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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.
... More importantly, this discrepancy suggests that metabolic health risk may be commonly mischaracterized in NHPI and other minority populations. In 2004, the WHO Expert Committee acknowledged racial-ethnic differences in obesity and BMI and identified "public health action points…along the continuum of BMI" (23.0, 27.5, 32.5, and 37.5 kg/m 2 ) at which a community may consider reevaluating cardiometabolic health risk while retaining traditional BMI cutoffs as the international diagnostic standard for overweight and obesity [23]. As such, independent institutions have recommended ethnic-specific BMI cutoffs to mitigate intergroup discrepancies (Table 1) [22][23][24][25][26][27][28][29]. ...
... In 2004, the WHO Expert Committee acknowledged racial-ethnic differences in obesity and BMI and identified "public health action points…along the continuum of BMI" (23.0, 27.5, 32.5, and 37.5 kg/m 2 ) at which a community may consider reevaluating cardiometabolic health risk while retaining traditional BMI cutoffs as the international diagnostic standard for overweight and obesity [23]. As such, independent institutions have recommended ethnic-specific BMI cutoffs to mitigate intergroup discrepancies (Table 1) [22][23][24][25][26][27][28][29]. According to the Korean Society for the Study of Obesity, such modifications have even been integrated into clinical practice guidelines for some Asian countries [28]. ...
... Overweight Obesity Community Location Institution [25] 25 In 2004, the WHO Expert Committee acknowledged racial-ethnic differences in obesity and BMI and identified "public health action points. . .along the continuum of BMI" (23.0, 27.5, 32.5, and 37.5 kg/m 2 ) at which a community may consider reevaluating cardiometabolic health risk while retaining traditional BMI cutoffs as the international diagnostic standard for overweight and obesity [23]. As such, independent institutions have recommended ethnic-specific BMI cutoffs to mitigate intergroup discrepancies (Table 1) [22][23][24][25][26][27][28][29]. ...
Compared to the general population of Hawai‘i, Native Hawaiians and Other Pacific Islanders (NHPI) shoulder a disproportionately high risk for obesity-related cardiometabolic disorders, such as type 2 diabetes and cardiovascular disease. The gut microbiome is an area of rapid research interest for its role in regulating adjacent metabolic pathways, offering novel opportunities to better understand the etiology of these health disparities. Obesity and the gut microbiome are influenced by regional, racial–ethnic, and community-specific factors, limiting the generalizability of current literature for understudied populations. Additionally, anthropometric and directly measured obesity indices are variably predictive of adiposity and metabolic health risk in this diverse population. Thus, further NHPI-inclusive research is required to adequately characterize community-specific factors in the context of obesity-related disease etiology. Culturally responsible research ethics and scientific communication are crucial to conducting such research, especially among indigenous and understudied populations. In this review, we explore these limitations in current literature, emphasizing the urgent need for NHPI-inclusive research to assess community-specific factors accurately. Such accuracy in Indigenous health research may ensure that findings relevant to individual or public health recommendations and/or policies are meaningful to the communities such research aims to serve.
... The growing prevalence of cardiometabolic diseases such as type 2 diabetes mellitus (T2DM) worldwide is well-documented [1,2]. High postprandial glycemic response (PPGR) and postprandial insulin response (PPIR) are considered major risk factors for the development of T2DM [3] and, in particular, foods high in readily digestible carbohydrates and low in dietary fiber tend to elicit a rapid and pronounced PPGR, accompanied by an increased release of insulin [4]. ...
... The characteristics of the study participants are detailed in Table 3. All 20 participants (10 men and 10 women; mean age: 29 y) were healthy, with their BMI, waist circumference, blood pressure, fasting glucose, and fasting insulin concentrations within a healthy range [1,2,18,19]. The majority (90%) of the participants were ethnically Chinese. ...
Incorporating β-glucan-rich oat bran (OB) can attenuate postprandial glycemic response (PPGR) in solid foods, but its effect in liquid matrices is unclear. This study investigated the ability of differently processed low-dose-β-glucan-containing beverages to lower PPGR, and the mechanisms of action. Twenty participants consumed five malt beverages made from cocoa powder: intact OB (Intact), OB treated with enzymatic hydrolysis (EnzymA, EnzymB) or extrusion (Extr), or no OB (Ctrl). Four-hour postprandial incremental areas under the curve (iAUC) and peak incremental concentrations (iCmax) of glucose, insulin, glucagon-like peptide 1 (GLP-1), gastric inhibitory polypeptide (GIP), and paracetamol were evaluated. The molecular weight (MW) and extractability of the β-glucan in all the test products were also assessed. The three-hour glucose iAUC significantly decreased by −26%, −28%, −32%, and −38% in Intact, EnzymA, EnzymB, and Extr, respectively, and the insulin levels of the oat-containing products were also significantly lower compared to Ctrl. Intact and Extr elicited a lower insulin iCmax and GLP-1 3 h iAUC compared to Ctrl. However, the GIP and paracetamol levels were not changed. All the processed OBs improved β-glucan extractability and lowered the MW of β-glucan compared to Intact. In conclusion, low-dose oat β-glucan in a beverage significantly reduced PPGR, with effects maintained across different oat processing methods.
... Obesity was defined as a BMI of ≥ 28 kg/m 2 , according to the Asia-Pacific criteria established by the World Health Organization (WHO). 24 ...
Purpose
This study aimed to investigate the association of the triglyceride-glucose index (TyG) and its related parameters with the risk of hyperuricemia in patients with obesity of different sexes.
Patients and Methods
In this cross-sectional study, a total of 951 patients with obesity were included. They were divided into two groups based on their serum uric acid levels, and separate analyses were conducted for males and females. Binary logistic regression analysis using the backward likelihood ratio (LR) approach was performed to investigate the association between hyperuricemia and indicators related to obesity and lipids.
Results
Multivariate logistic regression analysis indicated that, across the overall population, higher quartiles of the TyG and TyG-BMI indexes were significantly associated with an increased risk of hyperuricemia (HUA) after adjusting for confounding factors. Specifically, in the fourth quartile of the TyG index, the odds ratio (OR) for HUA was 3.16 (95% confidence interval [CI]: 1.39–7.18), and for the TyG-BMI index, the OR was 4.06 (95% CI: 1.73–9.52) in the fully adjusted model. In sex-specific analyses, for males, those in the third quartile of the TyG-WC index had a higher likelihood of HUA (OR, 8.13; 95% CI, 2.28–29.01) compared to the lowest quartile. Among females, an elevated TyG index was significantly associated with increased HUA risk, with an OR of 5.13 (95% CI: 1.66–15.92) in the fourth quartile.
Conclusion
Sex-based differences exist regarding the risk factors for hyperuricemia in patients with obesity. An elevated TyG-WC index is linked to an increased risk in males, while an elevated TyG index is associated with an increased risk in females.
... kg/m 2 ), overweight (BMI ≥25-29.9 kg/m 2 ), and obese (BMI ≥30 kg/m 2 ) [17]. ...
... The economic condition of the family of any one respondent was considered as lower (if the monthly income of a family was < Tk 50 thousand and expenditure was < Tk 40 thousand), medium (if income was Tk 50-100 thousand and expenditure was between Tk 40-< 80 thousand), upper medium (if income was Tk 50-100 thousand and expenditure was between Tk 80-< 100 thousand taka), and higher (if income was Tk 150 and above and expenditure was Tk 120 thousand and above). To identify the obese adults, the body mass index (BMI) (BMI, weight in kg divided by height in m 2 ), was measured and any respondent was identified as underweight if BMI < 18.5, normal if 18.5 < BMI < 23.0, overweight if 23.0 < BMI < 27.5, and obese if BMI ≥ 27.5 [36,37]. According to blood pressure (BP) mmHg measurement, the respondents were classified into two groups. ...
