Obesity In Asian Populations Research Articles

Correlation Between Body Mass Index and Serum Uric Acid Among Healthy Pakistani Adults: A Cross-Sectional Comparative Study

Aim: To assess the relationship between body mass index and serum uric acid among healthy Pakistani adults Study design: A cross-sectional comparative study Place and Duration This study was conducted in Bakhtawar Amin Medical and Dental College Multan from November 2020 to April 2022 Methodology:A total of 250 subjects were randomly recruited out of which 120 subjects were selected in this study. Each group comprised 60 subjects. Group A comprised healthy controls subjects, while Group B comprised hyperuricemic persons with no complaints. By dividing body weight (kg) by the square of height, the BMI was computed. We divided BMI into three categories using diagnostic criteria for obesity in Asian populations given by the WHO. Participants' fasting blood samples (5 mL) were taken under stringent aseptic conditions to measure the serum uric acid level Version 23.0 of IBM-SPSS was used to store and analyse the data, Counts with percentages were reported on gender and BMI classifications between the two studied groups, and Mean with standard deviation were given for BMI and serum uric acid. Results:In the present study in group A 66.7% were male gender, 63.3% were overweight, mean BMI was 24.2 (SD=±2.0) kg/m2, and mean serum uric acid was 4.5 (SD=±0.6) units, whereas in group B there were 60% male gender, 70% were overweight, mean BMI was 23.6 (SD=±1.4) and mean serum uric acid was 8.1 (SD=±0.6) units. The independent sample test gives a significant mean difference in serum uric acid between group A and B samples with p<0.05. Conclusion: The study's findings show no significant correlation between serum uric acid, overweight and obesity among the Pakistani adult population. Keywords: Body Mass Index, serum uric acid, Pakistan, adults, overweight

Lean Yet Unhealthy: Asian American Adults Had Higher Risks for Metabolic Syndrome than Non-Hispanic White Adults with the Same Body Mass Index: Evidence from NHANES 2011-2016.

(1) Background: Despite having consistently lower rates of obesity than other ethnic groups, Asian Americans (AAs) are more likely to be identified as metabolically obese, suggesting an ethnic-specific association between BMI and cardiometabolic outcomes. The goal of this study was to provide an estimate of metabolic syndrome (MetS) prevalence among AAs using national survey data and to compare this rate to that of non-Hispanic Whites (NHWs) over the BMI continuum. (2) Methods: Using the NHANES 2011–2016 data, we computed age-adjusted, gender-specific prevalence of MetS and its individual components for three BMI categories. Furthermore, we conducted multivariate binary logistic regression to examine the risk of MetS in AAs compared to NHWs, controlling for sociodemographic and lifestyle factors. The analysis sample consisted of 2121 AAs and 6318 NHWs. (3) Results: Among AAs, the prevalence of MetS and its components increased with higher BMI levels, with overall prevalence being 5.23% for BMI < 23, 38.23% for BMI of 23–27.4, and 77.68% for BMI ≥ 27.5 in men; and 18.61% for BMI < 23, 47.82% for BMI of 23–27.4, and 67.73% for BMI ≥ 27.5 in women. We also found that for those with a BMI > 23, AAs had a higher predicted risk of MetS than their NHW counterparts of the same BMI level, in both men and women. (4) Conclusions: Our findings support the use of lower BMI ranges for defining overweight and obesity in Asian populations, which would allow for earlier and more appropriate screening for MetS and may better facilitate prevention efforts.

