Body-composition phenotypes and their associations with cardiometabolic risks and health behaviours in a representative general US sample

Globally, one-third of adults are living with overweight or obesity (Powell-Wiley et al., 2021; Malik et al., 2013; World Health Organization, 2021; Blüher, 2019). Excess adiposity increases the risk for cardiometabolic abnormalities including hypertension, diabetes, and dyslipidemia (Guh et al., 2009). Most commonly, obesity is defined by a body mass index (BMI) ≥30 kg/m2. However, BMI cannot distinguish between muscle mass and fat mass, and the limitations of BMI are well-documented (Rothman, 2008; Frankenfield et al., 2001; Nuttall, 2015).

In 2014, Prado et al. (Prado et al., 2014) adapted the lambda-mu-sigma (LMS) methodology to propose phenotypes of fat and muscle mass using dual energy X-ray absorptiometry (DXA) data. The LMS methodology has been extensively used to identify typical growth patterns (e.g., length-for-age) in children while controlling for key characteristics such as sex and age (Cole, 1990; Flegal and Cole, 2013; Cole, 2012). Thus using that methodology, Prado et al., developed four mutually exclusive DXA-derived phenotypes based on whether an individual was above (≥50th centile) or below (<50th centile) the median of DXA-measured fat and muscle mass indices for their sex and age reference curves: high-adiposity with high-muscle, high-adiposity with low-muscle, low-adiposity with high-muscle, and low-adiposity with low-muscle (Prado et al., 2014).

However, beyond the conceptual framework (Prado et al., 2014), empirical studies of the epidemiology of the phenotypes are lacking. DXA is commonly used as the ‘gold standard’ for assessing adiposity and body composition in research, but not in clinical practice. Thus, improving our understanding of the health and behavioural correlates of DXA-measured body composition is necessary for clinical translation. Thus, the objective of this study was to investigate the behavioural, cardiometabolic health, and demographic characteristics of the DXA-derived phenotypes.

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