Optimal Cut-Points for Body Mass Index, Waist
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- Childhood Overweight, Obesity, and the Metabolic Syndrome in Developing Countries.
- Overweight and Obesity in the Eastern Mediterranean Region: Can We Control It
- Lifestyle and Ethnicity Play a Role in All-Cause Mortality.
- Obesity In Women from Developing Countries.
- Abstract OBJECTIVES
Optimal Cut-Points for Body Mass Index, Waist
Circumference and Waist-To-Hip Ratio Using the
Framingham Coronary Heart Disease Risk Score in an Arab
Population of the Middle East.
Al-Lawati JA, Barakat NM, Al-Lawati AM, Mohammed AJ.
We aimed to determine the gender-specific optimal cut-points for body
mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR)
associated with risk of cardiovascular disease, using Framingham risk score
and receiver-operating characteristic (ROC) analysis, among Omani Arabs.
Nine percent of men, compared to 3% of women, had a 10-year total
coronary heart disease (CHD) risk > or = 20%. In both genders, WHR was a
be er predictor of CHD (area under the ROC curve 0.771 for men and 0.802
for women), followed by WC (0.710 and 0.727) and BMI (0.601 and 0.639),
respec vely. For a 10-year CHD risk of > or = 20%, the op mal cut-points to
assess adiposity in Omani men and women were > 22.6 and 22.9 kg/m2 for
BMI, > 78.5 and 84.5 cm for WC, and > 0.96 and > 0.98 for WHR,
respectively. To identify obesity among Omani Arabs, different cut-points
for BMI, WC and WHR than the currently recommended ones are needed.
J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S9-30.
Obesity and the Metabolic Syndrome in Developing
Misra A, Khurana L.
Department of Diabetes and Metabolic Diseases, Fortis Flt. Lt. Rajan Dhall
CONTEXT: Prevalence of obesity and the metabolic syndrome is rapidly
increasing in developing countries, leading to increased morbidity and
mortality due to type 2 diabetes mellitus (T2DM) and cardiovascular
disease.EVIDENCE ACQUISITION: Literature search was carried out using
the terms obesity, insulin resistance, the metabolic syndrome, diabetes,
dyslipidemia, nutrition, physical activity, and developing countries, from
PubMed from 1966 to June 2008 and from web sites and published
documents of the World Health Organization and Food and Agricultural
EVIDENCE SYNTHESIS: With improvement in economic situation in
developing countries, increasing prevalence of obesity and the metabolic
syndrome is seen in adults and particularly in children. The main causes are
increasing urbanization, nutrition transition, and reduced physical activity.
Furthermore, aggressive community nutrition intervention programs for
undernourished children may increase obesity. Some evidence suggests
that widely prevalent perinatal undernutrition and childhood catch-up
obesity may play a role in adult-onset metabolic syndrome and T2DM. The
economic cost of obesity and related diseases in developing countries,
having meager health budgets is enormous.
CONCLUSIONS: To prevent increasing morbidity and mortality due to
obesity-related T2DM and cardiovascular disease in developing countries,
there is an urgent need to initiate large-scale community intervention
programs focusing on increased physical activity and healthier food options,
particularly for children. International health agencies and respective
government should intensively focus on primordial and primary prevention
programs for obesity and the metabolic syndrome in developing countries.
East Mediterr Health J. 2007 Mar-Apr;13(2):430-40.
Comparison of BMI-For-Age in Adolescent Girls in 3
Countries of the Eastern Mediterranean Region.
Jackson RT, Rashed M, Al-Hamad N, Hwalla N, Al-Somaie M.
Department of Nutrition and Food Science, University of Maryland,
Maryland, USA. firstname.lastname@example.org
International comparisons of adolescent overweight and obesity are
hampered by the lack of a single agreed measurement reference. We
compared 3 BMI-for-age references on samples of adolescent girls from
Egypt, Kuwait and Lebanon. Overweight and obesity was highest in Kuwait
and lowest in Lebanon. Performance of the 3 standards diﬀered only
slightly although one was particularly applicable in country-to-country
2007;29:62-76. Epub 2007 May 3.
