目的 探讨广西地区成人超重与肥胖的流行特征及其与心血管代谢危险因素的关联，为区域性体质量管理及心血管代谢疾病防控提供参考。 方法 采用横断面研究设计，纳入2024年1—12月广西壮族自治区人民医院健康管理中心108 804例成人体检数据。按体质量指数（BMI）分为低体质量、正常体质量、超重及肥胖组。通过多因素logistic回归分析不同体质量状态及BMI-中心型肥胖联合分组与代谢风险的关联，采用分层分析及交互项检验探讨性别和年龄的效应修饰作用，运用危险因素聚集分析评估多重代谢风险累积特征，并行Cochran?Armitage趋势检验评估线性趋势。 结果 广西地区成人超重率35.95%，肥胖率13.30%，合计49.25%，中心型肥胖检出率为26.6%。超重/肥胖是高血压、高血糖、血脂异常及脂肪肝的独立危险因素，其中与脂肪肝关联最强（校正年龄、性别后，肥胖组OR=25.03，95%CI：23.66 ~ 26.48）。BMI-中心型肥胖联合分组分析显示，超重/肥胖合并中心型肥胖组各代谢风险最高，高血压、高血糖、血脂异常及脂肪肝的OR值（95%CI）分别为3.48（3.33 ~ 3.63）、3.35（3.17 ~ 3.55）、2.76（2.66 ~ 2.86）和14.18（13.64 ~ 14.74）。性别分层分析发现，超重/肥胖与高血糖、脂肪肝的关联在女性中更强（OR=2.60 vs. 2.22；8.27 vs. 6.52），而与血脂异常、高血压的关联在男性中更突出（2.49 vs. 1.80；2.58 vs. 2.42）（交互P均<0.05）。年龄分层分析显示，18 ~ 29岁人群超重/肥胖与各代谢风险的关联最强，且随年龄增长逐渐减弱（交互P < 0.001）。危险因素聚集分析显示，从低体质量至肥胖，人均危险因素数从0.32增至2.22，合并≥ 3个危险因素者比例从0.45%升至36.92%（趋势χ2 = 27753.48，P < 0.001）。 结论 广西地区成人超重肥胖形势严峻，超重肥胖是心血管代谢危险因素聚集的关键驱动因素，其与代谢风险的关联存在显著的性别与年龄差异。同时，超重肥胖与中心型肥胖并存时代谢风险协同放大。应结合地域特点，实施针对性体质量管理与综合防控策略。

Objective To investigate the prevalence of overweight/obesity and its association with cardiometabolic risk factors among adults in Guangxi and provide evidence for regional weight management and cardiometabolic disease prevention. Methods A cross-sectional study recruited 108，804 adults who underwent health examinations at the People's Hospital of Guangxi Zhuang Autonomous Region from January to December 2024. The participants were classified according to BMI into underweight， normal weight， overweight， and obese groups. Multivariate logistic regression， stratified and interaction analyses， risk factor clustering， and Cochran–Armitage trend tests were carried out. Results The prevalence rates of overweight， obesity， and central obesity were 35.95%， 13.30% （combined 49.25%）， and 26.6%， respectively. Overweight/obesity was independently associated with hypertension， hyperglycemia， dyslipidemia， and fatty liver， and the strongest association was observed for fatty liver （obese group： OR = 25.03， 95%CI： 23.66–26.48， adjusted for age and sex）. The combined analysis of BMI and central obesity indicated that individuals with both overweight/obesity and central obesity had the highest metabolic risks， with odds ratios （ORs） （95% confidence intervals ［CI］） of 3.48 （3.33–3.63） for hypertension， 3.35 （3.17–3.55） for hyperglycemia， 2.76 （2.66–2.86） for dyslipidemia， and 14.18 （13.64–14.74） for fatty liver. Sex-stratified analyses disclosed stronger associations of overweight/obesity with hyperglycemia and fatty liver in women， and with dyslipidemia and hypertension in men （all interaction P < 0.05）. Age-stratified analyses demonstrated the strongest associations in the 18–29 age group， and these associations declined with age （interaction P < 0.001）. From underweight to obesity， the mean number of risk factors increased from 0.32 to 2.22， and the proportion of individuals with ≥3 risk factors rose from 0.45% to 36.92% （trend χ2 = 27753.48， P < 0.001）. Conclusions The prevalence of overweight and obesity is notably high among adults in Guangxi. This high prevalence acts as a crucial driver of cardiometabolic risk factor clustering， and there are significant sex-and age-related differences in these associations. Additionally， the co-occurrence of overweight/obesity and central obesity synergistically exacerbates metabolic risks. Therefore， targeted weight management and comprehensive prevention strategies customized to regional characteristics are necessary.