Objective: To investigate the association of central fat with metabolic risks in normal BMI Chinese people. Methods: Normal BMI subjects (18.5 ≤ BMI < 24, n = 520) aged 18-82 years were included. Blood pressure, triglycerides, high-density lipoprotein cholesterol and fasting plasma glucose were collected as metabolic risk factors. Dual-energy X-ray absorptiometry was used to measure total and central fat. Central fat was indicated as percent trunk fat (%TF) and android/gynoid fat ratio. Multiple adjusted regression models were applied to investigate the association of total and central fat with metabolic risk factors. The assessment values of these fat measures were further compared by receiver-operating characteristic (ROC) curves. Results: Both total and central fat were correlated with metabolic risk factors. After adjusting for BMI, the significant association of percent body fat (%BF) with metabolic risks diminished, whereas %TF and android/gynoid fat ratio were still correlated. When BMI was replaced with %BF in the models, the results remained unchanged. ROC analysis showed the areas under the curve (AUCs) of total and central fat for at least two metabolic risk factors were comparable in men. However, in women, the AUCs of %TF and android/gynoid fat ratio were significantly greater than those of BMI, %BF and waist circumference. Conclusions: Central fat accumulation had a stronger association with metabolic risks than total fat in normal BMI Chinese adults, particularly in women. Central fat had more important implications in assessing ‘metabolically obese' individuals among normal BMI subjects.

Keywords:
Fat mass, Metabolic risks, Dual-energy X-ray absorptiometry, Normal BMI, Chinese
1.
Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, et al: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683-689.
2.
Garber AJ: Obesity and type 2 diabetes: which patients are at risk? Diabetes Obes Metab 2012;14:399-408.
3.
Alberti KG, Zimmet P, Shaw J: The metabolic syndrome - a new worldwide definition. Lancet 2005;366:1059-1062.
4.
Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB: The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 2003;163:427-436.
5.
Tsai CH: Metabolic syndrome in non-obese Taiwanese: new definition of metabolically obese, normal-weight individual. Chin Med J (Engl) 2009;122:2534-2539.
6.
Choi J, Se-Young O, Lee D, Tak S, Hong M, Park SM, et al: Characteristics of diet patterns in metabolically obese, normal weight adults (Korean National Health and Nutrition Examination Survey III, 2005). Nutr Metab Cardiovasc Dis 2012;22:567-574.
7.
Yu Y, Venners SA, Wang B, Brickman WJ, Zimmerman D, Li Z, et al: Association of central adiposity with prediabetes and decreased insulin sensitivity in rural Chinese normal-weight and overweight women. Metabolism 2010;59:1047-1053.
8.
Pajunen P, Kotronen A, Korpi-Hyovalti E, Keinanen-Kiukaanniemi S, Oksa H, Niskanen L, et al: Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN-D2D Survey. BMC Public Health 2011;11:754.
9.
Voulgari C, Tentolouris N, Dilaveris P, Tousoulis D, Katsilambros N, Stefanadis C: Increased heart failure risk in normal-weight people with metabolic syndrome compared with metabolically healthy obese individuals. J Am Coll Cardiol 2011;58:1343-1350.
10.
Zhu S, Wang Z, Shen W, Heymsfield SB, Heshka S: Percentage body fat ranges associated with metabolic syndrome risk: results based on the third National Health and Nutrition Examination Survey (1988-1994). Am J Clin Nutr 2003;78:228-235.
11.
Dodson MV, Mir PS, Hausman GJ, Guan LL, Du M, Jiang Z, et al: Obesity, metabolic syndrome, and adipocytes. J Lipids 2011;2011:721686.
12.
Ye J: Emerging role of adipose tissue hypoxia in obesity and insulin resistance. Int J Obes (Lond) 2009;33:54-66.
13.
Lee K, Villena JA, Moon YS, Kim KH, Lee S, Kang C, et al: Inhibition of adipogenesis and development of glucose intolerance by soluble preadipocyte factor-1 (Pref-1). J Clin Invest 2003;111:453-461.
14.
Frankenfield DC, Rowe WA, Cooney RN, Smith JS, Becker D: Limits of body mass index to detect obesity and predict body composition. Nutrition 2001;17:26-30.
15.
Kennedy AP, Shea JL, Sun G: Comparison of the classification of obesity by BMI vs. dual-energy X-ray absorptiometry in the Newfoundland population. Obesity (Silver Spring) 2009;17:2094-2099.
16.
Shea JL, King MT, Yi Y, Gulliver W, Sun G: Body fat percentage is associated with cardiometabolic dysregulation in BMI-defined normal weight subjects. Nutr Metab Cardiovasc Dis 2012;22:741-747.
17.
Feng Y, Hong X, Li Z, Zhang W, Jin D, Liu X, et al: Prevalence of metabolic syndrome and its relation to body composition in a Chinese rural population. Obesity (Silver Spring) 2006;14:2089-2098.
18.
Thomas GN, Ho SY, Janus ED, Lam KS, Hedley AJ, Lam TH: The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) prevalence of the metabolic syndrome in a Chinese population. Diabetes Res Clin Pract 2005;67:251-257.
19.