Check point to get adequate weight loss within 6-months after laparoscopic sleeve gastrectomy for morbid obesity in Asian population

Purpose of this study is to develope a scoring system to predict the likelihood of excess body weight loss (EBWL) ≥ 50% 6-months after laparoscopic sleeve gastrectomy (LSG). From April 2016 to September 2018, data was collected from 160 patients (BMI ≥ 32) who underwent primary LSG with at least 6-months follow-up. They were separated into score generation (operated by one surgeon, n = 122) and validation groups (operated by 3 different surgeons, n = 38). EBWL at 6-months ≥ 50% was considered adequate weight loss. Independent variables including age, gender, initial body mass index (BMI), comorbidities, life-style habits, percentage of EBWL and percentage of total body weight loss at 1-week, 1-month, and 3-months were analyzed with mutivariate logistic regression to generate the scoring system. The system was applied to internal and external validation groups to determine efficacy. As results, between the score generation and internal validation groups, the only significant difference in patient characteristics was in exercise participation. EBWL at 1-month > 19.5% (1 point) and EBWL at 3-months > 37.7% (2 points) were identified as independent factors to predict EBWL at 6-months ≥ 50%. When scores were > 1, the system had 94.03% positive predictive value (PPV) and 81.82% negative predictive value (NPV) (AUC: 0.923). Internal validation scores > 1 had a 95.83% PPV and 85.71% NPV (AUC: 0.975). External validation results showed 88.59% PPV and 72.00% NPV (AUC: 0.802). We concluded that this scoring system provides a reliable, objective prediction of EBWL at 6-months ≥ 50%. Patients requiring more aggressive clinical follow-up and intervention can be detected as early as 1- to 3-months after LSG.

Asian BMI criteria are better than WHO criteria in predicting Hypertension: A cross-sectional study from rural India.

Background:International Obesity Task Force proposed lower body mass index (BMI) cut-off values for defining overweight and obesity in Asian population. However, there is an absence of unanimity regarding the definition of overweight and obesity that is confusing while estimating disease burden, resource allocation, and priority setting. Therefore, the primary aim of the study was to assess the prevalence of overweight and obesity and its predictors as per different criteria (WHO criteria, Modified Asian criteria of BMI classification and BF% estimation by bioelectric impedance analysis technique). The secondary aim was to assess the concordance of overweight and obesity as diagnosed using these three methods.Methodology:A community-based cross-sectional study was conducted in a rural area of Rohtak, north India over a period of 1 year with a sample size of 1080. Anthropometric measurements including height, weight, blood pressure, body fat % analysis were recorded using standard protocols.Results:The prevalence of overweight and obesity were observed to be 49.62% (N = 536) as per the modified criteria for the Asian Indians (BMI ≥23 kg/m2) and 34.62% (N = 374) according to WHO criteria (BMI ≥25 kg/m2). A total of 18.3% of the study population were hypertensive. Modified criteria of BMI classification for Asian Indians had high sensitivity (67%) as compared to WHO criteria (55%) in predicting, diagnosing hypertension, and resembled sensitivity estimate obtained through direct body fat percentage estimation (69%).Conclusion:Modified criteria of overweight and obesity classification are better in terms of reducing comorbid dysmetabolic conditions, as exemplified by hypertension.

Ambient particulate air pollution (PM2.5) is associated with the ratio of type 2 diabetes to obesity

We used county level data for T2D prevalence across the mainland USA and matched this to county level ambient PM2.5. Multiple linear regression was used to determine the relation between prevalence of T2D with PM2.5 after adjustment for confounding factors. PM2.5 explained 6.3% of the spatial variation in obesity, and 17.9% of the spatial variation in T2D. After correcting the T2D prevalence for obesity, race, poverty, education and temperature, PM2.5 still explained 8.3% of the residual variation in males (P < 0.0001) and 11.5% in females (P < 0.0001). The effect on obesity prevalence corrected for poverty, race education and temperature was much lower and hence the ratio of T2D to obesity prevalence was significantly associated with PM2.5 in males (R2 = 11.1%, P < 0.0001) and females (R2 = 16.8%, P < 0.0001). This association was repeated across non-African countries (R2 = 14.9%, P < 0.0001). High levels of PM2.5 probably contribute to increased T2D prevalence in the USA, but have a more minor effect on the obesity. Exposure to high environmental levels of PM2.5 (relative to the USA) may explain the disproportional risk of T2D in relation to obesity in Asian populations.

Anthropometric and cardiometabolic risk factors in parents and child obesity in Segamat, Malaysia.