In this paper, an attempt was made to identify the risk factors associated with the prevalence of cardiovascular disease (CVD) in Bangladeshi patients with elevated blood pressure. The patients were observed in investigating 995 adults of 18 years and above. The data of these adults were collected from some diagnostic centers located in urban and semi-urban areas when the adults were visiting the centers for their blood and urine screening tests. Among the investigated adults, 452 were patients with elevated blood pressure; 39 of these patients were suffering from CVD. The objective of the study was to identify some socioeconomic factors for the simultaneous prevalence of the diseases among the group of 39 patients. The risk of these two non-communicable diseases was significantly higher for younger adults, for physically inactive adults, and for diabetic patients of early stages. Higher risk was also noted for non-Muslim people, females, secondary educated persons, housewives, adults belonging to families of upper medium economic condition, processed food consumers, and underweight adults. The patients' group was well discriminated from others for the variables age, habit of doing physical work, and economic condition.
... 18.5 ≤ BMI < 24 kg/m² was used to identify normal-weight. 28 Serum uric acid levels of more than 420 μmol/L were used to define hyperuricemia. 2 Dyslipidemia criteria were based on Chinese guidelines: 29 elevated TG levels (TG ≥ 1.7 mmol/L), elevated total cholesterol (TC) levels (TC ≥ 5.2 mmol/L), lowered HDL-C levels (HDL-C < 1.0 mmol/L), and elevated low-density lipoprotein cholesterol (LDL-C) levels (LDL-C ≥ 3.4 mmol/L). ...
Purpose
Hyperuricemia has traditionally been associated with obesity and dyslipidemia. However, the relationship between waist circumference (WC) and hyperuricemia in normal-weight men is still unclear, particularly regarding the roles of triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). The aim of this research was to explore the mediating roles of TG and HDL-C in the association between WC and hyperuricemia in normal-weight men.
Methods
A retrospective observational study was conducted among normal-weight men (18.5 ≤ BMI < 24 kg/m²) aged ≥ 18 years who underwent health checkups in Nanjing from 2021–2023. Relationships between WC, blood lipids, and hyperuricemia were investigated by multivariable regression models and mediation analysis.
Results
We enrolled 35,984 participants, with an overall hyperuricemia prevalence of 24.2%. The research found a significant positive association between WC and hyperuricemia in normal-weight men (P < 0.001). For hyperuricemia across rising WC quartiles, with WC divided as follows: Q1 (59 ≤ WC < 77 cm), Q2 (77 ≤ WC < 81 cm), Q3 (81 ≤ WC < 85 cm), and Q4 (85 ≤ WC ≤ 107 cm), the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were 1.00 (reference), 1.09 (1.01, 1.18), 1.26 (1.15, 1.37), and 1.34 (1.22, 1.46), respectively (all P < 0.001). The mediation analysis indicated that WC had a significant total effect on hyperuricemia (Coefficient = 0.0046, 95% CI: 0.0028, 0.0070, P < 0.001), with significant indirect effects mediated through TG and HDL-C, contributing mediation proportions of 22.3% and 18.3%, respectively (both P < 0.05).
Conclusion
Elevated WC is associated with an increased likelihood of hyperuricemia in normal-weight men. TG and HDL-C play substantial mediating roles in this association. These findings suggest that monitoring WC and lipid profiles in normal-weight men could help identify those at higher risk of hyperuricemia, even in the absence of general obesity.
... In addition, 13 cases (8.8%) of lymphovascular invasion and 18 cases (12.2%) of perineural invasion were reported. According to previous medical history, 29 overweight according to Asian criteria [18]. Table 2 identifies the factors related to occurrence of lymphocytopenia induced by preoperative CRT. ...
... The World Health Organization (WHO) defines overweight as a BMI value in the range of 25 to <30 kg/m², while obesity is defined as a BMI value of ≥30 kg/m². Additionally, obesity can be categorized into three degrees: Class I obesity (30 to <35 kg/m²), Class II obesity (35 to <40 kg/m²), and Class III obesity (≥40 kg/m²) [2]. According to official statistics presented by the WHO, in 2022, 2.5 billion adults aged 18 and older were overweight, including over 890 million adults suffering from obesity. ...
Introduction and objective Obesity, characterized by excessive fat accumulation, poses significant health risks. The WHO classifies overweight as a BMI of 25 to <30 kg/m² and obesity as a BMI of ≥30 kg/m², divided into three classes. This study examines the relationship between obesity and bone health, focusing on osteoarthritis (OA), rheumatoid arthritis (RA), and fracture risks. Review methods A review of epidemiological and clinical studies was conducted, including WHO statistics, U.S. obesity trends, and recent findings on the mechanisms linking obesity with bone health and joint diseases. Studies were selected for their relevance to understanding obesity's impact on skeletal health. Abbreviated description of the state of knowledge Obesity is influenced by sociodemographic, behavioral, and genetic factors. While excess weight was once considered beneficial for bones due to increased mechanical loading, recent research shows its harmful effects. Obesity is linked to chronic inflammation, altered adipokine levels, and higher risk of atypical fractures. In OA, obesity accelerates joint degeneration through mechanical and metabolic pathways. In RA, obesity is associated with increased disease activity and cardiovascular complications. Summary Obesity significantly affects bone and joint health, increasing the risk of OA, RA, and fractures. The paradox of obesity providing mechanical benefits while causing metabolic and inflammatory issues is crucial. Understanding these mechanisms is vital for developing effective prevention and management strategies for obesity-related skeletal diseases. Further research is essential to clarify the complex interactions between adipose tissue and bone health, aiming to improve outcomes for obese individuals.
... Ethnic considerations: The pathobiological characteristics of adiposity-related chronic disorders are different in various ethnic subgroups therefore, the BMI cut-offs for these subgroups for consideration of bariatric procedures should be different. e.g., the BMI cut-off for defining obesity in South Asians[26] is 27.5 kg/m 2 while that for Indians [27] is 25 kg/m 2 because of the predominant abdominal adiposity in these populations compared to Caucasians. Although several studies and consensus statements have suggested lower cut-offs for diagnosing obesity in Asians [28], there is no clear international consensus on the BMI cut-offs for various bariatric interventions for different ethnic minorities across the globe. ...
Bariatric interventions have shown the best therapeutic benefits in individuals with obesity. They can be classified into surgical procedures (bariatric/metabolic surgery) and endoscopic procedures. Common surgical procedures include sleeve gastrectomy, Roux-en-Y gastric bypass, bilio-pancreatic diversion with or without duodenal switch and Stomach Intestinal Pylorus Sparing Surgery. Endoscopic procedures include intragastric balloons, transpyloric shuttle, endoscopic gastroplasties, aspiration therapy, duodenal mucosal resurfacing, duodeno-jejunal bypass liner, gastro-duodeno-jejunal bypass and incisionless magnetic anastomosis system among others. However, these procedures are limited by lack of wide availability, high costs, immediate and long-term complications and poor acceptability in some regions. Weight re-gain is a common concern and revisional metabolic surgery is often required. Appropriate pre-operative evaluation and correction of nutritional deficiencies post-surgery are very important. The most appropriate procedure for a person would depend on multiple factors like the intended magnitude of weight-loss, comorbidities and surgical fitness, as well as choice of the patient. Recently, glucagon-like insulinotropic peptide-1 receptor agonists (GLP) and the GLP-1/gastric inhibitory polypeptide co-agonist–Tirzepatide have shown remarkable weight loss potential, which is at par with bariatric interventions in some patients. How far these can help in avoiding invasive bariatric procedures in near future remains to be explored. An updated and comprehensive clinical review by He et al in the recent issue of World Journal of Diabetes address has addressed the avenues and challenges of currently available bariatric surgeries which will enable clinicians to make better decisions in their practice, including their applicability in special populations like the elderly and pediatric age groups, type 1 diabetes mellitus, and non-diabetics.
