제26차 대한당뇨병학회 춘계학술대회
S4. Obesity 2013.5.10.
What is the optimal
body mass index in Koreans?
김 대 중
아주의대 내분비대사내과
[email protected]
순
서
• History of body mass index
• Body mass index and diabetes
• Body mass index and cardiovascular
diseases: IHD, stroke
• Body mass index and cancer
• Body mass index and mortality
• What is the optimal BMI in Koreans?
History of Body mass index
• Lambert-Adolphe-Jacques Quetelet
– Belgian mathematician
– In 1832, Quetelet Index
– Among adults weight in kgs
seemed to increase in proportion
to the square of stature in meter.
– W/Sb (historically)
• Based on age, gender, race, diseases
• W/S2; Kg/m2, lb/in2*703
From wikipedia
History of Body mass index
• Ancel Keys, American scientist
– “Indices of relative weight and
obesity” (Journal of Chronic Diseases, 1972)
– 7,424 healthy men in 12 cohorts
– New term “body mass index”
– Useful index for grading adiposity
in population studies; kg/m2
From wikipedia
BMI Adult Chart
• Metropolitan Life
Insurance Company
(MLIC) mortality
tables in 1908
• Healthy weights
• Overweight
• obese
http://health.howstuffworks.com/wellness/diet-fitness/weight-loss/bmi4.htm
What is a healthy weight?
• Normative data based on the frequency
distribution of weights within the
population
– 85th (overweight) and 95th (obese) percentile
• Determining healthy body weight in
relation to the risk of morbidity and
overall mortality
Bray GA. J Nutr Biochem 9:489-492, 1998
What is a healthy weight?
• Normative data based on distribution
– National Center for Health Statistics (NCHS)
– In 1976-1980, aged 20-29yrs;
– 27.3 (F) 27.8 (M) kg/m2
• Problem of normative data
– Will change with survey
– 15% of population as overweight
Bray GA. J Nutr Biochem 9:489-492, 1998
What is a healthy weight?
• Minimal mortality rates and lowest risks
for developing diseases associated with
obesity
– BMI of 22 kg/m2
– 20-25 kg/m2; healthy weight range
– Committee on Dietary Guidelines;
– 19-25 as normal
Bray GA. J Nutr Biochem 9:489-492, 1998
BMI definition for obesity
• In 1980, dietary guidelines
– normal weight; <25-26 kg/m2(M) 24-25(F)
• In 1984, Health US
– Overweight; ≥28.0 kg/m2(M), 35.0kg/m1.5(F)
• In 1985, NIH consensus Development Panel
– Overweight, obesity; ≥27.8 kg/m2(M), 27.3kg/m2(F)
• In 1995, WHO, In 1998, NHLBI Expert panel
– Overweight; from BMI 27.8 to 25 kg/m2(M/F)
– Obese; ≥30.0 kg/m2(M/F)
• app. 29 million Americans, healthy to overweight
– South East Asian: cut-off BMI of 23
Am J Clin Nutr. 2000; 72(5): 1074-1081
Definition of obesity in adults
Bray GA. J Nutr Biochem 9:489-492, 1998
Accuracy of BMI to diagnose
obesity in the US adults
Int J Obes (Lond). 2008 June; 32(6): 959–966.
Accuracy of BMI to diagnose
obesity in the US adults
Int J Obes (Lond). 2008 June; 32(6): 959–966.
Accuracy of BMI to diagnose
obesity in the US adults
• Despite the good correlation between BMI
and Body Fat%, the diagnostic accuracy of
BMI to diagnose obesity is limited,
particularly for individuals in the
intermediate BMI ranges.
• A BMI cut-off of ≥ 30 kg/m2 has a good
specificity but misses more than half of
people with excess fat. These results help to
explain the U and J-shape association
between BMI and outcomes.
Int J Obes (Lond). 2008 June; 32(6): 959–966.
Risk associated with central fat
Bray GA. J Nutr Biochem 9:489-492, 1998
Cut-off points for central obesity
in Asia
Low risk: 85 (M) 80 (F)
High risk: 90 (M) 85 (F)
Oh SW. Diabetes Metab J 2011;35:561-566
BMI AND DIABETES
BMI and diabetes in Asia
Pooled cross-sectional analysis
Self-reported diabetes status
N=900,000, 18 cohorts
Korea Multi-center Cancer (KMCC) data
in Korea (n=15,058)
• Referent BMI; 22.5-24.9 kg/m2
•
•
•
•
PLoS ONE 2011;6:e19930
BMI and diabetes in Asia
PLoS ONE 2011;6:e19930
BMI and diabetes in Asia
PLoS ONE 2011;6:e19930
BMI and diabetes in Korea
-2011 KNHANES
Male
(%)
Female
85 percentiles: 27.1
95 percentiles: 29.2
25
20
15
10
5
0
1
2
3
4
5
M 23.6
F 22.9
6
24.3
23.8
7
25.1
24.7
8
26.0
25.7
9
10
BMI
Waist and diabetes in Korea
-2011 KNHANES
Male
(%)
Female
25
20
15
10
5
0
1
2
3
4
5
M 84.3
F 77.7
6
86.4
80.4
7
88.7
83.2
8
91.2
86.4
9
10
Waist
한국인 당뇨병 위험지수
No – 0
Yes – 1
흡연
<84/77cm – 0
84-90/77-84cm – 2
≥90/84cm – 3
<1잔 – 0
1-5잔 – 1
≥5잔 – 2
음주
<35세 – 0
35-44세 – 2
≥45세 - 3
나이
복부
비만
가족력
고혈압
No – 0
Yes – 1
No – 0
Yes – 1
총점이 5점 이상이면 혈당 검사를 해봐야 한다.
