In adults with normal BMI, increases in body adiposity measured by dual x-ray absorptiometry are significantly associated with increased cardiometabolic disease burden and all-cause mortality.
Key Findings
Results
Every 10-unit percent increase in total body fat percentage was associated with higher risk for insulin resistance, metabolic syndrome, dyslipidemia, and all-cause mortality in the normal BMI group.
Association was found specifically within individuals with normal BMI (18.5-24.9 kg/m2)
Body fat percentage was measured by dual x-ray absorptiometry (DXA)
Weighted logistic regression and Cox proportional hazard models were used to test associations
Models were adjusted for potential confounders while considering complex survey design
Results
Metabolic disorders were associated with body fat percentage tertiles in normal-weight individuals.
Metabolic disorders assessed included insulin resistance, metabolic syndrome, dyslipidemia, type 2 diabetes mellitus, and hypertension
Analysis was stratified by sex and body fat percentage tertiles in normal-weight individuals
The study sample included 6424 normal-weight individuals by BMI out of 20,613 total participants
Methods
The study population consisted of 6424 normal-weight adults drawn from a large nationally representative US survey sample.
Total study sample included 20,613 individuals, of whom 6424 had normal BMI (18.5-24.9 kg/m2)
Participants were adults aged 20 to 65 years with DXA examination in the US National Health and Nutrition Examination Survey (NHANES) from 1999-2006 and 2011-2018
Normal-weight sample was 45.7% men and 69.6% non-Hispanic Whites
Follow-up was conducted until December 2019
Conclusions
Body fat percentage measured by DXA provides cardiometabolic risk information beyond what is captured by normal BMI classification.
The study tested the hypothesis that body adiposity measured by DXA is associated with metabolic disorders and all-cause mortality in normal-weight individuals
Individuals classified as normal weight by BMI still showed significant associations between higher body fat and cardiometabolic disease burden
This suggests that normal BMI does not preclude elevated cardiometabolic and mortality risk attributable to excess adiposity
Chen Z, Li J, Medina-Inojosa B, Medina-Inojosa J, Lara-Breitinger K, Somers V, et al.. (2026). Body Fat and Cardiometabolic Disease Burden and All-Cause Mortality in Adults With Normal Body Mass Index.. Mayo Clinic proceedings. https://doi.org/10.1016/j.mayocp.2025.06.022