Normal Weight Obesity and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis

Nami Mohammadian Khonsari, Patricia Khashayar, Ehsan Shahrestanaki, Roya Kelishadi, Sahar Mohammadpoor Nami, Motahar Heidari-Beni, Zahra Esmaeili Abdar, Ozra Tabatabaei-Malazy, Mostafa Qorbani

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations


Background: Obesity is one of the most significant causes of morbidity and mortality worldwide. Current studies suggest a new type of obesity, normal weight obesity (NWO), which is defined as having a normal body mass index (BMI), but a high-fat percentage increases the risk of cardiometabolic risk factors (CMRFs). This systematic review and meta-analysis aimed to pool the association between NWO with CMRFs. Methods: A systematic search of the literature in all available electronic databases, including Scopus, Web of Science, EMBASE, and PubMed, was performed until October 2021. All English studies that assessed the association of NWOs [compared to normal weight non-obese (NWNO)] and the CMRFs were included. Two investigators extracted data and performed a quality assessment. The heterogeneity between studies was assessed with I-squared and Cochran’s Q tests. Odds ratio (OR) was used as an effect size to pool the association of NWO with CMRFs. Results: Twenty-five articles that met the inclusion criteria entered the study. The total number of participants was 177,792, with an age range of 13 to 75 years. Most studies were conducted on the general population (adults) and were from China. The result of fixed-effect model meta-analysis indicated an increased odds of hyperglycemia (OR:1.50, 95%:1.23, 1.76), high TG (OR:1.90, 95% CH:1.44, 2.35), low HDL (OR: 1.28, 95% CI:1.06, 1.49) and diabetes (OR:1.39, 95% CI:1.30, 1.49). Moreover, the random effect meta-analysis showed that NWO increased the odds of dyslipidemia (OR:1.83, 95% CI:1.61, 20.4), HTN (OR:1.40, 95% CI:1.28, 1.51) and metabolic syndrome (OR:1.92, 95% CI:1.58, 2.26). Moreover, the mean of all CMRFs except plasma glucose in NWO subjects was statistically higher than NWNO subjects (p-value<0.05). Conclusion: The present study showed that NWO increased the odds of CMRFs. These findings indicate the inadequacy of the BMI measurement and the need for body fat assessment for a better obesity risk assessment.

Original languageEnglish (US)
Article number857930
JournalFrontiers in Endocrinology
StatePublished - Mar 24 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © 2022 Mohammadian Khonsari, Khashayar, Shahrestanaki, Kelishadi, Mohammadpoor Nami, Heidari-Beni, Esmaeili Abdar, Tabatabaei-Malazy and Qorbani.


  • cardiometabolic
  • central obesity
  • metabolic syndrome
  • normal weight obesity
  • obesity

Cite this