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Pray R, Riskin S. The History and Faults of the Body Mass Index and Where to Look Next: A Literature Review. Cureus 2023; 15:e48230. [PMID: 38050494 PMCID: PMC10693914 DOI: 10.7759/cureus.48230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Body mass index (BMI) is an anthropometric index that is commonly used in the medical setting and is a factor in assessing various disease risks but its origins are unknown by many. More importantly, BMI does not properly assess body fat percentage and muscle mass or distinguish abdominal fat from gluteofemoral fat, which is important to note because abdominal fat is associated with insulin resistance, metabolic disease, and cardiovascular complications. Using a less accurate index to assess the relationship between weight and disease risk is conceptually invalid because the use of BMI ultimately trickles into patient treatment, preventive medicine, and overall health outcomes. Several different anthropometric indices that more accurately assess abdominal adiposity through the incorporation of waist circumference exist and have been extensively studied, such as waist-to-hip ratio, waist-to-height ratio, and a body shape index. It is important that we consider replacing BMI's usage in the healthcare setting with a different anthropometric index: one that considers height, sex, and race differences, accounts for abdominal adiposity, and more accurately predicts the relationship between obesity, mortality, and diseases such as cardiovascular disease, hypertension, insulin resistance, and diabetes.
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Affiliation(s)
- Rachel Pray
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Suzanne Riskin
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
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Scharf A, Bezerra FF, Zembrzuski VM, Fonseca ACPDA, Gusmão L, Faerstein E. Investigation of associations of European, African, Amerindian genomic ancestries and MC4R, FTO, FAIM2, BDNF loci with obesity-related traits in Rio de Janeiro, Brazil. AN ACAD BRAS CIENC 2023; 95:e20220052. [PMID: 36921152 DOI: 10.1590/0001-3765202320220052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/02/2022] [Indexed: 03/12/2023] Open
Abstract
A complex web of causation is involved in adiposity, including environmental, social and genetic factors. We aimed to investigate associations between genetic factors such as ancestry and single nucleotide polymorphisms, and obesity-related traits in a sampled Brazilian population. A sample of 501 unrelated adults participating in 2013 at the longitudinal Pró-Saúde Study (EPS) in Rio de Janeiro, Brazil was selected. We analysed 46 AIM-InDels (insertion/deletion) as genetic ancestry markers and four single nucleotide polymorphisms located in the genes MC4R (rs17782313), FTO (rs9939609), FAIM2 (rs7138803) and BDNF (rs4074134), previously described as associated with obesity. The selected obesity-related markers were anthropometric parameters such as body mass index, waist circumference and waist-to-hip ratio, and body composition measurements namely body fat percentage, android fat mass and gynoid fat mass. The sample showed greater European ancestry (57.20%), followed by African (28.80%) and lastly Amerindian (14%). Our results suggest that the rs4074134 (BDNF) CC genotype was directly associated with gynoid fat mass, whereas body fat percentage, android fat mass and the anthropometric parameters seem not to be associated with neither ancestry nor the four polymorphisms in this population sample, most likely due to a stronger role of social, behavioural and environmental determinants.
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Affiliation(s)
- Allan Scharf
- State University of Rio de Janeiro (UERJ), DNA Diagnostic Laboratory, São Francisco Xavier Street, 524, 20550-900 Rio de Janeiro, RJ, Brazil
| | - Flávia F Bezerra
- State University of Rio de Janeiro (UERJ), Institute of Nutrition, São Francisco Xavier Street, 524, 20550-900 Rio de Janeiro, RJ, Brazil
| | - Verônica M Zembrzuski
- Oswaldo Cruz Foundation (FIOCRUZ), Human Genetics Laboratory, Oswaldo Cruz Institute, Brasil Avenue, 4365, 21040-360 Rio de Janeiro, RJ, Brazil
| | - Ana Carolina P DA Fonseca
- Oswaldo Cruz Foundation (FIOCRUZ), Human Genetics Laboratory, Oswaldo Cruz Institute, Brasil Avenue, 4365, 21040-360 Rio de Janeiro, RJ, Brazil.,Oswaldo Cruz Foundation (FIOCRUZ), Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Brasil Avenue, 4365, 21040-360 Rio de Janeiro, RJ, Brazil
| | - Leonor Gusmão
- State University of Rio de Janeiro (UERJ), DNA Diagnostic Laboratory, São Francisco Xavier Street, 524, 20550-900 Rio de Janeiro, RJ, Brazil
| | - Eduardo Faerstein
- State University of Rio de Janeiro (UERJ), Institute of Social Medicine, São Francisco Xavier Street, 524, 20550-900 Rio de Janeiro, RJ, Brazil
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Farmaki AE, Garfield V, Eastwood SV, Farmer RE, Mathur R, Giannakopoulou O, Patalay P, Kuchenbaecker K, Sattar N, Hughes A, Bhaskaran K, Smeeth L, Chaturvedi N. Type 2 diabetes risks and determinants in second-generation migrants and mixed ethnicity people of South Asian and African Caribbean descent in the UK. Diabetologia 2022; 65:113-127. [PMID: 34668055 PMCID: PMC8660755 DOI: 10.1007/s00125-021-05580-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/26/2021] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS Excess risks of type 2 diabetes in UK South Asians (SA) and African Caribbeans (AC) compared with Europeans remain unexplained. We studied risks and determinants of type 2 diabetes in first- and second-generation (born in the UK) migrants, and in those of mixed ethnicity. METHODS Data from the UK Biobank, a population-based cohort of ~500,000 participants aged 40-69 at recruitment, were used. Type 2 diabetes was assigned using self-report and HbA1c. Ethnicity was both self-reported and genetically assigned using admixture level scores. European, mixed European/South Asian (MixESA), mixed European/African Caribbean (MixEAC), SA and AC groups were analysed, matched for age and sex to enable comparison. In the frames of this cross-sectional study, we compared type 2 diabetes in second- vs first-generation migrants, and mixed ethnicity vs non-mixed groups. Risks and explanations were analysed using logistic regression and mediation analysis, respectively. RESULTS Type 2 diabetes prevalence was markedly elevated in SA (599/3317 = 18%) and AC (534/4180 = 13%) compared with Europeans (140/3324 = 4%). Prevalence was lower in second- vs first-generation SA (124/1115 = 11% vs 155/1115 = 14%) and AC (163/2200 = 7% vs 227/2200 = 10%). Favourable adiposity (i.e. lower waist/hip ratio or BMI) contributed to lower risk in second-generation migrants. Type 2 diabetes in mixed populations (MixESA: 52/831 = 6%, MixEAC: 70/1045 = 7%) was lower than in comparator ethnic groups (SA: 18%, AC: 13%) and higher than in Europeans (4%). Greater socioeconomic deprivation accounted for 17% and 42% of the excess type 2 diabetes risk in MixESA and MixEAC compared with Europeans, respectively. Replacing self-reported with genetically assigned ethnicity corroborated the mixed ethnicity analysis. CONCLUSIONS/INTERPRETATION Type 2 diabetes risks in second-generation SA and AC migrants are a fifth lower than in first-generation migrants. Mixed ethnicity risks were markedly lower than SA and AC groups, though remaining higher than in Europeans. Distribution of environmental risk factors, largely obesity and socioeconomic status, appears to play a key role in accounting for ethnic differences in type 2 diabetes risk.
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Affiliation(s)
- Aliki-Eleni Farmaki
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK.
| | - Victoria Garfield
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - Sophie V Eastwood
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | - Ruth E Farmer
- London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- London School of Hygiene & Tropical Medicine, London, UK
| | - Olga Giannakopoulou
- Division of Psychiatry, University College London, London, UK
- UCL Genetics Institute, University College London, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
- Centre for Longitudinal Studies, University College London, London, UK
| | - Karoline Kuchenbaecker
- Division of Psychiatry, University College London, London, UK
- UCL Genetics Institute, University College London, London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
| | | | - Liam Smeeth
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK
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de França GVA, De Lucia Rolfe E, Horta BL, Gigante DP, Yudkin JS, Ong KK, Victora CG. Genomic ancestry and education level independently influence abdominal fat distributions in a Brazilian admixed population. PLoS One 2017; 12:e0179085. [PMID: 28582437 PMCID: PMC5459508 DOI: 10.1371/journal.pone.0179085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/23/2017] [Indexed: 01/07/2023] Open
Abstract
We aimed to identify the independent associations of genomic ancestry and education level with abdominal fat distributions in the 1982 Pelotas birth cohort study, Brazil. In 2,890 participants (1,409 men and 1,481 women), genomic ancestry was assessed using genotype data on 370,539 genome-wide variants to quantify ancestral proportions in each individual. Years of completed education was used to indicate socio-economic position. Visceral fat depth and subcutaneous abdominal fat thickness were measured by ultrasound at age 29–31y; these measures were adjusted for BMI to indicate abdominal fat distributions. Linear regression models were performed, separately by sex. Admixture was observed between European (median proportion 85.3), African (6.6), and Native American (6.3) ancestries, with a strong inverse correlation between the African and European ancestry scores (ρ = -0.93; p<0.001). Independent of education level, African ancestry was inversely associated with both visceral and subcutaneous abdominal fat distributions in men (both P = 0.001), and inversely associated with subcutaneous abdominal fat distribution in women (p = 0.009). Independent of genomic ancestry, higher education level was associated with lower visceral fat, but higher subcutaneous fat, in both men and women (all p<0.001). Our findings, from an admixed population, indicate that both genomic ancestry and education level were independently associated with abdominal fat distribution in adults. African ancestry appeared to lower abdominal fat distributions, particularly in men.
