Incidence of the metabolic syndrome is increasing worldwide, with notable exceptions of some Asian countries where seaweeds are commonly consumed. 13 men (mean age 47.4 ± 9.9 yr) and 14 women (average age 45.6 ± 12.2 yr) with at least one symptom of the metabolic syndrome were recruited in Quito Ecuador to a randomized double-blinded placebo-controlled trial. Subjects were assigned to either Group 1 (1 m placebo, followed by 1 m 4 g/d seaweed [Undaria pinnatifida]) or Group 2 (1 m of 4 g/d seaweed, followed by 1 m of 6 g/d of seaweed). Blood pressure, weight, waist circumference, inflammation biomarkers, and lipids were measured monthly. Re- peated measures analysis of variance with Tukey’s multiple comparison tests were used for statistical analysis. In Group 2, systolic blood pressure decreased 10.5 mmHg after a month of 6 g/d seaweed (95% CI: 4.1, 16.8 mmHg; p < 0.05), primarily in subjects with high-normal baseline blood pressure. Waist circumference changed only for women participants, with a 2.4 cm decrease in Group 1 after treatment with placebo (95% CI: 1.0, 3.7 cm; p < 0.01). In Group 2, women had a mean decrease of 2.1 cm after 4 g/d (95% CI: 0.4, 3.7 cm; p < 0.05) and a further 1.8 cm decrease after 1 m 6 g/d seaweed (95 % CI: 0.1, 3.4, p < 0.05). No other changes were observed. Consumption of 4 to 6 g/d seaweed, typical for most people in Japan, may be associated with low metabolic syndrome prevalence.
The purpose of this study was to determine the anthropometric index that best predicts common cardiovascular risk factors. A total of 2768 individuals (1310 men and 1458 women) aged 21-75 years with full relevant data from the Zanjan Healthy Heart Study (a prospective study in Zanjan and Abhar, two main cities of Zanjan Prov- ince, Iran) were recruited. Common cardiovascular risk factors (TG, TC, HDL-c, LDL-c, fast blood sugar, blood pressure), anthropometric indices (BMI, WC, WHR, WHtR) were measured using standard process, and their correlated classification was evaluated by partial correlation and Receiver Operator Characteristic (ROC) curve analysis. Area under curve (AUC) of WHtR was the largest for most (6 of 7) of the common cardiovascular risk factors in both men and women; followed by WC (4 of the 7 including ties) in men, while AUCs of three anthro- pometric indices (WC, BMI, WHR) were the same with the largest for 1 of 7 risk factors in women. These re- sults show that the high prevalence of lipid profiles, as cardiovascular risk factors, need special attention, inter- vention and appropriate treatment. Consistence with other reports, WHtR is a better discriminator of cardiovas- cular risk factors compared with the other three indices (BMI, WC, and WHR). We determined its optimal cut- off point of 0.5 for both genders. However, due to differences in reported cut-off values across different ethnic groups, future research and longitudinal data is needed before reaching an internationally accepted simple and appropriate measure that could be effectively used in the clinical and epidemiological fields.
Objective: To determine the prevalence and factors associated with overweight/obesity among adults in Ho Chi Minh City (HCMC) using Caucasian and Asian cut-offs. Study design: A cross-sectional survey. Methods: In 2005, 1,971 adults aged 25-64 years in HCMC were randomly selected using a proportional to population size sampling method to estimate the prevalence of overweight and obesity, measured by body mass index (BMI) and waist circumference. Multivariable logistic models were used to examine associations between overweight/obesity and socioeconomic status, health-related behaviors, and biochemical indices of chronic disease risk. Results: The prevalence of overweight and obesity using the Caucasian BMI cut-offs were 13.9% and 1.8% respectively, and those with the Asian BMI cut-offs were 27.5% and 5.7%, respectively. The abdominal adiposity rates were higher than the BMI overweight and obesity rates in women, but not in men. Increasing age, low education, high household wealth index, high levels of sitting and reclining time, cholesterol and high blood pressure were sig- nificantly associated with overweight and obesity. Current smoking and sedentary leisure time was significantly negatively associated with this status in men. Conclusion: Associations between overweight/obesity and meta- bolic disorders were evident using both cut-offs. Asian cut-offs identified more risk factors and therefore could be considered for defining at-risk groups. The results highlight the importance of intervention programs to pre- vent overweight/obesity in young adults.
