BMI and morbidity in relation to body composition: a cross-sectional study of a rural community in North-East India

Association between obesity and sickness in the past two weeks among middle-aged and elderly women: A cross-sectional study in Southern China

OBJECTIVES

Sickness situation in the past two weeks, an indicator of health service needs, is an increasing major health concern. However, data on the relationship between obesity and two-week morbidity in the female population, particularly in middle-aged and elderly women, is sparse. The present study aimed to examine the association between obesity and two-week morbidity among middle-aged and elderly women in Southern China, and to explore the independent contributions of socio-demographic variables, health-related factors, and obesity to two-week morbidity.

METHODS

In total, 2364 middle-aged and elderly women were included in this cross-sectional, community-based survey. Obesity was assessed using body mass index (BMI). The outcome variable was sickness situation over the past two weeks (two-week morbidity). Clustered logistic regression was applied to analyze the independent contribution of obesity to two-week morbidity.

RESULTS

Approximately 14.6% of participants experienced sickness in the past two weeks. Obesity (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.02-2.12) was significantly associated with two-week morbidity and its independent contribution accounted for 3.7%, lower than that of socio-demographic variables (73.7%) and health-related factors(22.6%).

CONCLUSIONS

Some degree of correlation was observed between obesity and two-week morbidity among middle-aged and elderly women in Southern China, which can be used as a reference for health-related decision-making.

The validity of mid-upper arm circumference as an indicator of low BMI in population screening for undernutrition: a study among adult slum dwellers in eastern India

OBJECTIVE

To explore the possibility for a statistically appropriate value of mid-upper arm circumference (MUAC) to identify the state of severe undernutrition, based on very low BMI, among adult Indian slum dwellers.

DESIGN

Cross-sectional study on adults. Height and MUAC were recorded and BMI was computed. Chronic energy deficiency (CED) was determined using the WHO international guidelines as BMI<18·5 kg/m2 and normal as BMI≥18·5 kg/m2. Besides calculating mean, sd and 25th, 50th and 75th percentile values, multiple linear regression analysis was undertaken to assess the associations between age, MUAC and BMI. Receiver-operating characteristic curve analysis was performed to determine the best MUAC cut-off to identify CED status. The χ 2 test was used to assess significance of the difference in CED prevalence across MUAC categories.

SETTING

An urban slum in Midnapore town, West Bengal State, India.

SUBJECTS

Male (n 467) and female (n 488) Indian slum dwellers.

RESULTS

MUAC of 22·7 and 21·9 cm, respectively, in males and females were the best cut-off points to differentiate CED from non-CED.

CONCLUSIONS

Results supported the validity of the WHO-recommended MUAC cut-offs for adults. There is still a need to establish statistically appropriate MUAC cut-offs to predict undernutrition and morbidity.

The Quételet index revisited in children and adults

BACKGROUND

The body mass index (BMI) is based on the original concept that body weight increases as a function of height squared. As an indicator of obesity the modern BMI assumption postulates that adiposity also increases as a function of height in states of positive energy balance.

OBJECTIVE

To evaluate the BMI concept across different adiposity magnitudes, in both children and adults.

METHODS

We studied 975 individuals who underwent anthropometric evaluation: 474 children and 501 adults. Tetrapolar bioimpedance analysis was used to assess body fat and lean mass.

RESULTS

BMI significantly correlated with percentage of body fat (%BF; children: r=0.893; adults: r=0.878) and with total fat mass (children: r=0.967; adults: r=0.953). In children, body weight, fat mass, %BF and waist circumference progressively increased as a function of height squared. In adults body weight increased as a function of height squared, but %BF actually decreased with increasing height both in men (r=-0.406; p<0.001) and women (r=-0.413; p<0.001). Most of the BMI variance in adults was explained by a positive correlation of total lean mass with height squared (r(2)=0.709), and by a negative correlation of BMI with total fat mass (r=-0.193).

CONCLUSIONS

Body weight increases as a function of height squared. However, adiposity progressively increases as a function of height only in children. BMI is not an ideal indicator of obesity in adults since it is significantly influenced by the lean mass, even in obese individuals.

Indices of body fat distribution for assessment of lipodysthrophy in people living with HIV/AIDS

BACKGROUND

Metabolic and morphological changes associated with excessive abdominal fat, after the introduction of Antiretroviral Therapy, increase the risk of cardiovascular disease in people living with HIV/AIDS(PLWHA). Accurate methods for body composition analysis are expensive and the use of anthropometric indices is an alternative. However the investigations about this subject in PLWHA are rare, making this research very important for clinical purpose and to advance scientific knowledge. The aim of this study is to correlate results of anthropometric indices of evaluation of body fat distribution with the results obtained by Dual-energy X-Ray Absorptiometry(DEXA), in people living with HIV/AIDS.

