{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T20:19:36Z","timestamp":1789676376317,"version":"4.0.1"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"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. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>Obesity is a core risk factor for metabolic diseases, and body mass index (BMI) serves as a key tool for assessing obesity. Current internationally adopted BMI standards (such as the WHO universal standard and the Asia-Pacific standard) differ from the Chinese standard developed based on data from the Chinese population. Given the unique genetic background and lifestyle of the population in Western Guangdong, China, their spectrum of metabolic diseases may exhibit distinct characteristics. This study aims to systematically compare the predictive capabilities of the three commonly used BMI standards for the \u201cfive highs\u201d (hypertension, dyslipidemia, diabetes, hyperuricemia, and hyperhomocysteinemia) and their clustering risk in this population, providing evidence for localized precision prevention and control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This cross-sectional study included 5,667 permanent residents in Western Guangdong who completed health examinations between 2023 and 2024. Participants were grouped according to three BMI standards: Chinese (overweight \u226524\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , obese \u226528\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ); WHO General (overweight \u226525\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , obese \u226530\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ); WHO Asia-Pacific (overweight \u226523\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , obese \u226525\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Multivariate logistic regression and restricted cubic spline (RCS) analyses examined the association between BMI and the risk of \u201cfive highs\u201d (hyperglycemia, hyperlipidemia, hypertension, hyperuricemia and hyperhomocysteinemia) and their clustering. Subgroup analyses by age and sex were conducted.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Individuals classified as overweight or obese according to Chinese criteria showed the strongest risk gradient for clustering two or more metabolic risks, with overweight and obesity increasing the risk of the five high by 79 and 140%, respectively. RCS analysis revealed a nonlinear positive correlation between BMI and the risk of clustering the \u201cfive highs,\u201d with the most significant change in risk slope occurring near the cut-off points defined by the Chinese standard (24 and 28\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Subgroup analysis further indicated that males and younger individuals exhibited heightened sensitivity to metabolic risks associated with increasing BMI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among the population in Western Guangdong, China, the Chinese BMI standard outperformed both the WHO universal and Asia-Pacific standards in identifying \u201cfive highs\u201d and their clustered risks, demonstrating greater sensitivity in screening high-risk individuals. It is recommended as the preferred tool for primary prevention of metabolic diseases and public health strategy development in this region.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2025.1732345","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T06:39:13Z","timestamp":1764743953000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Comparative analysis of three BMI cutoffs for five metabolic abnormalities in the population of Western Guangdong, China"],"prefix":"10.3389","volume":"12","author":[{"given":"Dengwen","family":"Pang","sequence":"first","affiliation":[{"name":"Department of Assets and Equipment Management, Guangdong Medical University","place":["Zhanjiang, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meizhu","family":"Chen","sequence":"additional","affiliation":[{"name":"Dongxin Street Community Health Service Center","place":["Zhanjiang, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengwen","family":"Xiao","sequence":"additional","affiliation":[{"name":"The First Clinical College, Guangdong Medical University","place":["Zhanjiang, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruijian","family":"Zhuang","sequence":"additional","affiliation":[{"name":"The First Clinical College, Guangdong Medical University","place":["Zhanjiang, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengyu","family":"Kong","sequence":"additional","affiliation":[{"name":"The First Clinical College, Guangdong Medical University","place":["Zhanjiang, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyuan","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Center, Affiliated Hospital of Guangdong Medical University","place":["Zhanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"ref1","first-page":"1","volume-title":"Physical status: the use and interpretation of anthropometry. Report of a WHO expert committee","year":"1995"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/inthealth\/2.2.952","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation","volume":"894","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/S0140-6736(03)15268-3","article-title":"Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies","volume":"363","year":"2004","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"83","DOI":"10.3967\/bes2022.0153","article-title":"Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults--study on optimal cut-off points of body mass index and waist circumference in Chinese adults","volume":"15","author":"Zhou","year":"2002","journal-title":"Biomed Environ Sci"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"973191","DOI":"10.3389\/fpubh.2022.973191","article-title":"Longitudinal transition of body mass index status and its associated factors among Chinese middle-aged and older adults in Markov model","volume":"10","author":"Pei","year":"2022","journal-title":"Front Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1093\/ajcn\/80.5.1129","article-title":"Appropriate body mass index and waist circumference cutoffs for categorization of overweight and central adiposity among Chinese adults","volume":"80","author":"Wildman","year":"2004","journal-title":"Am J Clin Nutr"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e67428","DOI":"10.7759\/cureus.67428","article-title":"A comprehensive review of metabolic syndrome and its role in cardiovascular disease and type 2 diabetes mellitus: mechanisms, risk factors, and management","volume":"16","author":"Dhondge","year":"2024","journal-title":"Cureus"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"500","DOI":"10.3346\/jkms.2012.27.5.500","article-title":"Use of serum homocysteine to predict cardiovascular disease in Korean men with or without metabolic syndrome","volume":"27","author":"Kang","year":"2012","journal-title":"J Korean Med Sci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1111\/1753-0407.13364","article-title":"The Association of Retinal age gap with metabolic syndrome and inflammation","volume":"15","author":"Zhu","year":"2023","journal-title":"J Diabetes"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2949","DOI":"10.1167\/iovs.04-0069","article-title":"Associations between the metabolic syndrome and retinal microvascular signs: the atherosclerosis risk in communities study","volume":"45","author":"Wong","year":"2004","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"154770","DOI":"10.1016\/j.metabol.2021.154770","article-title":"Non-alcoholic fatty liver disease, insulin resistance, metabolic syndrome and their association with vascular risk","volume":"119","author":"Muzurovi\u0107","year":"2021","journal-title":"Metabolism"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"7330133","DOI":"10.1155\/2024\/7330133","article-title":"Association between metabolic syndrome and musculoskeletal status: a cross-sectional study of NHANES","volume":"2024","author":"Shi","year":"2024","journal-title":"Int J Endocrinol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"347","DOI":"10.3390\/nu8060347","article-title":"The relationship between metabolic syndrome and osteoporosis: a review","volume":"8","author":"Wong","year":"2016","journal-title":"Nutrients"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"9825","DOI":"10.18632\/aging.103247","article-title":"Association between metabolic syndrome and endometrial cancer risk: a systematic review and meta-analysis of observational studies","volume":"12","author":"Wang","year":"2020","journal-title":"Aging (Albany NY)"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1002\/cncr.21950","article-title":"The metabolic syndrome and risk of incident colorectal cancer","volume":"107","author":"Ahmed","year":"2006","journal-title":"Cancer"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1002\/hep.24397","article-title":"Metabolic syndrome increases the risk of primary liver cancer in the United States: a study in the SEER-medicare database","volume":"54","author":"Welzel","year":"2011","journal-title":"Hepatology"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/j.cjca.2020.02.066","article-title":"Role of hyperinsulinemia and insulin resistance in hypertension: metabolic syndrome revisited","volume":"36","author":"da Silva","year":"2020","journal-title":"Can J Cardiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/s13098-024-01315-x","article-title":"The synergistic effect of obesity and dyslipidemia on hypertension: results from the STEPS survey","volume":"16","author":"Mohseni","year":"2024","journal-title":"Diabetol Metab Syndr"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.3760\/cma.j.cn112338-20240513-00267","article-title":"Interaction of obesity and dyslipidemia on the