Age and race impact the association between BMI and CVD mortality in women

Examining Generalizability across Different Surveys: Comparing Nutrient-Based Food Patterns and Their Cross-Sectional Associations with Cardiometabolic Health in the United States Hispanic/Latino Adults

Background

Ethnicity, cultural background, and geographic location differ significantly within the United States Hispanic/Latino population. These variations can greatly define diet and its relationship with cardiometabolic disease, thus influencing generalizability of results.

Objectives

We aimed to examine nutrient-based food patterns (NBFPs) of Hispanic/Latino adults and their association with cardiometabolic risk factors (dyslipidemia, hypertension, obesity, diabetes) across 2 United States population-based studies with differing sampling strategies.

Methods

Data were collected from Mexican or other Hispanic adult participants from 2007-2012 National Health and Nutrition Examination Survey (NHANES) (n = 3605) and 2007-2011 Hispanic Community Health Survey/Study of Latinos (HCHS/SOL, n = 14,416). NBFPs were derived using factor analysis on nutrient intake data estimated from 24-h dietary recalls and interpreted using common foods in which these nutrients are prominent. Cross-sectional associations between NBFPs (quintiles) and cardiometabolic risk factors, defined by clinical measures and self-report, were estimated using survey-weighted multivariable-adjusted logistic models, accounting for multiple testing.

Results

Five NBFPs were identified in both studies: 1) meats, 2) grains/legumes, 3) fruits/vegetables, 4) dairy, and 5) fats/oils. Associations with cardiometabolic risk factors differed by NBFP and study. In HCHS/SOL, the odds of diabetes were lower for persons in the highest quintile of meats NBFP (odds ratio [OR]: 0.73; 95% confidence interval [CI]: 0.58, 0.92) and odds were higher for those in the lowest quintile of fruits/vegetables (OR: 0.71; 95% CI: 0.55, 0.93) compared to those in the third (moderate intake) quintile. Those in the fourth quintile of dairy NBFP had higher odds of hypertension than those in the third quintile (OR: 1.31; 95% CI: 1.01, 1.70). In NHANES, the odds of hypertension were higher for those in the fourth quintile of dairy (OR: 1.88; 95% CI: 1.10, 3.24) than those in the third quintile.

Conclusions

Diet-disease relationships among Hispanic/Latino adults vary according to 2 population-based studies. These differences have research and practical implications when generalizing inferences on heterogeneous underrepresented populations.

The cerebellum plays more than one role in the dysregulation of appetite: Review of structural evidence from typical and eating disorder populations

OBJECTIVE

Dysregulated appetite control is characteristic of anorexia nervosa (AN), bulimia nervosa (BN), and obesity (OB). Studies using a broad range of methods suggest the cerebellum plays an important role in aspects of weight and appetite control, and is implicated in both AN and OB by reports of aberrant gray matter volume (GMV) compared to nonclinical populations. As functions of the cerebellum are anatomically segregated, specific localization of aberrant anatomy may indicate the mechanisms of its relationship with weight and appetite in different states. We sought to determine if there were consistencies in regions of cerebellar GMV changes in AN/BN and OB, as well as across normative (NOR) variation.

METHOD

Systematic review and meta-analysis using GingerALE.

RESULTS

Twenty-six publications were identified as either case-control studies (nOB  = 277; nAN/BN  = 510) or regressed weight from NOR data against brain volume (total n = 3830). AN/BN and OB analyses both showed consistently decreased GMV within Crus I and Lobule VI, but volume reduction was bilateral for AN/BN and unilateral for OB. Analysis of the NOR data set identified a cluster in right posterior lobe that overlapped with AN/BN cerebellar reduction. Sensitivity analyses indicated robust repeatability for NOR and AN/BN cohorts, but found OB-specific heterogeneity.

DISCUSSION

Findings suggest that more than one area of the cerebellum is involved in control of eating behavior and may be differentially affected in normal variation and pathological conditions. Specifically, we hypothesize an association with sensorimotor and emotional learning via Lobule VI in AN/BN, and executive function via Crus I in OB.

Body mass index, waist circumference and cardiovascular diseases in transitional ages (40 and 66 years)

BACKGROUND

There is lack of data on effect modification by age on the association between body mass index (BMI) or waist circumference (WC) and cardiovascular diseases (CVDs). We aimed to investigate the impact of BMI and WC on incident CVDs in individuals aged 40 and 66 years.

