Concordance and discriminatory capacity of two metabolic health definitions for cardiometabolic outcomes across BMI categories: Evidence from 100,000 Mexican adults

IF 0.3 Q4 NUTRITION & DIETETICS

CAHIERS DE NUTRITION ET DE DIETETIQUE Pub Date : 2026-08-01 Epub Date: 2026-09-24 DOI:10.1016/j.cnd.2026.08.102

Adolfo Ruiz-Ballesteros, Víctor Manuel Treviño Alvarado, Álvaro Colín Oviedo, Guillermo Torre-Amione, Ana Laura de la Garza

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This study evaluated the concordance between the MetS-based and empirically derived Zembic et al. definitions, and their discriminatory capacity – along with cardiometabolic indices – for cardiovascular disease (CVD), fatty liver disease (FLD), and chronic kidney disease (CKD) across BMI categories in Mexican adults.</div><div><h3>Methods</h3><div>A cross-sectional analysis was conducted using data from the oriGen project. MH was defined using two criteria: (1) the harmonized MetS-based definition (0–1 component=MH); and (2) the Zembic definition (absence of diabetes, elevated blood pressure, and high waist-to-hip ratio=MH). Agreement was assessed with Cohen's kappa (κ). Discriminatory capacity for self-reported CVD, FLD and CKD was evaluated using AUC (DeLong method), and associations through logistic regression adjusted for age and sex. Additionally, 28 cardiometabolic indices were assessed for the same outcomes. This study was approved by the research committee of “Centro Médico Zambrano Hellion, TecSalud” (approval letter No. 382-2026-CI-R).</div></div><div>A cross-sectional analysis was conducted using data from the oriGen project. MH was defined using two criteria: (1) the harmonized MetS-based definition (0–1 component=MH); and (2) the Zembic definition (absence of diabetes, elevated blood pressure, and high waist-to-hip ratio=MH). Agreement was assessed with Cohen's kappa (κ). Discriminatory capacity for self-reported CVD, FLD and CKD was evaluated using AUC (DeLong method), and associations through logistic regression adjusted for age and sex. Additionally, 28 cardiometabolic indices were assessed for the same outcomes. This study was approved by the research committee of “Centro Médico Zambrano Hellion, TecSalud” (approval letter No. 382-2026-CI-R).</div><div><h3>Results</h3><div>A total of 100,331 adults were included. CVD was present in 9,821 participants (9.8%), FLD in 5,105 (5.1%), and CKD in 758 (0.8%). MetS-based definition classified 17,557 (17.5%) participants as MH, compared with 29,448 (29.3%) using the Zembic definition. Agreement between definitions was moderate (κ=0.43) and declined progressively with BMI: normal-weight (κ=0.50), overweight (κ=0.27), and obesity (κ=0.11). Zembic definition better discriminated all outcomes across BMI categories, except for FLD in normal-weight individuals, where MetS-based definition performed better (AUC 0.597 vs. 0.564, <em>P</em>  <0.001), with Zembic definition yielding higher odds ratios.</div></div><div>A total of 100,331 adults were included. CVD was present in 9,821 participants (9.8%), FLD in 5,105 (5.1%), and CKD in 758 (0.8%). MetS-based definition classified 17,557 (17.5%) participants as MH, compared with 29,448 (29.3%) using the Zembic definition. Agreement between definitions was moderate (κ=0.43) and declined progressively with BMI: normal-weight (κ=0.50), overweight (κ=0.27), and obesity (κ=0.11). Zembic definition better discriminated all outcomes across BMI categories, except for FLD in normal-weight individuals, where MetS-based definition performed better (AUC 0.597 vs. 0.564, <em>P</em>  <0.001), with Zembic definition yielding higher odds ratios.</div><div><h3>Conclusion</h3><div>These findings suggest that the definition of metabolic health substantially influences phenotyping. The Zembic definition showed superior discrimination capacity, supporting its potential as a clinically meaningful framework for risk stratification in precision nutrition and obesity research, where indices such as TIMI index and fat mass index may enhance outcome discrimination.</div></div><div>These findings suggest that the definition of metabolic health substantially influences phenotyping. 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引用次数: 0

Abstract

Background/objective

Metabolic health (MH) lacks a universal definition, leading to heterogeneity in cardiometabolic phenotyping. This study evaluated the concordance between the MetS-based and empirically derived Zembic et al. definitions, and their discriminatory capacity – along with cardiometabolic indices – for cardiovascular disease (CVD), fatty liver disease (FLD), and chronic kidney disease (CKD) across BMI categories in Mexican adults.

Methods

A cross-sectional analysis was conducted using data from the oriGen project. MH was defined using two criteria: (1) the harmonized MetS-based definition (0–1 component = MH); and (2) the Zembic definition (absence of diabetes, elevated blood pressure, and high waist-to-hip ratio = MH). Agreement was assessed with Cohen's kappa (κ). Discriminatory capacity for self-reported CVD, FLD and CKD was evaluated using AUC (DeLong method), and associations through logistic regression adjusted for age and sex. Additionally, 28 cardiometabolic indices were assessed for the same outcomes. This study was approved by the research committee of “Centro Médico Zambrano Hellion, TecSalud” (approval letter No. 382-2026-CI-R).

Results

A total of 100,331 adults were included. CVD was present in 9,821 participants (9.8%), FLD in 5,105 (5.1%), and CKD in 758 (0.8%). MetS-based definition classified 17,557 (17.5%) participants as MH, compared with 29,448 (29.3%) using the Zembic definition. Agreement between definitions was moderate (κ = 0.43) and declined progressively with BMI: normal-weight (κ = 0.50), overweight (κ = 0.27), and obesity (κ = 0.11). Zembic definition better discriminated all outcomes across BMI categories, except for FLD in normal-weight individuals, where MetS-based definition performed better (AUC 0.597 vs. 0.564, P < 0.001). TIMI index showed the highest discriminatory capacity for CVD (AUC 0.645) and CKD (AUC 0.653), while fat mass index performed best for FLD (AUC 0.640). Metabolically unhealthy phenotype was associated with all outcomes under both definitions (P < 0.001), with Zembic definition yielding higher odds ratios.

Conclusion

These findings suggest that the definition of metabolic health substantially influences phenotyping. The Zembic definition showed superior discrimination capacity, supporting its potential as a clinically meaningful framework for risk stratification in precision nutrition and obesity research, where indices such as TIMI index and fat mass index may enhance outcome discrimination.

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两种代谢健康定义在BMI类别中对心脏代谢结果的一致性和区别性：来自10万名墨西哥成年人的证据

背景/目的代谢健康（MH）缺乏一个通用的定义，导致心脏代谢表型存在异质性。本研究评估了基于mets和经验推导的Zembic等定义之间的一致性，以及它们对墨西哥成年人心血管疾病（CVD）、脂肪性肝病（FLD）和慢性肾脏疾病（CKD）跨BMI类别的区分能力和心脏代谢指数。代谢健康（MH）缺乏一个通用的定义，导致心脏代谢表型的异质性。本研究评估了基于mets和经验推导的Zembic等定义之间的一致性，以及它们对墨西哥成年人心血管疾病（CVD）、脂肪性肝病（FLD）和慢性肾脏疾病（CKD）跨BMI类别的区分能力和心脏代谢指数。方法采用oriGen项目资料进行横断面分析。MH的定义采用两个标准：(1)统一的基于met的定义（0-1分量= MH）；(2) Zembic定义（无糖尿病、血压升高和高腰臀比= MH）。采用Cohen’s kappa （κ）评价一致性。使用AUC （DeLong方法）评估自我报告的CVD、FLD和CKD的区分能力，并通过调整年龄和性别的逻辑回归评估相关性。此外，对28项心脏代谢指标进行了相同结果的评估。本研究获得TecSalud Centro m dico Zambrano Hellion研究委员会批准（批准函号：382-2026-CI-R）。使用来自oriGen项目的数据进行了横断面分析。MH的定义采用两个标准：(1)统一的基于met的定义（0-1分量= MH）；(2) Zembic定义（无糖尿病、血压升高和高腰臀比= MH）。采用Cohen’s kappa （κ）评价一致性。使用AUC （DeLong方法）评估自我报告的CVD、FLD和CKD的区分能力，并通过调整年龄和性别的逻辑回归评估相关性。此外，对28项心脏代谢指标进行了相同结果的评估。本研究获得TecSalud Centro m dico Zambrano Hellion研究委员会批准（批准函号：382-2026-CI-R）。结果共纳入成人100331人。CVD患者9821例（9.8%），FLD患者5105例（5.1%），CKD患者758例（0.8%）。基于met的定义将17,557（17.5%）参与者归类为MH，而使用Zembic定义的参与者为29,448（29.3%）。定义之间的一致性为中等（κ = 0.43），并随着BMI逐渐下降：正常体重（κ = 0.50）、超重（κ = 0.27）和肥胖（κ = 0.11）。Zembic定义更好地区分了BMI类别的所有结果，除了正常体重个体的FLD，其中met -based定义表现更好（AUC 0.597比0.564,P < 0.001）。TIMI指数对CVD （AUC 0.645）和CKD （AUC 0.653）的鉴别能力最强，脂肪质量指数对FLD的鉴别能力最强（AUC 0.640）。代谢不健康表型与两种定义下的所有结果相关（P < 0.001），其中Zembic定义的比值比更高。共有100,331名成年人被纳入调查。CVD患者9821例（9.8%），FLD患者5105例（5.1%），CKD患者758例（0.8%）。基于met的定义将17,557（17.5%）参与者归类为MH，而使用Zembic定义的参与者为29,448（29.3%）。定义之间的一致性为中等（κ = 0.43），并随着BMI逐渐下降：正常体重（κ = 0.50）、超重（κ = 0.27）和肥胖（κ = 0.11）。Zembic定义更好地区分了BMI类别的所有结果，除了正常体重个体的FLD，其中met -based定义表现更好（AUC 0.597比0.564,P < 0.001）。TIMI指数对CVD （AUC 0.645）和CKD （AUC 0.653）的鉴别能力最强，脂肪质量指数对FLD的鉴别能力最强（AUC 0.640）。代谢不健康表型与两种定义下的所有结果相关（P < 0.001），其中Zembic定义的比值比更高。结论这些发现表明代谢健康的定义在很大程度上影响表型。Zembic定义显示出卓越的区分能力，支持其作为精确营养和肥胖研究中有临床意义的风险分层框架的潜力，其中诸如TIMI指数和脂肪质量指数等指标可能会增强结果区分。这些发现表明，代谢健康的定义实质上影响表型。Zembic定义显示出卓越的区分能力，支持其作为精确营养和肥胖研究中有临床意义的风险分层框架的潜力，其中诸如TIMI指数和脂肪质量指数等指标可能会增强结果区分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CAHIERS DE NUTRITION ET DE DIETETIQUE NUTRITION & DIETETICS-

CiteScore

0.60

自引率

33.30%

发文量

审稿时长

65 days

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