... As the Meitei people are one of Asian ethnicities, the Asian (Mongoloid) BMI cut-off was used to determine the participants' body mass index in the present study. In the Asian cut-off of BMI, the body mass index is classified into four categories: underweight, normal, overweight, and obese [21]. Overweight 23.0-24.9 ...
Diverse human characteristics significantly influence susceptibility to kidney stone disease (KSD), resulting in unequal risks of formation. Human variations can be classified by prakriti body types, rooted in holistic mind-body principles, and anthropometric somatotypes, focused solely on physical traits. Therefore, the study aims to investigate the susceptibility to KSD among the Meitei adult population of Manipur across different body types and other body adiposity variables. Among 712 participants (322 males, 390 females) from the Meitei adult population of Manipur, kidney stone prevalence is 11.24%. BMI and body fat show no association with stone formation. Interestingly, prakriti body types correlate with kidney stones, while somatotypes do not. The study emphasizes understanding one’s body type, especially prakriti, for proactive kidney stone prevention. Moreover, it highlights the ancient Ayurvedic system’s relevance in averting kidney stone development.
... For example, WHO experts argue that the relationships between BMI, body fat percentage, and health risks vary between Asian and European populations. Thus, the WHO panel suggested a lower BMI threshold for defining obesity in Asian populations at ≥27.5 kg/m 2 , compared to the standard cutoff of ≥30.0 kg/m 2 [1]. ...
Obesity, a global public health problem, is constantly increasing, so the concerns in preventing and combating it are increasingly focused on the intestinal microbiota. It was found that the microbiota is different in lean people compared to obese individuals, but the exact mechanisms by which energy homeostasis is influenced are still incompletely known. Numerous studies show the involvement of certain bacterial species in promoting obesity and associated diseases such as diabetes, hypertension, cancer, etc. Our aim is to summarize the main findings regarding the influence of several factors such as lifestyle changes, including diet and bariatric surgery, on the diversity of the gut microbiota in obese individuals. The second purpose of this paper is to investigate the potential effect of various microbiota modulation techniques on ameliorating obesity and its comorbidities. A literature search was conducted using the PubMed database, identifying articles published between 2019 and 2024. Most studies identified suggest that obesity is generally associated with alterations of the gut microbiome such as decreased microbial diversity, an increased Firmicutes-to-Bacteroidetes ratio, and increased SCFAs levels. Our findings also indicate that gut microbiota modulation techniques could represent a novel strategy in treating obesity and related metabolic diseases. Although some mechanisms (e.g., inflammation or hormonal regulation) are already considered a powerful connection between gut microbiota and obesity development, further research is needed to enhance the knowledge on this particular topic.
Metabolic syndrome (MetS) remains a significant global public health concern. However, the relationship between MetS, its individual components and melanoma metastasis remains unexplored. We analysed the clinical data of 258 Chinese melanoma patients who had not undergo systemic therapy. Binary logistic regression, adjusted for sex and age, was employed to evaluate the connection between MetS and its components and melanoma metastasis. Of the 258 melanoma patients, 92 met the MetS criteria upon diagnosis. No direct association between MetS and melanoma metastasis was identified. However, specific components of MetS, namely low HDL‐cholesterol levels (OR = 2.85, 95% CI:1.50–5.41, p < 0.05) and dysglycaemia (OR = 4.23, 95% CI:1.80–8.96, p < 0.05), were associated with melanoma metastasis. In subgroup analysis, hypertriglyceridemia correlated with melanoma metastasis in non‐elderly patients (< 65 years) (OR = 2.69, 95% CI: 1.14–6.33, p < 0.05). Central obesity and hypertension showed no association. A dose–response analysis further indicated that melanoma metastasis risk escalated with increasing fasting blood glucose and blood triglyceride concentrations, and with decreasing blood HDL concentration. Our results suggest that monitoring and managing individual components of the MetS, particularly HDL‐cholesterol levels, fasting glucose and triglyceride levels, may have potential prognostic benefits for melanoma in the Chinese population.
The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
A BSTRACT
Background
Obesity is a complex, multifactorial, chronic, relapsing disease with variable clinical phenotypes defined by abnormal or excessive adiposity which impairs physical and mental health. Although Bangladesh is experiencing a rise in the prevalence of obesity, it is still undermanaged. The metabolic phenotype of the people of our country is different from Caucasians. Therefore, there is an urgent need for a structured, customized and evidence-based clinical practice guideline for the management of obesity in Bangladesh.
Methodology
The Bangladesh Endocrine Society (BES) Obesity Taskforce undertook to develop a position statement for managing obesity in Bangladesh. The task force created a committee of 19 members to write the statement based on international obesity guidelines, randomized controlled trials, national observational studies, and expert opinion. Several consultative meetings were arranged to discuss the position statement until it was ratified unanimously by the committee.
Results
The position statement includes recommendations on the overall management of obesity. There are sections on the diagnosis, assessment, treatment, and prevention of obesity in adults of Bangladesh.
Conclusion
This is a position statement for the people of Bangladesh who are suffering from obesity. We hope it provides knowledge to primary care physicians and endocrinologists to improve the assessment and treatment of obesity. Through this position statement, BES hopes to improve the management of obesity in Bangladesh and make it structured and uniform.
Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterised by an elevated integrated relaxation pressure (IRP) with preserved peristalsis. Most functional EGJOO symptoms are self-limiting. This study aimed to evaluate the risk factors associated with non-resolution of symptoms for functional EGJOO. A retrospective single institution cohort study was performed on patients diagnosed with functional EGJOO on high-resolution manometry (HRM). Clinical, demographic, endoscopic and imaging parameters were recorded. Univariate and multivariate analyses were performed to identify factors associated with reduced likelihood of symptom resolution. Time to symptom resolution was then plotted on a Kaplan–Meier survival analysis. Over a 5-year period, 53 patients (41.5% male, 58.5% female) were diagnosed with functional EGJOO. The median age, body mass index and IRP at 4 s were 47.0 years (interquartile range (IQR): 36.0–58.0), 23.3 kg/m² (IQR: 20.9–26.5) and 39.9 mmHg (IQR: 28.6–52.3) respectively. Dysphagia and atypical chest pain accounted for 36.5% and 21.2% of symptoms respectively. On the univariate analysis, obesity (p = 0.002), heartburn (p = 0.098) and lack of epigastric pain (p = 0.090) were potentially correlated with failure of symptom resolution. In the multivariate analysis, only obesity (OR 0.11, 95% CI: 0.02–0.77; p = 0.026) was significantly associated with reduced likelihood of symptom resolution for EGJOO. On the survival analysis, 87.2% of non-obese patients, in contrast 37.5% of obese patients reported symptom resolution at up to 41-month follow-up period (p = 0.039). Patients with obesity are at an increased likelihood of having persistent symptoms. This association appeared to persist for patients with both manometric and clinically relevant EGJOO.
Background
The association between high body-mass index (BMI) and colorectal cancer (CRC) has been confirmed and gained attention. However, a detailed understanding of the disease burden of high BMI and CRC remains lacking.
Objective
This study aimed to assess the temporal and geographical trends of CRC deaths and disability-adjusted life years (DALYs) caused by high BMI globally from 1990 to 2021, providing effective guidance for developing prevention and treatment strategies.