METHODS

The sample was of 67 PLWHA(39 male and 28 female), aged 43.6±7.9 years. Body mass index, conicity index, waist/hip ratio, waist/height ratio and waist/thigh were calculated. Separated by sex, each index/ratio was plotted in a scatter chart with linear regression fit and their respective Pearson correlation coefficients. Analyses were performed using Prism statistical program and significance was set at 5%.

RESULTS

The waist/height ratio presented the highest correlation coefficient, for both male (r=0.80, p<0.001) and female (r=0.87, p <001), while the lowest were in the waist/thigh also for both: male group (r=0.58, p<0.001) and female group (r=0.03, p=0.86). The other indices also showed significant positive correlation with DEXA.

CONCLUSION

Anthropometric indices, especially waist/height ratio may be a good alternative way to be used for evaluating the distribution of fat in the abdominal region of adults living with HIV/ADIS.

Factors Associated With Nutritional Status Among Adult Women in Urban India, 1998-2006

This study attempts to understand the factors associated with chronic energy deficiency (CED) and overweight/obesity together with change in CED and overweight/obesity among urban Indian women during 1998-2006. Both National Family Health Survey (NFHS) 1998-1999 and NFHS 2005-2006 data sets were used. The standard cutoff points for both CED (BMI < 18.5 kg/m2) and overweight/obesity (BMI ≥ 23 kg/m2) were considered. The Phi and Cramer’s V tests and predicted probabilities were used to fulfill the study objective. Results indicate an almost 3% reduction in CED and a 6% increase in overweight/obesity during 1998-2006. The probability of CED has reduced among nonliterate women and women belonging to the poorest wealth quintile; on the other hand, the likelihood of being overweight/obese has increased among women with high school education and above and women belonging to the richest wealth quintile. Interventions to promote physical activities and nutritional awareness programs, which are effective in addressing nutritional problems, have been proposed.

[Reliability of the classification of nutritional status obtained through the BMI and three different methods of body fat percentage in patients with type 1 diabetes mellitus]

OBJECTIVE

To assess the reliability of classification of nutritional status (NS) obtained through the body mass index (BMI) and three different methods of body composition (BC) in individuals type 1 diabetics (T1D) and non-diabetic subjects.

METHODS

84 patients with T1D and 37 controls were evaluated. Anthropometric data was collected to calculate BMI and assessment of BC was performed through the methods of skinfold thickness (SF), bipolar (BI) and tetrapolar (TT) bioelectrical impedance. The agreement between the scores of each method was determined by Kappa (K) coefficient.

RESULTS

Considering all the patients, only 48 (57.1%) presented classification of BMI that agreed with the SF method, 58 (69%) with the BI and 45 (53.5%) with the TT. The K results for individuals with T1D was DC = 0.261, BI = 0.320 and TT = 0.174. The controls had higher values (DC = 0.605, BI = 0.360 and TT = 0.400). However, all values were considered low.

CONCLUSIONS

The method of BMI showed little sensitivity to BC changes in patients with T1D. Appropriated methods for the assessment of BC should be used to classify the NS of this population.

Body mass index and body fat among adult Bengalee male slum dwellers in West Bengal, India

SUMMARY

OBJECTIVE

The objective of the study is to explore the relationship between body mass index (BMI) and percent body fat (PBF) in relation to hypertension among adult Bengalee males of low socio-economic status living in a slum area of West Bengal, India.

METHODS

A cross-sectional survey was carried on 436 males aged 18-60 years in a slum area called Bidhan Colony, which is approximately 15 km from Kolkata city. Data on anthropometric measurements and blood pressure were collected, following standard techniques. Logistic regression and receiver operating characteristic (ROC) curve analysis were used for testing the relationship between BMI and PBF relative to hypertension.

RESULTS

About 4.25% and 50% of the normal (BMI 18.5-22.9 kg/m(2)) and overweight (BMI 23.0-24.9 kg/m(2)) subjects, respectively, were obese according to the PBF cut-off point of >25%. The ROC curve analysis indicated that the BMI cut-off ≥23 kg/m(2) was appropriate for detecting obesity relative to hypertension. It was observed that the prevalence of hypertension increased significantly with age (r = 0.226, p < 0.001). Adjusting for age, the subjects with BMI 23-24.99 kg/m(2) had about 3.2 times (95% CI: 1.61-6.27) greater risk of hypertension than those with BMI < 23 kg/m(2), and the risk for those with BMI ≥ 25 kg/m(2) was about 4.5 times (95% CI: 2.06-9.57). As for PBF, the risk of hypertension was about 2.6 times (95% CI: 1.38-4.80) for the subjects with PBF > 25% compared to those with PBF ≤ 25%.

