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WHO. World Health Organization (WHO) Expert Consultation: appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363, 157-163
Abstract
A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (⩾25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22kg/m2 to 25kg/m2 in different Asian populations; for high risk it varies from 26kg/m2 to 31kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23·0, 27·5, 32·5, and 37·5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.
... The discourse on biomarkers, anthropometric indices, and diabetes is largely confined to high-income countries (HICs), with limited attention paid to LMICs [33][34][35]. However, there have been exceptions in the form of studies that specifically concentrate on the aging Asian population and other contextual factors within LMICs [3,36,37]. Within HICs, numerous studies [5,38,39] have contributed to our understanding of diabetes prediction using various anthropometric indices and biomarkers, such as waist circumference (WC), waist-to-height ratio (WHtR), and FPG or FBG. The abundance of biomarkers and anthropometric indices in HICs supports the adoption of more accurate metrics as routine indicators for predicting diabetes [39,40]. ...
... Also, multiple central obesity indices were stronger predictors of diabetes. Consistent with my results is research in HICs informing the prediction of diabetes with several anthropometric indices and biomarkers [4,5,34,37,39]. These results heighten the need for health and nutritional policies reform to include central obesity measures such as WHtR, ABSI, BAI, BF% and glucose indices like FPG as primary screening tools of diabetes in LMICs. ...
... They demonstrated that, even though patients had normal body weight (BMI < 25 kg/m 2 ), the AH was the main cause of NAFLD development with an overall HR of 2.05 (95% CI 1. 87-2.25), and five different statistical methods were used for the HR calculation to assess the relationship [25]. Therefore, it can be concluded that the relationship between NAFLD and AH exists regardless of obesity (BMI ≥ 30 kg/m 2 for the Caucasian population [26] and BMI ≥ 25 kg/m 2 for the Asian population [27]) and overweight (BMI ≥ 25 kg/m 2 for the Caucasian population [26] and BMI ≥ 23 kg/m 2 for the Asian population [27]), and the combination of these two may have a more pronounced negative impact on the patient prognosis vs. the individual effect of each of them. ...
... They demonstrated that, even though patients had normal body weight (BMI < 25 kg/m 2 ), the AH was the main cause of NAFLD development with an overall HR of 2.05 (95% CI 1. 87-2.25), and five different statistical methods were used for the HR calculation to assess the relationship [25]. Therefore, it can be concluded that the relationship between NAFLD and AH exists regardless of obesity (BMI ≥ 30 kg/m 2 for the Caucasian population [26] and BMI ≥ 25 kg/m 2 for the Asian population [27]) and overweight (BMI ≥ 25 kg/m 2 for the Caucasian population [26] and BMI ≥ 23 kg/m 2 for the Asian population [27]), and the combination of these two may have a more pronounced negative impact on the patient prognosis vs. the individual effect of each of them. ...
Non-alcoholic fatty liver disease (NAFLD) and arterial hypertension (AH) are widespread noncommunicable diseases in the global population. Since hypertension and NAFLD are diseases associated with metabolic syndrome, they are often comorbid. In fact, many contemporary published studies confirm the association of these diseases with each other, regardless of whether other metabolic factors, such as obesity, dyslipidemia, and type 2 diabetes mellites, are present. This narrative review considers the features of the association between NAFLD and AH, as well as possible pathophysiological mechanisms.
... В отношении ИМТ авторы рекомендаций предложили использовать пороговые значения, указанные ВОЗ с учетом расы: >25 кг/м 2 для представителей монголоидной расы и >30 кг/м 2 для представителей европеоидной расы. Что касается ОТ, то в качестве пограничных для представителей европеоидной расы рекомендуется использовать значения, установленные NIH (Национальными институтами здравоохранения США): ≥90 см для мужчин и ≥80 см для женщин), а для представителей монголоидной расы -значения, полученные в исследовании Misra A. et al. (2006): ≥78 см для мужчин и ≥72 см для женщин [2,21,[25][26][27]. Важно отметить, что для дальнейшего продолжения алгоритма диагностического поиска необходимо наличие двух критериев одновременно. ...
Osteosarcopenic obesity in association with circulatory system sites requires study and scientific debate, despite the published years of completed research conducted in recent studies. Systemic inflammation, oxidative stress, and insulin resistance are involved in the development and progression of both osteosarcopenic obesity and adverse cardiovascular events. The presence of impaired bone mass and function, excess adipose tissue in consumption, an increase in the number of muscles, impaired muscle function and deterioration in muscle strength, an increase in the relationship between osteosarcopenic obesity and the cardiovascular system. The review article presents modern ideas about the epidemiology, etiology, modern approaches to the diagnosis of osteosarcopenic obesity in patients with dangerous circulatory systems, as well as possible pathogenetic mechanisms of its development.
... The obtained height and weight were used to calculate the body mass index (BMI) using the following formula: BMI = weight (kg)/height (m 2 ). According to the World Health Organization classification, we categorized the BMI of the patients into two groups: the obese group, with a BMI ≥ 25 kg/m 2 ; and the non-obese group, with a BMI < 25 kg/m 2 [26]. Dietary data were collected using a semi-quantitative food frequency questionnaire to assess the dietary intake of the patients within the past month. ...
Malignant colorectal tumors and precancerous lesions are closely associated with chronic inflammation. Specific dietary patterns can increase chronic inflammation in the body, thereby promoting the occurrence of tumors and precancerous lesions. We have conducted a case–control study in Kashgar Prefecture, Xinjiang, China, to explore the association between the energy-adjusted dietary inflammatory index (E-DII) and the risk of colorectal adenomatous polyps (CAP). A total of 52 newly diagnosed patients with CAP and 192 controls at the First People’s Hospital of Kashgar Prefecture were enrolled in this study. Dietary information was collected using a food frequency questionnaire. The E-DII was calculated based on dietary data, reflecting an individual’s dietary inflammatory potential. Logistic regression models were used to evaluate the relationship between the E-DII and the risk of CAP, with adjustments for potential confounding factors. The results showed that the maximum anti- and pro-inflammatory values of E-DII were −4.33 and +3.48, respectively. Higher E-DII scores were associated with an increased risk of CAP, and this association remained statistically significant after adjusting for age, sex, body mass index, smoking status, and other relevant variables. Notably, a more pro-inflammatory dietary pattern may be related to an increased risk of developing CAP in Kashgar Prefecture.
... Consequently, it has been noted that obesity lowers life expectancy by approximately seven years and that a 30 to 35 BMI lowers life expectancy by nearly four years even as BMIs greater than 40 reduce life expectancy by more than 10 years [38,39]. Still, obesity-related complications are either directly as a result of obesity or indirectly as a result of the mechanisms that share common causes including poor diets and sedentary lifestyles. ...
... The individuals were divided into FLD and non-FLD groups, and the T2DM incidence was analysed. Other clinical data were divided as follows [18][19][20]: age ≥ 45 years, overweight [BMI (body mass index) ≥ 24 kg/m 2 ], systolic hypertension (SBP ≥ 140 mmHg), diastolic hypertension (DBP ≥ 90 mmHg), hypertriglyceridaemia (TG > 1.7 mmol/L), hypercholesterolaemia (TC > 5.8 mmol/L), low HDL (HDL < 1.8 mmol/L), and high LDL (LDL > 3.3 mmol/L). We estimated the crude PAFs and crude HRs in a cohort study of FLD. ...
Purpose
To determine the population attributable fraction (PAF) of fatty liver disease (FLD) for type 2 diabetes mellitus (T2DM) and compare it to the PAFs of other metabolic abnormalities.
Methods
We conducted a 10-year retrospective cohort study of 33,346 individuals in Karamay Central Hospital of Xinjiang. Individuals were followed up for T2DM occurrence based on FBS. The PAFs of FLD were calculated generally and respectively in different sex and age groups. A comparison of the PAF of FLD and that of other metabolic abnormalities, as well as the PAFs of FLD in different groups classified based on age and sex, was performed using Cox regression.
Results
During an average follow-up period of 3.71 years, 1486 T2DM were diagnosed. The incidence density of T2DM was 1.2/100 person-years, and cumulative incidence rate was 4456.31/100,000 person-years. Partial PAF (PAFp) of FLD in the entire population was 23.11%. In the male population, PAFp was higher at 30–40 years old. In the female population, it was higher when age ≥ 60 years old. In multivariable Cox regression model, FLD, male sex, age ≥ 45 years old, overweight, hypertriglyceridaemia, and systolic hypertension were independent risk factors for T2DM, with corresponding PAFp of 25.00%, 24.99%, 36.47%, 24.96%, 5.71%, and 6.76%, respectively. Age ≥ 45 years old showed the highest PAFp and adjusted hazard ratio, followed by FLD.
Conclusions
FLD contributes more to T2DM incidence than other metabolic disorders. Particular attention should be given to male populations of 30–40 and female populations above 60 for FLD prevention and treatment.
... Moreover, the weight status of the present sample was summarized using frequencies and percentages with a BMI > 23 kg/m 2 classified as being overweight (Asian norm proposed by the World Health Organization). 62 Moreover, for participants who did not complete all items on the IPAQ, their data were not used for the statistical analyses in the PA-related analyses (eg, measurement invariance across different PA levels). The reason for removing them from PA-related analyses was because the IPAQ scoring needs all items for calculation. ...
... 12 BMI (kg/m 2 unit) was defined from body weight (kg) divided by height (m) squared and categorized into underweight, normal, overweight and obese as recommended by WHO for Asian populations. 13 Waist circumference was categorized into normal and obese using cut-offs for obesity of >90 cm for men and >80 cm for women using the recommendation of the International Diabetes Federation (IDF). Blood pressure was measured using a digital tensimeter (OMRON HEM 7120, OMRON Healthcare, Singapore) and classified into normal, pre-hypertension, hypertension I, and hypertension II following the recommendation of the Joint National Committee on Prevention Detection, Evaluation, and Treatment Joint Nation or High-Pressure VII (JNC-VII, 2003). ...
The prevalence of obesity continuously increase, as are associated comorbidities and healthcare expenses. Early detection, intervention, and effective treatment of obesity are important to improve quality of life and to reduce costs. This Community Practice Program aimed to evaluate health status and provide education about healthy life style of people at productive age in Pajimatan Hamlet, Imogiri, Bantul, Yogyakarta. Participants were 66 adults (26 men, 40 women) aged 19-64 years living in Pajimatan Hamlet. The program was held on November 2021. Education on healthy life style was done using WhatsApp group. Pre- and post-test were given to the participant before and after the education. Health screening was done by measuring height, weight, waist circumference (WC), blood pressure BP), and fasting blood glucose level. Obesity was determined using body mass index (BMI) and WC. There were significant increase scores before and after education in men (p= 0.017) and women (p< 0.001). Health screening indicated that men were significantly taller (p< 0.001) and heavier (p= 0.009) than women, however, there was no difference in BMI, WC, BP, and fasting blood glucose level (p> 0.05). There were no differences in the distribution of BMI obesity between men and women, however, women with central obesity were higher than men (70% women, 30% women, p= 0.021). Men having prehypertension were higher than women (46.2 vs. 15%), on the other hand, women with hypertension I and II seemed to be higher than men (p= 0.043). The prevalence of type-2 diabetes was slightly greater in women (12.5%) compared with 7.7% in men. In conclusion, the Community Service Program found high prevalence of obesity and hypertension in the population. Education on healthy life style program can help to improve knowledge of the target population.