Methods
We used data from the 2021 Global Burden of Disease study to assess the global, regional, and national Deaths, DALYs, age-standardized mortality rate (ASMR), and age-standardized DALY rates (ASDR) caused by CRC related to high BMI, and further calculated the estimated annual percentage change (EAPC). We also considered factors such as gender, age, and sociodemographic index (SDI). We explore the relationship between EAPC and ASMR/ASDR (1990) and between EAPC and SDI (2021). Further, the autoregressive integrated moving average (ARIMA) model was applied to predict the disease burden from 2022 to 2035. The risk factors were calculated by Population Attributable Fraction (PAF).
Results
In 2021, CRC caused by high BMI resulted in 99,268 deaths (95% Uncertainty Interval (UI): 42,956–157,949) and 2,364,664 DALYs (95% UI: 1,021,594–3,752,340) globally, with ASMR and ASDR being 1.17 per 100,000 population (95% UI: 0.51–1.87) and 27.33 per 100,000 population (95% UI: 11.8–43.37), respectively. The disease burden was higher in males and the elderly, with significant differences between regions and sociodemographic groups. From 1990 to 2021, the ASMR for CRC associated with high BMI revealed little change globally, while the ASDR revealed an upward trend. The burden of CRC caused by high BMI has shifted from high SDI regions to low and low-middle SDI regions. Additionally, from 2022 to 2035, ASMR and ASDR are expected to increase in males, while ASMR and ASDR in females are expected to remain relatively stable.
Conclusion
From 1990 to 2021, the number of deaths and DALYs related to high BMI-associated CRC globally, as well as ASMR and ASDR, continue to rise. We predict that ASMR and ASDR may further increase by 2035, making it crucial to take timely and targeted interventions.
Background
Plant-based diets have been found to be associated with hypertension. Dietary intake is a dynamic and changing process that can be better characterized by trajectories of dietary indices. However, the associations between plant-based diet trajectories and hypertension over time remained unknown.
Methods
We used data from the China Health and Nutrition Survey 2004–2015 to analyze a cohort of Chinese adults ≥ 18 years of age who had no hypertension at baseline. Plant-based diets were measured by an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) based on three 24-hour recalls. Trajectories of PDI, hPDI, and uPDI (2004 to 2011) were identified using group-based trajectory modeling. The associations between trajectories of PDIs and the risk of new-onset hypertension were estimated using Cox proportional hazard models.
Results
We identified three trajectories for PDI, two for hPDI, and four for uPDI among the 2853 participants with a mean follow-up of 9.6 years. Compared with the PDI “low and stable” class, the PDI “high and decreasing” class had a 23% decreased risk (HR: 0.77; 95% CI: 0.62–0.95) of hypertension. There was no significant association with PDI “low and increasing” class. Compared with the hPDI “low and stable” class, the hPDI “high and stable” class had a 24% decreased risk (HR: 0.76; 95%CI: 0.64–0.91). For uPDI trajectories, compared with the “low and decreasing” class, the “high and increasing,” “high and stable,” and “low and increasing” classes had increased risks of 43% (HR: 1.43; 95% CI: 1.06–1.94), 77% (HR: 1.77; 95% CI: 1.26–2.49), and 72% (HR: 1.72; 95% CI: 1.26–2.33), respectively.
Conclusions
This study underscores the importance of maintaining high intakes of healthful plant-based diets and low intakes of unhealthful plant-based diets overtime for hypertension prevention.
Background
Given the increasing global prevalence of obesity, the International Liaison Committee on Resuscitation (ILCOR) commissioned this scoping review to explore current evidence underpinning treatment and outcomes of obese patients (adult and children) in cardiac arrest.
Methods
This scoping review, conducted using Arksey and O’Malley’s framework and reported according to PRISMA-ScR guidelines, included studies of CPR in obese patients. ‘Obese’ was defined according to each individual study. Medline, EMBASE and Cochrane were searched from inception to 1 October 2024. Narrative synthesis was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines.
Results
36 studies were included: 2 paediatric and 34 adult studies. Fourteen studies reported on out-of-hospital cardiac arrest (OHCA), 12 on in-hospital cardiac arrest (IHCA), eight on both OHCA and IHCA: cardiac arrest location was not reported in two studies. The most common outcomes were survival (n = 29), neurological outcome (n = 17) and ROSC (n = 7). In adults there were variable results in neurological outcome, survival to hospital discharge, longer term survival (months to years), and ROSC. In children, there were two studies suggesting that obese children had worse neurological outcomes, lower survival and lower ROSC than normal weight children. Few studies reported resuscitation quality indicators or techniques, and no studies reported adjustments to CPR techniques.
Conclusion
The variability in results does not suggest an urgent need to deviate from standard CPR protocols, however there was some evidence that CPR duration may be longer in obese adults, which may have staffing and resource implications.
The interaction between major depressive disorder (MDD) and overweight/obesity has received considerable attention owing to its widespread occurrence and the intricate biopsychological implications involved. Despite extensive research, the neural mechanisms underlying these comorbid conditions, particularly in terms of functional network connectivity (FNC), are still not well understood. This study aimed to clarify these mechanisms by utilizing resting‐state functional magnetic resonance imaging (rs‐fMRI) to examine both static and dynamic FNC. We analyzed data from 57 patients with both MDD and overweight/obesity (MDD‐OW), 57 MDD patients of normal weight (MDD‐NW), and 44 healthy controls, using techniques such as independent component analysis, sliding window analysis, K‐means clustering, and graph theory. In contrast to static FNC, which showed no significant differences, dynamic FNC analysis identified four consistent states across all participants. Both MDD groups demonstrated reduced flexibility in functional coordination among these states and decreased nodal characteristics within the salience network. Notably, the MDD‐OW group displayed enhanced dynamic FNC between the default mode network (DMN) and the executive control network (ECN) during certain states, which was inversely associated with the severity of depressive symptoms. These results highlight the importance of altered dynamic connectivity patterns in individuals with MDD and concurrent overweight/obesity, especially between the DMN and ECN, suggesting their potential utility as biomarkers for depressive states. This research contributes to our understanding of how comorbid overweight/obesity affects brain network dynamics in depressive disorders and provides a basis for targeted therapeutic strategies.
The 6-minute walk test (6MWT) is a well-known instrument for assessing cardiovascular patients’ functional capacity; yet, little is known about its potential as a prognostic marker in the metabolic syndrome (MetS) population. Apart from its main application in determining walking distance, the 6MWT provides insightful information about functional capacity, response to therapy, and diagnostic potential for a wide range of disorders. In this work, we integrated wearable device-collected ECG data for heart-rate variability (HRV) analysis to improve our evaluation of cardiac function in the MetS patient group. Our main objective was to assess, with a wrist-worn device, the respiratory and cardiovascular system exercise tolerance using the 6MWT. We designed an Android-based mobile application for automated signal monitoring and distance measurement to simplify data collecting and analysis. 27 individuals in all, ranging in age from 24 to 79, made up our cohort. Three key indicators were included into HRV analysis: Poincaré metrics, frequency domain, and time domain. We found strong correlations between these 2/3/6 HRV parameters and 6MWT results. The aim of this study was to use HRV analysis to evaluate the functional capacities of MetS patients in comparison to non-MetS people.
Objective
This study aims to explore the combined risk of metabolic syndrome (MetS) and low fat‐free mass (FFM) on an individual's disability‐free survival (DFS). Disability is defined as a composite of dementia, physical disability, and mortality.
Methods
Using data from the Korean Genome and Epidemiology Study, we divided 3721 participants aged 40–69 years based on their MetS status and FFM index (FFMI) score. Kaplan–Meier survival analysis and Cox regression were used to analyze differences in DFS between the four groups.
