Abstract
Obesity contributes to increased morbidity and mortality, yet its metabolic heteroge-neity remains underexplored in sub-Saharan Africa. This study examined associations between body composition, insulin sensitivity, inflammation, and the metabolically healthy profile (MHP), and assessed cardiovascular risk among Camer-oonian adults with and without obesity. In this cross-sectional study, 490 participants from the West region of Cameroon underwent anthropometric and metabolic assessments. Ten-year cardiovascular risk was estimated using the Framingham risk score. Logistic regression identified predictors of MHP and determinants of elevated car-diovascular risk. The prevalence of MHP was 59.6% among individuals with normal weight, 11.5% among those with overweight, and 38.2% among those with obesity. Participants with overweight, obesity, android obesity or insulin resistance were 92%, 59%, 58%, and 46% less likely to have a MHP than participants in the control groups, respectively. Inflammation defined solely by CRP-hs was not predictive. Compared with metabolically unhealthy counterparts, metabolically healthy obese (OR = 6.27; 95% CI: 3.15-12.48) and overweight (OR = 2.50; 95% CI: 0.72-8.65) individuals had substantially lower predicted 10-year cardiovascular risk. Metabolic phenotyping reveals that not all Cameroonians with overweight and obesity present the same cardiovascular risk. Incorporating fat distribution and insulin sensitivity into clinical evaluation could improve early identification of high-risk individuals and guide tailored prevention strategies.