Normal weight adiposity in a Swedish population: how well is cardiovascular risk associated with excess body fat captured by BMI?

OBJECTIVE The aim of this study was to examine how well body mass index (BMI) reflects cardiovascular risk associated with excess adiposity in a Swedish population by examining the association between body fat, BMI and cardiovascular risk factors. METHODS A total of 3,010 adults participated. Normal weight adiposity was defined as the combination of BMI < 25 kg/m2 and percentage body fat ≥35% for women and ≥25% for men. Associations with blood pressure, blood lipids, apolipoproteins and C-reactive protein were analysed in age-adjusted regression models. RESULTS The majority of the individuals with overweight and obesity were correctly classified to adiposity, while a wide range of body fat was observed among the normal weight subjects. In total, 9% of the participants were categorised as normal weight with adiposity. Compared with the normal weight leanness group, participants with normal weight adiposity had higher levels of serum triglycerides, low-density lipoprotein cholesterol, C-reactive protein, apolipoptotein B and the apolipoprotein B/A-I ratio. In normal weight men, adiposity was also associated with higher blood pressure and lower high-density lipoprotein cholesterol. CONCLUSIONS Higher percentage of body fat was associated with less favourable risk factor profile even in subjects who were normal weight. Thus, it might be relevant to screen for metabolic risk factors in the upper end of the normal weight category.