Obesity science & practice · 2026
Association of Total Body Fat Percentiles, Obesity and Cardiometabolic Health Biomarkers in Adults in the United States.
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Herrington Grant, Xie Luyu, Yuan Zhenglin, Clark John, Rivara Anna C, Mathew M Sunil, Khan Sarah, Ernest Deepali K, Almandoz Jaime P, Messiah Sarah E
Аннотация
OBJECTIVE: To estimate total body fat percentage (TBFP) percentiles and their association with obesity and cardiometabolic risk biomarkers in the United States adult population.
METHODS: Cross-sectional data for adults (20-59 years) from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed (N = 14,347). TBFP was assessed using dual-energy X-ray absorptiometry. TBFP percentiles were calculated using age-adjusted, weighted quantile regression. Receiver operating characteristic (ROC) analyses assessed the ability of TBFP to predict obesity (body mass index [BMI] ≥ 30 kg/m2), elevated HbA1c (≥ 5.7%), and alanine aminotransferase (ALT) thresholds (≥ 20 and ≥ 40 U/L); and the ability of BMI to predict elevated TBFP.
RESULTS: TBFP percentiles were similar across groups, but non-Hispanic Black men had significantly lower odds of TBFP ≥ 90th percentile compared with non-Hispanic White men. TBFP demonstrated accuracy in predicting BMI-defined obesity (AUC 0.83-0.91), and BMI demonstrated accuracy in predicting elevated TBFP (AUC 0.80-0.90). TBFP had limited ability to predict elevated HbA1c (AUC 0.52-0.65) and ALT (AUC 0.51-0.63).
CONCLUSIONS: TBFP percentiles are associated with BMI-defined obesity but are insufficient to predict cardiometabolic risk independently. These findings support the continued use of BMI as a screening tool and suggest that TBFP may complement but not replace existing measures.
METHODS: Cross-sectional data for adults (20-59 years) from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed (N = 14,347). TBFP was assessed using dual-energy X-ray absorptiometry. TBFP percentiles were calculated using age-adjusted, weighted quantile regression. Receiver operating characteristic (ROC) analyses assessed the ability of TBFP to predict obesity (body mass index [BMI] ≥ 30 kg/m2), elevated HbA1c (≥ 5.7%), and alanine aminotransferase (ALT) thresholds (≥ 20 and ≥ 40 U/L); and the ability of BMI to predict elevated TBFP.
RESULTS: TBFP percentiles were similar across groups, but non-Hispanic Black men had significantly lower odds of TBFP ≥ 90th percentile compared with non-Hispanic White men. TBFP demonstrated accuracy in predicting BMI-defined obesity (AUC 0.83-0.91), and BMI demonstrated accuracy in predicting elevated TBFP (AUC 0.80-0.90). TBFP had limited ability to predict elevated HbA1c (AUC 0.52-0.65) and ALT (AUC 0.51-0.63).
CONCLUSIONS: TBFP percentiles are associated with BMI-defined obesity but are insufficient to predict cardiometabolic risk independently. These findings support the continued use of BMI as a screening tool and suggest that TBFP may complement but not replace existing measures.