Summary The objective was to study the relationship between body mass index (BMI) and body fat per cent (BF%) in different population groups of Asians. The study design was a literature overview with special attention to recent Asian data. Specific information is provided on Indonesians (Malays and Chinese ancestry), Singaporean Chinese, Malays and Indians, and Hong Kong Chinese. The BMI was calculated from weight and height and the BF% was determined by deuterium oxide dilution, a chemical-for-compartment model, or dual-energy X-ray absorptiometry. All Asian populations studied had a higher BF% at a lower BMI compared to Caucasians. Generally, for the same BMI their BF% was 3‐5% points higher compared to Caucasians. For the same BF% their BMI was 3‐4 units lower compared to Caucasians. The high BF% at low BMI can be partly explained by differences in body build, i.e. differences in trunk-to-leg-length ratio and differences in slenderness. Differences in muscularity may also contribute to the different BF%/BMI relationship. Hence, the relationship between BF% and BMI is ethnic-specific. For comparisons of obesity prevalence between ethnic groups, universal BMI cut-off points are not appropriate.

Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship

We performed a systematic review and meta-analysis of studies that assessed the performance of body mass index (BMI) to detect body adiposity. Data sources were MEDLINE, EMBASE, Cochrane, Database of Systematic Reviews, Cochrane CENTRAL, Web of Science, and SCOPUS. To be included, studies must have assessed the performance of BMI to measure body adiposity, provided standard values of diagnostic performance, and used a body composition technique as the reference standard for body fat percent (BF%) measurement. We obtained pooled summary statistics for sensitivity, specificity, positive and negative likelihood ratios (LRs), and diagnostic odds ratio (DOR). The inconsistency statistic (I2) assessed potential heterogeneity. The search strategy yielded 3341 potentially relevant abstracts, and 25 articles met our predefined inclusion criteria. These studies evaluated 32 different samples totaling 31 968 patients. Commonly used BMI cutoffs to diagnose obesity showed a pooled sensitivity to detect high adiposity of 0.50 (95% confidence interval (CI): 0.43–0.57) and a pooled specificity of 0.90 (CI: 0.86–0.94). Positive LR was 5.88 (CI: 4.24–8.15), I2=97.8%; the negative LR was 0.43 (CI: 0.37–0.50), I2=98.5%; and the DOR was 17.91 (CI: 12.56–25.53), I2=91.7%. Analysis of studies that used BMI cutoffs ⩾30 had a pooled sensitivity of 0.42 (CI: 0.31–0.43) and a pooled specificity of 0.97 (CI: 0.96–0.97). Cutoff values and regional origin of the studies can only partially explain the heterogeneity seen in pooled DOR estimates. Commonly used BMI cutoff values to diagnose obesity have high specificity, but low sensitivity to identify adiposity, as they fail to identify half of the people with excess BF%.

Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis.

Numerous techniques are available to estimate body composition and fat distribution, and the method to use will depend on the aim of the study, economic resources, availability, time, and sample size. 6–8 Multi-compartment models, such as underwater weighing, dilution techniques and dual-energy X-ray absorptiometry (DXA) are all reliable methods to obtain accurate measures of total body fat. However, because of their costs in terms of time andmoney, thesemethods are not practical in large epidemiological studies and for routine clinical use. In these situations, body mass index (BMI) is often used and assumed to represent the degree of body fat. BMI, however, does not distinguish between fat mass and lean (non-fat) mass. For example, well-trained body builders have a very low percentage of body fat, but their BMI may be in the overweight range because of their large lean (muscle) mass. In addition, in the elderly and non-Caucasian populations, the relationship between BMI and body fatness may be different as compared with younger Caucasian populations. 9–14 Another potential limitation of the BMI is that the distribution of fat over the body is not captured. Many studies have shown that an abdominal fat distribution, independent of overall obesity, is associated with metabolic disturbances and increased disease risk. 15–23 An increased abdominal fat accumulation is largely caused by the accumulation of visceral (or intraabdominal) fat (for distinction of these fat depots, see Figure 1). Owing tometabolic differences between different fat depots, they differ in their role of predicting metabolic disturbances and diseases. Table 1 summarizes the capability of the most commonly used methods to assess total adiposity and fat distribution. Abdominal obesity is usually assessed by the easily measured waist circumference, the waist-to-hip circumference ratio (WHR), or the less-commonly used sagittal abdominal diameter (SAD). By the use of sophisticated imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT), different fat depots can be distinguished at the waist level, and it has been shown that in particular the visceral fat depot is associated with metabolic disease risk. 24–30 Because the SAD or waist circumference alone are more strongly correlated with visceral fat than the WHR, 31–35 guidelines tend to focus onwaist circumference to estimate disease risk as suggested by Lean et al. 36 These widely used cut-points (i.e. 102 cm formen and 88 cm for women) were originally based on a replacement of the classification of BMI, 36 but other cut-points have also been suggested on the basis of relationships with visceral fat area. 37

