Paper
International Journal of Obesity (2005) 29, 656–667. doi:10.1038/sj.ijo.0802937 Published online 22 March 2005
Ethnic differences in the relationships between obesity and glucose-metabolic abnormalities: a cross-sectional population-based study
F Razak1, S Anand1, V Vuksan2, B Davis3, R Jacobs3, K K Teo4 and S Yusuf1 on behalf of the SHARE Investigators
- 1Population Health Research Institute, McMaster University, Hamilton General Hospital, Hamilton, ON, Canada
- 2Faculty of Medicine, University of Toronto, FitzGerald Building, Room 443, 150 College Street, Toronto, Ontario, Canada
- 3Six Nations Health Services, P.O. Box 5000, Oshweken, Ontario, Canada
- 4Population Health Research Institute, McMaster University, McMaster University Medical Center, Room 3U4, 1200 Main Street West, Hamilton, Ontario, Canada
Correspondence: Dr S Anand, McMaster Clinic Rm. 522, Hamilton General Hospital, Hamilton Health Sciences, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2. E-mail: anands@mcmaster.ca
Received 4 April 2004; Revised 30 November 2004; Accepted 7 January 2005; Published online 22 March 2005.
Abstract
OBJECTIVES:
To evaluate whether body mass index (BMI) and other anthropometric indices of visceral obesity vary by ethnic group in their distribution and their relationship to metabolic abnormalities.
DESIGN:
Cross-sectional study.
PARTICIPANTS:
Canadian men and women, aged 35–75 years, of South Asian (n=342), Chinese (n=317), European (n=326) and Aboriginal (n=301) descent were recruited using stratified random sampling.
PRIMARY MEASURES:
Anthropometric indices (BMI, waist to hip ratio (WHR) and waist circumference (WC)), metabolic markers (fasting glucose, HbA1c, the ratio of total cholesterol/HDL) and clinical markers (systolic blood pressure) were assessed.
RESULTS:
In subjects with BMI<30 kg/m2, the mean marker levels in people with elevated WC (>88 cm in women, >102 cm in men) vs people with normal WC were 6.16 vs 5.34 mmol/l for fasting glucose, 6.05 vs 5.66% for HbA1c and 5.46 vs 4.68 for the ratio of total cholesterol to HDL (P<0.001 in each case). At nearly every given level of BMI, non-European ethnic groups displayed significantly higher marker levels than Europeans. For example, for a given BMI, age and sex, the difference between European and non-European groups in HbA1c levels was 0.53% (95% confidence interval (CI): 0.37–0.69) for South Asians, 0.37% (95% CI: 0.2–0.54) for Chinese and 0.95% (95% CI: 0.78–1.12) for Aboriginal People.
CONCLUSIONS:
Uniform cut-points for the classification of obesity using BMI, WHR or WC result in marked variation in the levels of glucose-metabolic abnormalities between ethnic groups. Existing action thresholds for these anthropometric indices do not apply to non-European ethnic groups and warrant revision.
Keywords:
ethnicity, body mass index, waist to hip ratio, waist circumference, cardiovascular disease, diabetes
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