Body mass index and mortality in asian populations: implications for obesity cut-points

Investigators have questioned whether body mass index (BMI, kg/m2) cut-points for obesity used in the United States and Europe are appropriate for Asian countries. A recent study examined the association between BMI and mortality in a population-based cohort of Japanese men and women. These and other results did not indicate a need for lower cut-points in Asians.     

中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准

目的 建立全国统一的学龄儿童、青少年超重、肥胖筛查体重指数(13MI)值分类标准。方法 以“2000年全国学生体质调研”为参照人群，共调查汉族7～18岁中小学生244200余人。比较中国儿童青少年BMl分布与美国国立卫生统计中心(NCHS)国际标准差距，计算随年龄BMI百分位数分布。利用P85、P90和P95组合成三个暂定标准，利用生理、血脂生化和体成分指标进行交叉验证。运用B-spline曲线对选定标准作平滑化拟合。结果 利用中国沿海发达大城市样本作BMI分布曲线有助克服青春中期后曲线的低平现象。交叉验证显示以P85和P95为超重、肥胖筛查标准较适宜，灵敏性和特异性符合要求。18岁时男女性：BMI均以24和28为超重，肥胖界值点，与已颁布实施的中国成人超重、肥胖筛查标准接轨。以北京、河南、四川等省(市)分别作为中国儿童青少年生长发育上、中、下水平的三个代表人群作回代验证。城市7～18岁男女生中，北京市超重率17．00％和9．46％，肥胖率9．99％和6．47％；河南省超重率10．86％和6．64％，肥胖率4．27％和3．07％；四川省超重率6．95％和4．23％，肥胖率2．84％和2．09％，符合现实状况。结论 本标准兼顾前瞻性和现实性，既充分考虑近年来中国学龄儿童青少年生长的长期加速趋势，显著缩短和国际标准的差距，又具有中国特色，体现东亚人群的种族特征，具较高的现实性，可在全国范围推广。     

Body mass index cutoffs for underweight, overweight, and obesity in South Korean schoolgirls

OBJECTIVES: To establish BMI percentiles and cutoffs for underweight, overweight, and obesity in South Korean schoolgirls. RESEARCH METHODS AND PROCEDURES: A total of 1229 South Korean schoolgirls aged 8 to 18 years were randomly selected to complete a self-administered questionnaire. BMI charts and cutoffs were constructed after analyzing data from 1107 subjects. Percentile curves were established by the modified LMS method. RESULTS: The percentiles for underweight, overweight, and obesity corresponding to BMI of 18.5, 23.0, and 25.0 kg/m2 at age 18 were the 13.0th percentile, the 77.8th percentile, and the 91.2nd percentile, respectively. The corresponding prevalences of underweight, overweight, and obesity were 12.1, 12.5, and 9.8%, respectively. DISCUSSION: We established for the first time, to our knowledge, new BMI cutoffs for ages 8 to 18 that corresponded to BMIs of 18.5, 23.0, and 25.0 kg/m2 for Asian adults designated by the International Obesity Task Force. These newly established BMI cutoffs might help to estimate the prevalence of overweight and obesity in Asian children.     

Use of body mass index to identify obesity-related metabolic disorders in the Chinese population

OBJECTIVE: To identify the body mass index (BMI; in kg/m2) cutoff that predicts the risk for obesity-related metabolic disorders for the Chinese population. DESIGN: Community-based cross-sectional survey. SETTING: Rural regions of Jiangxi and Anhui provinces and an urban community of Jing'an District of Shanghai, China. SUBJECTS: Five hundred and twenty-nine non-pregnant, non-lactating urban and rural adults, aged 20-64 years without diagnosed diabetes. RESULTS: Subjects were divided into two groups: with or without obesity-related metabolic disorders, which was defined as having at least one of the following: hypertension, insulin resistance, high plasma triacylglycerol, low-density lipoprotein-cholesterol or glucose. Gender-specific multiple logistic regression analysis demonstrated a significant dose-response relationship between BMI and obesity-related metabolic disorders, after adjusting for potential confounders. The lowest BMI interval associated with significant risk for both men and women (odds ratios of 2.67 and 3.46, respectively) was that of 22.5-24.4. Receiver-operating characteristic (ROC) curve analysis indicated that a BMI cutoff of 23 had the best combination of sensitivity and specificity and the shortest distance in the ROC curve, with positive and negative predictive values of 0.6-0.7 in both genders. CONCLUSIONS: A BMI cutoff of 23 might be appropriate for use in identification of high risk of obesity-related metabolic disorders and serve as a public health action threshold in the Chinese population. SPONSORSHIP: Center of a Livable Future, John Hopkins Bloomberg School of Public Health.     

