Obesity and Ethnicity
- Although the nature of obesity-related health risks is similar in all populations, the specific level of risk associated with a given level of obesity is different depending on gender, race and socioeconomic conditions.1
- There is a graded increase in diabetes, hypertension and high blood cholesterol with increasing body weight.1 However, among obese individuals, the prevalence of hypertension was higher in black subjects.1
- The relationship between percent body fat (% BF) and body mass index (BMI) is different for European, pacific Island, and Asian Indians which may, at least in part, be due to differences in muscularity. For the same BMI, percentage body fat is 4% to 5% lower for blacks and Pacific Islanders and 7-8% points higher for Asian Indians compared to Europeans as well as other Asians.2, 3
- Compared to European men for the same % BF, BMI was 2-3 units higher for Pacific Island, and 3-6 units lower for Asian Indian.3
- Asian Indians have more abdominal fat deposition than their European and Pacific Island counterparts.3 The ratio of abdominal fat to thigh fat (adjusted for height, weight, and %BF) is significantly higher for Asian Indians than Europeans and Pacific Islanders.3
- Similarly, Filipinos share the tendency for accumulation of visceral adipose tissue (VAT), at any waist circumference and BMI, both of which are weaker estimates of VAT. A similar observation has also been reported among African-American women compared to whites.4
- Diabetes prevalence was highest among Filipino women at every level of VAT, but VAT did not explain their elevated diabetes risk.4
- The dangerous accumulation of adipose tissue also extends to pancreas, liver, kidney, and heart. Pancreatic fat fraction (PFF) is related to VAT, hepatic fat fraction and circulating free fatty acids and possibly contributes to increased risk for diabetes and metabolic syndrome.5 PFF is higher in Hispanics than African Americans, although both populations are known for their high risk of diabetes. 5
- International studies conducted among different Asian populations in China, Korea, Philippines, Singapore and Taiwan have shown increased risk of diabetes and cardiovascular disease (CVD) at lower BMI than Europids.6-13
- In general, obesity is the principal driver of diabetes. However in the UK, Chinese have lower BMI but the prevalence of glucose intolerance (a marker of diabetes risk) is similar to or higher than Europids. The diabetes risk among Chinese in the UK is intermediate between levels found in China and those in Mauritius. An increase in mean BMI among Chinese to the levels in the Europid population would result in a substantial increase in glucose intolerance in them.14 A similar phenomenon occurs in Asian Indians as well.
- Asians have higher adiposity than whites at any given levels of BMI (just like women have more adiposity than men). Hence, obesity guidelines based on Western populations markedly underestimate the risk among all Asians. 10, 15-19 The World Health Organization Western Pacific region has issued a lower cutoff point for overweight (BMI >23) and obesity (BMI >25) for all Asians (Table 006).20, 21 These cut-off points would remain effective until different Asian countries develop their own criteria for obesity based on the prevalence of obesity and the risks conferred by it.22
- By this criterion, 95% of the South Asian diabetic patients were identified as overweight and 80% were obese in the United Kingdom Asian Diabetes Study.23 Among Taiwanese, one-half of the population is overweight and one-quarter obese by this definition.24
- Research in Asian populations in the United States has corroborated this increased disease risk for metabolic syndrome at lower BMI.25 Asian Americans generally have lower mean BMI values and lower prevalence of overweight and obesity than Europids when using traditional BMI cut-off points are used but disappears when Asian specific cut-off pints are used.25
- These data demonstrate that the use of universal BMI cut-off points are not appropriate for comparison of obesity prevalence among Asian populations.3
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2. Jackson A. S., Ellis KJ, McFarlin BK, Sailors MH, Bray MS. Body mass index bias in defining obesity of diverse young adults: the Training Intervention and Genetics of Exercise Response (TIGER) study. The British journal of nutrition. Oct 2009;102(7):1084-1090.
3. Rush E, Plank L, Chandu V, et al. Body size, body composition, and fat distribution: a comparison of young New Zealand men of European, Pacific Island, and Asian Indian ethnicities. N Z Med J. Dec 17 2004;117(1207):U1203.
4. Araneta MR, Barrett-Connor E. Ethnic differences in visceral adipose tissue and type 2 diabetes: Filipino, African-American, and white women. Obesity research. Aug 2005;13(8):1458-1465.
5. Le KA, Ventura EE, Fisher JQ, et al. Ethnic differences in pancreatic fat accumulation and its relationship with other fat depots and inflammatory markers. Diabetes Care. Feb 2011;34(2):485-490.
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14. Unwin N, Harland J, White M, et al. Body mass index, waist circumference, waist-hip ratio, and glucose intolerance in Chinese and Europid adults in Newcastle, UK. J Epidemiol Community Health. Apr 1997;51(2):160-166.
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18. Deurenberg P, Yap M, van Staveren WA. Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord. Dec 1998;22(12):1164-1171.
19. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and international association for the Study of Obesity. Circulation. Oct 20 2009;120(16):1640-1645.
20. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome–a new worldwide definition. Lancet. Sep 24-30 2005;366(9491):1059-1062.
21. Asia Pacifuc Perspective:Redefing obesity and its treatmentf: World Health Organization, Western Pacific Region;February 2000.
22. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. Jan 10 2004;363(9403):157-163.
23. O’Hare JP, Raymond NT, Mughal S, et al. Evaluation of delivery of enhanced diabetes care to patients of South Asian ethnicity: the United Kingdom Asian Diabetes Study (UKADS). Diabet Med. Dec 2004;21(12):1357-1365.
24. Pan WH, Flegal KM, Chang HY, Yeh WT, Yeh CJ, Lee WC. 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. Jan 2004;79(1):31-39.
25. Palaniappan L P, Wong EC, Shin JJ, Fortmann SP, Lauderdale DS. Asian Americans have greater prevalence of metabolic syndrome despite lower body mass index. International journal of obesity (2005). Aug 3 2010.