Defining Obesity Cut Points in a Multiethnic Population

Abstract

, MBBS, DPhil, FRCP(c); for the SHARE Investigators Background-Body mass index (BMI) is widely used to assess risk for cardiovascular disease and type 2 diabetes. Cut points for the classification of obesity (BMI Ͼ30 kg/m 2 ) have been developed and validated among people of European descent. It is unknown whether these cut points are appropriate for non-European populations. We assessed the metabolic risk associated with BMI among South Asians, Chinese, Aboriginals, and Europeans. Methods and Results-We randomly sampled 1078 subjects from 4 ethnic groups (289 South Asians, 281 Chinese, 207Aboriginals, and 301 Europeans) from 4 regions in Canada. Principal components factor analysis was used to derive underlying latent or "hidden" factors associated with 14 clinical and biochemical cardiometabolic markers. Ethnicspecific BMI cut points were derived for 3 cardiometabolic factors. Three primary latent factors emerged that accounted for 56% of the variation in markers of glucose metabolism, lipid metabolism, and blood pressure. For a given BMI, elevated levels of glucose-and lipid-related factors were more likely to be present in South Asians, Chinese, and Aboriginals compared with Europeans, and elevated levels of the blood pressure-related factor were more likely to be present among Chinese compared with Europeans. The cut point to define obesity, as defined by distribution of glucose and lipid factors, is lower by Ϸ6 kg/m 2 among non-European groups compared with Europeans. Conclusions-Revisions may be warranted for BMI cut points to define obesity among South Asians, Chinese, and Aboriginals. Using these revised cut points would greatly increase the estimated burden of obesity-related metabolic disorders among non-European populations.

The Association of Duration of Residence in the United States with Cardiovascular Disease Risk Factors Among South Asian Immigrants

“…More recent immigrants were also less likely to be overweight/obese than more settled South Asians (OR = 0.59 for 5 to \10 years; 95 % CI 0.35, 0.98). Results were unchanged in sensitivity analyses with different cut-points for BMI [60][61][62][63][64]. We found that South Asian immigrants who were overweight/obese had 2.32 greater odds (95 % CI 1.11, 4.86) of reporting diabetes and 2.19 greater odds (95 % CI 1.34, 3.56) of reporting hypertension than those with a healthy BMI.…”

The prevalence of metabolic syndrome among low-income South Asian Americans

“…Our proposed BMI cut-offs are congruent with the previously recommended BMI cut-offs for SA by Misra et al (8) , who performed ROC curve analysis and suggested 23·0 kg/m 2 for females and 24·0 kg/m 2 for males. Ramachandran et al (4) studied South Indians of both sexes who attended hospitals in India found a MetS prevalence of 42 % overall, 36 % for men and 47 % for women (4,41) . In 2011, Dodani et al (33) conducted a community-based cross-sectional study to ascertain the prevalence of MetS in South Asian immigrants to examine the association between MetS and HDLC function, apolipoprotein (APO1) gene polymorphisms and subclinical coronary artery disease using common carotid intima-media thickness as a surrogate marker.…”

Appropriate cutoff values of anthropometric variables to predict cardiovascular outcomes: 7.6 years follow-up in an Iranian population

“…This means that as the mean values increase with the corresponding higher distributions, it would result automatically in a higher cut point using the ROC method. 37 Therefore, the higher cut point of BMI in women and similar cut points of WC in both genders could be attributed to the high prevalence of general and central obesity in Iranian women. 38 Recently, in a national survey of Iranian adults, the age-adjusted means of WCs among men and women were 86.6 and 89.6 cm, respectively.…”