Results
From 108 events, MetS group had significantly shorter DFS than the non‐MetS group regardless of FFMI ( p < 0.0001). After adjusting other potential confounding variables, the MetS group had a higher risk of shortened DFS regardless of FFMI, and the MetS group with low FFMI had a 2.06‐fold increased risk compared to the non‐MetS group with high FFMI ( p < 0.001). Older age and lower income were also associated with higher risk of shorter DFS ( p < 0.001).
Conclusions
The combination of MetS and low FFMI contribute to a cumulative risk of shortened DFS. Community nurses can perform MetS screening and body composition assessment to predict and control the risk of developing disability over time.
Objective
Allergic rhinitis (AR) is a prevalent inflammatory condition of the nasal mucosa, with significant burden worldwide. While studies have demonstrated a relationship between body mass index (BMI) and other atopic diseases, its association with AR is uncertain. This study aims to clarify the association between non‐normal BMI and AR.
Design
According to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) recommendations, independent authors screened studies for eligibility, extracted data and assessed bias of included studies using the Newcastle–Ottawa scale and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. A random‐effects meta‐analysis was used to pool maximally covariate‐adjusted estimates. Additional subgroup and bias analyses were performed.
Data Sources
PubMed, Embase, Cochrane Library, SCOPUS and CINAHL were searched from inception to 14 January, 2024.
Eligibility Criteria
Observational studies investigating the association between non‐normal BMI and AR in both children and adults.
Results
We included 32 articles comprising 2,008,835 participants. The risk of bias was low ( N = 20) or moderate ( N = 12) and GRADE certainty of evidence was very low to low. Pooled cross‐sectional analyses indicated that obese children (OR = 0.99, 95% CI = 0.96–1.03, I ² = 0%), obese adults (OR = 1.11, 95% CI = 0.92–1.33, I ² = 73%), overweight children (OR = 1.02, 95% CI = 0.98–1.06, I ² = 35%), and overweight adults (OR = 1.13, 95% CI = 0.90–1.40, I ² = 0%) showed similar odds of AR compared to controls. Additionally, longitudinal analyses did not identify any evidence for an association between overweight (OR = 1.03, 95% CI = 0.85–1.24, I ² = 29%) or underweight (OR = 1.09, 95% CI = 0.77–1.54, I ² = 72%) children and AR risk. These results remained largely robust across various subgroups and sensitivity assessments.
Conclusion
Abnormal BMI may not be associated with AR. This study adds to the expanding literature on the association between non‐normal BMI and atopic diseases. Further prospective studies are needed to explore the longitudinal relationship between BMI and AR and the effect of weight loss interventions on AR, given the limits of existing literature.
Trial Registration
PROSPERO CRD42024503589
Background
In Kazakhstan the pediatric population levels of obesity based on fat mass (FM) assessment are currently unknown. The present work aimed to assess average childhood FM levels and the prevalence of high levels of adiposity (based upon FM levels).
Methods
Cross‐sectional data from 2015 to 2020 nationally representative Childhood obesity surveillance initiative and 2022 regional surveys were used for this study of children aged 8 years (n = 4770) and 9 years (n = 3863). Childhood FM assessment was made using a validated prediction model using height, weight, age, sex and ethnicity. Average levels of FM, fat mass percent (FM%) and the prevalence of overfat and obesity were estimated.
Results
Amongst 8‐year‐olds, the population average FM% was 32.3% (95% CI: 31.7%–32.8%) for boys and 35.2% (95% CI: 34.8–35.6) for girls (2015) and 32.7% (95% CI: 32.3–33.1) for boys and 35.1% (95% CI: 34.7–35.5) for girls in 2020. The Almaty region had the average FM% 32.7% (95% CI: 32.1–33.2) and 34.8% (95% CI: 34.3–35.4) for boys and girls respectively in 2022. The similar pattern was observed for 9 year old children.
Conclusions
The present study reveals high FM% levels in primary school age children from Kazakhstan across study years. Understanding patterns of FM levels is important for preventing and addressing childhood obesity.
Background
The double burden of malnutrition (DBM), which involves both undernutrition and overweight/obesity, has become a significant global health concern. Significant research gaps exist in understanding the prevalence and trends of DBM among mother–child pairs in South and Southeast Asia, as existing studies frequently concentrate on single countries or specific populations. Therefore, the objective of this study is to estimate the prevalence and trends of DBM by utilising the most updated nationally representative data from four selected countries in these regions.
Methods
We analyzed cross-sectional, nationally representative secondary data from the Demographic and Health Survey, conducted from 2004 to 2022. The survey included households with at least one mother–child pair for Bangladesh, Cambodia, Nepal, and Timor-Leste. Using survey weights, we calculated the weighted prevalence of household level DBM, underweight children (< 5 years old), and overweight mothers () for each country. Using chi-square tests, we investigated associations between DBM prevalence and factors such as wealth index, place of residence, and child sex. We assessed socioeconomic disparities using odds ratios obtained from a multivariable logistic regression model.
Results
The prevalence of DBM at household level in Bangladesh rose from 4 in 2004 to 13.8% in 2018, with underweight children decreasing from 47.6 to 21.5% and overweight or obese mothers increasing from 11.6 to 42.3%. We observed similar trends in Cambodia (DBM prevalence: 7.4% in 2005 to 14.3% in 2022; underweight child: 28.3% in 2005 to 16.5% in 2022; overweight/obese mother: 18.6% in 2005 to 48.8% in 2022), Nepal (DBM prevalence: 5.6% in 2006 to 12.3% in 2022; underweight child: 38.6% in 2006 to 19% in 2022; overweight/obese mother: 14.4% in 2006 to 48.7% in 2022), and Timor-Leste (DBM prevalence: 9.4% in 2009 to 15.8% in 2016; underweight child: 44.1% in 2009 to 40.8% in 2016). In all four nations, households with a higher socioeconomic level (richest) consistently had a higher likelihood of developing DBM (odds ratio > 1) compared to households with a lower socioeconomic status (poorest). Furthermore, mother–child pairs living in rural regions had a lower likelihood of developing DBM compared to urban settings.
Conclusion
DBM is on the rise in households across South and South-east Asian nations, particularly in urban areas and among richest households. Despite several improvements in reducing underweight prevalence, persistent undernutrition remains a significant challenge in the region. Simultaneously, the rising prevalence of obesity is a growing concern. Future research should prioritise identifying country-specific risk factors of DBM and understanding factors contributing to the high prevalence of maternal overweight.
Background
Whether the progression of precursor lesions or the occurrence of cancer is influenced by lifestyle factors in carriers of genetic mutations has not been fully investigated, especially in Asian patients of hereditary colorectal cancer (CRC) syndrome.
Methods
Patients at a high risk of hereditary CRC were included. For polyposis CRC syndromes, colorectal polyp burden was measured using at least 60 images per colonoscopy in each patient and classified into five stages using the International Society for Gastrointestinal Hereditary Tumours staging system according to the polyp number and size. Increase in tumor burden stage for polyposis CRC syndrome and the occurrence of CRC or any cancer for Lynch syndrome were analyzed according to lifestyle factors.
Results
Ninety‐six patients with suspected hereditary polyposis CRC syndrome and 106 patients with Lynch syndrome were recruited. For polyposis CRC syndromes, multivariate analysis showed that exposure to smoking and > 100 polyps independently predicted a high risk of increased polyp burden ( p = 0.008 and p = 0.012, respectively). Significant genetic mutations or phenotype of polyposis syndromes were significantly associated with an increased polyp burden. For Lynch syndrome, smokers showed to be diagnosed with CRC in younger age than never‐smokers (42.2 years vs. 49.0 years; p = 0.021), and heavy drinkers had high risk for occurrence of CRC (HR, 2.381, 95% CI, 1.338–4.236; p = 0.003) and any cancer (HR, 2.254; 95% CI, 1.334–3.806; p = 0.002).
Conclusions
The lifestyle factors (smoking and alcohol consumption) were associated with increasing precursor lesions and occurrence of cancer in patients with hereditary CRC syndrome. Lifestyle modifications may reduce the risk of hereditary CRC in carriers.
Modifiable risk factors associated with cognitive functioning are important for identifying potential targets for intervention development. Although there are a few recognized modifiable risk factors (e.g., diabetes mellitus, diet, physical activity), there are limitations in the conclusions that can be drawn due to limited data. Therefore, this study examined the relationship between modifiable liver disease-linked metabolic and behavioral factors in a sample of community dwelling adults who do not currently experience functional limitations due to cognitive abilities. Individuals aged 19 to 69 were recruited to participate in this cross-sectional study in the Washington, DC area. Participants were assessed using anthropometric measures, ultrasound of the liver, glycated hemoglobin A1C, self-reported fatigue, clinical history, and 7 domains of cognitive function: processing speed, short- and long-term visual memory, working memory, inhibition, shifting, and abstract reasoning. The study included 104 participants (44% female, 51.1 ± 13.5 years old). The modifiable factors that were most consistently related to cognitive performance were waist-to-height ratio, which was related to a decrease in performance in 4 of the domains (short-term and long-term visual memory, working memory, and abstract reasoning), and the presence of nonalcoholic fatty liver disease, which was related to an increase in performance in the same 4 domains. This study suggests that liver disease-linked modifiable factors are associated with cognitive performance, even in middle-aged individuals without self-reported cognitive dysfunction. Further research is needed to explore the mechanisms that impact cognitive performance in relation to these factors to establish early intervention targets for reducing future cognitive deficits.
Objectives
This study aimed to assess the association between obesity or changes in body mass index (BMI) and the risk of RA considering the abdominal obesity status.
Methods
We included individuals aged 23 to 60 who underwent a national health examination in 2012–2013 (baseline) and four years prior. Obesity was defined by a BMI ≥ 25 kg/m². The change in BMI over 4 years was divided into quartiles. Cox proportional hazard analysis was performed to assess the association of obesity and BMI change with the risk of RA.
Results
A total of 6,207,246 subjects were included, and 7,859 incident cases of RA were identified. Obesity was associated with a reduced risk of RA in males (HR 0.78, 95% CI 0.71–0.85) and females (HR 0.91, 95% CI 0.85–0.97). In subgroup analysis according to abdominal obesity status, the associations were observed for obesity with normal waist circumference (WC) in males (HR 0.75, 95% CI 0.67–0.84) and females (HR 0.88, 95% CI 0.81–0.95). In terms of BMI change, compared to the stable BMI group (quartile 2), the third (HR 0.92, CI 0.85–0.99) and highest quartile (HR 0.89, CI 0.83–0.96) showed an inverse association with the risk of RA in females, particularly in those with normal WC.
Conclusion
Obesity was associated with a lower risk of RA, especially among individuals with a normal WC. Increased BMI was also associated with a lower risk of RA, but this association was mainly observed in females and specifically for those with normal WC.
Timing of food intake is an emerging aspect of nutrition; however, there is a lack of research accurately assessing food timing in the context of the circadian system. The study aimed to investigate the relation between food timing relative to clock time and endogenous circadian timing with adiposity and further explore sex differences in these associations among 151 young adults aged 18–25 years. Participants wore wrist actigraphy and documented sleep and food schedules in real time for 7 consecutive days. Circadian timing was determined by dim-light melatonin onset (DLMO). The duration between last eating occasion and DLMO (last EO-DLMO) was used to calculate the circadian timing of food intake. Adiposity was assessed using bioelectrical impedance analysis. Of the 151 participants, 133 were included in the statistical analysis finally. The results demonstrated that associations of adiposity with food timing relative to circadian timing rather than clock time among young adults living in real-world settings. Sex-stratified analyses revealed that associations between last EO-DLMO and adiposity were significant in females but not males. For females, each hour increase in last EO-DLMO was associated with higher BMI by 0·51 kg/m2 (P = 0·01), higher percent body fat by 1·05 % (P = 0·007), higher fat mass by 0·99 kg (P = 0·01) and higher visceral fat area by 4·75 cm2 (P = 0·02), whereas non-significant associations were present among males. The findings highlight the importance of considering the timing of food intake relative to endogenous circadian timing instead of only as clock time.
Introduction: Chronic venous insufficiency (CVI) is a condition that the function of venous system is impaired due to insufficiency of venous valves. The prolonged periods of standing or sitting is considered the most crucial risk factor of CVI. This study aims to determine the prevalence and associated factors of CVI among seafood processing workers. Methods: A cross-sectional study was conducted through clinical examination and face-to-face interviews with 1160 seafood processing workers in Hai Phong from March to November in 2023 to assess the prevalence and associated factors to CVI. Results: The prevalence of CVI was 51.9%; the prevalent symptom was restless legs (54.0%); nocturnal cramps (49.3%); tight feeling in calves (43.2%); pins and needles (36.4%); edema lower legs (28.6%). Of all participants 4.1% were C0, 82.9% were C1, 11.0% were C2 and 2.0% were C3. Some factors associated with CVI: female (OR = 2.51, p=0.002); advanced age; prolonged periods of standing or sitting (OR = 2.08, p=0.001); overweight and obesity (OR =1.82, p=0.037); Abdominal obesity (OR =2.11, p=0.025); diabetes (OR = 1.95, p=0.045); hypertension (OR =2.59, p=0.004); gave birth to 2 and 3 children (OR = 1.78 and 2.35, p=0.002); working time over 8 hours per day (OR =3.87, p<0.001). Conclusion: CVI is a disease with high incidence in seafood processing workers. On average, 1 of 2 workers have varicose veins. To prevent CVI, it is crucial to recommend workers exercise between shifts or breaks, have regular health check-ups to detect signs and symptoms of CVI.
Importance
Physical activity (PA) guidelines recommend the same amount of PA through adulthood to live longer.
Objective
To explore whether there is an age-dependent association between PA and all-cause mortality and to investigate the age-dependent associations between other modifiable health factors (high educational level, not smoking, not regularly consuming alcohol, healthy body weight, and living without hypertension and diabetes) and mortality.
Design, Setting, and Participants
This cohort study used a pooled analysis of 4 population-based prospective cohorts (National Health Interview Survey, 1997-2018; UK Biobank, 2006-2010; China Kadoorie Biobank, 2004-2008; and Mei Jau, 1997-2016). Data were analyzed from June 2022 to September 2024.
Exposures
Self-reported leisure-time PA.
Main Outcomes and Measures
The primary outcome was deaths identified through follow-up linkage to national death registries. Analyses were performed for the total sample and by age groups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and ≥80 years). Cox proportional hazards regression models with stratification by study were used to calculate mortality hazard ratios and their 95% CIs for the pooled dataset and by age group.
Results
A heterogeneous sample of 2 011 186 individuals (mean [SD] age, 49.1 [14.3] years; age range, 20-97 years; 1 105 581 women [55.0%]) were included. After a median (IQR) follow-up of 11.5 (9.3-13.5) years, 177 436 deaths occurred. The association between PA and mortality in the total sample showed a nonlinear dose-response pattern, but age modified this association ( P for interaction <.001); PA was consistently associated with a lower risk of mortality across all age groups, but the reduction in risk was greater in older vs younger age groups, especially at high levels of PA. The hazard ratio for mortality associated with meeting the recommended PA in the total sample was 0.78 (95% CI, 0.77-0.79). This inverse association between meeting PA recommendations and mortality was somewhat greater as age increased ( P for interaction <.001). Age also modified the associations of the other modifiable health factors with mortality (all P for interaction <.001), but the magnitude of associations was greater in younger vs older age groups.
