ArticleLiterature Review

Asians is different from Caucasians and from each other in their body mass index/body fat percent relationship

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Abstract

The objective was to study the relationship between body mass index (BMI) and body fat per cent (BF%) in different population groups of Asians. The study design was a literature overview with special attention to recent Asian data. Specific information is provided on Indonesians (Malays and Chinese ancestry), Singaporean Chinese, Malays and Indians, and Hong Kong Chinese. The BMI was calculated from weight and height and the BF% was determined by deuterium oxide dilution, a chemical-for-compartment model, or dual-energy X-ray absorptiometry. All Asian populations studied had a higher BF% at a lower BMI compared to Caucasians. Generally, for the same BMI their BF% was 3-5% points higher compared to Caucasians. For the same BF% their BMI was 3-4 units lower compared to Caucasians. The high BF% at low BMI can be partly explained by differences in body build, i.e. differences in trunk-to-leg-length ratio and differences in slenderness. Differences in muscularity may also contribute to the different BF%/BMI relationship. Hence, the relationship between BF% and BMI is ethnic-specific. For comparisons of obesity prevalence between ethnic groups, universal BMI cut-off points are not appropriate.

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... Therefore, tall and short individuals with different leg lengths may have different proportions of lean and fat mass over different segments of the body. Such differences in body proportion have been reported to have an effect on BMI as measure of body fatness between different ethnic group (14). Therefore, the greater risk of CVD reported in shorter stature subjects could be attributed to the differences in the body proportion or body segments length (i.e. ...
... Differences in height between different racial groups (i.e. Asian and Caucasian) have been reported to be attributable to the differences in leg length (14). Even within the same population, variation in stature might be attributed to differences in body proportions or leg length and trunk length. ...
... Another potential source of bias that could be associated with this method relates to the variation in body shape between individuals in terms of the length and composition of each segment of the body. Such differences in body shape between individuals have been reported to be associated with ethnicity(14), genetic and some postnatal environmental factors (i.e. diet in childhood)(170). ...
Thesis
p>The main purpose of this thesis was to examine the inter-relationship between body structure and metabolic function, and in particular, how fetal growth marked b birth weight may influence this relationship in such a way as to predispose the individual to greater risk of disease in later life. The central hypothesis that underlies the work reported in this thesis is that the pattern of growth in early life, marked by birth weight, results in structural and functional changes that are evident in adult life, thereby predisposing the individual to an increased risk of obesity, T2DM and CVD. Adults born wit a lower birth weight appear to be shorter, lighter and have lower lean and muscle mass and grater fat mass in particular in the central region of the body when compared to adults with higher birth weight. There were differences in body dimensions (both vertically and horizontally) associated with birth weight. The lower birth weight group had shorter leg length and taller trunk and non-limb length when compared to higher birth weight group at the same height. The differences in body composition associated with birth weight could not be simple explained by the observed differences in body dimensions between groups. In addition, adult with a lower birth weight have lower energy metabolism in both the fasted and fed state. These differences in energy metabolism were independent of body size and composition (lean mass). This implies that metabolic function in itself might be programmed, an effect greater than that simply explained by differences in size and composition. This less prudent metabolic phenotype associated with differences in birth weight may predispose to more obvious features such as adiposity and central fat which, in turn, may increase the risk of developing T2DM and CVD.</p
... Several studies have reported that in Asian people, the distribution of fat, especially in the abdominal area, is more common than in European people. Tis factor is more common in Asian people than in European people with the same BMI and WC, despite the presence of metabolic syndrome and the risk of cardiovascular events [37,38]. ...
... In Zhang et al. study, they also concluded that the VFA index in women has a strong relationship with hypertension [7]. Several studies have reported that in Asians, the distribution of total body fat in the abdomen is higher and the incidence of CVD and metabolic risk factors are higher than in European people with the same BMI [37,38] Terefore, BMI as a predictor of vascular disease or organic vascular dysfunction, it is not suitable especially for Asians [32]. ...
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Background: BMI has been evaluated as an old criterion to evaluate obesity in individuals, but it does not assess abdominal obesity and lean mass. We aimed to evaluate the possible relationship of new anthropometric indices (namely, a body shape index (ABSI), the body roundness index (BRI), the visceral adiposity index (VAI), the visceral fat area (VFA), and waist-hip ratio (WHR)), with one of the known critical factors of atherosclerosis, arterial stiffness. Methods: Overall 5921 individuals were enrolled and were divided into four groups according to BMI. Novel anthropometric parameters including, ABSI, BRI, VAI, VFA, and WHR were calculated. The carotid-femoral pulse wave velocity (cf-PWV) was used to evaluate arterial stiffness. Multiple regression analysis was performed to assess the relationship between cf-PWV and innovative Anthropometric indices. Results: This study population consisted of 3109 women and 2812 males. In men with overweight, cf-PWV was significantly related to BMI, ABSI, BRI, WC, VAI, VFA, and WHR. However, among men with obesity, cf-PWV was associated with BRI, VAI, and VFA. Among women with overweight, cf-PWV was also related to all mentioned indices except ABSI; although, cf-PWV was only associated with VFA and WHR in women with obesity. Conclusion: Our results showed that VFA in women and VAI in men are strongly related to arterial stiffness and can be used to identify predictors of vascular disease or organic vascular dysfunction.
... Among the patients with normal BMI, many had an obese BF% despite using the Asia-specific BMI cut off, which is lower than that used for Caucasians. 22 Of these patients with NWO, more females had an obese BF% than males. The correlation coefficient revealed a moderate positive relation between BMI and BF% in both males and females. ...
... Additionally, because of the heterogeneity of T2D among the states in India, it is vital to understand the link between risk factors and BF%. Previous studies from India have explored the relationship between BMI and BF%; however, there are gaps in evidence, as the studies had a limited sample size.[16][17][18][19][20][21][22][23] In this regard, large-scale registries can provide robust data on IP attributes in people with diabetes.This multistate IP registry aimed to evaluate the BF% across various BMI categories in patients with T2D in India. ...
Article
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Background : Indian patients with type 2 diabetes mellitus (T2D) constitute one-sixth of affected adults globally. Here, we evaluate the association of body mass index (BMI) with body fat percentage (BF%) and glycated haemoglobin (HbA1c) levels among patients with T2D in India. Method : This was a cross-sectional Indian registry study across 845 geographically diverse zones between December 2017 and August 2019. Results : Of 37,927 patients, 55.6% were men, with a mean ± standard deviation age of 54.2 ± 11.5 years and HbA1c of 8.3 ± 1.71%. Mean ± standard deviation BMI and BF% were 27.0 ± 4.6 kg/m2 and 32.0 ± 8.0%, respectively. Overall, 15.4% of patients were overweight, and 25.0% were obese. Despite fewer males (20.7%) having BMI-based obesity than females (31.2%), around three-quarters of both sexes had BF%-defined obesity (males 77.2%; females 71.2%). One-third of males (34.6%) and 41.9% of females had BF%-defined obesity despite normal BMI. The association was substantiated by a moderately significant correlation (r=0.51) between BMI and BF% in the overall population (p<0.0001). Conclusion : This pan-India registry presents a real-world reflection of the Asian Indian phenotype: high BF% despite lower BMI in people with T2D. This highlights the importance of primordial and primary prevention, and may guide decisions on the choice of agents for glycaemic control, with a preference for drugs that promote weight loss or are weight neutral.
... Very interesting, although so far rather limited data that could shed light on this problem come from the studies of Deurenberg et al. [20][21]. The authors observed that there existed significant differences in the fat mass/fatfree mass ratio among various ethnic groups, which influence the cut-off point of obesity. ...
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In this study, we compared the basic body dimensions (height, weight, body mass index/BMI) of 19,662 male Olympians from 159 countries competing at the Summer Olympic Games 2000-2016. We hypothesized that the average physique of national Olympic teams reflects the predominant body type of their native populations, and the knowledge of such physical differences could find practical use in creating more rational programs of sports talent selection. The results demonstrate that the mean height of men’s Olympic teams is highly correlated with the mean height of young men in their native countries ( r = 0.83, p < 0.001), and the Olympic means of BMI characteristically cluster at the regional level. This geographical trend in the Olympic BMI values remarkably agrees with the documented body composition of human populations, and identifies Polynesians as the group with the most robust body build, followed by Micronesians and Melanesians. The biological validity of these results is further supported by their highly significant relationships with genetic and climatic factors. These findings suggest that the physique of Olympic athletes can be used for the study of human physical variation and evolutionary ecological rules. Based on these data, it is also possible to identify the global sports potential and the spectrum of sports in which each country has the greatest chance of international success.
... Different from the WHO BMI categories applied in the IOM, the GWG range established in our analysis was based on the Asia-specific BMI categories, which are more proper recommendations for Chinese women. From the aspect of racial or ethnic differences, Asian populations have lower BMI levels but higher body fat levels than Caucasians [33] leading to their different susceptibility to weight gain in pregnancy. Moreover, evidence has shown that Asians have increased risk of obesity-related diseases at lower BMI levels than Caucasians [34,35], therefore, lower BMI cut-off utilized and lower GWG suggested in Table 3 Optimal gestational weight gain for Chinese pregnant women a Categorized by WHO Asian [25] b The curve of impact of GWG in the first two trimesters on adverse pregnancy outcome among pre-gravid overweight or obese women was almost linear, without the lowest risky value which is required to obtain the optimal GWG range, thus an optimal GWG range in this subgroup was inaccessible the present study should be safer for Asian populations. ...
Article
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Background Gestational weight gain (GWG) criteria recommended by the Institute of Medicine may not be appropriate for Asians. Our aims are to investigate the association between GWG and adverse pregnancy outcomes, and to propose optimal total GWG and rates of GWG for Chinese women. Methods Prospective data of 51,125 mother-child pairs from 27 hospitals and community health care centers from Guizhou, Yunnan and Sichuan provinces in China between 2014 and 2018 were analyzed. Generalized Additive Models were performed to determine the associations of GWG with the risk of aggregated adverse outcomes (gestational diabetes mellitus, preeclampsia, cesarean delivery, stillbirth, preterm birth, macrosomia, large for gestational age, and small for gestational age). The range that did not exceed a 2.5% increase from the lowest risk of aggregated adverse outcomes was defined as the optimal GWG range. Results Among all participants, U-shaped prospective association was found between GWG and the risk of aggregated adverse pregnancy outcomes. The optimal GWG range of 8.2–13.0 kg was proposed for underweight, 7.3–12.5 kg for normal weight, and 2.0–9.4 kg for overweight/obese women. Meanwhile, a higher GWG rate in the first two trimesters than that in the last trimester was suggested, except for overweight/obese women. After stratified by maternal age, mothers ≥35 years were suggested to gain less weight compared to younger mothers. Conclusions To keep a balance between maternal health and neonatal growth, optimal GWG ranges based on Asia-specific BMI categories was suggested for Chinese women with different pre-gravid BMIs and maternal ages.
... In the past decade, the BMI was utilized as a representative index in studies on obesity and related disorders. However, BMI is not regarded to be associated with the deleterious effect of intraabdominal fat on mortality and morbidity, particularly in persons who may have a "normal" BMI but a disproportionately high intra-abdominal fat content [25]. Consequently, adiposity measures have been proposed as alternatives that help mitigate the shortcomings of BMI. ...
Article
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Background: Numerous factors, including metformin doses and treatment adherence, may contribute to significant variations in glycemic control and adiposity markers of type 2 diabetes (T2DM) patients. Objectives: This study aims to determine the influence of metformin dose and treatment adherence on glycemic control and adiposity markers in Iraqi patients with T2DM. Methods: Between October 2021 and March 2022, a case-series study at the Diabetes and Endocrinology Center-Baghdad included 153 T2DM patients with a disease duration of more than one year. Clinical and physical examinations were conducted before enrolment. We measured anthropometric variables to calculate the body mass index (BMI), waist-to-hip ratio (WHR), visceral adiposity index (VAI), and other surrogate indicators. We measured glycated hemoglobin (HbA1c), leptin, C-reactive protein (CRP), total cholesterol, HDL-c, and triglycerides in the serum. Results: Increasing metformin doses did not improve the studied parameters. Adherence to treatment significantly influences fasting glycemia, HbA1c level, and the markers of adiposity. Meanwhile, increasing metformin doses is not associated with changes in insulin resistance and cardiovascular disease risk markers. Conclusion: Beyond metformin dose up-titration, treatment adherence affects glycemic control, visceral adiposity, and CVD risk surrogates. Metformin dose up-titration was not linked to insulin resistance and body fat contents.
