Clinical Investigation| Volume 365, ISSUE 2, P152-161, February 2023

The association between elevated body mass index and wide blood chemistry panel results in apparently healthy individuals

Published:September 19, 2022DOI:



      Blood chemistry panel and body mass index (BMI) are common ways to evaluate individual health. The study aimed to compare a wide range of blood chemistry tests between obese, overweight, and normal weight populations that are otherwise apparently healthy.


      We conducted a cross-sectional study of all adults (20-65 years) with BMI ≥18.5 kg/m2 who underwent routine annual health check-ups. Participants who had any known morbidity or taking medication were excluded. BMI was categorized using the current World Health Organization criteria. After fasting, glucose, renal and liver functions, albumin and total protein levels, lipid profile, electrolytes levels and inflammatory marker were observed and compared between BMI categories.


      The study included 10,211 adults (median BMI 25.1 kg/m2, 48.8% normal weight, 39.7% overweight, 11.5% obese). The mean age was 40.78 years (SD 9.69) and 35.4% were female. Triglyceride level was 23.5% in overweight and 50.6% higher in obese participants (p < 0.001). Liver enzymes were higher in overweight (5.6-18.7%, p < 0.001) and obese participants (13.4-48.3%, p < 0.001). C-reactive protein level was 134% higher in overweight and 430% higher in obese participants (p < 0.001). Differences were also documented in other blood tests.