METHODS

Overall, 2 430 510 participants who underwent a national health screening for transitional ages provided by the Korean National Health Insurance Service between 2009 and 2012 were included. The adjusted hazard ratios and 95% confidence intervals for myocardial infarction (MI), ischaemic stroke and CVDs as a composite outcome of MI and ischaemic stroke were calculated using multivariable Cox proportional hazard regression analysis.

RESULTS

During a mean follow-up of 7.7 years, 24 884 MI and 29 415 ischaemic stroke events occurred. Among participants aged 40 years, there was a J-shaped association of BMI with incident CVDs, MI and ischaemic stroke with nadir at BMI 18.5-22.9 kg/m2 (P for trend < 0.001 for all). Among those aged 66 years, there were significant U-shaped associations of BMI with CVDs and MI with nadir at a BMI of 23.0-24.9 kg/m2 (P for trend 0.013 and 0.017, respectively). WC was linearly associated with all study outcomes in both age groups (P for trend < 0.001). The impact of general and abdominal obesity on both study outcomes was more prominent in those aged 40 years than in those aged 66 years (P for interaction < 0.001).

CONCLUSIONS

To prevent cardiovascular risk, weight loss intervention should be cautiously implemented and individualized according to age. The maintenance of muscle mass may be essential in managing weight loss particularly in older population.

Soluble Epoxide Hydrolase Is Associated with Postprandial Anxiety Decrease in Healthy Adult Women

The metabolism of bioactive oxylipins by soluble epoxide hydrolase (sEH) plays an important role in inflammation, and sEH may be a risk modifier in various human diseases and disorders. The relationships that sEH has with the risk factors of these diseases remain elusive. Herein, sEH protein expression and activity in white blood cells were characterized before and after a high-fat meal in healthy women (HW) and women with anorexia nervosa (AN). sEH expression and sEH activity were significantly correlated and increased in both groups two hours after consumption of the study meal. Fasting sEH expression and activity were positively associated with body mass index (BMI) in both groups, while an inverse association with age was found in AN only (p value < 0.05). sEH was not associated with anxiety or depression in either group at the fasting timepoint. While the anxiety score decreased after eating in both groups, a higher fasting sEH was associated with a lower postprandial anxiety decrease in HW (p value < 0.05). sEH characterization using direct measurements verified the relationship between the protein expression and in vivo activity of this important oxylipin modulator, while a well-controlled food challenge study design using HW and a clinical control group of women with disordered eating elucidated sEH’s role in the health of adult women.

Effects of Caffeine on Brown Adipose Tissue Thermogenesis and Metabolic Homeostasis: A Review

The impact of brown adipose tissue (BAT) metabolism on understanding energy balance in humans is a relatively new and exciting field of research. The pathogenesis of obesity can be largely explained by an imbalance between caloric intake and energy expenditure, but the underlying mechanisms are far more complex. Traditional non-selective sympathetic activators have been used to artificially elevate energy utilization, or suppress appetite, however undesirable side effects are apparent with the use of these pharmacological interventions. Understanding the role of BAT, in relation to human energy homeostasis has the potential to dramatically offset the energy imbalance associated with obesity. This review discusses paradoxical effects of caffeine on peripheral adenosine receptors and the possible role of adenosine in increasing metabolism is highlighted, with consideration to the potential of central rather than peripheral mechanisms for caffeine mediated BAT thermogenesis and energy expenditure. Research on the complex physiology of adipose tissue, the embryonic lineage and function of the different types of adipocytes is summarized. In addition, the effect of BAT on overall human metabolism and the extent of the associated increase in energy expenditure are discussed. The controversy surrounding the primary β-adrenoceptor involved in human BAT activation is examined, and suggestions as to the lack of translational findings from animal to human physiology and human in vitro to in vivo models are provided. This review compares and distinguishes human and rodent BAT effects, thus developing an understanding of human BAT thermogenesis to aid lifestyle interventions targeting obesity and metabolic syndrome. The focus of this review is on the effect of BAT thermogenesis on overall metabolism, and the potential therapeutic effects of caffeine in increasing metabolism via its effects on BAT.