CONCLUSIONS

Our study validated the BMI cut-off point proposed by the WHO for Asia-Pacific populations for screening the individuals who are likely at risk of overweight. However, such data should be substantiated by independent risks of adverse health outcomes that need for public health intervention.

Is obesity becoming a public health problem in India? Examine the shift from under- to overnutrition problems over time

This study aimed to examine the prevalence and trends of overweight, obesity and undernutrition in recent decades in India. Based on a systematic literature search on PubMed and other data sources, most published studies were regional or local surveys in urban areas, while good representative data from the India National Family Health Surveys (NFHS, 1992-1993, 1998-1999 and 2005-2006) allowed for examining the trends at the national level. Overall, the available data showed that in India, prevalence of overweight was low while that of undernutrition remained high. Overweight was more prevalent among female, urban and high-socioeconomic-status (SES) groups. NFHS data showed that the prevalence of overweight in women and pre-school children did not increase much in the last decade: 10.6% and 1.6% in 1998-1999 to 12.6% and 1.5% in 2005-2006 respectively. As for underweight, NFHS 2005-2006 showed high prevalence among ever-married women (about 35%) and pre-school children (about 42%). The prevalence of overweight and obesity had increased slightly over the past decade in India, but in some urban and high-SES groups it reached a relatively high level. Factors associated with undernutrition need closer examination, and prevention of obesity should be targeted at the high-risk groups simultaneously.

Undernutrition in the Kora Mudi tribal population, West Bengal, India: a comparison of body mass index and mid-upper-arm circumference

BACKGROUND

Undernutrition among adult tribal women is a major health problem in India.

OBJECTIVES

To compare the utility of two different anthropometric indicators of chronic energy deficiency (CED) among tribal Kora Mudi women and to determine which of these two is a better indicator of undernutrition.

METHODS

A cross-sectional study of 123 individuals was conducted. The body mass index (BMI) and mid-upper-arm circumference (MUAC) were used to evaluate CED.

RESULTS

The prevalence of CED based on BMI less than 18.5 was 55.3%, and the prevalence of CED based on MUAC less than 22.0 cm was 51.2%. Both of these prevalence rates are classified in the very high-prevalence category (> or = 40%) and indicate a critical situation according to World Health Organization recommendations. Mean BMI increased significantly with higher quartile of MUAC. There was a significant difference in the prevalence of CED between the MUAC quartiles. The risk ratio for CED for women in the lowest quartile of MUAC was 9.33 compared with those in the highest quartile. There was a significant positive association between MUAC and BMI. Regression analysis demonstrated that MUAC had a significant positive impact on BMI; the percentage of the variation in BMI explained by MUAC was 52%. Logistic regression analysis demonstrated that overall, 82.11% of cases of CED were correctly classified with the use of MUAC. The use of MUAC correctly diagnosed 82.35% of cases of CED and 81.82% of women with normal nutritional status.

CONCLUSIONS

This population was facing severe nutritional stress. With limited resources and in the absence of skilled manpower, it may be more appropriate to use MUAC for human population surveys, particularly among tribal populations of developing countries.

Undernutrition among Adult Dhimals of Naxalbari, West Bengal: Comparison with other Tribes of Eastern India

Background

The tribes of India comprise approximately 8% of the total population of the country, which probably has the largest number of tribal communities in the world. In general, the tribal populations are among the most underprivileged and undernourished people in India.

Objectives

To determine the anthropometric characteristics and prevalence of undernutrition, based on body mass index (BMI), of adult Dhimals, a tribal population of Naxalbari, West Bengal, India, and to compare these results with those from four other tribes of Eastern India: the Bathudis, Kora Mudis, Santals, and Savars.

Methods

A total of 305 adult (18 years or older) Dhimals (159 men and 146 women) from three villages (Maniram, Hatighisa, and Buraganj) in the Mallabari area of Naxalbari were studied. These villages are located 5 km from Siliguri town, which is approximately 580 km from Kolkata, the provincial capital of West Bengal. Anthropometric measurements included height and weight. BMI was calculated by the standard equation. Undernutrition was evaluated according to World Health Organization (WHO) cutoff points.

Results

The overall prevalence of undernutrition (BMI < 18.5) was very high (36.4%). The prevalence was significantly higher in women than in men (46.4% vs. 27.0%; χ2 = 12.54; p < .001; odds ratio, 2.35). According to the WHO criterion, the prevalence of undernutrition was high and the situation was serious in men. Among women, the prevalence of undernutrition was very high and the situation was critical. However, in general, compared with other tribal people of eastern India except the Santals, adult Dhimals had better anthropometric and nutritional profiles.