This study aims to assess the prevalence of underweight, overweight and obesity among adults in urban Hanoi, Vietnam; and compare these results to previous estimates among adults in urban Ho Chi Minh City. Survey par- ticipants were residents in urban Hanoi, Vietnam and aged between 25-74 years. Data from a cross-sectional biomedical survey conducted in 2004 were collected; which included a questionnaire, physical examination and blood tests. The age-standardised prevalence of overweight and obesity in 2004, using Asian-specific body mass index cut-offs, were 28.6% and 2.1%, respectively. The prevalence of overweight/obesity (combined) was simi- lar in males (29.7%) and females (31.5%), and generally increased with age. The prevalence of over- weight/obesity was considerably lower if the standard cut-off values of the World Health Organization were used. The age-standardised prevalence of underweight was 13.3%; and that of ‘increased risk’/‘substantially in- creased risk’ waist circumference (combined) was 27.9% in males and 25.7% in females, respectively. Almost one in three adults in urban Hanoi were overweight or obese in 2004 and more than one in ten were underweight (based on Asian-specific cut-off values). This prevalence of overweight/obesity is similar to that for adults in ur- ban Ho Chi Minh City, but the prevalence of underweight is lower. While low body weight remains a concern, overweight and obesity are an increasing problem for urban Vietnamese adults.
Objective: To evaluate the validity and reproducibility of a food frequency questionnaire (FFQ) developed for assessing the association between dietary factors and breast cancer risk among Chinese women in Guangdong. Methods: 61 women (24-64 years) were recruited from the community in Guangzhou city. An 81-item FFQ was administered twice, one year apart (FFQ1, FFQ2). In the mean time, six 3-day dietary records (DRs) were col- lected at two month intervals within the year. Daily consumption of nutrients and foods from the FFQs and DRs, correlation coefficients between the two FFQs and the FFQ with DRs were calculated. Results: Median intakes of nutrients and food group items are higher in FFQ1 than FFQ2. The energy-adjusted Pearson correlation coef- ficients between the FFQ1 and FFQ2 ranged from 0.46 to 0.71 for nutrients and 0.36 to 0.66 for food group items, respectively. In the validation study, energy-adjusted correlation coefficients were 0.25 to 0.65 for nutri- ents and 0.30 to 0.68 for food groups. Mean proportion of subjects being classified into the same quartile of nu- trients and foods intake from the FFQ and DRs was 36% and 43%, respectively. Mean misclassification of sub- jects into opposite quartiles was 5% for nutrients and 3% for foods. Bland-Altman analysis showed that no linear trend existed between the differences and means for nutrients. Conclusions: The 81-item FFQ has satisfactory reproducibility and reasonable validity, and is useful in assessing the usual consumption of major nutrients and food groups among Chinese women in Guangdong.
Objectives: (1) To examine the validity of existing prediction equations (PREE) for estimating resting energy expenditure (REE) in obese Chinese children, (2) to correlate the measured REE (MREE) with anthropometric and biochemical parameters and (3) to derive a new PREE for local use. Design: Cross-sectional study. Subjects: 100 obese children (71 boys) were studied. Measurements: All subjects underwent physical examination and an- thropometric measurement. Upper and central body fat distribution was signified by centrality and conicity index respectively, and REE was measured by indirect calorimetry. Fat free mass (FFM) were measured by DEXA scan. Thirteen existing prediction equations for estimating REE were compared with MREE among these obese children. Fasting blood for glucose, lipid profile and insulin were obtained. Results: The overall, male and fe- male median MREEs were 7.1 mJ/d (IR 6.2-8.4), 7.3 mJ/d (IR 6.3-9.7) and 6.9 mJ/d (IR 5.6-8.1) respectively. No sex difference was noted in MREE (p=0.203). Most of the equations except Schofield equation under- estimated REE of our children. By multiple linear regression, MREE was positively correlated with FFM (p<0.0001), conicity index (p<0.001) and centrality index (p=0.001). A new equation for estimating REE for lo- cal use was derived as: REE = (17.4logFFM) + (11.4conicity index) – (2.4*centrality index) – 31.3. The mean difference of new PREE-MREE was -0.011 mJ/d (SD 1.51) with an interclass correlation coefficient of 0.91. Conclusion: None of the existing prediction equations were accurate in their estimation of REE, when applied to obese Chinese children. A new prediction equation has been derived for local use.