Do the Same Central Anthropometric Variables that Best Predict Blood Pressure in European Americans also Best Predict Blood Pressure in African Americans?

Objective

The purpose of this study was to determine if central anthropometric variables that best estimate blood pressure risks in European Americans also best estimate blood pressure risks in African Americans.

Design

The participants were 357 normotensive African and European American volunteers with a mean age of 32.6 ± 12.4 years. Participants were evaluated for central adiposity with dual energy X-ray absorptiometry, abdomen and thigh skinfolds, waist and hip circumferences, waist/hip ratio, waist/height ratio, body mass index, and systolic and diastolic blood pressures. Descriptive statistics, partial correlations, ANOVA and stepwise regressions were used to analyze the data.

Results

Central adiposity anthropometric indices made different contributions to blood pressure in African and European American men and women. When weight was held constant, waist circumference shared stronger partial relationships with blood pressure in African Americans (r = .30 to .47) than in European Americans (r = .11 to .32). Waist circumference in combination with other indices was a predictor of systolic and diastolic blood pressures in European American men (P<.05) but only a predictor for diastolic blood pressure in African American men and women (P<.01). Hip circumference was the only predictor for systolic blood pressure (P<.01) in African American men and women.

Conclusions

Further research on the relative contributions of central anthropometric indices to blood pressure in African and European Americans is warranted. A better understanding of this relationship may help reduce hypertensive morbidity and mortality disparities between African and European Americans.

Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

IMPORTANCE

Overweight and obesity have been associated with adverse health effects.

OBJECTIVE

To systematically review evidence on benefits and harms of behavioral and pharmacotherapy weight loss and weight loss maintenance interventions in adults to inform the US Preventive Services Task Force.

DATA SOURCES

MEDLINE, PubMed Publisher-Supplied Records, PsycINFO, and the Cochrane Central Register of Controlled Trials for studies published through June 6, 2017; ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials through August 2017; and ongoing surveillance in targeted publications through March 23, 2018. Studies from previous reviews were reevaluated for inclusion.

STUDY SELECTION

Randomized clinical trials (RCTs) focusing on weight loss or weight loss maintenance in adults.

DATA EXTRACTION AND SYNTHESIS

Data were abstracted by one reviewer and confirmed by another. Random-effects meta-analyses were conducted for weight loss outcomes in behavior-based interventions.

MAIN OUTCOMES AND MEASURES

Health outcomes, weight loss or weight loss maintenance, reduction in obesity-related conditions, and adverse events.

RESULTS

A total of 122 RCTs (N = 62 533) and 2 observational studies (N = 209 993) were identified. Compared with controls, participants in behavior-based interventions had greater mean weight loss at 12 to 18 months (-2.39 kg [95% CI, -2.86 to -1.93]; 67 studies [n = 22065]) and less weight regain (-1.59 kg [95% CI, -2.38 to -0.79]; 8 studies [n = 1408]). Studies of medication-based weight loss and maintenance interventions also reported greater weight loss or less weight regain in intervention compared with placebo groups at 12 to 18 months (range, -0.6 to -5.8 kg; no meta-analysis). Participants with prediabetes in weight loss interventions had a lower risk of developing diabetes compared with controls (relative risk, 0.67 [95% CI, 0.51 to 0.89]). There was no evidence of other benefits, but most health outcomes such as mortality, cardiovascular disease, and cancer were infrequently reported. Small improvements in quality of life in some medication trials were noted but were of unclear clinical significance. There was no evidence of harm such as cardiovascular disease from behavior-based interventions; higher rates of adverse events were associated with higher dropout rates in medication groups than in placebo groups.

CONCLUSIONS AND RELEVANCE

Behavior-based weight loss interventions with or without weight loss medications were associated with more weight loss and a lower risk of developing diabetes than control conditions. Weight loss medications, but not behavior-based interventions, were associated with higher rates of harms. Long-term weight and health outcomes data, as well as data on important subgroups, were limited.

Obesity Epidemiology Worldwide

Obesity continues to be a public health concern across the globe. Obesity has a demonstrated association with health behaviors and health outcomes, such as diabetes, hypertension, and cancer. Over the past 2 decades, obesity has increased worldwide and remains highest in the United States. It is critical to understand the definition of obesity, using body mass index appropriately, recent estimates, and risk factors as a framework within which clinicians should work to help reduce the burden of obesity. This framework, including the Healthy People 2020 place-based approach to social determinants of health, is described in this article.

Obesity and Pulmonary Function in African Americans

Background

Obesity prevalence in United States (US) adults exceeds 30% with highest prevalence being among blacks. Obesity is known to have significant effects on respiratory function and obese patients commonly report respiratory complaints requiring pulmonary function tests (PFTs). However, there is no large study showing the relationship between body mass index (BMI) and PFTs in healthy African Americans (AA).

Objective

To determine the effect of BMI on PFTs in AA patients who did not have evidence of underlying diseases of the respiratory system.

Methods

We reviewed PFTs of 339 individuals sent for lung function testing who had normal spirometry and lung diffusion capacity for carbon monoxide (DLCO) with wide range of BMI.

Results

Functional residual capacity (FRC) and expiratory reserve volume (ERV) decreased exponentially with increasing BMI, such that morbid obesity resulted in patients breathing near their residual volume (RV). However, the effects on the extremes of lung volumes, at total lung capacity (TLC) and residual volume (RV) were modest. There was a significant linear inverse relationship between BMI and DLCO, but the group means values remained within the normal ranges even for morbidly obese patients.

Conclusions

We showed that BMI has significant effects on lung function in AA adults and the greatest effects were on FRC and ERV, which occurred at BMI values < 30 kg/m2. These physiological effects of weight gain should be considered when interpreting PFTs and their effects on respiratory symptoms even in the absence of disease and may also exaggerate existing lung diseases.

Comparison of body mass index with waist circumference and skinfold-based percent body fat in firefighters: adiposity classification and associations with cardiovascular disease risk factors

PURPOSE

This study aims to examine whether body mass index (BMI) overestimates the prevalence of overweight or obese firefighters when compared to waist circumference (WC) and skinfold-based percent body fat (PBF) and to investigate differential relationships of the three adiposity measures with other biological cardiovascular disease (CVD) risk factors.

METHODS

The adiposity of 355 (347 males and eight females) California firefighters was assessed using three different measures. Other CVD risk factors (high blood pressure, high lipid profiles, high glucose, and low VO2 max) of the firefighters were also clinically assessed.

RESULTS

The prevalence of total overweight and obesity was significantly (p < 0.01) higher by BMI (80.4 %) than by WC (48.7 %) and by PBF (55.6 %) in male firefighters. In particular, the prevalence of overweight firefighters was much higher (p < 0.01) by BMI (57.3 %) than by WC (24.5 %) and PBF (38.3 %). 60-64 % of male firefighters who were assessed as normal weight by WC and PBF were misclassified as overweight by BMI. When overweight by BMI was defined as 27.5-29.9 kg/m(2) (vs. the standard definition of 25.0-29.9 kg/m(2)), the agreement of the adiposity classification increased between BMI and other two adiposity measures. Obese firefighters had the highest CVD risk profiles across all three adiposity measures. Only when overweight by BMI was defined narrowly, overweight firefighters had substantially higher CVD risk profiles. Obesity and overweight were less prevalent in female and Asian male firefighters.

CONCLUSIONS

BMI overestimated the prevalence of total overweight and obesity among male firefighters, compared to WC and skinfold-based PBF. Overweight by BMI needs to be more narrowly defined, or the prevalence of BMI-based overweight (27.5-29.9 kg/m(2)) should be reported additionally for prevention of CVD among male firefighters.

Influence of socioeconomic status on the association between body mass index and cause-specific mortality among older Japanese adults: The AGES Cohort Study

OBJECTIVE

Many studies have suggested a U-shaped curve for the association between body size and mortality risks, i.e., mortality risks increase in those who are both overweight and underweight. The strength of the associations may vary according to socioeconomic statuses (SES), as they determine levels of access to healthcare and psychosocial stresses. We investigated the modifying effects of SES on the relationship between body mass index (BMI) and mortality.

METHOD

We used prospective cohort data of participants in the Aichi Gerontological Evaluation Study in 2003 (n=14,931), who were 65years or older and physically and cognitively independent at baseline, and residing in eight municipalities in Japan. Data on all-causes mortality and mortality from cancer, cardiovascular disease, and respiratory disease was obtained from municipal government registries.

