The body mass index is a less-sensitive tool for detecting cases with obesity-associated co-morbidities in short stature subjects

Socioeconomic impacts on Andean adolescents’ growth

Background/Objectives

We evaluated potential socioeconomic contributors to variation in Andean adolescents’ growth between households within a peri-urban community undergoing rapid demographic and economic change, between different community types (rural, peri-urban, urban) and over time. Because growth monitoring is widely used for assessing community needs and progress, we compared the prevalences of stunting, underweight, and overweight estimated by three different growth references.

Methods

Anthropometrics of 101 El Alto, Bolivia, adolescents (Alteños), 11.0–14.9 years old in 2003, were compared between households (economic status assessed by parental occupations); to one urban and two rural samples collected in 1983/1998/1977, respectively; and to the WHO growth reference, a representative sample of Bolivian children (MESA), and a region-wide sample of high-altitude Peruvian children (Puno).

Results

Female Alteños’ growth was positively associated with household and maternal income indices. Alteños’ height averaged ∼0.8SD/∼0.6SD/∼2SDs greater than adolescents’ height in urban and rural communities measured in 1983/1998/1977, respectively. Overweight prevalence was comparable to the WHO, and lower than MESA and Puno, references. Stunting was 8.5/2.5/0.5 times WHO/MESA/Puno samples, respectively.

Conclusions/Implications

Both peri-urban conditions and temporal trends contributed to gains in Alteños’ growth. Rural out-migration can alleviate migrants’ poverty, partly because of more diverse economic options in urbanized communities, especially for women. Nonetheless, Alteños averaged below WHO and MESA height and weight medians. Evolved biological adaptations to environmental challenges, and the consequent variability in growth trajectories, favor using multiple growth references. Growth monitoring should be informed by community- and household-level studies to detect and understand local factors causing or alleviating health disparities.

Waist-To-Height Ratio Is a More Accurate Tool for Predicting Hypertension Than Waist-To-Hip Circumference and BMI in Patients With Type 2 Diabetes: A Prospective Study

Background: Anthropometric measures [i.e., body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)] have been used as prediction factors for incident hypertension. However, whether any of these measures is superior to another in the matter of accuracy in predicting hypertension in diabetic patients has been controversial. The present prospective study aimed to determine whether WHtR is a more accurate tool for predicting hypertension than WHR and BMI in patients with type 2 diabetes.

Methods: The study population consisted of 1,685 normotensive patients with type 2 diabetes. BMI, WHR, and WHtR were assessed at baseline and followed up for hypertension incidence for a mean of 4.8 years. A cox regression analysis was performed to assess the association between anthropometric measures (i.e., BMI, WHR, and WHtR) and incident hypertension during the follow-up period. The area under the ROC curve analysis was performed and optimal cutoff values were calculated for each anthropometric measure for hypertension prediction.

Results: WHtR and BMI were significantly associated with an increased incidence of hypertension (HR = 3.296 (0.936–12.857), P < 0.001, and HR = 1.050 (1.030–1.070), P < 0.001, respectively). The discriminative powers for each anthropometric index for hypertension were 0.571 (0.540–0.602) for BMI, 0.518 (0.486–0.550) for WHR, and 0.609 (0.578–0.639) for WHtR. The optimal cutoff points for predicting hypertension in patients with type 2 diabetes were 26.94 (sensitivity = 0.739, specificity = 0.380) for BMI, 0.90 (sensitivity = 0.718, specificity = 0.279) for WHR, and 0.59 (sensitivity = 0.676, specificity = 0.517) for WHtR.

Conclusion: WHtR was a more accurate tool for predicting hypertension compared to WHR and BMI in patients with type 2 diabetes.

Faktor yang Berhubungan dengan Konsumsi Energi Ibu Menyusui di Kecamatan Cipayung, Kota Depok, Indonesia

Latar Belakang: Untuk mendukung kebutuhan gizi yang tinggi saat menyusui, ibu menyusui membutuhkan lebih banyak energi dibandingkan ibu hamil. Namun, berbagai studi melaporkan bahwa konsumsi energi ibu menyusui justru lebih rendah dibandingkan ibu hamil.Tujuan: Mengetahui faktor yang berhubungan dengan konsumsi energi ibu menyusui yang rendah di Kecamatan Cipayung Kota Depok Tahun 2016.Metode: Penelitian ini menganalisis data sekunder dari penelitian eksperimental semu dengan pendekatan kohort prospektif di Kota Depok. Total sampel berjumlah 169 responden. Analisis data pada penelitian ini menggunakan uji chi-square dan uji regresi logistik ganda.Hasil:  Konsumsi energi ibu saat hamil merupakan faktor dominan yang berhubungan dengan konsumsi energi ibu saat menyusui setelah dikontrol dengan paritas dan usia ibu. Ibu yang mengonsumsi energi dalam jumlah kurang saat hamil berisiko 3,5 kali lebih besar untuk mengonsumsi energi dalam jumlah kurang saat menyusui.Kesimpulan: Konsumsi energi ibu hamil sangat penting diperhatikan karena selain diperlukan untuk pertumbuhan dan perkembangan janin, sebagai cadangan lemak yang akan digunakan saat menyusui, juga untuk menjamin agar ibu mengonsumsi energi dalam jumlah cukup saat menyusui. 

Differential risk factors and morbidity/mortality pattern in type 2 diabetes: A study among two Mendelian populations with different ancestry (India)

BACKGROUND AND AIMS

Association studies of type 2 diabetes mellitus (T2DM) with risk factors have shown variable results. Moreover, population-specific comparative investigations are negligible. Therefore, the present study aimed to evaluate the association of dyslipidemia and obesity with impaired fasting glucose (IFG) and T2DM among two ethnically, geographically and culturally different populations in India.

METHODS

This was a cross-sectional study among Jats and Meiteis, each inhabiting a separate geographical region. A total of 2371 individuals, age ≥30 years were recruited through household survey. Obesity variables were captured using anthropometric measurements while fasting blood (2.5 mL) was drawn to measure lipid and glucose levels using enzymatic assay by spectrophotometer. Participants were categorized under normal, IFG and T2DM groups, indicative of diabetes progression stages. Statistical analysis was performed using SPSS 16.0 version.

RESULTS

Significant differential distribution of lipid and obesity variables among IFG and T2DM in both populations were observed. Odds ratio revealed high TC and all obesity variables except BMI posed significant increased risk for T2DM among Jats. Abnormal TG, VLDL, WC, and WHtR posed significant increased risk for T2DM among Meiteis. Age-cohort wise prevalence of T2DM showed increasing trend at ≥60 years among Jats and decreasing trend at ≥60 years among Meiteis, suggesting a potential higher morbidity in the former and mortality in latter because of T2DM.

