title: The association of body mass index with health-related quality of life: an exploratory study in a multiethnic Asian population.
abstract: OBJECTIVE
  To evaluate the association between body mass index (BMI) and health-related quality of life (HRQoL) in a multiethnic Asian population in Singapore, and to explore if the World Health Organization (WHO) recommendation of alternative BMI cutoffs for Asians could be further strengthened by evidence of higher risk of impaired HRQoL using these criteria.
  
  
  METHODS
  Consenting English, Chinese, Malay and Tamil-speaking primary care patients (age >or= 21 years) were interviewed using English/their respective mother tongue versions of the EQ-5D/EQ-VAS, Health Utilities Index (HUI2 & HUI3) and the SF-6D. We first evaluated the relationship between BMI and HRQoL (overall and individual attributes for each instrument) using multiple linear/logistic regression (where appropriate) to adjust for factors known to affect HRQoL. We next reorganized BMI into five categories (reflecting the differences in cutoffs between International/Asian classifications) and evaluated if median HRQoL scores were significantly different across these categories.
  
  
  RESULTS
  Among 411 participants [response rate: 87%; median age: 51 years; obese: 19% (International); 33% (Asian)], after adjusting for sociodemographic and other factors, a tendency for underweight and obese subjects to report lower overall HRQoL scores was observed for most instruments. At the individual attribute level, obese subjects reported significantly lower HUI2 pain scores (regression coefficient: -0.035, P = 0.029) and greater odds of reporting problems for SF-6D role-limitations (odds ratio: 2.9, P = 0.005). Median overall HRQoL scores were not significantly different across the five BMI categories.
  
  
  CONCLUSIONS
  Consistent with available studies, obese subjects reported worse HRQoL than normal-weight subjects. That underweight subjects also reported worse HRQoL is interesting and requires confirmation. HRQoL was similar in Asians using either WHO criteria.
authors.affiliation: Department of Rheumatology and Immunology, Singapore General Hospital, Singapore.
authors.forename: Hwee-Lin
authors.initials: HL
authors.lastname: Wee
authors.forename: Yin-Bun
authors.initials: YB
authors.lastname: Cheung
authors.forename: Wai-Chiong
authors.initials: WC
authors.lastname: Loke
authors.forename: Chee-Beng
authors.initials: CB
authors.lastname: Tan
authors.forename: Mun-Hong
authors.initials: MH
authors.lastname: Chow
authors.forename: Shu-Chuen
authors.initials: SC
authors.lastname: Li
authors.forename: Kok-Yong
authors.initials: KY
authors.lastname: Fong
authors.forename: David
authors.initials: D
authors.lastname: Feeny
authors.forename: David
authors.initials: D
authors.lastname: Machin
authors.forename: Nan
authors.initials: N
authors.lastname: Luo
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
mesh_terms: D044466:Asian People; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002681:China / Q000208:ethnology; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012044:Regression Analysis; D012846:Singapore; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires