Appropriate body mass index cut-offs to determine thinness, overweight and obesity in South Asian children in the Netherlands.

Jeroen A De Wilde,Barend J C Middelkoop,Paula Van Dommelen,Kashish Goel

doi:10.1371/journal.pone.0082822

Abstract

BackgroundAsian populations have an increased risk of developing cardiometabolic disorders at a lower body mass index (BMI) than other ethnic groups. Therefore, lower adult BMI cut-offs to determine overweight and obesity are recommended to assess the associated health risks for Asian (23 and 27.5 kg/m2 respectively) and Asian Indian (23, 25 kg/m2) populations. The objective of this study was to develop BMI cut-offs for thinness, overweight, and obesity for South Asian children in the Netherlands, and to compare the BMI cut-offs and distribution with an Asian Indian reference, the WHO Child Growth Reference, and universal BMI cut-offs.MethodsA reference cohort of 546 Surinamese South Asian boys and 521 girls, born between 1974–1976 (during the pre-obesity era) with 3408 and 3267 BMI measurements respectively, was retrospectively analysed. BMI-for-age charts were created with the LMS method. BMI centile curves passing through the cut-off points of 15 (thinness), 23 (overweight), 25 and 27.5 kg/m2 (obesity) at 18y were drawn as cut-off levels.ResultsThe BMI of Surinamese South Asian children had a similar distribution to the Asian Indian reference, apart from a lower mean and less variation. The BMI distribution differed considerably from the WHO reference and universal BMI criteria. The calculated BMI cut-offs corresponding to a BMI of 15, 23, 25, and 27.5 kg/m2 at 18y were at the 7.1, 81.1, 89.8, and 95.5 percentile respectively in boys, and at the 2.7, 79.5, 89.2, and 95.2 percentile in girls.ConclusionsThis is the first study proposing BMI cut-offs for South Asian children based on measurements from a prosperous population unaffected by the obesity epidemic. We recommend the use of these cut-offs in South Asian children in the Netherlands as these better reflect the health risks associated with thinness, overweight and obesity, and therefore may prevent the development of cardiometabolic disorders.

Highlights

The body mass index (BMI) is generally used as a proxy for estimating the body fat percentage and associated health risks
Over the past decade evidence has emerged that Asian populations are at an increased risk of cardiometabolic disorders at lower BMI levels than other ethnic groups, which has been attributed to a considerably higher body fat percentage [2]
A total of 546 boys with 3408 BMI measurements, and 521 girls with 3267 measurements were included in this study. 2746 measurements were of children aged 0–3 years and 3929 of children 4–18 years

Summary

Introduction

The body mass index (BMI) is generally used as a proxy for estimating the body fat percentage and associated health risks. Over the past decade evidence has emerged that Asian populations are at an increased risk of cardiometabolic disorders at lower BMI levels than other ethnic groups, which has been attributed to a considerably higher body fat percentage [2]. There is evidence that these cutoffs are still too high for South Asian populations which have an increased risk of cardiovascular and metabolic disease risks at an even lower BMI [4,5,6,7]. Asian populations have an increased risk of developing cardiometabolic disorders at a lower body mass index (BMI) than other ethnic groups. Lower adult BMI cut-offs to determine overweight and obesity are recommended to assess the associated health risks for Asian (23 and 27.5 kg/m2 respectively) and Asian Indian (23, 25 kg/m2) populations. The objective of this study was to develop BMI cut-offs for thinness, overweight, and obesity for South Asian children in the Netherlands, and to compare the BMI cut-offs and distribution with an Asian Indian reference, the WHO Child Growth Reference, and universal BMI cut-offs

Objectives

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Conclusion