risk of hypertension","volume":"45","author":"Wang","year":"2024","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"756","DOI":"10.4093\/dmj.2021.0166","article-title":"Synergistic interaction between hyperuricemia and abdominal obesity as a risk factor for metabolic syndrome components in Korean population","volume":"46","author":"Lee","year":"2022","journal-title":"Diabetes Metab J"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2775","DOI":"10.12659\/MSM.905002","article-title":"Hyperhomocysteinemia as a metabolic risk factor for glucose intolerance among high-risk groups of Chinese adults","volume":"23","author":"Feng","year":"2017","journal-title":"Med Sci Monit"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/1471-2458-12-64","article-title":"The prevalence of metabolic syndrome and cardiovascular risk factors in adults in southern China","volume":"12","author":"Lao","year":"2012","journal-title":"BMC Public Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"929","DOI":"10.4103\/1319-562X.1134784","article-title":"Prevalence and distribution of metabolic syndrome in a southern Chinese population. Relation to exercise, smoking, and educational level","volume":"34","author":"Li","year":"2013","journal-title":"Saudi Med J"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.clnu.2025.03.016","article-title":"A comprehensive comparison of two commonly used BMI thresholds for non-communicable diseases and multimorbidity in the Chinese population","volume":"48","author":"Fan","year":"2025","journal-title":"Clin Nutr"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"182","DOI":"10.11909\/j.issn.1671-5411.2019.02.002","article-title":"2018 Chinese guidelines for prevention and treatment of hypertension-a report of the revision committee of Chinese guidelines for prevention and treatment of hypertension","volume":"16","year":"2019","journal-title":"J Geriatr Cardiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"618","DOI":"10.26599\/1671-5411.2023.09.007","article-title":"Chinese guideline for lipid management (2023): a new guideline rich in domestic elements for controlling dyslipidemia","volume":"20","author":"Li","year":"2023","journal-title":"J Geriatr Cardiol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3760\/cma.j.cn112138-20211027-00751","article-title":"Clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in China (2022 edition)","volume":"61","year":"2022","journal-title":"Zhonghua Nei Ke Za Zhi"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"461","DOI":"10.3760\/cma.j.cn112138-20230316-001586","article-title":"Multi-disciplinary expert consensus on the diagnosis and treatment of hyperuricemia-related diseases in China (2023 version)","volume":"43","author":"Diao","year":"2023","journal-title":"Chin J Pract Intern Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1097\/EMNC.00000000000002837","article-title":"Expert consensus on diagnosis and treatment of hyperhomocysteinemia","volume":"7","author":"Kong","year":"2020","journal-title":"Electr J Metabol Nutr Cance"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1007\/s13410-015-0373-5","article-title":"Evaluation of three BMI criteria performance to diagnose obesity in a Chinese population","volume":"36","author":"Yan","year":"2016","journal-title":"Int J Diabetes Dev Ctries"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e035216","DOI":"10.1136\/bmjopen-2019-035216","article-title":"Comparative study on prevalence of metabolic syndrome based on three criteria among adults in Zhejiang province, China: an observational study","volume":"10","author":"Wang","year":"2020","journal-title":"BMJ Open"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1093\/ajcn\/60.1.23","article-title":"Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements","volume":"60","author":"Wang","year":"1994","journal-title":"Am J Clin Nutr"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"5366","DOI":"10.1210\/jcem.86.11.7992","article-title":"Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians","volume":"86","author":"Raji","year":"2001","journal-title":"J Clin Endocrinol Metab"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e812","DOI":"10.1371\/journal.pone.0000812","article-title":"Insulin resistance and body fat distribution in south Asian men compared to Caucasian men","volume":"2","author":"Chandalia","year":"2007","journal-title":"PLoS One"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1210\/jcem.84.1.5371","article-title":"Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men","volume":"84","author":"Banerji","year":"1999","journal-title":"J Clin Endocrinol Metab"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2708","DOI":"10.3390\/nu5072708","article-title":"Obesity and dyslipidemia in south Asians","volume":"5","author":"Misra","year":"2013","journal-title":"Nutrients"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/ijerph13030257","article-title":"Change