BackgroundThere is little evidence regarding risk factors for child obesity in Asian populations, including the role of parental anthropometric and cardiometabolic risk factors. We examined the relation between parental risk factors and child obesity in a Malaysian population.MethodsWe used data from health and demographic surveillance conducted by the South East Asia Community Observatory in Segamat, Malaysia. Analyses included 9207 individuals (4806 children, 2570 mothers and 1831 fathers). Child obesity was defined based on the World Health Organization 2007 reference. We assessed the relation between parental anthropometric (overweight, obesity and central obesity) and cardiometabolic (systolic hypertension, diastolic hypertension and hyperglycaemia) risk factors and child obesity, using mixed effects Poisson regression models with robust standard errors.ResultsWe found a high burden of overweight and obesity among children in this population (30% overweight or obese). Children of one or more obese parents had a 2-fold greater risk of being obese compared with children of non-obese parents. Sequential adjustment for parental and child characteristics did not materially affect estimates (fully adjusted relative risk for obesity in both parents: 2.39, 95% confidence interval: 1.82, 3.10, P < 0.001; P for trend < 0.001). These associations were not modified by parental or child sex. We found no consistent evidence for associations between parental cardiometabolic risk factors and child obesity.ConclusionsParental obesity was strongly associated with child obesity in this population. Further exploration of the behavioural and environmental drivers of these associations may help inform strategies addressing child obesity in Asia.

Racial/ethnic differences in the associations between obesity measures and severity of sleep-disordered breathing: the Multi-Ethnic Study of Atherosclerosis

ObjectivesThe objective of this study was to evaluate associations between obesity measures and sleep-disordered breathing severity among White, Black, Hispanic, and Chinese Americans. MethodsThe method used in this study was a community-based cross-sectional study of 2053 racially/ethnically diverse adults in the Multi-Ethnic Study of Atherosclerosis. Anthropometry and polysomnography were used to measure obesity and apnea–hypopnea index (AHI). Linear regression models were fitted to investigate associations of body mass index (BMI) and waist circumference with AHI (log transformed) with adjustment for sociodemographics, lifestyle factors, and comorbidities. ResultsThe mean participant age was 68.4 (range: 54–93) years; 53.6% of participants were women. The median AHI was 9.1 events/h. There were significant associations of BMI and waist circumference with AHI in the overall cohort and within each racial/ethnic group. A significant interaction was observed between race/ethnicity and BMI (Pinteraction = 0.017). Models predicted that for each unit increase in BMI (kg/m2), the mean AHI increased by 19.7% for Chinese, 11.6% for Whites and Blacks, and 10.5% for Hispanics. Similarly, incremental changes in waist circumference were associated with larger increases in AHI among Chinese than among other groups. ConclusionsAssociations of BMI and waist circumference with AHI were stronger among Chinese than among other racial/ethnic groups. These findings highlight a potential emergence of elevated sleep-disordered breathing prevalence occurring in association with increasing obesity in Asian populations.

New cutoff values for fat mass index, fat-free mass index and percent body fat in overweight and obese men living in Riyadh, SA

The frequent clinical use of bioelectrical impedance analysis (BIA) devices has made clinical evaluations of BIA-based parameters mandatory. This study was performed to define new cutoff points for the fat mass index, fat-free mass index, and percent body fat for overweight and obese men living in Riyadh, KSA. Three hundred sixty-two male subjects aged 18 to 62 years were enrolled in this cross-sectional study. The participants were divided into two groups; one group was assessed with an InBody 720 (n = 179) device, and the other group was assessed with a Tanita BC-418 (n = 183) device. Fat mass, fat mass index (FMI), fat-free mass, fat-free mass index (FFMI), and percent body fat (PBF) were measured. In addition, anthropometric measures, including weight, height, body mass index (BMI), waist circumference, hip circumference, waist hip ratio, and mid-arm circumference were included. Pearson correlation coefficients, Kappa analyses, and ROC curves were used. FMI exhibited the strongest positive correlation with BMI among all of the measured BIA-based parameters in both the InBody and Tanita groups (r = 0.916 and 0.958, respectively, P < 0.00001). ROC curves indicated that FMI was the most accurate parameter for the diagnosis of obesity in both groups (AUCs = 0.970 and 0.980). The FMI, FFMI, and PBF cutoff values with the best sensitivities and specificities in both groups were 7.8 vs. 6.7 kg/m2, 19.2 vs. 20.7 kg/m2, and 27.8 vs. 24 %, respectively, based on the WHO criteria for the diagnosis of obesity in Asian population. FMI was the best predictor of obesity among all of the BIA-based parameters. Considerable differences were noted between the different machines. Knowledge of device-specific cutoff points would increase the clinical value of BIA in the diagnosis of obesity.

