Results: Chinese people experienced greater odds of comorbidities than whites for a given BMI after standardizing for age and sex: 43% for diabetes, 30% for dyslipidemia, 28% for hypertension, 38% for metabolic syndrome, and 48% for hyperuricemia. Comparisons of BMI-mortality associations found that the U-shaped BMI-mortality curve shifted 1-2 kg m 22 to the left in Chinese compared to whites. Compared to whites at BMIs of 25 and 30 kg m 22 , corresponding cutoffs in Chinese were 22.5 and 25.9 kg m 22 in men, and 22.8 and 26.6 kg m 22 in women after both fat and fat distribution were taken into account. Conclusions: Comorbidity, mortality, and body composition data consistently support the use of lower BMI cutoffs in Chinese than those in whites.

Objective: To investigate the association of regional fat depots with metabolic risk factors in Chinese women. Design: Total and regional fat depots including android fat and gynoid fat were measured by dual-energy X-ray absorptiometry. Central fat distribution was defined as android:gynoid fat ratio. Metabolic risk factors were defined as elevated TAG, reduced HDL-cholesterol, elevated blood pressure and elevated fasting plasma glucose. Logistic regression analyses were performed to examine the associations of regional fat depots with metabolic risk factors. The odds ratios of metabolic risks were further calculated according to tertiles of android fat and gynoid fat. Setting: Participants were recruited from a community-based cross-sectional study. Face-to-face questionnaires, anthropometric and dual-energy X-ray absorptiometry measures were conducted. Subjects: Chinese women (n 609) aged 18-79 years. Results: Android fat and android:gynoid fat ratio were associated with significantly increased odds (OR 5 1?4-3?7; P , 0?01) for almost all risk factors, whereas gynoid fat was independently associated with significantly decreased odds (OR 5 0?3-0?6; P , 0?01). The inverse associations of gynoid fat with metabolic risk factors remained after adjusting for android fat. Even if their android fat level was in high, women in the highest tertile of gynoid fat had lower odds of having at least two metabolic risk factors compared with women in the lowest gynoid fat tertile (P for trend , 0?01). Conclusions: There were opposite associations of android and gynoid fat with metabolic risks in Chinese women. Gynoid fat rather than android fat might be a more important inclusion in metabolic disease risk evaluation in female Asians. KeywordsFat mass Android fat Gynoid fat Dual-energy X-ray absorptiometry Metabolic risks WomenObesity is a complex heterogeneous disorder which is strongly associated with multiple metabolic dysfunctions including dyslipidaemia, impaired glucose tolerance and arterial hypertension (1,2) . Although previous studies have documented the association between obesity and metabolic diseases, there is increasing evidence suggesting that the presence of excess fat in specific regional body areas is a more significant indicator than total fat volume (3)(4)(5)(6) . The excess accumulation of central fat, even without manifestations of general obesity, is closely associated with metabolic disturbances that indicate increased risks of CVD and diabetes (7)(8)(9) whereas peripheral subcutaneous fat may be relatively benign with respect to metabolic disease risks (10)(11)(12) . For instance, the Quebec Family Study showed that larger hip circumference was inversely associated with several cardiovascular risk factors, including high TAG and insulin concentrations (13) . Therefore, collection of information on fat regional distribution patterns may add more insights in understanding the considerable metabolic variation among individuals. Women are more likely to store fat in the lower body (around the hips ...