... In fact, South Asians have the highest body-fat percentages and lowest lean mass of any ethnicity in the USA [44,45]. Compared with populations of European ancestry, South Asians have a total bodyfat composition that is 3-5% higher for any given BMI [46]. Notably, South Asians have especially high levels of body fat and are more prone to developing obesity [47,48]. ...
Article
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South Asians, representing one quarter of the world's population, have disproportionally high rates of obesity and cardiometabolic disease thus resulting an epidemic health crisis. This crisis could be the consequence of epigenetic effects exacerbated during the colonial-era famines resulting in a unique starvation-adapted physiology. Due to evolutionary mismatch in circumstances of abundance, this starvation-adapted physiology can become harmful. Evidence for this starvation adaptation in South Asians includes high body fat and unfavorable adipokines; low lean body mass; lower resting energy expenditure (compounded by lack of brown adipose tissue); greater insulin resistance and insulin response; exaggerated lipemic response to fat and sugar intake; less capacity to handle an overabundance of food; lower fat burning (oxidative capacity) and VO2max during aerobic exercise; and energy-conserving response to resistance exercise, as well as increased lipoprotein (a) levels. The Roma people, also of South Asian ancestry, may represent an interesting pre-colonial historical control. Physician and patient knowledge of this unique physiology in South Asians will promote a stronger physician-patient relationship and foster compliance with treatment.
... It has been stated that these differences in studies may be related to differences according to ethnic populations. An example of this is the correlation between increased BMI and daytime sleepiness, and a similar risk ratio in Asian people with normal BMI, regardless of BMI 16 . We also did not find any correlation between BMI and increased EDS in our study, but we found a negative correlation between education level and BMI. ...
Article
Aim:Traffic accidents have been reported by the World Health Organization as a global problem affecting the whole world. Many studies have shown that the majority of traffic accidents are associated with inadequate and/or disturbed sleep. We aimed to define possible sleep disorders and chronic fatigue in people who had had an in-vehicle traffic accident with applicable scales and to take the necessary precautions.Materials and Methods:Our study included 104 people with a suitable general condition and physical examination, who had an in-vehicle traffic accident and applied to Pamukkale University Faculty of Medicine Emergency Service. For all patients, demographic data inquiries were made, and the ‘Epworth Sleepiness Scale (ESS)’, ‘Pittsburg Sleep Quality Index (PUKİ)’, ‘Berlin Questionnaire’ and ‘Fatigue Severity Scale’ were applied.Results:Increased daytime sleepiness was determined in 10 (9.62%) people according to the ESS, poor sleep quality in 15 (14.42%) people according to the PUKİ, high risk of Obstructive sleep apnea syndrome (OSAS) in 15 (14.42%) people according to the Berlin Questionnaire, and chronic fatigue in 30 (29.1%) people according to the Fatigue Severity Scale.Conclusion:In our study, we showed with scales that people who had an in-vehicle traffic accident could have various sleep disorders and chronic fatigue syndrome that had not been diagnosed before. However, contrary to what is mentioned in the literature, we found the prevalence of OSAS risk to be low. Necessary measures should be taken to minimize the risk of preventable accidents while driving. In case of suspicion of respiratory disorder, which is one of the sleep disorders we frequently see, gold standard tests such as polysomnography should be used before saying that there is no respiratory disorder in sleep with scales, especially in people who will be driving as a profession.
... Asians tend to have a lower BMI in com par i son to Cau ca sians due to dif fer ences in body build and mus cu lar ity. 20 For the treat ment of can cerasso ci ated VTE, LMWH or DOACs can be used. The effi cacy of DOACs in can cer-asso ci ated throm bo sis has been dem on strated in ran dom ized tri als. ...
Article
There are clinical issues of special importance and practice variation in the management of venous thromboembolism (VTE) and in the use of anticoagulants among hematologists who practice in Asia. In Asian-inherited thrombophilia, coagulation is disturbed due to loss-of-function mutations of protein S and protein C causing protein S and protein C deficiencies, whereas the gain-of-function factor V Leiden and prothrombin G20210A mutations are almost absent. Thrombophilia screening is not recommended in patients with VTE patients who have major provoking factors. However, it can be considered in unprovoked young patients with VTE who have a strong family history of VTE. Cancer is the most important acquired risk factor for VTE in Asians. Limited cancer screening at the initial presentation of unprovoked VTE is appropriate, especially in the elderly. Direct oral anticoagulants have been shown to have similar efficacy and reduce risk of major bleeding, including intracranial hemorrhage and bleeding requiring hospitalization, compared with warfarin. Most clinical trials evaluating therapies for treatment and prevention of VTE have included small numbers of Asian patients. Despite this lack of evidence, direct oral anticoagulants have been increasingly used in Asia for cancer-associated thrombosis. Individualized assessment of thrombotic and bleeding risks should be used for all hospitalized Asian patients when deciding on pharmacologic thromboprophylaxis. More research is needed to understand the factors that contribute to risks of VTE and anticoagulant-associated bleeding in Asian patients as these may differ from Western populations.
... For example, physiological measures such as body mass index (BMI) thresholds and waist circumference cut-offs are different for South Asians due to a differential body fat distribution. [24][25][26] In addition, the dietary habits of South Asians are affected by cultural customs, beliefs, food availability and generational preferences. 26 While beneficial effects of diet and physical activity interventions have been well documented, findings from studies conducted in non-South Asian populations must be replicated in such an ethnically diverse population, given the variable risk factor profiles and cultural context. ...
Article
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Background The cardiovascular disease (CVD) burden among South Asians is high. Lifestyle interventions have been effective in the primary prevention of CVD, but this has not been replicated, through a synthesis of randomised trials, in South Asians. Methods Four electronic databases (MEDLINE, Embase, CENTRAL and CINAHL), two clinical trial registries and references of included articles were searched through June 2022 (featuring ≥90% South Asian participants). Random-effects pairwise meta-analyses were performed, and heterogeneity was quantified with the I2 statistic. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to report on the quality of evidence (International Prospective Register of Systematic Reviews registration (PROSPERO). Results Thirty-five studies were included. Twelve tested diet and physical activity interventions; 18 tested diet alone; and 5 tested physical activity alone. All reported effects of the intervention(s) on at least one established risk factor for CVD, including blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP) and blood lipids (high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc) or triglycerides). No trials reported clinical CVD. There is moderate-quality evidence that diet and physical activity interventions improve SBP (mean difference (MD) −2.72 mm Hg, 95% CI −4.11 to –1.33) and DBP (MD −1.53 mm Hg, 95% CI −2.57 to –0.48); high-quality to moderate-quality evidence that diet-only interventions improve DBP (MD −2.05 mm Hg, 95% CI −2.93 to −1.16) and blood lipids (triglycerides (MD −0.10 mmol/L, 95% CI −0.14 to −0.06) and LDLc (MD −0.19 mmol/L, 95% CI −0.32 to −0.06)); and moderate-quality evidence that physical activity-only interventions improve SBP (MD −9.7 mm Hg, 95% CI −11.05 to −8.35), DBP (MD −7.29 mm Hg, 95% CI −8.42 to −6.16) and HDLc (MD 0.08 mmol/L, 95% CI 0.04 to 0.11) compared with usual care. Conclusions Lifestyle interventions improve blood pressure and blood lipid profiles in adult South Asians at risk of CVD. Tailored interventions should be used to modify cardiovascular risk factors in this at-risk group.
... The cut-off points from our study were lower than those from aforementioned European and American studies. The ethnicity, to some extents, explains the disparity of body fat between Chinese and White populations, but previous studies also indicated that Asians had relatively higher body fat percentage which predisposed them to prediabetes and diabetes at the given BMI compared to other ethnic groups (16,31). ...
Article
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Objective Body fat percentage (BF%) might be an alternative index of obesity which is the major risk factor for developing type 2 diabetes (T2D). We aim to longitudinally evaluated the relationship between BF% and risk of T2D. Methods A sample of 5,595 adults aged 18–65 who participated in two waves of China Health and Nutrition Survey (CHNS 2015 and 2018) was analyzed. Two level mixed-effects modified Poisson regression with robust estimation of variance stratified by sex was used to evaluate the risk ratios (RRs) for T2D according to quintiles of BF%, and the curves of receiver operating characteristic (ROC) were plotted to identify the optimal total and trunk BF% cut-off points for predicting an increased T2D risk. Results In males, compared with subjects in the first quintile of total BF%, those in the third (RR = 2.03, 95% CI 1.09–3.79), fourth (RR = 2.56, 95%CI 1.46–4.48), and fifth (RR = 2.16, 95%CI 1.22–3.82) quintile had higher risk of T2D after adjusting for all potential confounders ( p -trend < 0.001). For females, the RR (95% CI) was 1.92 (1.14, 3.24) in the fifth quintile ( p -trend = 0.014). Males and females with a trunk BF% >25.5 and 34.4% (≥ quintile 4), respectively, were at significantly increased risk of T2D ( p -trend = 0.001). Besides, the optimal cut-off values of total and trunk BF% were 21.9 and 25.2% for males, and 36.7 and 30.3% for females, respectively. Conclusions The incident risk of T2D significantly increased over specific level of total and trunk BF% in both Chinese males and females, and the optimal BF% cut-off values were valuable for clinical application of BF% based on sex difference, which may be a cost-effective implementation for prevention and treatment of T2D in China.
... Obesity and overweight are defined as accumulated of excessive fat in the body. And it is one of World Series problem for increasing hypo kinetic disease [1]. Most probably many times body composition assessed by Skin fold Calipers, Hydrostatic Weighing, Bioelectrical Impedance Analysis (BIA), waist to hip ratio, girth measurement [2]. ...
Article
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AIM The intention of existing study was to compare the effects of varied aerobic exercise intensity on body composition of sedentary overweight females in Arbaminch. METHOD Forty overweight participants [body mass index (BMI) ≥ 25 kg/m 2 , age 18 years-32 years] were randomized into four equal groups (n = 10): light-intensity training group (LITG), 40%-60% heart rate reserve (HRR); middle intensity training group (MITG), 60%-70% HRR; high-intensity training group (HITG), 70%-80% HRR; and control group (CG). Aerobic exercise training program was conducted for 40 minutes-60 minutes per day on a treadmill 3 days per week for 12 weeks. All participant height, weight, WHR, BMI and %of BF were measured at pre and after 12 weeks. RESULT At the starting point, the component of body composition indicates did not differ significantly among the four groups (p >0.05). After 12 weeks exercise intervention, the HITG and MITG had significantly more changes in body weight, waist-to-hip ratio (WHR), %BF and BMI than the LITG. CONCLUSIONS A 12 weeks high and moderate intensity exercise intervention can considerably reduce body weight, body fat, WHR, and BMI, whereas a light-intensity exercise intervention can significantly reduce body weight and body 207 fat. Based on my investigation all types of intensity can reduce body weight. But high and moderate intensity training had reduced weight quickly than low intensity training.
... VAI was developed initially for Caucasians. However, compared to equivalent Caucasians, Asian subjects have a greater proportion of body fat for a given BMI level [26] and are more prone to accumulate fat around the abdomen [27]. ...
