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Age, Gender and Ethnic Differences in Prevalence of Overweight and Obesity in Asian American College Students and Their Parents Using Different BMI Cutoffs

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Title: Age, Gender and Ethnic Differences in Prevalence of Overweight and Obesity in Asian American College Students and Their Parents Using Different BMI Cutoffs
Language: English
Authors: Wang, Li Hui, Chen, Ying Chang, Ka Chung, Angela, Poon, George, Lew, Polong, Tam, Chick F.
Source: College Student Journal. Sep 2007 41(3):583-600.
Availability: Project Innovation, Inc. P.O. Box 8508 Spring Hill Station, Mobile, AL 36689-0508. Tel: 251-343-1878; Fax: 251-343-1878; Web site: http://www.projectinnovation.biz/csj.html
Peer Reviewed: Y
Page Count: 18
Publication Date: 2007
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Descriptors: College Students, Obesity, Incidence, Public Health, Asian Americans, Age Differences, Gender Differences, Body Weight, Ethnicity, Parents, Evaluation Criteria
Geographic Terms: California
ISSN: 0146-3934
Abstract: The objective was to determine if the WHO global BMI (kg/m[squared]) cutoffs for determining overweight and obesity in the general populations are appropriate for Asian populations and to consider whether population-specific cutoffs would be warranted. A nonrandomized biased sampling of 227 Asian Americans were composed of 149 college students, including 104 Chinese, 30 Vietnamese and 15 Japanese, enrolled in California State University at Los Angeles and 78 of their parents to examine the differences of prevalence of overweight and obesity based on two BMI cutoffs: (I) WHO global cutoffs, overweight BMI greater than or equal to 25, obesity: BMI greater than or equal to 30, and (II) WHO recommended cutoffs for Asians, overweight: BMI greater than or equal to 23, obesity: BMI greater than or equal to 27.5. The prevalence of overweight/obesity based on (II) were 2 times higher than those based on (I) in total young Asians, total Chinese, and in young, old, male Chinese. It was 4 times higher in young Vietnamese and 3 times higher in female Japanese. The prevalence of obesity was also fairly different using these two criteria. This study identified potential BMI cutoffs to consider for these Asians and established that the WHO cutoffs for Asians should be taken into consideration when making public health policy for these populations. (Contains 3 tables and 8 figures.)
Abstractor: Author
Number of References: 44
Entry Date: 2007
Access URL: https://www.projectinnovation.biz/csj.html
Accession Number: EJ777965
Database: ERIC
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  Value: <anid>AN0026885992;cgl01sep.07;2007Oct03.14:40;v2.2.460</anid> <title id="AN0026885992-1">AGE, GENDER AND ETHNIC DIFFERENCES IN PREVALENCE OF OVERWEIGHT AND OBESITY IN ASIAN AMERICAN COLLEGE STUDENTS AND THEIR PARENTS USING DIFFERENT BMI CUTOFFS </title> <p>The objective was to determine if the WHO global BMI (kg/m²) cutoffs for determining overweight and obesity in the general populations are appropriate for Asian populations and to consider whether population-specific cutoffs would be warranted. A nonrandomized biased sampling of 227 Asian Americans were composed of 149 college students, including 104 Chinese, 30 Vietnamese and 15 Japanese, enrolled in California State University at Los Angeles and 78 of their parents to examine the differences of prevalence of overweight and obesity based on two BMI cutoffs: (I) WHO global cutoffs, overweight BMI ≥25, obesity: BMI ≥ 30, and (II) WHO recommended cutoffs for Asians, overweight: BMI ≥ 23, obesity: BMI ≥ 27.5. The prevalence of overweight/obesity based on (II) were 2 times higher than those based on (I) in total young Asians, total Chinese, and in young, old, male Chinese. It was 4 times higher in young Vietnamese and 3 times higher in female Japanese. The prevalence of obesity was also fairly different using these two criteria. This study identified potential BMI cutoffs to consider for these Asians and established that the WHO cutoffs for Asians should be taken into consideration when making public health policy for these populations.</p> <p>Overweight and obesity were associated with cardiovascular disease, cancer, hypertension, metabolic disease and all-cause mortality (Wyatt et al., 2006; Gu et al., 2006; Flegal et al., 2005; Kurth et al., 2005; Kurth et al., 2002; Dey et al., 2002; Wilson et al., 2002; Stevens et al., 2002). Body Mass Index (BMI) is calculated by the Quetelet Index defined as weight in kilogram divided by the square of height in meters. BMI was broadly applied to assess the prevalence of overweight and obesity worldwide, which provided easy-to-obtain, non-invasive, low cost and very useful tool for the public to understand and to monitor their body conditions. Many governments used it to determine health policies, to undertake public health actions, to identify high risk population and to investigate outcome of any intervention. (WHO expert consultation, 2004)</p> <p>Asian Americans accounted for approximately 4% of the total American population in 2000 (U.S Census Bureau Population Estimates Program, 2003); the Chinese group, the Vietnamese group and the Japanese group accounted for 24%, 11% and 8% of the Asian American population, respectively. Previous and even the most updated national health surveys on prevalence of overweight and obesity in the United States (Ogden et al., 2006) addressed only non-Hispanic white, non-Hispanic black and Mexican Americans as their ethnic/racial categories but ignored Asian Americans as a growing, unique ethnic group in the U.S.</p> <p>In addition, Asian populations were acknowledged to have higher body fat, higher risk for cardiovascular disease at a lower level of BMI than Western populations (Wildman et al., 2004; Pan et al., 2004; WHO expert consultation, 2004; Deurenberg-Yap and Deurenberg, 2003; Deurenberg-Yap et al., 2002; Moon et al., 2002; He et al., 2001; Gallagher et al., 2000) and had a higher prevalence of type 2 diabetes than those of non-Hispanic white and Europeans (McNeely and Boyko, 2004; WHO expert consultation, 2004). For Asian populations, a conclusion concerning the BMI cut-off points was drawn based on many available data that the corresponding cutoffs for overweight and obesity should be lowered accordingly (Horie et al., 2006; Wildman et al., 2004; WHO expert consultation, 2004; Stevens et al., 2003; Deurenberg-Yap and Deurenberg, 2003; Zhou et al., 2002; He et al., 2001;). Nevertheless, the proposed cut-off values were fairly variable and could not reach an agreement among researches undertaken in different areas and on different ethnic groups. For example, Deurenberg-Yap proposed BMI 23 kg/m² for overweight and 27 kg/m² for obesity for Singaporeans (Deurenberg-Yap and Deurenberg, 2003), Horie proposed 24 kg/m² for central obesity for male Japanese (Horie et al., 2006); 24 kg/m² for overweight and 27 kg/m² for obesity were used in Yeh's study conducted in Taiwan (Yeh et al., 2005); WHO expert consultation held in 2002 suggested 23 kg/m² as increased risk and 27.5 kg/m² as high risk for Asians. BMI cut-off points vary from 22 kg/m² to 25 kg/m² for overweight and 26 kg/m² to 31 kg/m² for obesity in all acquired researches (WHO expert consultation, 2004).