... During enrollment, participants completed an assisted questionnaire, including questions related to basal metabolic rate (BMR), which was evaluated using the Harris-Benedict equation, habitual smoking (≥1 time/week and for ≥6 months), drinking (≥1 time/week and for ≥6 months), and physical activity (≥30 min/week and for ≥6 months). The questionnaire also included demographic characters and known BC risk factors, such as age, body mass index (BMI) [22], menopausal status, educational level, and family history of breast and/or ovarian cancer. ...
Although the incidence of invasive breast cancer (BC) among women in Asian is generally lower than that in Western countries, the incidence of BC has been on the rise in the past three decades in Asian countries. This hospital-based case-control study aimed to explore the relationship between dietary and metabolic factors and BC risk in pre- and post-menopausal women. We enrolled 285 patients with newly diagnosed BC at the National Taiwan University Hospital and 297 controls from the local community and hospital staff. Before receiving anticancer therapy, all patients with BC and control participants completed a 57-question semi-quantitative Food Frequency Questionnaire. For pre-menopausal women, plant-based factor scores rich in seeds and nuts, soy, fruits, and seaweeds correlated significantly with reduced BC risks, whereas menarche occurring at <12 years of age, reduced physical activity, and high-density lipoprotein <40 mg/dL were associated with increased BC risks. For post-menopausal women, plant-based dietary factor scores were also associated with reduced risks, whereas increased body mass index and energy intake levels correlated with increased BC risks. Diets rich in plant-based dietary patterns are protective against BC risk, regardless of menopausal status. Habitual physical activity is protective against BC risk among pre-menopausal Taiwanese women. Maintaining optimal weight and caloric intake is beneficial for reducing post-menopausal BC risk.
... However, compared to Caucasians, Chinese individuals have higher percentages of body fat, cardiovascular risk factors, and overall mortality rates at the same BMI level [18]. Therefore, considering that our study population consisted of Chinese individuals, we also defined overweight/obesity as BMI ≥ 24 kg/m2 [18,19]. According to WHO criteria, central obesity is defined as WC ≥ 80 cm for females or ≥ 90 cm for males [17]. ...
Background
This study investigated the relationship between fibroblast growth factor 21 (FGF-21) and newly diagnosed type-2 diabetes mellitus (T2DM).
Methods
In this cross-sectional study, FGF-21 and T2DM risk were analyzed using restricted cubic splines with univariate or multivariate logistic regression analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated via logistic regression analysis. Cluster and subgroup analyses were conducted to evaluate the associations between FGF-21 and diabetes in different subpopulations. Nomograms and ROC curves were used to explore the clinical utility of FGF-21 in the diabetes assessment model.
Results
High levels of FGF-21 were significantly associated with a high risk of T2DM after adjusting for confounding factors in both the total population and subpopulations (P for trend < 0.001). In the total population, the ORs of diabetes with increasing FGF-21 quartiles were 1.00 (reference), 1.24 (95% CI 0.56–2.80; quartile 2), 2.47 (95% CI 1.18–5.33; quartile 3), and 3.24 (95% CI 1.53–7.14; quartile 4) in Model 4 (P < 0.001), and the trend was consistent in different subpopulations. In addition, compared with the model constructed with conventional noninvasive indicators, the AUC of the model constructed by adding FGF-21 was increased from 0.668 (95% CI: 0.602–0.733) to 0.715 (95% CI: 0.654–0.777), indicating that FGF-21 could significantly improve the risk-assessment efficiency of type-2 diabetes.
Conclusion
This study demonstrated that a high level of circulating FGF-21 was positively correlated with diabetes, and levels of FGF-21 could be an important biomarker for the assessment of diabetes risk.
... He was classified as obese class II in accordance with the classification of body weight according to the World Health Organization. 13 In patients with obesity, absolute values of total blood and plasma volume appear to be increased. However, when body weight is taken into account, patients with obesity have a blood volume of only approximately 45 mL/kg compared with 70 mL/kg in patients with a normal weight. ...
Rosai-Dorfman disease (RDD) is a rare, benign, non-Langerhans cell histiocytic proliferative disease. RDD with central nervous system involvement is extremely rare. Surgical excision is generally regarded as the appropriate treatment of choice for this disease, especially when the lesion causes neurological compression. RDD can be accompanied by systemic symptoms, such as malaise, fever, weight change, leukocytosis, anemia, and hormonal disturbance, which may be challenging during general management. Little is known regarding peri-anesthesia management of this rare disease. We report a case of a patient in his 20s who had recurrent RDD and had general anesthesia with perioperative management. He was obese and hepatic insufficiency. This case report adds to the literature regarding the perioperative anesthetic management of RDD with central nervous system involvement.
... Each mother's weight was assessed using the same electronic scale, and height was evaluated using a portable stadiometer. The WHO method was utilized to categorize overweight and obesity in the enrolled women [40]. GWG was estimated by subtracting the recovered determined weight from the initial weeks of gestation by the recovered determined body weight immediately prior to childbirth. ...
Background and Objectives: The Mediterranean diet (MD) has been recognized as a beneficial nutritional pattern that promotes human health, decreasing the risks of a variety of human disorders and pathological states, including adverse pregnancy outcomes. In this aspect, the current survey aimed to assess the potential association of compliance with the MD during gestation with various sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Materials and Methods: This was a cross-sectional study performed on 5688 pregnant women from 10 distinctive Greek areas. Face-to-face interviews with qualified questionnaires and thorough retrievals of medical records were performed to collect data concerning the participants’ sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Results: Elevated compliance with the MD during pregnancy was independently related with older age, higher educational status, and better economic status as well as decreased incidences of pre-pregnancy overweight/obesity and excess gestational weight gain and a lower likelihood of gestational diabetes. Moreover, greater adherence to the MD was independently associated with an increased prevalence of delivering vaginally and a greater prevalence of exclusive breastfeeding for at least 16 weeks postpartum. Conclusions: A higher level of compliance with the MD for the period of gestation was associated with several favorable lifestyle factors that may promote maternal health. Further studies with a prospective design as well as studies exploring the potential effects of maternal compliance with the MD for the period of pregnancy on the health of children should be performed. Future studies should also be extended beyond the MD by assessing the potential beneficial effects of adopting a Mediterranean lifestyle on maternal and child health.
... Participants provided their weight and height, which were then used to calculate their body mass index (BMI). The BMI values were further categorized into specific weight categories based on the cutoffs recommended by the World Health Organization [17]. Additionally, participants reported their ideal body weight, which refers to the weight they desired to be. ...
This study examines the association between gender expression, weight status, and the risk of experiencing eating disorders among gender-diverse adults assigned male at birth living in Bangkok, Thailand. Participants completed self-administered questionnaires to provide demographic data and anthropometric measures, and an Eating Attitude Test-26 (EAT-26) to determine the risk of experiencing eating disorders. The associations between gender expression, weight status, and the risk of experiencing eating disorders were analyzed using multivariable logistic regression models. No significant differences were observed in weight-related variables based on gender expression. Participants self-described as feminine/androgynous had lower odds of experiencing a high risk of eating disorders compared to those self-described as masculine (odds ratio (OR) = 0.49; 95% confidence interval (95% CI) = 0.27, 0.88). A higher body mass index (BMI) (OR = 1.07; 95% CI = 1.01, 1.14) and BMI discrepancy (OR = 1.13; 95% CI = 1.03, 1.24) were associated with higher odds of engaging in extreme weight-control behaviors. The risk of experiencing eating disorders among Thai gender-diverse adults assigned male at birth could differ across gender expression and weight status. Further research is needed to expand the understanding of these relationships and develop tailored intervention programs to mitigate the risk.
Objective
This study aims to explore the association between metabolic syndrome (MetS) and left ventricular diastolic dysfunction (LVDD) and systolic dysfunction (LVSD), defined by impaired global longitudinal strain (GLS), and assess additive and multiplicative interactions among age, sex, obesity, and MetS regarding LVDD and LVSD.
Methods
We prospectively recruited 5503 participants from the China PEACE (Patient‐Centered Evaluative Assessment of Cardiac Events) Million Persons Project with complete echocardiography exam. Multivariable logistic models were used to calculate adjusted odds ratios to evaluate both additive and multiplicative interactions.
Results
The mean age was 56.59 years; 59.4% were women, 46.7% had MetS, 26.6% had left ventricular hypertrophy, 46.3% had LVDD, and 12.50% had impaired GLS. Compared to the non‐MetS, the odds ratio (OR) of LVDD and impaired GLS in MetS were 1.40 (1.20–1.64) and 1.26 (1.03–1.54), respectively. For LVDD, relative excess risk due to additive interaction (RERI) for women and MetS, elderly and MetS, obesity and MetS were 0.76 (0.02–1.50), 35.65 (17.51–53.79), and 2.14 (0.66–3.62), respectively, thus suggesting additive interactions. For impaired GLS, RERI for obesity and MetS was 3.37 (0.50–6.24), thus suggesting additive interactions.
Conclusions
The MetS is independently associated with LVDD and impaired GLS. From the public health implications, prevention of MetS in women, elderly, and obese individuals might result in a greater reduction of LVDD and LVSD risk in cardiovascular high‐risk population.
Although the number of patients reaching end-stage kidney disease without a biopsy- proven diagnosis is increasing, kidney biopsies play a key role in diagnosing kidney disease. We analyzed prospective data from patients with kidney disease who underwent percutaneous native kidney biopsies from January 2006 to December 2017. Demographic data, clinical presentations, and the laboratory and radiological findings at the time of biopsy were analyzed. Of 530 patients, 42.8% were male. The mean age was 33.9 (32.8–34.9.2) years; 66.3% were aged 25–64 years. Edema was the main clinical presentation (61.9%), with clinical urine changes seen in 66.7%. Most (89.6%) were nondiabetic; 46.8% had high blood pressure or were on antihypertensive therapy. Most patients (77.5%) were in Stages I, II, and III, and 12.3% underwent hemodialysis at the time of admission. Most (54.4%) were obese. Low hemoglobin (31.8%), high triglycerides (30%), high total cholesterol (58.2%), low serum albumin (73.9%), nephrotic proteinuria (61.8.6%), and microscopic hematuria (79.8%) were the main laboratory findings. The immunological investigations showed that antinuclear antibodies, positive anti-double-stranded DNA (anti–dsDNA), and extractable nuclear antigens were positive in 29.6%, 20.7%, and 19.7%, respectively. Perinuclear antineutrophil cytoplasmic antibodies (ANCA) were positive in 9.6% and cytoplasmic ANCA were positive in 5.4%, whereas immunoglobulin A was detected in 4.6%. More than one- third of the patients had reached advanced chronic kidney disease (CKD) Stages IIIB, IV, and V. This indicates the need to increase awareness about CKD, greater utilization of kidney biopsies, and earlier investigations to enable accurate diagnoses, and proper and timely management.
