Metabolic and body composition alterations in normal-weight adults with prediabetes: A DEXA-based analysis

This study examines clinical, biochemical, and body composition differences between healthy and prediabetic normal-weight individuals (BMI 18.5-24.9 kg/m²), with a focus on central fat distribution.

Sixty participants (30 prediabetic, 30 healthy) underwent clinical evaluations, including body composition analysis using DEXA.

• Women: Multivariate regression analysis demonstrated that the android-to-gynoid fat ratio remained an independent and significant predictor of prediabetes (p = 0.014). • Men: GFR and creatinine levels were significantly impaired (p = 0.008, p = 0.019). Central fat distribution, especially trunk fat, correlated with fasting glucose, although this association lost significance after age adjustment.

In women, prediabetes is associated with impaired glucose metabolism and central fat accumulation, particularly reflected by an elevated DEXA-derived android/gynoid fat ratio, highlighting a "normal-weight obesity" phenotype even in individuals with normal BMI. In men, central fat distribution, especially the trunk-to-limb fat ratio, is linked to glucose metabolism; however, this relationship diminishes after adjusting for age, suggesting that age-related fat redistribution may modulate metabolic risk. Additionally, early renal dysfunction, as indicated by reduced eGFR, is evident in men with prediabetes, underscoring the importance of comprehensive metabolic and renal assessment. These findings emphasize the clinical relevance of body composition-based screening, particularly using DEXA-derived regional fat ratios, to identify high-risk normal-weight individuals and enable timely preventive interventions.