CONCLUSIONS

The present study observed a differential association of risk factors for T2DM among Jats and Meiteis. This study emphasize the need to implement community-specific intervention programs for prevention, treatment and management of T2DM.

Waist-to-height ratio is a better discriminator of cardiovascular disease than other anthropometric indicators in Kurdish adults

It has been suggested that abdominal obesity might be a better cardiovascular diseases (CVDs) discriminator than overall obesity. The most appropriate obesity measures for estimating CVD events in Kurdish populations have not been well-recognized. The objective of the present study was, therefore, to determine the cutoff points of BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist to height ratio (WHtR) as the diagnostic cut-offs to discriminate the prevalent cardiovascular diseases. The data collected from Ravansar Non-Communicable Disease (RaNCD) cohort, the first Kurdish population-based study, was analyzed. The information related to BMI, WC, WHR and WHtR of 10,065 adult participants in the age range of 35-65 was analyzed in this study. Receiver operating characteristic (ROC) analyses were conducted to evaluate the optimum cut-off values and to predict the incidence of cardiac events. The results showed that WHtR had the largest areas under the ROC curve for cardiac events in both male and female participants, and this was followed by WHR, WC, and BMI. The optimal cut-off values for determining the cardiac events in the Kurdish population were BMI = 27.02 kg/m2 for men and BMI = 27.60 kg/m2 for women, WC = 96.05 cm in men and 99.5 cm for women, WHRs = 0.96 in both sexes, and WHtR = 0.56 for men and 0.65 for women. The current study, therefore, showed that WHtR might serve as a better index of prevalent cardiac event than BMI, WHR and WC.

Body Fat Percentage Rather than Body Mass Index Related to the High Occurrence of Type 2 Diabetes

BACKGROUND

Diabetes prevalence estimation and reduction of its risk factors remain the major goals of health services. While obesity is the major risk factor for diabetes, body fat distribution may be a better predictor.

AIMS

To estimate the prevalence of diabetes in an adult working population in Mexico City, and to evaluate the strength of association with different risk factors.

METHODS

A cross-sectional survey was conducted in two city halls of Mexico City. Anthropometrics, blood pressure, physical activity, diet, and biochemical parameters were assessed. Diabetes was defined as a fasting plasma glucose level ≥7.0 mmol/l or referred diabetes. The bioelectrical impedance analysis of body components was performed and weight, soft lean mass, body fat percentage and abdominal fat were obtained. Prevalence with 95% confidence intervals was estimated, as well as odds ratios derived from a logistic regression model.

RESULTS

The prevalence of type 2 diabetes was 11.0% (95% CI 9.6-12.4%). The proportion of individuals with diabetes who were unaware of having the disease was higher in women (42.5 vs. 36.9%), and the degree of metabolic control was better in women (39.1 vs. 25.0%). Age, blood pressure, triglycerides and the percentage of body fat, were major risk factors related to the occurrence of type 2 diabetes. No relation was observed with physical activity and diet.

CONCLUSIONS

The prevalence of type 2 diabetes in Mexico continues to be high and obesity measured by body fat percentage seems to be a better predictor of its occurrence than body mass index.

Physical growth and body adiposity patterns in children and adolescents at high altitudes in Peru: Proposed percentiles for assessment

OBJECTIVES

This study's purpose was to compare physical growth (PG) patterns of children and adolescents living at high elevations with those of other geographic regions, relate body adiposity indicators, and develop percentile reference tables for assessing physical growth and body adiposity.

METHODS

The sample included 1536 children and adolescents ages 5.0 to 17.9 years from Puno (Peru) located between 3821 and 4349 m above sea level. Weight, height, arm and waist circumferences (WC), and three skinfolds measurements were recorded. Body mass index (BMI) and waist-height Index (WHI) were calculated.

RESULTS

PG patterns for children living at a high altitude reflected similar values for weight, height, and arm circumference (AC) to those of their counterparts living in Puno (Peru) and La Paz (Bolivia). When compared with children living at moderate altitudes in Peru, they showed slightly lower PG values. BMI explained between 41% and 64% of the variance in sum of the skinfolds, while WC explained between 47% and 66%. HWI was not a strong predictor of variation in sum of skinfolds. Percentiles were generated for WC and the sum of skinfolds.

CONCLUSION

Weight, height, and, arm and waist circumference patterns for children and adolescents living at high altitudes were similar to those of La Paz (Bolivia). WC and the sum of the skinfolds were better indicators for analyzing abdominal obesity compared to BMI and WHI. The percentiles proposed may be a useful tool for identifying high risk of developing overweight disorders in pediatric populations living at high altitudes.

Thinness, overweight, and obesity in indigenous school children and youth in Mexico

Background: The prevalence of overweight (OWT) and obesity (OB), defined by the body mass index (BMI, kg/m²) among children and youth has increased worldwide in the last 30-40 years.Aim: To evaluate the weight status, defined by the BMI, of indigenous school children and youth resident in different regions of MexicoSubjects and methods: Students 6-18 years (31,448 boys, 27,306 girls) were enrolled in bilingual schools for indigenous children and youth in Mexico in 2012. Height and weight were measured; the BMI was calculated. The BMI of each student was classified relative to International Obesity Task Force (IOTF) age- and sex-specific criteria as thin (three grades), normal, overweight (OWT) or obese (OB). The sample was divided into five geographic regions for analysis: North, Central, South-Gulf, South-Pacific, and South-Southeast. Age- and sex-specific prevalence, 95% confidence intervals, and Chi-square tests were calculated.Results: Prevalence of OWT + OB was highest in the South-Gulf, South-Pacific and South-Southeast regions and lowest in the North and Central regions, while thinness was most prevalent in the North and Central regions.Conclusion: Prevalence of severe and moderate thinness was relatively low, while the combined prevalence of OWT + OB was generally more prevalent in indigenous boys than girls. However, the prevalence of thinness, OWT + OB among indigenous children and youth was lower than in the general population of children and youth in Mexico.

Geographic variation in the growth status of indigenous school children and youth in Mexico

OBJECTIVE

To analyze variation in the growth status of indigenous children and youth attending bilingual schools, escuelas albergues, for the indigenous population in México.

MATERIALS AND METHODS

The children and youth attended escuelas albergues in 1,009 localities in 21 Mexican states in 2012. Heights and weights of 31,448 boys and 27,306 girls 6-18 years of age were measured by trained staff at each school; the BMI was calculated. The students were divided into five geographic regions for analysis: North, Central, South-Gulf, South-Pacific, and South-Southeast. Growth status was compared to United States reference percentiles (P).