</p> <p>The goal of this study was to determine if there was a different prevalence of overweight and obesity among three Asian American groups using WHO global standard BMI cut-offs and the WHO recommended cut-offs for Asians. This study chose two cut-off values recommended by WHO expert consultation 2002 (WHO expert consultation, 2004) to compare the differences of prevalence of overweight/obesity and obesity in adult Chinese Americans, Vietnamese Americans and Japanese Americans.</p> <cn>Methods</cn> <hd id="AN0026885992-2"> Human Subjects </hd> <p>This population studied was a convenient, nonrandomized, biased sample due to the location, ethnicity and education levels of the subjects who participated. The total subjects were 227 Asian Americans residing in the Greater Los Angeles Areas. The classifications of Asian ethnic groups were based on self disclosures with Asian surnames, including Chinese, Vietnamese, and Japanese. Age, height and weight were self-reported and Body Mass Index (BMI) was calculated by the Quetelet Index as weight in kilogram divided by the square of height in meters. The classification of age is based on the Recommended Daily Allowances (RDA) guideline that classifies age into two categories: greater than or equal to 51 years old is regarded as the old group, whereas, less than 51 and at or older than 18 years old is considered as the young group. The young group was composed of 149 college students enrolled in California State University at Los Angeles (CSULA) and their older parents (N=78, age ≥ 51 y). This study was approved by the Institutional Review Board on Human Subjects Committee at CSULA.</p> <hd id="AN0026885992-3"> Data Analysis </hd> <p>The results were analyzed by SPSS 12.0 for Windows and Microsoft Office Excel 2003. Age, height, weight and body mass index of subject characteristics were expressed as mean ± standard deviation (SD). Prevalence was calculated by the number of persons with a condition at a certain time point divided by the total number of persons examined and expressed as a percentage. Prevalence of underweight, overweight/obesity and obesity in three Asian groups estimated by 1) WHO cutoffs for global use: underweight, BMI < 18.5 kg/m²; overweight, BMI ≥ 25 kg/m²; obesity, BMI ≥ 30 kg/m²; 2) WHO recommended cutoffs for Asians (WHO expert consultation, 2004): underweight, BMI < 18.5 kg/m²; increased risk, BMI 23 kg/m² (used to define overweight); high risk, BMI ≥ 27.5 kg/m² (used to define obesity), were expressed as frequencies adjusted for age, gender and ethnicity. The comparisons of mean BMIs between young and old, male and female of these three ethnic groups were performed by the Independent T-Test (with the exception for young and old Vietnamese Americans comparisons, it was performed by the Wilkoxon Rank Sum Test). Based on BMI data, the comparisons of prevalence of underweight, overweight/obesity and obesity in these three ethnic groups were adjusted for age, gender and ethnicity and the results were expressed by column charts as shown in Figures 1A, 1B, 2A, 2B, 3A, 3B, 4A, 4B.</p> <cn>Results</cn> <hd id="AN0026885992-4"> Subject Characteristics </hd> <p>The Chinese Americans consisted of 154 subjects including 58 males and 96 females. The group was composed of 104 youngs and 50 olds. The mean age for total Chinese American group was 35.5 years (range 17.1 to 53.9 years) of age. Their average height was 162.8 cm (154.5 to 171.1 cm). The average weight was 57.3 kg (47.4 to 67.2 kg). The mean BMI was 21.6 kg/m² (18.5 to 24.7 kg/m²). After adjusted for age, the mean BMI was 20.9 kg/m² of the youngs and 23.1 kg/m² of the olds. Based on gender, the mean BMI was 23.0 kg/m² of the males and 20.7 kg/m² of the females. The average BMIs between young and old, male and female Chinese Americans had statistically significant differences (p < 0.05)</p> <p>The Vietnamese Americans consisted of 52 subjects including 10 males and 42 females. The group was composed of 30 youngs and 22 olds. The mean age for total Vietnamese American group was 39.4 years (19.2 to 59.6 years) of age. Their average height was 157.4 cm (150.0 to 164.8 cm). The average weight was 53.4 kg (42.6 to 64.2 kg). The mean BMI was 21.5 kg/m² (18.0 to 25.0 kg/m²). After adjusted for age, the mean BMI was 20.1 kg/m² of the youngs and 23.3 kg/m² of the olds. Based on gender, the mean BMI was 24.8 kg/m² of the males and 20.7 kg/m² of the females. The average BMIs between young and old, male and female Vietnamese Americans had statistically significant differences (p < 0.05).</p> <p>The Japanese Americans consisted of 21 subjects including 10 males and 11 females. The group was composed of 15 youngs and 6 olds. The mean age for total Japanese American group was 34.1 years (16.2 to 52 years) of age. Their average height was 165.6 cm (156.3 to 174.9 cm). The average weight was 63.8 kg (50.9 to 76.7 kg). The mean BMI was 23.1 kg/m² (19.8 to 26.4 kg/m²). After adjusted for age, the mean BMI of the youngs was 22.6 kg/m² and 24.4 kg/m² of the olds. Based on gender, the mean BMI was 24.7 kg/m² of the males and 21.7 kg/m² of the females. The average BMIs between young and old had no significant difference (p > 0.05) whereas between male and female Japanese Americans, the average BMIs had statistically significant difference (p < 0.05). The detailed characteristics of these three adult Asian American groups are shown in Table 1.</p> <p>1. Prevalence of Underweight, Over weight/Obesity and Obesity in adults (≥ 18 y) among Chinese Americans, Vietnamese Americans and Japanese Americans by Age, Gender and Ethnicity based on WHO Global BMI Cutoffs</p> <p>Based on WHO global BMI cutoffs (18.5 kg/m² for underweight, 25 kg/m² for overweight/obesity and 30 kg/m² for obesity) (WHO expert consultation, 2004), the average prevalence of underweight was 14.5% for all participants. The average prevalence of overweight/obesity and obesity for these three Asian American groups were 16.7% and 0.4% respectively, which were much lower than the recent published data for American adults during year 20032004 (57.1% to 73.1% for overweight/obesity; 28.5% to 36.8% for obesity in different age levels) (Ogden et al., 2006). There was no extreme obesity (BMI ≥ 40 kg/m²) among these 227 subjects. Japanese American group had the highest prevalence of overweight/obesity (33.3%, as a matter of fact, none was of obesity) among these three Asian American groups. This result was consistent with the finding of Lauderdale and Rathouz in which Japanese Americans had the highest prevalence of overweight among six Asian American ethnic groups (Lauderdale and Rathouz, 2000). Vietnamese American group had the highest prevalence of underweight (17.3%). After adjusted for age and gender, the highest prevalence of overweight/obesity and obesity were seen in male Japanese Americans (60.0%) and male Chinese Americans (1.7%), respectively. Among Chinese American group, old Chinese Americans had the higher prevalence of overweight/obesity (28.0%) than the young, male and female subgroups. Among Vietnamese American group, male Vietnamese Americans had the higher prevalence of overweight/obesity (50.0%) than those of the female, young or old subgroups. The highest prevalence of underweight was observed in young Vietnamese American group (23.3%). Detailed prevalence estimates of these subjects are shown in Table 2.</p> <p>2. Prevalence of Underweight, Over weight/Obesity and Obesity in adults (≥ 18 y) among Chinese Americans, Vietnamese Americans and Japanese Americans by Age, Gender and Ethnicity based on WHO Recommended BMI Cutoffs for Asians</p> <p>Based on WHO recommended BMI cutoffs of 18.5 kg/m² for underweight, 23 kg/m² for overweight/obesity and 27.5 kg/m² for obesity for Asians (WHO expert consultation, 2004), the average prevalence of overweight/obesity and obesity among these three Asian American groups was 30.0% and 6.2%, respectively, which were much higher than those estimated based on WHO global cutoffs (16.7% and 0.4%, respectively). Japanese American group had the highest prevalence of overweight/obesity (47.6%) among these three Asian American groups. Vietnamese American group had the highest prevalence of obesity (9.6%). After adjusted for age and gender, the highest prevalence of overweight/obesity were observed in male Japanese and Vietnamese Americans (70.0%). The highest prevalence of obesity was observed in male Vietnamese Americans (30.0%). Among Chinese American group, old Chinese Americans had the highest prevalence of overweight/obesity (56.0%) and of obesity (8%). Among Japanese American group, male Japanese Americans had the highest prevalence of obesity (10.0%). Detailed prevalence estimates of these groups are shown in Table 3. Between two different WHO BMI criteria, the outcomes revealed that the prevalence of overweight/obesity of the olds was higher than those of the youngs and the prevalence of overweight/obesity of the males was higher than those of the females.</p> <p>3. Comparisons of Prevalence of Over weight/Obesity among Chinese Americans, Vietnamese Americans and Japanese Americans by Age, Gender and Ethnicity based on WHO Global BMI Cutoffs and WHO Recommended Cutoffs for Asians</p> <p>Based on two different criteria (WHO global cutoffs, BMI ≥ 25 kg/m² versus WHO recommended cutoffs for Asians, BMI ≥ 23 kg/m²), a comparison of differences of prevalence of overweight/obesity in a total of 227 Asian Americans is shown in Figure 1A. By age and gender, the difference of prevalence of overweight/obesity between two cutoffs was 13.3% for total Asian American subjects, 9.4% in total young Asian American group, 20.5% in total old Asian American group, 21.8% in total male and 8.7% in total female Asian American group. By ethnicity (Figure 2A), the difference between cutoffs was 14.9% in total Chinese American group, 7.7% in total Vietnamese American group and 14.3% in total Japanese American group. After adjusted for age and ethnicity (Figure 3A), the difference between cutoffs in young Chinese Americans was 8.6%, in old Chinese Americans was 28%, in young Vietnamese Americans was 10%, in old Vietnamese Americans was 4.5%, in young Japanese Americans was 13.3% and in old Japanese Americans was 16.7%. After adjusted for gender and ethnicity (Figure 4A), the calculated cutoff difference was 24.2% in male Chinese Americans, 9.4% in female Chinese Americans, 20% in male Vietnamese Americans, 4.8% in female Vietnamese Americans, 10% in male Japanese Americans and 18.2% in female Japanese Americans.</p> <p>4. Comparisons of Prevalence of Obesity among Chinese Americans, Vietnamese Americans and Japanese Americans by Age, Gender and Ethnicity based on WHO Global BMI Cutoffs and WHO Recommended Cutoffs for Asians The comparisons of prevalence of obesity among 227 Asian Americans based on two different BMI criteria (WHO global cutoffs, BMI ≥ 30 kg/m² versus WHO recommended cutoffs for Asians, BMI ≥ 27.5 kg/m²) are shown in Figure 1B. By age and gender, the difference of prevalence of obesity between two cutoffs was 5.8% in total Asian American subjects, 2.0% in total young Asian American group, 12.8% in total old Asian American group, 9.0% in total male Asian American group and 4.0% in total female Asian American group. By ethnicity (Figure 2B), the difference between cutoffs was 3.9% in total Chinese American group, 9.6% in total Vietnamese American group and 9.5% in total Japanese American group. After adjusted for age and ethnicity (Figure 3B), the difference between cutoffs was 1.9% in young Chinese Americans, 8% in old Chinese Americans, 22.7% in old Vietnamese Americans, 6.7% in young Japanese Americans and 6.7% in old Japanese Americans. After adjusted for gender and ethnicity (Figure 4B), the difference between cutoffs was 5.2% in male and 3.1% in female Chinese Americans, 30% in male and 4.8% in female Vietnamese Americans, 10% in male and 9.1% in female Japanese Americans.</p> <cn>Discussion</cn> <p>Although the WHO Expert Committee 2002 proposed that the standard cut-off values of BMI of 25 kg/m² and of 30 kg/m² for overweight and obesity, respectively, should be retained as an international or global classification, yet the Committee suggested that the BMI cut-off values of 23 kg/m² and 27.5 kg/m² for overweight/obesity and obesity, respectively, should be focused as values for public health action for many Asian populations. The Committee also acknowledged that the influence of race and ethnicity on BMI cutoffs should not be ignored or underestimated (WHO Expert Committee, 2004).</p> <p>Based on a large national cohort study (169,871 Chinese) conducted in China (Gu et al., 2006), the researchers concluded that a single cutoff of BMI for all racial and ethnic groups was adequate. This Chinese study, however, contained a limitation that the changes of body weights over time was not taken into account, for example, the BMI values were calculated based on heights and weights collected ten years ago (year 1991) whereas the all-cause mortality rates were followed and investigated by the years 1999-2000. Since the lifestyle of people in China had shown a drastic change from year 1991 to 2000, such change could result in an uncontrollable impact on BMI values of the Chinese subjects. The body weight changes in these surveyed Chinese subjects through a 10-year period could complicate the authors' conclusion.</p> <p>Based on the current research, it revealed that the prevalence of overweight/obesity and obesity based on the cut-off values recommended for Asians by the WHO expert Committee 2002 (WHO Expert Consultation, 2004) were significantly different from those based on WHO global cutoffs (Figures 1A and 1B to 4A and 4B).</p> <p>While the sample size of Japanese American group and male Vietnamese American group were relatively small (Table 1), the prevalence of overweight/ obesity observed in old Japanese American group was 50%, in male Japanese American group was 60% and in male Vietnamese American group was 50%, whereas there was no obese case in male Vietnamese American group based on the WHO global cut-off values (Table 2). By comparisons, the different results were obtained by the prevalence calculated based on recommended cutoffs for Asians: 66.7% of old Japanese American group were overweight/obese, 70% of male Japanese and Vietnamese Americans were overweight/obese and 30% of male Vietnamese Americans were found to be obese. It was noteworthy that higher prevalence of overweight/obesity and obesity were observed when BMI of 23 kg/m² and 27.5 23 kg/m² were used as cut-off values in these Asian American groups (Table 3).