Impact of Asian American mothers’ feeding beliefs and practices on child obesity in a diverse community sample.

Asian Americans suffer from childhood obesity yet are a particularly understudied population. Objective was to examine the impact of ethnicity on child feeding practices believed to be associated with childhood obesity in a community sample of mothers and their children. Prior research with White samples indicates a positive relationship between parental overcontrol of child feeding and child adiposity. Participants were 425 mothers (66 Asian/Asian American, 218 Hispanic/Latino, 26 Black/African American, 115 White/Caucasian) with children between the ages of 2 and 11. Participants provided demographic and height and weight information, and completed the Child Feeding Questionnaire (CFQ). Analyses focused on associations between ethnicity, parental feeding attitudes (factors of the CFQ) and child Body Mass Index (BMI). Results indicated significant ethnicity by CFQ factor interactions for 2 of the 6 CFQ factors examined (pressure to eat and restriction). Post hoc tests demonstrated that for these 2 CFQ factors, there was a significant association between child BMI and the CFQ factor score only within the Asian group; among Asians, for each of these 2 CFQ factors, children from families with above-median factor scores had significantly lower BMI (p .05). As predicted, for Asian Americans there was an inverse relationship between mothers’ control of feeding and child BMI. These findings suggest that lower levels of parental control over feeding may contribute to childhood obesity in Asian populations. The relationship between parental control over eating and child BMI found in middle-class White families does not generalize to populations with diverse ethnic or socioeconomic backgrounds.

Metabolic Syndrome in Rural Population of Western UP (India) A Prospective Study

To evaluate prevalence of metabolic syndrome (Mets) in rural population of Western UP (India)- A prospective Study was carried out w.e.f. Dec 2008 to June 2013. Total 5400 adults of 25 to 65 years age group from 3000 families were enrolled. Anthropometric measurement, blood pressure, plasma lipids, fasting glucose and a questionnaire based interview were obtained from each participant. Three different working definitions for Mets including U.S. National Cholesterol Education Program's Adult Treatment Panel III, a modified adult treatment panel III that adopts the World Health Organization's criterion for central obesity in Asian Population and one recently proposed by the International Diabetes Federation were used in the study.

Combined linkage and association analyses identify a novel locus for obesity near PROX1 in Asians

Although genome-wide association studies (GWAS) have substantially contributed to understanding the genetic architecture, unidentified variants for complex traits remain an issue. One of the efficient approaches is the improvement of the power of GWAS scan by weighting P values with prior linkage signals. Our objective was to identify the novel candidates for obesity in Asian populations by using genemapping strategies that combine linkage and association analyses. To obtain linkage information for body mass index (BMI) and waist circumference (WC), we performed a multipoint genome-wide linkage study in an isolated Mongolian sample of 1,049 individuals from 74 families. Next, a family-based GWAS, which integrates within- and between-family components, was performed using the genotype data of 756 individuals of the Mongolian sample, and P values for association were weighted using linkage information obtained previously. For both BMI (LOD = 3.3) and WC (LOD = 2.6), the highest linkage peak was discovered at chromosome 10q11.22. In family-based GWAS combined with linkage information, six single-nucleotide polymorphisms (SNPs) for BMI and five SNPs for WC reached a significant level of association (linkage weighted P < 1 × 10(-5) ). Of these, only one of the SNPs associated with WC (rs1704198) was replicated in 327 Korean families comprising 1,301 individuals. This SNP was located in the proximity of the prosperorelated homeobox 1 (PROX1) gene, the function of which was validated previously in a mouse model. Our powerful strategic analysis enabled the discovery of a novel candidate gene, PROX1, associated with WC in an Asian population.

