Obesity measures and heart disease risks— the risks of overtraining and being underweight

Benjamin Hubert; Aroued Khelifi; Paul  Matthieu; Håkan Lane; Shreyansh  Shailaan; Samuel Engst; Charalambos Plousiou; April Htoon; Huda Amer

doi:10.55225/hppa.693

Authors

Benjamin Hubert Johannes Gutenberg University Mainz, Germany
Aroued Khelifi University of Sousse, Higher Institute of Management of Sousse, Department of Business Intelligence, Sousse, Tunisia
Paul Matthieu Johannes Gutenberg University Mainz, Germany
Håkan Lane Johannes Gutenberg University Mainz, Germany https://orcid.org/0000-0001-6113-9637
Shreyansh Shailaan Sir Seewoosagur Ramgoolam Medical College, Department of Public Health, Vacoas-Phoenix, Mauritius https://orcid.org/0009-0000-6317-7717
Samuel Engst Stockholm Technological Institute, Department of Health Data Analytics, Stockholm, Sweden
Charalambos Plousiou National and Kapodistrian University of Athens, Athens, Greece https://orcid.org/0009-0002-4183-0230
April Htoon Atilim University, Faculty of Medicine, Ankara, Turkey https://orcid.org/0009-0005-5416-9092
Huda Amer Atilim University, Faculty of Medicine, Ankara, Turkey https://orcid.org/0009-0005-2609-648X

DOI:

https://doi.org/10.55225/hppa.693

Keywords:

cardiovascular disease, body mass index, waist-to-height ratio, physical activity, CKM syndrome, obesity

Abstract

Purpose: Obesity and abnormal fat distribution are major components of the Cardiovascular–Kidney–Metabolic (CKM) syndrome and are strongly associated with cardiovascular disease (CVD). However, the comparative performance of different anthropometric measures and the modifying role of physical activity remain incompletely defined. We aimed to examine the associations between body mass index (BMI), body fat percentage (BFP), waist-to-height ratio (WHtR), physical activity, and prevalent CVD in a large population-based cohort.
Materials and methods: We conducted a cross-sectional analysis of UK Biobank participants aged 40–69 years. After excluding individuals with missing data, N = 489909 participants were included. Prevalent CVD was defined as a history of angina, myocardial infarction, or stroke at baseline assessment. Multivariable logistic regression models were used to evaluate associations between anthropometric measures and CVD, adjusting for age, sex, smoking status, and major comorbidities. Physical activity was analyzed by type and duration. Results are reported as odds ratios (OR) with 95% confidence intervals (CI).
Results: BMI showed a U-shaped association with CVD, with higher prevalence observed at both low (<18.5 kg/m²) and high (>25 kg/m²) values. WHtR was positively associated with CVD across its range, whereas BFP provided little additional predictive value after adjustment. Moderate physical activity was associated with lower odds of CVD, while very high volumes of vigorous activity showed no additional benefit and were associated with slightly higher CVD prevalence.

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