The objective of this study was to explore the perception of, feelings and attitudes toward overweight or obesity, and the perceived barriers to weight loss among native adults from lower socio-economic background. A total of six gender- and ethnic-specific focus groups consisted of 38 overweight and obese purposefully and criterion se- lected adults (21 women and 17 men), participated in this study. An unstructured discussion guide based on the study objectives were used for the focus groups. The results showed that some participants perceived themselves as ugly, felt ashamed of their body size and were frustrated because they did not desire to be overweight. Due to their excess weight, most also expressed they were less effective in their work performances. Although some participants had negative attitudes toward themselves because of excess weight, this appeared to link to self- stigmatization rather than anti-obesity discrimination. The participants remained in the Pre-contemplation stage of losing weight probably because of perceived barriers such as difficulty to resist eating, lack of know how and previous failed attempts to lose weight. Importantly, this study provided some evidence that individuals in the Pre-contemplation stage are unable to take action to lose weight, even if effective strategies are suggested.
We described the body composition and nutrient intake of Buddhist vegetarians and compared the data with that of omnivores in South Korea. Vegetarian subjects were 54 Buddhist nuns, who adhered to a vegetarian diet in accordance with Buddhist teachings. We compared these finding with a group of 31 omnivore Catholic nuns who shared a similar lifestyle but different dietary pattern than those of the Buddhist nuns. All subjects com- pleted the estimated three-day dietary record. Body composition was determined by a segmental multi-frequency- bioelectrical impedance analysis method. No height difference between the dietary groups existed but the vege- tarians had a significantly higher body weight, fat free mass, body fat and body mass index (BMI, kg/m2) than the omnivores. The median BMI of both vegetarians and omnivores fell in the normal range (22.6 vs. 20.7 kg/m2). In vegetarians, body fat was inversely correlated with the duration of vegetarianism (p for trend = 0.043). The long duration group of the vegetarians had lower body fat than the short duration group (12.l vs. 15.0 kg, p = 0.032). The status of the nutrient intake of Korean Buddhist vegetarians was comparable to that of omnivores, and the intake of some nutrients in vegetarians was more favorable than in the omnivores.
Background: To determine whether separate anthropometric screening tools are needed for obesity and the metabolic syndrome in children, we compared the predictability of several anthropometric indices, including waist circumference (WC) and body mass index (BMI), with regard to metabolic disorders. Study design: The Nutrition and Health Survey in Taiwan Elementary School Children (2000-2001) collected data from 2,215 chil- dren. Logistic regression analysis was used to study the association between anthropometric indices and meta- bolic abnormalities, which was defined as two or more of the following conditions: high fasting triglycerides, high fasting glucose levels, high blood pressure and low high-density lipoprotein-cholesterol. The receiver oper- ating characteristic curve was used to study the sensitivity and specificity of these anthropometric indices. Re- sults: predictability was the ranked highest for WC (R2 = 10.69%), followed by BMI (R2 = 9.80%), arm girth (R2 = 9.75%), hip circumference (R2 = 9.43%), scapular skinfold thickness (R2 = 9.28%) and waist-to-height ratio (R2 = 9.25%). Waist circumference or BMI cut-offs for maximal balanced sensitivity and specificity were close to the 60th percentile for each age and gender group. Values were greater in boys than in girls and increased with age. Conclusion: It is justifiable to use the WC criteria to define the metabolic syndrome in children. Due to its practicality, BMI remains the most suitable index for defining overweight/obesity. Only moderate levels of sen- sitivity and specificity were achieved with these two popular obesity indices with regard to metabolic abnormali- ties.
The purpose of this study was to estimate the prevalence of ‘metabolically obese, but normal-weight’ (MONW) and ‘metabolically healthy, but obese’ (MHO) phenotypes in Korean adults and identify the characteristics and health behaviors related to both phenotypes. Of the 5267 participants (2227 men, 3040 women) from the 3rd Ko- rean National Health and Nutrition Examination Survey, the MONW phenotype (8.7% of total subjects, 12.7% of normal-weight subjects) was defined as individuals of normal weight (BMI < 25) with the metabolic syn- drome (MS), and the MHO phenotype (15.2% of total subjects, 47.9% of obese subject) was defined as obese individuals (BMI ≥ 25) without the MS. The odds ratio for MONW phenotype was significantly higher for those at older age, those with lower education, those who had moderate alcohol consumption, and time spent partici- pating in moderate-intensity exercise. The odds ratio for MHO phenotype was significantly lower for those at older age, men, those with lower education, and former/current smokers. In conclusion, regardless of weight status, health behaviors should be modified to prevent MS.
