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Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians

  • Chi Pang Wen (a1), Ting Yuan David Cheng (a2), Shan Pou Tsai (a3), Hui Ting Chan (a1), Hui Ling Hsu (a1), Chih Cheng Hsu (a1) and Michael P Eriksen (a4)...
Abstract
AbstractObjectives

To assess whether overweight Asians, assessed on the basis of WHO criteria, are at greater mortality risk than overweight Caucasians, and to determine whether alternative cut-off points (BMI = 23·0–24·9 kg/m2 for overweight and BMI ≥ 25·0 kg/m2 for obesity) suggested by the WHO Western Pacific Regional Office are appropriate.

Design

The cohort was followed prospectively until the end of 2001. All-cause and CVD mortality risks of the overweight and obese group, relative to the reference group (BMI = 18·5–24·9 or 18·5–22·9 kg/m2), were assessed using Cox regression analysis, adjusting for age, smoking and gender. Excess deaths were estimated with a method proposed by the US Centers for Disease Control and Prevention.

Setting

National Health Interview Survey (NHIS 2001) and a middle-aged perspective cohort in Taiwan.

Subjects

Subjects comprised 36 386 civil servants and school teachers, aged 40 years and older, who underwent a medical examination during 1989–1992.

Results

In the WHO-defined overweight group, Asians showed a significant increase in all-cause mortality risk compared with Caucasians. Asians showed risks equivalent to Caucasians’ at lower BMI (around 5 units). Every unit of BMI increase, at 25·0 kg/m2 or above, was associated with a 9 % increase in relative mortality risk from all causes. Applying a cut-off point of 25·0 kg/m2 for obesity would result a prevalence of 27·1 %, while the traditional WHO cut-off point of 30·0 kg/m2 yielded obesity prevalence of 4·1 %. Excess deaths due to obesity accounted for 8·6 % of all deaths and 21·1 % of CVD deaths, based on the alternative cut-offs.

Conclusions

In this Asian population, significant mortality risks started at BMI ≥ 25·0 kg/m2, rather than at BMI ≥ 30·0 kg/m2. The study supports the use of BMI ≥ 25·0 kg/m2 as a new cut-off point for obesity and BMI = 23·0–24·9 kg/m2 for overweight. The magnitude of obesity-attributable deaths has been hitherto under-appreciated among Asians.

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Corresponding author
Corresponding author: Email cwengood@nhri.org.tw
References
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1.Mokdad AH, Marks JS, Stroup DF & Gerberding JL (2004) Actual causes of death in the United States, 2000. JAMA 291, 12381245.
2.Wen CP, Tsai SP, Chen CJ, Cheng TY, Tsai MC & Levy D (2005) Smoking attributable mortality for Taiwan and its projection to 2020 under different smoking scenarios. Tobacco Control 14, Suppl. 1, i76i80.
3.US Centers for Disease Control and Prevention (2002) Annual smoking attributable mortality, years of potential life lost, an economic costs – United States, 1995–1999. Morbid Mortal Wkly Rep 51, 300303.
4.Calle EE, Teras LR & Thun MJ (2005) Obesity and mortality. N Engl J Med 353, 21972199.
5.Willett WC, Hu FB, Colditz GA & Manson JE (2005) Underweight, overweight, obesity, and excess deaths. JAMA 294, 551.
6.Flegal KM, Graubard BI, Williamson DF & Gail MH (2005) Excess deaths associated with underweight, overweight, and obesity. JAMA 293, 18611867.
7.Flegal KM, Graubard BI, Williamson DF & Gail MH (2007) Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 298, 20282037.
8.Allison DB, Fontaine KR, Manson JE, Stevens J & VanItallie TB (1999) Annual deaths attributable to obesity in the United States. JAMA 282, 15301538.
9.Flegal KM, Graubard BI & Williamson DF (2004) Methods of calculating deaths attributable to obesity. Am J Epidemiol 160, 331338.
10.Mark DH (2005) Deaths attributable to obesity. JAMA 293, 19181919.
11.Banegas JR, López-García E, Gutiérrez-Fisac JL, Guallar-Castillón P & Rodríguez-Artalejo F (2007) A simple estimate of mortality attributable to excess weight in the European Union. Eur J Clin Nutr 57, 201208.
12.Ko GT, Tang J, Chan JC, Sung R, Wu MM, Wai HP & Chen R (2001) Lower BMI cut-off value to define obesity in Hong Kong Chinese: an analysis based on body fat assessment by bioelectrical impedance. Br J Nutr 85, 239242.
13.Deurenberg-Yap M, Chew SK & Deurenberg P (2002) Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians. Obes Rev 3, 209215.
14.Guricci S, Hartriyanti Y, Hautvast JGAJ & Durenberg P (1998) Relationship between body fat and body mass index: differences between Indonesians and Dutch Caucasians. Eur J Clin Nutr 52, 779783.
15.Haslam DW & James WPT (2005) Obesity. Lancet 366, 11971209.
16.World Health Organization, International Association for the Study of Obesity & International Obesity Task Force (2000) The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Sydney: Health Communications.
17.Jee SH, Sull JW, Park J, Lee SY, Ohrr H, Guallar E & Samet JM (2006) Body-mass index and mortality in Korean men and women. N Engl J Med 355, 779787.
18.Pan WH, Flegal KM, Chang HY, Yen WT, Yen CJ & Lee WC (2004) Body mass index and obesity-related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians. Am J Clin Nutr 79, 3139.
19.Shiwaku K, Anuurad E, Enkhmaa B, Nogi A, Kitajima K, Shimono K, Yamane Y & Oyunsuren T (2004) Overweight Japanese with body mass indexes of 23.0 to 24.9 have higher risks for obesity associated disorders: a comparison of Japanese and Mongolians. Int J Obes Relat Metab Disord 28, 152158.
20.Lin WY, Lee LT, Chen CY, Lo H, Hsia HH, Liu IL, Lin RS, Shau WY & Huang KC (2002) Optimal cut-off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan. Int J Obes Relat Metab Disord 26, 12321238.
21.Gu D, He J, Duan X, Reynolds R, Wu X, Chen J, Huang G, Chen CS & Whelton PK (2006) Body weight and mortality among men and women in China. JAMA 295, 776783.
22.Stevens J & Nowicki EM (2003) Body mass index and mortality in Asian populations: implications for obesity cut-points. Nutr Rev 61, 104107.
23.James WPT (2005) Assessing obesity: are ethnic differences in body mass index and waist classification criteria justified? Obes Rev 6, 179181.
24.Oh SW, Shin SA, Yun YH, Yoo T & Huh BY (2004) Cut-off point of BMI and obesity-related comorbidities and mortality in middle-aged Koreans. Obes Rev 12, 20312040.
25.Huxley R, Barzi F, Stolk R, Caterson I, Gill T, Lam TH, Omari A & Woodward M, Obesity in Asia Collaboration (OAC) (2005) Ethnic comparisons of obesity in the Asia-Pacific region: protocol for a collaborative overview of cross-sectional studies. Obes Rev 6, 179181.
26.WHO Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363, 157163.
27.Department of Health (2003) Identification, Evaluation, and Treatment of Overweight and Obesity in Adults in Taiwan. Taipei, Taiwan: Department of Health.
28.McGee DL; Diverse Populations Collaboration (2005) Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol 15, 8797.
29.Gronniger JT (2006) A semiparametric analysis of the relationship of body mass Index to mortality. Am J Public Health 96, 173178.
30.Calle EE, Thun MJ, Petrelli JM, Rodriguez C & Heath CW Jr (1999) Body-mass index and mortality in a prospective cohort of US adults. N Engl J Med 341, 10971105.
31.Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, Hennekens CH & Speizer FE (1995) Body weight and mortality among women. N Engl J Med 333, 677685.
32.Ajani UA, Lotufo PA, Gaziano JM, Lee I-M, Spelsberg A, Buring JE, Willett WC & Manson JE (2004) Body mass index and mortality among US male physicians. Ann Epidemiol 14, 731739.
33.Tsai SP, Donnelly RP & Wendt JK (2006) Overweight, obesity, and mortality in a prospective study of a middle-aged industrial population. J Occup Environ Med 48, 2227.
34. National Health Research Institutes (2002) National Health Interview Survey (NHIS) in 2001. Bureau of Health Promotion and National Health Research Institutes. http://nhis.nhri.org.tw
35.Ho MS (1993) A Long-term Follow-up Study of Chronic Diseases among Civil Servants and Teachers in Taiwan. The Project Report. Taiwan: Institute of Biomedical Science, Academia Sinica.
36.Wen CP, Tsai SP, Chen CJ & Cheng TY (2004) The mortality risks of smokers in Taiwan. Part I: cause-specific mortality. Prev Med 39, 528535.
37.Wen CP, Cheng TY, Tsai SP, Hsu HL & Wang SL (2005) Increased mortality risks of pre-diabetes (impaired fasting glucose) in Taiwan. Diabetes Care 28, 27562761.
38.Wen CP, Tsai SP, Cheng TY, Chung WSI, Jan HT & Chen CJ (2005) Excess injury mortality among smokers – a neglected tobacco hazard. Tobacco Control 14, i28i32.
39.World Health Organization (2000) Obesity: Preventing and Managing the Global Epidemic. WHO Technical Report Series no. 894. Geneva: WHO.
40.Flegal KM, Carroll MD, Ogden CL & Johnson CL (2002) Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288, 17231727.
41.Katzmarzyk PT, Craig CL & Bouchard C (2001) Underweight, overweight and obesity: relationships with mortality in the 13-year follow-up of the Canada Fitness Survey. J Clin Epidemiol 54, 916920.
42.He J, Gu D, Wu X et al. (2005) Major causes of death among men and women in China. N Engl J Med 353, 11241134.
43.Gu D, Reynolds K, Wu X, Chen J, Duan X, Reynolds RF, Whelton PK & He J; InterASIA Collaborative Group (2005) Prevalence of the metabolic syndrome and overweight among adults in China. Lancet 365, 13981405.
44.He J, Gu D & Whelton PK (2006) Major causes of death among men and women in China (author reply). N Engl J Med 354, 876.
45.Deurenberg P, Deurenberg-Yap M & Guricci S (2002) Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev 3, 141146.
46.Yuan JM, Ross RK, Gao YT & Yu MC (1998) Body weight and mortality: a prospective evaluation in a cohort of middle-aged men in Shanghai, China. Int J Epidemiol 27, 824832.
47.Ko GTC, Chan JCN, Cockram CS & Woo J (1999) Prediction of hypertension, diabetes, dyslipidaemia or albuminuria, using simple anthropometric indexes in Hong Kong Chinese. Int J Obes Relat Metab Disord 23, 11361142.
48.US Centers for Disease Control and Prevention (2005) Adult participation in recommended levels of physical activity – United States, 2001 and 2003. MMWR Morb Mortal Wkly Rep 54, 12081212.
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