The relationship between normal-weight obesity (NWO)—high percent body fat (%BF) in individuals with normal body mass index (BMI)—and cardiometabolic abnormalities has not been explored in Africa. We determined the prevalence of the NWO and evaluated its association with hypertension, elevated blood sugar and dyslipidaemia among adults in Addis Ababa, Ethiopia. A cross-sectional study was conducted among adults 18–64 years (n?=?600). Blood pressure, blood glucose, lipid profile, and anthropometric measurements were completed. As a function of skinfold thickness, body density and %BF were estimated using Durnin & Womersley and Siri Equations, respectively. The relationship between the NWO and the outcomes of interest, assessed using adjusted linear and logit models. The age- and sex-standardised prevalence of NWO was 18.9% (95% confidence interval (CI) 15.8, 22.2%). Comparison between normal-weight lean (normal %BF and BMI) and normal-weight obese individuals suggested no difference in systolic blood pressure (ß?=?2.55; 95% CI -?0.82, 5.92); however, diastolic blood pressure (ß?=?3.77: 95% CI 1.37, 6.18) and odds of hypertension (adjusted odds ratio (AOR)?=?2.46: 95% CI 1.18, 5.13) were significantly raised in the latter. Similarly, adults with NWO had elevated blood glucose (ß?=?2.30; 95% CI 1.23, 15.66) and increased odds of high blood sugar level (AOR?=?1.68; 95% CI 1.05, 2.67). LDL (ß?=?8.73: 1.56, 15.90), triglyceride (ß?=?20.99: 0.78, 41.22), total cholesterol (ß?=?10.47: 1.44, 19.50), and Cholesterol to HDL ratio (ß?=?0.65: 0.27, 1.04) were also raised among adults with NWO. NWO is common among adults in Addis Ababa and is associated with cardiometabolic derangements.

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We have also provided alternative NWO prevalence figures based on the following three sex-specific %BF thresholds commonly used in the literature: (1) American Council on Exercise (ACE) threshold (=?25% for men and?=?32% for women)30, (2) =?25% for males and =?35% for females31 and (3) =?20·6% for men and =?33·4% for women15,32.

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