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Epidemiology and Population Health

Association of novel metabolic status with asymptomatic intracranial arterial stenosis: A cross-sectional study

International Journal of Obesity volume 49, pages 1024–1030 (2025)Cite this article

Subjects

Abstract

Objectives

To investigate the association of metabolic status newly defined or obesity with asymptomatic intracranial arterial stenosis (aICAS) among populations in rural China.

Methods

The cross-sectional study is based on the Rose asymptomatic IntraCranial Artery Stenosis (RICAS) cohort, which enrolled 2005 participants aged 40 years or older without a history of clinical stroke or transient ischemic attack. Metabolically healthy status (MH) was defined by a newly proposed criterion: (1) systolic blood pressure (SBP) < 130 mmHg and without antihypertensive medication; (2) a waist-to-hip ratio (WHR) below 1.03 for men and below 0.95 for women; (3) no diabetes. All participants were categorized based on their metabolic status and obesity. Multivariate logistic regression models were used to investigate the association between metabolic status or obesity and aICAS.

Results

Among 2005 participants, 1597 (79.65%) were defined as metabolically unhealthy status (MU) according to the new criterion. MU was significantly associated with aICAS (OR 2.02, 95% CI 1.11–3.68, P = 0.021), especially moderate-to-severe aICAS (OR 2.43, 95% CI 1.04–5.72, P = 0.042). The prevalence of aICAS increased with the numbers of metabolic disorders (P for linear trend <0.001). Both metabolically unhealthy normal-weight (MUN) (OR 2.11, 95% CI 1.10–4.03, P = 0.025) and metabolically unhealthy obesity (MUO) (OR 3.30, 95% CI 1.64–6.64, P = 0.001) were significantly correlated with aICAS, but not metabolically healthy obesity (MHO). Subgroup analysis further confirmed the association between MU and aICAS risk only in men (P for interaction = 0.042).

Conclusions

MU defined by the new criterion was significantly associated with aICAS, especially with moderate-to-severe aICAS. This novel criterion effectively identifies individuals with a high prevalence of aICAS among populations with obesity, which could be crucial for stroke prevention.

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Fig. 1: Flow chart of the study participants.
Fig. 2: Association between metabolic status and aICAS in subgroups according to sociodemographic characteristics.

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Data availability

All data used in this study were available upon request.

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Acknowledgements

We are grateful to all the RICAS study participants and the staff at Shandong Provincial Hospital, China involved in this study.

Funding

This study was supported by grants from the Jinan Science and Technology Bureau (201704101), the Department of Science and Technology of Shandong Province (ZR2017MH114, ZR2020QH109, ZR2022LSW010, and ZR2023MH070), the National Natural Science Foundation of China (81971128, and 82201477). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Author notes

  1. These authors contributed equally: Liying Guo, Yongli Pan.

Authors and Affiliations

  1. Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China

    Liying Guo, Yumeng Yang, Shiqing Song & Qinjian Sun

  2. Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China

    Yongli Pan, Xianglong Kong, Maoyu Li, Yuanyuan Zhao, Xiaotong Ma, Xiang Wang & Qinjian Sun

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Contributions

LG, YP, YY, SK and SS analysed the data and contributed to the original draft. ML,YZ, XM and XW contributed to the review and revision of the manuscript. QS conceived and designed the study. All the authors have read and approved the manuscript.

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Correspondence to Qinjian Sun.

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Guo, L., Pan, Y., Yang, Y. et al. Association of novel metabolic status with asymptomatic intracranial arterial stenosis: A cross-sectional study. Int J Obes 49, 1024–1030 (2025). https://doi.org/10.1038/s41366-025-01723-7

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