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Relationships between indices of obesity and its co-morbidities in multi-ethnic Singapore

International Journal of Obesity volume 25, pages 1554–1562 (2001)Cite this article

Abstract

OBJECTIVE: To investigate the effect of body mass index (BMI) and body fat distribution as measured by waist-to-hip ratio (WHR) on the cardiovascular risk factor profile of the three major ethnic groups in Singapore (Chinese, Malay and Indian people) and to determine if WHO recommended cut-off values for BMI and WHR are appropriate for the different sub-populations in Singapore.

DESIGN: Cross-sectional population study.

SUBJECTS: A total of 4723 adult subjects (64% Chinese individuals, 21% Malay individuals and 15% Indian individuals) were selected through a multi-staged sampling technique to take part in the National Health Survey in 1998.

MEASUREMENTS: Data on socio-economic status (education level, occupation, housing type) and lifestyle habits (smoking and physical activity), body weight, body height, waist and hip circumferences and blood pressure measured using standardised protocols. Fasting venous blood samples were obtained for determination of serum total cholesterol (TC), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), triglycerides (TG). Venous blood samples were taken for 2 h oral glucose tolerance test (2 h glu).

RESULTS: Absolute and relative risks for at least one cardiovascular risk factor (elevated TC, elevated TC/HDL ratio, elevated TG, hypertension and diabetes mellitus) were determined for various categories of BMI and WHR. At low categories of BMI (BMI between 22 and 24 kg/m2) and WHR (WHR between 0.80 and 0.85 for women, and between 0.90 and 0.95 for men), the absolute risks are high, ranging from 41 to 81%. At these same categories the relative risks are significantly higher compared to the reference category, ranging from odds ratio of 1.97 to 4.38. These categories of BMI and WHR are all below the cut-off values of BMI and WHR recommended by WHO.

CONCLUSIONS: The results show that, at relatively low BMI and WHR, Singaporean adults experience elevated levels of risks (absolute and relative) for cardiovascular risk factors. These findings, in addition to earlier reported high percentage body fat among Singaporeans at low levels of BMI, confirm the need to revise the WHO cut-off values for the various indices of obesity and fat distribution, viz BMI and WHR, in Singapore.

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Acknowledgements

The authors wish to thank the following: Ministry of Health in Singapore for sponsoring the study; The National Health Survey working committee and staff from the Epidemiology and Disease Control Department, Ministry of Health, Singapore for the organisation and overseeing of the National Health Survey 1988; participating households and subjects who have given their full cooperation and support to the study.

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Authors and Affiliations

  1. Research and Information Management, Health Promotion Board, Singapore

    M Deurenberg-Yap & VFP Lin

  2. Department of Epidemiology and Disease Control, Ministry of Health HQ, Singapore

    SK Chew & BY Tan

  3. Division of Human Nutrition and Epidemiology, Wageningen Agricultural University, Wageningen, The Netherlands

    WA van Staveren & P Deurenberg

  4. Nutrition Consultant, Chiltern Park, Singapore

    P Deurenberg

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  1. M Deurenberg-Yap
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  2. SK Chew
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  3. VFP Lin
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  4. BY Tan
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  6. P Deurenberg
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Correspondence to M Deurenberg-Yap.

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Deurenberg-Yap, M., Chew, S., Lin, V. et al. Relationships between indices of obesity and its co-morbidities in multi-ethnic Singapore. Int J Obes 25, 1554–1562 (2001). https://doi.org/10.1038/sj.ijo.0801739

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