Article
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Purpose We aimed to evaluate the performance of Chinese visceral adiposity index (CVAI), visceral adiposity index (VAI), lipid accumulation product (LAP), triglyceride glucose (TyG) as indices in screening abnormal glucose tolerance (AGT) in Chinese women with polycystic ovary syndrome (PCOS), using the oral glucose tolerance test (OGTT) as a reference test. In addition, we essentially compared the abilities of these indices with body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG). Materials and methods All 1113 PCOS patients evaluated in this study underwent OGTTs. The 2-h post-oral glucose load (2 h-PG) level was used to categorize subjects into two groups: those having AGT or normal glucose tolerance (NGT) levels. Results A statistically significant positive correlation between levels of 2 h-PG and FPG, BMI, WC, LAP, VAI, CVAI, TyG, (P < 0.05), was observed. The strongest correlation was found between the levels of 2 h-PG and CVAI (r = 0.47). The CVAI provided the highest area under the receiver-operating characteristic curve (AUC) for AGT, followed by LAP, BMI, TyG, VAI, WC, and FPG. The CVAI of 32.61 (with AUC: 0.76, sensitivity: 73%, specificity: 70%, positive preductive value (PPV): 0.41, negative predictive value (NPV): 0.90) was found to be the cut-off point for AGT in Chinese women with PCOS. Conclusions CVAI may not reliably detect AGT in Chinese women with PCOS. However, it is suitable as a first screening indicator to guide physicians to ordering OGTT.
... According to a relatively recent study examining the association between BMI and DM, cardiovascular disease, and mortality, the cut-off point for BMI was different for each disease and showed a reverse J-shape relationship with allcause mortality [33]. In particular, Asians have a lower BMI but a higher BF ratio than other races, making them suitable for NWO research [34]. Therefore, this study investigated the relationship between NWO and shift work using Korean community-dwelling adults. ...
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Backgruound: Shift work is associated with obesity and metabolic syndrome. However, this association in the normal-weight population remains unclear. This study aimed to investigate whether shift work is associated with normal-weight obesity (NWO). Methods: From the nationally representative Korea National Health and Nutrition Examination Survey (KNHANES) dataset (2008 to 2011), 3,800 full-time workers aged ≥19 years with a body mass index (BMI) ≤25 kg/m2 were analysed. We defined NWO as BMI ≤25 kg/m2 and body fat percentage ≥25% in men and ≥37% in women. Working patterns were classified into "daytime," "other than daytime," and "shift." Multivariable logistic regression analysis was performed to evaluate the relationship between shift work and NWO. Results: Shift work was associated with higher odds of NWO than daytime work (adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.04 to 2.09) and night/evening work (aOR, 1.87; 95% CI, 1.11 to 3.14) after adjustment for type of work, working hours, age, sex, BMI, 25-hydroxyvitamin D levels, homeostatic model assessment for insulin resistance, and other sociodemographic factors. In subgroup analyses, the association between shift work and NWO was more robust in those aged ≥60 years and those working ≥56 hours/week. Conclusion: Shift work was associated with NWO in community-dwelling Korean adults, independent of age, sex, BMI, and other covariates.
... It is associated with high healthcare burden and socioeconomic loss, and these factors deteriorate at a rate higher than that associated with other health conditions [1]. Asian populations tend to have 3-5% higher total body fat content [2], and a higher risk of cardiovascular disease and associated mortality than European populations with the same body mass index (BMI) [3,4]. Moreover, the prevalence of obesity and being overweight in Koreans exceeded 30% in 2005, reaching 33.8% in 2019. ...
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Lifestyle and physical characteristics affect body weight, and understanding these factors improves the precision of weight loss treatment. Many obese patients in Korea are receiving Korean medicine (KM) treatment, including herbal medicine and acupuncture, for weight loss. However, the real-world data (RWD) are insufficient in terms of being longitudinal and diverse. Weight Control Registry using KM is a prospective registry study that enrolls patients receiving KM treatment for weight loss and collects RWD from multiple clinics. The patients who are eligible for this study are aged 19–65 years, receive KM weight loss treatment, understand the study objectives, and consent voluntarily. Clinical data of patient characteristics and KM treatment patterns will be regularly collected until 2026. The longitudinal accumulation of various RWD will establish a high-quality study database for KM weight loss treatment. With this study, we expect to contribute to understanding the current trend of weight loss treatment with KM and solve further questions regarding this treatment.
... Obesity is classified as general obesity and abdominal obesity. Compared with Western societies, Asian population have a relatively lower body mass index (BMI) but are predisposed to central or abdominal obesity [8][9][10][11]. In particular, abdominal obesity has a close relationship with central fat localization and cardiovascular disease, independently of general obesity [12,13]. Studies have shown that abdominal adipose tissue is more metabolically active and is the key determinant of metabolic abnormalities that contribute to obesity-related disease risk [12,14,15]. ...
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Abstract Background Few animal experiments and volunteer-based intervention studies have showed a controversial effect of spicy foods on abdominal obesity. We aimed to examine the association between spicy food frequency, spicy flavor, and abdominal obesity among Chinese Han population in the Sichuan Basin which area eating spicy foods relatively often. Methods A cross-sectional analysis was conducted using the Sichuan Basin baseline data from the China Multi-Ethnic Cohort (CMEC) study, including data from electronic questionnaires, anthropometric measurements and blood sample collection. A total of 40,877 adults (22,503 females) aged 30–79 years were included in the final analysis. Multivariable logistic regression yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for abdominal obesity associated with the strength of spicy flavor and frequency of spicy food intake. Results The prevalence of daily spicy food eating was 47.3% in males and 52.7% in females, the percentages of abdominal obesity were 52.3%, 48.8%, 51.6% and 55.5% in the spicy food intake subgroups of never, 1–2 days/week, 3–5 days/week and 6–7 days/week, respectively. Compared with males who never consumed spicy food, the adjusted ORs (95% CIs) in the 1–2 days/week, 3–5 days/week and 6–7 days/week subgroups were 1.21 (1.09, 1.34), 1.35 (1.21, 1.51), and 1.35 (1.25, 1.47), respectively (P trend
... We note that Asians have lower body fat compared to Europeans given the same BMI (Deurenberg et al., 2002), which means the human models employed in the current study may not adequately represent the body compositions of both Asian and British populations. Unfortunately, there is limited information about the sample sources of the models in the BMI 3D program. ...
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Differences in preferences for body size between cultures are well documented. A well known explanation is that differences are a result of psychological adaptation to local environments. Since the optimal body size (often measured as Body Mass Index/BMI, weight divided by squared height kg/m²) for health differs between areas, the attractiveness and health judgements should also be different. Until now, no study has directly tested whether the difference in attractiveness perception is accompanied by a difference in health perception. In the current study, we compared the attractiveness and health judgements of male and female bodies varying in BMI and muscularity between British and Chinese participants. Since the health risks are greater for Chinese than British individuals with increasing BMI, one may expect Chinese participants to perceive a lower BMI as more attractive and healthier than British participants. Analyses showed that, although the Chinese participants preferred thinner partners compared to their British counterparts, there was no difference in the health judgements made by Chinese and British participants. Moreover, the male and female bodies that were seen as most attractive were thinner than those perceived as most healthy by Chinese participants. These findings challenge the adaptation account that people adjust their mate preferences to match what is most healthy in local environments.
... BD is not the only complex disease that shows population differentiation. Some human complex traits including common diseases such as cardiovascular diseases (Menotti et al., 1999;Chaturvedi, 2003), body fat percentage (Deurenberg et al., 2002), body mass index (Robinson et al., 2015), and height variation (Stulp and Barrett, 2016) show differentiation among worldwide populations. Whether these phenotypic differentiations have genetic components, and whether selection or neutral (demographic and drift) processes have been shaping the genetic differentiation underlying these phenotypes has drawn much attention. ...
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Behçet disease (BD) is a polygenic, multifactorial, multisystem inflammatory condition with unknown etiology. Global distribution of BD is geographically structured, highest prevalence observed among East Asian, Middle Eastern, and Mediterranean populations. Although adaptive selection on a few BD susceptibility loci is speculated, a thorough evolutionary analysis on the genetic architecture of BD is lacking. We aimed to understand whether increased BD risk in the human populations with high prevalence is due to past selection on BD associated genes. We performed population genetics analyses with East Asian (high BD prevalence), European (low/very low BD prevalence), and African (very low/no BD prevalence) populations. Comparison of ancestral and derived alleles’ frequencies versus their reported susceptible or protective effect on BD showed both derived and ancestral alleles are associated with increased BD risk. Variants showing higher risk to and more significant association with BD had smaller allele frequency differences, and showed less population differentiation compared to variants that showed smaller risk and less significant association with BD. Results suggest BD alleles are not unique to East Asians but are also found in other world populations at appreciable frequencies, and argue against selection favoring these variants only in populations with high BD prevalence. BD associated gene analyses showed similar evolutionary histories driven by neutral processes for many genes or balancing selection for HLA (Human Leukocyte Antigen) genes in all three populations studied. However, nucleotide diversity in several HLA region genes was much higher in East Asians suggesting selection for high nucleotide and haplotype diversity in East Asians. Recent selective sweep for genes involved in antigen recognition, peptide processing, immune and cellular differentiation regulation was observed only in East Asians. We conclude that the evolutionary processes shaping the genetic diversity in BD risk genes are diverse, and elucidating the underlying specific selection mechanisms is complex. Several of the genes examined in this study are risk factors (such as ERAP1, IL23R, HLA-G) for other inflammatory diseases. Thus, our conclusions are not only limited to BD but may have broader implications for other inflammatory diseases.
... Postoperative complications were examined according to the Clavien-Dindo classification system [24]. Patients were categorized into the normal (BMI ≤ 24 kg/ m 2 ) or the high BMI group (BMI > 24 kg/m 2 ) based on BMI values [25]. ...
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Background Studies on surgical outcomes after robotic surgery are increasing; however, long-term oncological results of studies comparing robotic-assisted distal gastrectomy (RADG) versus laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC) are still limited. This study aimed to assess the surgical and oncological outcomes of RADG and LADG for the treatment of AGC. Methods A total of 1164 consecutive AGC patients undergoing RADG or LADG were enrolled between January 2015 and October 2021. Propensity score-matched (PSM) analysis was performed to minimize selection bias. The perioperative and oncological outcomes between the two groups were compared. Results Patient’s characteristics were comparable between the two groups after PSM. RADG group represented a longer operative time (205.2 ± 43.1 vs 185.3 ± 42.8 min, P < 0.001), less operative blood loss (139.3 ± 97.8 vs 167.3 ± 134.2 ml, P < 0.001), greater retrieved lymph nodes (LNs) number (31.4 ± 12.1 vs 29.4 ± 12.3, P = 0.015), more retrieved LNs in the supra-pancreatic areas (13.4 ± 5.0 vs 11.4 ± 5.1, P < 0.001), and higher medical costs (13,608 ± 4326 vs 10,925 ± US $3925, P < 0.001) than LADG group. The overall complication rate was 13.7% in the RADG group and 16.6% in the LADG group, respectively; the difference was not significantly different (P = 0.242). In the subgroup analysis, the benefits of RADG were more evident in high BMI patients. Moreover, the 3-year overall survival (75.5% vs 73.1%, P = 0.471) and 3-year disease-free survival (72.9% vs 71.4%, P = 0.763) were similar between the two groups. Conclusion RADG appears to be a safe and feasible procedure and could serve as an alternative treatment for AGC in experienced centers.
... However, as a measure of nutritional status, BMI and albumin have various deficiencies. First, the proportion of body fat increases with age, whereas muscle mass decreases, but the corresponding changes in height, weight, and BMI may not reflect these changes, and so the specificity of BMI is poor [11,12]. Second, the level and function of albumin are affected by many liver-related diseases, such as liver cirrhosis, and patients with liver cirrhosis present post-translational modifications to albumin that compromise its level and function [13]. ...
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Background: The nutritional risk index (NRI) is an independent prognostic factor for overall survival in various cancers, but its prognostic value in breast cancer remains unclear. This study aimed to explore the relationship between the NRI and overall survival (OS) in breast cancer and to develop a predictive nomogram. Methods: We retrospectively enrolled 1347 breast cancer patients who underwent mastectomy or lumpectomy between January 2011 and November 2012. Using a cutoff value of 110.59, patients were divided into a high-NRI group and a low-NRI group. OS was compared between the two groups. Clinicopathological factors independently associated with survival were used to construct a predictive nomogram. Results: Of the 1347 patients, 534 patients were classified as high NRI and 813 as low NRI. OS was significantly shorter in low-NRI patients. The 3- and 5-year OS rates were 87.3% and 73.4%, respectively, in the high-NRI group whereas they were 83.0% and 67.2%, respectively, in the low-NRI group. Cox regression analysis found that histopathological type, tumor size, lymph node status, progesterone receptor (PR) status, Ki-67, and NRI were independently associated with OS. Conclusions: NRI is an independent prognostic factor of OS in breast cancer patients. The proposed nomogram model may be a useful tool for individualized survival prediction.
... men: 30.3%) in Chinese adults (7). Several studies also indicated that the Asian population had a relatively higher body fat percentage which predisposed them to prediabetes and diabetes at the same BMI compared to other ethnic groups (8,9). BMI and waist circumference (WC) deserve comprehensive consideration to study whether obesity might play a superimposed role in type 2 diabetes. ...
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Aims To examine longitudinal associations of obesity profiles, continuous BMI, and waist circumference (WC) with the risk of type 2 diabetes in Chinese adults. Methods Data were derived from three waves (2009, 2015, and 2018) of the China Health and Nutrition Survey, and 3,595 adults aged 18–65 years who participated in at least two waves of the survey and had completed data were analyzed. Obesity profiles included BMI- or WC-related single obesity and combined obesity. Combined obesity was categorized into six groups including Group 1 with normal BMI and WC, Group 2 with normal BMI but pre-abdominal obesity, Group 3 with normal BMI but abdominal obesity, Group 4 with abnormal BMI (overweight and general obesity) and normal WC, Group 5 with abnormal BMI and pre-abdominal obesity, and Group 6 with abnormal BMI and abdominal obesity. Three-level mixed-effects logistic regressions with random intercept stratified by gender and restricted cubic splines were performed to examine ORs and 95%CIs for the risk of type 2 diabetes. Results In men, compared with subjects of Group 1, those in Group 3 had higher risk, with an OR of 4.83 (95% CI: 1.99–11.74), followed by those in Group 6 (OR = 4.05, 95%CI: 2.32–7.08) and Group 5 (OR = 2.98, 95%CI: 1.51–5.87) after adjusting for all potential confounders. For women, the subject of Group 6 had highest risk (OR = 8.79, 95%CI: 4.04–19.12), followed by Group 3 (OR = 3.30, 95%CI: 1.23–8.86) and Group 5 (OR = 3.16, 95%CI: 1.21–8.26). No significant association between abnormal BMI and normal WC (Group 4) was observed in both genders. Type 2 diabetes risk increased steeply at BMI of 23.5 kg/m ² and 22.5 kg/m ² or higher, and WC of 82.0 cm and 83.0 cm or higher in Chinese adult men and women, respectively ( p for overall <0.001). Conclusion Chinese adults with pre-abdominal or abdominal obesity had a relative high risk of type 2 diabetes independent of BMI levels. Lower BMI (≤23.5 kg/m ² for men and ≤22.5 kg/m ² for women) and lower WC (82.0 cm for men and ≤83.0 cm for women) values than the current Chinese obesity cut-offs were found to predict the risk of type 2 diabetes. These findings urge to inform WC modification and optimization of early screening guidelines.
... Due to the substantial differences in body composition by race, anthropometric indicators such as BMI have different cut-points for identifying obesity according to race [21]. For instance, the risk of diabetes in Chinese populations with a BMI of 26.9 kg/m² was the same as that of White populations with a BMI of 30 kg/m² [22]. ...
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Background As a new obesity-related index, the weight-adjusted-waist index (WWI) appears to be a good predictor of cardiovascular disease (CVD) in East Asian populations. This study aimed to evaluate the association between WWI and the risk of CVD in United States (US) adults. Methods The data were obtained from the 2009–2016 National Health and Nutrition Examination Survey (NHANES). WWI was calculated as waist circumference divided by the square root of weight, and CVD was ascertained based on self-reported physician diagnoses. Multivariable regression analysis and subgroup analysis were performed to evaluate the association between WWI and CVD. Results A total of 21,040 participants were included, with the mean age being 47.11 ± 16.79 years. There was a positive linear relationship between WWI and the odds of CVD (P = 0.310). After adjusting for all covariates, each unit of increased WWI was associated with a 48% increased risk of CVD (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.25–1.74). Moreover, compared with the lowest quintile (< 10.3 cm/√kg), the multivariable-adjusted OR was 3.18 (95% CI: 1.81–5.60) in the highest quintile (≥ 11.8 cm/√kg). Besides, subgroup analyses showed that stronger associations between WWI and CVD were detected in participants younger than 50 years of age (P for interaction < 0.001). Conclusions High levels of WWI were significantly associated with an increased risk of CVD in US adults, particularly in people under 50 years of age. These findings indicate that WWI may be an intervention indicator to reduce the risk of CVD in the general adult population.
... The body composition of Asians is different from people with different biogeographical ancestries owing to the genetic and environmental heterogeneity. Therefore, observations from one population cannot be extrapolated to another and population-specific nutritional characteristics need to be defined [18][19][20][21]. ...
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Background Inflammatory bowel disease (IBD) is associated with an increased risk of malnutrition and sarcopenia. Aims To evaluate the nutritional status of patients with IBD and determine the threshold values of different parameters of nutritional assessment to identify malnutrition. Methods This was a single-centre cross-sectional analysis of adult patients with IBD [ulcerative colitis (UC) and Crohn’s disease (CD)] who underwent anthropometry [body mass index (BMI), mid upper arm circumference (MUAC) and triceps-fold thickness (TSF)], body composition analysis and assessment for sarcopenia [hand-grip strength and skeletal muscle index (SMI) at L3 vertebral level)]. Age- and gender-matched healthy adults served as controls. Malnutrition was defined according to the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria. Results A total of 406 patients [336 (82.76%) UC and 70 (17.24%) CD; mean age 40.56 ± 13.67 years; 215 (52.95%) males] with IBD and 100 healthy controls (mean age 38.69 ± 10.90 years; 56 (56%) males) were enrolled. The mean BMI, MUAC, TSF thickness, fat and lean mass, hand-grip strength, and SMI at L3 vertebral level were lower in patients with IBD compared to controls. The prevalence of malnutrition was similar in UC and CD [24.40% (n = 82) and 28.57% (n = 20), respectively (p = 0.46)]. Thresholds for fat mass in females (15.8 kg) and visceral fat index in males (0.26) were both sensitive and specific to detect malnutrition. The cutoff values of MUAC and TSF thickness to identify malnutrition were 23.25 cm and 25.25 cm, and 16.50 mm and 8.50 mm, in females and males, respectively. Conclusion Malnutrition and sarcopenia were common in patients with IBD, with the prevalence being similar in patients with both UC and CD.
... Peng et al. [35,41] noted that BMI confounds the relationship between sarcopenia and NAFLD in studies using different definitions for sarcopenia. We also know that BMI is limited as an estimate of body fatness, and it varies with age, sex, and ethnicity [42,43]. ...
... In this study, we used a BMI cut-off of 25 kg/m 2 , which is classified as obese in Japan [27] . Differences in body composition between East Asians and other races have been found on a population level, as Asians typically have a higher body fat percentage than Caucasians with the same BMI [28] . Therefore, we consider the threshold of obesity in our study to be appropriate with respect to comparing expulsion risk with studies conducted in Western countries with a higher cut-off. ...
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Objectives We collected real-world data on the safety and clinical outcomes of levonorgestrel-releasing intrauterine system (LNG-IUS) for heavy menstrual bleeding (HMB) and dysmenorrhea. Study Design This was a prospective, multicenter, single-cohort, open-label, post-authorization 12-month follow-up study of Japanese patients initiating the LNG-IUS for HMB and/or dysmenorrhea. The primary endpoint was the safety profile based on adverse events and adverse drug reactions (ADRs), including expulsions and abnormal bleeding, within 12 months of LNG-IUS insertion. Secondary endpoints included changes from baseline in menstrual blood loss based on bleeding days and dysmenorrhea graded on a visual analog scale (VAS). Results Of the 595 patients included, many had underlying conditions such as adenomyosis (39.5%), uterine leiomyoma (30.8%), or endometriosis (12.9%). The incidences of ADRs and serious ADRs were 59.7% and 0.3%, respectively. Frequently reported ADRs were metrorrhagia (48.9%), procedural pain (14.1%), and ovarian cyst (6.2%). The cumulative incidence of expulsions at 12 months was 8.7%. Risk factors for expulsion were obesity (body mass index ≥25 kg/m²), adenomyosis, and uterine cavity length ≥8 cm. The median [interquartile range] VAS score for dysmenorrhea improved from 46.5 [13.0–68.0] at insertion to 1.0 [0.0–13.0] at 12 months, and improvements were also observed in chronic pelvic pain and painful defecation. Conclusions The LNG-IUS safely and effectively reduced dysmenorrhea, chronic pelvic pain and painful defecation. Risk factors for expulsion suggest that patients with underlying organic disease should be monitored carefully when using the LNG-IUS. Implications LNG-IUS is an effective treatment for secondary dysmenorrhea with organic disease, and for the reduction of chronic pelvic pain; however, physicians should be aware of the increased risk of expulsion in patients with organic complications.
... Because of the relatively limited number of obese subjects in this cohort, we divided subjects into two body shape groups: NW (lean) vs. OW/OB (non-lean) groups. Sex-specific abdominal obesity was defined according to the Asian-Pacific Guidelines using the national WC cutoff points: a WC ≥ 90 cm for men and ≥ 85 cm for women 21 . We used the National Cholesterol Education Program-Adult Treatment Panel III definition of MetS to determine the MU phenotype (WC was not included in the definition of metabolic health because of collinearity with BMI): (1) hypertriglyceridemia, defined as a triglyceride (TG) level ≥ 1.69 mmol/L and/or the use of lipid-lowering drugs; (2) low HDL cholesterol, defined as a HDL cholesterol level < 1.03 mmol/L in men and < 1.29 mmol/L in women; (3) elevated BP, defined as a systolic BP ≥ 130 mmHg and/or a diastolic BP ≥ 85 mmHg and/or the use of antihypertensive drugs and/or a self-reported history of hypertension; and (4) hyperglycemia, defined as a blood glucose level ≥ 5.6 mmol/L and/ or the use of any medications for diabetes (insulin or oral glucose-lowering medications) and/or a self-reported history of diabetes. ...
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Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome (MetS), and the relationship between NAFLD and metabolic deterioration remains unclear. This study aimed to investigate dynamic changes in metabolically healthy phenotypes and to assess the impact of non-alcoholic fatty liver disease (NAFLD) on the conversion from metabolically healthy (MH) to metabolically unhealthy (MU) phenotypes across body shape phenotypes and phenotypic change patterns. We defined body shape phenotypes using both the body mass index (BMI) and waist circumference (WC) and defined metabolic health as individuals scoring ≤ 1 on the NCEP-ATP III criteria, excluding WC. A total of 12,910 Chinese participants who were MH at baseline were enrolled in 2013 and followed-up in 2019 or 2020. During a median follow-up of 6.9 years, 27.0% (n = 3,486) of the MH individuals developed an MU phenotype. According to the multivariate Cox analyses, NAFLD was a significant predictor of conversion from the MH to MU phenotype, independent of potential confounders (HR: 1.12; 95% confidence interval: 1.02–1.22). For the MH-normal weight group, the relative risk of NAFLD in phenotypic conversion was 1.21 (95% CI 1.03–1.41, P = 0.017), which was relatively higher than that of MH-overweight/obesity group (HR: 1.14, 95% CI 1.02–1.26, P = 0.013). Interestingly, the effect of NAFLD at baseline on MH deterioration was stronger in the “lean” phenotype group than in the “non-lean” phenotype group at baseline and in the “fluctuating non-lean” phenotype change pattern group than in the “stable non-lean” phenotype change pattern group during follow-up. In conclusion, lean NAFLD is not as benign as currently considered and requires more attention during metabolic status screening.
... The problem relates not only to the gender and age divisions but also to the standardization of BMI values worldwide without taking into account the ethnic variation in physique caused by the climatic conditions in which the subjects live (different physiques of Central Africans, East Asians, or Northern Europeans). This is why an increasing number of authors are questioning the WHO classification of body mass abnormalities, especially in seniors or in gender comparisons (World Health Organization Obesity, 2000;Deurenberg et al., 2002;World Health Organization Expert Consultation, 2004;Gupta and Kapoor, 2012;Bhogal and Langford, 2014;Chwałczyńska, 2017;Silva et al., 2017;Christensen et al., 2018;Mialich et al., 2018;Provencher et al., 2018;Chwałczyńska and Andrzejewski, 2021;Zhu et al., 2022). ...
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The study aimed to personalize the classification of body weight using the fat-fat-free (FFF) index with the percentage of body fat and to develop classification standards for the FFF index for men aged 18-25 years. Moreover, 1,642 adolescents (1,200 \) were examined. Using body composition analyzers, weight was determined, as well as overall and segmental body composition. Based on the obtained values for fat mass and fat-free tissue mass, an overall FFF index was calculated. According to the BMI classification, 9% of \ and 6% of _ are underweight, 29% of \ and 13% of _ are overweight, and 5% of the subjects are obese. Women and men classified in the same group according to BMI differed statistically significantly in terms of body weight, FM%, and FFM. In contrast to BMI and FM%, the FFF used takes into account the ratio of fat mass to fat-free tissue and muscle tissue mass. The proposed classification of FFF was made taking into account the differences that arise with sexual development and physiological changes occurring in ontogeny. Assessment of body mass using the FFF index should be used as part of preventive screening for the early diagnosis and prevention of overweight and thus many chronic diseases for which overweight or obesity is a risk factor. KEYWORDS personalized fat-fat-free index, prevention of overweight, prevention of obesity, body composition, segmental body composition
... T2DM develops in East Asian populations at a lower mean body mass index (BMI) compared with those of other populations, for example, European descent [28]. In addition, the Asian populations have a higher body fat percentage at a lower BMI compared to Caucasians [28,29]. Diabetes develops at a younger age in Asian patients, and is characterized by early β-cell dysfunction in the setting of insulin resistance [28]. ...
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A diabetes risk score cannot directly be translated and applied in different populations, and its performance should be evaluated in the target population. This study aimed to translate the Finnish Diabetes Risk Score (FINDRISC) instrument and compare its performance with the modified version for detecting undiagnosed type 2 diabetes mellitus (T2DM) and dysgly-caemia among the Indonesian adult population. Forward and backward translations were performed and followed by cultural adaptation. In total, 1,403 participants were recruited. The FINDRISC-Bahasa Indonesia (FINDRISC-BI) was scored according to the original FIN-DRISC instrument, while a Modified FINDRISC-BI was analyzed using a specific body mass index and waist circumference classification for Indonesians. The area under the receiver operating characteristic curve, sensitivity, specificity, and the optimal cutoffs of both instruments were estimated. The area under the receiver operating characteristic curve for detecting undiagnosed T2DM was 0.73 (0.67-0.78) for the FINDRISC-BI with an optimal cutoff score of �9 (sensitivity = 63.0%; specificity = 67.3%) and 0.72 (0.67-0.78) for the Modified FINDRISC-BI with an optimal cutoff score of �11 (sensitivity = 59.8%; specificity = 74.9%). The area under the receiver operating characteristic curve for detecting dysglycaemia was 0.72 (0.69-0.75) for the FINDRISC-BI instrument with an optimal cutoff score of �8 (sensi-tivity = 66.4%; specificity = 67.0%), and 0.72 (0.69-0.75) for the Modified FINDRISC-BI instrument with an optimal cutoff score �9 (sensitivity = 63.8%; specificity = 67.6%). The PLOS ONE PLOS ONE | https://doi.org/10.1371/journal.pone. Indonesian version of the FINDRISC instrument has acceptable diagnostic accuracy for screening people with undiagnosed T2DM or dysglycaemia in Indonesia. Modifying the body mass index and waist circumference classifications in the Modified FINDRISC-BI results in a similar diagnostic accuracy; however, the Modified FINDRISC-BI has a higher optimal cutoff point than the FINDRISC-BI. People with an above optimal cutoff score are suggested to take a further blood glucose test.
... BMI that is unsuitable when describing adiposity in SA children confirms previous studies highlighting the inadequacy of BMI in describing overweight and obesity in SA children (24)(25)(26)(27). Increased body fat in SA adults when compared with WE adults with the same BMI has, in part, been attributed to differences in muscularity (28). Our findings demonstrate that these ethnic differences in fat distribution originate in early childhood. ...
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Importance The links between maternal and offspring adiposity and metabolic status are well established. There is much less evidence for the impact of these relationships combined with ethnic background on cardiac structure and function in childhood. Objective To test the hypothesis that ethnicity, maternal adiposity and glycemic status, and child adiposity affect cardiac structure and function. Design A prospective cohort study. Setting A single-center mother-child cohort study. The cohort is a subset of the international multi-center Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. Participants This study included 101 healthy pre-pubertal British-born children [56 White Europeans (WEs) and 45 South Asians (SAs)] with a median age of 9.1 years, range 6.0–12.2 years, at the time of the investigation. Main Outcomes and Measures Anthropometric and echocardiographic measurements were made on the cohort. Maternal pregnancy and birth data were available. Relationships between maternal parameters (BMI and glucose status), child adiposity, and echo measures were assessed. Results Despite no ethnic difference in BMI SDS at a median age of 9.1 years, SA children exhibited higher levels of body fat than WE children (whole body, right arm, and truncal fat all p < 0.001). SA children also exhibited greater changes in weight and height SDS but not BMI SDS from birth than WE children. As expected, maternal BMI correlated with child BMI ( r = 0.28; p = 0.006), and body fat measures (e.g., whole body fat r = 0.25; p = 0.03). Maternal fasting glucose levels were associated with child body fat measures ( r = 0.22–0.28; p = 0.02–0.05). Left ventricular (LV) indices were not different between SA and WE children, but E/A and E′/A′ (measures of diastolic function) were lower in SA when compared with WE children. LV indices correlated positively to BMI SDS and body fat markers only in SA children. Maternal fasting and 2-h glucose were negatively correlated with E′/A′ in SA children ( r = −0.53, p = 0.015, and r = −0.49, p = 0.023, respectively) but not in WE children. Conclusion and Relevance SA and WE children exhibit differences in adiposity and diastolic function at a median age of 9.1 years. Novel relationships between maternal glycemia, child adiposity, and cardiac structure and function, present only in SA children, were identified.
... However, body fat distribution varies by race, and it has been reported that the Asian population seems to be more inclined to visceral fat accumulation at a lower BMI (26). Previous studies have shown that VAI is not superior to BMI or WC in estimating visceral adipose tissue and predicting type 2 diabetes in the Chinese population (27). Similar results were observed in our study, with no significant difference in the predictive power of VAI for renal damage compared with BMI, WC, and WHtR. ...
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Objective To evaluate the association between Chinese visceral adiposity index (CVAI) and incident renal damage and compared its predictive power with that of other visceral obesity indices in patients with hypertension and abnormal glucose metabolism (AGM). Methods This retrospective cohort consecutively included patients with hypertension and AGM who did not have renal damage at baseline. Renal damage was defined using the estimated glomerular filtration rate (eGFR) and urine protein. Multivariable Cox regression analysis was used to evaluate the association between CVAI and incident renal damage. Restricted cubic splines were used to determine the shape of the association. The predictive power of the CVAI was examined and directly compared with other indices, including the VAI, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), using the area under the receiver operating characteristic curve (AUC) and C-index. Results In total, 2,033 patients with hypertension and AGM were included. During a median follow-up of 2.6 years, the incidence of renal damage was 31.5, 48.9, 56.8, and 67.5/1,000 person-years across the quartiles of CVAI. Compared with the first quartile, the risk of renal damage was higher in the second (hazard ratio (HR) = 1.36 [95% CI: 0.93−1.97]), third (HR = 1.57 [95% CI: 1.09−2.27]), and fourth (HR = 1.65 [95% CI: 1.11−2.44]) quartiles ( p for trend = 0.011). A linear dose–response association was observed. Sensitivity and subgroup analyses confirmed the robustness and consistency of the results. In terms of predictive power, the CVAI had the highest AUC and C-index values. Conclusions CVAI is positively associated with renal damage risk in a linear dose–response pattern and has the best performance in predicting incident renal damage in patients with hypertension and AGM. The CVAI may serve as a reliable indicator for identifying patients at a high risk of renal damage.
... However, they are still not enough to assess accurately the body fat distribution (21). The previous study has shown that Asian population has a considerably higher body fat percentage (BF) for the same BMI when compared with Caucasians (22). Asians have a higher prevalence of metabolic dysregulation than those reported in Caucasian groups with equivalent BMI or WC (21,23). ...
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Background Our study aimed to investigate the association between iron metabolism and body composition in patients with type 2 diabetes mellitus (T2DM). Methods A total of 824 patients with T2DM were enrolled. Measurements of body composition were obtained by dual-energy X-ray absorptiometry. Patients were stratified into three groups according to their sex-specific ferritin levels. Basic information, laboratory results, and body composition were collected. Results Serum iron and transferrin saturation (TSAT) were increased significantly with increased serum ferritin (all p < 0.05). Total iron-binding capacity (TIBC) was decreased significantly with increased serum ferritin ( p < 0.05). Visceral fat mass (VF), android fat/total body fat mass, android-to-gynoid fat ratio (A/G ratio), and high-sensitivity C-reactive protein were all increased significantly with increased serum ferritin (all p < 0.05). Patients with a high A/G ratio (A/G ratio ≧ 1) had significantly higher serum iron, ferritin, and TSAT, but significantly lower TIBC. In the model adjusted for age and gender, higher ferritin levels were associated with a higher VF (all p < 0.05). Serum iron was positively correlated with the occurrence of a high A/G ratio (A/G ratio ≧ 1) after the adjustment of confounding factors [an odds ratio (OR = 1.09, 95% CI, 1.02–1.19, p = 0.02)]. With receiver operating curve analysis, the cutoff value of serum iron for a high A/G ratio was 18.56, and the area under the curve was 0.771 (sensitivity 88.9%and specificity 63.9%, p = 0.01). Conclusion Higher serum iron and ferritin concentrations were positively associated with a higher VF. Higher serum iron concentrations were positively correlated with a high A/G ratio. This study indicates the potential relationship between iron overload and the body composition in patients with T2DM.
Chapter
Appropriate patient selection is one of the key steps to the success of bariatric surgery (BS). In 1991, the National Institutes of Health (NIH) produced a consensus statement about the indications for BS. Over time, these have been repeatedly revalidated and reinforced. Worldwide, most of the criteria set by NIH are still applicable with minor variations. The evidence derived from national databases is helping to refine the criteria for patient selection. A significant number of recommendations made by NIH are based on majority consensus rather than being based on evidence. There are no absolute reliable indicators which would predict success of one operation over another in any individual patient, and neither is there any absolute contraindication to BS. However, certain factors identified during the preoperative patient assessment may influence the type of bariatric operation possible in that patient. For a successful outcome, all individual-complicating factors should be dealt with prior to any surgical intervention. The importance of a multidisciplinary team approach to patient selection and management is now well established. In this chapter, we discuss the relevant factors that would affect the suitability of any patient for BS.
