Metabolic health phenotypes and cardiovascular disease among U.S. adults with central obesity: Evidence from NHANES 2011– March 2020

Background: Central obesity is strongly associated with cardiometabolic dysfunction and cardiovascular disease (CVD), yet CVD burden may vary by metabolic phenotype among affected adults. This study examined whether metabolically unhealthy central obesity (MUCO) is associated with higher CVD prevalence than metabolically healthy central obesity (MHCO), whether CVD increases in a dose-response manner with metabolic abnormality burden, and whether associations vary by age, sex, and race/ethnicity. Methods: We conducted a cross-sectional analysis of NHANES 2011-March 2020, including adults ≥20 years with central obesity (≥102 cm (40″) in men; ≥88 cm (35″) in women). Metabolic phenotype was defined by four abnormalities: elevated blood pressure (≥130/85 mmHg or antihypertensive use), dysglycemia (HbA1c ≥ 5.7%, self-reported diabetes, or diabetes medication use), low HDL cholesterol (