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BMI does not accurately predict overweight in Asian Indians in northern India

Published online by Cambridge University Press:  09 March 2007

V. Dudeja ,
A. Misra ,
R.M. Pandey ,
G. Devina ,
G. Kumar  and
N.K. Vikram
V. Dudeja
Affiliation:
Department of Medicine, All India Institute of Medical Sciences, New Delhi-110029, India
A. Misra*
Affiliation:
Department of Medicine, All India Institute of Medical Sciences, New Delhi-110029, India
R.M. Pandey
Affiliation:
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi-110029, India
G. Devina
Affiliation:
Department of Medicine, All India Institute of Medical Sciences, New Delhi-110029, India
G. Kumar
Affiliation:
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi-110029, India
N.K. Vikram
Affiliation:
Department of Medicine, All India Institute of Medical Sciences, New Delhi-110029, India
*
*Corresponding author: Professor A. Misra, fax +91 11 6862663/6521041, email anoopmisra@hotmail.com
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Abstract

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Asian Indians are at high risk for the development of atherosclerosis and related complications, possibly initiated by higher body fat (BF). The present study attempted to establish appropriate cut-off levels of the BMI for defining overweight, considering percentage BF in healthy Asian Indians in northern India as the standard. A total of 123 healthy volunteers (eighty-six males aged 18–75 years and thirty-seven females aged 20–69 years) participated in the study. Clinical examination and anthropometric measurements were performed, and percentage BF was calculated. BMI for males was 21·4 (SD 3·7) KG/M2 AND FOR FEMALES WAS 23·3 (sd 5·5) kg/m2. Percentage BF was 21·3 (sd 7·6) in males and 35·4 (sd 5·0) in females. A comparison of BF data among Caucasians, Blacks, Polynesians and Asian ethnic groups (e.g. immigrant Chinese) revealed conspicuous differences. Receiver operating characteristic (ROC) curve analysis showed a low sensitivity and negative predictive value of the conventional cut-off value of the BMI (25 kg/m2) in identifying subjects with overweight as compared to the cut-off value based on percentage BF (males >25, females >30). This observation is particularly obvious in females, resulting in substantial misclassification. Based on the ROC curve, a lower cut-off value of the BMI (21·5 kg/m2 for males and 19·0 kg/m2 for females) displayed the optimal sensitivity and specificity, and less misclassification in identification of subjects with high percentage BF. Furthermore, a novel obesity variable, BF:BMI, was tested and should prove useful for interethnic comparison of body composition. In the northern Indian population, the conventional cut-off level of the BMI underestimates overweight and obesity when percentage BF is used as the standard to define overweight. These preliminary findings, if confirmed in a larger number of subjects and with the use of instruments having a higher accuracy of BF assessment, would be crucial for planning and the prevention and treatment of various obesity-related metabolic diseases in the Asian Indian population.

Keywords

Body fatBMIAsian IndiansObesitySkinfolds
Type
Research Article
Information
British Journal of Nutrition , Volume 86 , Issue 1 , July 2001 , pp. 105 - 112
Copyright
Copyright © The Nutrition Society 2005