Childhood Overweight, Obesity, and the Metabolic
Syndrome in Developing Countries.
Department of Preventive Pediatric Cardiology, Isfahan Cardiovascular
Research Center (WHO Collaborating Center), Isfahan University of Medical
Sciences, Isfahan, Iran. email@example.com
The incidence of chronic disease is escalating much more rapidly in
developing countries than in industrialized countries. A potential emerging
public health issue may be the increasing incidence of childhood obesity in
developing countries and the resulting socioeconomic and public health
burden faced by these countries in the near future. In a systematic review
carried out through an electronic search of the literature from 1950-2007,
the author compared data from surveys on the prevalence of overweight,
obesity, and the metabolic syndrome among children living in developing
countries. The highest prevalence of childhood overweight was found in
Eastern Europe and the Middle East, whereas India and Sri Lanka had the
lowest prevalence. The few studies conducted in developing countries
showed a considerably high prevalence of the metabolic syndrome among
youth. These findings provide alarming data for health professionals and
policy-makers about the extent of these problems in developing countries,
many of which are still grappling with malnutrition and micronutrient
deficiencies. Time trends in childhood obesity and its metabolic
consequences, defined by uniform criteria, should be monitored in
developing countries in order to obtain useful insights for primordial and
primary prevention of the upcoming chronic disease epidemic in such
East Mediterr Health J. 2004 Nov;10(6):789-93.
Obesity has become an epidemic problem worldwide, and in the Eastern
Mediterranean Region the status of overweight has reached an alarming
level. A prevalence of 3%-9% overweight and obesity has been recorded
among preschool children, while that among schoolchildren was 12%-25%.
A marked increase in obesity generally has been noted among adolescents,
ranging from 15% to 45%. In adulthood, women showed a higher
prevalence of obesity (35%-75%) than men (30%-60%). Several factors, such
as change in dietary habits, socioeconomic factors, inactivity and
multiparity (among women) determine obesity in this Region. There is an
urgent need for national programmes to prevent and control obesity in the
countries of the Region.
Asia Pac J Clin Nutr. 2003;12(3):337-43.
Nutrition-Related Health Patterns in the Middle East.
Nutritionally-related health patterns in the Middle East have changed
significantly during the last two decades. The main forces that have
contributed to these changes are the rapid changes in the demographic
characteristics of the region, speedy urbanization, and social development
in the absence of steady and significant economic growth. Within these
changes, the Middle East has the highest dietary energy surplus of the
developing countries. The population in the region has a low poverty
prevalence, at 4%. The region's child malnutri on rate is 19%, sugges ng
that nutrition insecurity remains a problem due mainly to poor health care
and not due to inadequate dietary energy supply or poverty. The one
extreme country, Afghanistan, has an extremely high dietary energy deficit
of 490 kilocalories and a 40% malnutri on rate. Iran and Egypt have
rela vely high child malnutri on rates of 39 and 16% respec vely, but
belong to the dietary energy surplus group. Morocco and the United
Emirates have the lowest child malnutri on rates of 6 and 8% respec vely.
In the Middle East, as in other parts of the world, large shifts have occurred
in dietary and physical activity patterns. These changes are reflected in
nutritional and health outcomes. Rising obesity rates and high levels of
chronic and degenerative diseases are observed. These pressing factors
that include the nature and changes in the food consumption pattern,
globalization of food supply, and the inequity in health care will be
J Nutr. 2003 Apr; 133(4):1180-5.
Lifestyle and Ethnicity Play a Role in All-Cause Mortality.
Lubin F, Lusky A, Chetrit A, Dankner R.
