Body Mass Index and Waist Circumference Cut-Points in Multi-Ethnic Populations from the UK and India: The ADDITION-Leicester, Jaipur Heart Watch and New Delhi Cross-Sectional Studies

Danielle H Bodicoat,Laura J Gray,David Webb,Anoop Misra,Melanie J Davies,Naveed Sattar,Arvind Guru,Kamlesh Khunti,Rajeev Gupta,Joseph Henson,Naval Vikram

doi:10.1371/journal.pone.0090813

Abstract

AimsTo derive cut-points for body mass index (BMI) and waist circumference (WC) for minority ethnic groups that are risk equivalent based on endogenous glucose levels to cut-points for white Europeans (BMI 30 kg/m2; WC men 102 cm; WC women 88 cm).Materials and MethodsCross-sectional data from participants aged 40–75 years: 4,672 white and 1,348 migrant South Asian participants from ADDITION-Leicester (UK) and 985 indigenous South Asians from Jaipur Heart Watch/New Delhi studies (India). Cut-points were derived using fractional polynomial models with fasting and 2-hour glucose as outcomes, and ethnicity, objectively-measured BMI/WC, their interaction and age as covariates.ResultsBased on fasting glucose, obesity cut-points were 25 kg/m2 (95% Confidence Interval: 24, 26) for migrant South Asian, and 18 kg/m2 (16, 20) for indigenous South Asian populations. For men, WC cut-points were 90 cm (85, 95) for migrant South Asian, and 87 cm (82, 91) for indigenous South Asian populations. For women, WC cut-points were 77 cm (71, 82) for migrant South Asian, and 54 cm (20, 63) for indigenous South Asian populations. Cut-points based on 2-hour glucose were lower than these.ConclusionsThese findings strengthen evidence that health interventions are required at a lower BMI and WC for South Asian individuals. Based on our data and the existing literature, we suggest an obesity threshold of 25 kg/m2 for South Asian individuals, and a very high WC threshold of 90 cm for South Asian men and 77 cm for South Asian women. Further work is required to determine whether lower cut-points are required for indigenous, than migrant, South Asians.

Highlights

There is an extensive literature showing that high levels of adiposity are related to morbidity and mortality
This has resulted in leading health organisations recommending weight loss interventions for obese individuals, who are typically identified using body mass index (BMI) and/or waist circumference (WC) as both measures are strongly correlated with body fat and are simple to measure [1,2]
Of the participants screened in the ADDITION-Leicester study (n = 6749; response rate = 22%), we excluded from these analyses those who were younger than 40 years of age (n = 359), those whose ethnic group was unknown (n = 203) or was not White or South Asian, those whose WC and BMI were missing (n = 8) and those with no fasting or 2-hour glucose data (n = 20)

Summary

Introduction

There is an extensive literature showing that high levels of adiposity are related to morbidity and mortality This has resulted in leading health organisations recommending weight loss interventions for obese individuals, who are typically identified using body mass index (BMI) and/or waist circumference (WC) as both measures are strongly correlated with body fat and are simple to measure [1,2]. The World Health Organisation (WHO) defines the following cutpoints for BMI: ,18.5 kg/m2 underweight, 18.5–24.9 kg/m2 healthy weight, 25.0–29.9 kg/m2 overweight, and $30 kg/m2 obese [1] These cut-points were based on visual inspection of the relationship between BMI and mortality, which tends to be J or U shaped, and guidelines suggest weight loss interventions when BMI reaches at least 25 kg/m2, with a greater focus on 30 kg/m2 or higher [1]. Though both BMI and WC have their limitations, both measures independently contribute to the prediction of nonabdominal, abdominal subcutaneous and visceral fat

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Discussion

Conclusion