International Body Mass Index Cut-offs Research Articles

Assessment of Nutritional Status in Sri Lankan Children: Validity of Current Anthropometry Cutoffs?

Despite socioeconomic improvement, undernutrition rates stagnate in Sri Lanka, while a slow rise in obesity and noncommunicable diseases (NCD) is seen. Inability to improve undernutrition and detection of NCD could be due to overdiagnosing stunting/wasting and underdiagnosing overweight/obesity. Obesity, being a risk factor for NCDs, needs correct tools for early diagnosis. Although body mass index (BMI) is a commonly used surrogate index, the validity of universal cutoffs is questioned. Evidence shows that body composition varies with ethnic origin and cutoff value reflecting fat mass (FM) varies in different ethnic groups. This study was conducted in 12 788, 5- to 15-year-old children from 8 schools in Negombo, Sri Lanka, to identify the validity of current anthropometric cutoffs. Obesity prevalence identified by body fat content was high. International BMI cutoffs had high specificity but varied sensitivity. Locally developed BMI cutoffs had high sensitivity and specificity. Validity of internationally developed anthropometric cutoffs in South Asian children is unsatisfactory; hence, locally/regionally developed anthropometric tools should be used for screening of obesity.

Does the Severity of Obesity Influence Bone Mineral Density Values in Premenopausal Women?

The aim of this study was to compare bone mineral content (BMC), bone mineral density (BMD), and geometric indices of hip bone strength among 3 groups of adult obese premenopausal women (severely obese, morbidly obese, and super morbidly obese). This study included 65 young adult premenopausal women whose body mass index (BMI) > 35 kg/m2. They were divided into 3 groups using international cut-offs for BMI. Body composition and bone variables were measured by DXA. DXA measurements were completed for the whole body (WB), lumbar spine, total hip (TH), and femoral neck (FN). Geometric indices of FN strength (cross-sectional area, cross-sectional moment of inertia [CSMI], section modulus [Z], strength index [SI], and buckling ratio) were calculated by DXA. Results showed that age and height were not significantly different among the 3 groups. WB BMC values were higher in super morbidly obese women compared to severely and morbidly obese women. WB BMD, L1-L4 BMD, total hip BMD, FN BMD, cross-sectional area, CSMI, Z, and buckling ratio values were not significantly different among the 3 groups. SI values were lower in super morbidly obese compared to morbidly and severely obese women. In the whole population (n = 65), body weight, BMI, lean mass, fat mass, and trunk fat mass were positively correlated to WB BMC and negatively correlated to SI. Weight and lean mass were positively correlated to WB BMD and CSMI. Our findings suggest that the severity of obesity does not influence BMD values in premenopausal women.

URIC ACID IS ASSOCIATED WITH CARDIOMETABOLIC RISK FACTORS IN OVERWEIGHT AND OBESE CHILDREN AND ADOLESCENTS

Objective: This study examined the association of serum uric acid (UA) with levels of cardiometabolic risk factors in overweight and moderate obese children and adolescents. Design and method: Three hundred and thirty three Caucasians of both sexes (149 females), of European origin, from 5 to 18 years of age (mean age 11.4 2.6) were included. Overweight and obesity were defined based on the extended international body mass index cut-offs. The subjects were divided into 3 groups according to serum UA: <5 mg/dl n = 118 subjects (35%); UA 5-6 mg/dl n = 130 subjects (39%) or UA>6 mg/dl n = 85 subjects (26%). Fasting blood was obtained and uric acid, glucose, insulin, and lipid profile, were measured. Likewise office BP and 24-hour ABPM were assessed. Hyperinsulinemia was defined from norms for pubertal stage. Abnormal fasting lipids were defined from normative data (Daniels et al, 2008). Subjects were qualified as normotensive, high-normal or hypertensive according to the ESH criteria (Lurbe et al, 2016). Results: There were significant differences among groups regarding, BMI, waist, fasting insulin, office SBP and night-time SBP increasing progressively across the serum UA groups. Controlling by age and sex, uric acid was significantly correlated with BMI (r = 0.27, p = 0.000), waist (r = 0.33; p = 0.000), birth weight (r = −0.11; p = 0.05), office SBP (r = 0.21; p = 0.000), daytime SBP, (r = 0.16; p = 0.03), nighttime SBP (r = 0.24; p = 0.000), insulin (r = 0.25; p = 0.000), and Log Tryglicerides (r = −0.137; p = 0.019). In a multiple regression analysis sex, waist, birth weight, SBP (office, daytime and nighttime), were independent determinants of uric acid when age, BMI, HDL-C and insulin were included (R2 = 0.29). The prevalence of hyperinsulinemia, low HDL-C, high-normal BP, and hypertension in each UA group are shown in the Figure.Conclusions: In overweight and moderate obese children and adolescents there is a trend toward greater prevalence of cardiometabolic risk factors as the uric acid values rose. The role of hyperuricemia and its association with cardiometabolic risk factors should receive more attention, beginning in early childhood.