The Israeli population is characterized by its marked ethnic diversity. These
ethnic groups (originating mainly from Yemen/Aden, the Middle East, North
Africa and Europe/America) have kept traditional distinct lifestyle habits
and exhibit different morbidity and mortality trends. The aim of the present
study was to evaluate the associations among ethnic background, lifestyle
pa erns and 18-y all-cause mortality. A subgroup of 632 individuals aged
41-70 y, drawn from a larger stra ﬁed cohort from the Israel Glucose
Intolerance, Obesity and Hypertension study, were personally interviewed,
using a quantified food-frequency questionnaire, including most food items
consumed by the different subpopulations in Israel. Physical activity was
also evaluated, as well as smoking status. Weight, height and blood
pressure (BP) measurements were taken. Predictors of mortality were
assessed using Cox proportional hazards models. Over the 18-y follow-up
period, 151 deaths occurred (24%). In comparison with Yemenites, the
adjusted hazard ra os (HR) for all cause mortality were HR = 1.77 [95%
conﬁdence interval (CI): 1.01-3.09] for Europeans/Americans; HR = 1.63
(95% CI: 0.89-2.99) for those from a Middle Eastern background; and HR =
1.56 (95% CI: 0.82-2.97) for North Africans. Mortality risk was 43% lower
among those consuming > or =25 g of dietary ﬁber daily [HR = 0.57 (95% CI:
0.41-0.72)], and 42% lower for those consuming <300 mg/d of cholesterol
[HR = 0.58 (95% CI: 0.34-0.96)]. Accumula ng an average of 0.5 h/d of
moderate physical ac vity reduced mortality by 47% [HR = 0.53 (95% CI:
0.29-0.97)]. Smoking increased systolic BP, older age and male sex
increased mortality risk. We conclude that in our study, although ethnic
origin and lifestyle habits are interrelated, each affects mortality
Eur J Clin Nutr. 2000 Mar;54(3):247-52.
Obesity In Women from Developing Countries.
Martorell R, Khan LK, Hughes ML, Grummer-Strawn LM.
Department of International Health, The Rollins School of Public Health of
Emory University, Atlanta, GA 30322, USA.
The key objective was to estimate obesity (>/=30 kg/m2) in
15-49 y from developing countries. A second objective was to study
how obesity varies by educational level and by residence in urban and rural
areas. A third objective was to investigate how national incomes shape the
relationship between obesity and eduction or residence.DESIGN: The
analyses use cross-sectional data from nationally representative surveys
from developing countries carried out in the last decade. Most of the
surveys were Demographic Health Surveys (DHS). Data from a survey from
the USA are used for comparison. Se ng:The 39 surveys used come from
and the USA.
A total of 147,938 non-pregnant women 15-49 y were included
in the analyses
The percentage of obese women was 0.1% in South Asia, 2.5% in
Sub-Saharan Africa, 9. 6% in La n America and the Caribbean, 15.4% in
Central Eastern Europe/Commonwealth of Independent States (CEE/CIS),
17.2% in the Middle East and North Africa, and 20.7% in the USA. Levels of
in countries increased sharply until a gross national product of
US$1500 per capita (1992 values) was reached and changed li le
thereafter. In very poor countries, such as in Sub-Saharan Africa, obesity
levels were greatly concentrated among urban and higher educated
. In more developed countries, such as those in Latin America and
the CEE/CIS regions, obesity levels were more equally distributed in the
Based on the analyses presented and on a review of the
literature, it is concluded that obesity among women is a serious problem in
Latin America and the Caribbean, the Middle East and North Africa, and the
CEE/CIS region. Obesity is less of a concern in Sub-Saharan Africa, China and
South Asia. Obesity levels increased over time in most of the limited
number of countries with data, but at varying rates. Rising national incomes
in developing countries and increased 'Westernization' will most likely lead
to increased levels of obesity in the future.
Financial support was provided by the Food and Nutrition
Program of the Pan American Health Organization and by the World Bank.
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