/pdf/what-aspects-of-body-fat-are-particularly-hazardous-and-how-qiphgw55re.pdf

What aspects of body fat are particularly hazardous and how do we measure them

Objectives: To assess whether overweight Asians, assessed on the basis of WHO criteria, are at greater mortality risk than overweight Caucasians, and to determine whether alternative cut-off points (BMI 5 23?0–24?9 kg/m 2 for overweight and BMI $ 25?0 kg/m 2 for obesity) suggested by the WHO Western Pacific Regional Office are appropriate. Design: The cohort was followed prospectively until the end of 2001. All-cause and CVD mortality risks of the overweight and obese group, relative to the reference group (BMI 5 18?5–24? 9o r 18?5–22? 9k g/m 2 ), were assessed using Cox regression analysis, adjusting for age, smoking and gender. Excess deaths were estimated with a method proposed by the US Centers for Disease Control and Prevention. Setting: National Health Interview Survey (NHIS 2001) and a middle-aged perspective cohort in Taiwan. Subjects: Subjects comprised 36 386 civil servants and school teachers, aged 40 years and older, who underwent a medical examination during 1989–1992. Results: In the WHO-defined overweight group, Asians showed a significant increase in all-cause mortality risk compared with Caucasians. Asians showed risks equivalent to Caucasians’ at lower BMI (around 5 units). Every unit of BMI increase, at 25?0 kg/m 2 or above, was associated with a 9 % increase in relative mortality risk from all causes. Applying a cut-off point of 25?0 kg/m 2 for obesity would result a prevalence of 27?1 %, while the traditional WHO cut-off point of 30?0 kg/m 2 yielded obesity prevalence of 4?1 %. Excess deaths due to obesity accounted for 8?6 % of all deaths and 21?1 % of CVD deaths, based on the alternative cut-offs. Conclusions: In this Asian population, significant mortality risks started at BMI $ 25?0 kg/m 2 , rather than at BMI $ 30?0 kg/m 2 . The study supports the use of BMI $ 25?0 kg/m 2 as a new cut-off point for obesity and BMI 5 23?0–24?9 kg/m 2 for overweight. The magnitude of obesity-attributable deaths has been hitherto under-appreciated among Asians.

/pdf/are-asians-at-greater-mortality-risks-for-being-overweight-523y8xzfpt.pdf

Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians.

The aim of this study was to investigate the relationship between body mass index (BMI) and body fat percentage (BF%) in Singaporean Chinese, Malays and Indians, and to determine the risk for selected comorbidities at various BMI categories and abdominal fat distributions, as assessed by waist circumference (WC). The study was a cross-sectional (population) design. In total, 4723 subjects participated in the National Health Survey of 1998 in which the risks were investigated. A selected subsample of 291 subjects participated in a detailed body composition study, where weight, height and WC were measured, as were blood pressure, total and high-density lipoprotein (HDL) cholesterol, serum triglycerides and fasting glucose. In the subsample, BF% was determined by means of a chemical four-compartment model. At any given BF% the BMI of Singaporeans was about 3 kg m(-2) lower than that of Caucasians. There were slight differences in the BF%/BMI relationship between the three ethnic groups. For all the ethnic groups, it was found that at low categories of BMI (between 22 and 24 kg m(-2)) and WC (between 75 and 80cm for women and between 80 and 85 cm for men), the absolute risks for having at least one of the aforementioned risk factors were high, ranging from 41 to 81%. At these same categories the relative risks were significantly higher compared to the reference category, odds ratios ranging from 1.97-4.38. These categories of BMI and WC were all far below the cut-off values of BMI and WC as currently recommended by the World Health Organization (WHO). The data from the current study, which includes evidence that not only risk factors, but also BF% are elevated at low BMI values, presents a strong case for lowering the BMI cut-off value for overweight and obesity among Singaporeans, from 25 kg m(-2) and 30 kg m(-2) to 23 kg m(-2) and 27 kg m(-2), respectively.

Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians.

There is increasing evidence suggesting that the cut-off values for defining obesity used in the Western countries cannot be readily applied to Asians, who often have smaller body frames than Caucasians. We examined the BMI and body fat (BF) as measured by bioelectrical impedance in 5153 Hong Kong Chinese subjects. We aimed to assess the optimal BMI reflecting obesity as defined by abnormal BF in Hong Kong Chinese. Receiver operating characteristic curve (ROC) analysis was used to assess the optimal BMI predicting BF at different levels. The mean age and SD of the 5153 subjects (3734 women and 1419 men) was 51.5 (SD 16.3) years (range: 18.0-89.5 years, median: 50.7 years). Age-adjusted partial correlation (r) between BMI and BF in women and men were 0.899 (P < 0.001) and 0.818 (P < 0.001) respectively. Using ROC analysis, the BMI corresponding to the conventional upper limit of normal BF was 22.5-23.1 kg/m(2), and the BMI corresponding to the 90 percentiles of BF was 25.4-26.1 kg/m(2). Despite similar body fat contents, the BMI cut-off value used to define obesity in Hong Kong Chinese should be lower as compared to Caucasians. We suggest a BMI of 23 kg/m(2) and 26 kg/m(2) as the cut-off values to define overweight and obesity respectively in Hong Kong Chinese.

/pdf/lower-bmi-cut-off-value-to-define-obesity-in-hong-kong-2unvga2bt6.pdf

Lower BMI cut-off value to define obesity in Hong Kong Chinese: an analysis based on body fat assessment by bioelectrical impedance.

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Lower BMI cut-off value to define obesity in Hong Kong Chinese: an analysis based on body fat assessment by bioelectrical impedance.