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Trends in the prevalence of cardiometabolic disease and cardiovascular events by body mass index category in adults from 1999 to 2016
  1. Priya Chelliah1,
  2. Xilong Li2,
  3. Beverley Adams-Huet1,2,3,
  4. Ildiko Lingvay2,3
  1. 1 Medical School, University of Texas Southwestern Medical, Dallas, Texas, USA
  2. 2 Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  3. 3 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  1. Correspondence to Ildiko Lingvay, Department of Internal Medicine/Endocrinology, Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA; Ildiko.Lingvay{at}


Objectives An increasing percentage of the US population is obese. Cardiometabolic risk in the population increases with body mass index (BMI), but whether this correlation changes over time is unknown. We analysed the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2016 to determine if the prevalence of cardiometabolic disease and cardiovascular events within each BMI category is changing over time as the BMI of the population is increasing.

Study design For each of the nine survey cycles covering this period, we divided the population by BMI category (normal, overweight, class 1 obesity, class ≥2 obesity) and subsequently by the presence of cardiovascular events or cardiometabolic disease. NHANES participants are a group of 5000 individuals/cycle selected to be representative of the US population. We used the weighted data sets to perform trend analyses for each risk/BMI group adjusted for relevant confounders.

Results The distribution of the highest risk category (cardiovascular event) has not changed over time within any BMI category. The distribution of the lowest risk category (cardiometabolically healthy) increased significantly over time in all BMI categories. This was noted in the 18- to 45-year subgroup but not in the group aged >45 years.

Conclusions The increase in the prevalence of overweight and obese individuals might be associated with a ‘healthy obesity’ phenotype in those <45 years; however, individuals >45 years showed a proportional increase in associated cardiometabolic risk.

  • Cardiology
  • hypertension
  • diabetes & endocrinology
  • general diabetes
  • epidemiology
  • general medicine (see internal medicine)
  • nutrition & dietetics

Statistics from


  • PC and XL contributed equally.

  • Contributors Conceptualisation: IL and PC. Methodology: PC and XL. Software: XL and BA-H. Validation: IL and PC. Formal analysis: PC, XL and IL. Investigation: PC. Resources: PC and XL. Data curation: XL, PC, BA-H. Writing—original draft preparation: PC. Writing—review and editing: IL, XL and BA-H. Visualisation: IL and PC. Supervision: IL and BA-H. Project administration: IL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Data sharing statement Data are available in a public, open access repository.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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