Supplementary file 1_Metabolically unhealthy normal weight is associated with subclinical carotid atherosclerosis: cross-sectional and longitudinal evidence from a Chinese health examination cohort.docx

Background and aims<p>Whether metabolically unhealthy normal weight (MUNW) is associated with subclinical carotid atherosclerosis (SCAS) and how its risk compares with that of metabolically unhealthy overweight/obesity (MUO) remain uncertain, particularly in longitudinal analyses and across age groups.</p>Methods<p>A cross-sectional sample (n = 26,202) and a longitudinal subcohort (n = 4,938) were derived from a health examination database; all participants in the longitudinal subcohort were free of SCAS at baseline.

Participants were classified into four metabolic-obesity phenotypes based on body mass index and metabolic health status: metabolically healthy normal weight (MHNW), metabolically healthy overweight/obesity (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy overweight/obesity (MUO). SCAS was defined as carotid intima-media thickness ≥1.0 mm and/or carotid plaque.</p>Results<p>Compared with metabolically healthy normal weight (MHNW), MUNW was associated with increased odds of prevalent SCAS (OR 1.55, 95% CI 1.30–1.84) and increased risk of incident SCAS (HR 1.69, 95% CI 1.12–2.56).