Wang J, Thornton JC, Russell M, Burastero S, Heymsfield S, et al: Asians have lower-body mass index (BMI) but higher percent body fat than do whites - comparisons of anthropometric measurements. Am J Clin Nutr 1994;60:23-28.
20.
Wang D, Li Y, Lee SG, Wang L, Fan J, et al: Ethnic differences in body composition and obesity related risk factors: study in Chinese and white males living in china. PLoS One 2011;6:e19835.
21.
He W, Zhang S, Song A, Yang M, Jiao J, Allison DB, et al: Greater abdominal fat accumulation is associated with higher metabolic risk in Chinese than in white people: an ethnicity study. PLoS One 2013;8:e58688.
22.
Lin J, Zhang MX, Song FF, Qin J, Wang R, Yao P, et al: Association between C-reactive protein and pre-diabetic status in a Chinese Han clinical population. Diabetes Metab Res 2009;25:219-223.
23.
Wang L: Report of China National Nutrition and Health Survey 2002. 1. Summary Report. Beijing, People's Medical Publishing House, 2005.
24.
Alberti KG, Zimmet P, Shaw J: Metabolic syndrome - a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 2006;23:469-480.
25.
Novotny R, Going S, Teegarden D, Van Loan M, McCabe G, McCabe L, et al: Hispanic and Asian pubertal girls have higher android/gynoid fat ratio than whites. Obesity (Silver Spring) 2007;15:1565-1570.
26.
Sankhla M, Sharma TK, Mathur K, Rathor JS, Butolia V, Gadhok AK, et al: Relationship of oxidative stress with obesity and its role in obesity-induced metabolic syndrome. Clin Lab 2012;58:385-392.
27.
Van Pelt RE, Evans EM, Schechtman KB, Ehsani AA, Kohrt WM: Contributions of total and regional fat mass to risk for cardiovascular disease in older women. Am J Physiol Endocrinol Metab 2002;282:E1023-E1028.
28.
Tatsukawa M, Kurokawa M, Tamari Y, Yoshimatsu H, Sakata T: Regional fat deposition in the legs is useful as a presumptive marker of antiatherogenesity in Japanese. Proc Soc Exp Biol Med 2000;223:156-162.
29.
Nakanishi N, Nakamura K, Suzuki K, Matsuo Y, Tatara K: Associations of body mass index and percentage body fat by bioelectrical impedance analysis with cardiovascular risk factors in Japanese male office workers. Ind Health 2000;38:273-279.
30.
Bosy-Westphal A, Geisler C, Onur S, Korth O, Selberg O, Schrezenmeir J, et al: Value of body fat mass vs anthropometric obesity indices in the assessment of metabolic risk factors. Int J Obes (Lond) 2006;30:475-483.
31.
Demerath EW, Reed D, Rogers N, Sun SS, Lee M, Choh AC, et al: Visceral adiposity and its anatomical distribution as predictors of the metabolic syndrome and cardiometabolic risk factor levels. Am J Clin Nutr 2008;88:1263-1271.
32.
Vega GL, Adams-Huet B, Peshock R, Willett D, Shah B, Grundy SM: Influence of body fat content and distribution on variation in metabolic risk. J Clin Endocrinol Metab 2006;91:4459-4466.
33.
Jacobs EJ, Newton CC, Wang Y, Patel AV, McCullough ML, Campbell PT, et al: Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med 2010;170:1293-1301.
34.
Wu CH, Heshka S, Wang J, Pierson RN Jr, Heymsfield SB, Laferrere B, et al: Truncal fat in relation to total body fat: influences of age, sex, ethnicity and fatness. Int J Obes (Lond) 2007;31:1384-1391.
35.
Pascot A, Lemieux S, Lemieux I, Prud'homme D, Tremblay A, Bouchard C, et al: Age-related increase in visceral adipose tissue and body fat and the metabolic risk profile of premenopausal women. Diabetes Care 1999;22:1471-1478.
36.
Ley CJ, Lees B, Stevenson JC: Sex- and menopause-associated changes in body fat distribution. Am J Clin Nutr 1992;55:950-954.
37.
Van Pelt RE, Jankowski CM, Gozansky WS, Wolfe P, Schwartz RS, Kohrt WM: Sex differences in the association of thigh fat and metabolic risk in older adults. Obesity (Silver Spring) 2011;19:422-428.
38.
Lee K, Lee S, Kim YJ: Waist circumference, dual-energy X-ray absortiometrically measured abdominal adiposity, and computed tomographically derived intra-abdominal fat area on detecting metabolic risk factors in obese women. Nutrition 2008;24:625-631.
39.
Ito H, Nakasuga K, Ohshima A, Maruyama T, Kaji Y, Harada M, et al: Detection of cardiovascular risk factors by indices of obesity obtained from anthropometry and dual-energy X-ray absorptiometry in Japanese individuals. Int J Obes Relat Metab Disord 2003;27:232-237.
40.
Lim S, Kwon SY, Yoon JW, Kim SY, Choi SH, Park YJ, et al: Association between body composition and pulmonary function in elderly people: the Korean Longitudinal Study on Health and Aging. Obesity (Silver Spring) 2011;19:631-638.
41.
Giovino GA, Mirza SA, Samet JM, Gupta PC, Jarvis MJ, Bhala N, et al: Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet 2012;380:668-679.
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