RESULTS

Mean heights of children and youth from the five regions varied between P10 and P5 of the reference until about 13 years (girls) and 14 years (boys); subsequently, heights were ≤P5. Mean weights in both sexes were at P25 of the reference between 6 and 12 years, and then varied between P25 and P10 in boys and were ≥P25 in girls. Given the elevated weights relative to heights compared to the reference, mean BMIs of indigenous boys and girls were at or above the reference medians. Children and youth in the North and Central regions were, on average, taller than those in the South-Pacific and South-Southeast regions, while heights of those in the South-Gulf region were generally intermediate. In contrast, mean weights and BMIs differed negligibly among the regions.

CONCLUSIONS

The geographic gradient in heights of indigenous children and youth was consistent with a north-to-south pattern noted among indigenous adults in studies spanning 1898 through 2013. Variation in height among children and youth likely reflected ethnic-specific and geographic variation interacting with economic and nutritional factors.

Life history trade-offs and the partitioning of maternal investment: Implications for health of mothers and offspring

Lay Summary: This review sets out the hypothesis that life history trade-offs in the maternal generation favour the emergence of similar trade-offs in the offspring generation, mediated by the partitioning of maternal investment between pregnancy and lactation, and that these trade-offs help explain widely reported associations between growth trajectories and NCD risk. Growth patterns in early life predict the risk of non-communicable diseases (NCDs), but adaptive explanations remain controversial. It is widely assumed that NCDs occur either because of physiological adjustments to early constraints, or because early ecological cues fail to predict adult environmental conditions (mismatch). I present an inter-generational perspective on developmental plasticity, based on the over-arching hypothesis that a key axis of variability in maternal metabolism derives from life history trade-offs, which influence how individual mothers partition nutritional investment in their offspring between pregnancy and lactation. I review evidence for three resulting predictions: (i) Allocating relatively more energy to growth during development promotes the capacity to invest in offspring during pregnancy. Relevant mechanisms include greater fat-free mass and metabolic turnover, and a larger physical space for fetal growth. (ii) Allocating less energy to growth during development constrains fetal growth of the offspring, but mothers may compensate by a tendency to attain higher adiposity around puberty, ecological conditions permitting, which promotes nutritional investment during lactation. (iii) Since the partitioning of maternal investment between pregnancy and lactation impacts the allocation of energy to 'maintenance' as well as growth, it is expected to shape offspring NCD risk as well as adult size and body composition. Overall, this framework predicts that life history trade-offs in the maternal generation favour the emergence of similar trade-offs in the offspring generation, mediated by the partitioning of maternal investment between pregnancy and lactation, and that these trade-offs help explain widely reported associations between growth trajectories and NCD risk.

Low Estimated Glomerular Filtration Rate Is Prevalent among North Korean Refugees in South Korea

Background

The number of North Korean refugees entering South Korea is rising. Few studies have investigated the risk of non-communicable disease in North Korean refugees. Moreover, kidney insufficiency, a risk factor for cardiovascular disease, has not been studied in this population. We compared the prevalence of non-communicable disease and kidney function in North Korean refugees and South Koreans.

Methods

Our study was conducted using a case-control design. We enrolled 118 North Korean refugees from the Hana Center and selected 472 randomly sampled South Korean individuals as controls, who were age- and sex-matched with the North Korean refugees in a ratio of 1:4, from the 2014 Korea National Health and Nutrition Examination Survey database.

Results

The prevalence of non-communicable disease did not differ significantly between the groups; however, a low estimated glomerular filtration rate (eGFR; <90 mL/min per 1.73 m²) was more prevalent in the North Korean refugees than in the South Korean population (52.1% vs. 29.9%, P<0.001). After adjusting for covariates and weight gain after escape, the prevalence of a low eGFR was associated with the length of residence in South Korea (odds ratio, 2.84; 95% confidence interval, 1.02–7.89).

Conclusion

The prevalence of non-communicable disease did not differ between North Korean refugees and the South Korean population, while a low eGFR was more prevalent in North Korean refugees than in South Koreans. Moreover, after adjusting for other covariates, the prevalence of a low eGFR in North Korean refugees was associated with the length of residence in South Korea.

Stature in adults as an indicator of socioeconomic inequalities in Mexico

OBJECTIVE

To estimate the association between stature in Mexican adults and some sociodemographic factors.

METHODS

We studied a sample of 30 970 subjects, using anthropometric data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). The first quartile was used as the cutoff to define short stature. We analyzed differences among stature strata for sociodemographic variables by using the Kruskal-Wallis test. We estimated odds ratios to measure the association between stature and sociodemographic variables, controlling for potential confounders.

RESULTS

Persons from the southern region of the country were some three times as likely to be of short stature than were subjects in the northern region. The stature difference between the Mexican states with the highest and the lowest average stature was larger than the average difference in stature between Mexico and the United States of America. Adults who had had less than six years of schooling presented the highest prevalence of short stature, regardless of sex, region of the country, place of residence (rural or urban), or the proportion of indigenous language speakers in a state. In addition, the stratum with the highest marginalization (percentage of the population lacking education and services, with a low income, and living in a small community) showed the highest prevalence of short stature.

CONCLUSION

In Mexico, adults who are of short stature have unequal living conditions when compared to those of average or high stature, and this could drive increases in health inequity.

Secular trends are associated with the demographic and epidemiologic transitions in an indigenous community in Oaxaca, Southern Mexico

OBJECTIVE

To test the hypothesis that secular changes in body size and age at menarche are related to the demographic and epidemiologic transitions in an indigenous community in Oaxaca, southern Mexico.

METHODS

Data were derived from surveys of a Zapotec-speaking community conducted between 1968 and 2000. Segmented linear regressions of height, weight, BMI and recalled age at menarche on year of birth in cohorts of adults born before and after the demographic transition were used to evaluate secular changes. Corresponding comparisons of body size (MANCOVA controlling for age) and age at menarche (status quo, probit analysis) were done for samples of children and adolescents born before and after the epidemiological transition.

RESULTS

Height and weight increased in adults born after the demographic transition (mid-1950s), and especially in children and adolescents born after the epidemiological transition (mid-1980s). Age at menarche also decreased significantly in women born after the demographic transition, but at a more rapid estimated rate in adolescents born after the epidemiological transition. Secular gains in body weight were proportional to those for height among children and adolescents, but adults, males more so than females, gained proportionally more weight.

CONCLUSIONS

The secular trend in height in adults of both sexes was associated with the decade of the demographic transition in the mid-1950s. Significant secular gains in size attained and age at menarche occurred in children and youth born after the epidemiologic transition which likely reflected improved health and nutritional conditions since the mid-1980s.