References

Abate, N, Garg, A, Peshock, RM, Stray-Gunderson, J & Grundy, SM (1995) Relationship of generalised and regional adiposity to insulin sensitivity in men. Journal of Clinical Investigation 96, 88–98.CrossRefGoogle ScholarPubMed
Banerji, MA, Faridi, N, Atluri, R, Chaiken, RL & Lebovitz, HE (1999) Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. Journal of Clinical Endocrinology and Metabolism 84, 137–144.Google ScholarPubMed
Bjorntorp, P (1993) Visceral obesity: a civilization syndrome. Obesity Research 1, 206–222.CrossRefGoogle ScholarPubMed
Cohn, SH, Abesamis, C, Zanzi, I, Aloia, JF, Yasumura, S & Ellis, KJ (1977) Body elemental composition: comparison between black and white adults. American Journal of Physiology 232, E419–E422.Google ScholarPubMed
Deurenberg, P, Weststrate, JA & Seidell, JC (1991) Body mass index as a measure of body fatness: age and sex specific predictive formula. British Journal of Nutrition 65, 105–114.CrossRefGoogle Scholar
Durnin, JVGA & Womersely, J (1974) Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. British Journal of Nutrition 32, 77–97.CrossRefGoogle ScholarPubMed
Dvorak, RV, DeNino, WF, Ades, PA & Pohelman, ET (1999) Phenotypic characteristics associated with insulin resistance in metabolically obese but normal-weight young women. Diabetes 48, 2210–2214.CrossRefGoogle ScholarPubMed
Gallagher, D, Visser, M, Sepulveda, D, Pierson, RN, Harris, T & Heymsfield, SB (1996) How useful is body mass index for comparison of body fatness across age, sex and ethnic groups?. American Journal of Epidemiology 143, 228–239.CrossRefGoogle ScholarPubMed
Gasperino, JA, Wang, J, Pierson, RN & Heymsfield, SB (1995) Age-related changes in musculoskeletal mass between Black and White women. Metabolism 44, 30–34.Google Scholar
Gopinath, N, Chadha, SL, Jain, P, Shekhawat, S & Tandon, R (1994) An epidemiological study of obesity in adults in the urban population of Delhi. Journal of the Association of Physicians of India 42, 212–215.Google ScholarPubMed
Han, TS, van Leer, EM, Seidell, JC & Lean, MEJ (1995) Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. British Medical Journal 311, 1401–1405.CrossRefGoogle ScholarPubMed
Hortobagyi, T, Israel, RG & O'Brien, KF (1994) Sensitivity and specificity of the Quetelet index to assess obesity in men and women. European Journal of Clinical Nutrition 48, 769–775.Google ScholarPubMed
Ko, GTC, Chan, JCN, Cockram, CS & Woo, J (1999) Prediction of hypertension, diabetes, dyslipidemia or albuminuria using simple anthropometric indexes in Hong Kong Chinese. International Journal of Obesity 23, 1136–1142.CrossRefGoogle ScholarPubMed
Kuriyan, R, Petracchi, C, Ferro-Luzzi, A, Shetty, PS & Kurpad, AV (1998) Validation of expedient methods for measuring body composition in Indian adults. Indian Journal of Medical Research 107, 37–45.Google ScholarPubMed
Law, CM, Barker, DJ, Osmond, C, Fall, CH & Simmonds, SJ (1992) Early growth and abdominal obesity in later life. Journal of Epidemiology and Community Health 46, 184–186.CrossRefGoogle Scholar
Luke, A, Arvizzu, DR, Rotimi, C, Prewitt, E, Forrester, T, Wilks, R, Ogunbiyi, OJ, Schoeller, DA, McGee, D & Cooper, RS (1997) Relation between body mass index and body fat in Black population samples from Nigeria, Jamaica, and the United States. American Journal of Epidemiology 145, 620–628.CrossRefGoogle ScholarPubMed
McKeigue, PM, Shah, B & Marmot, MG (1991) Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 337, 382–386.Google Scholar
Misra, A, Garg, A, Abate, N, Peshock, RM, Gunderson, JS & Grundy, SM (1997) Relationship of anterior and posterior subcutaneous abdominal fat to insulin sensitivity in nondiabetic men. Obesity Research 5, 93–99.Google Scholar
Pollock, ML & Wilmore, JH (1990) Exercise in Health and Disease. Philadelphia, PA: WB Saunders.Google Scholar
Reaven, GM (1988) Role of insulin resistance in human diseases. Diabetes 37, 1595–1607.CrossRefGoogle Scholar
Ruderman, NB, Chisholm, D, Pi-Sunyer, X & Schneider, S (1998) The metabolically obese, normal-weight individual revisited. Diabetes 47, 699–713.CrossRefGoogle ScholarPubMed
Ruderman, NB, Schneider, SH & Berchtold, P (1981) The metabolically obese, normal-weight individuals. American Journal of Clinical Nutrition 34, 1617–1621.Google Scholar
Sardinha, LB, Going, SB, Teixeira, PJ & Lohman, TG (1999) Receiver operating characteristic analysis of body mass index, triceps skinfold thickness, and arm girth for obesity screening in children and adolescents. American Journal of Clinical Nutrition 70, 1090–1095.CrossRefGoogle ScholarPubMed
Shetty, P (2000) Malnutrition and obesity. Bulletin of the Nutrtition Foundation of India, New Delhi 21, 6–8.Google Scholar
Swinburn, BA, Craig, PL, Daniel, R, Dent, DPD & Strauss, BJG (1996) Body composition differences between Polynesians and Caucasians assessed by bioelectrical impedance. International Journal of Obesity 20, 889–894.Google ScholarPubMed
Wang, J, Thornton, JC, Russell, M, Burastero, S, Heymsfield, S & Pierson, RN (1994) Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. American Journal of Clinical Nutrition 60, 23–28.CrossRefGoogle ScholarPubMed
Wellens, RI, Roche, AF, Khamis, HJ, Jackson, AS, Pollock, ML & Siervogel, RM (1996) Relationship between the body mass index and body composition. Obesity Research 4, 35–44.CrossRefGoogle ScholarPubMed
Willett, WC, Dietz, WH & Colditz, GA (1999) Guidelines For healthy weight. New England Journal of Medicine 341, 427–434.CrossRefGoogle ScholarPubMed
World Health Organization (1995) Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series no. 854. Geneva: WHO.Google Scholar
World Health Organization (1998) Obesity: Prevention and Managing the Global Epidemic. Report of a WHO Consultation on Obesity. Geneva: WHO.Google Scholar
World Health Organization (2000) The Asia–Pacific Perspective. Redefining Obesity and its Treatment. International Diabetes Institute. Health Communications Australia Pty Ltd.Google Scholar
Yap, MD, Schmidt, G, van Stavern, WA & Deurenberg, P (2000) The paradox of low body mass index and high body fat percentage among Chinese, Malays and Indians in Singapore. International Journal of Obesity 24, 1011–1017.Google Scholar
Yap, MD, Yian, TB, Kai, CS, Deurenberg, P & Stavern, WAV (1999) Manifestations of cardiovascular risk factors at low levels of body mass index and waist hip ratio in Singaporean Chinese. Asia Pacific Journal of Clinical Nutrition 8, 177–183.Google Scholar