{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:05:57Z","timestamp":1789535157469,"version":"build-2803163510"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats: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 \u22651.0 mm and\/or carotid plaque.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with metabolically healthy normal weight (MHNW), MUNW was associated with increased odds of prevalent SCAS (OR 1.55, 95% CI 1.30\u20131.84) and increased risk of incident SCAS (HR 1.69, 95% CI 1.12\u20132.56). Compared with MUO, MUNW showed a numerically higher risk estimate for prevalent SCAS, although the difference was not statistically significant (OR 1.11, 95% CI 0.93\u20131.32,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.247); a similar pattern was observed for incident SCAS (HR 1.25, 95% CI 0.83\u20131.91,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.290). Metabolically healthy overweight\/obesity (MHO) was associated with prevalent but not incident SCAS (OR 1.10, 95% CI 1.02\u20131.20; HR 1.14, 95% CI 0.94\u20131.38). A significant phenotype-by-age interaction was observed (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.029); among adults aged &amp;lt;50 years, MUNW was associated with more than twofold higher odds of prevalent SCAS (OR 2.33, 95% CI 1.39\u20133.76). Findings were consistent in sensitivity analyses excluding covariates overlapping with phenotype definitions and in plaque-restricted analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MUNW was associated with increased odds of prevalent SCAS and a higher hazard of incident SCAS after multivariable adjustment, with numerically higher risk estimates than MUO, although direct comparisons did not reach statistical significance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1925899","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:35:08Z","timestamp":1789533308000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolically unhealthy normal weight is associated with subclinical carotid atherosclerosis: cross-sectional and longitudinal evidence from a Chinese health examination cohort"],"prefix":"10.3389","volume":"17","author":[{"given":"Sai","family":"Zhang","sequence":"first","affiliation":[{"name":"Health Management & Physical Examination Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science","place":["Xiangyang, Hubei, China"]},{"name":"School of Public Health, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"An","sequence":"additional","affiliation":[{"name":"Health Management & Physical Examination Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science","place":["Xiangyang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmei","family":"Liu","sequence":"additional","affiliation":[{"name":"Health Management & Physical Examination 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