It is important to elucidate the dietary factors contributing to the development of metabolic syndrome among middle-aged women to better prevent and manage the syndrome. The objective was to determine the relationship between dietary intake and metabolic syndrome in urban Babolian middle-aged women. Systematic random sampling was used to select 984 women 30-50 years of age from urban area of Babol, Mazandaran, Iran. Dietary patterns were evaluated using a food frequency questionnaire. The ATP III criteria were used to classify study participants as having the metabolic syndrome. Correlations of component foods with indices of the metabolic syndrome were assessed using Spearman's rank correlation coefficient (rho). The adjusted odds ratios (OR) and their 95% confidence intervals were obtained for the nutrient groups. Mean total kilocalories consumed per day were 2965. The study suggests that a good dietary pattern that is rich in fruits, legumes, vegetables, cereals, and fish (component 1), as well as high intake of dairy products and eggs (components 4) decrease the likelihood of having metabolic syndrome. The adjusted OR for the metabolic syndrome in women with low fat intake was higher than in women with high and moderate fat (OR= 2.92; 95% CI= 1.36, 6.28). It is necessary to emphasize the benefits of lifestyle modification, including losing weight, and consumption of more fruits, legumes, vegeta- bles, cereals, fish, dairy products in reducing the risk of the metabolic syndrome in middle aged women.
The objective of this study is to evaluate the long-term clinical significance of enteral nutrition (EN) in weaning adult short bowel patients off parenteral nutrition (PN) undergoing intestinal rehabilitation therapy (IRT). Sixty- one adult patients with small bowel length 47.95 ± 19.37 cm were retrospectively analyzed. After a 3-week IRT program, including recombinant human growth hormone (rhGH, 0.05 mg/kg/d), glutamine (30 g/d), and com- bined EN and PN support, patients were maintained on EN or plus a high-carbohydrate, low fat (HCLF) diet. Continuous tube feeding was used when EN was started. Patients were followed up for 50.34 ± 24.38 months and had an overall survival rate 95.08% (58/61). On last evaluation, 85.24% (52/61) of the patients were free of PN. For 77.42% patients (24/31) with small bowel length <35 cm in jejunoileocolic anastomosis (type III) and <60 cm in jejunocolic anastomosis (type II), weaning off PN was achieved. EN comprised of 52.56 ± 13.47 % of patients’ daily calorie requirements on follow-up. Five patients were maintained on home PN (HPN) plus EN. Nutritional and anthropometric parameters, urine 5-hr D-xylose excretion and serum citrulline levels all in- creased significantly after IRT and on follow-up compared with baseline. In conclusion, with proper EN man- agement during and after IRT, a significant number of SBS patients could be weaned from PN, especially for those who were considered as permanent intestinal failure; continuous tube feeding is recommended for enteral access, and long-term EN support could meet the daily nutritional requirement in majority of SBS patients.
There is paucity of data on the association of various risk factors of the metabolic syndrome in urban Asian In- dian adolescents. This cross-sectional study included 948 subjects (527 males; 421 females) aged 14-19 y, se- lected randomly from New Delhi, India. Principal component factor analysis included variables such as: body mass index (BMI), waist circumference (WC), triceps (TR) and subscapular (SS) skinfold thickness, systolic and diastolic blood pressures, fasting blood glucose, serum triglycerides, high-density lipoprotein cholesterol and fasting insulin. Factor scores were used to generate a cumulative risk scale and identify independent correlates of high cumulative risk. Three factors namely: obesity/insulin factor (BMI, WC, TR, SS and fasting insulin) ex- plained 40.9% and 35.5%, ‘blood pressure’ factor explained 14.1% and 14.2%, and the ‘metabolic’ factor (glu- cose/triglycerides) explained 10.4% and 10.8% of the variance data in males and females, respectively. Over- weight and hyperinsulinemia in both genders and high SS in males were independently associated with high cu- mulative risk. More than one factor is associated with the metabolic syndrome in Asian Indian adolescents. Obe- sity (generalized, abdominal and truncal sub-cutaneous) accounts for the maximum variance in clustering and appears to be the stronger correlate of high cumulative risk rather than hyperinsulinemia.
As the obesity epidemic grows, not only in advanced economies, but in virtually every economic context, even in the face of essential nutrient deprivation, its economics has become of increasing interest. Most of the analysis has had to do with the costs of the health outcomes of obesity and of its management (Access Economics, 2006: Wahlqvist, 2006). Increasingly, the economic determi- nants of obesity, especially in terms of food choice and access to body composition-friendly environments have been explored, which is the purview of ‘Fat Economics’ by Mazzocchi and colleagues published in 2009.
