Performance of body mass index and percentage of body fat in predicting cardiometabolic risk factors in Thai adults

Figures & data

Table 1 Characteristics of participants defined as nonobese and obese using obesity measures

Variables	Body mass index			Percentage of body fat
	Normal weight (N = 169)	Overweight (N = 65)	P-value	Lean (N = 139)	Fat (N = 95)	P-value
Male, n (%)	56 (33.1)	20 (30.8)	0.758	46 (33.1)	30 (31.6)	0.808
Age, years	51.4 (1.1)	52.7 (1.4)	0.509	49.4 (1.2)	55.3 (1.1)	0.001
Body mass, kg	56.8 (0.6)	71.6 (1.4)	<0.001	56.9 (0.8)	66.8 (1.2)	<0.001
Height (cm)	160.4 (0.6)	158.7 (1.0)	0.145	160.9 (0.7)	158.5 (0.8)	0.026
Waist circumference, cm	80.5 (0.8)	93.6 (1.1)	<0.001	79.7 (1.0)	90.7 (0.9)	<0.001
Body mass index, kg/m^2	22.00 (0.16)	28.32 (0.38)	<0.001	21.88 (0.21)	26.50 (0.37)	<0.001
Lean body mass, kg	22.31 (0.41)	24.77 (0.80)	0.002	23.19 (0.50)	22.70 (0.58)	0.517
Body fat mass, kg	15.80 (0.35)	26.34 (0.79)	<0.001	14.49 (0.33)	24.87 (0.59)	<0.001
Body fat mass, %	27.95 (0.59)	37.11 (0.95)	<0.001	25.72 (0.56)	37.43 (0.65)	<0.001
Waist-hip fat ratio	0.890 (0.004)	0.945 (0.007)	<0.001	0.879 (0.004)	0.945 (0.005)	<0.001
Visceral fat area, cm^2	86.6 (2.0)	123.8 (3.5)	<0.001	79.7 (2.0)	122.0 (2.5)	<0.001
Biochemical measures
Insulin, μIU/mL	3.98 (0.32)	6.85 (0.68)	<0.001	3.64 (0.33)	6.45 (0.55)	<0.001
HOMA-IR	0.972 (0.083)	1.935 (0.264)	<0.001	0.895 (0.100)	1.743 (0.188)	<0.001
Glucose, mmol/L	5.34 (0.08)	5.84 (0.20)	0.004	5.27 (0.08)	5.80 (0.15)	0.001
HbA1c, mmol/mol	42.4 (0.7)	45.2 (1.1)	0.038	41.7 (0.8)	45.3 (0.9)	0.003
Triglycerides, mmol/L	1.20 (0.04)	1.66 (0.10)	<0.001	1.15 (0.05)	1.58 (0.08)	<0.001
Total cholesterol, mmol/L	5.67 (0.08)	5.65 (0.13)	0.865	5.66 (0.08)	5.68 (0.11)	0.875
HDL-C, mmol/L	1.47 (0.03)	1.29 (0.04)	<0.001	1.49 (0.03)	1.32 (0.03)	<0.001
LDL-C, mmol/L	3.44 (0.06)	3.51 (0.10)	0.593	3.42 (0.07)	3.53 (0.09)	0.344
Lipoprotein subclass, mmo/L
VLDL	0.88 (0.02)	0.98 (0.03)	0.005	0.87 (0.02)	0.95 (0.03)	0.014
MIDC	0.47 (0.01)	0.48 (0.02)	0.853	0.46 (0.01)	0.49 (0.02)	0.137
MIDB	0.40 (0.01)	0.40 (0.02)	0.797	0.40 (0.01)	0.41 (0.01)	0.677
MIDA	0.55 (0.02)	0.51 (0.03)	0.261	0.55 (0.02)	0.52 (0.02)	0.339
LDL1	1.08 (0.02)	1.01 (0.05)	0.133	1.10 (0.03)	1.00 (0.04)	0.039
LDL2	0.69 (0.02)	0.72 (0.03)	0.441	0.68 (0.02)	0.73 (0.03)	0.187
Small-dense LDL	0.23 (0.02)	0.36 (0.05)	0.009	0.20 (0.02)	0.36 (0.04)	<0.001
Mean LDL particle size, nm	26.80 (0.04)	26.58 (0.08)	0.005	26.84 (0.04)	26.59 (0.06)	<0.001
Non-HDL-C, mmol/L	4.19 (0.08)	4.34 (0.12)	0.308	4.16 (0.08)	4.34 (0.11)	0.173
ApoA-I, mg/dL	160.2 (1.9)	152.3 (3.2)	0.034	161.6 (2.1)	152.7 (2.6)	0.009
ApoB, mg/dL	97.8 (1.7)	103.8 (2.7)	0.058	96.4 (1.7)	104.0 (2.4)	0.009
hsCRP, mg/L	1.811 (0.352)	3.670 (0.837)	0.016	1.315 (0.177)	3.809 (0.795)	<0.001
25-hydroxyvitamin D, nmol/L	53.0 (1.5)	49.6 (2.0)	0.208	53.0 (1.8)	50.6 (1.5)	0.310
Leptin, ng/mL	8.04 (0.45)	16.66 (1.36)	<0.001	7.19 (0.47)	15.26 (1.00)	<0.001
Adiponectin, mg/mL	23.00 (1.29)	17.06 (1.30)	0.009	23.45 (1.48)	18.21 (1.16)	0.012

