Obesity misclassification and the metabolic syndrome in adults with functional mobility impairments: Nutrition Examination Survey 2003–2006

ObjectivesThe purpose of this study was to estimate the degree of obesity misclassification between body mass index (BMI) and body fat percentage in adults with functional mobility impairment, and to determine cardiometabolic risk profiles.MethodsData from the combined 2003–2006 National Health and Nutrition Examination Survey (NHANES) were incorporated. The representative sample included 852 individuals, aged 20–85 years, reporting at least one major physical limitation related to mobility or lower body function, and 4724 individuals reporting no impairments. Body mass index, percent body fat (%BF) as determined by dual energy X-ray absorptiometry (DXA), objectively measured sedentary behavior and activity, and markers of cardiometabolic risk were compared between adults with and without functional mobility impairments. Among functional mobility impaired individuals, sensitivity, specificity, and receiver operating characteristic curves were used to evaluate the performance of BMI as a continuous variable, as well as various BMI thresholds to detect obesity defined by sex-specific %BF cutoffs.ResultsAdults with functional mobility impairments were older, had larger waist circumferences (WC), had greater prevalence of obesity according to BMI and %BF, were more sedentary, had less physical activity, and had higher overall cardiometabolic risk. The standard BMI cutoff for obesity had excellent specificity in both men (100%) and women (98.4%) with functional mobility impairment, but sensitivity was poor (< 55%). Whereas approximately 36% and 43% of impaired men and women fell into the obese BMI category, over 80% of men and women were obese according to %BF. Individuals with high %BF who were misclassified as not obese, according to BMI, had a significantly higher prevalence of the metabolic syndrome (17.6%) compared to subjects with normal BMI and low %BF (2.1%).ConclusionsObesity misclassification and cardiometabolic risk are prevalent among individuals with functional mobility impairments, and thus diagnostic screening for obesity should be modified to account for %BF and/or waist circumference. Behavioral interventions to decrease sedentary behavior, increase activity, and reduce abdominal obesity are warranted.     

Abdominal obesity, TV-viewing time and prospective declines in physical activity

ObjectiveTo examine the prospective associations of baseline abdominal obesity and TV-viewing time with five-year reductions in leisure-time physical activity level.MethodsWe used data from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab), a nationally representative population-based cohort study with measures collected in 1999–2000 and 2004–2005. Abdominal obesity was determined by waist circumference and TV-viewing time and physical activity level were assessed using established interviewer-administered questionnaires.ResultsAmong 2,191 men and 2,650 women aged ≥ 25 years, odds ratios (ORs) of 5-year reductions from sufficient to insufficient or no physical activity, and from insufficient to no physical activity were estimated with logistic regression. We adjusted for sociodemographic characteristics. The odds of reducing physical levels from baseline to the follow-up survey for obese men (34.2%) and women (38.1%), respectively were 1.40 (1.10–1.79) and 1.44 (1.16–1.80), compared to those with a normal waist circumference. Women, but not men, with higher levels of TV-viewing time had higher odds of reducing physical activity levels (8.6%; OR 1.46; 1.01–2.11), independent of abdominal obesity.ConclusionsThese findings suggest that abdominal obesity is associated with prospective reductions in physical activity level, and that high levels of TV-viewing time might have an additional adverse influence for women.     

Levels of physical activity and relationship with markers of diabetes and cardiovascular disease risk in 5474 white European and South Asian adults screened for type 2 diabetes

ObjectiveInvestigate levels of physical activity and their association with health in a white European (WE) and South Asian (SA) population.MethodsThis study reports data from a diabetes screening programme, 2004–2007, Leicester, UK. Physical activity was measured using the International Physical Activity Questionnaire; additional outcomes included fasting and 2-h post-challenge glucose, lipid profile, body mass index (BMI) and waist circumference.Results1164 SA (female = 48%) and 4310 WE (female = 53%) were included. SAs were more likely fall below the minimum physical activity recommendations for health compared to WEs (age-adjusted OR for SA men = 2.35; 95% CI = 1.89–2.93, age adjusted OR for SA women = 2.25; 95% CI = 1.81–2.80). There were significant associations between levels of physical activity and BMI (men and women), waist circumference (men and women), 2-h glucose (women), HDL-cholesterol (men) and triglycerides (men) in WEs and waist circumference (women) and HDL-cholesterol (men) in SAs. Significant interactions between ethnicity and physical activity existed in the relationship with BMI and waist circumference in men.ConclusionsSAs are substantially less physically active than WEs. There may also be differences between SAs and WEs in the health benefits associated with higher physical activity that warrant further investigation.     

Vulnerabilidad de la obesidad definida por el índice de masa corporal,perímetro abdominal y porcentaje de grasa corporal

AimTo ascertain to what extent it is possible to stop being obese (to normalize body mass index [BMI], waist circumference [WC] and/or body fat percentage [BFP]).DesignLongitudinal observational and retrospective study.SiteEleven Spanish health centers.ParticipantsMen and women with BMI ≥ 30 kg/m² (n = 1246) or general obesity (GO), with WC > 102 cm and > 88 cm, respectively (n = 2122) or abdominal obesity (AO) and with BFP > 25% and > 35%, respectively (n = 2436) or excess body fat (EBF), from the PEPAF Study cohort of 4927 participants aged 20-80 years.Main measurementsData from the PEPAF study at baseline and at 6, 12 and 24 months: gender, age, diagnoses of diabetes, hypertension and dyslipidemia, smoking, levels of and compliance with physical activity recommendations, maximum oxygen consumption, weigh, height, WC and three skin-folds (thoracic, umbilical and anterior thigh for men and triceps, suprailiac and anterior thigh for women).ResultsOf 2054 participants with any type of obesity at baseline and valid data at 2 years, 240 (11.6%) had normalized all of their obesity diagnostic indexes. 19.5% (95% confidence interval (95% CI: 17.6-21.4) ceased to have EBF, 12.0% (95% CI: 10.4-13.7) ceased to have AO and 10.5% (95% CI: 8.5-12.7) ceased to have GO.ConclusionsObesity differs from other chronic diseases in that it can be «cured» by normalizing the amount of body fat.     

The association of circulating endocannabinoids with appetite regulatory substances in obese women

BackgroundsEndocannabinoids especially anadamide (AEA) and 2‑arachidonoylglycerol (2-AG) together with appetite modulators have recently been of great importance in body weight regulation and obesity incidence. The present study was carried out to investigate AEA and 2-AG levels and their association with leptin, insulin, orexin – A, and anthropometric indices in obese women.MethodsThe demographic and anthropometric data of 180 overweight/ obese women with mean age 34.2 ± 8.27 years old, and mean BMI 32.54 ± 3.73 kg/m² were evaluated. The plasma levels of anadamide and 2‑arachidonoylglycerol levels and also serum levels of leptin, insulin and orexin- A concentrations were measured. Pearson and spearmen correlation tests along with hieratical regression test were used to assess the association of endocannabinoids levels with anthropometric indices and appetite modulators.ResultsSignificant correlations were revealed between AEA and 2-AG with leptin, BMI, waist circumference (WC) and body fat percent (BF%) (P < 0.001). 2-AG levels correlated positively with mean insulin levels (P < 0.001). Neither AEA nor 2-AG correlated significantly with serum orexin - A levels. Leptin, insulin, BMI, WC, and BF% were significant independent predictors of AEA and 2-AG in the hierarchical regression model (P < .001) and explained 65% and 68% of variance in AEA and 2-AG respectively (P < 0.001).ConclusionThe findings showed that levels of AEA and 2-AG were associated with BMI, WC, BF%, and leptin and insulin levels. Also, BMI, WC, BF%, leptin and, insulin levels can have predictive value for determining AEA and 2-AG.     

Influence of home/school environments on children's obesity,diet, and physical activity: the SUECO study protocol

ObjectiveThe SUECO study examines the relationship between urban obesogenic environments and health outcomes among school-age children in the city of Madrid, Spain. We will study how features of the urban environment (related to the food- and the physical activity environment) associate with children's anthropometrics, eating habits, and physical activity levels.MethodWe describe the study protocol of this multilevel study in a representative sample of school-age children in the city of Madrid (2017; n = 5,961 children ages 3-12). Main outcome variables include anthropometrics (body mass index, waist circumference, and body fat), healthy and unhealthy consumption measures, and physical activity measures. The primary explanatory variables are grouped into food environment (e.g., unhealthy food retailers’ density) and physical activity environment (e.g., walkability, physical activity opportunities) variable categories. Multilevel models will be used to calculate the associations between each indicator and obesity and physical inactivity.     

Prevalence of obesity and overweight and associated nutritional factors in a population-based Swiss sample: an opportunity to analyze the impact of three different European cultural roots

Purpose

Obesity represents a growing public health concern worldwide. The latest data in Switzerland rely on self-reported body mass index (BMI), leading to underestimation of prevalence. We reassessed the prevalence of obesity and overweight in a sample of the Swiss population using measured BMI and waist circumference (WC) and explored the association with nutritional factors and living in different linguistic-cultural regions.

Methods

Data of 1,505 participants of a cross-sectional population-based survey in the three linguistic regions of Switzerland were analyzed. BMI and WC were measured, and a 24-h urine collection was performed to evaluate dietary sodium, potassium and protein intake.

Results

The prevalence of overweight, obesity and abdominal obesity was 32.2, 14.2 and 33.6 %, respectively. Significant differences were observed in the regional distribution, with a lower prevalence in the Italian-speaking population. Low educational level, current smoking, scarce physical activity and being migrant were associated with an higher prevalence of obesity. Sodium, potassium and protein intake increased significantly across BMI categories.

Conclusions

Obesity and overweight affect almost half of the Swiss adolescents and adults, and the prevalence appears to increase. Using BMI and WC to define obesity led to different prevalences. Differences were furthermore observed across Swiss linguistic-cultural regions, despite a common socio-economic and governmental framework. We found a positive association between obesity and salt intake, with a potential deleterious synergistic effect on cardiovascular risk.     

Obesity and its associations with hypertension and type 2 diabetes among Chinese adults age 40 years and over

AimTo investigate the prevalence of obesity in a Chinese community according to the World Health Organization recommended criteria for Asians in 2000 based on body mass index (BMI) and waist circumference (WC), and to examine the associations between obesity and the risk of hypertension and type 2 diabetes among adults age 40 years and over in Shanghai, China.MethodsA population-based survey was conducted in Youyi Community in Shanghai. Five thousand seventy-one subjects (1917 men and 3154 women) were included in this study. Standard questionnaires were used to collect baseline data of participants. Body weight, height, WC, blood pressure, and glucose in the blood were measured.ResultsThe prevalence of general obesity was 44.6% (46.4% for men and 43.6% for women) according to BMI and 36.1% (25.5% for men and 42.6% for women) for central obesity according to WC. The prevalence of obesity I was higher in men (41.6%) than in women (36.2%; χ² = 14.8, P < 0.05), although the rate was higher in women than in men for obesity II (7.4% versus 4.8%, χ² = 13.6, P < 0.01) or central obesity (42.6% versus 25.5%, χ² = 152.1, P < 0.01). Odds ratios of hypertension and type 2 diabetes were significantly higher in the obesity group compared with either the group with BMI 18.5–<23.0 kg/m² or the group with WC < 90 cm for men or <80 cm for women.ConclusionsAccording to the criteria of obesity for Asians, the prevalence of obesity among Chinese adults age 40 years and over in Shanghai is high. Subjects with obesity have a significantly higher risk of hypertension and type 2 diabetes.     

Change in general and central adiposity measures in prediction of incident dysglycemia; Tehran Lipid and Glucose Study

ObjectivesTo examine the change in general and central adiposity measures as a predictor of incident dysglycemia during a 6-year follow-up.SubjectsA total of 4029 (2333 women and 1696 men) non-dysglycemic Iranians aged ≥ 20 years, underwent standard fasting and 2-h post-challenge plasma glucose tests at baseline and follow-up.ResultsDuring follow-up, 458 new cases of dysglycemia occurred. In multivariable models including baseline values of each anthropometric measure, odds ratios (ORs) for dysglycemia incidence corresponding to a 1-SD increase in changes of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and hip circumference (HC), were 1.32, 1.56, 1.39, 1.51 and 1.39 for men and 1.59, 1.50, 1.37, 1.47, and 1.38, for women, respectively (all P < 0.05). After controlling for weight change and WC change among men and women, respectively, HC change did not remain as a predictor. Using the paired homogeneity test, there was no superiority for changes in central obesity measures compared to changes in BMI to predict dysglycemia.ConclusionThe association between HC changes and incident dysglycemia was dependent upon changes in central and general adiposity measures, where the former did not have higher predictability than the latter in prediction of dysglycemia.     

Urinary triclosan concentrations are inversely associated with body mass index and waist circumference in the US general population: Experience in NHANES 2003–2010

BackgroundHumans are extensively exposed to triclosan, an antibacterial and antifungal agent. Triclosan's effects on human health, however, have not been carefully investigated.ObjectiveTo examine whether triclosan exposure is associated with obesity traits.MethodsThis study included 2898 children (6–19 years old) and 5066 adults (20 years or older) who participated in the National Health and Nutrition Examination Surveys (NHANES) 2003–2010 and had a detectable level of urinary triclosan. Multiple linear regression models were used to examine the association between urinary triclosan and both body mass index (BMI) and waist circumference.ResultsEach standard deviation increase in urinary triclosan was associated with a 0.34 (95% confidence interval, CI: 0.05, 0.64) kg/m² lower level of BMI (P = 0.02) and 0.92 (95% CI: 0.09, 1.74) cm smaller waist circumference (P = 0.03) in boys, and a 0.62 (95% CI: 0.31, 0.94) kg/m² lower level of BMI (P = 0.0002) and 1.32 (95% CI: 0.54, 2.09) cm smaller waist circumference in girls (P = 0.001); a 0.42 (95% CI: 0.06, 0.77) kg/m² lower level of BMI (P = 0.02) and 1.35 (95% CI: 0.48, 2.22) cm smaller waist circumference (P = 0.003) in men, and a 0.71 (95% CI: 0.34, 1.07) kg/m² lower level of BMI (P = 0.0002) and 1.68 (95% CI: 0.86, 2.50) cm smaller waist circumference (P = 0.0001) in women. In both children and adults, there was a consistent trend for lower levels of BMI and smaller waist circumference with increasing levels of urinary triclosan, from the lowest to the highest quartile of urinary triclosan (P ≤ 0.001 in all cases).ConclusionTriclosan exposure is inversely associated with BMI and waist circumference. The biological mechanisms linking triclosan exposure to obesity await further investigation.     

银川城区儿童青少年骨矿物质含量与肥胖相关关系的研究

目的 分析儿童青少年骨矿物质含量(BMC)与肥胖之间的关系,为预防儿童青少年骨质疏松提供更有力的依据.方法 于2017-2020年以整群随机抽样的方法从银川市随机抽取1578名儿童青少年作为研究对象,进行问卷调查、体格检查、骨矿物质含量测定,采用二元Logistic回归分析不同定义的肥胖指标与骨矿物质含量之间的关系.结...     

Abdominal obesity as a mediator of the influence of physical activity on insulin resistance in Spanish adults

ObjectiveThe aim of the study was to analyze the relationship between moderate-to-vigorous physical activity (MVPA) and insulin resistance (IR) in Spanish adults and to examine whether this relationship is mediated by abdominal obesity (waist circumference — WC).MethodsThe cross-sectional study included 1162 healthy subjects belonging to the EVIDENT study (mean age 55.0 ± 13.3 years; 61.8% women) from six different Spanish provinces. Moderate-to-vigorous physical activity (MVPA) was measured objectively over 7 days using Actigraph accelerometers, collecting data in 60-second epochs, and retaining respondents with ≥ 4 valid days for the analysis. The homeostasis model of assessment (HOMA-IR) was used to determine IR, and its individual components – fasting glucose and insulin – were determined using standard protocols. Linear regression models were fitted according to Baron and Kenny's procedures for mediation analysis.ResultsFasting insulin and HOMA-IR levels were significantly worse in adults who spent fewer minutes in MVPA (first quartile ≤ 30.1 and 22.7 min/day in men and women, respectively) after adjusting for age, sex, smoking habits, drinking habits, accelerometer wear time, sedentary time, and Mediterranean diet adherence. However, when WC was added to the ANCOVA models as a covariate, the effects disappeared. Mediation analysis reported that WC acts as a full mediator in the relationship between MVPA and IR (HOMA-IR and fasting insulin).ConclusionThese findings show that WC plays a pivotal role in the relationship between MVPA and IR, and therefore highlights that decreasing abdominal obesity might be considered as an intermediate outcome for evaluating interventions aimed at preventing diabetes mellitus.     

Change in general and central adiposity measures in prediction of incident dysglycemia; Tehran Lipid and Glucose Study

ObjectivesTo examine the change in general and central adiposity measures as a predictor of incident dysglycemia during a 6-year follow-up.SubjectsA total of 4029 (2333 women and 1696 men) non-dysglycemic Iranians aged ≥ 20 years, underwent standard fasting and 2-h post-challenge plasma glucose tests at baseline and follow-up.ResultsDuring follow-up, 458 new cases of dysglycemia occurred. In multivariable models including baseline values of each anthropometric measure, odds ratios (ORs) for dysglycemia incidence corresponding to a 1-SD increase in changes of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and hip circumference (HC), were 1.32, 1.56, 1.39, 1.51 and 1.39 for men and 1.59, 1.50, 1.37, 1.47, and 1.38, for women, respectively (all P < 0.05). After controlling for weight change and WC change among men and women, respectively, HC change did not remain as a predictor. Using the paired homogeneity test, there was no superiority for changes in central obesity measures compared to changes in BMI to predict dysglycemia.ConclusionThe association between HC changes and incident dysglycemia was dependent upon changes in central and general adiposity measures, where the former did not have higher predictability than the latter in prediction of dysglycemia.     

Prevalence of obesity in primary care using different anthropometric measures – Results of the German Metabolic and Cardiovascular Risk Project (GEMCAS)

Background  

Obesity is one of the greatest challenges in primary health care. The BMI describes fat mass and waist circumference (WC) fat distribution and total metabolic and cardiovascular risk. It was aim of the present study to assess the prevalence of a) overweight and obesity and b) an increased and high WC in adults seeking primary care in Germany and to describe the associations of both measures with cardiovascular risk factors and prognosis.     

The effects of phthalate and nonylphenol exposure on body size and secondary sexual characteristics during puberty

BackgroundSome phthalic acid esters (PAEs) and nonylphenol (NP) are endocrine-disrupting chemicals (EDCs) that are widely used in consumer products. Consequently, the general population is exposed simultaneously to both groups of chemicals.ObjectiveTo investigate the single- and co-exposure effects of PAEs (DMP, DEP, DnBP, DiBP, BBzP, and DEHP) and NP on obesity and pubertal maturity to compare the body sizes of general adolescents with the complainants of the phthalate-tainted foods scandal that occurred in Taiwan.MethodsThis study included 270 general adolescents aged 6.5–15.0 years and 38 complainants aged 6.5–8.5 years. Nine metabolites of the five PAEs and of NP were measured in urine. We used a questionnaire to evaluate pubertal maturity, measured anthropometric indices (APs) to assess body size, and collected urine samples to measure the two groups of chemicals.ResultsWe found that urinary PAE metabolite concentrations (specifically, metabolites of DEP, DnBP, DiBP, and DEHP) were positively associated with the APs for abdominal obesity (including skinfold thickness, waist circumference, waist-to-height ratio, and waist-to-hip) and indicated a dose–response relationship. Mono-methyl phthalate (MMP) exposure was inversely associated with pubarche among boys. The daily intake of DEHP in general adolescents exceeded the reference doses (RfD-20 μg/kg bw/day) and tolerable daily intake (TDI-50 μg/kg bw/day) by 3.4% and 0.4%, respectively. No associations were observed between NP exposure or co-exposure and the APs or pubertal maturity. No significant differences were observed between general adolescents and the complainants with regard to weight, height, or BMI.ConclusionsThe study suggests that PAE (specifically, DEP, DnBP, DiBP, and DEHP) exposure is associated with abdominal obesity in adolescents and that the APs for abdominal obesity are more sensitive than BMI for measuring obesity among adolescents. We suggest that the RfD and TDI for PAEs should be revised to provide sufficient protection.     

Association of self-perceived body image with body mass index and type 2 diabetes—The ADDITION-PRO study

ObjectiveWeight loss is important for prevention of type 2 diabetes and an accurate self-perceived body image can promote weight reduction. We evaluated the association of self-perceived body image with body mass index (BMI) and type 2 diabetes.MethodsData from the Danish ADDITION-PRO cohort study (2009–2011) were used. A total of 2082 men and women attended a health examination including assessment of BMI, waist circumference, the Stunkard scale of self-perceived obesity and an oral glucose tolerance test for assessment of diabetes risk.ResultsMean (SD) age was 66.2 (6.9) years and 24% were obese (BMI ≥ 30 kg/m²). However, only 7% of obese men and 11% of obese women perceived themselves as obese. Among obese women, for a given level of BMI and waist circumference, one unit higher self-perceived body image was associated with 52% (95% CI: 14–73) lower risk of having type 2 diabetes and 45% (95% CI: 12–65) lower risk of having pre-diabetes. Overweight, but not obese, men had a 35% (95% CI: 36–56) lower risk of type 2 diabetes per unit increase in body image.ConclusionsObese individuals seem to underestimate their body shape. However, having a realistic body image (higher self-perceived obesity) is independently associated with lower diabetes risk. Self-perceived body image might serve as a valuable tool for type 2 diabetes risk assessment.     

Incidence and potential risk factors of obesity among Tehranian adults

AimEvaluating the incidence of obesity and its risk factors among Tehranian adults.Material & methodsIn this population-based cohort, non-obese participants, aged ≥ 20 years, were followed for development of obesity (Body Mass Index (BMI) ≥ 30). Incidence density and cumulative incidence rates of obesity were calculated for each sex. Cox proportional hazard regression was used to determine the association of potential obesity risk factors including: age, BMI, metabolic syndrome, waist circumference (WC), smoking, marital status, education, and physical activity.ResultA total of 7257 participants (3536 men) were followed for a median of 8 years. At baseline, mean age, BMI and WC were 41.3 ± 14.6 years, 25.1 ± 2.9 kg/m² (24.9 ± 3 kg/m² men and 25.2 ± 3 kg/m² women), and 84.8 ± 9.8 cm (87.06 ± 9.2 cm men and 82.6 ± 9.9 cm women) respectively. During the follow-up, 1345 participants (876 women) developed obesity contributing to cumulative incidences of 31.3% (CI: 29.9%–32.7%), 38.1% (CI: 36.2%–40.1%), and 23.4% (CI: 21.6%–25.3%) for the whole population, women, and men, respectively. Corresponding incidence density rates per 1000 person-year were 25.9 (CI: 24.5–27.3), 33.67 (CI: 31.5–36.0), and 18.0 (CI: 16.5–19.7), respectively. Highest incidence rates were observed during their 40s and 20s for women and men, respectively. Participants with metabolic syndrome, lower educational level, higher BMI and WC, were at higher risk of obesity development in both sexes.ConclusionHigh incidence of obesity was observed among Tehranian adults with higher incidence of obesity in women. Different modifiable variables may act as risk factors for obesity development which should be targeted to control the epidemic of obesity.     