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Affiliation(s)
- Giovanny Vinícius Araújo de França
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil, Rua Marechal Deodoro, 1160–3° Piso, Bairro Centro—Pelotas, RS
- Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Hills R, Cambridge, United Kingdom
- * E-mail:
| | - Emanuella De Lucia Rolfe
- Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Hills R, Cambridge, United Kingdom
| | - Bernardo Lessa Horta
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil, Rua Marechal Deodoro, 1160–3° Piso, Bairro Centro—Pelotas, RS
| | - Denise Petrucci Gigante
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil, Rua Marechal Deodoro, 1160–3° Piso, Bairro Centro—Pelotas, RS
| | | | - Ken K. Ong
- Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Hills R, Cambridge, United Kingdom
| | - Cesar Gomes Victora
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil, Rua Marechal Deodoro, 1160–3° Piso, Bairro Centro—Pelotas, RS
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Klimentidis YC, Arora A, Zhou J, Kittles R, Allison DB. The Genetic Contribution of West-African Ancestry to Protection against Central Obesity in African-American Men but Not Women: Results from the ARIC and MESA Studies. Front Genet 2016; 7:89. [PMID: 27313598 PMCID: PMC4888933 DOI: 10.3389/fgene.2016.00089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 05/01/2016] [Indexed: 11/13/2022] Open
Abstract
Over 80% of African-American (AA) women are overweight or obese. A large racial disparity between AA and European-Americans (EA) in obesity rates exists among women, but curiously not among men. Although socio-economic and/or cultural factors may partly account for this race-by-sex interaction, the potential involvement of genetic factors has not yet been investigated. Among 2814 self-identified AA in the Atherosclerosis Risk in Communities study, we estimated each individual's degree of West-African genetic ancestry using 3437 ancestry informative markers. We then tested whether sex modifies the association between West-African genetic ancestry and body mass index (BMI), waist-circumference (WC), and waist-to-hip ratio (WHR), adjusting for income and education levels, and examined associations of ancestry with the phenotypes separately in males and females. We replicated our findings in the Multi-Ethnic Study of Atherosclerosis (n = 1611 AA). In both studies, we find that West-African ancestry is negatively associated with obesity, especially central obesity, among AA men, but not among AA women (pinteraction = 4.14 × 10−5 in pooled analysis of WHR). In conclusion, our results suggest that the combination of male gender and West-African genetic ancestry is associated with protection against central adiposity, and suggest that the large racial disparity that exists among women, but not men, may be at least partly attributed to genetic factors.
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Affiliation(s)
- Yann C Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona Tucson, AZ, USA
| | - Amit Arora
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona Tucson, AZ, USA
| | - Jin Zhou
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona Tucson, AZ, USA
| | - Rick Kittles
- Department of Surgery, College of Medicine, University of Arizona Tucson, AZ, USA
| | - David B Allison
- Nutrition and Obesity Research Center, University of Alabama at BirminghamBirmingham, AL, USA; Office of Energetics, University of Alabama at BirminghamBirmingham, AL, USA
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Abstract
Race/ethnic and socioeconomic status (SES) disparities in obesity are substantial and may widen in the future. We review nine potential mechanisms that recent research has used to explain obesity disparities. Those nine mechanisms fall into three broad groups-health behaviors, biological factors, and the social environment-which incorporate both proximate and upstream determinants of obesity disparities. Efforts to reduce the prevalence of obesity in the US population and to close race/ethnic and SES disparities in obesity will likely require the use of multifaceted interventions that target multiple mechanisms simultaneously. Unfortunately, relatively few of the mechanisms reviewed herein have been tested in an intervention framework.
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Affiliation(s)
- Patrick M Krueger
- Department of Health and Behavioral Sciences, University of Colorado Denver | Anschutz Medical Campus, Administration Building, 1201 5th Street, Denver, CO, 80217, USA.
| | - Eric N Reither
- Department of Sociology and the Yun Kim Population Research Laboratory, Utah State University, 0730 Old Main Hill, Logan, UT, 84322, USA.
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