</p> <p>The patient's BMI, waist circumference and the existing comorbid conditions altogether helped to determine the patient's risk status due to overweight or obesity. (Kushner and Blatner, 2005). With numerous evidences identifyng the correlations among body fat, central obesity, morbidity and mortality, the factor of waist circumference was suggested as an appropriate index for obesity (WHO, 1998) and the cutoffs for waist circumference for Asian populations were recommended to be lower (Wildman, RP. et al, 2004; WHO Western Pacific Region, 2000). In the present study, although waist circumference was not available, a study conducted in Singapore revealed that BMI was found to be more precise than waist circumference or hip circumference to predict obesity (Gob et al., 2004). Many researches advised that measurement of both waist circumference and BMI as guidelines for obesity might greatly promote the risk assessment of cardiovascular disease and metabolic disorder in Chinese adults (Wildman et al., 2005; Yeh, et al., 2005). Based on these findings, we recommend that waist circumference should be taken into account for our future study.</p> <p>Nativity (US-born or foreign-born), years since immigration and socioeconomic status were associated with BMI as the indicator for the risk of being overweight or obesity (Lauderdale and Rathouz., 2000) for Asian Americans. The US-born subjects were identified to have higher risk of being overweight or obese. As for the foreign-born people, the longer they stayed in the U.S., the more likely they became overweight or obese. Low socioeconomic status was also a related risk factor for the US-born Asian Americans but not for the foreign-borns. In the current study, we did not test the influences of nativity. We would also like to include the study of nativity of these Asian American groups in our future study.</p> <p>Moreover, we would like to point out that the cut-off value for "underweight" was a neglected issue in most researches. In the present study, for young Asian Americans, the prevalence of underweight was about 20% (Table 2). It was noteworthy that one out of five surveyed Asian Americans aged less than 51 years old, was classified to be underweight. Increased mortality was observed to be associated with underweight in Flegal's study (Flegal et al., 2005). The cut-off value of underweight should be adjusted more accurately to measure the underweight risk for Asians.</p> <p>In the current report, the prevalence of overweight/obesity and obesity based on WHO global BMI cutoffs found in 149 Asian American college students (total young subjects) were only 8.7% and 0.7%, respectively (Figure 1A and 1B). When compared to the latest national surveyed BMI data, the prevalence of overweight/obesity and obesity in 20 to 39-year-old Americans (the mean age of our young subjects was 23.5 years) were 57.1% and 28.5%, respectively (Ogden et al., 2006). Indeed, based on WHO global BMI cutoffs, the prevalence of overweight/obesity and obesity found in young Asian Americans in this study were lower than those of the average young Americans. The prevalence of overweight/obesity in total young Asian Americans based on the recommended BMI cutoffs for Asians was 18.1% (Figure 1A) and it was 2 times higher than that based on the global cutoffs (Figure 1A). The prevalence of obesity in total young Asian Americans based on the WHO recommended cutoffs for Asians was 2.7% (Figure 1B). This result implied that more Asian college students fell into the category of being overweight and obese. These findings would help Asian Americans to correct a false security regarding their BMIs based on 25 kg/m2 and 30 kg/m² as cut-off values.</p> <p>Based on BMI data, the epidemiological prevalence of overweight/obesity and obesity for Americans older than age 60 years were 71.0% and 31.0%, respectively (Ogden et al., 2006). In this study, the prevalence of overweight/obesity and obesity for total old Asian Americans (students' older parents, mean age was 60.7 years), were 32.1% and 0.0%, respectively based on WHO global cutoffs. It was noteworthy that there were 52.6% and 12.8%, respectively, based on WHO recommended cutoffs for Asians in this study (Figure 1A and Figure 1B). If one takes WHO global cutoffs (BMI of 25 kg/m² and of 30 kg/m²) as a guideline to estimate older Asian Americans in this study, 20% of these older subjects could not be considered as being overweight/obese and about 13% of the older subjects could not be considered as being obese. (Figures 1A and 1B).</p> <p>After adjusted for age, gender and ethnicity, the prevalence of overweight/obesity based on recommended criteria for Asians (BMI of 23) was 2 times higher than that based on global criteria in total Chinese American group (Figure 2A), as well as in young and in old Chinese American group (Figure 3A), and in male Chinese American group (Figure 4A). Likewise, it was 4 times higher in young Vietnamese American group (Figure 3A) and 3 times higher in female Japanese American group (Figure 4A) when compared to BMI of 25 kg/m² as base.</p> <p>In addition, the 4% obese cases in total female Asian American group (Figure 1B), 9.6% in total Vietnamese American group and 9.5% in total Japanese American group (Figure 2B), 8% obese cases in old Chinese American group, 22.7% in old Vietnamese American group, 6.7% in young Japanese American group and 6.7% obese cases in old Japanese American group (Figure 3B) and 30% obese cases in male Vietnamese American group, 4.8% in female Vietnamese American group, 10% in male Japanese American group and 9.1% in female Japanese American group (Figure 4B) were observed based on WHO recommended BMI criteria for Asians. All these identifiable cases of obesity would have been totally neglected if one takes WHO global cutoffs to estimate the prevalence of obesity in the aforementioned Asian American subjects.</p> <p>The calculation of BMI is based on the body weight and body height factors. From our laboratory, with respect to body weight gain and in Liang's current study (Liang et al., 2006), college students were found to spend most time on reading, eating, writing, sleeping, sitting and not exercising during a day and they generally live a sedentary lifestyle. There was a concern about their body weight gains. Moreover, with reference to Wu-Tso's study (Wu-Tso et al., 1995), young Asian college students were used to dining out and their food choices were relatively westernized, they ate foods that were higher in saturated fat and in cholesterol contents. This westernized lifestyle and dietary patterns may explain in part Lauderdale and Rathouz's findings (Lauderdale and Rathouz, 2000) which demonstrated the effect of nativity and years since immigration being on overweight and obesity. Indeed, physical inactivity and westernized dietary habit are the two insidious factors of danger to the health of Asian college students living in the U.S.