Keywords: cardiovascular risk factors, obesity phenotype, South Africa, sub-clinical cardiovascular disease.Efforts to characterize the disease risk associated with obesity 1 suggest that related metabolic abnormalities are not uniform in all obese persons. The concepts of "metabolically-healthy-" and "metabolicallyabnormal-" normal-weight, overweight and obese have been used to characterize the phenotypes resulting from the cross-classification of individuals by body mass index (BMI) and metabolic status. 2 Studies, mostly from developed countries, suggest each phenotype to represent a sizable proportion of the population. However, evidence on their association with cardiovascular disease (CVD) risk is inconclusive, and no study has assessed the prevalence of obesity phenotypes and correlation with disease risk in Africans. 3 We assessed the prevalence of obesity phenotypes, and their association with sub-clinical CVD in mixed-ancestry South Africans. MethodsParticipants were from the Bellville-South community in Cape Town, as described elsewhere. 4,5 Based on BMI (weight [kg]/height [m 2 ]), participants were classified as normal-weight (BMI, <25.0), overweight (BMI, 25.0-29.9), or obese (BMI, ≥30.0). The metabolic status was considered abnormal if two or more of the following: (i) systolic (or diastolic) blood pressure ≥130 (85) mmHg, or history of doctor-diagnosed hypertension;(ii) fasting blood glucose ≥5.6 mmol/L or diabetes mellitus (known/screen-detected using oral glucose tolerance test); (iii) serum triglycerides ≥1.69 mmol/L; and (iv) high-density lipoprotein (HDL)-cholesterol <1.04 mmol/L for men (<1.29 mmol/L women). Crossclassification of participants by BMI and metabolic status resulted in the following categories: normalweight metabolically-healthy (NWMH), overweight metabolically-healthy (OvMH), obese metabolicallyhealthy (OMH), normal-weight metabolic-abnormal (NWMA), overweight metabolically-abnormal (OvMA), and obese metabolically-abnormal (OMA).Sub-clinical CVD was based on the common carotid intima-media thickness (CIMT) and the cardiac interventricular septum (IVS) thickness. CIMT was measured by qualified sonographer observers, in longitudinal section at the far wall of the distal common carotid arteries, at three consecutive end-points, 5-10 mm apart. The median of the six readings (three from each side) was calculated for each participant using a portable B-mode and spectral Doppler ultrasound scanner. The same device was used to measure the telediastolic IVS thickness based on B-mode images.The Cochrane-Armitage trend test and modified Brown-Forsythe Levene-type procedures were used to investigate the linear trend of baseline characteristics across BMI categories overall, and by metabolic status. The R statistical software version 2.13.0 (13-04-2011), (The R Foundation for Statistical Computing, Vienna, Austria) was used for all statistical analyses. ResultsThe starting sample comprised 574 individuals examined in 2011; 235 (40.9) did not consent for the CIMT meaCorrespondence

No abstract