title: Prevalence of obesity and overweight, its clinical markers and associated factors in a high risk South-Asian population.
abstract: BACKGROUND
  Obesity is a global epidemic, which is a risk factor for cardiovascular diseases and metabolic abnormalities. It is measured by body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), body fat (BF) distribution and abdominal fat mass, each having its own merits and limitations. Variability in body composition between ethnic groups in South-Asians is significant and may not be truly reflected by BMI alone, which may result in misclassification. This study therefore, aims to determine the frequency of obesity, body fat composition and distribution, in a high risk population of an urban slum of Karachi, Pakistan. This survey included 451 participants selected by systematic sampling who were administered pre-tested questionnaires on socio-demographics, diet and physical activity. Chi-square was used to determine the association between categorical variables and multiple linear regression was used for quantitative variables. A P value of less than 0.05 was considered significant.
  
  
  RESULTS
  Classified by BMI, 29% study subjects were overweight and 21% obese (58.7% with central obesity). Body fat percent (BF%) classified 81% as overweight. Females were more obese (P 0.03) with higher prevalence of central obesity (P <0.001) and WHR (P 0.003) but with a lower muscle mass (P 0.001). Activity score and muscle mass showed inverse linear association with BF% whereas, WC, weight, BMI and WHR had a positive linear association with BF%. The relationship between BMI and BF% was quadratic with a weaker association at lower BMI. Adjusting for socio-demographic variables, BF%, weight, diastolic blood pressure (DBP), BMI and score on the diet questionnaire had a positive linear association with WC, while WC, WHR and BP had a positive linear association with BF%. BF%, muscle content and WC had a positive linear association with BMI.
  
  
  CONCLUSIONS
  Considering lower cut-offs for South-Asians BMI and WC, this study showed a high prevalence of obesity among a sub-urban population of Karachi, which was even higher when BF% was measured. Considering the rising prevalence of non-communicable diseases, BF%, WC, WHR and BMI measurements are convenient and feasible means of identifying population at risk and hence addressing it through public awareness and early detection.
authors.affiliation: Natural Product Research Unit, Department of Biological and Biomedical Sciences, The Aga Khan University Medical College, Karachi, 74800 Pakistan.
authors.forename: Faridah
authors.initials: F
authors.lastname: Amin
authors.affiliation: Department of Biological and Biomedical Sciences, The Aga Khan University Medical College, Karachi, 74800 Pakistan.
authors.forename: Syeda Sadia
authors.initials: SS
authors.lastname: Fatima
authors.affiliation: Department of Medicine, The Aga Khan University Medical College, Karachi, 74800 Pakistan.
authors.forename: Najmul
authors.initials: N
authors.lastname: Islam
authors.affiliation: Natural Product Research Unit, Department of Biological and Biomedical Sciences, The Aga Khan University Medical College, Karachi, 74800 Pakistan ; College of Health Sciences, Mekelle University, PO Box 1871, Mekelle, Ethiopia.
authors.forename: Anwar H
authors.initials: AH
authors.lastname: Gilani
keywords: Body fat percentage; Body mass index; Obesity; Waist circumference; Waist-hip ratio