Central and General Obesity and Their Cardiometabolic Determinants in a Pakistani Clinical Population: Insights from the PREVENT-CARD Registry

Objectives: This study aimed to reassess the frequency and clinical correlates of general and central obesity using Asian-specific criteria in a large Pakistani cohort. Methodology: This observational study utilized data from the PREVENT-CARD registry (NCT06503341). Anthropometric assessments, clinical history, and laboratory investigations were extracted for adults presenting to preventive cardiology clinics across NICVD Karachi and its affiliated units. Obesity was classified using Asian BMI cut-offs, while central obesity was defined through gender-specific WC thresholds with an additional borderline range (±5 cm) to account for measurement variability. Descriptive statistics and multivariable logistic regression were performed to identify factors associated with general and central obesity. Results: Among 2,144 individuals, 71.2% were obese and 68.2% of the 1,174 participants with available WC data were centrally obese. Central obesity was observed even among individuals with normal BMI, while 83.4% of obese individuals also met criteria for central obesity. Obesity and central obesity were significantly associated with female gender, middle age (40–60 years), hypertension, diabetes, and dyslipidemia. Logistic regression demonstrated positive associations of obesity with male gender (adjusted OR: 1.24 [95% CI: 1.00–1.53]) and hypertension (adjusted OR: 3.79 [95% CI: 3.04–4.72]), while age >60 years showed an inverse association. Central obesity was significantly associated with male gender, hypertension, and diabetes. Conclusion: A strikingly high burden of general and central obesity was identified using South Asian–appropriate cut-offs. The strong overlap between WC and BMI, alongside substantial rates of normal-weight central obesity, underscores the need for routine WC measurement in cardiovascular risk assessment. These findings call for urgent, culturally tailored public health strategies to mitigate obesity-related cardiometabolic risk in Pakistan.