Notes: Data except for number (%) are the mean (standard error of mean). All biochemical markers are expressed in Système International units; conversions to conventional units are as follows: fasting glucose (mg/dL), multiply by 18.02; HbA1c (%), use the formula: [0.0915 HbA1c (mmol/mol) + 2.15]; triglycerides (mg/dL), multiply by 88.5; cholesterol (mg/dL), multiply by 38.6; 25-hydroxyvitamin D (ng/mL), multiply by 0.40.

Abbreviations: ApoA-I, apolipoprotein A-I; ApoB, apolipoprotein B; HbA1c, hemoglobin A1c; HDL, high density lipoprotein; HDL-C, high density lipoprotein-cholesterol; HOMA-IR, Homeostasis Model Assessment of Insulin Resistance; hsCRP, high sensitive C-reactive protein; LDL, low density lipoprotein; LDL-C, low density lipoprotein–cholesterol; MID, intermediate density lipoprotein midband; VLDL, very low density lipoprotein.

Figure 1 Correlation plots of body mass index (BMI) versus percentage of body fat (PBF) in (A) all participants; (B) men; and (C) women.

Table 2 Characteristics of participants by group, as classified by BMI and PBF

Variablesa	Categories of obesity indicesb				P-value
	Group A (N = 126)	Group B (N = 13)	Group C (N = 43)	Group D (N = 52)
Male, n (%)	42 (33.3)	4 (30.8)	14 (32.6)	16 (30.8)	0.995
Age, years	49.4 (1.3)	49.3 (3.2)	57.3 (1.5)	53.6 (1.6)	0.005
Smoke, n (%)	16 (12.8)	3 (23.1)	7 (16.7)	7 (13.5)	0.736
Height, cm	160.7 (0.7)	163.1 (2.2)	159.6 (1.2)	157.6 (1.1)	0.058
Body mass index, kg/m^2	21.34 (0.17)	27.21 (0.36)	23.96 (0.19)	28.60 (0.45)	<0.001
Bioelectrical impedance analysis
Lean body mass, kg	22.55 (0.48)	29.47 (1.87)	21.61 (0.79)	23.59 (0.82)	<0.001
Body fat mass, kg	13.93 (0.31)	19.88 (1.17)	21.14 (0.41)	27.96 (0.80)	<0.001
Body fat mass, %	25.49 (0.58)	27.92 (2.01)	35.04 (0.93)	39.40 (0.82)	<0.001
Waist-hip fat ratio	0.876 (0.004)	0.902 (0.018)	0.932 (0.005)	0.955 (0.007)	<0.001
Visceral fat area, cm^2	77.86 (2.02)	97.00 (5.80)	111.71 (2.60)	130.99 (3.60)	<0.001
Abdominal obesity, n (%)c	35 (27.8)	12 (92.3)	33 (75.0)	50 (98.0)	<0.001
Hypertension, n (%)d	22 (17.5)	6 (46.2)	15 (34.9)	27 (51.9)	<0.001
Triglycerides ≥1.70 mmol/L, n (%)	18 (14.3)	5 (38.5)	16 (37.2)	22 (42.3)	<0.001
HDL-C <1.04 mmol/L (men) or <1.30 mmol/L (women), n (%)	17 (13.5)	6 (46.2)	14 (32.6)	20 (38.5)	<0.001
Hyperglycemia, n (%)e	29 (23.0)	5 (38.5)	16 (37.2)	27 (51.9)	0.002
Metabolic syndrome, n (%)f	18 (14.3)	7 (53.8)	22 (51.2)	34 (65.4)	<0.001