      Overweight and obesity were found to be associated with significant abnormalities in blood tests. A periodic wide panel of blood tests, especially for overweight and obese populations, is essential to identify and intervene as secondary prevention before the onset of symptoms.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nakar S
        • Vinker S
        • Neuman S
        • Kitai E
        • et al.
        Baseline tests or screening: what tests do family physicians order routinely on their healthy patients?.
        J Med Screen. 2002; 9: 133-134
        • Boland BJ
        • Wollan PC
        • Silverstein MD.
        Review of systems, physical examination, and routine tests for case-finding in ambulatory patients.
        Am J Med Sci. 1995; 309: 194-200
        • Bloomfield HE
        • Wilt TJ.
        Evidence brief: role of the annual comprehensive physical examination in the asymptomatic adult.
        VA Evidence Synthesis Program Evidence Briefs [Internet]. Washington (DC): Department of Veterans Affairs (US), 2011
        • Dubey V
        • Glazier R.
        Preventive care checklist form. Evidence-based tool to improve preventive health care during complete health assessment of adults.
        Can Fam Physician. 2006; 52: 48-55
        • Munro J
        • Booth A
        • Nicholl J.
        Routine preoperative testing: a systematic review of the evidence.
        Health Technol Assess. 1997; 1: 1-62
        • Peleg R
        • Ostermich A
        • Gienco V
        • et al.
        Screening tests among family doctors: do we do as we preach?.
        Public Health. 2013; 127: 282-289
        • Leurquin P
        • Van Casteren V
        • De Maeseneer J
        Use of blood tests in general practice: a collaborative study in eight European countries. Eurosentinel Study Group.
        Br J Gen Pract. 1995; 45: 21-25
        • Prochazka AV
        • Lundahl K
        • Pearson W
        • et al.
        Support of evidence-based guidelines for the annual physical examination: a survey of primary care providers.
        Arch Intern Med. 2005; 165: 1347-1352
        • Ziv-Baran T
        • Wasserman A
        • Goldiner I
        • et al.
        The association between C-reactive protein and common blood tests in apparently healthy individuals undergoing a routine health examination.
        Clin Chim Acta. 2020; 501: 33-44
        • U.S
        Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews.
        Agency for Healthcare Research and Quality (US), Rockville (MD)1998
        • LeBlanc E
        • O'Connor E
        • Whitlock EP
        • et al.
        Screening for and Management of Obesity and Overweight in Adults.
        Agency for Healthcare Research and Quality (US), Rockville (MD)2011
      1. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults - The Evidence Report. National Institutes of Health.
        Obes Res. 1998; 6: 51S-209S
        • Obesity: preventing and managing the global epidemic
        Report of a WHO consultation, World Health Organ.
        Tech Rep Ser. 2000; 894: 1-253
        • Williams EP
        • Mesidor M
        • Winters K
        • et al.
        Overweight and obesity: prevalence, consequences, and causes of a growing public health problem.
        Curr Obes Rep. 2015; 4: 363-370
        • May AL
        • Freedman D
        • Sherry S
        • et al.
        Obesity—United States, 1999–2010 in: morbidity and mortality weekly report: division of nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion.
        CDC. 2013; : 120-128
        • Kopelman PG.
        Obesity as a medical problem.
        Nature. 2000; 404: 635-643
        • Wyatt SB
        • Winters KP
        • Dubbert PM.
        Overweight and obesity: prevalence, consequences, and causes of a growing public health problem.
        Am J Med Sci. 2006; 331: 166-174
        • Arroyo-Johnson C
        • Mincey KD.
        Obesity Epidemiology Worldwide.
        Gastroenterol Clin North Am. 2016; 45: 571-579
        • Abdelaal M
        • Le Roux CW
        • Docherty NG
        Morbidity and mortality associated with obesity.
        Ann Transl Med. 2017; 5: 161
        • Haslam DW
        • James WP.
        Obesity. Lancet. 2005; 366: 1197-1209
        • Gill RS
        • Sharma AM
        • Gill SS
        • et al.
        The impact of obesity on diabetes mellitus and the role of bariatric surgery.
        Maturitas. 2011; 69: 137-140
        • Nakamura K
        • Fuster JJ
        • Walsh K.
        Adipokines: a link between obesity and cardiovascular disease.
        J Cardiol. 2014; 63: 250-259
        • Tsuboi N
        • Utsunomiya Y
        • Kanzaki G
        • et al.
        Low glomerular density with glomerulomegaly in obesity-related glomerulopathy.
        Clin J Am Soc Nephrol. 2012; 7: 735-741
        • Day CP.
        Non-alcoholic fatty liver disease: a massive problem.
        Clin Med (Lond.). 2011; 11: 176-178
        • Machado M
        • Marques-Vidal P
        • Cortez-Pinto H
        Hepatic histology in obese patients undergoing bariatric surgery.
        J Hepatol. 2006; 45: 600-606
        • Fan R
        • Wang J
        • Du J.
        Association between body mass index and fatty liver risk: a dose-response analysis.
        Sci Rep. 2018; 8: 15273
        • Bayard M
        • Holt J
        • Boroughs E.
        Nonalcoholic fatty liver disease.
        Am Fam Physician. 2006; 73: 1961-1968
        • Fan JG
        • Kim SU
        • Wong VW.
        New trends on obesity and NAFLD in Asia.
        J Hepatol. 2017; 67: 862-873
        • Bays HE
        • Toth PP
        • Kris-Etherton PM
        • et al.
        Obesity, adiposity, and dyslipidemia: a consensus statement from the National Lipid Association.
        J Clin Lipidol. 2013; 7: 304-383
        • Grundy SM.
        Obesity, metabolic syndrome, and cardiovascular disease.
        J Clin Endocrinol Metab. 2004; 89: 2595-2600
        • Franssen R
        • Monajemi H
        • Stroes ES
        • Kastelein JJ.
        Obesity and dyslipidemia.
        Med Clin North Am. 2011; 95: 893-902
        • Klop B
        • Elte JW
        • Cabezas MC.
        Dyslipidemia in obesity: mechanisms and potential targets.
        Nutrients. 2013; 5: 1218-1240
        • Aronson D
        • Bartha P
        • Zinder O
        • et al.
        Obesity is the major determinant of elevated C-reactive protein in subjects with the metabolic syndrome.
        Int J Obes Relat Metab Disord. 2004; 28: 674-679
        • Qian Y
        • Lin Y
        • Zhang T
        • et al.
        The characteristics of impaired fasting glucose associated with obesity and dyslipidaemia in a Chinese population.
        BMC Public Health. 2010; 10: 139
        • Ziv-Baran T
        • Shenhar-Tsarfaty S
        • Etz-Hadar I
        • et al.
        The ability of the wide range CRP assay to classify individuals with low grade inflammation into cardiovascular risk groups.
        Clin Chim Acta. 2017; 471: 185-190
        • Shenhar-Tsarfaty S
        • Shapira I
        • Toker S
        • et al.
        Weakened cholinergic blockade of inflammation associates with diabetes-related depression.
        Mol Med. 2016; 22: 156-161
        • Ziv-Baran T
        • Wasserman A
        • Goldiner I
        • et al.
        Characteristics of apparently healthy individuals with a very low C-reactive protein.
        Clin Chim Acta. 2019; 495: 221-226
        • Grundy SM
        • Cleeman JI
        • Daniels SR
        • et al.
        Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Executive summary.
        Circulation. 2005; 112: e285-e290
        • Kershaw EE
        • Flier JS.
        Adipose tissue as an endocrine organ.
        J Clin Endocrinol Metab. 2004; 89: 2548-2556
        • Fisher E
        • Rafael RY
        • Ehrenwald M
        • et al.
        Increase of body mass index and waist circumference predicts development of metabolic syndrome criteria in apparently healthy individuals with 2 and 5 years follow-up.
        Int J Obes. 2019; 43: 800-880
        • Ridker PM.
        Clinical application of C-reactive protein for cardiovascular disease detection and prevention.
        Circulation. 2003; 28: 363-369
        • Ridker PM
        • Buring JE
        • Cook NR
        • et al.
        C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women.
        Circulation. 2003; 107: 391-397
        • Rutter MK
        • Meigs JB
        • Sullivan LM
        • et al.
        C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study.
        Circulation. 2004; 110: 380-385