a1 Center for Health Policy Research and Development, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 350, Taiwan, Republic of China
a2 Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
a3 University of Texas School of Public Health, Houston, TX, USA
a4 Institute of Public Health, Georgia State University, Atlanta, GA, USA
Objectives To assess whether overweight Asians, assessed on the basis of WHO criteria, are at greater mortality risk than overweight Caucasians, and to determine whether alternative cut-off points (BMI = 23·0–24·9 kg/m2 for overweight and BMI ≥ 25·0 kg/m2 for obesity) suggested by the WHO Western Pacific Regional Office are appropriate.
Design The cohort was followed prospectively until the end of 2001. All-cause and CVD mortality risks of the overweight and obese group, relative to the reference group (BMI = 18·5–24·9 or 18·5–22·9 kg/m2), were assessed using Cox regression analysis, adjusting for age, smoking and gender. Excess deaths were estimated with a method proposed by the US Centers for Disease Control and Prevention.
Setting National Health Interview Survey (NHIS 2001) and a middle-aged perspective cohort in Taiwan.
Subjects Subjects comprised 36 386 civil servants and school teachers, aged 40 years and older, who underwent a medical examination during 1989–1992.
Results In the WHO-defined overweight group, Asians showed a significant increase in all-cause mortality risk compared with Caucasians. Asians showed risks equivalent to Caucasians’ at lower BMI (around 5 units). Every unit of BMI increase, at 25·0 kg/m2 or above, was associated with a 9 % increase in relative mortality risk from all causes. Applying a cut-off point of 25·0 kg/m2 for obesity would result a prevalence of 27·1 %, while the traditional WHO cut-off point of 30·0 kg/m2 yielded obesity prevalence of 4·1 %. Excess deaths due to obesity accounted for 8·6 % of all deaths and 21·1 % of CVD deaths, based on the alternative cut-offs.
Conclusions In this Asian population, significant mortality risks started at BMI ≥ 25·0 kg/m2, rather than at BMI ≥ 30·0 kg/m2. The study supports the use of BMI ≥ 25·0 kg/m2 as a new cut-off point for obesity and BMI = 23·0–24·9 kg/m2 for overweight. The magnitude of obesity-attributable deaths has been hitherto under-appreciated among Asians.
(Received March 21 2007)
(Accepted March 06 2008)