中国2～18岁儿童青少年超重和肥胖筛查体重指数界值点的研究

目的 研究中国2～18岁儿童青少年超重、肥胖筛查体重指数(BMI)界值点.方法 在中国0～18岁儿童青少年BMI生长参照值的基础上,根据常用的超重、肥胖筛查界值点选择方法(与成年人界值点接轨法、百分位法或Z分值法),初步分别确定[BMI 24kg/m2 (BMI24)、28 kg/m2(BMI28)]、(P85、P95)和(Z1、Z2)三组界值点,通过对不同界值点进行差值和检出率比较,并与中国肥胖问题工作组(WGOC)和国际肥胖问题工作组(IOTF)的超重、肥胖界值点做对比分析,最后确定适宜界值点.结果 按照不同的超重、肥胖筛查BMI界值点选择方法获得三组界值点,不同界值点之间存在不同程度差异,但在超重合并肥胖检出率上差异相对较小.与WGOC相比,男章超重、肥胖及女童肥胖界值点非常接近,女童在8.5～15.5岁其超重界值点比WGOC标准低0.3～1.0 kg/m2,通过筛查"2004年北京市儿童代谢综合征调查"数据库,女童超重检出率比WGOC标准高约3.4%.结论 采用与成年人界值点接轨法(BMI24、BMI28)获得的中国2～18岁儿童青少年超重、肥胖筛查BMI界值点是适宜的,实现了在使用BMI指标上年龄的连贯性和筛查标准的一致性.     

Body mass index in individuals with HIV infection and factors associated with thinness and overweight/obesity

A cross-sectional study was conducted using body mass index (BMI) to estimate the prevalence of thinness and overweight/obesity and associated factors in 2,018 individuals with HIV/AIDS attending health services referral centers. The dependent variable was classified as thinness, overweight/obesity and eutrophy. Multinomial logistic regression analyses were performed considering eutrophy as the reference level. The prevalence of thinness was 8.8% and of overweight/obesity, 32.1%. The variables associated with thinness were anemia and CD4 cell count < 200mm3. The variables associated with risk of overweight/obesity were age > 40 years and diabetes, and the variables identified as decreasing likelihood of overweight/obesity were having no long-term partner, smoking, presence of an opportunistic disease, anemia, and albumin levels < 3.5mg/dL. The main nutritional problem observed in this population was overweight and obesity, which were much more prevalent than thinness. Older individuals with diabetes should be targeted for nutritional interventions and lifestyle changes.     

Body mass definitions of obesity: sensitivity and specificity using self-reported weight and height

A high correlation between continuous measures of self-reported and measured weight and height has led investigators to infer that self-report of these variables is appropriate in epidemiologic studies. We evaluated the sensitivity and specificity of categorical definitions of body mass defined using self-reported height and weight on 7,455 adult participants of the Lipid Research Clinics Family Study (1975-1978) on whom both self-reported and measured height and weight were available. The categorical definition of obesity used here was a body mass index of at least 30 kg/m2. Overall, the sensitivity of the obese category when defined with self-reported weight and height was 74% (95% CI = 72%-76%), and the specificity was 99%. The sensitivities of the categories defined using self-reported measures varied considerably by sex, age, and educational level. Overall, the sensitivities were higher for women compared with men, as men were less accurate in reporting height. The sensitivity of the categorical definitions of obesity decreased with increasing age and education in both men and women. The sensitivity for elderly obese men was below 50%. These results suggest that substantial misclassification can occur when self-reported information is used to define body mass categories.     

Correlates of breast-feeding in a low-income population of whites, blacks, and southeast Asians

Infant feeding was examined in 492 children in a population-based survey conducted in a low-income, urban county of St Paul, Minn. Of 41 Southeast Asian infants who were foreign born, 93% (38) had been breast-fed compared with 10% (12) of Southeast Asian infants born in the United States (n = 116). Among non-Southeast Asian infants, 73% (173) of whites (n = 237), 63% (27) of blacks (n = 43) and 65% (36) of other ethnic groups (n = 55) had been breast-fed. Among the non-Southeast Asian infants, the initiation of breast-feeding was associated with higher parental education and with being married. Ethnic group, level of poverty, and participation in the Supplemental Food Program for Women, Infants, and Children during pregnancy did not appear to influence the initiation of breast-feeding. The findings indicate a higher incidence of breast-feeding than in previous surveys of low-income black and white women; however, this may reflect the higher educational level of the non-Southeast Asian study population. In contrast, the sharp decline in the incidence of breast-feeding among Southeast Asian infants who were born in the United States compared with those who were foreign born indicates the need for public health approaches to strengthen traditional breast-feeding practices.     

Body mass index, overweight and obesity among Kuwaiti intermediate school adolescents aged 10-14 years

OBJECTIVES: The purpose of this cross-sectional study was to assess the levels of overweight and obesity among Kuwaiti intermediate school adolescents aged 10-14 y. The study comprised a multistage stratified random sample of 14659 adolescents (7205 males and 7454 females), which constitutes approximately 17% of the target population of this school level. METHODS: Weights and heights of the adolescents were measured, from which the body mass index (BMI), which is the weight in kilograms divided by the height in meters squared (kg/m2), was calculated. Overweight and obesity were defined as BMI >85th and >95th centiles, respectively, of the National Center for Health Statistics (NCHS) reference data. RESULTS: The overall prevalence of overweight and obesity among males were 30.0 and 14.7%, respectively (P<0.001). The overall prevalence of overweight and obesity among females were 31.8 and 13.1%, respectively (P<0.001 and P<0.01). There was no consistent rise or decline in overweight and obesity in both genders with respect to age. However, the overall prevalence of overweight was lower in males than in females but obesity was higher in males than in females. CONCLUSION: When compared to the NCHS reference population, the BMI of Kuwaiti adolescents exceeded that of the Americans in each centile category > or = 50th centile. Health education programmes should be instituted to control this syndrome in order to prevent future risk of obesity-related diseases.     

Resting metabolic rate is an important predictor of serum adiponectin concentrations: potential implications for obesity-related disorders

BACKGROUND: Little is known about the regulation of adiponectin. Animal studies suggest local regulation by adipocytokines or alterations in energy expenditure, and studies in humans suggest regulation by alcohol intake and ethnicity. OBJECTIVE: To identify regulators of adiponectin in humans, we measured resting metabolic rate (RMR), serum adiponectin, glucose, insulin, triacylglycerol, alcohol intake, and anthropometric indexes in 457 white patients with overweight or obesity. DESIGN: A cross-sectional design was used, and multivariate regression analysis was performed with adiponectin as the dependent variable and potential predictors as independent variables. RESULTS: Simple linear analyses showed significant associations between adiponectin and sex, with a standardized coefficient of -0.38 (women compared with men) and an explanation of variation of the model (R(2)) of 14%; age (0.21; 4%); RMR (-0.52; 27%); fat-free mass (-0.40; 16%); fat mass (-0.16; 2%); visceral fat (-0.24; 6%; computed tomography at L4-L5); fasting triacylglycerol (-0.28; 8%); and insulin resistance (-0.38; 14%; homeostasis model assessment). Adiponectin and alcohol were not associated (-0.04; 0%). Multivariate analyses, which allowed adjustment for confounding, showed that RMR is the most important predictor of adiponectin (-0.31; 29%), followed successively by insulin resistance (-0.16; 31%; model containing RMR and insulin resistance), fat mass (0.20; 34%), age (0.34; 35%), visceral fat (-0.34; 40%), and fasting triacylglycerol (-0.12, 41%). CONCLUSIONS: Low resting metabolism (RMR) is associated with high serum adiponectin. We speculate that subjects with low RMR, who are theoretically at greater risk of obesity-related disorders, are especially protected by adiponectin.     

父母体质指数与学龄前儿童超重肥胖的关联研究

目的 掌握城市学龄前儿童超重、肥胖的流行现状,探究父母体质指数与学龄前儿童超重肥胖的关系.方法 选取江苏省南京市、山东省淄博市4所幼儿园的2 037名学龄前儿童作为研究对象,采用logistic模型分析父母体质指数与儿童超重肥胖的关系.结果 所调查学龄前儿童超重肥胖率为24.30％,超重率为13.16％(男14.54％...     

Sensitivity and specificity of the body mass index for the diagnosis of overweight/obesity in elderly

The aim of this article was to verify the sensitivity and specificity of the body mass index (BMI) cut-off points proposed by the World Health Organization (WHO) and the Nutrition Screening Initiative (NSI) for the diagnosis of obesity in the elderly. A cross-sectional study was made with 180 healthy elderly subjects from Florianópolis, Santa Catarina State, Brazil. Body fat percentage (%BF) was determined using DEXA (dual energy X-ray absorptiometry). The BMI cut-off point of the NSI offers better sensitivity and specificity for men (73.7% and 72.5% respectively). For women, the lower the cut-off point the better the sensitivity, with a BMI of 25kg/m2 (sensitivity of 76.3% and specificity of 100%) being the most accurate for diagnosing obesity in elderly women. The WHO cut-off point offered very low sensitivity (28.9%). The results of this investigation lead to the conclusion that the cut-off points proposed by the WHO and the ones adopted by the NSI and by Lipschitz are not good indicators of obesity for the elderly of either sex, since they offer low sensitivity.     

Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence

BACKGROUND: The Centers for Disease Control and Prevention (CDC) introduced the clinical use of the body mass index (BMI; in kg/m(2)) in growth charts for young males and females. OBJECTIVE: This study updates our previous report with the use of new CDC BMI charts and definitions of adult overweight and obesity to predict adult overweight or obesity. DESIGN: Logistic models were fitted to relate adult overweight and obesity to childhood and adolescent BMI values at each age for 166 males and 181 females in the Fels Longitudinal Study and were applied to predict adult overweight and obesity at the 75th, 85th, and 95th percentiles on the CDC charts of childhood and adolescent BMI. RESULTS: A child or adolescent with a high BMI percentile on the CDC BMI-for-age growth charts has a high risk of being overweight or obese at 35 y of age, and this risk increases with age. For example, the probability of adult obesity at the 85th percentile for young males was 相似文献   

体质指数正常人群多代谢异常与代谢综合征

目的了解体质指数（BMI）正常人群多代谢异常与代谢综合征（MS）的患病情况。方法以江苏省多代谢异常和代谢综合征防治队列研究的调查人群为研究对象,符合纳入标准的对象共4251名（男2003名,女2248名）。采用美国国家胆固醇教育计划成人治疗组第3次会议报告（NCEP-ATPⅢ）亚裔标准诊断MS,依据BMI将研究对象分为4组后,分性别计算各组MS患病率及OR值。结果4 251名对象的MS患病率为12.66%（男性7.69%,女性17.08%,P〈0.001）。男性随BMI升高MS患病率由2.58%增至12.54%,女性MS患病率由6.33%增至30.50%,趋势检验P〈0.001。Logistic回归分析显示,BMI为20.71~24.99 kg/m^2相对于BMI为18.50~20.70kg/m^2的男性患MS的OR值（BMI）分别为2.23（20.71~22.16 kg/m^2）,3.30（22.17~23.49 kg/m^2）,6.19（23.50~24.99 kg/m^2）;女性OR值分别为1.93,3.97,7.77。去除腰围重新定义MS进入模型计算OR值,得出男性为2.27,3.46,5.17;女性为1.39，2.36，2.59，所有OR值都调整了年龄、吸烟、饮酒、居住地、文化水平、婚姻状况、人均。收入变平和总胆固醇，趋势检验P〈0.001。结论体质指数正常人群中多代谢异常和代谢综合征的患病率同样较高；腰围与代谢综合征的关联可能比体质指数更密切。     

上海市0～18岁体质指数百分位曲线及超重肥胖界值点标准的研制

【目的】建立上海市0～18岁体质指数(body mass index，BMI)百分位及超重肥胖界值点。【方法】①采用分层整群随机抽样方法，收集上海市区0～19岁儿童96104人(男48790，女47314)的性别、出生年月及1999～2002年身高和体重测量资料；②应用偏度-中位数-变异系数法(λ-median-coefficient of variation method，LMS法)建立上海市0～18岁儿童BMI百分位；③根据国际肥胖工作小组(IOTF)和中国肥胖问题工作组(WGOC)建议，建立在18岁时通过25和30及24和28kg／m^2的百分位曲线，分别作为2～18岁各年龄段超重和肥胖界值点标准。【结果】应用LMS方法获得了0～18岁男女童体质指数百分位曲线，它随年龄有大幅度的变化。出生时男女BMI中位数分别为13．7和13．4kg／m^2，以后迅速上升，至6个月时出现一个高峰，之后持续下降，男童在5．5岁为15．7kg／m^2，女童在6岁为15．4kg／m^2，之后重新上升，至18岁时分别达21．3和20．2kg／m^2。18岁时通过25及30kg／m^2的百分位曲线男为P82．0和P96.5女为P93.0和P99.2；通过24及28kg／m^2的百分位曲线男为P75.3和P93.3，女为P89.1和P98.2。这些特殊的百分位曲线分别提供了2～18岁不同年龄及性别超重和肥胖的界值点标准。【结论】按IOTF及WGOC建议，首次建立了上海市2～18岁BMI超重和肥胖两套界值点标准。