Introduction
Research on the prevalence of body mass index (BMI) categories across different living arrangements remains limited. We aimed to quantify the prevalence of BMI categories among those living alone (LA) and those not living alone (NLA).
Methods
In this population-based cross-sectional study, we used individual-level data from the 2011–2021 Behavioral Risk Factor Surveillance System. Main outcomes were prevalence of BMI categories in LA and NLA, adjusted for age, gender, and race/ethnicity, and socioeconomic status, using logistic regression and model-predicted marginal prevalence to estimate BMI categories prevalence.
Results
Between 2011 and 2021, we quantified BMI categories prevalence in 4,195,414 adults in the BRFSS, with 1,197,787 (28.5%) adults LA and 2,997,627 (71.5%) adults NLA. In comparison to NLA, LA consistently demonstrates lower adjusted obesity prevalence across genders and age groups, with the highest prevalence observed in the 45–64 age range, particularly within the 45–54 group (LA: 37.4%, 95% CI: 37.1–37.8%; NLA: 34.3%, 95% CI: 33.8–34.7%). Additionally, LA displays an overall lower adjusted prevalence of overweight compared to NLA, notably in the 18–34 and >64 age groups.
Conclusions
Heterogeneity in BMI categories prevalence exists between LA and NLA. Future studies and public health efforts should consider this heterogeneity.
Vitamin D inadequacy is a global problem in all age groups. Although there are various studies of vitamin D status in pregnant women in Southeast Asia, to date there are few studies from Southeast Asia examining vitamin D status in non-pregnant women of reproductive age. To examine the prevalence of vitamin D insufficiency (VDI) in healthy non-pregnant women of reproductive age in Southern Thailand, 120 healthy non-pregnant women aged 18–42 years were enrolled. Demographic and lifestyle data relevant to vitamin D assessment (sunlight exposure, nutritional intake, type of dress, sunscreen use) and biochemical studies (serum 25-hydroxyvitamin D or 25OHD, parathyroid hormone, calcium, phosphate) were obtained. VDI was classified as serum 25OHD < 20 ng/mL. The average serum 25OHD level was 23.1 ± 6.0 ng/mL. The overall prevalence of VDI was 34.1%. The average dietary intake of calcium, phosphorus and vitamin D and the average duration of sunlight exposure per week were not significantly different between the VDI women and the vitamin D sufficient (VDS) women. Logistic regression analysis found that the significant risk factors for VDI were greater body mass index and higher family income (p-values 0.01 and 0.02, respectively). The prevalence of VDI in non-pregnant women was high at 34%. As the dietary sources of vitamin D are limited and cutaneous vitamin D synthesis is limited by avoidance of sunlight exposure, vitamin D fortification in common daily foods would be an alternative option to reach the recommended vitamin D intake generally of at least 800 IU/day.
Obesity is a complex and multifactorial condition that poses significant health risks. Recent advancements in our understanding of obesity have highlighted the heterogeneity within this disorder. Identifying distinct subtypes of obesity is crucial for personalised treatment and intervention strategies. This review paper aims to examine studies that have utilised clinical biomarkers and genetic data to identify clusters or subtypes of obesity. The findings of these studies may provide valuable insights into the underlying mechanisms and potential targeted approaches for managing obesity‐related health issues such as type 2 diabetes.
Background
Height loss starting in middle age was previously shown to be associated with high cardiovascular mortality in later life. However, the factors associated with height loss remain unknown. Since low serum albumin levels are reported to be associated with high mortality caused by cardiovascular disease, they may also contribute to height loss.
Methods
To clarify the association between serum albumin and height loss, we conducted a retrospective study of 7637 Japanese workers who participated in general health check-ups from 2008 to 2019. Height loss was defined as the highest quartile of height loss per year.
Results
Individual with high serum concentration of albumin possess beneficial influence on preventing incidence of height loss. In both men and women, serum albumin level was significantly inversely associated with height loss. After adjustment for known cardiovascular risk factors, the adjusted odd ratio (OR) and 95% confidence interval (CI) for height loss per 1 standard deviation of albumin (0.2 g/dL for both men and women) were 0.92 (0.86, 0.98) in men and 0.86 (0.79, 0.95) in women. Even when the analysis was limited to participants without hypoalbuminemia, essentially same association was observed, with fully adjusted corresponding ORs (95%CI) of 0.92 (0.86, 0.98) in men and 0.86 (0.78, 0.94) in women.
Conclusion
Independent of known cardiovascular risk factors, higher serum albumin levels may prevent height loss among Japanese workers. While several different diseases cause hypoalbuminemia, they may not be the main reasons for the association between serum albumin and height loss. Though further research is necessary, this finding may help clarify the mechanisms underlying the association between height loss and higher mortality in later life.
Background
This study aimed to examine the associations between osteoporosis and hand grip strength (HGS), a surrogate marker of muscular strength, among Korean adults stratified by body mass index (BMI), age, and renal function.
Methods
This study was conducted using the data obtained from the Korea National Health and Nutrition Examination Survey 2015–2019, a cross-sectional and nationally representative survey performed by the Korea Centers for Diseases Control and Prevention.
Results
Of the 26,855 subjects included in this study, those with low muscle strength (LMS) and normal muscle strength were showed in 4,135 (15.4%) and 22,720 (84.6%) subjects, respectively. The osteoporotic subjects had a higher prevalence rate for LMS than those without osteoporosis after adjusting for age [odds ratio (OR), 1.684; 95% confidence interval (CI), 1.500–1.890). The subjects with osteoporosis and BMI < 18.5 kg/m² also had a higher prevalence rate for LMS after adjusting for age compared to those with non-osteoporosis and BMI < 18.5 kg/m² (OR, 1.872; 95% CI, 1.043–3.359). Compared to the non-osteoporotic subjects with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m², those with osteoporosis and eGFR ≥ 60 mL/min/1.73 m² had a higher prevalence rate for LMS after controlling for age and sex (OR, 1.630; 95% CI, 1.427–1.862).
Conclusions
The results showed that osteoporosis was likely to contribute to an increased prevalence rate of LMS in terms of HGS. Aging, BMI, and renal function also had significant effects on the association between osteoporosis and LMS. This association is likely to assist in developing better strategies to estimate bone health in clinical or public health practice.
Background
Metabolic dysfunction-associated fatty liver disease (MAFLD) is a common liver disease, the risk of which can be increased by poor diet. The objective of this study was to evaluate the associations between food items and MAFLD, and to propose reasonable dietary recommendations for the prevention of MAFLD.
Methods
Physical examination data were collected from April 2015 through August 2017 at Nanping First Hospital (n = 3,563). Dietary intakes were assessed using a semi-quantitative food frequency questionnaire. The association between food intake and the risk of MAFLD was assessed by using the inverse probability weighted propensity score.
Results
Beverages (soft drinks and sugar-sweetened beverages) and instant noodles were positively associated with MAFLD risk, adjusting for smoking, drinking, tea intake, and weekly hours of physical activity [adjusted odds ratio (ORadjusted): 1.568; P = 0.044; ORadjusted: 4.363; P = 0.001]. Milk, tubers, and vegetables were negatively associated with MAFLD risk (ORadjusted: 0.912; P = 0.002; ORadjusted: 0.633; P = 0.007; ORadjusted: 0.962; P = 0.028). In subgroup analysis, the results showed that women [odds ratio (OR): 0.341, 95% confidence interval (CI): 0.172–0.676] had a significantly lower risk of MAFLD through consuming more tubers than men (OR: 0.732, 95% CI: 0.564–0.951).
Conclusions
These findings suggest that reducing consumption of beverages (soft drinks and sugar-sweetened beverages) and instant noodles, and consuming more milk, vegetables, and tubers may reduce the risk of MAFLD.
Objective
To investigate the association between female body mass index (BMI) and live birth rates and maternal and perinatal outcomes after in-vitro fertilization (IVF).
Methods
We performed a national, population-based cohort study including women undergoing IVF between 2002 and 2020. The cohort included 126,620 fresh cycles and subsequent frozen embryo transfers between 2007 and 2019 (subpopulation 1) and 58,187 singleton deliveries between 2002 and 2020 (subpopulation 2). Exposure was female BMI (kg/m ² ) categorized according to the World Health Organization as underweight (<18.5), normal weight (18.5–24.9, reference), overweight (25.0–29.9), class I obesity (30.0–34.9), class II obesity (35.0–39.9), and class III obesity (≥40.0). The primary outcome in subpopulation 1 was cumulative live birth per started fresh IVF cycle, including fresh and subsequent frozen embryo transfers. Primary outcomes in subpopulation 2 were hypertensive disorders of pregnancy and preterm birth at less than 37 weeks. Risk ratios (RRs) with 95% confidence intervals (CIs) for the association between BMI class and outcomes were calculated using generalized linear models after adjustment for relevant confounders.
Results
The cumulative live birth rate decreased significantly with increasing BMI from 32.6% in normal-weight women to 29.4% in overweight women, 27.0% in women in obesity class I, 21.8% in women in obesity class II, and 7.6% in women in obesity class III. The risk of hypertensive disorders of pregnancy increased significantly and progressively with increasing BMI, from 4.6% in normal-weight women to 7.8% in overweight women and 12.5%, 17.9%, and 20.3% in women in obesity classes I, II, and III. The risk of preterm birth followed a similar pattern, from 6.3% in normal-weight women to 7.5% in overweight women and 8.9%, 9.9%, and 15.3% in women in obesity classes I, II, and III. The risks of other perinatal complications, such as perinatal death, showed an even more pronounced increase.
Conclusion
Using a large and complete national cohort of women undergoing IVF, we demonstrate a dose-dependent decrease in live birth rate and a substantial increase in maternal and perinatal complications with increasing BMI. Strategies to improve this situation are warranted.
Abstract Background Obesity is an independent risk factor for cardiovascular disease and affects the human population. This study aimed to evaluate left ventricular (LV) dysfunction in obese patients with three-dimensional speckle-tracking echocardiography (3D-STE) and investigate the possible related mechanisms at the exosomal miRNA level. Methods In total, 43 participants (16 obese patients and 27 healthy volunteers) were enrolled. All subjects underwent full conventional echocardiography as well as 3D-STE. Characterization and high-throughput sequencing for the isolated circulating exosomes and the differentially expressed miRNAs (DEMs) were screened for target gene prediction and enrichment analysis. Results Obese patients had significantly lower global longitudinal strain (GLS) (-20.80%±3.10% vs. -14.77%±2.05%, P
Food parenting practices, especially Autonomy support practices and Structure practices, have not been comprehensively studied among parents of children born with low birth weight in Asia. The aim of this study was to investigate food parenting practices among parents of preschoolers who were born with low (<2500 g) and normal birth weight (>2500 g) in Singapore. We recruited 197 parents of pre-school children (aged 3-5 years) who completed a socio-demographic questionnaire and the HomeSTEAD questionnaire, which examined food parenting practices. Among parents, 98 (49.8%) and 99 (50.2%) had children who were normal (NBW) and low birth weight (LBW) respectively. Parents of children with LBW had lower scores in one Autonomy support practice (Encouragement) and three Structure practices (Meal setting, Planning and preparation of healthy meals, Rules and limits around unhealthy foods), after controlling for ethnicity and education. Parents of children with LBW also scored higher in one Autonomy support practice (Guided choices: when food is given). There were no significant differences in Coercive control practices between parents of both groups. Healthcare professionals could use this information to assess parental needs when facilitating parents' positive food parenting practices, especially among children with low birth weight.
Background:
Wide brachial pulse pressure (PP) has been associated with cardiovascular events, while its population distribution and association with body composition were poorly characterized in large populations.
Methods:
We evaluated the age and sex distributions of PP and its associations with body composition using baseline data from the China Kadoorie Biobank. A total of 434 200 participants without diagnosed hypertension were included in the analysis. Wide PP was defined as PP above 65 mmHg. Body composition variables, including BMI, waist circumference, waist-to-hip ratio (WHR), fat mass index (FMI), fat-free mass index (FFMI), and body fat percentage (BF%), were obtained from bioelectrical impedance analysis.
Results:
Overall, 14.3% of the participants had wide PP. Older age was consistently associated with wider PP in women but only after the andropause stage in men. The independent associations of BMI with wide PP were stronger than other body composition measures. The adjusted differences (men/women, mmHg) in PP per standard deviation (SD) increase in BMI (1.55/1.47) were higher than other body composition (BF%: 0.32/0.64, waist circumference: 0.33/0.39; WHR: 0.49/0.42). In addition, sex differences were observed. In men, the per SD difference in PP was higher for FFMI than for FMI (0.91 vs. 0.67, P < 0.05), whereas in women, it was higher for FMI than for FFMI (1.01 vs. 0.72, P < 0.05).
Conclusion:
Our nationwide population-based study presented the sex-specific distribution of PP over age and identified differential associations of PP with fat and fat-free mass in men and women.
Background:
"Obesity paradox" occurs in type 2 diabetes mellitus (T2DM) patients when body mass index (BMI) is applied to define obesity. We examined the association of visceral fat area (VFA) as an obesity measurement with arterial stiffness in seven ideal cardiovascular health metrics (ICVHMs).
Methods:
A total of 29 048 patients were included in the analysis from June 2017 to April 2021 in 10 sites of National Metabolic Management Centers. ICVHMs were modified from the recommendations of the American Heart Association. Brachial-ankle pulse wave velocity (BaPWV) ≥ 1400 cm/s was employed to evaluate increased arterial stiffness. Multivariate regression models were used to compare the different effects of BMI and VFA on arterial stiffness.
Results:
Lower VFA was more strongly associated with low BaPWV than lower BMI when other ICVHMs were included (adjusted odds ratio [OR], 0.85 [95% confidence interval [CI], 0.80-0.90] vs OR 1.08 [95% CI, 1.00-1.17]). Multivariable-adjusted ORs for arterial stiffness were highest in patients with the VAT area VFA in the range of 150-200 cm2 (adjusted OR, 1.26 [95% CI 1.12-1.41]). Compared with participants with VAT VFA < 100 cm2 , among participants with higher VAT VFA, the OR for arterial stiffness decreased gradually from 1.89 (95% CI, 1.73-2.07) in patients who had ≤1 ICVHM to 0.39 (95% CI, 0.25-0.62) in patients who had ≥5 ICVHMs.
Conclusion:
In patients with T2DM, using VAT for anthropometric measures of obesity, VFA was more relevant to cardiovascular risk than BMI in the seven ICVHMs. For anthropometric measures of obesity in the ICVHMs to describe cardiovascular risk VFA would be more optimal than BMI.
Introduction
Menopausal hormone therapy (MHT) is used to alleviate the symptoms associated with menopause, despite the lack of recommendations for MHT in preventing dementia. Recent nationwide studies have explored the association between MHT and dementia risk, but the findings remain limited. This study aims to investigate the association between MHT and the incidence of Alzheimer’s disease (AD) and non-AD dementia using national population data from Korea.
Methods
We conducted a retrospective study using data from the National Health Insurance Service in Korea between January 1, 2002, and December 31, 2019. Women over 40 years were eligible for this study and classified into the MHT or non-MHT groups. The MHT group consisted of women who used Tibolone (TIB), combined estrogen plus progestin by the manufacturer (CEPM), estrogen, combined estrogen plus progestin by a physician (CEPP), and transdermal estrogen during menopause. We compared the risk of dementia between the MHT and non-MHT groups.
Results
The study included 1,399,256 patients, of whom 387,477 were in the MHT group, and 1,011,779 were in the non-MHT group. The median duration of MHT was 23 months (range: 10–55 months). After adjusting for available confounders, we found that different types of MHT had varying effects on the occurrence of dementia. TIB (HR 1.041, 95% confidence interval (CI) 1.01–1.072) and oral estrogen alone (HR 1.081, 95% CI 1.03–1.134) were associated with a higher risk of AD dementia. In contrast, there was no difference in the risk of AD dementia by CEPM (HR 0.975, 95% CI 0.93–1.019), CEPP (HR 1.131, 95% CI 0.997–1.283), and transdermal estrogen (HR 0.989, 95% CI 0.757–1.292) use. The use of TIB, CEPM, and oral estrogen alone increased the risk of non-AD dementia (HR 1.335, 95% CI 1.303–1.368; HR 1.25, 95% CI 1.21–1.292; and HR 1.128, 95% CI 1.079–1.179; respectively), but there was no risk of non-AD dementia in the other MHT groups (CEPP and topical estrogen).
Conclusion
Our findings indicate that MHT has varying effects on the incidence of AD and non-AD dementia. Specifically, TIB, CEPM, and oral estrogen alone increase the risk of non-AD dementia, while transdermal estrogen is not associated with dementia risk. It is essential to consider the type of MHT used when assessing the risk of dementia in women.
Background
Guideline recommendations for preoperative chest radiographs vary to the extent that individual patient benefit is unclear. We developed and validated a prediction score for abnormal preoperative chest radiographs in adult patients undergoing elective non-cardiothoracic surgery.Methods
Our prospective observational study recruited 703 adult patients who underwent elective non-cardiothoracic surgery at Ramathibodi Hospital. We developed a risk prediction score for abnormal preoperative chest radiographs with external validation using data from 411 patients recruited from Thammasat University Hospital. The discriminative performance was assessed by receiver operating curve analysis. In addition, we assessed the contribution of abnormal chest radiographs to perioperative management.ResultsAbnormal preoperative chest radiographs were found in 19.5% of the 703 patients. Age, pulmonary disease, cardiac disease, and diabetes were significant factors. The model showed good performance with a C-statistics of 0.739 (95% CI, 0.691–0.786). We classified patients into four groups based on risk scores. The posttest probabilities in the intermediate-, intermediate-high-, and high-risk groups were 33.2%, 59.8%, and 75.7%, respectively. The model fitted well with the external validation data with a C statistic of 0.731 (95% CI, 0.674–0.789). One (0.4%) abnormal chest radiograph from the low-risk group and three (2.4%) abnormal chest radiographs from the intermediate-to-high-risk group had a major impact on perioperative management.Conclusions
Four predictors including age, pulmonary disease, cardiac disease, and diabetes were associated with abnormal preoperative chest radiographs. Our risk score demonstrated good performance and may help identify patients at higher risk of chest abnormalities.
Background:
A clear understanding of the anthropometric and sociodemographic risk factors related to BMI and hypertension categories is essential for more effective disease prevention, particularly in India. There is a paucity of nationally representative data on the dynamics of these risk factors, which have not been assessed among healthy reproductive-age Indian women.
Objective:
This cross-sectional polycystic ovary syndrome (PCOS) task force study aimed to assess the anthropometric and sociodemographic characteristics of healthy reproductive-age Indian women and explore the association of these characteristics with various noncommunicable diseases.
Methods:
We conducted a nationwide cross-sectional survey from 2018 to 2022 as part of the Indian Council of Medical Research-PCOS National Task Force study, with the primary aim of estimating the national prevalence of PCOS and regional phenotypic variations among women with PCOS. A multistage random sampling technique was adopted, and 7107 healthy women (aged 18-40 years) from 6 representative geographical zones of India were included in the study. The anthropometric indices and sociodemographic characteristics of these women were analyzed. Statistical analysis was performed to assess the association between exposure and outcome variables.
Results:
Of the 7107 study participants, 3585 (50.44%) were from rural areas and 3522 (49.56%) were from urban areas. The prevalence of obesity increased from 8.1% using World Health Organization criteria to 40% using the revised consensus guidelines for Asian Indian populations. Women from urban areas showed higher proportions of overweight (524/1908, 27.46%), obesity (775/1908, 40.62%), and prehypertension (1008/1908, 52.83%) categories. A rising trend of obesity was observed with an increase in age. Women aged 18 to 23 years were healthy (314/724, 43.4%) and overweight (140/724, 19.3%) compared with women aged 36 to 40 years with obesity (448/911, 49.2%) and overweight (216/911, 23.7%). The proportion of obesity was high among South Indian women, with 49.53% (531/1072) and 66.14% (709/1072), using both World Health Organization criteria and the revised Indian guidelines for BMI, respectively. BMI with waist circumference and waist-to-height ratio had a statistically significant linear relationship (r=0.417; P<.001 and r=0.422; P<.001, respectively). However, the magnitude, or strength, of the association was relatively weak (0.3<|r|<0.5). Statistical analysis showed that the strongest predictors of being overweight or obese were older age, level of education, wealth quintile, and area of residence.
Conclusions:
Anthropometric and sociodemographic characteristics are useful predictors of overweight- and obesity-related syndromes, including prehypertension, among healthy Indian women. Increased attention to the health of Indian women from public health experts and policy makers is warranted. The findings of this study can be leveraged to offer valuable insights, informing health decision-making and targeted interventions that mitigate risk factors of overweight, obesity, and hypertension.
International registered report identifier (irrid):
RR2-10.2196/23437.
Aim:
To assess the effects of canagliflozin on clinical outcomes and intermediate markers across population-specific body mass index (BMI) categories in the CANVAS Program and CREDENCE trial.
Methods:
Individual participant data were pooled and analysed in subgroups according to population-specific BMI. The main outcomes of interest were: major adverse cardiovascular events (MACE, a composite of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death); composite renal outcome; and changes in systolic blood pressure (SBP), body weight, albuminuria and estimated glomerular filtration rate (eGFR) slope. Cox proportional hazards models and mixed-effect models were used.
Results:
A total of 14 520 participants were included, of whom 9378 (65%) had obesity. Overall, canagliflozin reduced the risk of MACE (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.75 to 0.93) with no heterogeneity of treatment effect across BMI subgroups (Pheterogeneity = 0.76). Similarly, canagliflozin reduced composite renal outcomes (HR 0.75, 95% CI 0.66 to 0.84) with no heterogeneity across subgroups observed (Pheterogeneity = 0.72). The effects of canagliflozin on body weight and SBP differed across BMI subgroups (Pheterogeneity <0.01 and 0.04, respectively) but were consistent for albuminuria (Pheterogeneity = 0.60). Chronic eGFR slope with canagliflozin treatment was consistent across subgroups (Pheterogeneity >0.95).
Conclusions:
The cardiovascular and renal benefits of canagliflozin and its safety profile were consistent across population-specific BMI subgroups for adults in the CANVAS Program and CREDENCE trial.
Objective
To assess how inaccurately the body mass index (BMI) is used to diagnose obesity compared to body fat percentage (BF%) measurement and to compare the cardiometabolic risk in children and adolescents with or without obesity according to BMI but with a similar BF%.
Methods
A retrospective cross-sectional investigation was conducted including 553 (378 females/175 males) white children and adolescents aged 6–17 years, 197 with normal weight (NW), 144 with overweight (OW) and 212 with obesity (OB) according to BMI. In addition to BMI, BF% measured by air displacement plethysmography, as well as markers of cardiometabolic risk had been determined in the existing cohort.
Results
We found that 7% of subjects considered as NW and 62% of children and adolescents classified as OW according to BMI presented a BF% within the obesity range. Children and adolescents without obesity by the BMI criterion but with obesity by BF% exhibited higher blood pressure and C-reactive protein (CRP) in boys, and higher blood pressure, glucose, uric acid, CRP and white blood cells count, as well as reduced HDL-cholesterol, in girls, similar to those with obesity by BMI and BF%. Importantly, both groups of subjects with obesity by BF% showed a similarly altered glucose homeostasis after an OGTT as compared to their NW counterparts.
Conclusions
Results from the present study suggest increased cardiometabolic risk factors in children and adolescents without obesity according to BMI but with obesity based on BF%. Being aware of the difficulty in determining body composition in everyday clinical practice, our data show that its inclusion could yield clinically useful information both for the diagnosis and treatment of overweight and obesity.
Background and objectives: Reduction of weight improves different manifestations of polycystic ovary syndrome (PCOS). This study compared the effects of liraglutide plus metformin versus metformin alone on weight loss and metabolic profiles in obese women with PCOS.
Methods: This open-label randomized controlled clinical trial consecutively recruited newly-diagnosed PCOS patients of reproductive age with obesity (body mass index ≥ 27.5 kg/m2). Following randomization into two equal groups, Group-1 received treatment with metformin 1000 mg daily alone while Group-2 was given metformin 1000 mg plus subcutaneous (SC) liraglutide 1.2 mg daily for 12 weeks. Anthropometric, biochemical and hormonal data and ovarian morphology were assessed at baseline and after 12 weeks. Clinical information and side effects were recorded every four weeks after initiation of the treatment. Glucose, lipids, and all hormones were analyzed by glucose oxidase, precipitation method, and chemiluminescent microparticle immunoassay respectively. Insulin resistance was measured by homeostatic model assessment (HOMA-IR).
Results: Study included 30 participants comprising 15 for each group. Among 15 participants, 5 dropped out from the Group-1 and 1 dropped out from the Group-2. The final analysis was done among 24 participants (Gr-1: 10 and Gr-2: 14). Waist and hip circumference (WC, HC) significantly (p
Objective:
Polycystic ovary syndrome (PCOS) is a complex disorder with diverse metabolic implications. Diagnosis typically relies on oligo-amenorrhoea (OA), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). However, the role of polymenorrhoea in PCOS remains understudied. Additionally, limited information exists regarding metabolic disturbances in women with partial PCOS phenotypes that do not meet diagnostic criteria. This extensive database aims to provide substantial evidence on the metabolic implications of polymenorrhoea and partial PCOS phenotypes.
Design:
Prospective observational study.
Patients and measurements:
In this single-centre study, 6463 women with PCOS-like characteristics and 3142 age-matched healthy women were included. The study compared clinical (anthropometry, modified Ferriman Gallwey [mFG] score), hormonal (serum testosterone), and metabolic (plasma glucose, serum lipids, insulin) characteristics between women diagnosed with PCOS, those with partial PCOS phenotypes, and the healthy control group RESULTS: In all, 5174 women met Rotterdam criteria for PCOS diagnosis, while 737 were classified as Pre-PCOS, including HA (n = 538), OA (n = 121), or PCOM (n = 78). Common clinical features included oligomenorrhoea (75.5%), hirsutism (82.9%), obesity (27.2%), hypertension (1.6%), metabolic syndrome (19.6%), and diabetes mellitus (5.6%). Women diagnosed with PCOS, HA only, and OA only exhibited higher average body mass index, plasma glucose levels (both fasting and 2 h after the oral glucose tolerance test), and lipid fractions in comparison to those with PCOM and the healthy controls. However, indices of insulin resistance were similar among women with PCOS, HA, PCOM, and OA, albeit higher than in the healthy controls. The polymenorrhoea subgroup (5.9%) had lower BMI and serum testosterone, but similar mFG score, plasma glucose, insulin, and lipid levels as the oligomenorrhoea subgroup.
Conclusion:
The metabolic disturbances observed in Pre-PCOS women highlight the need to reassess diagnostic criteria. Including the polymenorrhoea subcategory in PCOS criteria is recommended due to similar metabolic dysfunctions as the oligomenorrhoea group.
Background:
Diabetes is more prevalent among overweight/obese individuals, but has become a significant public health challenge among normal weight populations. In this meta-analysis, we aimed to estimate diabetes/prediabetes incidence and its temporal trends by weight status.
Methods:
PubMed, Embase, Web of Science, and Cochrane Library were searched until 8 December 2021. Prospective cohort studies reporting diabetes incidence by baseline body mass index (BMI) categories in adults were included. The median year of data collection was used to assess the temporal trends. Subgroup analyses and meta-regression were also performed.
Results:
We included 94 studies involving 3.4 million adults from 22 countries. The pooled diabetes incidence in underweight, normal-weight, and overweight/obese adults was 4.5 (95% confidence interval (CI) = 2.8-7.3), 2.7 (95% CI = 2.2-3.3), and 10.5 (95% CI = 9.3-11.8) per 1000 person-years, respectively. The diabetes incidence in low- and middle-income countries (LMICs) was higher than in high-income countries among normal-weight (5.8 vs 2.0 per 1000 person-years) or overweight/obese (15.9 vs 8.9 per 1000 person-years) adults. European and American regions had a higher diabetes incidence than the non-Western areas, regardless of weight status. Underweight diabetes incidence decreased significantly from 1995-2000 to 2005-2010. Diabetes incidence in normal-weight populations has increased continuously since 1985 by an estimated 36% every five years. In overweight/obese adults, diabetes incidence increased between 1985-1990 and 1995-2000, stabilised between 2000 and 2010, and spiked suddenly after 2010.
Conclusions:
Diabetes incidence and its temporal trends differed by weight status. The continuous upward trend of diabetes incidence among overweight/obese individuals requires urgent attention, particularly in LMICs. Furthermore, diabetes among normal-weight individuals is becoming a significant public health problem.
Registration:
PROSPERO (CRD42020215957).
Background:
To investigate whether recovery from or development of metabolic syndrome (MetS) in a population is associated with an altered risk for ocular motor cranial nerve palsy (CNP).
Methods:
This cohort study included 4,233,273 adults without a history of ocular motor cranial nerve palsy (ocular motor CNP) who underwent 2 consecutive biennial health screenings provided by the Korean National Health Insurance System between 2009 and 2011. They were followed up until December 31, 2018. Participants were categorized into a MetS-free, MetS-developed, MetS-recovered, or MetS-chronic group. A multivariable Cox proportional hazard regression model was used. Model 3 was adjusted for age, sex, smoking status, alcohol consumption, and physical activity.
Results:
Compared with the MetS-free group, the MetS-chronic group had the highest risk of ocular motor CNP (hazard ratio [HR]: 1.424; 95% confidential interval [CI]: 1.294-1.567, Model 3), followed by the MetS-developed group (HR: 1.198, 95% CI: 1.069-1.343), and the MetS-recovered group (HR: 1.168, 95% CI: 1.026-1.311) after adjusting for potential confounders. The hazard ratio of ocular motor CNP in men with chronic MetS was 1.566 (95% CI, 1.394-1.761) while that of women with chronic MetS was 1.191 (95% CI, 1.005-1.411). Among age groups, those in their 30s and 40s showed the highest association between dynamic MetS status and ocular motor CNP.
Conclusions:
In our study, recovering from MetS was associated with a reduced risk of ocular motor CNP compared with chronic MetS, suggesting that ocular motor CNP risk could be managed by changing MetS status.
Abstract Background Low birth weight is a key indicator for child health, especially a concern in low-middle-income countries. However, health and medically-related reforms are being actively implemented in some middle-income countries like India. Identifying low birth weight (LBW) babies with their determinants across the whole country is essential to formulate regional and area-specific interventions. The objective of this study was to find out the burden and determinants of LBW on the regional and residential (rural–urban) divisions of India. Methods The present study was based on the NFHS-5 dataset (2019–21), a nationally representative survey in India. A total of 209,223 births were included in this study. A newborn weighing less than 2500 g was considered as LBW. According to the objectives, we used frequency distribution, chi-square test and binary logistic regression analysis for analysing the data. Results About 18.24% of the babies were LBW in India, significantly higher in rural areas than in urban areas (18.58% vs 17.36%). Regionally prevalence was more frequent in western (20.63%) and central (20.16%) rural areas. Regarding maternal concerns, in the eastern and southern regions of India, mothers aged 25–34 were less likely to have LBW children than mothers aged 35–49 years. It was found that the risk of LBW was more likely among the children born out of unintended pregnancies in almost all regions except for eastern part. In rural India, women who delivered children at home were more likely to have LBW children in India (AOR = 1.19, CI: 1.12–1.28, p
The relationship between high body mass index (BMI) >25 kg/m2 and risk for stillbirth in the Japanese population remains unclear. This study aimed to estimate the impact of maternal obesity on the risk of stillbirth in a Japanese population. This prospective cohort study used data from the Japan Environment and Children's Study, which recruited pregnant individuals between 2011 and 2014. A total of 93,772 fetuses were considered eligible for inclusion in this study. Stillbirth (fetal death before or during labor at ≥22 completed weeks of gestation) rates were compared among four pre-pregnancy BMI groups: underweight (<18.5 kg/m2), reference (18.5 to <25.0 kg/m2), overweight (25.0 to <30.0 kg/m2), and obese (≥30.0 kg/m2). The association between pre-pregnancy BMI and the risk of stillbirth was estimated using multiple logistic regression analyses. The overall stillbirth incidence was 0.33% (305/93,722). Compared with the reference group, the risk of stillbirth was significantly higher in the overweight group (adjusted odds ratio [aOR]: 1.55; 95% confidence interval [CI]: 1.08-2.23) and the obese group (aOR: 2.60; 95% CI: 1.59-4.24). The overall incidence of early stillbirth (i.e., <28 weeks) was 0.17% (155/93,722). Similarly, after adjusting for potential confounding factors, the risk of early stillbirth was significantly higher in the obese group (aOR: 4.33; 95% CI: 2.44-7.70). Increased maternal BMI was associated with an increased risk of stillbirth in the Japanese population. Therefore, counselling women planning for pregnancy on the importance of an appropriate pre-pregnancy BMI to minimize the risk of stillbirth is important.
Background:
The body mass index (BMI) ≥30 kg/m2 is the universally accepted cut-off point for defining obesity; however, its accuracy in classifying obesity in older adults is poorly understood.
Objectives:
To assess the performance of the BMI cut-off point ≥30 kg/m2 in classifying obesity in older adults, using the fat mass index (FMI) and fat mass percentage (FM%) as reference criteria; and to establish region- and sex-specific BMI-based cut-off points to classify obesity in older adults.
Methods:
The present study is a secondary analysis derived from a cross-sectional project that included a sample of 1463 older adults from ten Latin American and Caribbean countries. Volunteers underwent total body water measurements using the deuterium dilution technique to determine FMI and FM%. Accuracy of the BMI and derived cutoff points was assessed by the area under the receiver operating characteristic curve (AUC).
Results:
The BMI cut-off point ≥30 kg/m2 had low sensitivity for classifying obesity in these older adults compared to the FMI and FM%. The AUC values for the optimal BMI-derived cut-off points showed an acceptable-to-outstanding discriminatory capacity in diagnosing obesity defined by the FMI. There was also a better balance between sensitivity and specificity than with the values obtained by a BMI ≥30 kg/m2 in older subjects in both regions.
Conclusion:
The BMI cut-off point ≥30 kg/m2 had poor sensitivity for accurately diagnosing obesity in older adults from two regions. The region- and sex-specific BMI-derived cut-off points for defining obesity using the FMI are more accurate in classifying obesity in older men and women subjects from both regions.
Background:
The Global Leadership Initiative on Malnutrition (GLIM), comprising several of the major global clinical nutrition societies, suggested the world's first criteria for diagnosis of the severity of malnutrition. However, the impact of the resulting diagnosis on patient outcomes for those with hepatocellular carcinoma (HCC) following liver resection (LR) has not been investigated.
Methods:
A retrospective analysis of 293 patients with HCC who underwent LR between January 2011 and December 2018 was performed. We compared overall survival (OS) and recurrence-free survival (RFS) and evaluated prognostic factors after LR using Cox proportional hazards regression models.
Results:
Preoperative patient nutritional status, n (%), was classified as follows: normal, 130 (44%), moderate malnutrition, 116 (40%), and severe malnutrition, 47 (16%). The median OS (129 vs. 43 months, p < 0.001) and median RFS (54 vs. 20 months, p = 0.001) were significantly greater in the normal group than in the severe malnutrition group. Multivariate analysis showed that severe malnutrition was a significant risk factor for OS (p = 0.006) and RFS (p = 0.010) after initial LR.
Conclusion:
Severe malnutrition, as diagnosed by the GLIM criteria, is a significant prognostic factor for survival and recurrence in patients with HCC after LR.
Background:
Despite much evidence showing the effectiveness of structured self-management education for diabetes, poor glycemic control remains a challenge among empty nest older adults.
Objective:
We explored the effect of a health education intervention based on the PRECEDE-PROCEED model on the self-management of empty nest older adults with type 2 diabetes in Lanzhou, China.
Methods:
We conducted a 2-armed, randomized controlled trial using a multistage sampling method. A total of 100 patients were randomly assigned to receive either community nurse-led diabetes education based on the PRECEDE-PROCEED model or general community diabetes education. Self-management scores and blood glucose were compared at baseline and at 3 and 6 months after the intervention.
Results:
Analyses were conducted on the 98 patients completing follow-up. In the experimental group, diabetes self-management knowledge (t = 7.578, P < .001), self-management attitude (t = 9.155, P < .001), self-management behavior (t = 7.809, P < .001), and overall self-management scores (t = 7.626, P < .001) improved, with hemoglobin A1c (t = -2.825, P = .006), fasting plasma glucose (t = -3.100, P = .003), 2-hour postprandial blood glucose (t = -3.812, P < .001), and diastolic blood pressure (t = -2.104, P = .038) decreasing compared with the control group at 6 months postintervention.
Conclusions:
This study demonstrated that education based on the PRECEDE-PROCEED model was more effective than general health education in improving diabetes self-management and glycemic control among empty nest older adults.
Introduction
Long COVID is commonly encountered by many individuals during the coronavirus 2019 pandemic. It is best diagnosed by a history consistent with acute coronavirus disease 2019 (COVID-19) followed by a prolonged recovery. An attempt has been made to enlist the sequel of long COVID clinically and to assess their risk factors.
Materials and Methods
Confirmed COVID-19 patients admitted to our hospital were enquired about their persistent symptoms following infection after 3– 12 weeks for acute symptoms and after 12 weeks for chronic symptoms through the predesigned questionnaire schedule about their manifestations and followed up every month for 6 months.
Results
A total of 152 patients were included in our study and found acute long COVID symptoms related to neurological (72.2%), respiratory (64.7%), and musculoskeletal (61.4%) system being most commonly affected. Chronic symptoms were comprised predominantly musculoskeletal (63.1%) followed by fatigue (43.4%) and neurological (29.6) manifestations. Risk factors estimate of postacute COVID-19 symptoms showed that females had increased risk with odds ratio (OR) (and 95% confidence intervals) (OR) of 2.412 (1.239–4.692), sedentary lifestyle OR 1.775 (1.345–2.762), body mass index (BMI) >23 OR 3.877 (1.613–6.144), and presence of comorbidities OR 2.526 (1.277–4.997). Similarly, risk factor estimate of Postchronic COVID-19 symptoms showed that females had increased risk with OR 1.879 (0.952–3.709), sedentary lifestyle OR 5.091 (2.853–9.085), BMI >23 OR 2.082 (1.005–4.134), and presence of comorbidities OR 1.851 (0.925–3.705).
Conclusions
Long COVID symptoms noted were mainly related to musculoskeletal disorders, neurological, respiratory, and fatigue. This enumeration will help us to bring the further pathway to include this long COVID entity for preventive strategies in our regular setup at the primary care level.
Introduction
A body shape index (ABSI) is independently associated with mortality in general population, but studies on the predictability of ABSI in the risk of mortality in patients with type 2 diabetes (T2D) are limited. We aimed to examine the independent and joint association of ABSI, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body roundness index (BRI) with mortality in patients with T2D.
Research design and methods
The study included 11 872 patients (46.5% women) aged 30 years and older and who took part in diabetes care management program of a medical center in Taiwan. Body indices were evaluated by anthropometric measurements at baseline between 2001 and 2016, and their death status was followed up through 2021. Multivariate Cox regression models were used to assess the effect of body indices on mortality.
Results
During a mean follow-up of 10.2 years, 560 cardiovascular disease (CVD) deaths and 3043 deaths were recorded. For ABSI, WC, WHR, WHtR and BRI, all-cause mortality rates were statistically significantly greater in Q4 versus Q2. For BMI and WHtR, all-cause mortality rates were also statistically significantly greater in Q1 versus Q2. The combination of BMI and ABSI exhibited a superiority in identifying risks of all-cause mortality and CVD mortality (HRs: 1.45 and 1.37, both p<0.01).
Conclusions
Combined use of ABSI and BMI can contribute to the significant explanation of the variation in death risk in comparison with the independent use of BMI or other indices.
Aims The SCORE project was initiated to develop a risk scoring system for use in the clinical management of cardiovascular risk in European clinical practice.
Methods and results The project assembled a pool of datasets from 12 European cohort studies, mainly carried out in general population settings. There were 205 178 persons (88 080 women and 117 098 men) representing 2.7 million person years of follow-up. There were 7934 cardiovascular deaths, of which 5652 were deaths from coronary heart disease. Ten-year risk of fatal cardiovascular disease was calculated using a Weibull model in which age was used as a measure of exposure time to risk rather than as a risk factor. Separate estimation equations were calculated for coronary heart disease and for non-coronary cardiovascular disease. These were calculated for high-risk and low-risk regions of Europe. Two parallel estimation models were developed, one based on total cholesterol and the other on total cholesterol/HDL cholesterol ratio. The risk estimations are displayed graphically in simple risk charts. Predictive value of the risk charts was examined by applying them to persons aged 45–64; areas under ROC curves ranged from 0.71 to 0.84.
Conclusions The SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.
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.
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.
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.
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.
It is important to determine what values of simple anthropometric measurements are associated with the presence of adverse cardiovascular risk factors such as diabetes or hypertension to provide an indication for further detailed investigations. In this analysis, we aimed to assess which anthropometric cutoff values are best at predicting the likelihood of diabetes, hypertension, dyslipidaemia and albuminuria in Hong Kong Chinese.
The data were obtained from a previously reported prevalence survey for glucose intolerance in a representative Hong Kong Chinese working population.
1513 subjects (910 men and 603 women) with mean age+/-s.d. 37.5+/-9.2 y.
We examined the likelihood ratios of having diabetes, hypertension, dyslipidaemia and albuminuria in subjects with various cutoff values of the four simple anthropometric indexes, namely, body mass index, waist-hip ratio, waist circumference and the ratio of waist-to-height.
We developed a nomogram to show the predictive values of different indexes for the cardiovascular risk factors using likelihood ratio analysis. Using Caucasian mean levels of the simple anthropometric indexes to predict diabetes or hypertension in Hong Kong Chinese gave a high likelihood ratio of 2:3:5.
Higher levels of body mass index, waist-hip ratio, waist circumference and the ratio of waist-to-height are associated with risk of having diabetes mellitus or hypertension in Hong Kong Chinese as in Caucasians. However, the cutoff values of those anthropometric indexes to define obesity used in Caucasians may not be applicable to Chinese.
Biological differences exist in the body composition of blacks and whites. We reviewed literature on the differences and similarities between the 2 races relative to fat-free body mass (water, mineral, and protein), fat patterning, and body dimensions and proportions. In general, blacks have a greater bone mineral density and body protein content than do whites, resulting in a greater fat-free body density. Additionally, there are racial differences in the distribution of subcutaneous fat and the length of the limbs relative to the trunk. The possibility that these differences are a result of ethnicity rather than of race is also examined. Because most equations that predict relative body fat were derived from predominantly white samples, biological variation between the races in these body-composition indexes has practical significance. Systematic error can result in the inaccurate estimation of the relative body fat of blacks, and therefore of definitions of obesity, if these inherent differences are ignored.