Optimal waist circumference cut-off values for predicting cardiovascular risk factors in a multi-ethnic Malaysian population

Previous studies have proposed the lower waist circumference (WC) cutoffs be used for defining abdominal obesity in Asian populations. To determine the optimal cut-offs of waist circumference (WC) in predicting cardiovascular (CV) risk factors in the multi-ethnic Malaysian population. We analysed data from 32,703 respondents (14,980 men and 17,723 women) aged 18 years and above who participated in the Third National Health and Morbidity Survey in 2006. Gender-specific logistic regression analyses were used to examine associations between WC and three CV risk factors (diabetes mellitus, hypertension, and hypercholesterolemia). The Receiver Operating Characteristic (ROC) curves were used to determine the cut-off values of WC with optimum sensitivity and specificity for detecting these CV risk factors. The odds ratio for having diabetes mellitus, hypertension, and hypercholesterolemia, or at least one of these risks, increased significantly as the WC cut-off point increased. Optimal WC cut-off values for predicting the presence of diabetes mellitus, hypertension, hypercholesterolemia and at least one of the three CV risk factors varied from 81.4 to 85.5 cm for men and 79.8 to 80.7 cm for women. Our findings indicate that WC cut-offs of 81 cm for men and 80 cm for women are appropriate for defining abdominal obesity and for recommendation to undergo cardiovascular risk screening and weight management in the Malaysian adult population.

Meta‐analysis Added Power to Identify Variants in FTO Associated With Type 2 Diabetes and Obesity in the Asian Population

Several common variants in the intron 1 of FTO (fat mass and associated obesity) gene have been reliably associated with BMI and obesity in European populations. We analyzed two variants (rs9939609 and rs8050136) in 4,189 Chinese Han individuals and conducted a meta-analysis of published studies in Asian population to investigate whether these variants are associated with type 2 diabetes (T2D) and obesity in Asian population. In this study, both the minor allele A of rs9939609 and the minor allele A of rs805136 were associated with increased risk of T2D, independent of measures of BMI; the odds ratios (ORs) per copy of the risk allele were 1.19 for rs9939609 (95% confidence interval (CI), 1.04-1.37; P = 0.01) and 1.22 for rs8050136 (95% CI, 1.07-1.40; P = 0.004) after adjusting for age, sex, and BMI. Our results also showed association with risk of obesity (rs9939609: OR = 1.39 (95% CI 1.04-1.85), P = 0.02; rs8050136: OR = 1.45 (95% CI 1.09-1.93), P = 0.01) but no association with overweight. These results were consistent with the pooled results from our meta-analysis study (for diabetes, rs8050136, P = 1.3 x 10(-3); rs9939609, P = 9.8 x 10(-4); for obesity, rs8050136, P = 2.2 x 10(-7); rs9939609, P = 9.0 x 10(-9)). Our findings indicate that the two variants (rs9939609 and rs8050136) in the FTO gene contribute to obesity and T2D in the Asian populations.

Commentary: Optimal body mass index cut points

Commentary: Optimal body mass index cut points

Association between obesity and the risk of malignant lymphoma in Japanese: a case–control study

