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Perspective on Diagnostic Criteria for Obesity and Abdominal Obesity in Korean Adults

  • Nam, Ga Eun (Department of Family Medicine, Sahmyook Medical Center) ;
  • Park, Hye Soon (Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2018.07.27
  • Accepted : 2018.08.19
  • Published : 2018.09.30

Abstract

Excessive body weight is associated with increased health risks in humans. In general, the risk of mortality increases with greater obesity. The 2018 guideline for the management of obesity by the Korean Society for the Study of Obesity proposed the body mass index (BMI) cut-off levels of $25kg/m^2$ and $23kg/m^2$ as diagnostic criteria for obesity and overweight (pre-obese) in Korean adults, respectively. Abdominal obesity has been defined as waist circumference (WC) ${\geq}90cm$ in men and WC ${\geq}85cm$ in women. In this review, the validity of these criteria for Korean adults was examined based on the evidence regarding the associations of obesity index with mortality and morbidity. The American Association of Clinical Endocrinologists/American College of Endocrinology algorithm and American Diabetes Association guideline for the medical care of obese and overweight patients support a BMI of $25kg/m^2$ and $23kg/m^2$, respectively, as the cut-off levels for Asians (and some ethnicities) corresponding to the BMI values of $30kg/m^2$ and $25kg/m^2$, respectively, for Caucasians. In the future, the optimal cut-off levels for obesity and abdominal obesity may require adjustment as the demographic characteristics of the Korean population change. In addition, development of more valid indicators that better reflect health risks of obesity is needed.