Conclusions

This study provides evidence that although the anthropometric and nutritional profiles of adult Dhimals are better than those of some of the other tribal populations of eastern India, immediate appropriate nutritional intervention programs are needed for implementation among this ethnic group.

Nutritional Status of Adult Santal Men in Keonjhar District, Orissa, India

Background

Although tribal people constitute a sizable proportion of India's population, there is little information on their anthropometric and nutrition status.

Objective

The present study was undertaken to study the anthropometric characteristics of adult Santal males. It also attempted to evaluate their nutritional status based on body-mass index (BMI) and mid-upper-arm circumference (MUAC).

Methods

A cross-sectional study was conducted of adult (aged > 18 years) male Santals, a tribal population of Keonjhar District, Orissa, India. A total of 332 Santals from five villages (Gourshinga, Kashibera, Kumunia, Majhisahi, and Sonatangri) in the Anandapur Region of Keonjhar District were included in the study. These villages are located approximately 150 km from Bhubaneswar, the provincial capital of Orissa. Anthropometric measurements, including height, weight, and MUAC, were performed according to a standard protocol. Nutritional status was evaluated on the basis of internationally accepted cutoff points of BMI and MUAC.

Results

The mean height, weight, MUAC, and BMI of the men were 162.5 cm, 51.7 kg, 23.7 cm, and 19.6 kg/m2, respectively. The prevalence of undernutrition (chronic energy deficiency [CED]) based on BMI was 26.2%; 3.3%, 3.9%, and 19.0% had grades III, II, and I CED, respectively. According to MUAC cutoff points, the prevalence of undernutrition was 33.7%.

Conclusions

The level of undernutrition among adult Santal males was high. Appropriate nutritional intervention programs should be implemented immediately.

Índice de massa corporal como indicativo da gordura corporal comparado às dobras cutâneas

FUNDAMENTOS: A gordura corporal está associada com grandes incidências de doenças crônicas degenerativas. Portanto, estimar a gordura com o menor erro possível é fundamental. OBJETIVO: Verificar se o índice de massa corporal (IMC) apresenta consistência perante o somatório das dobras cutâneas do tríceps e da panturrilha (TR + PA) para classificar moças e rapazes acima, abaixo e dentro do padrão (critério de referência) considerado adequado para uma boa saúde. MÉTODOS: A amostra foi composta por 694 moças e 716 rapazes com idades de 10,50 a 17,49 anos. As variáveis foram medidas e analisadas em relação aos critérios de referência apresentados pela AAHPERD (1988). Os resultados foram analisados pelo coeficiente de contingência e índice kappa. RESULTADOS E CONCLUSÃO: Os dados indicaram que somente 48,98% das moças e 57,32% dos rapazes foram classificados concomitantemente pelo IMC e TR + PA. O índice kappa indicou uma fraca concordância entre as três categorias de classificação da gordura corporal (acima, abaixo e dentro do padrão recomendado). Desta forma, conclui-se que o IMC não apresenta consistência para classificar moças e rapazes quanto à gordura corporal.

Excess male chronic energy deficiency among adolescents: a cross-sectional study in the context of patrilineal and matrilineal societies in Northeast India

OBJECTIVE

To determine the sex differences in chronic energy deficiency (CED) among adolescents in the context of patrilineal and matrilineal societies in Northeast India.

DESIGN

Cross-sectional, community-based study of the Hmar patrilineal society and the Khasi (War and Khynriam) matrilineal society.

SETTING

Mizoram and Meghalaya in Northeast India.

SUBJECTS

In total, 1733 adolescent boys and girls aged 9-16 y: Khynriam Khasis (n = 1005), War Khasis (n = 305) and Hmars (n = 423).

MEASUREMENTS

Weight, height, and socio-economic characteristics. Body mass index (weight in kg/height in m2) was used for assessing CED relative to the international reference values.

RESULTS

The overall prevalence of CED was significantly greater in boys than in girls. The sex differences in the prevalence of CED were 5, 10 and 6% points in the Khynriam Khasis, War Khasis and Hmars, respectively. Allowing for age and socio-economic variables, the risks of CED were about 1.82 (95% CI 1.14-2.90), 1.83 (95% CI 1.19-3.33) and 1.78 (95% CI 1.10-3.25) times greater in boys than in girls among the Khynriam Khasis, War Khasis and Hmars, respectively. Using logistic regression analysis, the prevalence of CED was negatively associated with family income across study populations. No significant association was found between CED and religion.

CONCLUSION

Patrilineal and matrilineal forms of society were not reflected in the prevalence of CED among adolescents. Subject to further studies of the research problems concerning the nutritional status of adolescents, girls fare better than boys with respect to the prevalence of CED.