Although marked differences in anthropometric characteristics and malignant lymphoma (ML) incidence suggest that the association between obesity and ML risk in Asian and non-Asian populations may differ, few studies have investigated this association in Asian populations. Here, we conducted a sex- and age-matched case-control study in a Japanese population using 782 cases and 3,910 noncancer controls in the hospital-based Epidemiological Research Program at Aichi Cancer Center Hospital. Odds ratios (ORs) and 95% confidence intervals (CIs) for anthropometric characteristics were estimated using a conditional logistic regression model that incorporated smoking and alcohol intake. Recent body weight and body mass index (BMI) showed marginally significant association with ML risk (ORs [95% CIs] per 5-unit increase in recent weight and BMI; 1.04 [0.99-1.09] and 1.11 [0.98-1.27], respectively). On the other hand, weight and BMI in early adulthood exhibited a strong association with ML risk (ORs [95% CIs] per 5-unit increase in early adulthood weight and BMI; 1.11 [1.05-1.18] and 1.33 [1.13-1.55], respectively). Further, in women, a BMI of 25.0-29.9 kg/m(2), defined as obesity in Asian populations, during early adulthood was significantly associated with ML risk compared to the normal range of 18.5-22.9 kg/m(2). By histological ML subtype, the point estimates of ORs for obesity relative to normal weight in early adulthood were over unity for non-Hodgkin lymphoma (NHL) as a whole and significant for diffuse large B-cell lymphoma (DLBCL). In conclusion, our study in Japanese subjects suggested that early adulthood obesity is associated with the risk of NHL, particularly DLBCL.

Body mass index and cancer risk in Korean men and women

Obesity is associated with diverse health risks, but the role of body weight (BMI) as a risk factor for all and site-specific cancers remains controversial and risks for cancer associated with obesity have not been well-characterized in Asians. Body weight and risk for cancer were examined in a 14-year prospective cohort study of 1,213,829 Koreans aged 30-95 years insured by the National Health Insurance Corporation who had a biennial medical evaluation in 1992-1995. Incidence rates for all cancers and site-specific cancers were examined in relation to BMI. Age- and smoking-status adjusted hazard ratios (HR) with 95% confidence intervals (CI) were examined using the Cox proportional hazards model. For both sexes, the average baseline BMI was 23.2 kg/m(2), and the association of risk for all-cancers with BMI was positive. Obese men (BMI >or= 30 kg/m(2)) were at increased risk for developing the following cancers: stomach (1.31, 1.05-1.64), colon (1.42, 1.02-1.98), liver (1.63, 1.27-2.10) and gallbladder (1.65, 1.11-2.44). Obese women (BMI >or= 30 kg/m(2)) were at increased risk for developing liver cancer (1.39, 1.00-1.94), pancreatic cancer (1.80, 1.14-2.86) and breast cancer among women aged >or=50 years old (1.38, 1.00-1.90). The HRs were comparable in never and ever smokers for all cancers and all specific sites except for lung cancer. For all cancers common to both sexes, the association was significantly weaker (p < 0.01) in females. Our study provides further confirmation of the excess cancer risk associated with obesity. Rising obesity in Asian populations raises concern that increasing numbers of avoidable cancer cases will occur among Asians.

Prevalence of Metabolic Syndrome and Its Relation to Body Composition in a Chinese Rural Population

To investigate the prevalence of metabolic syndrome (MetS) with three different working definitions in a rural Chinese population and to examine its relation to body composition. A total of 18,630 adults 25 to 64 years old (mean age, 45.8 years; 51.2% men) from 5686 families were enrolled from Anhui province of China during 2004 to 2005. Anthropometric measurement, body composition, blood pressure, plasma lipids, and fasting glucose and insulin and a questionnaire-based interview were obtained from each participant. Three different working definitions for MetS, including the U.S. National Cholesterol Education Program's Adult Treatment Panel III, a modified Adult Treatment Panel III that adopts the World Health Organization's criterion for central obesity in Asian populations, and one recently proposed by the International Diabetes Federation, were used in the study. According to the three definitions, the age-adjusted prevalence of MetS for adults 25 to 64 years old was 3.2%, 4.9%, and 3.9% in men and 7.2%, 11.5%, and 10.9% in women, respectively. MetS prevalence increases significantly with age in women, but not in men. Body fat percentage and BMI and waist circumference were significantly associated with each component of MetS, especially with triglyceride level, insulin resistance index, and number of MetS components (r = 0.28 to 0.49). The age-adjusted prevalence of MetS in our study population is lower than that reported in other urban Chinese populations. Significant gender differences in MetS prevalence were observed. The waist circumference is a good surrogate for abdominal fat percentage.

