Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Adiposity-based obesity classification and cardiometabolic and kidney outcomes: a longitudinal UK Biobank analysis

Gunnarsson, Sophie LU orcid ; Karlsson, Cecilia LU ; Prasad, Rashmi LU orcid and Hansson, Sara LU (2026) In EBioMedicine p.1-10
Abstract
Background
Obesity is commonly diagnosed using BMI, which does not capture total adiposity or fat distribution, as highlighted by the recent Lancet D&E Commission report. We assessed the prognostic value of an adiposity-based classification combining body fat percentage (BF%) and waist circumference (WC) in relation to cardiometabolic and kidney outcomes and evaluated its concordance with BMI.
Methods
We classified 489,311 UK Biobank participants into five risk groups (Groups 1–5) with increasingly adverse adiposity profiles based on BF%–WC. Associations with three-point major adverse cardiovascular events (3P-MACE), type 2 diabetes (T2D), and chronic kidney disease (CKD) were estimated using cumulative incidence and Cox PH... (More)
Background
Obesity is commonly diagnosed using BMI, which does not capture total adiposity or fat distribution, as highlighted by the recent Lancet D&E Commission report. We assessed the prognostic value of an adiposity-based classification combining body fat percentage (BF%) and waist circumference (WC) in relation to cardiometabolic and kidney outcomes and evaluated its concordance with BMI.
Methods
We classified 489,311 UK Biobank participants into five risk groups (Groups 1–5) with increasingly adverse adiposity profiles based on BF%–WC. Associations with three-point major adverse cardiovascular events (3P-MACE), type 2 diabetes (T2D), and chronic kidney disease (CKD) were estimated using cumulative incidence and Cox PH models. Comparison with BMI categories was visualised with an alluvial plot.
Findings
Over a median 13.1 years (IQR 1.7), 24,778 (5.1%) participants experienced 3P-MACE, 30,376 (6.2%) had incident T2D, and 14,906 (3.0%) had incident CKD. The BF%–WC classification yielded stepwise risk stratification across endpoints. Compared to the reference Group 1, Group 5 had significantly higher risk: age- and sex-adjusted HR 9.23 (95% CI 8.70–9.83) for T2D, 2.27 (2.10–2.41) for CKD, and 1.63 (1.60–1.71) for 3P-MACE. Discordance with BMI was notable: 32.6% of individuals in the high-risk Group 5 had a BMI in the normal-to-overweight range, while the overweight category spanned all BF%–WC risk groups.
Interpretation
An adiposity-based classification integrating BF% and WC associates significantly with cardiometabolic and kidney outcomes and reveals discordance with BMI, reinforcing the Commission’s framing of obesity as a disease driven by excess adiposity. (Less)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
EBioMedicine
article number
106272
pages
1 - 10
publisher
Elsevier
external identifiers
  • pmid:42151022
ISSN
2352-3964
DOI
10.1016/j.ebiom.2026.106272
language
English
LU publication?
yes
id
4c0eaf33-36c4-4cbd-afb5-0a5214048adc
date added to LUP
2026-05-21 09:11:19
date last changed
2026-05-22 03:31:36
@article{4c0eaf33-36c4-4cbd-afb5-0a5214048adc,
  abstract     = {{Background<br/>Obesity is commonly diagnosed using BMI, which does not capture total adiposity or fat distribution, as highlighted by the recent Lancet D&amp;E Commission report. We assessed the prognostic value of an adiposity-based classification combining body fat percentage (BF%) and waist circumference (WC) in relation to cardiometabolic and kidney outcomes and evaluated its concordance with BMI.<br/>Methods<br/>We classified 489,311 UK Biobank participants into five risk groups (Groups 1–5) with increasingly adverse adiposity profiles based on BF%–WC. Associations with three-point major adverse cardiovascular events (3P-MACE), type 2 diabetes (T2D), and chronic kidney disease (CKD) were estimated using cumulative incidence and Cox PH models. Comparison with BMI categories was visualised with an alluvial plot.<br/>Findings<br/>Over a median 13.1 years (IQR 1.7), 24,778 (5.1%) participants experienced 3P-MACE, 30,376 (6.2%) had incident T2D, and 14,906 (3.0%) had incident CKD. The BF%–WC classification yielded stepwise risk stratification across endpoints. Compared to the reference Group 1, Group 5 had significantly higher risk: age- and sex-adjusted HR 9.23 (95% CI 8.70–9.83) for T2D, 2.27 (2.10–2.41) for CKD, and 1.63 (1.60–1.71) for 3P-MACE. Discordance with BMI was notable: 32.6% of individuals in the high-risk Group 5 had a BMI in the normal-to-overweight range, while the overweight category spanned all BF%–WC risk groups.<br/>Interpretation<br/>An adiposity-based classification integrating BF% and WC associates significantly with cardiometabolic and kidney outcomes and reveals discordance with BMI, reinforcing the Commission’s framing of obesity as a disease driven by excess adiposity.}},
  author       = {{Gunnarsson, Sophie and Karlsson, Cecilia and Prasad, Rashmi and Hansson, Sara}},
  issn         = {{2352-3964}},
  language     = {{eng}},
  month        = {{05}},
  pages        = {{1--10}},
  publisher    = {{Elsevier}},
  series       = {{EBioMedicine}},
  title        = {{Adiposity-based obesity classification and cardiometabolic and kidney outcomes: a longitudinal UK Biobank analysis}},
  url          = {{http://dx.doi.org/10.1016/j.ebiom.2026.106272}},
  doi          = {{10.1016/j.ebiom.2026.106272}},
  year         = {{2026}},
}