Adiposity and glycemic patterns among adults meeting measured cardiovascular-kidney-metabolic stage 1 criteria: a multicohort study

Background The 2026 AHA/ACC/ADA/ASN guideline defines cardiovascular-kidney-metabolic (CKM) stage 1 by excess or dysfunctional adiposity. Whether adiposity and glycemic patterns distinguish subsequent risk is uncertain. Methods Adults aged 45–79 years meeting measured stage 1 criteria were studied in CHARLS and CHNS. Four patterns combined body mass index (BMI), waist circumference, and prediabetes. Modified Poisson models estimated risk ratios (RRs). Progression and hypertension models used censoring weights; cumulative self-reported cardiovascular disease (CVD) models used baseline-covariate imputation. The nonglycemic composite was a key secondary outcome. NHANES assessed reclassification with ancestry-appropriate thresholds and age–sex standardization. Chinese cohorts lacked albuminuria and subclinical CVD assessment. Results In CHARLS (model n = 965), adiposity plus prediabetes was associated with metabolic progression versus prediabetes only (RR, 1.38; 95% CI, 1.18–1.61). Corresponding RRs were 1.45 (1.21–1.74) for nonglycemic progression and 1.55 (1.21–1.98) for CHNS hypertension. Among 1824 participants, concordant BMI and waist adiposity was associated with cumulative reported CVD through 2020 (RR, 1.83; 95% CI, 1.23–2.71). CVD associations attenuated in complete-case models and after additional adjustment for metabolic measures. Standardized NHANES reclassification ranged from 0.8% to 9.0%. Conclusions Adiposity and glycemic patterns identified prognostic heterogeneity among adults meeting measured CKM stage 1 criteria, supporting joint assessment of these features.