Body Mass Disorders in Healthy Short Children and in Children with Growth Hormone Deficiency

The aim of the study was to determine the degree of adiposity and the incidence of body mass disorders, including abdominal obesity, in healthy short children and children with growth hormone deficiency. The study included 134 short children (height < 10th percentile) aged 7-15. In this cohort there were 63 (31 boys and 32 girls) children without diagnosed hormonal disorders and 71 patients (35 boys and 36 girls) with growth hormone deficiency. Basic somatic features were assessed and the study participants were categorized according to the percentage of body fat (%FAT), body mass index (BMI), and waist-to-height ratio (WHtR). We found that there were no significant differences in %FAT and the incidence of body weight disorders depending on gender or diagnosis. %FAT deficit was observed in 12-21% of the participants and underweight in almost every fourth child. Overweight involved 3-14% of the participants and obesity was diagnosed in isolated cases (0-3%); both were considerably lower compared to the estimates based on %FAT. Using the cut-off points of WHtR, abdominal adiposity was observed in 3-15% of the participants. In conclusion, quite a large number of short children (between 25 and 50%) are characterized by abnormal body fat or body mass index values. The results indicate a limited usefulness of BMI in evaluating the incidence of overweight and obesity in children characterized by a height deficit.

Is waist circumference ≥102/88cm better than body mass index ≥30 to predict hypertension and diabetes development regardless of gender, age group, and race/ethnicity? Meta-analysis

Between body mass index (BMI) ≥30 and waist circumference (WC) ≥102/88cm, we investigated which of the two measures is a better predictor of two of the most common chronic diseases - diabetes mellitus and hypertension while also examining differential association by gender, age group, and race/ethnicity. Meta-analysis was conducted for all longitudinal studies with at least 12months of follow-up published up to April 2015. Ratio of relative risk (rRR) and relative risk of diseases were computed and compared by baseline obesity measurement. The final sample included 23 longitudinal observation studies involving 62 study arms with 259,200 individuals. WC≥102/88cm was a better predictor than BMI≥30 for development of diabetes (rRR=0.81, 95% CI=0.68-0.96), but not for hypertension (rRR=0.92, 95% CI=0.80-1.06). Subgroup analyses showed WC≥102/88cm was a better predictor for diabetes in women than men, and for ages 60 and older than other ages. Only WC≥102/88cm, not BMI≥30, predicted development of hypertension among Hispanic/Latinos. Neither BMI≥30 nor WC≥102/88cm were significant predictors of hypertension when age group was controlled. Central obesity may be a more serious risk factor for diabetes development in women and for older ages. The predictive power of BMI≥30 or WC≥102/88cm in hypertension development should not be emphasized as either could mask the effect of age.

The impact of length and weight on survival after heart transplantation in children less than 24 months of age

Adults, older children, and adolescent patients with a BMI categorized as overweight or obese have decreased survival after HTx. Anthropometric correlates of survival after HTx in infants have not been well defined. In a retrospective analysis of the UNOS registry, patients age 0-24 months were classified according to the WHO height-for-age and weight-for-age norms, as well as arbitrary BMI-for-age percentiles. Outcomes of 1-year survival, conditional long-term survival, and cause-specific mortality were examined. Infants with stunted growth according to the WHO definition had increased risks of early mortality, late mortality, and death due to graft failure after HTx. Secondary analysis of first-year survival demonstrated increased mortality in children who were underweight according to weight-for-age, but a survival disadvantage in the highest BMI-for-age category, likely due to short recumbent length leading to relatively high BMI values. Stunted growth relative to WHO standards predicts mortality following heart transplant in children less than 2 years of age. The association between post-transplant mortality and high BMI-for-age, as demonstrated in older cohorts, was observed in the infant cohort only due to stunting, and not due to overweight classification.

Impact of anthropometric cut-off values in determining the prevalence of metabolic alterations

BACKGROUND

The prevalence of obesity has increased worldwide in parallel with associated metabolic disturbances such as diabetes and non-alcoholic fatty liver disease.

OBJECTIVE

The objective of this article is to underscore discrepancies in the standard anthropometric cut-off values and the presence of metabolic disturbances including diabetes and non-alcoholic fatty liver disease caused by biological and ethnic variations.

MATERIALS AND METHODS

We performed a literature review regarding the diagnosis and prevalence of obesity, diabetes, metabolic syndrome and non-alcoholic fatty liver disease and about the different available indicators to define obesity.

RESULTS

There is an ongoing epidemic of these chronic diseases, partially attributed to the increased prevalence of obesity. The available markers to indicate adiposity are imperfect, and the selection of accurate cut-off points is still not clear.

CONCLUSION

Methods to quantify adiposity that are useful in clinical practice should be developed to better classify individuals and to reflect metabolic risk more appropriately.

The Body and the Beautiful: Health, Attractiveness and Body Composition in Men's and Women's Bodies

The dominant evolutionary theory of physical attraction posits that attractiveness reflects physiological health, and attraction is a mechanism for identifying a healthy mate. Previous studies have found that perceptions of the healthiest body mass index (weight scaled for height; BMI) for women are close to healthy BMI guidelines, while the most attractive BMI is significantly lower, possibly pointing to an influence of sociocultural factors in determining attractive BMI. However, less is known about ideal body size for men. Further, research has not addressed the role of body fat and muscle, which have distinct relationships with health and are conflated in BMI, in determining perceived health and attractiveness. Here, we hypothesised that, if attractiveness reflects physiological health, the most attractive and healthy appearing body composition should be in line with physiologically healthy body composition. Thirty female and 33 male observers were instructed to manipulate 15 female and 15 male body images in terms of their fat and muscle to optimise perceived health and, separately, attractiveness. Observers were unaware that they were manipulating the muscle and fat content of bodies. The most attractive apparent fat mass for female bodies was significantly lower than the healthiest appearing fat mass (and was lower than the physiologically healthy range), with no significant difference for muscle mass. The optimal fat and muscle mass for men's bodies was in line with the healthy range. Male observers preferred a significantly lower overall male body mass than did female observers. While the body fat and muscle associated with healthy and attractive appearance is broadly in line with physiologically healthy values, deviations from this pattern suggest that future research should examine a possible role for internalization of body ideals in influencing perceptions of attractive body composition, particularly in women.

