title: Ethnic differences in the relationships between obesity and glucose-metabolic abnormalities: a cross-sectional population-based study.
abstract: OBJECTIVE
  To evaluate whether body mass index (BMI) and other anthropometric indices of visceral obesity vary by ethnic group in their distribution and their relationship to metabolic abnormalities.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Canadian men and women, aged 35-75 years, of South Asian (n=342), Chinese (n=317), European (n=326) and Aboriginal (n=301) descent were recruited using stratified random sampling.
  
  
  METHODS
  Anthropometric indices (BMI, waist to hip ratio (WHR) and waist circumference (WC)), metabolic markers (fasting glucose, HbA1c, the ratio of total cholesterol/HDL) and clinical markers (systolic blood pressure) were assessed.
  
  
  RESULTS
  In subjects with BMI<30 kg/m2, the mean marker levels in people with elevated WC (>88 cm in women, >102 cm in men) vs people with normal WC were 6.16 vs 5.34 mmol/l for fasting glucose, 6.05 vs 5.66% for HbA1c and 5.46 vs 4.68 for the ratio of total cholesterol to HDL (P<0.001 in each case). At nearly every given level of BMI, non-European ethnic groups displayed significantly higher marker levels than Europeans. For example, for a given BMI, age and sex, the difference between European and non-European groups in HbA1c levels was 0.53% (95% confidence interval (CI): 0.37-0.69) for South Asians, 0.37% (95% CI: 0.2-0.54) for Chinese and 0.95% (95% CI: 0.78-1.12) for Aboriginal People.
  
  
  CONCLUSIONS
  Uniform cut-points for the classification of obesity using BMI, WHR or WC result in marked variation in the levels of glucose-metabolic abnormalities between ethnic groups. Existing action thresholds for these anthropometric indices do not apply to non-European ethnic groups and warrant revision.
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton General Hospital, Hamilton, ON, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Razak
authors.forename: S
authors.initials: S
authors.lastname: Anand
authors.forename: V
authors.initials: V
authors.lastname: Vuksan
authors.forename: B
authors.initials: B
authors.lastname: Davis
authors.forename: R
authors.initials: R
authors.lastname: Jacobs
authors.forename: K K
authors.initials: KK
authors.lastname: Teo
authors.forename: S
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000328:Adult; D000368:Aged; D001210:Asia, Southeastern / Q000208:ethnology; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D001794:Blood Pressure; D015992:Body Mass Index; D002170:Canada; D002681:China / Q000208:ethnology; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003430:Cross-Sectional Studies; D005060:Europe / Q000208:ethnology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007198:Indians, North American; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000208:ethnology* / Q000378:metabolism*; D012015:Reference Standards; D013599:Systole
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002784:Cholesterol; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin