TABLE 1.

Definitions of Metrics for Each Cardiometabolic Component, Categorized by Optimal, Intermediate, and Poor Levels^a

Cardiometabolic Component	Optimal	Intermediate	Poor
Adiposityb	BMI <25 kg/m2 AND WC ≤88 cm (women)/WC ≤102 cm (men)	BMI 25–30 kg/m2 AND WC ≤88 cm (women)/WC ≤102 cm (men)	BMI >30 kg/m2 OR WC >88 cm (women)/WC>102 cm (men)
Blood glucosec,d	FPG <100 mg/dL AND HbA1c <5.7% AND NOT taking diabetes medication	FPG 100–125 mg/dL OR HbA1c 5.7%−6.4% OR FPG <100 mg/dL AND HbA1c <5.7% AND taking diabetes medication	FPG ≥126 mg/dL OR HbA1c ≥6.5%
Blood lipidse,f	TC:HDL <3.5:1 AND NOT taking lipid-lowering medication	TC:HDL 3.5–5:1 OR TC:HDL <3.5:1 AND taking lipid-lowering medication	TC:HDL >5:1
Blood pressureg	SBP <120 AND DBP <80 AND NOT taking BP-lowering medications	(SBP 120–139 OR DBP 80–89) OR (SBP <120 AND DBP <80 AND taking BP-lowering medications)	SBP ≥140 OR DBP ≥90
History of CVDh	None of the listed conditions	Angina only	One or more of CHD, myocardial infarction, heart failure, stroke

^aWe separately evaluated metabolic syndrome as defined by the ATPIII/National Heart, Lung, and Blood Institute guidelines as presence of 3 or more of the following: HDL-C <40 mg/dL (men)/<50 mg/dL (women) or on drug treatment for reduced HDL-C; triglycerides ≥150 mg/dL or on drug treatment for elevated triglycerides; blood pressure ≥130 SBP or ≥85 DBP or on antihypertensive drug treatment with a history of hypertension; WC ≥102 cm (men)/ ≥88 cm (women); and fasting plasma glucose ≥100 mg/dL or on drug treatment for elevated glucose.¹⁴

^bIn sensitivity analyses, BMI thresholds for Asian American individuals were as follows: optimal: BMI <23 kg/m², intermediate: 23–27.5 kg/m², and poor: BMI >27.5 kg/m², based on guidelines from National Institute for Health and Care Excellence, United Kingdom, World Health Organization, and American Diabetes Association.¹³

^cFPG and HbA_1c levels from the American Diabetes Association³⁷ FPG values before 2015–2016 NHANES survey cycles were corrected to account for differences in measurement instruments used. See Supplemental Text 1 for further details.

^dSelf-reported history of diabetes was not separately included in the definitions.

^eTC:HDL levels from Calling et al.³⁸

^fIn sensitivity analyses, we evaluated LDL-cholesterol and triglyceride levels instead of the TC:HDL ratio. Optimal: LDL<100 mg/dL, TG <150 mg/dL, and not taking lipid-lowering medication; intermediate: LDL 100–159 mg/dL or TG 150–174 mg/dL, regardless of lipid-lowering medication usage or LDL <100 mg/dL and TG <150 mg/dL and taking lipid-lowering medication; and poor: LDL ≥160 mg/dL or TG ≥175 mg/dL or taking lipid-lowering medication.³⁹

^gBlood pressure levels from Unger et al.⁴⁰

^hPrior CHD, myocardial infarction, heart failure, or stroke based on self-reported history. Presence of angina based on having both a positive Rose Questionnaire or use of anti-anginal medication.

BMI = body mass index; CHD = coronary heart disease; CVD = cardiovascular disease; DBP = diastolic blood pressure; FPG = Fasting Plasma Glucose; HbA_1c = Hemoglobin A_1c; LDL = low-density lipoprotein; SBP = systolic blood pressure; TC:HDL = total cholesterol to high-density lipoprotein ratio; TG = triglycerides; WC = waist circumference.