Physical Growth, Biological Age, and Nutritional Transitions of Adolescents Living at Moderate Altitudes in Peru

Background: Peru is experiencing a stage of nutritional transition where the principal characteristics are typical of countries undergoing development. Objectives: The objectives of this study were the following: (a) compare physical growth patterns with an international standard; (b) determine biological age; and (c) analyze the double nutritional burden of adolescents living at a moderate altitude in Peru. Design: Weight, standing height, and sitting height were measured in 551 adolescents of both sexes (12.0 to 17.9 years old) from an urban area of Arequipa, Peru (2328 m). Physical growth was compared with the international standard of the CDC-2000. Biological age was determined by using a non-invasive transversal technique based on years from age at peak height velocity (APHV). Nutritional state was determined by means of weight for age and height for age. Z scores were calculated using international standards from the CDC-2000. Results: Body weight for both sexes was similar to the CDC-2000 international standards. At all ages, the girls’ height (p < 0.05) was below the standards. However, the boys’ height (p < 0.05) was less at ages, 15, 16, and 17. Biological age showed up in girls at age 12.7 years and for boys at 15.2 years. Stunted growth (8.7% boys and 18.0% girls) and over weight (11.3% boys and 8.8% girls) occurred in both groups. A relationship existed in both sexes between the categories of weight for the age and stunted growth by sex. Conclusions: Adolescents living at a moderate altitude exhibited stunted linear growth and biological maturation. Furthermore, adolescents of both sexes showed the presence of the double nutritional burden (stunted growth and excessive weight).

State-wise dynamics of the double burden of malnutrition among 15-49 year-old women in India: how much does the scenario change considering Asian population-specific BMI cut-off values?

This article assesses the gravity of the "double burden of malnutrition" across 21 states of India, through a comparative analysis of traditional and Asian population-specific BMI categorizations for overweight and obesity. This study analyzes data on ever-married women (15-49 years) from the National Family Health Survey (NFHS-2, 1998-1999; NFHS-3, 2005-2006). Findings depict that Indian women tilt toward high BMI resulting in a co-existence of under- and overweight populations, which portray a regional pattern. With Asian population-specific cut-offs, 11 states can be classified as "double burden states"; however, following traditional categorization, only 4 states face such dual pressure.

The relationship between anthropometric indices and type 2 diabetes mellitus among adults in north-east China

OBJECTIVE

The present study was performed to test the predictive value of different cut-off points of anthropometric parameters for the presence of type 2 diabetes (T2DM) or glucose tolerance abnormalities in north-east Chinese adults.

DESIGN

Multistage random cluster sampling method in a cross-sectional study.

SETTING

Height, body weight, maximal body weight in the past, waist and hip circumferences, blood pressure, 2 h post-load glucose and other lifestyle factors were measured.

SUBJECTS

We used data from 1058 adults aged 20 years or over, selected in the city of Mudanjiang, in 2005.

RESULTS

BMI, maximal BMI in the past (MAXBMI), waist:hip ratio (WHR), waist:height ratio (WHtR) and waist circumference (WC) were significantly correlated with each other. Partial correlation coefficients between WHtR and WC, and between MAXBMI and BMI, were higher than those between the other indices. The association of anthropometric indices with T2DM or glucose tolerance abnormalities was significantly highest for the collaboration cut-off points of MAXBMI (≥ 23.0 kg/m(2) for T2DM, ≥ 22.0 kg/m(2) for glucose tolerance abnormalities) with WHtR (≥ 0.52). Areas under the receiver-operating characteristic curves also showed that WHtR was a better anthropometric index that discriminated between the presence and absence of T2DM and an excellent indicator with high Youden's index.

CONCLUSIONS

MAXBMI combined with WHtR was a better anthropometric index associated with T2DM or glucose tolerance abnormalities. The combined use of these two measures is a good choice for T2DM prevention and screening.

Altitude effects on growth of indigenous children in Oaxaca, Southern Mexico

The effect of altitude of residence on the growth status of 11,454 indigenous school children 6-14 years of age in Oaxaca, southern Mexico, was examined. Indicators of living conditions (human development index [HDI], index of community nutritional risk [INR], index of marginalization [IM], index of relative isolation [II]) were regressed on z-scores for height, weight and BMI, and the residuals were regressed on altitude of residence (km). Independent of other environmental conditions, altitude negatively affected height by approximately -0.07 z-scores per kilometer altitude above sea level. The estimated average decrease in stature was 0.92 cm per kilometer elevation. BMI was significantly increased, 1.2 units per kilometer elevation, consistent with earlier studies of growth status and altitude. In contrast, weight was not affected by altitude of residence. Approximately 36% of the reduction in height and 54% of the increase in BMI were due to altitude effects; the remaining changes in height and BMI were associated with environmental factors reflected in the indices of community well-being considered.

Obesity does not imply poor outcomes in Asians after total knee arthroplasty

BACKGROUND

In Asia, obesity has reached epidemic proportions and physicians are likely to face a burden of obesity-related disorders, of which osteoarthritis of the knee is one. However, it is unclear whether obesity affects improvement of conventional TKAs in Asian patients.

PURPOSE

We therefore asked whether obese patients with a BMI of 30 kg/m(2) or greater would have worse ROM and function after TKA compared with their nonobese counterparts and whether they would have less improvement preoperatively to postoperatively.

METHODS

We retrospectively reviewed 369 patients who underwent TKAs from 2006 to 2010. We stratified patients into four groups: (1) 98 patients with BMIs less than 25 kg/m(2); (2) 158 patients with BMIs between 25 kg/m(2) and 29.9 kg/m(2); (3) 87 patients with BMIs between 30 kg/m(2) and 34.9 kg/m(2); and (4) 26 patients with BMIs greater than 35 kg/m(2). We then compared ROM, function score, Knee Society score, Oxford Knee Questionnaire, and SF-36 questionnaire(®) across the four groups at 6- and 12-month follow-ups.

RESULTS

At the 6-month followup, we found a difference only in the ROM. At the 2-year followup, there were no differences in any functional scores across the four groups. Severely obese patients had greater improvement in postoperative ROM than the other groups but did not have any greater improvement in function.

CONCLUSION

BMI had little clinical impact on short-term outcomes of conventional TKAs in Asian patients. The data suggest that BMI should not be used as a major determinant to exclude obese patients from surgery with the presumption of poorer outcomes.

Risk of type 2 diabetes according to traditional and emerging anthropometric indices in Spain, a Mediterranean country with high prevalence of obesity: results from a large-scale prospective cohort study

BACKGROUND

Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). A proper anthropometric characterisation of T2DM risk is essential for disease prevention and clinical risk assessement.

METHODS

Longitudinal study in 37 733 participants (63% women) of the Spanish EPIC (European Prospective Investigation into Cancer and Nutrition) cohort without prevalent diabetes. Detailed questionnaire information was collected at baseline and anthropometric data gathered following standard procedures. A total of 2513 verified incident T2DM cases occurred after 12.1 years of mean follow-up. Multivariable Cox regression was used to calculate hazard ratios of T2DM by levels of anthropometric variables.