</p> <p>Asian Americans were found to have 60% higher in prevalency of having diabetes than those of non-Hispanic whites, after adjustment by lower BMI for Asians (McNeely and Boyko, 2004). With richly acquired evidences, Asians were also demonstrated to have less insulin sensitivity than those of Caucasians (Torrens et al., 2004; Dickinson et al., 2002; Lear et al., 2002; Chiu et al., 2000). According to "Heart disease and stroke statistics" (American Heart Association, 2004), nearly 65% of diabetic patients died by heart disease and stroke. Uncontrolled or poorly controlled diabetes are prone to develop hypertension, hypercholesterolemia and cardiovascular disease. If WHO cutoffs for global use were employed as a guideline, it would misguide nearly 10% (Figure 1A) of the Asian American college students to underestimate the risk of being overweight/obesity and same, it would misguide nearly 2% (Figure 1B) of the young Asian College students to underestimate their risks of being obese. For Asian Americans, this situation could create a public health loophole in the prevention of chronic diseases, such as hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and endometrial, breast, prostate, colon cancers (National Heart Lung and Blood Institute, 2000; Klein et al., 2004) and even mental illness (Kottke et al., 2003) because overweight and obesity were linked to all of the aforementioned diseases.</p> <p>In addition, 101 out of 149 (67.8%) Asian American college students recruited in this study were females. Asian women were observed to have higher incidence of gestational diabetes mellitus than those of Caucasians (Ben-Haroush et al., 2004; Gunton et al., 2001) regardless Asian women had lower BMIs. Asian women were found to have increased insulin resistance during late pregnancy (Retnakaran et al., 2006). The 1990 Committee on Nutritional Status during Pregnancy and Lactation, under the Food and Nutrition Board of the Institute of Medicine, the National Academy of Sciences, advised different weight gain for pregnant women based on their pre-maternal BMI values. If young female Asians do not have accurate BMI evaluations for their risks of being overweight and obese, the prevention of gestational diabetes in Asian women could not be possible or effective.</p> <p>This current study provided a clear view to examine the differences of prevalence of overweight/obesity and obesity using two WHO BMI criteria among Asian Americans. Using WHO recommended BMI cutoffs for Asians, the significant aim of this study was therefore to provide evidences regarding identifying more overweight/obese and obese cases among Asian American ethnic subgroups (Chinese, Vietnamese and Japanese) as to correct a false security using WHO global BMI of 25 kg/m² and 30 kg/m² as cutoffs for these Asians. The findings also contributed valuable information to the possibly existed flaw in public health policy for Asians. The issue discussed in this study would be more important in the near future since US-born Asians and new Asian immigrants had grown rapidly in the U.S (U.S Census Bureau Population Estimates Program, 2003), and evidently overweight and obesity had been a growing public health problem in the U.S. (Wyatt et al., 2006). The comorbid conditions of overweight and obesity were the most costly based on health care budgets and public health resources (Friedman and Fanning, 2004). It was noteworthy that approximately 5.7% to 9.1% of the total US health care expenditures were consumed by overweight/obesity comorbid diseases (McTigue et al., 2003). With respect to the growing populations of Asians living in the U.S., BMI cut-off values should therefore be more specifically tailored for Asian Americans when making public health policy and implementing public health intervention plan in order to effectively prevent obesity-related diseases in these populations.</p> <hd id="AN0026885992-5">Table 1. Asian American Subject Characteristics shown by Age, Gender and Ethnicity</hd> <ct id="AN0026885992-6"> Legend for Chart: A - Sample Size B - Age (y)(2) C - Height (cm)(2) D - Weight (kg)(2) E - BM (1),(2) A B C D E Chinese Americans Total 154 35.5±18.4 162.84±8.3 57.3±9.9 21.6±3.1 Young (<51y) 104 23.6±5.0 164.3±7.9 56.5±10.0 20.9±2.8 Old (≥51y) 50 60.4±8.3 159.8±8.3 59.0±9.7 23.1±3.2 Male 58 36.8±18.0 169.3±7.7 65.8±9.0 23.0±3.1 Female 96 34.7±18.7 159.0±5.8 52.2±6.3 20.7±2.7 Vietnamese Americans Total 52 39.4±20.2 157.4±7.4 53.4±10.8 21.5±3.5 Young (<51y) 30 23.3±4.9 158.2±6.1 50.5±7.3 20.1±2.4 Old (≥51y) 22 61.3±9.3 156.3±8.9 57.4±13.5 23.3±4.0 Male 10 49.1±18.5 163.4±4.8 66.54±10.6 24.8±3.6 Female 42 37.1±20.1 155.9±7.2 50.3±8.3 20.7±3.0 Japanese Americans Total 21 34.1±17.9 165.6±9.3 63.8±12.9 23.1±3.3 Young (<51y) 15 23.4±3.4 166.6±9.0 63.0±11.7 22.6±3.2 Old (≥51y) 6 60.8±7.4 163.0±10.3 66.0±16.7 24.4±3.3 Male 10 33.7±15.3 173.0±6.2 74.0±9.9 24.7±3.1 Female 11 34.5±20.8 158.9±5.9 54.6±7.0 21.7±2.8 (1.) Body mass index was calculated as weight in kilograms divided by the square of height in meters. (2.) Age, height, weight and BMI were described as mean ± SD.</ct> <hd id="AN0026885992-7">Table 2.</hd> <ct id="AN0026885992-8"> Prevalence of Underweight, Overweight/Obesity and Obesity for Chinese, Vietnamese and Japanese Americans in adults (≥ 18 y) by Age, Gender and Ethnicity (WHO Global BMI Cutoffs(1)) Legend for Chart: A - Underweight(%) B - Overweight/Obesity (%)(2) C - Obesity (%)(3) A B C D Total (N=227) 14.5 16.7 0.4 Young (< 51y, N=149) 19.5 8.7 0.7 Old (≥ 51y, N=78) 5.1 32.1 0.0 Male (N=78) 3.8 30.8 1.3 Female (N=149) 20.1 9.4 0.0 Chinese Americans Total (N=154) 14.9 14.3 0.6 Young (< 51y, N=104) 20.2 7.7 1.0 Old (≥ 51y, N=50) 4.0 28.0 0.0 Male (N=58) 3.4 22.4 1.7 Female (N=96) 21.9 9.4 0.0 Vietnamese Americans Total (N=52) 17.3 17.3 0.0 Young (<51y, N=30) 23.3 3.3 0.0 Old (≥ 51y, N=22) 9.1 36.4 0.0 Male (N=10) 10.0 50.0 0.0 Female (N=42) 19.0 9.5 0.0 Japanese Americans Total (N=21) 4.8 33.3 0.0 Young (< 51y, N=15) 6.7 26.7 0.0 Old (≥ 51y, N=6) 0.0 50.0 0.0 Male (N=I0) 0.0 60.0 0.0 Female (N=11) 9.1 9.1 0.0 (1.) WHO cutoffs = BMI < 18.5 kg/m², Underweight; BMI ≥ 25 kg/m², Overweight; BMI 7ge; 30 kg/m², Obesity (2.) Defined as BMI of 25 kg/m² or higher (3.) Defined as BMI of 30 kg/m² or higher</ct> <hd id="AN0026885992-9">Table 3.</hd> <ct id="AN0026885992-10"> Prevalence of Underweight, Overweight/Obesity and Obesity for Chinese Americans, Vietnamese Americans and Japanese Americans in adults (≥ 18 y) by Age, Gender and Ethnicity (WHO Recommended BMI Cutoffs for Asians (1)) Legend for Chart: A - Underweight(%) B - Overweight/Obesity (%)(2) C - Obesity (%)(3) A B C Total (N=227) 14.5 30.0 6.2 Young (< 51y, N=149) 19.5 18.1 2.7 Old (< 51y, N=78) 5.1 52.6 12.8 Male (N=78) 3.8 52.6 10.3 Female (N=149) 20.1 18.1 4.0 Chinese Americans Total (N=154) 14.9 29.2 4.5 Young (< 51y, N=104) 20.0 16.3 2.9 Old (< 51y, N=50) 4.0 56.0 8.0 Male (N=58) 3.4 46.6 6.9 Female (N=96) 21.9 18.8 3.1 Vietnamese Americans Total (N=52) 17.3 25.0 9.6 Young (< 51y, N=30) 23.3 13.3 0.0 Old (< 51y, N=22) 9.1 40.9 22.7 Male (N=10) 10.0 70.0 30.0 Female (N=42) 19.0 14.3 4.8 Japanese Americans Total (N=21) 4.8 47.6 9.5 Young (< 51y, N=15) 6.7 40.0 6.7 Old (< 51y, N=6) 0.0 66.7 6.7 Male (N=10) 0.0 70.0 10.0 Female (N=11) 9.1 27.3 9.1 (1.) Recommended cutoffs for Asians = BMI < 18.5 kg/m², Underweight; BMI ≥ 23 kg/m², Overweight; BMI ≥ 27.5 kg/m², Obesity (2.) Defined as BMI of 23 kg/m² or higher (3.) Defined as BMI of 27.5 kg/m² or higher</ct> <hd id="AN0026885992-11">Figure 1A.