Article
Introduction: Dietary intake plays an important role in determining body mass index (BMI) and glycemic profile in patients with type 2 diabetes mellitus (T2DM). Our aim was to describe habitual dietary intake and its associations with BMI and glycemic profile in a cohort of patients with newly diagnosed T2DM in Sri Lanka. Methods: A cross-sectional study was carried out among 158 patients with newly diagnosed T2DM in Galle, Sri Lanka. Data on demographic, lifestyle, and family history of diabetes mellitus, and clinical measures were collected. The dietary information was collected using a 24-h dietary recall. Results: Among the total number of study subjects, only 12.0%, 5.7% and 1.3% met the recommended daily consumption value of protein, fat, and fiber, respectively, whereas 99.4% of subjects had taken carbohydrates that exceeded the recommended consumption. There was a positive association between carbohydrate intake and BMI (0.004, [0.002], p = .048) and carbohydrate intake and glycated hemoglobin (HbA1C ) (0.001, [0.000], p = .049). Fat intake showed positive associations with BMI (0.029, [0.011], p = .006) and HbA1C (0.005, [0.002], p = .050). Protein intake showed a positive association with HbA1C (0.006, [0.003], p = .023). The aforementioned associations were observed after adjusting for demographic, lifestyle, and history of diabetes among the first-degree family members. The carbohydrate intake was positively associated with BMI (0.010, [0.003], p = .003) and HbA1C (0.001, [0.000], p = .050) with further adjustment in nutrient intake (except when used as an independent variable). Furthermore, the fat intake was associated with BMI (0.031, [0.011], p = .004) and HbA1C (0.005 [0.002], p = .050) with additional adjustments. Conclusions: The diet of the majority of newly diagnosed T2DM patients in this cohort consisted of a higher carbohydrate intake than the recommended level. However, they did not meet the recommended daily intake of protein, fat, and fiber. Both carbohydrate and fat intake were significantly and positively associated with BMI and HbA1C in patients with newly diagnosed T2DM.
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Background Uncertainty persists about carotid intima–media thickness (CIMT) as a marker of subclinical atherosclerosis and the independent relevance of different measures of adiposity for CIMT. We assessed the independent relevance of general adiposity (body mass index), central adiposity (waist circumference), and body composition (fat mass index and fat‐free mass index) with CIMT among adults in the United Kingdom. Methods and Results Multivariable linear regression of cross‐sectional analyses of UK Biobank assessed the mean percentage difference in CIMT associated with equivalent differences in adiposity measures. To assess independent associations, body mass index and waist circumference were mutually adjusted, as were fat mass index and fat‐free mass index. Among 39 367 participants (mean [SD] age 64 [8] years, 52% female, 97% White), median (interquartile range) CIMT was 0.65 (0.14) mm in women and 0.69 (0.18) mm in men. All adiposity measures were linearly and positively associated with CIMT after adjusting for confounders. Fat‐free mass index was most strongly associated with CIMT after adjustment for fat mass index (% difference in CIMT: 1.23 [95% CI 0.93–1.53] women; 3.44 [3.01–3.86] men), while associations of fat mass index were attenuated after adjustment for fat‐free mass index (0.28 [−0.02, 0.58] women; −0.59 [−0.99, −0.18] men). After mutual adjustment, body mass index remained positively associated with CIMT, but waist circumference was completely attenuated. Conclusions Fat‐free mass index was the adiposity measure most strongly associated with CIMT, suggesting that CIMT may reflect vascular compensatory remodeling rather than atherosclerosis. Hence, screening for subclinical atherosclerosis should evaluate carotid plaques in addition to CIMT.
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Objective: This study examines associations between the risk of sleep apnea and abdominal obesity (assessed by waist-to-hip ratio (WHR)) and general obesity (assessed by body mass index (BMI)) in a sample of Chinese and Korean American immigrants. Methods: The dataset included Chinese and Korean participants aged 50-75 who were recruited from primary care physicians' clinics from April 2018 to June 2020 in the Baltimore-Washington D.C. Metropolitan area (n = 394). Abdominal obesity was determined if WHR ≥ 0.9 in men and WHR ≥ 0.85 in women. General obesity was determined if BMI ≥ 30. The risk of sleep apnea was determined by using the Berlin questionnaire. Poisson regression models examined associations between sleep apnea risk and obesity. Models controlled for socio-demographic risk factors. Results: Twelve percent of the study participants were classified as a high risk for sleep apnea, and 75% had abdominal obesity whereas 6.4% had general obesity. High risk of sleep apnea was positively associated with abdominal obesity (PR = 1.31, 95% CI: 1.17-1.47) and general obesity (PR = 2.19, 95% CI: 0.90-5.32), marginally significant at p < 0.1). Conclusions: Chinese and Korean immigrants living in the USA who are at high risk of sleep apnea have higher abdominal obesity, even after accounting for sociodemographic characteristics. Abdominal obesity may be a better indicator than general obesity when examining the risk of sleep apnea among Asian Americans. Information on clinical trial: Name: Screening To Prevent ColoRectal Cancer (STOP CRC) among At-Risk Asian American Primary Care Patients NCT Number: NCT03481296; Date of registration: March 29, 2018 URL: https://clinicaltrials.gov/ct2/show/NCT03481296?term=Sunmin+Lee&draw=2&rank=1.
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Objectives: To investigate the methodology and clinical application of ultrasound attenuation imaging (ATI) and comparative analyze the diagnostic performance of ATI and controlled attenuation parameters (CAP) for detecting and grading hepatic steatosis. Methods: A total of 159 patients with NAFLD were prospectively enrolled. CAP and ATI examinations were performed within a week before proton magnetic resonance spectroscopy (1 H-MRS). Ten liver attenuation coefficient (AC) measurements by ATI were obtained in each patient. The interclass correlation coefficients (ICCs) of the intraobserver consistencies and the ICCs between the median of the first two through the first nine measurements and all 10 measurements were calculated. The correlations between 1 H-MRS, CAP, biological data, and ATI were evaluated. The significant factors associated with ATI and the diagnostic performance of ATI and CAP for detecting hepatic steatosis was evaluated. Results: The median value of AC for detecting hepatic steatosis was 0.831 dB/cm/MHz. For the intraobserver consistency of ATI, the ICC was 0.931. Compared with 10 measurements, a minimum of four ATI measurements was required. The correlation of AC with hepatic fat fraction (HFF) was significantly higher than that of CAP (0.603 vs 0.326, P = .0015). The HFF and triglyceride (TG) were the significant factors for the ATI. The area under the receiver operating characteristics (ROC) curves of ATI and CAP were 0.939 and 0.788 for detecting ≥10% hepatic steatosis; 0.751 and 0.572 for detecting >33% hepatic steatosis. The cutoff values of ATI and CAP were 0.697 dB/cm/MHz and 310 dB/m for detecting ≥10% hepatic steatosis; 0.793 dB/cm/MHz and 328 dB/m for detecting >33% hepatic steatosis. The sensitivity of ATI and CAP were 85.92% and 52.11% for detecting ≥10% hepatic steatosis; 87.50% and 82.14% for detecting >33% hepatic steatosis. The specificity of ATI and CAP were 94.12% and 100% for detecting ≥10% hepatic steatosis; 54.37% and 43.69% for detecting >33% hepatic steatosis. Conclusions: ATI technology showed excellent intraobserver consistency and the optimal minimum number of ATI measurements was 4. ATI is a promising noninvasive, quantitative and convenient tool for assessing hepatic steatosis.
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No previous studies have evaluated the intra- and interobserver reliability between the Weber, Lauge-Hansen and AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification systems under time constraints. This study compares the interobserver and intraobserver reliability of the aforementioned classification systems under simulated time constraints. Anteroposterior and lateral radiographs of ankle malleolar fractures from 80 consecutive patients from 2015 to 2016 were classified by 2 independent observers according to Weber, Lauge-Hansen and AO/OTA. Classifications were conducted over 4 successive weeks under timed (25-seconds) and untimed conditions, with 1-week gaps between each classification. Cohen's kappa and percentage agreement were calculated. Cohen's kappa for interobserver agreement ranged 0.67 to 0.67 and 0.59 to 0.73 for untimed and timed classifications for Weber; 0.38 to 0.47 and 0.44 to 0.50 for Lauge-Hansen; 0.28 to 0.49 and 0.13 to 0.37 for AO/OTA. Intraobserver agreement ranged from 0.83 to 0.85 and 0.78 to 0.79 for untimed and timed classifications for Weber; 0.46 to 0.65 and 0.59 to 0.73 for Lauge-Hansen; 0.42 to 0.63 and 0.40 to 0.51 for AO/OTA. Based on the Landis and Koch's benchmark scale, there was substantial agreement in the inter- and intraobserver variables for Weber; moderate agreement in inter- and intraobserver variables for Lauge-Hansen; fair and moderate agreement in inter- and intraobserver variables respectively for AO/OTA. Interobserver and intraobserver reliability was the most substantial for Weber, followed by Lauge-Hansen and AO/OTA. Time constraint did not have a statistically significant effect on the reliability of classifications. We recommend concurrent usage of the Weber and Lauge-Hansen system, since they demonstrate the greatest reliability and reproducibility, and confer better understanding of the fracture type, respectively.
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Background Adolescent obesity can lead to long-term health problems and is a topic of major concern in pediatric and broader medical and public health spheres. Numerous national and state-wide initiatives aimed at increasing physical activity and/or improving nutrition in this age group have assumed the goal of reducing the prevalence adolescent obesity. Objectives We assess trends in U.S. adolescent physical activity and body mass index between 1999 and 2019. Methods Using data from the U.S. Youth Risk Behaviour Surveillance System, we analyse data from 144 544 14-to-18-year-old respondents. We use multilevel linear and logistic regression to perform age-period-cohort analyses attributing changes in physical activity and body mass index over time to these three sources. Results Age and period effects are strong in all outcomes studied. Physical activity consistently decreases with age across the study period. Age trends in obesity have reversed in recent years, with older adolescents now more likely to be have obesity than younger adolescents. Both female and Asian adolescents report less physical activity but lower rates of obesity than their male and non-Asian counterparts. Conclusions The reversal of obesity trends by age with little change in physical activity over the study period suggests other lifestyle factors have changed over the study period to increase the prevalence of obesity in older adolescents.
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Background: The estimated prevalence of diabetes mellitus has increased and become a burden among non-communicable diseases due to the accelerated aging population worldwide and the increased prevalence in low-income countries. In Korea, diabetes has become a serious public health concern.Current Concepts: There are four major concerns in diabetes epidemiology. First, the increased obesity rate is associated with increased diabetes prevalence. Second, a more than 40% increase in men and women with prediabetes has been observed. Prediabetes is not only a risk factor for diabetes but can also have pathophysiological effects. Third, one in three patients did not know that they had the disease. Three in four persons with diabetes experienced uncontrolled blood glucose even with treatment. Moreover, the treatment and awareness rates among people with diabetes in their 30s and 40s were lower than 50%. Unhealthy habits such as smoking, alcohol drinking, and inadequate physical activity persist in patients undergoing treatment. Finally, it has recently been found that the risk of developing diabetes is high among cancer survivors and patients recovering from coronavirus disease 2019.Discussion and Conclusion: A strategy should be developed to improve early detection and treatment rate in young people. We need to emphasize the seriousness of the increasing number of people with prediabetes and examine the effects of drug intervention for prediabetes, on the basis of academic research. We should also pay attention to patients who recovered from the newly emerging coronavirus disease 2019 and cancer survivors at risk of developing diabetes.
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The health and fertility hypothesis suggests that low body weight young women are healthy and fertile, thereby judged as attractive to men. Although it has been widely accepted, few studies have tested the health and fertility hypothesis on a perceptual level, that is whether the most attractive female body is also perceived as the healthiest and most fertile. In the current study, we investigated young and older men's preferences women's body weight, using 3D human body models. With an interactive body preference task, men chose the BMI and body fat of women's body shapes perceived as most attractive, healthiest and most fertile. The results showed that both young and older men had similar patterns of preferences for women's bodies. For BMI, the most attractive body weight was not seen as the healthiest or the most fertile. Compared to the most attractive BMI, higher BMI was required to be seen as the healthiest and this figure was even higher for fertility judgements. Body fat generally showed similar patterns of results as BMI. Our findings challenge the health and fertility hypothesis and point to the alternative explanation that the judgement of women's attractiveness tracks cues indicating youth and low parity.
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Background and Aims Although lower lean mass is associated with greater diabetes prevalence in cross-sectional studies, prospective data specifically in middle-aged Black and White adults are lacking. Relative appendicular lean mass (ALM), such as ALM adjusted for body mass index BMI, is important to consider since muscle mass is associated with overall body size. We investigated whether ALM/BMI is associated with incident type 2 diabetes in the Coronary Artery Risk Development in Young Adults study. Methods and Results 1,893 middle-aged adults (55% women) were included. ALM was measured by DXA in 2005-06. Incident type 2 diabetes was defined in 2010-11 or 2015-16 as fasting glucose ≥7 mmol/L(126 mg/dL), 2-hour glucose on OGTT ≥11.1 mmol/L(200 mg/dL)(2010-11 only), HbA1C ≥48 mmol/mol(6.5%)(2010-11 only), or glucose-lowering medications. Cox regression models with sex stratification were performed. In men and women, ALM/BMI was 1.07 ± 0.14(mean±SD) and 0.73±0.12, respectively. Seventy men(8.2%) and 71 women(6.8%) developed type 2 diabetes. Per sex-specific SD higher ALM/BMI, unadjusted diabetes risk was lower by 21% in men[HR 0.79 (0.62-0.99), p=0.04] and 29% in women[HR 0.71 (0.55-0.91), p=0.008]. After adjusting for age, race, smoking, education, physical activity, and waist circumference, the association was no longer significant. Adjustment for waist circumference accounted for the attenuation in men. Conclusion Although more appendicular lean mass relative to BMI is associated with lower incident type 2 diabetes in middle-aged men and women over 10 years, its effect may be through other metabolic risk factors such as waist circumference, which is a correlate of abdominal fat mass.
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Introduction The use of Asian-specific Body Mass Index (aBMI) cutoffs may be more appropriate than general World Health Organization BMI (gBMI) cutoffs in determining recommended gestational weight gain (GWG) for Asian women. Since aBMI cutoffs are lower than gBMI, more Asian women will be reclassified into higher aBMI categories from gBMI. The prevalence of reclassification and its impact on GWG are not known. Methods We utilized the electronic health records of 8886 Kaiser Permanente Hawaii members aged ≥ 18 with a singleton live birth. Prepregnancy BMI was first classified using gBMI criteria, then aBMI criteria. BMI categories were “underweight”, “normal”, “overweight” and “obese”; GWG was classified into lower (“lGWG”), met (“mGWG”), and exceed (“eGWG”) GWG per WHO recommendations. Self-reported race/ethnicity include Asian, Asian + Pacific Islander, and Asian + white. Multiple logistic regression was used to estimate adjusted odds of reclassification. The Cochran-Mantel–Haenszel test was used to evaluate associations between race/ethnicity and GWG. Results > 40% of women in each racial/ethnic group were reclassified. Asian + Pacific Islander women had significantly higher odds of being reclassified (p < .0001). In the normal gBMI and aBMI category, Asian + Pacific Islander women had the largest eGWG group. In the overweight gBMI category, Asian + Pacific Islander women had the largest eGWG group; in the overweight aBMI category, Asian + white women had the largest eGWG group. Discussion A sizable percent of women were reclassified into higher BMI categories when aBMI was applied. Mixed-race Asian women were more likely to exceed GWG recommendations than Asian women.
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IntroductionVitamin D deficiency and insufficiency are highly prevalent among several populations across the globe. Numerous studies have shown a significant correlation between body-mass-index (BMI) and Vitamin D status, however, some results differed according to ethnicity. Despite the abundance of sunshine throughout the year, vitamin D deficiency is prominent in the United Arab Emirates (UAE). In this study, we analyzed the UAE Healthy Future Study (UAEHFS) pilot data to investigate the association between serum 25-hydroxyvitamin D (25(OH)D) and % body fat (BF) composition as well as BMI.Material and methodsData from a total of 399 Emirati men and women aged ≥ 18 years were analyzed. Serum 25(OH)D and standard measures of weight and height were included in the analyses. Vitamin D deficiency was defined as serum 25(OH)D concentration<20 ng/ml. Multivariate quantile regression models were performed to explore the relationship between serum 25(OH)D levels and % BF composition and BMI correspondingly.ResultsThere were 281 (70.4%) males and 118 (29.6%) females included in this study. More than half of the study participants had vitamin D insufficiency (52.4%), and nearly a third had vitamin D deficiency (30.3%); while only 17.3% had optimal levels. A statistically significant negative association between serum 25(OH) D levels and % BF composition was observed at intermediate percentiles while a statistically significant negative association between serum 25(OH)D and BMI was only observed at the median (50th percentile).Conclusion The study findings support the association between low serum 25(OH) D levels (low vitamin D status) and high % BF composition and high BMI among adult Emiratis. Further longitudinal data from the prospective UAEHFS could better elucidate the relationship between serum 25(OH) D levels, % BF composition, and BMI in the context of various health outcomes among this population.
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Background To establish a new and accurate model for standard liver volume (SLV) estimation and graft size prediction in liver transplantation for Chinese adults. Methods In this study, the data of morphologic indices and liver volume (LV) were retrospectively obtained on 507 cadaveric liver transplantation donors between June 2017 and September 2020 in Shulan (Hangzhou) Hospital. Linear regression analysis was performed to evaluate the impact of each parameter and develop a new SLV formula. The new formula was then validated prospectively on 97 donors between October 2020 and June 2021, and the prediction accuracy was compared with previous formulas. Results The average LV in all subjects was 1445.68 ± 309.94 mL. Body weight (BW) showing the strongest correlation (r = 0.453, P < .001). By stepwise multiple linear regression analysis, BW and age were the only 2 independent correlation factors for LV. Shulan estimation model derived: SLV (mL) = 13.266 × BW (kg) – 4.693 × age + 797.16 (R2 = 0.236, P < .001). In the validation cohort, our new model achieved no significant differences between the estimated SLV and the actual LV (P > .05), and showed the lowest mean percentage error of 0.33%. The proportions of estimated SLV within the actual LV ± 20%, ± 15%, and ± 10% percentage errors were 69.1%, 55.7%, and 40.2%, respectively. Discussion The Shulan SLV estimation model predicted LV more accurately than previous formulas on Chinese adults, which could serve as a simple screening tool during the initial assessment of graft volume for potential donors.
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Nocturia can be caused by urological disorders and systemic diseases, including heart diseases. We aimed to investigate the relationship between nocturia and structural abnormalities on echocardiography. Adult patients who underwent echocardiography for cardiac symptoms or heart murmur or had a history of structural heart disease were included. The voiding times during sleep hours were collected prospectively. Univariate and multivariate analyses were performed to evaluate the predictive value of bothersome nocturia (nocturia ≥ 2) on echocardiographic abnormalities. Of 299 patients, 182 (60.9%) reported bothersome nocturia. In patients aged ≥ 65 years, hypertension and left atrial enlargement (LAE) were associated with higher occurrences of bothersome nocturia. On multivariate analysis, bothersome nocturia was a predictive factor of LAE (odds ratio [OR] 2.453, 95% confidence interval [CI] 1.363–4.416, p = 0.003). Moreover, bothersome nocturia could predict both LAE and left ventricular hypertrophy (LVH) (OR 2.285, 95% CI 1.151–4.536, p = 0.018; OR 2.056, 95% CI 1.025–4.124, p = 0.043) in the elderly. Older age, hypertension, and LAE were risk factors for bothersome nocturia. Moreover, bothersome nocturia was predictive of LAE and LVH in the elderly. Patients with bothersome nocturia without other significant lower urinary tract symptoms should be referred to cardiologists.
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As global obesity rates continue to rise, it is important to understand the origin, role, and range of human variation of the body mass index (BMI) in assessing health and healthcare. A growing body of evidence suggests that BMI is a poor indicator of health across populations, and that there may be a metabolically healthy obese phenotype. Here we review the reasons why BMI is an inadequate tool for assessing cardiometabolic health. We then suggest that cold climate adaptations may also render BMI an uninformative metric. Underlying evolutionary and environmental drivers may allow for heat conserving larger body sizes without necessarily increasing metabolic health risks. However, there may also be a potential mismatch between modern obesogenic environments and physical adaptations to cold climates, highlighting the need to further investigate the potential of metabolically healthy obese phenotypes among circumpolar and other populations and the broader meaning for metabolic health. Lay Abstract Global obesity rates are on the rise; however, body mass index (BMI) is a poor indicator of metabolic health. Here we propose that cold climate populations may exhibit high BMIs, but relatively healthy metabolic profiles (metabolically healthy obesity) due to environmental and evolutionary pressures associated with inhabiting a cold climate.
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OBJECTIVES This study was conducted to examine the effect of obesity, and physical activity on the prevalence of dyslipidemia in persons with type 2 diabetes mellitus (T2DM).METHODS A cross-sectional , correlational design was used. Participants aged 20 years or older were recruited from a diabetes clinic affiliated with a university hospital. Body composition, blood glucose, glycated hemoglobin, and blood lipid level were measured in addition to self-reported physical activity. Final data analysis was conducted with 177 participants. The differences on physical activity measures and body composition between those with or without dyslipidemia were analyzed using independent t-tests. The associations between dyslipidemia and physical activity and obesity were assessed with the odds Ratio (OR) and 95% confidence intervals (CI) after adjusting potential confounding factors.RESULTS The participation rate of regular physical activity in T2DM patients was 55.9%. BMI and regular physical activity participation influenced the prevalence of dyslipidemia in persons with T2DM. The regular physical activity participation rate of T2DM patients without dyslipidemia was higher than that of T2DM patients with dyslipidemia ( p <.05). Moreover, participation in regular physical activity decreased the risk of dyslipidemia prevalence ( p <.05). With regard to body composition, T2DM patients with dyslipidemia had a higher body mass index ( p <.01). As the body mass index 1 increased, odd ratio of the dyslipidemia prevalence increased 1.21 times ( p <.05).CONCLUSIONS The risk of dyslipidemia in T2DM patients was influenced by BMI and participation in regular physical activity. Therefore, reducing obesity through regular physical activity will be a way to lower the prevalence of dyslipidemia in T2DM.
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The purposes of this study were to determine whether there are significant differences between two- and four-compartment model estimates of body composition, whether these differences are associated with aqueous and mineral fractions of the fat-free mass (FFM); and whether the differences are retained in equations for predicting body composition from anthropometry and bioelectric resistance. Body composition was estimated in 98 men and women aged 65-94 y by using a four-compartment model based on hydrodensitometry, 3H2O dilution, and dual-photon absorptiometry. These estimates were significantly different from those obtained by using Siri's two-compartment model. The differences were associated significantly (P less than 0.0001) with variation in the aqueous fraction of FFM. Equations for predicting body composition from anthropometry and resistance, when calibrated against two-compartment model estimates, retained these systematic errors. Equations predicting body composition in elderly people should be calibrated against estimates from multicompartment models that consider variability in FFM composition.
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In 1229 subjects, 521 males and 708 females, with a wide range in body mass index (BMI; 13.9-40.9 kg/m2), and an age range of 7-83 years, body composition was determined by densitometry and anthropometry. The relationship between densitometrically-determined body fat percentage (BF%) and BMI, taking age and sex (males = 1, females = 0) into account, was analysed. For children aged 15 years and younger, the relationship differed from that in adults, due to the height-related increase in BMI in children. In children the BF% could be predicted by the formula BF% = 1.51 x BMI-0.70 x age - 3.6 x sex + 1.4 (R2 0.38, SE of estimate (SEE) 4.4% BF%). In adults the prediction formula was: BF% = 1.20 x BMI + 0.23 x age - 10.8 x sex - 5.4 (R2 0.79, SEE = 4.1% BF%). Internal and external cross-validation of the prediction formulas showed that they gave valid estimates of body fat in males and females at all ages. In obese subjects however, the prediction formulas slightly overestimated the BF%. The prediction error is comparable to the prediction error obtained with other methods of estimating BF%, such as skinfold thickness measurements or bioelectrical impedance.
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Renewed interest in the assessment of human body composition has stimulated the need for a balanced understanding of available methodologies of estimating fat-free mass and percent body fat. This review summarizes the physical bases and assumptions, describes applications, and discusses the theoretical and practical limitations of currently available indirect methods. Although standard methods are discussed, recent modifications and adaptations are emphasized.