이용호, 김대중, 박석원 등. Diabetes Care 2012
Risk for diabetes in middle-aged
Korean: KoGES, n=6,342
3
2.5
2
1.78
1.5
1
1
1.18
1.27
0.5
0
<23.0
Clinical model 2. AROC 0.77
23.0-24.9
25.0-29.9
Lim NK, et al. Circulation J 2012
30+
(BMI)
BMI AND CARDIOVASCULAR
DISEASES
BMI and incident IHD
• Korea Medical Insurance Corporation
(KMIC)
• In 1990 & 1992,
• 62,657 female and 106,803 male workers
– 35-59years; 44.8(M), 42.1(F)
• Follow-up for 9 years (1993-2001)
Jee SH, et al. Am J Epidemiol 2005;162:42-48
BMI and incident IHD
HR: 2.01 (1.32-3.05)
Average BMI: 23.4(M) 22.3(F)
Jee SH, et al. Am J Epidemiol 2005;162:42-48
BMI and stroke risk in Korean
women
• National Health Insurance Corporation
(NHIC)
• From 1992 to 1995
• 439,582 women
• Overall incidence of stroke and subtypes
– From 1993-2005
– 13yrs
Park JW, et al. Obesity 2008;16: 396-401
BMI and stroke risk in Korean
women
BMI>30.0 vs. 18.5-19.9
Ischemic stroke 2.01
Hemorrhagic Stroke 1.27
Baseline BMI 23.2
Park JW, et al. Obesity 2008;16: 396-401
BMI AND CANCER
BMI and cancer risk
NHIC, n=1,213,829, 14yrs
1.6
1.5
1.4
1.33
1.3
1.2
1.1
1
1
1
1
1.03
0.9
0.8
<20
20-22.9
23-24.9
25-29.9
30+
Jee SH et al. Int J Cancer 2008: 123;1892-1896
BMI and cancer risk
NHIC, n=1,213,829, 14yrs
• Obesity (BMI ≥30) were at increased risk for
developing cancers
– Men
•
•
•
•
Stomach cancer: HR 1.31
Colon cancer: HR 1.42
Liver cancer: HR 1.63
GB cancer: HR 1.65
– Women
• Liver cancer: HR 1.39
• Pancreatic cancer: HR 1.80
• Breast cancer (>50yr): HR 1.38
Jee SH et al. Int J Cancer 2008: 123;1892-1896
BMI AND MORTALITY
BMI and mortality in Korean
• Korean Cancer Prevention Study (KCPS)
• 12yr prospective cohort study
• N=1,213,829, age of 30-95
– Baseline BMI 23.2
• 82,372 death
– 29,123 from cancer, 16,426 from CVD
Jee SH, et al. N Engl J Med 2006; 355: 779-87
BMI and mortality in Korean
Referent BMI 23-24.9
Jee SH, et al. N Engl J Med 2006; 355: 779-87
BMI and mortality in Korean
: Cancer death
Referent BMI 23-24.9
Jee SH, et al. N Engl J Med 2006; 355: 779-87
BMI and mortality in Korean
: Cardiovascular death
Referent BMI 23-24.9
Jee SH, et al. N Engl J Med 2006; 355: 779-87
BMI and mortality in Korean
: Respiratory cause
Referent BMI 23-24.9
Jee SH, et al. N Engl J Med 2006; 355: 779-87
BMI and CV death;
KMIC, men, 11% increase
Jee SH, et al. Am J Epidemiol 2005;162:42-48
BMI and cardiovascular mortality in
Korean men: Kangwha Cohort
Hong JS, et al. Amm Epidemiol 2007; 17: 622-627
BMI and cancer mortality in the
Asia-Pacific Cohort Studies
• Pooled analyses of 424,519 participants
• 39 cohorts, including Korea
• Overweight and obese individuals have a
significantly increased risk of mortality from
cancer (BMI≥30 vs. 18.5-24.9)
– HR 1.21 for all-cause cancer, excluding lung
and UGI tract cancer
– Colon (1.50), rectum (1.68), breast in
women >60y (1.63), ovary (2.62), cervix (4.21),
prostate (1.45), leukemia (1.66)
Lancet Oncol 2010; 11: 741-752
BMI and cancer mortality in the
Asia-Pacific Cohort Studies
1.21
1.06
Lancet Oncol 2010; 11: 741-752
Rationale for redefining obesity
in Koreans
• IASO, IOTF and WHO proposed BMI cutpoints 23.0 to 24.9 kg/m2 for being
overweight and ≥25.0 kg/m2 for obesity
in adults Asians
• In 2002, the WHO Expert Consultation
concluded that there was no universal
cut-point for overweight or obese in all
Asian populations
Rationale for redefining obesity
in Koreans
• Consultation’s recommendations
– Current WHO cut-point; 23 vs. 25
– New BMI cut-points of ≥23.0 kg/m2 for
“increased risk” and ≥27.5 kg/m2 for “high
risk” as thresholds for public health
intervention
Optimal BMI in Koreans?
• Percentiles (2011 KNHANES)
– 85 percentiles: 27.1 / 95 percentiles: 29.2
• Risk for diseases and mortality
– Diabetes: 25(F), ?(M)
• Waist: 90/85(M), 85/80(F)
–
–
–
–
–
–
IHD: 23-24
Stroke: linear, 21.5-22.9 (esp. <50yrs)
Cancer: 30
All-cause mortality: U shape, 30
Cancer mortality: 26-28
Cardiovascular mortality: 26-28(M) 28-30(F)
Optimal BMI in Koreans?
• Increased risk?
• High risk?
Optimal BMI in Koreans?
• Increased risk: 23
2
kg/m
–Optimal BMI: <23.0
• High risk: 27
–Obese: ≥27.0
2
kg/m
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