RESULTS

Overall and central obesity were independently associated with T2DM risk. BMI showed the strongest association with T2DM in men whereas waist-related indices were stronger independent predictors in women. Waist-to-height ratio revealed the largest area under the ROC curve in men and women, with optimal cut-offs at 0.60 and 0.58, respectively. The most discriminative waist circumference (WC) cut-off values were 99.4 cm in men and 90.4 cm in women. Absolute risk of T2DM was higher in men than women for any combination of age, BMI and WC categories, and remained low in normal-waist women. The population risk of T2DM attributable to obesity was 17% in men and 31% in women.

CONCLUSIONS

Diabetes risk was associated with higher overall and central obesity indices even at normal BMI and WC values. The measurement of waist circumference in the clinical setting is strongly recommended for the evaluation of future T2DM risk in women.

Obesity epidemiology

Obesity has progressed in a few decades from a public health footnote in developed countries to a top-priority international issue. Because obesity implies increased morbidity and mortality from chronic, debilitating disorders, it is a major burden on individuals and health systems in both developing and developed countries. Obesity is a complex disorder unequally affecting all age groups and socioeconomic classes. Of special concern is increasing childhood obesity. This review presents the extent of the obesity epidemic and its impact worldwide by way of introduction to a discussion of colon and rectal surgery in the obese patient.

O uso das curvas de crescimento da Organização Mundial da Saúde em crianças e adolescentes que vivem em regiões de altitude moderada

OBJETIVO: Determinar a aplicabilidade do uso das curvas de crescimento da Organização Mundial da Saúde (OMS) em escolares que vivem em regiões de altitude moderada. MÉTODOS: Estudo transversal cuja população foi constituída por uma amostra probabilística estratificada com 955 crianças e adolescentes de seis a 12 anos, sendo 473 meninos e 482 meninas que frequentavam escolas públicas da área urbana da Região de Arequipa (Peru). As variáveis avaliadas envolveram medidas de massa corpórea (kg) e estatura (m) e índice de massa corporal. Para as comparações, utilizou-se o escore Z e o teste t para medidas pareadas. RESULTADOS: Os meninos apresentaram valores similares de massa corpórea quando comparados com a referência. No entanto, as meninas mostraram valores superiores à referência nas idades de seis, sete e dez anos (p<0,001). No caso da estatura e do índice de massa corporal, houve diferenças (p<0,001) entre a referência e os escolares de moderada altitude em todas as idades e em ambos os sexos, com estatura inferior à referência e, consequentemente, maior índice de massa corporal, sendo o escore Z para os meninos: 1,0 (seis anos), 0,69 (sete anos), 0,50 (oito anos), 1,20 (nove anos), 0,75 (dez anos) 0,41 (11 anos) e 0,82 (12 anos); para as meninas, 0,36 (seis anos), 0,53 (sete e oito anos), 0,48 (nove anos), 0,89 (dez anos), 0,55 (11 anos) e 0,43 (12 anos). CONCLUSÕES: O índice de massa corporal não deve ser aplicado a crianças e adolescentes de moderada altitude devido ao retardo no crescimento linear, o que compromete o resultado final deste índice.

Anthropometric indices of central obesity how discriminators of metabolic syndrome in Brazilian women with polycystic ovary syndrome

BACKGROUND

Central obesity is highly prevalent in women with polycystic ovary syndrome (PCOS) and is strongly associated with metabolic syndrome (MetS).

OBJECTIVES

To define cut-off points of waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and conicity index (C-Index) to discriminate metabolic syndrome (MetS) in Brazilian women with PCOS.

METHODS

In a cross-sectional study, anthropometric, biochemical and clinical parameters were measured in 113 Brazilian PCOS women (27.2 ± 4.5 years). Receiver operating characteristic (ROC) analysis was used to find out the cut-off points of anthropometric indices to predict MetS according with National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria.

RESULTS

Considering the ROC curve analysis the WC and WHtR had a similar performance in predicting MetS and these parameters were better than WHR and C-Index. The optimal cut-off values of the anthropometric indices for discriminate MetS were: WC = 95 cm; WHtR = 0.59; WHR = 0.88; and C-Index = 1.25. By using these cut-off points the sensitivity and specificity rates of WC and WHtR were higher than those observed for WHR and C-Index.

CONCLUSION

Our results indicated that WC and WHtR are more accurate than WHR and C-Index to predict MetS in Brazilian PCOS women.

Waist-to-height ratio, waist circumference, and body mass index as indices of cardiometabolic risk among 36,642 Taiwanese adults

PURPOSE

We aimed to investigate the association of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with cardiometabolic risk.

METHODS

In this cross-sectional study, 21,038 men and 15,604 women who participated in a health check-up were included.

RESULTS

In both men and women, the area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of diabetes, hypertension, high total cholesterol, high triglycerides, and low HDL-cholesterol (P < 0.05 for all). The AUC for WHtR in the prediction of metabolic syndrome (MS) was also highest in the women (P < 0.05). After adjustment for potential confounders, the odds ratios and 95% confidence intervals for MS for each standard deviation increase in BMI, WHtR, and WC were 1.47 (1.46-1.49), 1.32 (1.31-1.33), and 1.19 (1.18-1.19), respectively. Finally, patients of either sex with a normal BMI or WC level, but with an elevated WHtR, had higher levels of various cardiometabolic risk factors in comparison with their normal BMI or WC, but low WHtR, counterparts (P < 0.05 for all).

CONCLUSION

Among Taiwanese adults, a WHtR greater than 0.5 is a simple, yet effective indicator of centralized obesity and associated cardiometabolic risk, even among individuals deemed 'healthy' according to BMI and WC.

How useful is BMI in predicting adiposity indicators in a sample of Maya children and women with high levels of stunting?

OBJECTIVES

Body mass index (BMI) is used frequently to estimate adiposity levels in children and adults. However, the applicability of BMI to populations with high levels of stunting has been questioned. Stunted people can have disproportionately short legs, which may increase BMI without increasing body fat because of the relatively larger trunk compared with the legs.

METHODS

A sample of 57 urban Maya schoolchildren, aged 7-9 years (31 boys), and 53 adult women underwent anthropometric assessments and bioelectrical impedance analysis. Multiple linear regression was performed to determine whether the ability of BMI to predict adiposity indicators is altered by stunting and sitting height ratio (SHR). The adiposity indicators were waist circumference, sum of skinfolds, upper arm muscle area, upper arm fat area, and arm fat index.