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

References

  1. World Health Organization. Obesity and overweight [Internet]. Geneva: World Health Organization; 2018 [cited 2018 Sep 3]. Available from: http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  2. Medscape. Obesity to overtake smoking as leading cause of death [Internet]. New York, NY: Medscape; 2004 [cited 2018 Sep 3]. Available from: https://www.medscape.com/viewarticle/474966
  3. OECD. Obesity update 2017. Paris: OECD; 2017.
  4. World Health Organization. Obesity preventing and managing the global epidemic: report of a WHO consultation on obesity. Geneva: World Health Organization; 1997.
  5. Korean Society for the Study of Obesity. Guideline for the management of obesity 2018. Seoul: Korean Society for the Study of Obesity; 2018.
  6. Bray GA. Complications of obesity. Ann Intern Med 1985;103(6 Pt 2):1052-62. https://doi.org/10.7326/0003-4819-103-6-1052
  7. Kvamme JM, Holmen J, Wilsgaard T, Florholmen J, Midthjell K, Jacobsen BK. Body mass index and mortality in elderly men and women: the Tromso and HUNT studies. J Epidemiol Community Health 2012;66:611-7. https://doi.org/10.1136/jech.2010.123232
  8. Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol 2004;43:1439-44. https://doi.org/10.1016/j.jacc.2003.11.039
  9. Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 2003;63:793-808. https://doi.org/10.1046/j.1523-1755.2003.00803.x
  10. Zhang X, Liu Y, Shao H, Zheng X. Obesity paradox in lung cancer prognosis: evolving biological insights and clinical implications. J Thorac Oncol 2017;12:1478-88. https://doi.org/10.1016/j.jtho.2017.07.022
  11. Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju SN, Wormser D, Gao P, Kaptoge S, et al. Body-mass index and all-cause mortality: individual-participant-data metaanalysis of 239 prospective studies in four continents. Lancet 2016;388:776-86. https://doi.org/10.1016/S0140-6736(16)30175-1
  12. Park HS, Song YM, Cho SI. Obesity has a greater impact on cardiovascular mortality in younger men than in older men among non-smoking Koreans. Int J Epidemiol 2006;35:181-7. https://doi.org/10.1093/ije/dyi213
  13. Childers DK, Allison DB. The 'obesity paradox': a parsimonious explanation for relations among obesity, mortality rate and aging? Int J Obes (Lond) 2010;34:1231-8. https://doi.org/10.1038/ijo.2010.71
  14. Kivimaki M, Ferrie JE, Batty GD, Davey Smith G, Elovainio M, Marmot MG, et al. Optimal form of operationalizing BMI in relation to all-cause and cause-specific mortality: the original Whitehall study. Obesity (Silver Spring) 2008;16:1926-32. https://doi.org/10.1038/oby.2008.322
  15. Vecchie A, Dallegri F, Carbone F, Bonaventura A, Liberale L, Portincasa P, et al. Obesity phenotypes and their paradoxical association with cardiovascular diseases. Eur J Intern Med 2018;48:6-17.
  16. Kalantar-Zadeh K, Rhee CM, Chou J, Ahmadi SF, Park J, Chen JL, et al. The obesity paradox in kidney disease: how to reconcile it with obesity management. Kidney Int Rep 2017;2:271-81. https://doi.org/10.1016/j.ekir.2017.01.009
  17. Dorner TE, Rieder A. Obesity paradox in elderly patients with cardiovascular diseases. Int J Cardiol 2012;155:56-65. https://doi.org/10.1016/j.ijcard.2011.01.076
  18. Lopez-Jimenez F. Speakable and unspeakable facts about BMI and mortality. Lancet 2009;373:1055-6. https://doi.org/10.1016/S0140-6736(09)60628-0
  19. Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K, et al. Association between body-mass index and risk of death in more than 1 million Asians. N Engl J Med 2011;364:719-29. https://doi.org/10.1056/NEJMoa1010679
  20. Faeh D, Braun J, Tarnutzer S, Bopp M. Obesity but not overweight is associated with increased mortality risk. Eur J Epidemiol 2011;26:647-55. https://doi.org/10.1007/s10654-011-9593-2
  21. Park HS, Cho SI, Song YM, Sung J. Multiple metabolic risk factors and total and cardiovascular mortality in men with low prevalence of obesity. Atherosclerosis 2006;187:123-30. https://doi.org/10.1016/j.atherosclerosis.2005.08.027
  22. Allison DB, Zhu SK, Plankey M, Faith MS, Heo M. Differential associations of body mass index and adiposity with allcause mortality among men in the first and second National Health and Nutrition Examination Surveys (NHANES I and NHANES II) follow-up studies. Int J Obes Relat Metab Disord 2002;26:410-6. https://doi.org/10.1038/sj.ijo.0801925
  23. Jee SH, Sull JW, Park J, Lee SY, Ohrr H, Guallar E, et al. Bodymass index and mortality in Korean men and women. N Engl J Med 2006;355:779-87. https://doi.org/10.1056/NEJMoa054017
  24. Kim NH, Lee J, Kim TJ, Kim NH, Choi KM, Baik SH, et al. Body mass index and mortality in the general population and in subjects with chronic disease in Korea: a nationwide cohort study (2002-2010). PLoS One 2015;10:e0139924. https://doi.org/10.1371/journal.pone.0139924
  25. Statistics Korea. 2016 Life tables [Internet]. Daejeon: Statistics Korea; 2017 [cited 2018 Sep 5]. Available from: http://kostat.go.kr/portal/korea/kor_nw/2/2/7/index.board
  26. Statistics Korea. 2016 Statistics for causes of death [Internet]. Daejeon: Statistics Korea; 2017 [cited 2018 Sep 5]. Available from: http://kostat.go.kr/portal/korea/kor_nw/2/6/2/index.board
  27. Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, et al. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 2016;353:i2156.
  28. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care 2018;41(Suppl 1):S13-27. https://doi.org/10.2337/dc18-S002
  29. Iliodromiti S, Celis-Morales CA, Lyall DM, Anderson J, Gray SR, Mackay DF, et al. The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296 535 adults of white European descent. Eur Heart J 2018;39:1514-20. https://doi.org/10.1093/eurheartj/ehy057
  30. Korean Society for the Study of Obesity. 2017 Obesity fact sheet. Seoul: Korean Society for the Study of Obesity; 2017.
  31. World Health Organization; Regional Office for the Western Pacific; International Diabetes Institute; International Association for the Study of Obesity; International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia; 2000.
  32. Gregg EW, Cheng YJ, Cadwell BL, Imperatore G, Williams DE, Flegal KM, et al. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA 2005;293:1868-74. https://doi.org/10.1001/jama.293.15.1868
  33. He W, Li Q, Yang M, Jiao J, Ma X, Zhou Y, et al. Lower BMI cutoffs to define overweight and obesity in China. Obesity (Silver Spring) 2015;23:684-91. https://doi.org/10.1002/oby.20995
  34. Takahashi H, Mori M. Characteristics and significance of criteria for obesity disease in Japan 2011. Nihon Rinsho 2013;71:257-61.
  35. Sun K, Kusminski CM, Scherer PE. Adipose tissue remodeling and obesity. J Clin Invest 2011;121:2094-101. https://doi.org/10.1172/JCI45887
  36. American Association of Clinical Endocrinologists. AACE/ACE algorithm for the medical care of patients with obesity [Internet]. Jacksonville, FL: American Association of Clinical Endocrinologists; 2016 [cited 2018 Sep 3]. Available from: https://www.aace.com/files/guidelines/ObesityAlgorithm.pdf
  37. Hsu WC, Araneta MR, Kanaya AM, Chiang JL, Fujimoto W. BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care 2015;38:150-8. https://doi.org/10.2337/dc14-2391
  38. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ 1995;311:158-61. https://doi.org/10.1136/bmj.311.6998.158
  39. Han TS, van Leer EM, Seidell JC, Lean ME. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ 1995;311:1401-5. https://doi.org/10.1136/bmj.311.7017.1401
  40. Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008;359:2105-20. https://doi.org/10.1056/NEJMoa0801891
  41. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 2007;75:72-80. https://doi.org/10.1016/j.diabres.2006.04.013
  42. Kashihara H, Lee JS, Kawakubo K, Tamura M, Akabayashi A. Criteria of waist circumference according to computed tomography-measured visceral fat area and the clustering of cardiovascular risk factors. Circ J 2009;73:1881-6. https://doi.org/10.1253/circj.CJ-09-0183
  43. Bao Y, Lu J, Wang C, Yang M, Li H, Zhang X, et al. Optimal waist circumference cutoffs for abdominal obesity in Chinese. Atherosclerosis 2008;201:378-84. https://doi.org/10.1016/j.atherosclerosis.2008.03.001
  44. Han JH, Park HS, Kim SM, Lee SY, Kim DJ, Choi WH. Visceral adipose tissue as a predictor for metabolic risk factors in the Korean population. Diabet Med 2008;25:106-10.