Abdominal fat predicts heart disease risk better than BMI

腹部脂肪比 BMI 更能预测心脏病风险

WASHINGTON (Aug 11, 2026) - The size of a person’s midsection is a better indicator of cardiovascular disease risk when compared to their body mass index (BMI) alone, according to a study published in JACC, the flagship journal of the American College of Cardiology. BMI has traditionally been used to determine overweight or obesity, common risk factors for heart disease, but this study shows that not accounting for waist circumference (WC) or waist-to-hip ratio (WHR) can lead to misclassification of cardiovascular disease risk.

华盛顿（2026 年 8 月 11 日）——根据发表在《美国心脏病学会杂志》（JACC，美国心脏病学会旗舰期刊）上的一项研究，与单独使用身体质量指数（BMI）相比，一个人的腰围大小是心血管疾病风险的更好指标。BMI 传统上用于确定超重或肥胖（心脏病的常见风险因素），但这项研究表明，如果不考虑腰围（WC）或腰臀比（WHR），可能会导致心血管疾病风险分类错误。

“Indeed, it appears that WC and WHR reclassify risk defined by traditional BMI thresholds,” said Michael J. Blaha, MD, MPH, senior author of the study and director of clinical research at Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. “We saw individuals with clinically determined normal weight who had elevated central adiposity and high WHR, associating them with higher risk across most outcomes.”

“确实，WC 和 WHR 似乎重新分类了由传统 BMI 阈值定义的风险，”该研究的高级作者、约翰斯·霍普金斯大学 Ciccarone 心血管疾病预防中心临床研究主任 Michael J. Blaha 医学博士、公共卫生硕士说。“我们看到一些临床确定为正常体重的人具有升高的中心性肥胖和高 WHR，这使他们与大多数结果相关的风险更高。”

BMI is calculated by dividing weight in kilograms by height in meters squared and is a common practice for diagnosing obesity. However, BMI cannot account for distribution of body fat. Studies have shown that visceral fat, which is fat that surrounds the internal organs in the abdominal area, is associated with chronic diseases like heart disease and diabetes, while subcutaneous fat, which is located directly under the skin, is not as strongly associated.

BMI 是通过将体重（公斤）除以身高（米）的平方来计算的，是诊断肥胖的常见做法。然而，BMI 无法解释身体脂肪的分布。研究表明，内脏脂肪（围绕腹部内部器官的脂肪）与心脏病和糖尿病等慢性疾病有关，而位于皮肤正下方的皮下脂肪则没有如此强烈的关联。

Despite evidence linking central adiposity, the accumulation of both visceral and subcutaneous fat in the abdominal area, to adverse cardiovascular health outcomes, BMI is still the most used metric to determine overweight and obesity and future cardiovascular risk. This study examines whether adding WC and WHR to BMI better predicts future cardiovascular risk.

尽管有证据将中心性肥胖（腹部区域内脏脂肪和皮下脂肪的积累）与不良心血管健康结果联系起来，但 BMI 仍然是确定超重、肥胖和未来心血管风险最常用的指标。这项研究考察了在 BMI 基础上增加 WC 和 WHR 是否能更好地预测未来的心血管风险。

Researchers from the Cross Cohort Collaboration looked at over 260,000 people over an average of 20 years who had either WC or WHR data and at least one of nine outcomes: time to first fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, heart failure, atrial fibrillation, total coronary heart disease (CHD), total cardiovascular disease (CVD), CHD mortality, CVD mortality and/or all-cause mortality.

来自跨队列合作（Cross Cohort Collaboration）的研究人员观察了超过 260,000 人，平均时间为 20 年，这些人拥有 WC 或 WHR 数据，并且至少有九种结果中的一种：首次致命和非致命心肌梗死的时间、致命和非致命中风、心力衰竭、心房颤动、总冠心病（CHD）、总心血管疾病（CVD）、CHD 死亡率、CVD 死亡率和/或全因死亡率。

In individuals with normal weight as determined by BMI, 5% had high WC and 18% had high WHR; among those with overweight, 39% had high WC and 40% had high WHR. Among those with obesity, 9% had low WC and 45% had low WHR.

在由 BMI 确定的正常体重个体中，5% 具有高 WC，18% 具有高 WHR；在超重者中，39% 具有高 WC，40% 具有高 WHR。在肥胖者中，9% 具有低 WC，45% 具有低 WHR。

Those individuals with normal weight or overweight and clinically defined high WC or WHR were associated with a 15% - 50% greater risk for most of the nine studied outcomes. Those with obesity and low WC were not found to be associated with a significantly different risk of outcomes compared with those who had normal weight and low WC, except for all-cause mortality, for which risk was significantly lower.

那些正常体重或超重且临床定义为高 WC 或 WHR 的个体，与所研究的九种结果中的大多数风险增加 15% - 50% 相关。那些肥胖且 WC 较低的个体，与正常体重且 WC 较低的个体相比，未发现结果风险有显著不同，全因死亡率除外，其风险显著较低。

“Our findings emphasize the critical role of identifying elevated central adiposity, even in individuals with a normal BMI or with a BMI in the overweight range. Relying solely on BMI may result in misclassification of cardiovascular risk across a wide range of cardiovascular outcomes,” Zeina A. Dardari, PhD, MS, lead author of the study, said. “We encourage clinicians to consider central adiposity distribution across the entire BMI spectrum when evaluating cardiovascular risk in primary prevention settings.”

“我们的发现强调了识别中心性肥胖升高的关键作用，即使是在 BMI 正常或 BMI 处于超重范围内的人中。仅依赖 BMI 可能导致广泛心血管结果的风险分类错误，”该研究的主要作者 Zeina A. Dardari 博士、理学硕士说。“我们鼓励临床医生在初级预防环境中评估心血管风险时，考虑整个 BMI 谱系中的中心性肥胖分布。”

Limitations of the study include that it did not have measures of physical activity, diet or genetic obesity risk, which have all been shown to play a role in the development of CVD. It also included only one assessment of WC and WHR, which could limit understanding of how changes in central fat accumulation over time influences CVD risk.

该研究的局限性包括它没有衡量体力活动、饮食或遗传肥胖风险，这些都被证明在 CVD 的发展中起作用。它还只包括一次 WC 和 WHR 评估，这可能限制了对中心脂肪积累随时间变化如何影响 CVD 风险的理解。

“It is time to abandon a sole focus on body mass index,” said Harlan M. Krumholz, MD, SM, MACC, FAHA, Editor-in-Chief of JACC and the Harold H. Hines, Jr Professor at the Yale School of Medicine. “This enormously important study, based on data from hundreds of thousands of participants in large-scale cohort studies, authoritatively shows that waist circumference and waist-to-hip ratio provide critical information about cardiovascular risk, even among people with a BMI considered normal. Where fat is distributed matters, and these simple measures should be part of routine cardiovascular risk assessment.”

“是时候放弃仅关注身体质量指数了，”JACC 主编、耶鲁医学院 Harold H. Hines, Jr 教授 Harlan M. Krumholz 医学博士、科学硕士、MACC、FAHA 说。“这项极其重要的研究基于大规模队列研究中数十万参与者的数据，权威地表明腰围和腰臀比提供了关于心血管风险的关键信息，即使在 BMI 被认为正常的人群中也是如此。脂肪分布的位置很重要，这些简单的测量应该成为常规心血管风险评估的一部分。”