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We studied the correlations between body mass index (BMI) and percent body fat (fat%) measured by dual-photon absorptiometry (DPA) in 445 white and 242 Asian adults aged 18-94 y. In addition, comparisons in six circumferences and eight skinfold-thickness measurements between whites and Asians were made to explain the discrepancies. Although Asians had lower BMI, they were fatter than whites of both sexes. The correlations between fat% and BMI varied by BMI and sex and race. Comparisons in anthropometry show that Asians had more subcutaneous fat than did whites and had different fat distributions from whites. Asians had more upper-body subcutaneous fat than did whites. The magnitude of differences between the two races was greater in females than in males. Prediction equations developed for each sex and race, based on BMI alone, gave SEEs ranging from 4.4% to 5.7%. All were significantly improved to the range of 3.5-4.4% when age and several skinfold-thickness measurements were added.
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This study tested the hypothesis that body mass index (BMI) is representative of body fatness independent of age, sex, and ethnicity. Between 1986 and 1992, the authors studied a total of 202 black and 504 white men and women who resided in or near New York City, were ages 20-94 years, and had BMIs of 18-35 kg/m2. Total body fat, expressed as a percentage of body weight (BF%), was assessed using a four-compartment body composition model that does not rely on assumptions known to be age, sex, or ethnicity dependent. Statistically significant age dependencies were observed in the BF%-BMI relations in all four sex and ethnic groups (p values < 0.05-0.001) with older persons showing a higher BF% compared with younger persons with comparable BMIs. Statistically significant sex effects were also observed in BF%-BMI relations within each ethnic group (p values < 0.001) after controlling first for age. For an equivalent BMI, women have significantly greater amounts of total body fat than do men throughout the entire adult life span. Ethnicity did not significantly influence the BF%-BMI relation after controlling first for age and sex even though both black women and men had longer appendicular bone lengths relative to stature (p values < 0.001 and 0.02, respectively) compared with white women and men. Body mass index alone accounted for 25% of between-individual differences in body fat percentage for the 706 total subjects; adding age and sex as independent variables to the regression model increased the variance (r2) to 67%. These results suggest that BMI is age and sex dependent when used as an indicator of body fatness, but that it is ethnicity independent in black and white adults.
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To assess differences in body composition between Polynesians and Caucasians subjects. 48 male and 80 female Polynesians from a village in Rarotonga, Cook islands (81% response rate) and representative sample of 243 male and 250 female Caucasians from Melbourne, Australia. Body mass index, resistance from bioelectrical impedance, percent body fat derived from 4 equations using resistance, weight, height, age and sex. Male and female Polynesians were younger (by 7.7 years, P < 0.001 and 4.1 years, P < 0.05) and heavier (by 10.7 kg and 12.5 kg, P < 0.0001) than their Caucasian counterparts. Electrical resistance was significantly lower in Polynesians of both sexes by over 130 omega (P < 0.0001). At every level of weight (adjusted for height and age), resistance was lower in the Polynesians (P < 0.0001) and at every level of body mass index, the predicted body fat from 4 different equations was lower in Polynesians (P < 0.0001). These results imply that, at any given body size. Polynesians are significantly leaner than Caucasians and that specific Polynesian standards for defining obesity need to be developed. The findings will need to be confirmed by other reference methods for measuring body composition.
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Body mass index (BMI) is the most commonly used measure of obesity. Recently, some investigators have advocated direct measurement of adiposity rather than use of the BMI. This study was undertaken to determine the ability of BMI to predict body fat levels in three populations of West African heritage living in different environments. A total of 1,054 black men and women were examined in Nigeria, Jamaica, and the United States during 1994 and 1995. A standardized protocol was used to measure height, weight, waist and hip circumferences, and blood pressure at all sites; percentage of body fat was estimated using bioelectrical impedance analysis. Percentage of body fat and BMI were highly correlated within site- and sex-specific groups, and the resulting r2 ranged from 0.61 to 0.85. The relation was quadratic in all groups except Nigerian men, in whom it was linear. The regression coefficients were similar across sites, yet the mean body fat levels differed significantly (p < 0.001) as estimated by the intercept, making intersite comparison difficult. Compared with BMI, percentage of body fat was not a better predictor of blood pressure or waist or hip circumference.
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To study the relationship between percent body fat and body mass index (BMI) in two different ethnic groups (Indonesians and Caucasians) in order to evaluate the validity of the BMI cut-off points for obesity. Cross-sectional study. Not specially selected populations living in southern Sumatra (Palembang, Indonesia) and Caucasian Dutch living in Wageningen. Body weight, body height, body fat by deuterium oxide dilution and skinfold thickness. Body fat could be well predicted by body mass index (BMI) and sex in the Indonesians and by BMI, sex and age in the Dutch with a prediction error of 3.6 and 3.3% for the two populations respectively. Although the body mass index in the Indonesian group was about 2 kg/m2 lower compared to the Dutch, the amount of body fat was 3% points higher. Because of small differences between the groups in age, weight and height the differences in body fat were corrected for this (ANOVA). Indonesians having the same weight, height, age and sex have generally 4.8% points more body fat compared to Dutch. Indonesians having the same % BF, age and sex have generally a 2.9 kg/m2 lower BMI compared to the Dutch. The results show that the relationship between % BF and BMI is different between Indonesians and Dutch Caucasians. If obesity is regarded as an excess of body fat and not as an excess of weight (increased BMI), the cut-off points for obesity in Indonesia based on the BMI should be 27 kg/m2 instead of 30 kg/m2.
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To study the relationship between percent body fat and body mass index (BMI) in different ethnic groups and to evaluate the validity of the BMI cut-off points for obesity. Meta analysis of literature data. Populations of American Blacks, Caucasians, Chinese, Ethiopians, Indonesians, Polynesians and Thais. Mean values of BMI, percent body fat, gender and age were adapted from original papers. The relationship between percent body fat and BMI differs in the ethnic groups studied. For the same level of body fat, age and gender, American Blacks have a 1.3 kg/m2 and Polynesians a 4.5 kg/m2 lower BMI compared to Caucasians. By contrast, in Chinese, Ethiopians, Indonesians and Thais BMIs are 1.9, 4.6, 3.2 and 2.9 kg/m2 lower compared to Caucasians, respectively. Slight differences in the relationship between percent body fat and BMI of American Caucasians and European Caucasians were also found. The differences found in the body fat/BMI relationship in different ethnic groups could be due to differences in energy balance as well as to differences in body build. The results show that the relationship between percent body fat and BMI is different among different ethnic groups. This should have public health implications for the definitions of BMI cut-off points for obesity, which would need to be population-specific.
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Weight-height (W-H) indices continue to be popular methods of assessing fatness in both clinical practice and population studies, even though skinfold thicknesses provide simple valid estimates. Different grades of obesity have been defined in terms of W/H2 values but these have not been related to fatness. So far, no allowance has been made for the changing body composition with age which alters the relationships between fatness and W/H2 or the other W-H indices. These relationships were calculated in an industrial sample of 138 adult men and 22-55 yr. W/H2 and relative weight (weight/desirable weight) were the best of the W-H indices of fatness, having the lowest correlations with height (r = 0.07), the highest correlation with percentage of body weight as fat (%F) (r = 0.75), and with fat mass (r = 0.88), and the lowest standard error of estimate (SEE) (4.1%F). However, W/H and W/H3 had very similar r and SEE with %F. Adding age to W/H2 improved the accuracy of the estimation of %F, (R2=0.66 SEE = 3.6%), and reduced the overestimation of %F in the young and underestimation in the middle-aged that occur with W/H2 alone. Validated equations for estimating %F and fat mass in men from W/H2 and age are presented. However, W-H indices should be used cautiously as they cannot distinguish between overweight due to muscle, bone, water or fat.
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This paper examines the relationships between body mass index (BMI) and body composition in different population groups where low BMIs might be expected to occur and assesses the extent to which BMIs are influenced by size and shape. The relationship between BMI and fat as a percentage of body weight is approximately linear although theoretically a curvilinear relationship is to be expected. However, by allowing for a variable composition of weight differences, an approximately linear theoretical relationship is obtained. There are few direct data (e.g. from densitometry, hydrometry etc.) on body composition in the groups in question and to examine the relationships indirect data were used. The regression coefficients of fat-free mass on BMI for 285 samples of Africans, people of Asian origin, Indo-Mediterraneans and Pacific people were not significantly different in the various groups of each sex; % fat on BMI was similarly related in four groups of women. Intercept terms were all significantly different. Using the sitting height-to-stature ratio (SH/S) as an index of body shape in 158 groups, the regression coefficient of BMI on SH/S was 0.90 kg/m2 per 0.01 SH/S. Mean SH/S lies between 0.50 and 0.55 in most populations so that shape could affect BMI by 5 kg/m2 and influence markedly the interpretation of BMI. However, allowing for SH/S is not straightforward as there is as much variation within as between groups. In conclusion, low BMI approximates to low weight, fat mass and fat-free mass. There are differences in the relationships of BMI to body composition but over the range 20-25 kg/m2 these may not be important in epidemiological studies. To interpret BMI in terms of body composition in more detail it is necessary to take into account sex, age, shape and ethnicity.
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Low body mass index (BMI kg/m2) has been proposed as a practical measure of energy undernutrition although it has some well-known limitations. Some reports have suggested that those Australian Aborigines living a largely traditional way of life have low BMI without compromised health status and may have paradoxically high levels of subcutaneous adipose tissue. The evidence for low BMI, in Australian Aborigines is reviewed from the mean data of 1,174 individuals in 26 groups of adults and from the individual data of 349 of these individuals, collected before 1970. Three of the nine groups of women had mean BMI less than 18.5 kg/m2 and 4% of the individual men and 14% of the individual women had values less than 16kg/m2, a value regarded as indicating severe chronic energy deficiency. Skinfold thicknesses were greater than expected from the BMI, suggesting paradoxically high subcutaneous fatness. The contribution of long-leggedness to low BMI was estimated from the regression of BMI on the sitting height to stature ratio (SH/S). For the 26 groups, this was estimated to be 2 kg/m2, r2 = 31%. The relationship was weaker with the individual data, r2 = 15%. Body shape as evinced by low SH/S does contribute to low BMI in these Australian Aborigines. Single cut-offs of BMI are not applicable to all population groups and allowance may have to be made for body form when using BMI to assess nutritional status.
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The latest data (NHANES III) from the National Center for Health Statistics (NCHS) show that the black population has the highest proportion of overweight among all adult populations in the United States. The present study compared the body mass index (BMI) and body fat percent from dual-photon absorptiometry in 1,324 healthy adults aged 18 to 107 years recruited from four ethnic groups in the New York City area; 523 whites, 280 blacks, 267 Asians and 254 Puerto Ricans. Puerto Ricans had the largest BMI and the largest percent of subjects with body weight more than 120% of their ideal weight, and the largest fat percent of the four ethnic groups: 76% of Puerto Rican males had fat percent above the median value for white males (fat percent = 19.6%) and 95% of Puerto Rican females had fat percent above the median for white females (fat percent = 30.8%). Asians had the smallest BMI, but 63% of them had fat percent above the median values for whites in each gender. Puerto Ricans also had the largest waist-to-hip ratios among the four ethnic groups. In blacks, the percent of subjects with fat percent larger than the median for whites was slightly smaller than that for Puerto Ricans, 64% and 82% of males and females respectively. These results differ from the latest NCHS data and show that Puerto Ricans in this sample are heavier and fatter than blacks.
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The assumed "constancy" of fat-free body mass hydration is a cornerstone in the body-composition research field. Hydration, the observed ratio of total body water to fat-free body mass, is stable at approximately 0.73 in mammals and this constancy provides a means of estimating total body fat in vivo. This review examines both in vitro and in vivo data that support the hydration constancy hypothesis and provides a critique of applied methodology. Biological topics of interest are then examined and critical areas in need of future research are identified. These are important issues because water dilution is the only method currently available for estimating body fat in all mammals, which range in body mass by a factor of 10(4).