Context: The body mass index (BMI) and waist circumference (WC) as diagnostic tools of obesity do not reflect the same level of fat mass and whether obesity leads to various effects on cardiometabolic risk factors among different racial/ethnic population is unknown.

Objective: The study aims to address the multicollinearity between BMI and WC by using the residual model approach, and to assess and compare the effects of obesity metrics on cardiometabolic risk factors among different races/ethnicities.

Design, setting and participants: Data from a nationally representative sample of Mainland Chinese adults collected in 2010, and data from the National Health and Nutrition Evaluation Survey (NHANES) 2005-2016 were used. By conducting a regression analysis between WC and BMI, the variation of BMI was removed from WC measures and residual of WC was obtained. The associations between obesity metrics and cardiometabolic risk factors were compared among different races/ethnicities by sex.

Results: The residual WC was significantly associated with all the cardiometabolic risk factors in Mainland Chinese, and most of the factors in Non-Hispanic White and Non-Hispanic Black adults, but not in the other races/ethnicities. The standardized regression coefficients of the associations between obesity metrics and cardiometabolic factors showed that the obesity metrics had greater impact on systolic blood pressure, diastolic blood pressure and triglyceride in Chinese adults than those of other racial/ethnic groups.

Conclusions: Chinese adults are more susceptible to the effects of overall obesity and fat distribution on cardiometabolic risk factors than the other racial/ethnic population.