</hd> <ct id="AN0026885992-12"> By Age and Gender, a Comparison of Prevalence of Overweight/ Obesity in Total Asian Americans with Different BMI Cutoffs (WHO Global Cutoffs, BMI ≥ 25 kg/m² vs. WHO Recommended Cutoffs for Asians, BMI ≥ 23 kg/m²) Prevalence of overweight/obesity(%) Age and Gender overweight/obesity overweight/obesity (BMI_ 25) (BMI_ 23) TAA 16.7 30 TYAA 8.7 18.1 TOAA 32.1 52.6 TMAA 30.8 52.6 TFAA 9.4 18.1</ct> <hd id="AN0026885992-13">Figure 1B.</hd> <ct id="AN0026885992-14"> By Age and Gender, a Comparison of Prevalence of Obesity in Total Asian Americans with Different BMI Cutoffs (WHO Global Cutoffs, BMI ≥ 30 kg/m² vs. WHO Recommended Cutoffs for Asians, BMI ≥ 27.5 kg/m²) Prevalence of obesity(%) Age and Gender obesity obesity (BMI_ 30) (BMI_ 27.5) TAA 0.4 6.2 TYAA 0.7 2.7 TOAA 0 12.8 TMAA 1.3 10.3 TFAA 0 4</ct> <hd id="AN0026885992-15">Figure 2A.</hd> <ct id="AN0026885992-16"> By Ethnicity, a Comparison of Prevalence of Overweight/Obesity among Three Asian American Groups with Different BMI Cutoffs (WHO Global Cutoffs, BMI ≥ 25 kg/m² vs. WHO Recommended Cutoffs for Asians. BMI ≥ 23 kg/m²) Prevalence of overweight/obesity(%) Ethnicity overweight/obesity overweight/obesity (BMI_ 25) (BMI_ 23) TCA 14.3 29.2 TVA 17.3 25 TJA 33.3 47.6</ct> <hd id="AN0026885992-17">Figure 2B.</hd> <ct id="AN0026885992-18"> By Ethnicity, a Comparison of Prevalence of Obesity among Three Asian American Groups with Different BMI Cutoffs (WHO Global Cutoffs, BMI ≥ 30 kg/m² vs. WHO Recommended Cutoffs for Asians, BMI ≥ 27.5 kg/m²) Prevalence of obesity(%) Ethnicity obesity obesity (BMI_ 30) (BMI_ 27.5) TCA 0.6 4.5 TVA 0 9.6 TJA 0 9.5</ct> <hd id="AN0026885992-19">Figure 3A.</hd> <ct id="AN0026885992-20"> By Age and Ethnicity, a Comparison of Prevalence of Overweight/ Obesity among Chinese, Vietnamese and Japanese Americans with Different BMI Cutoffs (WHO Global Cutoffs, BMI ≥ 25 kg/m² vs. WHO Recommended Cutoffs for Asians, BMI ≥ 23 kg/m²) Prevalence of overweight/obesity(%) Age and Ethnicity overweight/obesity overweight/obesity (BMI_ 25) (BMI_ 23) YCA 7.7 16.3 OCA 28 56 YVA 3.3 13.3 OVA 36.4 40.9 YJA 26.7 40 OJA 50 66.7</ct> <hd id="AN0026885992-21">Figure 3B.</hd> <ct id="AN0026885992-22"> By Age and Ethnicity, a Comparison of Prevalence of Obesity among Chinese, Vietnamese and Japanese Americans with Different BMI Cutoffs (WHO Global Cutoffs, BMI ≥ 30 kg/m² vs. WHO Recommended Cutoffs for Asians, BMI ≥ 27.5 kg/m²) Prevalence of obesity(%) Age and Ethnicity obesity obesity (BMI_ 30) (BMI_ 27.5) YCA 1 2.9 OCA 0 8 YVA 0 0 OVA 0 22.7 YJA 0 6.7 OJA 0 6.7</ct> <hd id="AN0026885992-23">Figure 4A.</hd> <ct id="AN0026885992-24"> By Gender and Ethnicity, a Comparison of Prevalence of Overweight/Obesity among Chinese, Vietnamese and Japanese Americans with Different BMI Cutoffs (WHO Global Cutoffs, BMI ≥ 25 kg/m2 vs. WHO Recommended Cutoffs for Asians, BMI > 23 kg/m²) Prevalence of overweight/obesity (%) Gender and Ethnicity overweight/obesity overweight/obesity (BMI_ 25) (BMI_ 23) MCA 22.4 46.6 FCA 9.4 18.8 MVA 50 70 FVA 9.5 14.3 MJA 60 70 FJA 9.1 27.3</ct> <hd id="AN0026885992-25">Figure 4B.</hd> <ct id="AN0026885992-26"> By Gender and Ethnicity, a Comparison of Prevalence of Obesity among Chinese, Vietnamese and Japanese Americans with Different BMI Cutoffs (WHO Global Cutoffs, BMI ≥ 30 kg/m² vs. WHO Recommended Cutoffs for Asians, BMI ≥ 27.5 kg/m²) Prevalence of obesity(%) Gender and Ethnicity obesity obesity (BMI_ 30) (BMI_ 27.5) MCA 1.7 6.9 FCA 0 3.1 MVA 0 30 FVA 0 4.8 MJA 0 10 FJA 0 9.1</ct> <p>GRAPH: Figure 1A</p> <p>GRAPH: Figure 1B</p> <p>GRAPH: Figure 2A</p> <p>GRAPH: Figure 2B</p> <p>GRAPH: Figure 3A</p> <p>GRAPH: Figure 3B</p> <p>GRAPH: Figure 4A</p> <p>GRAPH: Figure 4B</p> <ref id="AN0026885992-27"> <title> References </title> <blist> <bibl id="bib1" type="bt"></bibl> <bibtext>American Heart Association, (2004). Heart dis ease and stroke statistics-2004 update. Dallas TX: American Heart Association.</bibtext> </blist> <blist> <bibl id="bib2" type="bt"></bibl> <bibtext>Ben-Haroush, A., Yogev, Y., Hod, M., (2004). Epidemiology of gestational diabetes mellitus and its association with type 2 diabetes. Diabetic Medicine, 21, 103-13.</bibtext> </blist> <blist> <bibl id="bib3" type="bt"></bibl> <bibtext>Chiu, K.C., Cohan, P., Lee, N.P., Chuang, L.M., (2000). Insulin sensitivity differs among ethnic groups with a compensatory response in cell function. Diabetes Care, 23, 1353-8.</bibtext> </blist> <blist> <bibl id="bib4" type="bt"></bibl> <bibtext>Deurenberg-Yap, M., Chew, S.K., Deurenberg, P., (2002). Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians. Obesity Reviews, 3, 209-15.</bibtext> </blist> <blist> <bibl id="bib5" type="bt"></bibl> <bibtext>Deurenberg-Yap, M., Deurenberg, P.,(2003). Is a re-evaluation of WHO body mass index cut off values needed? The case of Asians in Singapore. Nutrition Reviews, 61 (5), 80-7.</bibtext> </blist> <blist> <bibl id="bib6" type="bt"></bibl> <bibtext>Dey, D.K., Rothenberg, E., Sundh, V., Bosaeus, I., Steen, B., (2002). Waist circumference, body mass index, and risk for stroke in older people: a 15 year longitudinal population study of 70-year-olds. Journal of the American Geriatrics Society, 50, 1510-8.</bibtext> </blist> <blist> <bibl id="bib7" type="bt"></bibl> <bibtext>Dickinson, S., Colagiuri, S., Faramus, E., Petocz, P., Brand-Miller, J.C., (2002). Postprandial hyperglycemia and insulin sensitivity differ among lean young adults of different ethnicities. The Journal of Nutrition, 132, 2574-9.</bibtext> </blist> <blist> <bibl id="bib8" type="bt"></bibl> <bibtext>Flegal, K.M., Graubard, B.I., Williamson, D.F., Gail, M.H., (2005). Excess deaths associated with underweight, overweight, and obesity. Journal of American Medical Association, 293(15), 1861-67.</bibtext> </blist> <blist> <bibl id="bib9" type="bt"></bibl> <bibtext>Friedman, N., Fanning, E.L., (2004). Overweight and obesity: an overview of prevalence, clinical impact, and economic impact. Disease Management, 7(Suppl 1), S1-6.</bibtext> </blist> <blist> <bibl id="bib10" type="bt"></bibl> <bibtext>Gallagher, D., Heymsfield, S.B., Heo, M., Jebb, S.A., Murgatroyd, P.R., Sakamoto, Y., (2000). Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. The American Journal of Clinical Nutrition, 72, 694-701.</bibtext> </blist> <blist> <bibl id="bib11" type="bt"></bibl> <bibtext>Goh, V.H.H., Tain, C.F., Tong, Y.Y., Mok, H.P.P., Wong, M.T., (2004). Are BMI and other anthropometric measures appropriate as indices for obesity? A study in an Asian population. Journal of Lipid Research, 45, 1892-8.</bibtext> </blist> <blist> <bibl id="bib12" type="bt"></bibl> <bibtext>Gu, D., He, J., Duan, X., Reynolds, K., Wu, X., Chen, J., Huang, G., Chen, C.S., Whelton, P.K., (2006). Body weight and mortality among men and women in China. Journal of American Medical Association, 295(7), 776-83.</bibtext> </blist> <blist> <bibl id="bib13" type="bt"></bibl> <bibtext>Gunton, J.E., Hitchman, R., McElduff, A., (2001). Effects of ethnicity on glucose tolerance, insulin resistance and cell function in 223 women with an abnormal glucose challenge test during pregnancy. The Australian & New Zealand journal of obstetrics & gynaecology, 41, 182-6.