ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutrition and Metabolism
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1617929
Associations of metabolic heterogeneity of obesity with cardiometabolic multimorbidity progression: A nationwide prospective cohort study
Provisionally accepted
- Shenzhen Hospital(Futian) of Guangzhou University of Chinese Medicine,Shenzhen,Guangdong, Shenzhen, China
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Previous studies have demonstrated that both obesity and metabolic heterogeneity impact cardiovascular disease. However, the effect of different BMI-metabolic phenotypes on the progression of cardiometabolic multimorbidity (CMM) remains unclear.This study utilized baseline data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, enrolling 5,850 participants for a longitudinal cohort analysis. Laboratory data from 2015 were used to assess 4,471 participants and evaluate the association between BMI-metabolic phenotype transitions (2011)(2012)(2013)(2014)(2015) and incident CMM. Participants were categorized into four BMI-metabolic phenotype groups: metabolically healthy normal weight (MHNW), metabolically healthy overweight/obesity (MHOO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy overweight/obesity (MUOO). Logistic regression models adjusted for potential confounders were applied to analyze the relationship between BMI-metabolic phenotypes, their dynamic changes, and CMM incidence.Among the 5,850 participants, 562 (11.15%) developed CMM during the follow-up period.Both overweight/obesity and metabolically unhealthy status significantly accelerated CMM progression. The MUOO group exhibited the highest risk (OR = 3.31, 95% CI: 2.60-4.24; p < 0.001), followed by the MUNW (OR = 1.91, 95% CI: 1.47-2.47; p < 0.001) and MHOO groups (OR = 1.89, 95% CI: 1.30-2.69; p = 0.001), compared to the MHNW group. Further analysis revealed that changes in metabolic status had a greater impact on CMM risk than changes in BMI alone, with metabolic transitions in individuals with obesity being particularly associated with CMM onset.Worsening metabolic health and obesity significantly increase the risk of CMM. Notably, metabolic health plays a more critical role than obesity in predicting CMM incidence. This study highlights the importance of maintaining and improving metabolic health and suggests personalized obesity management strategies based on metabolic status to reduce CMM risk.
Keywords: Obesity, Metabolic status, Transitions, heterogeneity, cardiometabolic multimorbidity
Received: 25 Apr 2025; Accepted: 25 Jul 2025.
Copyright: © 2025 Cai, Zhang, Zhang, Tian, Mo and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bohai Yu, Shenzhen Hospital(Futian) of Guangzhou University of Chinese Medicine,Shenzhen,Guangdong, Shenzhen, China
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