Profiles of blood pressure among children and adolescents with different body mass index categories in Shandong, China

Background: The International Obesity Task Force recently developed an extended body mass index (BMI) cut-offs for screening thinness, overweight and obesity among children and adolescents. The present study examined the profiles of blood pressure (BP) among children and adolescents with different BMI categories in Shandong, China.Methods: Data for this study were obtained from a large cross-sectional survey of schoolchildren. A total of 44,630 students (22,404 boys and 22,226 girls) aged 7–18 years participated in this study. The grades of body weight (thinness grade 1–3, normal weight, overweight and obesity grade 1–3) was defined by the international BMI cut-offs. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured on one occasion. High BP was defined as SBP and/or DBP ≥95th percentile for age and gender.Results: The overall prevalence of thinness (grade 1–3), overweight and obesity (grade 1–3) were 7.80, 18.74 and 8.56% for boys and 11.16, 13.53 and 3.70% for girls, respectively, boys had a lower prevalence of thinness and higher prevalence of overweight and obesity than girls (p < .01). Urban boys and girls had a lower prevalence of thinness and higher prevalence of overweight and obesity than their rural counterparts (p < .01). Children and adolescents with high BMI had a higher BP levels than their counterparts with normal and low BMI.Conclusion: High BMI is strongly related to elevated BP. Our findings emphasize the importance of the prevention of overweight/obesity to prevent future-related problems such as hypertension in children and adolescents.

Trends in adult overweight and obesity prevalence in Mongolia, 2005-2013.

To analyze trends in the prevalence of overweight and obesity among Mongolian adults during the past decade as measured by body mass index (BMI) and waist circumference (WC). Data from the repeated cross-sectional surveys on the prevalence of noncommunicable disease risk factors conducted in 2005, 2009, and 2013 in Mongolia were used. Linear regression was used to quantify trends in mean BMI and WC, adjusted for age group, sex, and survey year. The age-standardized prevalence of obesity, denoted by the international BMI cutoff values, in men and women between 2005 and 2013 increased from 10.8% to 17.6% and from 18.9% to 26.4%, respectively. Using Asian-specific BMI cutoff values for men and women, the age-standardized prevalence of obesity between 2005 and 2013 increased from 20.0% to 32.8% and 33.4% to 43.7%, respectively. The prevalence of overweight and obesity has increased markedly between 2005 and 2013 similarly across all age groups and sexes. It is important to consider the use of Asian-specific cut-offs as the burden of obesity is twice as high as when using international BMI cutoffs. These data demonstrate the urgent need for obesity treatment, prevention, and monitoring in Mongolia.

Profiles of body mass index and the nutritional status among children and adolescents categorized by waist-to-height ratio cut-offs

BackgroundWaist-to-height ratio (WHtR) is proposed as a simple, valid and convenient measure of abdominal obesity and health risks in practice. The present study examined the distribution of nutritional status among children and adolescents categorized by WHtR cut-offs. MethodsA total of 30,459 students (15,249 boys and 15,210 girls) aged 7–18years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and WHtR were calculated. The grades of nutritional status (thinness, normal weight, overweight and obesity) was defined by the international BMI cut-offs. All subjects were divided into three groups (low, moderate and high) according to their WHtR, BMI level and the distribution of nutritional status among the three groups were compared. ResultsIn both boys and girls, significant differences in BMI level and the nutritional status were observed among the three groups. Children and adolescents aged 7–18years in the ‘high WHtR group’ (≥0.5) had higher BMI than those in the ‘low WHtR group’ (<0.4) by 6.00–10.15kg/m2 for boys and 5.24–9.51kg/m2 for girls. ‘low WHtR group’ had higher prevalence of thinness, and ‘high WHtR group’ had higher prevalence of overweight and obesity. The optimal distribution of nutritional status is found in the ‘moderate WHtR group’ (between 0.4 and 0.5) with the highest proportion of normal weight and low prevalence of thinness and obesity. ConclusionWHtR is associated with nutritional status, which could be an indicator of nutritional status and early health risk. It is necessary to develop optimal boundary values in the future.

Prevalence of thinness among children and adolescents in Shandong, China.

Thinness in children and adolescents poses a considerable public health problem globally, especially in developing countries. The present study examined the prevalence of thinness among children and adolescents in Shandong, China. Data for this study were obtained from a large cross-sectional survey of schoolchildren. A total of 42,348 students (21,248 boys and 21,100 girls) aged 7-18 years participated in this study. Stature and weight of all subjects were measured; body mass index (BMI) was calculated from their stature and weight. International BMI cutoffs were used to define thinness. The overall prevalences of thinness grade 1, grade 2 and grade 3 among children and adolescents aged 7-18 years were 7.74, 1.43 and 0.61 % for boys and 11.51, 2.54 and 1.03 % for girls, respectively; these figures were all significantly higher in girls than in boys (P < 0.01). Thin children and adolescents had lower stature levels than their counterparts in not thin group in all age groups (7-18 years). The prevalence of childhood thinness is still wide in Shandong Province, and public health and nutritional strategies must give attention to the intervention for thinness, including periodic monitoring, education on pattern of nutrition and healthy dietary behavior.

