Is BMI normal and healthy? Normal weight of central obesity is more deadly!

Release date: 2015-11-11

A new study from the Mayo Clinic showed that people with normal-weight obese people were at greater risk of death from overweight or obese people with normal abdominal fat. The findings were published online November 9, 2015. The Journal of Internal Medicine Medicine.

Dr. Karine R Sahakyan and colleagues analyzed data from the Third National Health and Nutrition Examination Survey (1988–1994), which included more than 15,000 participants with an average follow-up of 14 years. The results showed that BMI was normal (BMIs 18.5–24.9 kg/m2) but there was central obesity compared with participants with normal abdominal fat regardless of body mass index (WHO criteria – female waist-to-hip ratio ≥ 0.85, Participants with a lower waist-to-hip ratio ≥0.90) had lower long-term survival rates.

"I originally speculated that normal-weight obese people are more at risk of death than non-central obesity with normal BMI. But the above results show that those with normal-weight obese people are higher than those with higher BMI. The risk of death is high, which is amazing," said Dr. Francisco Lopez-Jimenez, lead author of the study.

According to Dr. Francisco Lopez-Jimenez, the results of this study indicate that the distribution of abdominal fat in the patient is measured and that the waist-to-hip ratio is determined as part of the routine medical evaluation of the patient by the clinician.

The recommendation runs counter to the latest (2013) obesity management guidelines published by the American Heart Association (AHA), the American College of Cardiology (ACC), and the Obesity Society, which recommends that doctors only measure the waist circumference of obese or overweight patients with large BMI. (Does not measure hip circumference).

Dr Lopez-Jimenez commented, “The distribution of fat is critical in assessing the risk of cardiovascular disease in patients, even for those with normal weight. Without understanding the distribution of body fat, the BMI is normal or Produce the wrong message."

Dr. Paul Poirier from the University of Quebec in Laval University agreed with Dr. Francisco Lopez-Jimenez in an editorial. He said, "Although epidemiological studies have confirmed the effectiveness of using BMI, there are indeed many limitations in using BMI to assess obesity in clinical practice. When calculating BMI, the denominator refers to the overall weight of the body. Does not distinguish between muscle and fat content."

“The long-term harm of obesity is obvious and serious, and the new evidence provided by the study suggests that clinicians should not only focus on the patient's BMI, but also on the distribution of their fat.”

Normal weight, more abdominal fat

The study included 7249 males and 7935 females with a total of 15,184 subjects. 40% of the subjects had normal BMI, 35% of the subjects were overweight (BMI 25–29.9 kg/m2), and 25% of the subjects were Obese patients (BMI > 30.0 kg / m2). At the same time, according to the waist-to-hip ratio standard of centripetal obesity prescribed by the WHO, more than 70% of the subjects studied were central obesity.

Among the subjects with normal BMI, 11% of men and 3% of women had a waist-to-hip ratio of >1.0. Among the subjects who were classified as super-recombinant only according to the large BMI, 37% of men and 12% of women met the criteria for centripetal obesity, while only 63% of those who were classified as obese according to the BMI were too large. Men and 14% of women meet the criteria for central obesity.

During the 14-year average follow-up period, a total of 3222 subjects died, and 1404 of them died of cardiovascular disease. After adjusting for confounding factors, there was a close correlation between waist-to-hip ratio and mortality, but there was no correlation between BMI and mortality.

For men with normal weight and central obesity, the overall risk of death is 87% higher than that of patients with similar BMI but not to obesity (hazard ratio [HR] is 1.87), and is overweight or obese but undirected Men with normal-weight obese people have a more than two-fold higher risk of death from men with normal-weight but obese obesity.

In women, for women with normal weight and obesity, the risk of total death was 48% higher than that of patients with similar BMI but not to obesity, and compared with patients who were overweight but not obese. The risk of death in women with normal weight but obesity is 40% higher. For women who are obese but have no central obesity, the risk of death in women with normal weight but obesity is 32% higher.

Sensitivity analysis, including analysis of mortality within 6 months and mortality from cardiovascular disease, yielded similar results: cardiovascular mortality in people with normal weight but with central obesity, male or female It was higher than those with similar BMI but no centripetal obesity (1.78 for males and 2.25 for females).

Measurement of waist circumference and hip circumference

Dr. Lopez-Jimenez said, “Most experts ignore the measurement of waist circumference, or calculate the waist-to-hip ratio. Because they think that people with central obesity have already determined obesity according to BMI, why bother measuring waist circumference and hip circumference? But our Research has proved that this view is wrong."

Although measurement of hip circumference and waist circumference is easy, Dr. Lopez-Jimenez acknowledges that reducing centripetal obesity may be more difficult than simply reducing overall body weight.

“Patients with abnormal waist-to-hip ratios may require more effort to improve their eating habits and increase physical activity to reduce excess fat tissue,” Dr. Lopez-Jimenez added, adding strength training to improve muscle mass. Helps reduce the patient's central obesity.

Dr. Poirier pointed out that the 2013 AHA / ACC / TOS guidelines lack useful data that does not recommend the evaluation of waist/hip ratio as a cause, but some argue that BMI and waist circumference should be measured when assessing obesity.

In addition, Dr. Poirier writes that “patients with elevated BMI or a ratio of waist circumference to measured BMI should be evaluated along with other cardiovascular risk factors to assess further risk stratification.”

supplement:

Centripetal obesity, sometimes becoming central obesity or abdominal obesity, refers to a type of obesity in which the deposition of fat in a patient begins to develop centering on the heart and abdomen. Obesity is divided into central obesity (ie, central obesity) and systemic obesity. The risk of various complications in patients with central obesity is higher, and the greater the waist circumference, the higher the risk. Because early body obesity patients have a large waist circumference and relatively small limbs, it is difficult to find the body mass index alone, which leads to the loss of optimal treatment time. According to the latest International Standards for Diabetes (IDF) standard on centripetal obesity (this standard is defined by waist circumference), Chinese males (waist circumference) ≥ 90cm and female (waist circumference) ≥ 80cm will be identified as central obesity.

Source: MedSci

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