in body mass index and its impact on incidence of hypertension in 18-65-year-old Chinese adults","volume":"13","author":"Ren","year":"2016","journal-title":"Int J Environ Res Public Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1007\/s11684-012-0204-8","article-title":"Obesity and overweight prevalence and its association with undiagnosed hypertension in Shanghai population, China: a cross-sectional population-based survey","volume":"6","author":"Li","year":"2012","journal-title":"Front Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"2513","DOI":"10.1038\/s41598-019-39221-2","article-title":"The prevalence of pre-diabetes and diabetes and their associated factors in Northeast China: a cross-sectional study","volume":"9","author":"Wang","year":"2019","journal-title":"Sci Rep"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1093\/jn\/138.7.1377","article-title":"Optimal cutoff values for overweight: using body mass index to predict incidence of hypertension in 18- to 65-year-old Chinese adults","volume":"138","author":"Nguyen","year":"2008","journal-title":"J Nutr"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ypmed.2016.05.004","article-title":"Joint effects of age and body mass index on the incidence of hypertension subtypes in the China health and nutrition survey: a cohort study over 22\u202fyears","volume":"89","author":"Qi","year":"2016","journal-title":"Prev Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1038\/hr.2009.159","article-title":"Enhanced hypertension prevalence in non-Han Chinese minorities from Xinjiang Province, China","volume":"32","author":"Lu","year":"2009","journal-title":"Hypertens Res"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"640","DOI":"10.46234\/ccdcw2022.138","article-title":"Prevalence of metabolic syndrome and risk factors among Chinese adults: results from a population-based study - Beijing, China, 2017-2018","volume":"4","author":"Liu","year":"2022","journal-title":"China CDC Wkly"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1001\/jama.1995.03530130055028","article-title":"A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes","volume":"274","author":"Boushey","year":"1995","journal-title":"JAMA"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"729","DOI":"10.3949\/ccjm.71.9.729","article-title":"Homocysteine: is it a clinically important cardiovascular risk factor","volume":"71","author":"Lentz","year":"2004","journal-title":"Cleve Clin J Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.14456\/jamc.2007.90.7.1506","article-title":"Correlation between change in serum homocysteine levels during hyperinsulinemia and insulin sensitivity","volume":"90","author":"Soonthornpun","year":"2007","journal-title":"J Med Assoc Thail"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.1097\/HJH.0000000000003515","article-title":"Genome-wide analysis of DNA methylation and its relationship with serum homocysteine levels in patients with hypertension","volume":"41","author":"Zhu","year":"2023","journal-title":"J Hypertens"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1016\/j.dsx.2019.02.023","article-title":"Insulin resistance is a cardiovascular risk factor in humans","volume":"13","author":"Adeva-Andany","year":"2019","journal-title":"Diabetes Metab Syndr"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"955","DOI":"10.14218\/JCTH.2024.00311","article-title":"Guideline for the prevention and treatment of metabolic dysfunction-associated fatty liver disease (version 2024)","volume":"12","author":"Fan","year":"2024","journal-title":"J Clin Transl Hepatol"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1016\/S2213-8587(21)00118-2","article-title":"Health policy and public health implications of obesity in China","volume":"9","author":"Wang","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"683","DOI":"10.2337\/diacare.24.4.683","article-title":"Cardiovascular morbidity and mortality associated with the metabolic syndrome","volume":"24","author":"Isomaa","year":"2001","journal-title":"Diabetes Care"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"765","DOI":"10.3390\/ijerph7030765","article-title":"Prevention of overweight and obesity: how effective is the current public health approach","volume":"7","author":"Chan","year":"2010","journal-title":"Int J Environ Res Public Health"}],"updated-by":[{"DOI":"10.3389\/fnut.2026.1835814","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000}}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1732345\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T12:49:01Z","timestamp":1775566141000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1732345\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":52,"alternative-id":["10.3389\/fnut.2025.1732345"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2025.1732345","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,3]]},"article-number":"1732345"}}