RESULTS

BMI was the strongest predictor of all adiposity indicators and in most cases, explained more of the variance in adiposity of Maya children than Maya women. Abdominal adiposity was better predicted by BMI than peripheral adiposity in Maya women and Maya children. Stunting was significant in predicting adiposity in some models but never substantially changed the variance explained. SHR was never a significant predictor.

CONCLUSIONS

The relationship between BMI and adiposity indicators is not changed by stunting status or body proportions in this short population of urban Maya children and women. BMI can be used as an indicator of adiposity for these children but not the women. It is recommended that BMI is used in conjunction with other estimates of body composition.

Methods for measuring abdominal obesity in the prediction of severe acute pancreatitis, and their correlation with abdominal fat areas assessed by computed tomography

BACKGROUND

Obesity increases the risk for severe acute pancreatitis, although abdominal obesity may be a better prognostic marker.

AIM

To determine if a single anthropometric parameter best predicts severe acute pancreatitis and correlates with intra-abdominal fat.

METHODS

Ninety-nine patients with acute pancreatitis were studied prospectively. Anthropometry included body mass index (BMI) and girths (umbilical/minimum waist, iliac/trochanter hip, thigh). Several waist-to-hip/waist-to-thigh ratios (WHR/WTR) were constructed. A CT-scan with calculation of cross-sectional abdominal fat areas was obtained in 37 cases.

RESULTS

Severe acute pancreatitis occurred in 25 patients. Waist circumference (WC), WHR and WTR - all using the umbilical reference - most accurately predicted severe acute pancreatitis. Only umbilical WC was retained in multivariate analysis: the risk for severe acute pancreatitis increased 16% with every 1 cm (OR 1.16, 95%CI: 1.1-1.3). Abdominal obesity caused a 6-fold increase in risk. Umbilical WC correlated best with subcutaneous fat area (r = 0.791, P < 0.001), whereas WHR with intra-abdominal (r = 0.594, P < 0.001).

CONCLUSIONS

Abdominal obesity according to umbilical WC is a better predictor for development of severe acute pancreatitis than BMI, minimum WC, WHR and WTR. The protocol for anthropometry must be standardized as it may affect results. Both subcutaneous and intra-abdominal fat appears to affect the likelihood of a severe outcome.

Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population

BACKGROUND

Optimal cutoffs for obesity indices are rarely studied in Asians. We evaluated these cutoffs for diabetes, hypertension, dyslipidemia and any risk factor for the Taiwanese general population.

METHODS

Body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), waist-height ratio (WHeiR) and other data for 4683 (2280 men and 2403 women) participants of the population-based Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia were used. Areas under curves (AUCs) were analyzed and optimal cutoffs were estimated by maximizing the sums of sensitivity and specificity. Potential confounders included age, smoking, alcohol, betel nut chewing and exercise.

RESULTS

Optimal cutoffs for men and women, respectively, were 23.7-26.3 and 22.1-23.2 kg/m2 for BMI; 85.0-87.0 and 74.0-83.0 cm for WC; 0.87-0.90 and 0.78-0.83 for WHR; and 0.48-0.52 and 0.48-0.52 for WHeiR. AUCs were not significantly different among the indices for diabetes in men and for hypertension in women. In men, WHR was significantly inferior to the other indices for predicting hypertension, dyslipidemia and any risk factor. In women, BMI was significantly inferior to the others for diabetes. For dyslipidemia and any risk factor in women, WHeiR showed the largest AUCs and significant differences were seen in the following pairs: WHeiR vs. BMI and WHeiR vs. WHR for dyslipidemia and WC vs. WHR and WHeiR vs. WHR for any risk factor.

CONCLUSIONS

WC and WHeiR have similar efficacy and are superior to BMI and WHR. However, WHeiR has the extra benefit of a unisex cutoff within a narrow range.

Performance of body mass index in predicting diabetes and hypertension in the Eastern Province of Saudi Arabia

BACKGROUND AND OBJECTIVES

Body mass index (BMI) is the most widely used measure to define obesity and predict its complications, such as diabetes and hypertension, but its accuracy and usefulness in Saudi subjects is unknown. This study aimed to assess the validity of standard BMI cut-point values in the Saudi population.

SUBJECTS AND METHODS

197 681 adults participated in a cross-sectional study to detect diabetes and hypertension in the Saudi Eastern province in 2004/2005, with blood pressure, fasting blood sugar, height and weight measurements taken. Sensitivities, specificities, areas under the curves, predictive values, likelihood ratios, false positive, false negatives and total misclassification ratios were calculated for various BMI values determined from receiver operating characteristic (ROC) curves. The significance of the association between risk factors and BMI was assessed using regression analysis.

RESULTS

For the definition of overweight, ROC curve analysis suggested optimal BMI cut-offs of 28.50 to 29.50 in men and 30.50 to 31.50 in women, but the levels of sensitivity and specificity were too low to be of clinical value and the overall misclassification was unacceptably high across all the selected BMI values (>0.80). The relationship between BMI and the presence of diabetes and/or hypertension was not improved when a BMI of 25 was used. Using regression analyses, the odds ratios for hypertension and/or diabetes increased significantly from BMI values as low as 21-23 with no improvement in the diagnostic performance of BMI at these cutoffs.

CONCLUSION

In Saudi population, there is an increased risk of diabetes and hypertension relative to BMI, starting at a BMI as low as 21 but overall there is no cutoff BMI level with high predictive value for the development of these chronic diseases, including the WHO definition of obesity at BMI of 30.

Short stature and obesity: positive association in adults but inverse association in children and adolescents

Shorter than average adults are at a higher risk for obesity and are also more susceptible to diabetes and CVD, independent of BMI. In contrast, taller children have a higher risk of obesity. We hypothesised that short stature is related to adverse body composition and that the association between stature and obesity differs between generations. In a cross-sectional German database of 213 804 adults and 12 411 children and adolescents, the prevalence of overweight and obesity was compared between percentiles of height. The association between stature and percentage of fat mass (%FM), lean BMI (LBMI; kg/m2) or waist:hip ratio (in children only) was analysed within BMI groups. In adults, the prevalence of BMI >30 kg/m2 gradually increased with decreasing percentile of height whereas in children and adolescents, a positive association between height and weight status was observed. Short-stature women and girls had a 0·8–3·2 % lower %FM than tall subjects (P < 0·05), whereas no trend for %FM was observed in males. When compared with tall subjects, LBMI was 0·2–0·6 kg/m2 lower in short-stature men, as well as obese women (P < 0·05). There was a non-significant trend for a lower LBMI and a higher waist:hip ratio in shorter children. In conclusion, short stature is associated with an increased risk of obesity in adults. Cardiometabolic risk in short stature is not explained by an adverse body composition.