RESULTS

Proportional hazard regression analyses showed that, among men, the associations between overweight (BMI≥25kg/m(2)) and higher mortality risks by any cause were stronger among lower income groups. Even adjusting for multiple confounding factors, hazard ratios (95% confidence intervals) for mortality by all causes among low income group (household income<1.5 million yen) were 1.96 (1.02-3.73) for overweight compared with BMIs between 23.0 and 24.9, whereas they were 0.94 (0.57-1.38) among men in high income group (income>3 million yen). The modifying effects of income were not marked among women.

CONCLUSION

Household income, which may directly reflect accessibility to healthcare and psychosocial stress among older Japanese men, may be an important modifying factor in the health risks attributable to overweight.

Body-mass index and mortality risk in U.S. blacks compared to whites

OBJECTIVE

To compare body-mass index (BMI)-related mortality risk in U.S. Blacks vs. Whites as the relationship appears to differ across race/ethnicity groups.

METHODS

Cross-sectional surveys of nationally representative samples of 11,934 Blacks and 59,741 Whites aged 35-75 in the National Health Interview Survey from 1997 to 2002 with no history of cardiovascular disease (CVD) or cancer were pooled. Mortality follow-up was available through 2006. BMI was calculated from self-reported height and weight. We used adjusted Cox regression analysis to adjust for potential confounders.

RESULTS

Over 9 years of follow-up, there were 4303 deaths (1205 among never smokers). Age-adjusted mortality rates were higher in Blacks compared to Whites at BMI < 25 kg/m2 and showed no increase at higher levels of BMI. In men, adjusted hazard ratios for all-cause death rose in a similar fashion across upper BMI quintiles in Blacks and Whites; in women, however, BMI was positively associated with mortality risk in Whites, but inversely associated in Blacks (P interaction = 0.01). Racial disparities were amplified in subsidiary analyses that introduced a 12-month lag for mortality or focused on CVD mortality.

CONCLUSIONS

The relationship of elevated BMI to mortality appeared weaker in US Blacks than in Whites, especially among women.

Obesity and life expectancy among long-lived Black adults

BACKGROUND

In samples of African Americans and the elderly adults, obesity is often not found to be a risk factor for mortality. These data contradict the evidence linking obesity to chronic disease in these groups. Our objective was to determine whether obesity remains a risk factor for mortality among long-lived black adults.

METHODS

The Adventist Health Study 2 is a large prospective cohort study of Seventh-day Adventist church members who are encouraged by faith-based principles to avoid tobacco, alcohol, and meat consumption. We conducted an attained age survival analysis of 22,884 U.S. blacks of the cohort-half of whom attained an age of 58-108 years during the follow-up (adult life expectancy of 84 years in men, 89 years in women).

RESULTS

Women in the highest body mass index quintile (>33.8) experienced a significant 61% increase (hazard ratio [95% CI] = 1.62 [1.23, 2.11] relative to the middle quintile) in mortality risk and a 6.2-year (95% CI = 2.8-10.2 years) decrease in life expectancy. Men in the highest body mass index quintile (>30.8) experienced a significant 87% increase (hazard ratio [95% CI] = 1.87 [1.28, 2.73] relative to the middle quintile) in mortality risk and 5.9-year (95% CI = 2.1- 9.5 years) decrease in life expectancy. Obesity (>30) was a significant risk factor relative to normal weight (18.5-24.9) in never-smokers. Instantaneous hazards indicated excess risk from obesity was evident through at least age 85 years. The nonobese tended to follow plant-based diets and exercise vigorously.

CONCLUSIONS

Avoiding obesity promotes gains in life expectancy through at least the eighth decade of life in black adults. Evidence for weight control through plant-based diets and active living was found in long-lived nonobese blacks.

BLACK AND WHITE BODY MASS INDEX VALUES IN NINETEENTH CENTURY DEVELOPING PHILADELPHIA COUNTY

This paper demonstrates that although modern BMIs in the US have increased, 19th century BMIs in Philadelphia were lower than elsewhere within Pennsylvania, indicating that urbanization and agricultural commercialization were associated with lower BMIs. After controlling for stature, blacks consistently had greater BMI values than mulattos and whites; therefore, there is no evidence of a 19th century mulatto BMI advantage in the industrializing North. Farmers' BMIs were consistently heavier than those of non-farmers.