Conclusions and Relevance
In this pooled analysis of cohort studies, the association between PA and mortality risk remained consistent across the adult lifespan, which contrasts with other modifiable health factors, for which associations with mortality risk diminished with age. Given these findings, the promotion of regular PA is essential at all stages of adult life.
This study analysed data collected from 995 adults aged 18 years and above in Bangladesh. The analysis was performed to identify the variables responsible for the prevalence of retinopathy in obese-diabetic adults. There were 30.2% obese adults, 67.0% diabetic patients, and 12.4% patients with retinopathy. All these non-communicable diseases were noted in 4.7% of the adults. The same rate was also noted in males and females also. A higher prevalence rate was found in secondary educated adults (7.6%), adults of families of upper medium income (9.8%), adults of optimum blood pressure (6.3%), and patients with diabetes for longer periods (12.7%). The risks of prevalence for secondary educated adults, adults belonging to upper medium income groups of families, adults with optimum blood pressure, and diabetic patients of longer duration were 1.99, 2.24, 2.20, and 3.08 times, respectively. All 4.7% of the patients were obese. Logistic regression analysis revealed that age, smoking habits, blood pressure, body mass index, and duration of diabetes were the identified variables responsible for the prevalence of retinopathy in obese-diabetic adults.
Background
Metabolic syndrome (MetS) and coronary artery stenosis (CAS) independently increase the risk of cardiovascular events, while the impact of CAS on left ventricular (LV) function and deformation in MetS patients remains unclear. This study investigates how varying degrees of CAS exacerbate LV function and myocardial deformation in MetS patients.
Methods
One hundred thirty-one MetS patients who underwent CMR examinations were divided into two groups: the MetS(CAS−) group (n = 47) and the MetS(CAS+) group (n = 84). The MetS(CAS+) group was divided into MetS with non-obstructive CAS(NOCAS+) (n = 30) and MetS with obstructive CAS(OCAS+) group (n = 54). Additionally, 48 age- and sex-matched subjects were included as a control group. LV functional and deformation parameters were measured and compared among subgroups. The determinants of decreased LV global peak strains in all MetS patients were identified using linear regression. The receiver operating characteristic (ROC) curve and logistic regression model (LRM) evaluated the diagnostic accuracy of the degree of CAS for identifying impaired LV strain.
Results
Compared to MetS(CAS−), MetS(NOCAS+) showed a significantly increased LV mass index (p < 0.05). Global longitudinal peak strain was decreased gradually from MetS(CAS−) through MetS(NOCAS+) to MetS(OCAS+) (− 13.02 ± 2.32% vs. − 10.34 ± 4.05% vs. − 7.55 ± 4.48%, p < 0.05). MetS(OCAS+) groups showed significantly decreased LV global peak strain (GPS), PSSR and PDSR in radial and circumferential directions compared with MetS(NOCAS+) (all p < 0.05). The degree of CAS was independently associated with impaired global radial peak strain (GRPS) (β = − 0.289, p < 0.001) and global longitudinal peak strain (GLPS) (β = 0.254, p = 0.004) in MetS patients. The ROC analysis showed that the degree of CAS can predict impaired GRPS (AUC = 0.730) and impaired GLPS (AUC = 0.685).
Conclusion
Besides traditional biochemical indicators, incorporating CAS assessment and CMR assessment of the LV into routine evaluations ensures a more holistic approach to managing MetS patients. Timely intervention of CAS is crucial for improving cardiovascular outcomes in this high-risk population.
Background
Etonogestrel and levonorgestrel implants are effective for 3 and 5 years of contraception, respectively. The removal of contraceptive implants before the due date, also known as implant early discontinuation, contributes to unplanned pregnancies, which can lead to unfavourable reproductive health outcomes, especially in adolescents. We aimed to assess the magnitude of early implant discontinuation among those who initiated the method at our hospital, and to compare this rate between adolescents and adults.
Methods
This retrospective cohort study reviewed the medical records of participants who initiated contraceptive implants from January 2014 to December 2019 at King Chulalongkorn Memorial Hospital. Early discontinuation was defined as the removal of implants prior to the due date. Cox proportional hazard regression analysis was performed to identify factors associated with early discontinuation.
Results
Our analysis included 1,435 participants, 409 of whom were adolescents. Levonorgestrel implants were used by 53.3% of the participants(68.7% and 47.1% of adolescents and adults, respectively); the remainder used etonogestrel implants. The total early discontinuation rate was 19.3%, which was comparable between the two implant types. The most common reason for discontinuation was intolerance of side effects, with abnormal bleeding being the most frequent. Adolescents were less likely to discontinue implants early (HR 0.72, 95% CI = 0.55–0.95). Factors significantly associated with decreased early discontinuation were: free-of-charge implants (HR 0.75, 95% CI = 0.58–0.95), continuous users of implants (HR 0.56, 95% CI = 0.36–0.86), postpartum status during implant initiation (HR 0.77, 95% CI = 0.60–0.98), and participants with children (HR 0.77, 95% CI = 0.60–0.99).
Conclusion
Compared with adults, adolescents were less likely to discontinue contraceptive implants before the due date. Participants who received free implants, continuous users who had previously used implants, postpartum insertion, and having children were associated with less early discontinuation. Our findings supports continued government funding for free implants in Thailand.
This article summarizes and compares 18 sets of guidelines for adult obesity treatment, highlighting key recommendations for patient evaluation, lifestyle intervention, anti-obesity medications (AOMs), and metabolic and bariatric surgery. Guidelines are consistent in many regards, although there is divergence regarding preferred AOMs. Metabolic and bariatric surgery is still recognized as the most durable form of obesity treatment, and newer guidelines suggest these procedures at lower BMI thresholds for people with uncontrolled type 2 diabetes. Overall, guidelines for obesity treatment show a high degree of agreement, although updates are needed to incorporate new treatment innovations.
Background
Over the past several decades, the overweight and obesity epidemic in the USA has resulted in a significant
health and economic burden. Understanding current trends and future trajectories at both national and state levels is
crucial for assessing the success of existing interventions and informing future health policy changes. We estimated
the prevalence of overweight and obesity from 1990 to 2021 with forecasts to 2050 for children and adolescents (aged
5–24 years) and adults (aged ≥25 years) at the national level. Additionally, we derived state-specific estimates and
projections for older adolescents (aged 15–24 years) and adults for all 50 states and Washington, DC.
Methods
In this analysis, self-reported and measured anthropometric data were extracted from 134 unique sources,
which included all major national surveillance survey data. Adjustments were made to correct for self-reporting bias. For
individuals older than 18 years, overweight was defined as having a BMI of 25 kg/m² to less than 30 kg/m² and obesity
was defined as a BMI of 30 kg/m² or higher, and for individuals younger than 18 years definitions were based on
International Obesity Task Force criteria. Historical trends of overweight and obesity prevalence from 1990 to 2021 were
estimated using spatiotemporal Gaussian process regression models. A generalised ensemble modelling approach was
then used to derive projected estimates up to 2050, assuming continuation of past trends and patterns. All estimates
were calculated by age and sex at the national level, with estimates for older adolescents (aged 15–24 years) and adults
aged (≥25 years) also calculated for 50 states and Washington, DC. 95% uncertainty intervals (UIs) were derived from the
2·5th and 97·5th percentiles of the posterior distributions of the respective estimates.
