168(15):1617-1624.

Background  The prevalence and correlates of obese individuals who are resistant to the development of the adiposity-associated cardiometabolic abnormalities and normal-weight individuals who display cardiometabolic risk factor clustering are not well known.

Methods  The prevalence and correlates of combined body mass index (normal weight, <25.0; overweight, 25.0-29.9; and obese, 30.0 [calculated as weight in kilograms divided by height in meters squared]) and cardiometabolic groups (metabolically healthy, 0 or 1 cardiometabolic abnormalities; and metabolically abnormal, 2 cardiometabolic abnormalities) were assessed in a cross-sectional sample of 5440 participants of the National Health and Nutrition Examination Surveys 1999-2004. Cardiometabolic abnormalities included elevated blood pressure; elevated levels of triglycerides, fasting plasma glucose, and C-reactive protein; elevated homeostasis model assessment of insulin resistance value; and low high-density lipoprotein cholesterol level.

Results  Among US adults 20 years and older, 23.5% (approximately 16.3 million adults) of normal-weight adults were metabolically abnormal, whereas 51.3% (approximately 35.9 million adults) of overweight adults and 31.7% (approximately 19.5 million adults) of obese adults were metabolically healthy. The independent correlates of clustering of cardiometabolic abnormalities among normal-weight individuals were older age, lower physical activity levels, and larger waist circumference. The independent correlates of 0 or 1 cardiometabolic abnormalities among overweight and obese individuals were younger age, non-Hispanic black race/ethnicity, higher physical activity levels, and smaller waist circumference.

Conclusions  Among US adults, there is a high prevalence of clustering of cardiometabolic abnormalities among normal-weight individuals and a high prevalence of overweight and obese individuals who are metabolically healthy. Further study into the physiologic mechanisms underlying these different phenotypes and their impact on health is needed.

Author Affiliations: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York (Drs Wildman, McGinn, Rajpathak, and Wylie-Rosett); Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York (Dr Muntner); Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Dr Reynolds); and Department of Epidemiology, University of Michigan, Ann Arbor (Dr Sowers).

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