AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Mobility Limitation Identifies Premature Cardiometabolic Vulnerability in Younger U.S. Adults: NHANES 2021-2023
By Nasr J, Gill B, Castro Molina A et al.
Background: Cardiometabolic screening in adults is generally guided by age, BMI, and traditional risk factors, while functional limitation is not routinely considered in risk assessment. In adults under 50 years, mobility limitation is relatively unexpected and may identify individuals with reduced functional reserve and higher cardiometabolic burden. Whether a single mobility-limitation question identifies cardiometabolic multimorbidity in younger U.S. adults remains unclear. Methods: We analyzed adults aged 20-49 years from NHANES August 2021-August 2023, excluding pregnant participants. Mobility limitation was defined as any reported difficulty walking or climbing steps (FNQ440). Cardiometabolic multimorbidity was defined as ≥2 of: elevated waist circumference (>102 cm in men, >88 cm in women), elevated blood pressure (≥130/85 mmHg) or antihypertensive treatment, dysglycemia (HbA1c ≥5.7% or diabetes diagnosis/treatment), and low HDL-C (<40 mg/dL in men, <50 mg/dL in women). Non-adiposity cardiometabolic burden was defined as ≥2 of 3 components excluding waist circumference. The primary total-effect model used survey-weighted logistic regression adjusted for age, sex, race/ethnicity, education, income-to-poverty ratio, and smoking. A secondary model additionally adjusted for BMI to quantify attenuation by adiposity. Results: Among 1,973 adults aged 20-49 with complete data (weighted prevalence of mobility limitation: 13.2%), cardiometabolic multimorbidity was present in 58.2% of those with mobility limitation versus 34.2% of those without. In the primary model, mobility limitation was associated with twofold higher odds of cardiometabolic multimorbidity (OR 2.13; 95% CI 1.51-3.01; p=0.001). After BMI adjustment, the association was attenuated (OR 1.34; 95% CI 0.85-2.11; p=0.196). Severe cardiometabolic clustering (≥3/4 abnormalities) was also more prevalent with mobility limitation (28.8% vs 13.0%; adjusted OR 2.34; 95% CI 1.56-3.51; p=0.001). Non-adiposity cardiometabolic burden was 32.5% versus 16.1%. In an exploratory normal-BMI subgroup, mobility limitation remained associated with higher cardiometabolic multimorbidity (OR 2.55; 95% CI 1.18-5.51; p=0.021). Conclusion: Among U.S. adults aged 20-49, self-reported mobility limitation identified a subgroup in which nearly 6 in 10 had ≥2 measured cardiometabolic abnormalities. The association was substantially attenuated after BMI adjustment, suggesting that mobility limitation may represent an adiposity-linked phenotype of premature cardiometabolic vulnerability. However, the signal persisted in the normal-BMI subgroup and extended beyond adiposity to include dysglycemia and non-adiposity cardiometabolic burden. These findings support further evaluation of functional limitation questions as low-cost prompts for earlier cardiometabolic screening in younger adults.