Findings
In 2021, an estimated 15·1 million (95% UI 13·5–16·8) children and young adolescents (aged 5–14 years),
21·4 million (20·2–22·6) older adolescents (aged 15–24 years), and 172 million (169–174) adults (aged ≥25 years) had
overweight or obesity in the USA. Texas had the highest age-standardised prevalence of overweight or obesity for male
adolescents (aged 15–24 years), at 52·4% (47·4–57·6), whereas Mississippi had the highest for female adolescents
(aged 15–24 years), at 63·0% (57·0–68·5). Among adults, the prevalence of overweight or obesity was highest in North
Dakota for males, estimated at 80·6% (78·5–82·6), and in Mississippi for females at 79·9% (77·8–81·8). The
prevalence of obesity has outpaced the increase in overweight over time, especially among adolescents. Between
1990 and 2021, the percentage change in the age-standardised prevalence of obesity increased by 158·4% (123·9–197·4)
among male adolescents and 185·9% (139·4–237·1) among female adolescents (15–24 years). For adults, the percentage
change in prevalence of obesity was 123·6% (112·4–136·4) in males and 99·9% (88·8–111·1) in females. Forecast
results suggest that if past trends and patterns continue, an additional 3·33 million children and young adolescents
(aged 5–14 years), 3·41 million older adolescents (aged 15–24 years), and 41·4 million adults (aged ≥25 years) will have
overweight or obesity by 2050. By 2050, the total number of children and adolescents with overweight and obesity will
reach 43·1 million (37·2–47·4) and the total number of adults with overweight and obesity will reach 213 million
(202–221). In 2050, in most states, a projected one in three adolescents (aged 15–24 years) and two in three adults
(≥25 years) will have obesity. Although southern states, such as Oklahoma, Mississippi, Alabama, Arkansas, West
Virginia, and Kentucky, are forecast to continue to have a high prevalence of obesity, the highest percentage changes
from 2021 are projected in states such as Utah for adolescents and Colorado for adults.
Interpretation
Existing policies have failed to address overweight and obesity. Without major reform, the forecasted
trends will be devastating at the individual and population level, and the associated disease burden and economic
costs will continue to escalate. Stronger governance is needed to support and implement a multifaceted whole-system
approach to disrupt the structural drivers of overweight and obesity at both national and local levels. Although clinical
innovations should be leveraged to treat and manage existing obesity equitably, population-level prevention remains
central to any intervention strategies, particularly for children and adolescents.
Aims
To investigate (1) the association between maternal dietary choices during the first and second trimesters and the diagnosis of gestational diabetes mellitus (GDM), (2) the association between a GDM diagnosis and dietary choices during pregnancy, and (3) the differences in pregnancy outcomes between individuals with and without GDM.
Methods
A prospective cohort study. Pregnant individuals with singleton pregnancy aged 19 ∼ 44 years, without severe pregnancy complications were enrolled in the study. Dietary data were collected at three time points during routine antenatal appointments: 8 ∼ 12 weeks gestation(n = 993), 20 ∼ 24 weeks gestation(n = 732), and 32 ∼ 36 weeks gestation(n = 536). GDM diagnosis and pregnancy outcomes were collected during follow-up from the electronic medical record (EMR).
Results
A total of 93 participants (12.9%) were diagnosed with GDM. Livestock and poultry meat intake during the second trimester were associated with an increased risk of developing GDM (aOR 1.371, 95%CI 1.070–1.756, P = 0.013), and a GDM diagnosis may lead to decreased intake of cereals and its products (P = 0.001), potatoes and its products (P < 0.001), and fruit (P = 0.002) and increased intake of fish, shrimp and shellfish (P = 0.001), eggs (P = 0.015), and milk and milk products (P = 0.011) in the third trimester. Individuals with GDM related to lower risk of excessive gestational weight gain (aOR 0.384, 95%CI 0.188–0.646, P = 0.001) but may increase the risk of fetal macrosomia (aOR 3.873, 95%CI 1.364–10.996, P = 0.011).
Conclusions
Understanding maternal dietary choices around GDM diagnosis is crucial for accurate nutritional assessment and effective education programs. While our findings suggest dietary changes may occur post-diagnosis, further research is needed to confirm these patterns and the potential benefits of early dietary counseling for individuals with GDM.
Background
Varied demands and stressors experienced by clergy can contribute adversely to their overall well-being. Data from United Methodist Church (UMC) clergy in North Carolina in 2008 revealed that clergy had significantly higher non-communicable disease (NCD) rates than their fellow North Carolinians.
Methods
Using data from the Clergy Health Initiative and Behavioral Risk Factor Surveillance Survey, the present study provided an updated analysis of obesity and 6 other NCDs among North Carolina UMC clergy compared to the general North Carolina population. First, we described the prevalence of each health condition among North Carolina UMC clergy and the general North Carolina population across multiple waves from 2008 to 2021. Then, we compared the predicted probabilities of each health condition in 2021 using logistic regressions to adjust for age, sex, and race.
Results
Comparing the unadjusted prevalence of health conditions between 2008 and 2021, we found that North Carolina UMC clergy have higher rates of obesity, hypertension, hypercholesterolemia, diabetes, angina, arthritis, and asthma than North Carolinians overall. Adjusting for age, sex, and race, we found that significantly higher rates of obesity, severe obesity, hypercholesterolemia, and asthma persisted among UMC clergy in 2021 compared to all North Carolinians, with the higher rates of severe obesity being particularly concerning.
Limitations
While the current study is limited to an update of health prevalence among UMC clergy, pastors across denominations are influential leaders in their communities, shaping the physical and social health environments of their congregations.
Conclusions
Further research is needed to investigate risk factors, such as relocation and adverse childhood experiences, which may influence the higher prevalence of NCDs within and potentially beyond the UMC.
Background and Aim
Globally, diabetes mellitus is a major public health concern affecting 10.5% of the population. Nearly 90% of these people have Type 2 diabetes mellitus (T2DM). In Bhutan, T2DM is prevalent in 5.6% of the population, and around 60% are unaware of their diagnosis of diabetes. There is no baseline information on the rate and the risk factors for complications of diabetes in Bhutan. The study assessed the clinical profile and the risk factors for complications of T2DM at the Jigme Dorji Wangchuk (JDW) National Referral Hospital, Bhutan.
Methods
A descriptive cross‐sectional study was conducted at the JDW National Referral Hospital, Bhutan, from January to December 2019. Patients with T2DM attending diabetic clinics were included in the study. Demographic variables and metabolic profiles were recorded using a standard pro forma. Descriptive statistics were used to express the results. The association of clinical profiles with the microvascular complication was assessed using multivariate logistic analysis with statistical significance at p < 0.05.
Results
There were 292 patients with T2DM during the study period. The rate of microvascular complication is around 25% in T2DM. Among the complications, diabetic retinopathy occurred in over 51%, followed by neuropathy (29.7%) and nephropathy (18.9%). Over 1/3rd of patients had a duration of diabetes over 10 years with a mean duration of 6.3 (5.4) years, and around 44% (127/292) of them had poor glycemic control (HbA1C ≥ 7%). The age ≥ 60 years and the duration of diabetes ≥ 10 years were independent risk factors for microvascular complications in T2DM patients. Regular exercise prevents retinopathy (OR 0.4, 95%CI 0.2–0.9, p = 0.026).
Conclusion
There is a microvascular complication in 1 in 4 of type 2 diabetic patients. Age over 60 years and a duration of diabetes of more than 10 years are independent risk factors for microvascular complications, and regular exercise is preventive for microvascular complications.
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