Notes:

a Data except for number (%) are the mean (standard error of mean).

b Individual group is defined as follows: Group A (normal-weight and lean), BMI <25.0 kg/m² for women and <27.0 kg/m² for men and PBF <35% for women and <25% for men; Group B (overweight and lean), BMI ≥25.0 kg/m² for women and ≥27.0 kg/m² for men and PBF <35% for women and <25% for men; Group C (normal-weight and fat), BMI <25.0 kg/m² for female and <27.0 kg/m² for men and PBF ≥35% for women and ≥25% for men; and Group D (overweight and fat), BMI ≥25.0 kg/m² for women and ≥27.0 kg/m² for men and PBF ≥35% for women and ≥25% for men.

c Defined as waist circumference ≥90 cm for men or ≥80 cm for women.

d Defined as systolic ≥130 and/or diastolic ≥85 mmHg or treatment with antihypertensive drug.

e Defined as fasting glucose ≥5.55 mmol/L or previous diagnosis of diabetes.

f Metabolic syndrome is defined using the NCEP ATP III criteria modified for Asian population.²⁰

Abbreviations: BMI, body mass index; PBF, percentage of body fat; HDL-C, high density lipoprotein-cholesterol; NCEP ATP III, National Cholesterol Education Program-Third Adult Treatment Panel.

Table 3 Comparison of metabolic biomarkers between groups defined using different obesity measures

Variablesa	Categories of obesity indicesb				P-value
	Group A N = 126	Group B N = 13	Group C N = 43	Group D N = 52
Insulin, μIU/mL	3.52 (0.33)	4.75 (1.54)	5.33 (0.79)	7.37 (0.75)	<0.001
HOMA-IR	0.850 (0.087)	1.330 (0.578)	1.328 (0.195)	2.087 (0.297)	<0.001
Glucose, mmol/L	5.24 (0.08)	5.46 (0.27)	5.63 (0.18)	5.94 (0.23)	0.004
HbA1c, mmol/mol	41.5 (0.8)	43.7 (2.3)	45.0 (1.3)	45.6 (1.3)	0.023
VLDL, mmol/L	0.87 (0.02)	0.98 (0.08)	0.92 (0.04)	0.97 (0.04)	0.020
Small-dense LDL, mmol/L	0.20 (0.02)	0.28 (0.07)	0.34 (0.062)	0.38 (0.06)	0.003
Mean LDL particle size, nm	26.86 (0.04)	26.68 (0.13)	26.62 (0.09)	26.55 (0.09)	0.002
Triglycerides, mmol/L	1.11 (0.05)	1.58 (0.20)	1.45 (0.10)	1.68 (0.14)	<0.001
HDL-C, mmol/L	1.51 (0.03)	1.27 (0.10)	1.34 (0.05)	1.30 (0.04)	<0.001
ApoA-I, mg/dL	163.0 (2.3)	148.0 (7.4)	151.9 (3.8)	153.4 (3.5)	0.011
ApoB, mg/dL	96.1 (1.9)	99.5 (3.9)	102.8 (3.7)	104.9 (3.2)	0.064
hsCRP, mg/L	1.232 (0.185)	2.118 (0.565)	3.507 (1.249)	4.058 (1.032)	0.004
25-hydroxyvitamin D, nmol/L	53.8 (1.9)	45.7 (4.1)	50.5 (1.9)	50.6 (2.2)	0.339
Leptin, ng/mL	6.70 (0.44)	11.72 (2.23)	12.02 (1.02)	18.02 (1.58)	<0.001
Adiponectin, μg/mL	24.07 (1.59)	17.75 (3.73)	19.79 (1.98)	16.87 (1.33)	0.026

Notes:

a Data are given as mean (standard error of mean).

b Individual group is defined as in Table 2.

Abbreviations: ApoA-I, apolipoprotein A-I; ApoB, apolipoprotein B; hsCRP, high sensitive C-reactive protein; HbA1c, hemoglobin A1c; HOMA-IR, Homeostasis Model Assessment of Insulin Resistance; HDL-C, high density lipoprotein-cholesterol; hsCRP, high sensitive C-reactive protein; LDL, low density lipoprotein; VLDL, very low density lipoprotein.