Relationship between body composition and blood pressure in Bahraini adolescents

The objective of the present study was to examine the relationship between body composition and blood pressure (BP) in Bahraini adolescents. A sample of 504 Bahraini schoolchildren aged 12-17 years (249 boys and 255 girls) was selected using a multi-stage stratified sampling procedure. BP measurements were performed on the students. Anthropometric data including weight, height, waist circumference (WC), hip circumference, and triceps, subscapular and medial calf skinfold thicknesses were also collected. BMI, percentage body fat, waist:hip (WHR), and subscapular:triceps skinfold ratio were calculated. Mean systolic BP and mean diastolic BP were higher in males than in females. Weight and height in boys and weight only in girls were significantly associated with systolic BP independent of age or percentage fat. Nearly 14 % of the adolescents were classified as having high BP. BMI and percentage body fat were significantly and positively associated with the risk of having high BP in the boys and girls. Adolescents with high WHR or WC, as indicators for central obesity, tended to have higher BP values. The results from the present study indicate that obesity influences the BP of Bahraini adolescents and that simple anthropometric measurements such as WHR and WC are useful in identifying children at risk of developing high BP. These findings together with the known tracking of BP from adolescence into adulthood underline the importance of establishing intervention programmes in order to prevent the development of childhood and adolescent obesity.     

Obesity and Dyslipidemia in South Asians

Obesity and dyslipidemia are emerging as major public health challenges in South Asian countries. The prevalence of obesity is more in urban areas than rural, and women are more affected than men. Further, obesity in childhood and adolescents is rising rapidly. Obesity in South Asians has characteristic features: high prevalence of abdominal obesity, with more intra-abdominal and truncal subcutaneous adiposity than white Caucasians. In addition, there is greater accumulation of fat at “ectopic” sites, namely the liver and skeletal muscles. All these features lead to higher magnitude of insulin resistance, and its concomitant metabolic disorders (the metabolic syndrome) including atherogenic dyslipidemia. Because of the occurrence of type 2 diabetes, dyslipidemia and other cardiovascular morbidities at a lower range of body mass index (BMI) and waist circumference (WC), it is proposed that cut-offs for both measures of obesity should be lower (BMI 23–24.9 kg/m² for overweight and ≥25 kg/m² for obesity, WC ≥80 cm for women and ≥90 cm for men for abdominal obesity) for South Asians, and a consensus guideline for these revised measures has been developed for Asian Indians. Increasing obesity and dyslipidemia in South Asians is primarily driven by nutrition, lifestyle and demographic transitions, increasingly faulty diets and physical inactivity, in the background of genetic predisposition. Dietary guidelines for prevention of obesity and diabetes, and physical activity guidelines for Asian Indians are now available. Intervention programs with emphasis on improving knowledge, attitude and practices regarding healthy nutrition, physical activity and stress management need to be implemented. Evidence for successful intervention program for prevention of childhood obesity and for prevention of diabetes is available for Asian Indians, and could be applied to all South Asian countries with similar cultural and lifestyle profiles. Finally, more research on pathophysiology, guidelines for cut-offs, and culturally-specific lifestyle management of obesity, dyslipidemia and the metabolic syndrome are needed for South Asians.     

Association of different obesity indices with blood pressure and blood lipids in children and adolescents

The aim of the present study was to compare individual associations of BMI, triceps skinfold (TSF), waist circumference (WC) and percentage fat mass (%FM) with blood pressure (BP) and blood lipids in children and adolescents. Cross-sectional data on BMI, TSF, WC, %FM as well as on BP, TAG and HDL were analysed in 4220 (BP) and 729 (lipids) 9-11-year-old children and 3174 (BP) and 536 (lipids) 13-16-year-old adolescents as part of the Kiel Obesity Prevention Study. All obesity indices were similarly associated with BP and blood lipids. In girls, WC had closer correlations to BP than BMI (systolic BP: 0.27 and 0.24 for BMI, 0.34 and 0.28 for WC in 9-11- and 13-16-year-olds). Subjects with an obesity index > or = 90th percentile had higher prevalences of elevated BP and blood lipids than subjects with a normal index. In children with normal BMI or WC, an additionally elevated second obesity index was associated with a 2.5-7.4-fold higher prevalence of high BP when compared with children with normal indices. In adolescents, an elevated WC plus an elevated second obesity index was associated with a 2.6-8.2-fold higher prevalence of high BP when compared with adolescents with an elevated WC plus a normal second index. We conclude that (i) both BMI and WC are appropriate to estimate CVD risk, (ii) the use of a second obesity index is recommended in children with normal BMI or normal WC as well as in adolescents with elevated WC and (iii) all obesity indices seemed to be appropriate for risk assessment.