Association between Obesity and Cardiometabolic Health Risk in Asian-Canadian Sub-Groups

Jason X Nie,Chris I Ardern,David Meyre

doi:10.1371/journal.pone.0107548

Abstract

ObjectivesTo quantify and compare the association between the World Health Organizations’ Asian-specific trigger points for public health action [‘increased risk’: body mass index (BMI) ≥23 kg/m2, and; ‘high risk’: BMI ≥27.5 kg/m2] with self-reported cardiovascular-related conditions in Asian-Canadian sub-groups.MethodsSix cycles of the Canadian Community Health Survey (2001–2009) were pooled to examine BMI and health in Asian sub-groups (South Asians, Chinese, Filipino, Southeast Asians, Arabs, West Asians, Japanese and Korean; N = 18 794 participants, ages 18–64 y). Multivariable logistic regression, adjusting for demographic, lifestyle characteristics and acculturation measures, was used to estimate the odds of cardiovascular-related health (high blood pressure, heart disease, diabetes, ‘at least one cardiometabolic condition’) outcomes across all eight Asian sub-groups.ResultsCompared to South Asians (OR = 1.00), Filipinos had higher odds of having ‘at least one cardiometabolic condition’ (OR = 1.29, 95% CI: 1.04–1.62), whereas Chinese (0.63, 0.474–0.9) and Arab-Canadians had lower odds (0.38, 0.28–0.51). In ethnic-specific analyses (with ‘acceptable’ risk weight as the referent), ‘increased’ and ‘high’ risk weight categories were the most highly associated with ‘at least one cardiometabolic condition’ in Chinese (‘increased’: 3.6, 2.34–5.63; ‘high’: 8.9, 3.6–22.01). Compared to normal weight South Asians, being in the ‘high’ risk weight category in all but the Southeast Asian, Arab, and Japanese ethnic groups was associated with approximately 3-times the likelihood of having ‘at least one cardiometabolic condition’.ConclusionDifferences in the association between obesity and cardiometabolic health risks were seen among Asian sub-groups in Canada. The use of WHO’s lowered Asian-specific BMI cut-offs identified obesity-related risks in South Asian, Filipino and Chinese sub-groups that would have been masked by traditional BMI categories. These findings have implications for public health messaging, especially for ethnic groups at higher odds of obesity-related health risks.

Highlights

Asians currently represent the fastest growing ethnic group in Canada, with South Asians (4.0% of total Canadian population) and Chinese (3.9%) currently ranked as the first and second largest visible minority groups, respectively [1]
Our knowledge of obesity and cardiometabolic health risks has been historically derived from studies of Occidental groups or persons of White European or American ancestry, the assumptions of which may not hold true when applied to other ethnic groups [3,4]
Despite having a lower prevalence of obesity, Asians are known to be at an increased risk of cardiovascular disease (CVD) risk factors compared with those of European descent [4,5,6,7,8,9], a finding that has been attributed at least in part due to differences in body fat distribution and body build and frame size [10,11,12,13,14]

Summary

Introduction

Asians currently represent the fastest growing ethnic group in Canada, with South Asians (4.0% of total Canadian population) and Chinese (3.9%) currently ranked as the first and second largest visible minority groups, respectively [1]. Despite lower mean body mass index (BMI), Asian Americans are 30–50% more likely to have Type 2 Diabetes Mellitus (T2DM) than their White counterparts (6). In this analysis, Asian Indians had the highest odds of prevalent type 2 diabetes, followed by Filipinos, other Asians, and Chinese [6]. Insulin resistance has shown to be higher in Asian Indians, and higher prevalence of metabolic syndrome is seen among Filipino and Japanese compared to other Asian groups [8,21,22,23]

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