Waist-to-height ratio and coronary artery disease in Taiwanese type 2 diabetic patients

Waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHeiR), and BMI are indicators for obesity. This study examined the usefulness of these indicators for coronary artery disease (CAD) in Taiwanese type 2 diabetic patients. A total of 1,345 (646 men and 699 women) patients aged 63.3 +/- 11.5 years were studied. CAD was defined by history or Minnesota-coded electrocardiogram. The relative importance was evaluated by the magnitude of adjusted odds ratio per 1-s.d. increment, the decrease in -2 log likelihood after adding the index to the logistic model, the c-index, and the Akaiki's information criterion (AIC). Results showed that the four indices were highly intercorrelated and except BMI for men, all indices differed significantly between patients with and without CAD in either sex. In logistic regressions, the respective adjusted odds ratios for WC, WHR, WHeiR, and BMI for every 1-s.d. increment were 1.209 (1.010-1.448), 1.109 (0.935-1.316), 1.231 (1.027-1.474), and 1.207 (0.997-1.461) for men; and were 1.176 (0.995-1.390), 1.105 (0.923-1.322), 1.280 (1.079-1.518), and 1.277 (1.083-1.507) for women. Only WHeiR was significant for both sexes and it also showed the greatest decrease in -2 log likelihood, the largest magnitude of odds ratio, and the smallest AIC while compared with the other indices in either sex. It is concluded that WHeiR has the superiority of independent association with CAD and the highest magnitude of association than WC, WHR, and BMI in both sexes. The usefulness of WHeiR should not be neglected in clinical practice.

Detection of cardio-metabolic risk by BMI and waist circumference among a population of Guatemalan adults

BACKGROUND

BMI and waist circumference (WC) are used to screen for cardio-metabolic risk; however it is unclear how well these indices perform in populations subject to childhood stunting.

OBJECTIVES

To evaluate BMI and WC as indicators of cardio-metabolic risk and to determine optimal cut-off points among 1,325 Guatemalan adults (44 % stunted: 162 cm men).

METHODS

Cardio-metabolic risk factors were systolic/diastolic blood pressure 85 mmHg, glucose 5 mmol/l, TAG 7 mmol/l, ratio of total cholesterol to HDL-cholesterol 0, and the presence of two or more and three or more of the preceding risk factors. Receiver operating characteristic (ROC) curve analysis was used.

RESULTS

Areas under the ROC curve were in the range of 005978 for WC among men and 006472 among women, respectively. Optimal cut-off points for BMI were 242651 kg/m2 stunted; 242656 kg/m2 among women (262769 kg/m2 non-stunted). Optimal cut-off points for WC were 879134 cm stunted; 889333 cm among women (909486 cm non-stunted).

CONCLUSION

Optimal cut-off points for BMI were slightly higher among women than men with no meaningful differences by stature. Optimal cut-off points for WC were several centimetres lower for stunted compared with non-stunted men, and both were substantially lower than the current recommendations among Western populations. Cut-off points derived from Western populations may not be appropriate for developing countries with a high prevalence of stunting.

Overweight and obesity in a rural Amerindian population in Oaxaca, Southern Mexico, 1968-2000

The purpose of this study was to evaluate secular change in the prevalence of overweight and obesity in a rural Zapotec Indian community in southern Mexico between 1968 and 2000. Cross-sectional surveys of children 6-13 years, adolescents 13-17 years, and adults 19 years of age and older resident in a rural community in Oaxaca were conducted in 1968/1971, 1978, and 2000. Individuals present in the 1968, 1978, and 2000 surveys provided a small longitudinal component. Height and weight were measured; the BMI was calculated. International criteria for overweight and obesity were used. Overweight and obesity were virtually absent in school children 6-13 years in 1968 and 1978 and in adolescents in 1978. Small proportions of children (boys, 5%; girls, 8%) and adolescents (boys, 3%; girls, 15%) were overweight in 2000; two children (1%) and no adolescents were obese. Among adults, 7% of males and 19% of females were overweight and <1% of males and 4% of females were obese in 1971/1978, but 46% of males and 47% of females were overweight; and 5% of males and 14% of females were obese in 2000. The trends for children, adolescents, and adults were confirmed in the longitudinal subsamples. In conclusion, overweight and obesity are not presently a major problem in children and adolescents in this rural Zapotec community. Overweight, in particular, and to a lesser extent obesity have increased in prevalence among adults since the late 1970s. The results suggest adulthood as a critical period for onset of overweight and obesity in this sample.

Anthropometric predictors for the risk of chronic disease in non-diabetic, non-hypertensive young Mexican women

OBJECTIVES

To assess the ability of anthropometric measurements to identify young women at risk of developing diabetes, hypertension and heart disease in the future and to compare cut-off points for common anthropometric measures established with receiver-operating characteristic (ROC) curves with those reported in the literature.

DESIGN

Cross-sectional study.

SUBJECTS

Eight hundred and two young Mexican women living in semi-urban poverty. MEASUREMENTS/METHODS: The ability of anthropometric measures of fatness and fat distribution (body mass index (BMI), summed skinfold thickness (SST), waist circumference (WC), waist-to-hip ratio (WHR), conicity index (CI), abdominal volume index (AVI)) to predict risk of future disease (pre-diabetes: fasting blood glucose 100-126 mg dl-1; pre-hypertension: systolic blood pressure 120-139 mmHg and/or diastolic blood pressure 80-89 mmHg; hypertriglyceridaemia: triglycerides > or =150 mg dl-1; or a combination of risk factors) was assessed using ROC curve analysis.

RESULTS

Twenty-three of the 802 women who were interviewed had incomplete data and 50 (6.4%) were eliminated from the analysis due to hypertension and/or diabetes. Mean age of the remaining 729 women was 29.6 +/- 5.4 years and mean BMI was 27.7 +/- 4.5 kg m-2. There were no significant differences in the area under the ROC curve for BMI, WC, AVI or SST for any of the four outcomes. However, these indices performed significantly better than WHR and CI (P < 0.05). The BMI cut-off points that maximised sensitivity and specificity for the four outcomes were in the range of 27.7-28.4 kg m-2, and for WC were 89.3-91.2 cm. To detect 90% of the cases of any metabolic alteration, the necessary BMI cut-off was 26.1 kg m-2. Younger women (<25 years) were at greater risk than older women for a given BMI increment (P < 0.05).

CONCLUSIONS

We found that BMI and WC cut-off points commonly used for the identification of risk of existing disease were also appropriate in this population for the identification of risk in the future among women without diabetes or hypertension. The early identification of at-risk individuals, prior to the onset of disease, is fundamental particularly in the context of a country with scarce resources that is rapidly undergoing nutrition transition.