Higher BMI levels showed progressive associations with increased cardiometabolic disease burden in a large cohort of adults with obesity. This study in Cardiovascular Diabetology evaluated how different BMI measures relate to arterial hypertension and T2DM. 

The cross-sectional analysis evaluated 3,486 adults assessed before bariatric surgery. BMI was analysed as a continuous measure, as quartiles, and as obesity classes. Frequencies of arterial hypertension and T2DM, along with a combined comorbidity score, were recorded. Univariable and multivariable stepwise regression models assessed associations between BMI measures and cardiometabolic outcomes.

T2DM prevalence increased across ascending BMI quartiles (p<0.001), and arterial hypertension showed the same pattern (p<0.001). Age demonstrated similar associations (p<0.001). In multivariable analysis, BMI quartiles were more strongly associated with arterial hypertension, T2DM, and the combined comorbidity score (all p<0.001) compared with absolute BMI values or obesity class categories. Receiver operating characteristic analysis showed greater predictive performance for BMI quartiles, with larger areas under the curve compared with BMI and obesity classes.

These findings indicate that finer BMI stratification improves risk modelling for arterial hypertension and T2DM than traditional BMI groupings.