Impact of Obesity and Body Fat Distribution on Cardiovascular Risk Factors in Hong Kong Chinese

Body fat distribution has been reported to differentially contribute to the development of cardiovascular risk. We report the relative associations between general and central obesity and risk factors in 2893 Chinese subjects recruited from the Hong Kong population. Anthropometric parameters [waist circumference (WC) and BMI], surrogate measures of insulin resistance (fasting plasma glucose and insulin, oral glucose tolerance test, 2 hours glucose and insulin), fasting lipids (total, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglycerides) and systolic and diastolic blood pressure were measured. General obesity was classified as BMI > or =25.0 kg/m(2) and central obesity as a WC > or =80 or > or =90 cm in women and men, respectively. A total of 39.2% of the population was found to be obese. Obesity per se increased the levels of the risk factors, but central adiposity contributed to a greater extent to adverse high-density lipoprotein-cholesterol, triglyceride, and insulin resistance levels. There was a continuous relationship between increasing obesity, both general and central, and cardiovascular risk, with lowest risk associated with the lowest indices of obesity. In the 1759 nonobese subjects divided into quartiles of BMI or WC, the levels of the cardiovascular risk factors still significantly increased with increasing quartiles of adiposity. Central adiposity appears to contribute to a greater extent than general adiposity to the development of cardiovascular risk in this population. The relationship between obesity parameters and risk is a continuum, with risk factors significantly increasing even at levels usually considered nonobese. These observations support the proposed redefinition of overweight and obesity in Asian populations using lower cut-off points.

Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies

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 (> or =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 22 kg/m2 to 25 kg/m2 in different Asian populations; for high risk it varies from 26 kg/m2 to 31 kg/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.

High blood pressure and associated risks in an Indian industrial population

High blood pressure, and other cardiovascular disese (CVD) risk factors are increasingly prevalent in the urban Indian population. Data regarding this clustering of risk factors is scarce from developing countries. We carried out a comprehensive cross-sectional CVD risk factor prevalence study on 2200 male employees aged 21–59 years of an urban industrial population in India employing questionnaire, clinical examination and biochemical estimations. Most of the employees were below 45 years of age and the mean age was 42 years. The prevalence of hypertension (as per JNC VI criteria) and high-normal blood pressure was 30% and 17% respectively. Only 25% of the population had optimal blood pressure. Only a third of the hypertensives were aware of their status, while just 8% had their blood pressure controlled. Even in the age group 21–29 years, the prevalence of hypertension was 18%. The prevalence of other CVD risk factors in the hypertensive population was as follows: diabetes 20%, impaired fasting glucose 23%, total cholesterol>200mg/dl 35%, total cholesterol/HDL-C ratio≥4.5 67%, hypertriglyceridemia 48%, and central obesity (waist hip ratio≥ 0.95) 80% . The mean BMI for this population was 24 kg/m 2 and the mean waist circumference was high at 97 cm. . 41% of the study population was actively smoking at the time of the study. While the overall population had high prevalence of these risk factors, adverse trends in risk factors were significantly higher in the hypertensives as compared to non-hypertensives. As per the NCEP guidelines, about 25% of the overall population had metabolic syndrome. The prevalence rose further if the proposed lower cut-offs for obesity in Asian population were employed. While only 15% of the study population was free of any of traditional four risk factors, 45% had at least two risk factors. The prevalence of coronary heart disease, using modified Rose angina questionnaire and/or Minnesota-coded ECG abnormalities, in this population was 7.3%. This study demonstrates the high prevalence of adverse blood pressure profile in this comparatively young population and a low awareness of the same. The significant clustering of risk factors in this population is likely to increase greatly the absolute cardiovascular risk and underscores the urgent preventive measures which need to be implemented in developing countries like India.