Atherogenic risk in normal-weight workers: Associations with sociodemographic and healthy lifestyle factors using lipid-based indexes.

BACKGROUND

Atherogenic dyslipidemia is a significant but often underrecognized cardiovascular risk factor in individuals with normal weight. Traditional metrics such as body mass index (BMI) may fail to identify metabolically unhealthy phenotypes. This study aimed to assess the prevalence and sociodemographic and lifestyle determinants of atherogenic risk using lipid-based indices in a large cohort of normal-weight Spanish workers.

METHODS

A cross-sectional study was conducted in a sample of 166,008 normal-weight workers (BMI 18.5-24.9kg/m2). Four atherogenic risk indices were calculated: TC/HDL-c, LDL/HDL-c, TG/HDL-c, and a composite Dyslipidemia Atherogenic Index (DA). Multivariate logistic regression analyses were performed to assess associations with age, sex, educational level, occupational category (CNAE-11), physical activity (IPAQ), adherence to the Mediterranean diet (MEDAS), smoking, and alcohol consumption.

RESULTS

Male sex, older age, low physical activity, and poor adherence to the Mediterranean diet were independently associated with elevated values in all four atherogenic indices. The strongest associations were observed for DA with sedentary lifestyle (OR: 9.15; 95% CI: 8.08-10.23) and poor diet quality (OR: 5.23; 95% CI: 4.39-6.07). Notably, 17-22% of normal-weight workers showed abnormal lipid ratios suggestive of increased cardiometabolic risk.

CONCLUSIONS

Normal BMI does not guarantee cardiometabolic health. A considerable proportion of normal-weight individuals exhibit lipid profiles consistent with atherogenic dyslipidemia, largely driven by modifiable lifestyle factors. Lipid-based indices are valuable tools for early risk identification in occupational settings and should complement traditional anthropometric screening.