Objectively-measured physical activity and body weight in Japanese pre-schoolers

Background: The prevalence of thinness has increased among Japanese children.Aim: The purpose of this study was to examine the association between physical activity and body mass index (BMI) among Japanese pre-school children.Subjects and methods: Subjects were 425 4–6-year-old Japanese girls and boys. Their weights were classified as normal, overweight or thin, based on Cole’s international cut-offs for BMI. Physical activity was assessed using a triaxial accelerometer (ActivTracer, GMS) for 6 consecutive days.Results: Physical activity in overweight children was comparable to that in normal-weight children after controlling for age and gender. However, thin children spent significantly greater time engaged in low-intensity activities (physical activity ratio < 2) and spent less time engaged in light-intensity physical activity (2 ≤ physical activity ratio < 3) and moderate-to-vigorous physical activity (physical activity ratio ≥ 3) than normal-weight and overweight children, and less time engaged in higher-intensity physical activity (physical activity ratio ≥ 4) than normal-weight children. Moreover, thin children spent significantly less time engaged in locomotive physical activity than normal-weight or overweight children.Conclusion: This study suggests that thinness, rather than excess weight, is associated with decreased light, moderate and high intensity physical activity in Japanese pre-school children.

Childhood obesity and overweight prevalence trends in England: evidence for growing socioeconomic disparities

ObjectivePrevious data indicate a rapidly increasing prevalence of obesity and overweight among English children and an emerging socioeconomic gradient in prevalence. The main aim of this study was to update prevalence trends among school-age children and assess the changing socioeconomic gradient.DesignA series of nationally representative household-based health surveys conducted between 1997 and 2007 in England.Subjects15,271 white children (7880 boys) aged 5 to 10 years with measured height and weight.MeasurementsHeight and weight were directly measured by trained fieldworkers. Overweight (including obesity) and obesity prevalence were calculated using the international body mass index cut-offs. Socioeconomic position (SEP) score was a composite score based on income and social class. Multiple linear regression assessed the prevalence odds with time point (1997/8, 2000/1, 2002/3, 2004/5, 2006/7) as the main exposure. Linear interaction terms of time by SEP were also tested for.ResultsThere are signs that the overweight and obesity trend has levelled off from 2002/3 to 2006/7. The odds ratio (OR) for overweight in 2006/7 compared to 2002/3 was 0.99 (95% CI 0.88 to 1.11) and for obesity OR = 1.06 (0.86 to 1.29). The socioeconomic gradient has increased in recent years, particularly 2006/7. Compared to 1997/8, the 2006/7 age and sex-adjusted OR for overweight was 1.88 (1.52 to 2.33) in low SEP, 1.25 (1.04 to 1.50) in middle SEP, and 1.13 (0.86 to 1.48) in high SEP children.ConclusionChildhood obesity and overweight prevalence among school-age children in England has stabilised in recent years, but children from lower socio-economic strata have not benefited from this trend. There is an urgent need to reduce socio-economic disparities in childhood overweight and obesity.

Secular Trends in Overweight and Obesity among Japanese Children and Adolescents

The prevalence of childhood obesity has increased worldwide. It is a major public health concern in Japan as well. There are, however, few studies on the trends of childhood obesity in Japan. PURPOSE: To examine the trends of overweight and obesity in Japanese youth using international BMI cutoffs. METHODS: In Japan, a large-scale nationwide, cross- sectional survey has been carried out every year under the direction of the Ministry of Education, Culture, Sports, Science and Technology. Standing height and body mass are measured in the survey, and the frequency matrices on height (every 1 cm) and mass (every 1 kg), but not the raw data, have been published. For the present study, we used the matrix data for 5-, 8-, 11-, 14-, and 17-year-old males and females from the 1978, 1983, 1988, 1993, 1998, and 2003 surveys. The body mass index (BMI) in each cell of the matrix was calculated from the body mass (kg) of the cell divided by square of the standing height (m) of the cell. Then the BMI of each cell was compared with sex- and age-specific international BMI cutoffs presented by Cole et al (2000). When the BMI of a cell exceeded the international cutoffs for overweight or obesity, we identified the subjects included in that cell as overweight or obese, respectively. The prevalence of overweight and obesity were obtained from the sum of frequencies included in the cells where the BMI exceeded the international cutoffs. RESULTS: The percentage (%) of overweight and obesity increased over the 25 years, as shown in the Table. The highest percentages were seen at age 11 for overweight and at age 8 for obesity in 2003, for both males and females. Mean values for standing height, body mass, and BMI gradually increased over time. However, the modes of BMI were almost constant during the 25 years, suggesting that the increasing percentage of youth having high BMI above a cutoff is not attributed to secular increase in body size or secular trends towards earlier maturation.TableCONCLUSION: A substantial increase over time in overweight and obesity was observed in Japanese youth, particularly for younger children aged 8 and 11 years.