Figure 2 Multinomial logistic regression analysis for (A) hypertension, (B) insulin resistance, (C) impaired fasting glucose, (D) increased HbA1c, (E) hypertriglyceridemia, (F) hypo HDL cholesterolemia, (G) atherogenic lipoproteins, and (H) atherogenic lipoprotein pattern for the following groups compared with the reference normal-weight and lean group (Group A): overweight and lean (Group B), BMI ≥25.0 kg/m² for women and ≥27.0 kg/m² for men, and PBF <35% for women and <25% for men; normal weight and fat (Group C), body mass index (BMI) <25.0 kg/m² for women and <27.0 kg/m² for men, and percentage of body fat (PBF) ≥35% for women and ≥25% for men; and overweight and fat (Group D), BMI ≥25.0 kg/m² for women and ≥27.0 kg/m² for men, and PBF ≥35% for women and ≥25% for men.

Note: *P < 0.05; **P < 0.01.

Table 4 Logistic regression analysis of obesity measures associated with CVD risk factors

Dependent variables	Independent variables	Men		Women
		OR (95% CI)a	P-value	OR (95% CI)a	P-value
Blood pressureb	BMI	7.65 (2.23–26.32)	0.001	3.56 (1.53–8.27)	0.003
	PBF	–	–	–	–
HOMA-IRc	BMI	–	–	3.23 (1.45–7.00)	0.003
	PBF	9.37 (2.90–30.29)	<0.001	–	–
Fasting glucosed	BMI	–	–	2.40 (1.07–5.38)	0.033
	PBF	4.25 (1.54–11.78)	0.005	–	–
HbA1ce	BMI	–	–	–	–
	PBF	–	–	–	–
Triglyceridesf	BMI	–	–	2.74 (1.19–6.32)	0.018
	PBF	5.38 (1.93–15.00)	<0.001	–	–
HDL-Cg	BMI	6.69 (1.61–27.8)	0.009	2.91 (1.35–6.26)	0.006
	PBF	–	–	–	–
Small-dense LDLh	BMI	–	–	–	–
	PBF	3.27 (1.20–8.87)	0.020	2.31 (1.20–4.47)	0.013
LDL particle sizei	BMI	–	–	–	–
	PBF	3.48 (1.27–9.58)	0.016	2.16 (1.06–4.39)	0.033
hsCRPj	BMI	–	–	–	–
	PBF	–	–	–	–
25-hydroxyvitamin Dk	BMI	–	–	–	–
	PBF	–	–	–	–
Leptinl	BMI	–	–	27.5 (3.37–224.6)	0.002
	PBF	15.09 (1.50–152.1)	0.021	–	–
Adiponectinm	BMI	–	–	2.51 (1.21–5.23)	0.014
	PBF	–	–	–	–

Notes:

a Data are from logistic regression analyses adjusted for age, height, and smoking; Dashes mean variable removed from the equation by backward stepwise selection.

b Defined as systolic ≥130 and/or diastolic ≥85 mmHg or treatment with antihypertensive drug.

c Defined as HOMA-IR ≥3.0.

d Defined as glucose ≥5.55 mmol/L or previous diagnosis of diabetes.

e Defined as HbA1c ≥38.8 mmol/mol.

f Defined as triglycerides ≥1.70 mmol/L.

g Defined as HDL-C <1.04 mmol/L (men) or <1.30 mmol/L (women).

h Defined as small-dense LDL >0.16 mmol/L.

i Defined as mean LDL particle size <26.5 nm.

j Defined as hsCRP >3.0 mg/L.

k Defined as 25-hydroxyvitamin D <50 nmol/L.

l Defined as leptin over upper limit: >12.0 ng/mL (men) or >24.2 ng/mL (women).

m Defined as adiponectin lower upper limit: <13.9 μg/mL (men) or <19.4 μg/mL (women).

Abbreviations: BMI, body mass index; CI, confidence interval; CVD, cardiovascular disease; HbA1c, hemoglobin A1c; HOMA-IR, Homeostasis Model Assessment of Insulin Resistance; HDL-C, high density lipoprotein-cholesterol; hsCRP, high sensitive C-reactive protein; LDL, low density lipoprotein; OR, odds ratio; PBF, percentage of body fat.

Alberti KG Eckel RH Grundy SM International Diabetes Federation Task Force on Epidemiology and Prevention National Heart, Lung, and Blood Institute American Heart Association World Heart Federation International Atherosclerosis Society International Association for the Study of Obesity Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity Circulation 2009 120 16 1640 1645 19805654

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