To study the relationship between body fat percentage and body mass index (BMI) in three different ethnic groups in Singapore (Chinese, Malays and Indians) in order to evaluate the validity of the BMI cut-off points for obesity.
Cross-sectional study.
Two-hundred and ninety-one subjects, purposively selected to ensure adequate representation of range of age and BMI of the general adult population, with almost equal numbers from each ethnic and gender group.
Body weight, body height, sitting height, wrist and femoral widths, skinfold thicknesses, total body water by deuterium oxide dilution, densitometry with Bodpod(R) and bone mineral content with Hologic(R) QDR-4500. Body fat percentage was calculated using a four-compartment model.
Compared with body fat percentage (BF%) obtained using the reference method, BF% for the Singaporean Chinese, Malays and Indians were under-predicted by BMI, sex and age when an equation developed in a Caucasian population was used. The mean prediction error ranged from 2.7% to 5.6% body fat. The BMI/BF% relationship was also different among the three Singaporean groups, with Indians having the highest BF% and Chinese the lowest for the same BMI. These differences could be ascribed to differences in body build. It was also found that for the same amount of body fat as Caucasians who have a body mass index (BMI) of 30 kg/m2 (cut-off for obesity as defined by WHO), the BMI cut-off points for obesity would have to be about 27 kg/m2 for Chinese and Malays and 26 kg/m2 for Indians.
The results show that the relationship between BF% and BMI is different between Singaporeans and Caucasians and also among the three ethnic groups in Singapore. 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 Singapore based on the BMI would need to be lowered. This would have immense public health implications in terms of policy related to obesity prevention and management.
Although international interest in classifying subject health status according to adiposity is increasing, no accepted published ranges of percentage body fat currently exist. Empirically identified limits, population percentiles, and z scores have all been suggested as means of setting percentage body fat guidelines, although each has major limitations.
The aim of this study was to examine a potential new approach for developing percentage body fat ranges. The approach taken was to link healthy body mass index (BMI; in kg/m(2)) guidelines established by the National Institutes of Health and the World Health Organization with predicted percentage body fat.
Body fat was measured in subjects from 3 ethnic groups (white, African American, and Asian) who were screened and evaluated at 3 universities [Cambridge (United Kingdom), Columbia (United States), and Jikei (Japan)] with use of reference body-composition methods [4-compartment model (4C) at 2 laboratories and dual-energy X-ray absorptiometry (DXA) at all 3 laboratories]. Percentage body fat prediction equations were developed based on BMI and other independent variables.
A convenient sample of 1626 adults with BMIs < or =35 was evaluated. Independent percentage body fat predictor variables in multiple regression models included 1/BMI, sex, age, and ethnic group (R: values from 0.74 to 0.92 and SEEs from 2.8 to 5.4% fat). The prediction formulas were then used to prepare provisional healthy percentage body fat ranges based on published BMI limits for underweight (<18.5), overweight (> or =25), and obesity (> or =30).
This proposed approach and initial findings provide the groundwork and stimulus for establishing international healthy body fat ranges.
To determine the relationship between percent body fat and body mass index (BMI) in the Chinese population of Hong Kong and to investigate whether the newly proposed lower BMI cut-offs for obesity in the Asia-Pacific Region recommended jointly by the International Association for the Study of Obesity, the International Obesity Task Force and the WHO are appropriate for Hong Kong Chinese.
A total of 190 female and 140 male healthy subjects were recruited from the community. BMI was calculated as weight/height(2). Body fat content (%BF) was measured by dual-energy X-ray absorptiometry (DEXA).
Comparing %BF measured by DEXA with predicted %BF derived from BMI using a prediction formula developed in Caucasian population showed that the formula significantly under-predicted %BF by 1.1% in males and 3.4% in females. A predicted BMI of 25 and 30 kg/m(2) using a Caucasian-based formula corresponds to an actual BMI of 23 and 25 kg/m(2), respectively. On linear regression analysis, 25% BF corresponds to a BMI of 24.6 kg/m(2) in males and a waist circumference of 86 cm; 35% BF corresponds to a BMI of 22.6 kg/m(2) and a waist circumference of 73.5 cm in females.
Hong Kong Chinese population have a higher %BF for a given BMI which would partly explain why the health risks associated with obesity occur at a lower BMI. Our results would support the recommendations of using lower BMI cut-offs to define obesity in the Asia Region.
To investigate the effect of body mass index (BMI) and body fat distribution as measured by waist-to-hip ratio (WHR) on the cardiovascular risk factor profile of the three major ethnic groups in Singapore (Chinese, Malay and Indian people) and to determine if WHO recommended cut-off values for BMI and WHR are appropriate for the different sub-populations in Singapore.
Cross-sectional population study.
A total of 4723 adult subjects (64% Chinese individuals, 21% Malay individuals and 15% Indian individuals) were selected through a multi-staged sampling technique to take part in the National Health Survey in 1998.
Data on socio-economic status (education level, occupation, housing type) and lifestyle habits (smoking and physical activity), body weight, body height, waist and hip circumferences and blood pressure measured using standardised protocols. Fasting venous blood samples were obtained for determination of serum total cholesterol (TC), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), triglycerides (TG). Venous blood samples were taken for 2 h oral glucose tolerance test (2 h glu).
Absolute and relative risks for at least one cardiovascular risk factor (elevated TC, elevated TC/HDL ratio, elevated TG, hypertension and diabetes mellitus) were determined for various categories of BMI and WHR. At low categories of BMI (BMI between 22 and 24 kg/m(2)) and WHR (WHR between 0.80 and 0.85 for women, and between 0.90 and 0.95 for men), the absolute risks are high, ranging from 41 to 81%. At these same categories the relative risks are significantly higher compared to the reference category, ranging from odds ratio of 1.97 to 4.38. These categories of BMI and WHR are all below the cut-off values of BMI and WHR recommended by WHO.
The results show that, at relatively low BMI and WHR, Singaporean adults experience elevated levels of risks (absolute and relative) for cardiovascular risk factors. These findings, in addition to earlier reported high percentage body fat among Singaporeans at low levels of BMI, confirm the need to revise the WHO cut-off values for the various indices of obesity and fat distribution, viz BMI and WHR, in Singapore.
Ethnic differences in the relation of body mass index (BMI; in kg/m2) to morbidity and mortality have led investigators to question whether a single cutoff for obesity should be applied to all ethnic groups.
The effects of using 4 different outcomes and 3 different measures of effect as criteria for comparing BMI cutoffs were shown with the use of data from 45- to 64-y-old African American and white women.
Data were from the Cancer Prevention Study I (CPS-I) and the Atherosclerosis Risk in Communities (ARIC) Study. The outcomes were mortality (9211 deaths), diabetes (757 cases), hypertension (1518 cases), and hypertriglyceridemia (1264 cases). The measures of effect were incidence rate, rate ratio, and rate difference. The BMI in African American women that was associated with a risk equivalent to that of white women with a BMI of 30 was estimated.
There was no significant association between BMI and mortality in African American women. The BMI in African American women that was associated with a risk of diabetes equivalent to that of white women with a BMI of 30 was 28.0-34.5, depending on the measure of effect. For hypertension, the equivalent risk in African American women occurred at a BMI of <18-38, depending on the measure of effect. There was no BMI at which African American women had an incidence rate or rate ratio for hypertriglyceridemia that was as high as that of white women with a BMI of 30.
BMI cutoffs associated with equivalent risk across ethnic groups differ widely depending on the outcome and the risk estimate.
For prevention of obesity in the Chinese population, it is necessary to define the optimal range of healthy weight and the appropriate cut-off points of body mass index (BMI) and waist circumference for Chinese adults. The Working Group on Obesity in China under the support of the International Life Sciences Institute Focal Point in China organized a meta-analysis on the relationship between BMI, waist circumference and risk factors of related chronic diseases (e.g., high diabetes, diabetes mellitus, and lipoprotein disorders). Thirteen population studies in all met the criteria for enrolment, with data of 239 972 adults (20-70 years of age) surveyed in the 1990s. Data on waist circumference was available for 111 411 persons, and data on serum lipids and glucose were available for more than 80 000. The study populations were located in 21 provinces, municipalities and autonomous regions in mainland China as well as in Taiwan. Each enrolled study provided data according to a common protocol and uniform format. The Center for Data Management in the Department of Epidemiology, Fu Wai Hospital, was responsible for the statistical analysis. The prevalence of hypertension, diabetes, dyslipidemia and clustering of risk factors all increased with increasing levels of BMI or waist circumference. A BMI of 24 with best sensitivity and specificity for identification of the risk factors' was recommended as the cut-off point for overweight; a BMI of 28, which may identify the risk factors with specificity around 90%, was recommended as the cut-off point for obesity. A waist circumference over 85 cm for men and over 80 cm for women were recommended as the cut-off points for central obesity. Analysis of a population-attributable risk percentage illustrated that reducing the BMI to the normal range (<24) could prevent 45-50% of the clustering of risk factors. Treatment of obese persons (BMI = 28) with drugs could prevent 15-17% of clustering of risk factors. When waist circumference is controlled at under 85 cm for men and under 80 cm for women, it could prevent 47-58% of clustering of risk factors. Based on these guidelines, a classification of overweight and obesity for Chinese adults is recommended.
The relation between body mass index (kg/m2) and body fat from body density was compared in a group of Chinese and Dutch healthy subjects in relation to sex and age. The Dutch group was selected in relation to the Chinese group in that age, weight, height and body mass index did not exceed the maximal observed values of the Chinese subjects. Mean weight, height and body mass index was higher in the Dutch group, but body fat from density did not differ between the groups. Body fat predicted from body mass index, age and sex did not differ from the value obtained by densitometry in both countries. The correlation between measured body fat and predicted body fat was 0.84 (p<0.01) in the Chinese and 0.90 (p<0.01) in the Dutch. The difference between measured and predicted body fat was related to the level of body fatness (r=0.55, p<0.01), but did not differ between the countries. In different age groups there were slight differences in the measured minus predicted values of the countries, but these differences were less after correcting for differences in the level of body fatness in each age group. It is concluded that the relation between body fatness and body mass index is not different between the two studied populations.
Until recently it was practical to divide body weight into only two or three chemical compartments in living subjects due to an inability to quantify directly total body mineral, protein, and fat in vivo. The six-compartment chemical model is now the cornerstone of research in human body composition. Advanced technologies, including neutron activation analysis systems and dual photon absorptiometry, now enable investigators to extend body composition estimates and to construct near-complete chemical models in vivo. These new or refined approaches will advance our knowledge of human body composition and will also improve our accuracy in calibrating simpler epidemiologic and bedside body-composition techniques.