</bibtext> </blist> <blist> <bibl id="bib14" type="bt"></bibl> <bibtext>He, M., Tan, K.C., Li, E.T., Kung A.W., (2001). Body fat determination by dual energy X-ray absorptiometry and its relation to body mass index and waist circumference in Hong Kong Chinese. International journal of obesity and related metabolic disorders, 25, 748-52.</bibtext> </blist> <blist> <bibl id="bib15" type="bt"></bibl> <bibtext>Horie, N., Komiya, H., Mori, Y., Tajima, N., (2006). New body mass index criteria of central obesity for male Japanese. The Tohoku journal of experimental medicine, 208, 83-6.</bibtext> </blist> <blist> <bibl id="bib16" type="bt"></bibl> <bibtext>Klein, S., Burke, L.E., Bray, G.A., Blair, S., Allison, D.B., Pi-Sunyer, X., Hong, Y., Eckel, R.H., (2004). Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism; endorsed by the American College of Cardiology Foundation. Circulation, 110, 2952-67.</bibtext> </blist> <blist> <bibl id="bib17" type="bt"></bibl> <bibtext>Kottke, T.E., Wu, L.A., Hoffman, R.S., (2003). Economic and psychological implications of the obesity epidemic. Mayo Clinic proceedings, 78, 92-4.</bibtext> </blist> <blist> <bibl id="bib18" type="bt"></bibl> <bibtext>Kushner, R.F., Blatner, D.J., (2005). Risk assessment of the overweight and obese patient. Journal of the American Dietetic Association, 105(5), 53-61.</bibtext> </blist> <blist> <bibl id="bib19" type="bt"></bibl> <bibtext>Kurth, T., Gaziano, JM., Berger, K., kase, C.S., Rexrode, K.M., Cook, N.R., Buring, J.E., Mansor, J.E., (2002). Body mass index and the risk of stroke in men. Archives of Internal Medicine, 162, 2557-62.</bibtext> </blist> <blist> <bibl id="bib20" type="bt"></bibl> <bibtext>Kurth, T., Gaziano, JM., Berger, K., Kase, C.S., Cook, N.R., Manson, J.E., Buring, J.E., (2005). Prospective study of body mass index and risk of stroke in apparently healthy women. Circulation, 111(15), 1992-8.</bibtext> </blist> <blist> <bibl id="bib21" type="bt"></bibl> <bibtext>Lauderdale, D.S., Rathouz, P.J., (2000). Body mass index in a US national sample of Asian Americans: effects of nativity, years since immigration and socioeconomic status. Inter national Journal of Obesity, 24, 1188-94.</bibtext> </blist> <blist> <bibl id="bib22" type="bt"></bibl> <bibtext>Lear, S., Chen, M., Frohlich, J., Birmingham, C.L., (2002). The relationship between waist circumference and metabolic risk factors: cohorts of European and Chinese descent. Metabolism, 51, 1427-32.</bibtext> </blist> <blist> <bibl id="bib23" type="bt"></bibl> <bibtext>Liang, Y., Keating, X.D., Lee, J., Bridges, E., Tam, C.F., (2006). A two-generation study of body mass index, energy balance and specific physical activity of college students and their respective parents living in the same house hold at Los Angeles, California, U.S.A. College Student Journal, in press.</bibtext> </blist> <blist> <bibl id="bib24" type="bt"></bibl> <bibtext>McNeely, M.J., Boyko, D.J., (2004). Type 2 diabetes prevalence in Asian Americans. Diabetes Care, 27(1), 66-9.</bibtext> </blist> <blist> <bibl id="bib25" type="bt"></bibl> <bibtext>McTigue, K.M., Harris, R., Hemphill, B., Lux, L., Sutton, S., Bunton, A.J., Lohr, K.N., (2003). Screening for obesity in adults: summary of the evidence for the US Preventive Services Task Force. Rockville, MD, Agency for Health Care Research and Quality.</bibtext> </blist> <blist> <bibl id="bib26" type="bt"></bibl> <bibtext>Moon, O.R., Kim, N.S., Jang, S.M., Yoon, T.H., Kim, S.O., (2002). The relationship between body mass index and the prevalence of obesity-related diseases based on the 1995 National Health Interview Survey in Korea. Obesity Reviews, 3, 191-6.</bibtext> </blist> <blist> <bibl id="bib27" type="bt"></bibl> <bibtext>National Heart Lung and Blood Institute, (2000). The Clinical Guide: identification, evaluation, and treatment of overweight and obesity in adults. Washington, DC: National Institutes of Health. Available from <ulink href="http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm">http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm</ulink>.</bibtext> </blist> <blist> <bibl id="bib28" type="bt"></bibl> <bibtext>Ogden, C.L., Carroll, M.D., Curtin, L.R., McDowell, M.A., Tabak, C.J., Flegal, K.M., (2006). Prevalence of overweight and obesity in the United States, 1999-2004. Journal of American Medical Association, 295(13), 1549-55.</bibtext> </blist> <blist> <bibl id="bib29" type="bt"></bibl> <bibtext>Pan, W.H., Flegal, K.M., Chang, H.Y., Yeh, W.T., Yeh, C.J., Lee, W.C., (2004). Body mass index and obesity-related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians. American Journal of Clinical Nutrition, 79, 31-9.</bibtext> </blist> <blist> <bibl id="bib30" type="bt"></bibl> <bibtext>Retnakaran, R., Hanley, A.J.G., Connelly, P.W., Sermer, M., Zinman, B., (2006). Ethnicity modifies the effect of obesity on insulin resistance in pregnancy: a comparison of Asian, south Asian and Caucasian women. The journal of Clinical Endocrinology & Metabolism, 91(1), 93-7.</bibtext> </blist> <blist> <bibl id="bib31" type="bt"></bibl> <bibtext>Stevens, J., Cai, J., Evenson, K.R., Thomas, R., (2002). Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. American Journal of Epidemiology, 156, 832- 41.</bibtext> </blist> <blist> <bibl id="bib32" type="bt"></bibl> <bibtext>Stevens, J., Nowicki, E.M., (2003). Body mass index and mortality in Asian populations: implications for obesity cut-points. Nutrition Reviews, 61, 104-107.</bibtext> </blist> <blist> <bibl id="bib33" type="bt"></bibl> <bibtext>Torrens, J.I., Skurnick, J., Davidow, A.L., Koren man, S.G., Santoro, N., Soto-Greene, M., Lasser, N., Weiss, G., (2004). Ethnic differences in insulin sensitivity and cell function in premenopausal or early perimenopausal women without diabetes: the Study of Women's Health Across the Nation (SWAN). Diabetes Care, 27, 354-61.</bibtext> </blist> <blist> <bibl id="bib34" type="bt"></bibl> <bibtext>U. S. Census Bureau Population Estimates Pro gram, Profiles of General Demographic Characteristics (2003): National summary: 2000 census of population and housing, 2001. Available from <ulink href="http://www2.census.gov/census_2000/datasets/demographi">http://www2.census.gov/census_2000/datasets/demographi</ulink> c_profile/0_National _Summary/2khus.pdf. Accessed 14 July 2003</bibtext> </blist> <blist> <bibl id="bib35" type="bt"></bibl> <bibtext>WHO: Obesity: preventing and managing the glob al epidemic, (1998). Report of a WHO consultation of obesity, Geneva, 1997, World Health Organization. Obesity Research, 6, 51-210.</bibtext> </blist> <blist> <bibl id="bib36" type="bt"></bibl> <bibtext>WHO: The World Health Organization Western Pacific Region, (2000). The International Association for the Study of Obesity; The International Obesity Task Force. The Asia Pacific Perspective: Redefining Obesity and Its Treatment. Sydney, Australia: Health Communications Australia Pty Limited.</bibtext> </blist> <blist> <bibl id="bib37" type="bt"></bibl> <bibtext>WHO expert consultation (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, (363), 157-63</bibtext> </blist> <blist> <bibl id="bib38" type="bt"></bibl> <bibtext>Wildman, R.P., Gu, D., Reynolds, K., Duan, X., He, J., (2004). Appropriate body mass index and waist circumference cutoffs for categorization of overweight and central adiposity among Chinese adults. American Journal of Clinical Nutrition, 80, 1129-36.