Differences in health-related behaviors and body mass index risk categories in African American women in college

OBJECTIVE

To determine if differences in health-related behaviors (diet and physical activity) exist in African American college women based on body mass index (BMI) risk categories.

METHODS

One hundred eighty-six African American women (age, 19.5 +/- 2.5 y) in college were surveyed using the modified National College Health Risk Behavior Survey. Data regarding demographics, weight loss history/methods, food choices, and physical activity frequency were compared for obese (BMI > or = 30, n = 30), overweight (25 < or = BMI < 30, n = 45), and normal-weight (BMI < 25, n = 111) groups. Data were analyzed using multiple 2-way analyses of variance.

RESULTS

No differences in food choices were determined between the groups. The overweight and obese groups were more likely than the normal-weight group to have used healthy modalities such as diet and/or exercise to try to lose weight instead of unhealthy methods such as laxatives and diet pills. The overweight group reported more vigorous aerobic training and strength training workouts than the normal-weight group.

CONCLUSIONS

Food selection and activity frequency are not enough to differentiate African American women in different BMI categories. Other factors may contribute to obesity such as food portion sizes, genetics, and/or intensity of physical activities.

A moderator-mediator analysis of coronary heart disease mortality

OBJECTIVE

The purpose of this study is to better understand how risk factors for coronary heart disease (CHD) mortality may interact.

METHODS

We conducted a moderator-mediator analysis of a representative national sample of 5027 and 2902 community-dwelling women and men in the first National Health and Nutrition Examination Survey free of CHD in 1982. The outcome was 10-year CHD mortality.

RESULTS

Two hundred sixty-seven subjects experienced CHD mortality. In the complete sample, gender moderated the effect of depressive symptoms, and among women, race-ethnicity moderated the effect of nonleisure activity on CHD mortality, defining three subgroups for further analysis: men, white women, and black/other women. Among men, baseline differences from median age (55 to 64 years), systolic blood pressure (129 to 158 mmHg), or self-rated general health ("good" to "poor") were associated with equivalent increases in 10-year CHD mortality from 2.3% to 5.3% [area-under-the-curve effect size (ES)=0.53]. These factors appeared to mediate the effect of education on CHD mortality. Severe depression in men was associated with higher 10-year CHD mortality than less or no depression, 10.0% vs. 2.5% (ES=0.55). Among white women, baseline differences from median age (51 to 65 years) was also associated with 10-year mortality (1.2 to 13.4%, ES=0.56), as was higher blood pressure (125 to 151 mmHg) or worse self-rated health ("very good" to "fair") to a lesser extent (1.2% to 3.5%, ES=0.51).

CONCLUSION

Moderators (gender, race-ethnicity) defined possible pathways to CHD mortality characterized by varying factors and interactions between factors, highlighting potential utility for targeted interventions among community-dwelling persons.

Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults

BACKGROUND

Body mass index (BMI), waist circumference (WC), and the waist-stature ratio (WSR) are considered to be possible proxies for adiposity.

OBJECTIVE

The objective was to investigate the relations between BMI, WC, WSR, and percentage body fat (measured by dual-energy X-ray absorptiometry) in adults in a large nationally representative US population sample from the National Health and Nutrition Examination Survey (NHANES).

DESIGN

BMI, WC, and WSR were compared with percentage body fat in a sample of 12,901 adults.

RESULTS

WC, WSR, and BMI were significantly more correlated with each other than with percentage body fat (P < 0.0001 for all sex-age groups). Percentage body fat tended to be significantly more correlated with WC than with BMI in men but significantly more correlated with BMI than with WC in women (P < 0.0001 except in the oldest age group). WSR tended to be slightly more correlated with percentage body fat than was WC. Percentile values of BMI, WC, and WSR are shown that correspond to percentiles of percentage body fat increments of 5 percentage points. More than 90% of the sample could be categorized to within one category of percentage body fat by each measure.

CONCLUSIONS

BMI, WC, and WSR perform similarly as indicators of body fatness and are more closely related to each other than with percentage body fat. These variables may be an inaccurate measure of percentage body fat for an individual, but they correspond fairly well overall with percentage body fat within sex-age groups and distinguish categories of percentage body fat.