Body-composition research is a branch of human biology that has three interconnecting areas: body-composition levels and their organizational rules, measurement techniques, and biological factors that influence body composition. In the first area, which is inadequately formulated at present, five levels of increasing complexity are proposed: I, atomic; II, molecular; III, cellular; IV, tissue-system; and V, whole body. Although each level and its multiple compartments are distinct, biochemical and physiological connections exist such that the model is consistent and functions as a whole. The model also provides the opportunity to clearly define the concept of a body composition steady state in which quantitative associations exist over a specified time interval between compartments at the same or different levels. Finally, the five-level model provides a matrix for creating explicit body-composition equations, reveals gaps in the study of human body composition, and suggests important new research areas.
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.
To compare the relationship between body size and body composition in New Zealanders of Polynesian and European descent and to develop specific regression equations for fat mass for Polynesians.
189 Maori (93 males, 96 females), 185 Samoans (88 males, 97 females) and 241 Europeans (89 males, 152 females) aged 20-70 y.
Height, weight, four skinfold thicknesses, bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA).
At higher body mass index levels, Polynesians (Maori and Samoans combined) had a significantly higher ratio of lean mass:fat mass compared with Europeans. Four multiple regression equations incorporating resistance and reactance, height and weight, sum of four skinfolds or sum of two skinfolds were developed in two-thirds of the Polynesian participants using DXA fat mass as the dependent variable. In the remaining one-third of participants, the mean difference between fat mass predicted by these equations (r2 range 0.89-0.93) and DXA fat mass ranged from -0. 06 to +0.25 kg (s.d. -3.67 to +3.71 kg).
At higher BMI levels, Polynesians were significantly leaner than Europeans, implying the need for separate BMI definitions of overweight and obesity for Polynesians. The regression equations using BIA, height and weight or skinfold thicknesses were good predictors of body composition in Polynesians.
To examine body mass index (BMI) and the proportion overweight and obese among adults age 18-59 in the six largest Asian American ethnic groups (Chinese, Filipino, Asian Indian, Japanese, Korean, Vietnamese), and investigate whether BMI varies by nativity (foreign-vs native-born), years in US, or socioeconomic status.
Cross-sectional interview data were pooled from the 1992-1995 National Health Interview Survey (NHIS).
254,153 persons aged 18-59 included in the 1992-1995 NHIS. Sample sizes range from 816 to 1940 for each of six Asian American ethnic groups.
Self-reported height and weight used to calculate BMI and classify individuals as overweight (BMI > or = 25 kg/m2) or obese (BMI > or = 30 kg/m2), age, sex, years in the US, household income and household size.
For men, the percentage overweight ranges from 17% of Vietnamese to 42% of Japanese, while the total male population is 57% overweight. For women, the percentage overweight ranges from 9% of Vietnamese and Chinese to 25% of Asian Indians, while the total female population is 38% overweight. The percentage of Asian Americans classified as obese is very low. Adjusted for age and ethnicity, the odds ratio for obese is 3.5 for women and 4.0 for men for US-vs foreign-born. Among the foreign-born, more years in the US is associated with higher risk of being overweight or obese. The association between household income for women is similar for US-born Asian Americans and Whites and Blacks, but is much weaker for foreign-born Asian Americans.
While these data find low proportions of Asian Americans overweight at present, they also imply the proportion will increase with more US-born Asian Americans and longer duration in the US.
Comparative data on ecological differences in body fatness and fat distribution within Europe are sparse. Migration studies may provide information on the impact of environmental factors on body size in different populations. The objective was to investigate differences in adiposity between European immigrants and native Swedes, specifically to examine gender differences and the effect of time since immigration, and to compare two selected immigrant groups with their native countrymen.
A cross-sectional analysis of 27,808 adults aged 45 to 73 years participating in the Malmö Diet and Cancer prospective cohort study in Sweden was performed. Percentage body fat (impedance analysis) and waist-hip ratio (WHR) were compared between Swedish-born and foreign-born participants.
Obesity was 40% more prevalent in non-Swedish Europeans compared with Swedes. Controlling for age, height, smoking, physical activity, and occupation, it was found that women born in the former Yugoslavia, southern Europe, Hungary, and Finland had a significantly higher percentage of body fat, and those from Hungary, Poland, and Germany had more centralized adiposity compared with Swedish women. Men born in the former Yugoslavia, Hungary, and Denmark had a significantly higher mean percentage of body fat compared with Swedish-born men, whereas Yugoslavian, Finnish, and German men differed significantly in mean WHR. Length of residence in Sweden was inversely associated with central adiposity in immigrants. A comparison between German and Danish immigrants, their respective native populations, and Swedes indicated an intermediate positioning of German immigrants with regard to body mass index and WHR.
Differences in general and central adiposity by country of origin appear to remain after migration. Central adiposity seems to be more influenced than fatness per se by time of residency in Sweden.
Along with their foods and dietary customs, Africans were carried into diaspora throughout the Americas as a result of the European slave trade. Their descendants represent populations at varying stages of the nutrition transition. West Africans are in the early stage, where undernutrition and nutrient deficiencies are prevalent. Many Caribbean populations represent the middle stages, with undernutrition and obesity coexisting. African-Americans and black populations in the United Kingdom suffer from the consequences of caloric excess and diets high in fat and animal products. Obesity, non-insulin-dependent diabetes mellitus, hypertension, coronary heart disease, and certain cancers all follow an east-to-west gradient of increasing prevalence. Public health efforts must focus not only on eradicating undernutrition in West Africa and the Caribbean but also on preventing obesity, hypercholesterolemia, and their consequences. Fortunately, a coherent and well-supported set of recommendations exists to promote better nutrition. Implementation of it founders primarily as a result of the influence of commercial and political interests.
For prevention of obesity in Chinese population, it is necessary to define the optimal range of healthy weight and the appropriate cut-off points of BMI and waist circumference for Chinese adults. The Working Group on Obesity in China under the support of International Life Sciences Institute Focal point in China organized a meta-analysis on the relation between BMI, waist circumference and risk factors of related chronic diseases (e.g., high diabetes, diabetes mellitus, and lipoprotein disorders).
13 population studies in all met the criteria for enrollment, with data of 239,972 adults (20-70 year) surveyed in the 1990s. Data on waist circumference was available for 111,411 persons and data on serum lipids and glucose were available for more than 80,000. The study populations located in 21 provinces, municipalities and autonomous regions in mainland China as well as in Taiwan. Each enrolled study provided data according to a common protocol and uniform format. The Center for data management in Department of Epidemiology, Fu Wai Hospital was responsible for statistical analysis.
The prevalence of hypertension, diabetes, dyslipidemia and clustering of risk factors all increased with increasing levels of BMI or waist circumference. BMI at 24 with best sensitivity and specificity for identification of the risk factors, was recommended as the cut-off point for overweight, BMI at 28 which may identify the risk factors with specificity around 90% was recommended as the cut-off point for obesity. Waist circumference beyond 85 cm for men and beyond 80 cm for women were recommended as the cut-off points for central obesity. Analysis of population attributable risk percent illustrated that reducing BMI to normal range (< 24) could prevent 45%-50% clustering of risk factors. Treatment of obese persons (BMI > or = 28) with drugs could prevent 15%-17% clustering of risk factors. The waist circumference controlled under 85 cm for men and under 80 cm for women, could prevent 47%-58% clustering of risk factors. According to these, a classification of overweight and obesity for Chinese adults is recommended.
This study was undertaken to review the links between maternal nutrition, offspring's birth weight and the propensity to early insulin resistance and high diabetes rates in Indian adults. Studies included a comparison of maternal size and nutrition with birth weights in Pune, India, and Southampton, UK. In Pune, the growth, insulin resistance and blood pressure of four-year-old children were assessed. Adults >40 years of age, who were resident in rural areas, were compared with adults living in urban areas for size, glucose handling, lipid status and blood pressure. Newly diagnosed diabetic adults living in urban areas were also monitored. Height, weight, head, waist and hip circumferences, skin-fold measurements and blood pressure were routinely measured. Fasting glucose, insulin, total and high-density lipoprotein cholesterol and triglycerides were linked to the glucose and insulin responses during glucose tolerance tests. Cytokine levels were measured in plasma samples of urban and rural adults. Indian babies were lighter, thinner, shorter and had a relatively lower lean tissue mass than the Caucasian babies. However, the subcutaneous fat measurements of these babies were comparable to those of the white Caucasian babies. The Indian mothers were small, but relatively fat mothers produced larger babies. Maternal intake of green vegetables, fruit and milk, and their circulating folate and vitamin C levels, predicted larger fetal size. Rapid childhood growth promoted insulin resistance and higher blood pressure. Rural adults were thin, with a 4% prevalence of diabetes and a 14% prevalence of hypertension, but the risks increased within the normal body mass index (BMI) range. Type 2 diabetes was common in urban adults younger than 35 years of age. Although the average BMI was 23.9 kg m(-2), central obesity and thin limbs were noteworthy. Levels of interleukin-6 and tumour necrosis factor-a were markedly increased in urban dwellers. Hence, there is evidence of a remarkably powerful, intergenerational effect on body size and total and central adiposity. Indians are highly susceptible to insulin resistance and cardiovascular risks, with babies being born small but relatively fat. Insulin resistance is amplified by rapid childhood growth. Dietary factors seem to have profound long-term metabolic influences in pregnancy. Overcrowding with infections and central obesity may amplify cytokine-induced insulin resistance and early diabetes in Indian adults with a low BMI.
Body composition methods can be classified into direct, indirect and doubly indirect methods. In vivo direct methods use neutron activation analysis to get information on body composition. Indirect methods rely on rules and constants derived from direct methods. Most basic research, especially the development of rules and models has been done in Caucasian subjects in Europe or USA. The critical use of more advanced body composition methodologies in various ethnic groups has shown that assumptions may differ between ethnic groups, an example being the assumption of constant density of the fat free mass. Indirect or predictive methods rely on statistical relationships between body parameters and components of body composition. Subcutaneous fat patterning differs among ethnic groups, and this may have consequences for the validity of body fat predicted from skinfold thickness. Relative leg length and relative arm length also differ between ethnic groups. As a result the body mass index (weight/height squared, BMI), often used as surrogate for body fat percent, and formulas based on bioelectrical impedance measurement show different validity among ethnic groups. Less information is available about the validity of indicators for body fat distribution. There are indications that the relationship between the amount of visceral adipose tissue and waist circumference or waist-hip circumference ratio also differs among ethnic groups. Ethnic differences in body composition rules and constants are important and challenging to investigate, especially in relation to overweight and obesity.
Relationship between body fat and body mass index: differences between Indonesians and Dutch Caucasians.
- Guricci S
- Hartriyanti Y
- Hautvast JGAJ
- Deurenberg P
Relationships between indices of obesity and its co-morbidities among Chinese, Malays and Indians in Singapore.
- Deurenberg-Yap M
- Chew SK
- Lin FP
- van Staveren WA
- Deurenberg P
Relationships between indices of obesity and its co-morbidities among Chinese, Malays and Indians in Singapore
- Deurenberg-Yap
Human body composition: human kinetics
- A F Roche
- S B Heymsfield
- T G Lohman