</bibtext> </blist> <blist> <bibl id="bib39" type="bt"></bibl> <bibtext>Wildman, R.P., Gu, D., Reynolds, K., Duan, X., He, J., (2005). Are waist circumference and body mass index independently associated with cardiovascular disease risk in Chinese adults? American Journal of Clinical Nutrition, 82, 1195-202.</bibtext> </blist> <blist> <bibl id="bib40" type="bt"></bibl> <bibtext>Wilson, P.W., D'Agostino, R.B., Sullivan, L., Parise, H., Kannel, W.B., (2002). Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Archives Internal Medicine, 162, 1867-72.</bibtext> </blist> <blist> <bibl id="bib41" type="bt"></bibl> <bibtext>Wu-Tso, P., Yeh, I., Tam, C.F., (1995). Comparisons of dietary intake in young and old Asian Americans: a two-generation study. Nutrition Research, 15, 1445-62.</bibtext> </blist> <blist> <bibl id="bib42" type="bt"></bibl> <bibtext>Wyatt, S.B., Winters, K.P., Dubbert, P.M., (2006). Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. The American Journal of the Medical Science, 331(4), 166-74.</bibtext> </blist> <blist> <bibl id="bib43" type="bt"></bibl> <bibtext>Yeh, W.T., Chang, H.Y., Yeh, C.J., Tsai, K.S., Chen, H.J., Pan, W.H., (2005). Do centrally obese Chinese with normal BMI have increased risk of metabolic disorders? Inter national Journal of Obesity, 29, 818-25.</bibtext> </blist> <blist> <bibl id="bib44" type="bt"></bibl> <bibtext>Zhou, B.F., Cooperative Meta-Analysis Group of the Working Group on Obesity in China, (2002). Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults--study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomedical and Environmental Sciences, 15, 83-95.</bibtext> </blist> </ref> <aug> <p>By Li Hui Wang, School of Kinesiology and Nutritional Science, California State University at Los Angeles, 5151 State University Dr., Los Angeles CA 90032; Ying Chang Chen, Keck School of Medicine, Department of Preventive Medicine, University of Southern California, 1975 Zonal Ave., KAM500, Los Angeles, CA 90089; Angela Ka Chung, School of Kinesiology and Nutritional Science, California State University at Los Angeles 5151 State University Dr., Los Angeles CA 90032; George Poon, Chinatown Senior Citizen Service Center, 600 N. Broadway, Los Angeles, CA 90032; Polong Lew, Chinatown Senior Citizen Service Center 600 N. Broadway, Los Angeles, CA 90032 and Chick F. Tam, School of Kinesiology and Nutritional Science, California State University at Los Angeles, 5151 State University Dr., Los Angeles CA 90032</p> </aug>
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  Data: Age, Gender and Ethnic Differences in Prevalence of Overweight and Obesity in Asian American College Students and Their Parents Using Different BMI Cutoffs
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  Group: Date
  Data: 2007
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Obesity%22">Obesity</searchLink><br /><searchLink fieldCode="DE" term="%22Incidence%22">Incidence</searchLink><br /><searchLink fieldCode="DE" term="%22Public+Health%22">Public Health</searchLink><br /><searchLink fieldCode="DE" term="%22Asian+Americans%22">Asian Americans</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Body+Weight%22">Body Weight</searchLink><br /><searchLink fieldCode="DE" term="%22Ethnicity%22">Ethnicity</searchLink><br /><searchLink fieldCode="DE" term="%22Parents%22">Parents</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+Criteria%22">Evaluation Criteria</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22California%22">California</searchLink>
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0146-3934
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The objective was to determine if the WHO global BMI (kg/m[squared]) cutoffs for determining overweight and obesity in the general populations are appropriate for Asian populations and to consider whether population-specific cutoffs would be warranted. A nonrandomized biased sampling of 227 Asian Americans were composed of 149 college students, including 104 Chinese, 30 Vietnamese and 15 Japanese, enrolled in California State University at Los Angeles and 78 of their parents to examine the differences of prevalence of overweight and obesity based on two BMI cutoffs: (I) WHO global cutoffs, overweight BMI greater than or equal to 25, obesity: BMI greater than or equal to 30, and (II) WHO recommended cutoffs for Asians, overweight: BMI greater than or equal to 23, obesity: BMI greater than or equal to 27.5. The prevalence of overweight/obesity based on (II) were 2 times higher than those based on (I) in total young Asians, total Chinese, and in young, old, male Chinese. It was 4 times higher in young Vietnamese and 3 times higher in female Japanese. The prevalence of obesity was also fairly different using these two criteria. This study identified potential BMI cutoffs to consider for these Asians and established that the WHO cutoffs for Asians should be taken into consideration when making public health policy for these populations. (Contains 3 tables and 8 figures.)
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: Author
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 44
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2007
– Name: URL
  Label: Access URL
  Group: URL
  Data: <link linkTarget="URL" linkTerm="https://www.projectinnovation.biz/csj.html" linkWindow="_blank">http://www.projectinnovation.biz/csj.html</link>
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ777965
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ777965
RecordInfo BibRecord:
  BibEntity:
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 18
        StartPage: 583
    Subjects:
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Obesity
        Type: general
      – SubjectFull: Incidence
        Type: general
      – SubjectFull: Public Health
        Type: general
      – SubjectFull: Asian Americans
        Type: general
      – SubjectFull: Age Differences
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Body Weight
        Type: general
      – SubjectFull: Ethnicity
        Type: general
      – SubjectFull: Parents
        Type: general
      – SubjectFull: Evaluation Criteria
        Type: general
      – SubjectFull: California
        Type: general
    Titles:
      – TitleFull: Age, Gender and Ethnic Differences in Prevalence of Overweight and Obesity in Asian American College Students and Their Parents Using Different BMI Cutoffs
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Wang, Li Hui
      – PersonEntity:
          Name:
            NameFull: Chen, Ying Chang
      – PersonEntity:
          Name:
            NameFull: Ka Chung, Angela
      – PersonEntity:
          Name:
            NameFull: Poon, George
      – PersonEntity:
          Name:
            NameFull: Lew, Polong
      – PersonEntity:
          Name:
            NameFull: Tam, Chick F.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 09
              Type: published
              Y: 2007
          Identifiers:
            – Type: issn-print
              Value: 0146-3934
          Numbering:
            – Type: volume
              Value: 41
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: College Student Journal
              Type: main
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