The Mazzocchi book is rich in information about the economic epidemiology of obesity, especially in its ap- preciation of settings like communities and households and their exposure to various market forces. This is worth seeing in the light of Katan’s critical appraisal of the rela- tive ineffectuality of various diets for obesity compared with community interventions to reduce the adverse trends (Katan, 2009) as in northern France (Fleurbaix and Laventie), in Victoria, Australia (Colac and Horsham) and in Massachusetts, USA (Somerville). Thus the pre- sent volume leads on to evidence-based policy making and policy intervention which can embrace not only clini- cal, but school, workplace and community settings in a cost-effective and lasting way.
What is now needed is greater attention to the ecologi- cal factors in the pathogenesis of obesity, which have been articulated in the eco-nutrition view of the origins of so-called chronic disease including obesity (Wahlqvist, 2004); and the environmental costs incurred as a conse- quence (Marlow et al, 2009; Carlsson-Kanyama et al, 2009). These considerations point to most, but not all, plant-based diets as being less demanding on the envi- ronment, its energy reserves, soil health and water status. It is this broader cost-sustainability-effectiveness canvass for nutritional economics to which we now must look. The present book is an important brush stroke along the way.
Water intake was described and quantified in samples of urban Guatemalan schoolchildren stratified by gender and socio-economic status. The frequency of consumption and quantity of plain water drinking was estimated from one- day pictorial registries of all beverages, foods and snacks consumed over a 24-h period collected from 449 3rd and 4th graders from two social classes: 230 from higher SES and 219 from lower SES. Plain water was reported by 28.1% of participants on the day of registry. Quantities consumed ranged from 250 to 2250 ml. For the 449 one-day intake records, a cumulative total of 62,000 mL of water consumption was reported. This constitutes an average of 138 ± 289 ml across all participants but, when divided by for water consumers only, the mean is 492 ± 352 ml. Given the relatively low percentage of children consuming water, more attention is needed to ensure freely available, safe, drinking water in the school environment.
Objective: To investigate the associations between mRNA levels that encodes for insulin-like growth factors (IGFS) and their receptors in term placenta, and the risk of macrosomia. Methods: Term placentas were collected from 37 neonates with macrosomia and 37 neonates with normal birth weight in Changzhou Women and Chil- dren Health Hospital from March 1 to June 30, 2008. The IGF mRNA levels and their receptors in those placen- tas were measured by Real-time PCR. Results: The placental weight was positively correlated with the birth weight both in the macrosomia group (r=0.550, p=0.004) and the control group (r=0.678, p=0.000). After ad- justing for potential confounders, multivariable adjusted ORs of neonates with macrosomia for those in the in- creasing two tertiles were 17.3 (95%CI: 2.50-19.2) and 5.94 (95%CI: 0.96, 36.8), respectively, compared with those in the lowest tertile in terms of IGF-IImRNA level. Similarly, multivariable adjusted ORs of neonates with macrosomia for those in the increasing two tertiles of IGF-IR mRNA were 25.3 (95%CI: 3.43-187) and 43.0 (95%CI: 4.89, 378), respectively. Conclusion: These results indicate that the levels of placental IGF-IIand IGF-IR mRNA may be involved in the development of macrosomia.
The objective of this work is to conduct a systematic review that investigates the efficacy of phytosterols/stanols in lowering lipid concentration in individuals with non-familial hypercholesterolemia. Randomized controlled intervention trials were identified through selected international journal databases and reference lists of relevant publications. Two researchers extracted data from each identified trial and only trials of sufficient quality were included in the review. Main outcomes of interest were differences between treatment and control groups in terms of low density lipoprotein cholesterol, total cholesterol, high density lipoprotein cholesterol and triacyl- glycerol. Of the studies reviewed, 20 out of 76 studies were of sufficient quality. The results of the systematic review indicated that phytosterols/stanols could significantly decrease low density lipoprotein cholesterol, total cholesterol and triacylglycerol in treatment groups compared with control groups and that the mean differences were [-0.35 mmol/L, 95%CI(-0.47, -0.22), p<0.00001], [-0.36 mmol/L, 95%CI(-0.46, -0.26), p<0.00001] and [- 0.1 mmol/L, 95%CI(-0.16, -0.03), p=0.004] respectively. Foods enriched with 2.0 g of phytosterols/stanols per day had a significant cholesterol lowering effect.
Although the disadvantages of trans fatty acids (TFAs) are widely mentioned, limited data are available on the TFAs contents of Iranian foods, including fast foods. The aim of this study was to quantify the amounts of com- mon fatty acids in several fast foods in Iran, with specific focus on TFAs. The most commonly consumed fast foods in Iran: sausage, calbas, hamburgers and pizzas, were randomly selected seven times from products avail- able in supermarkets and restaurants. Each time a 10 g sample was drawn and prepared for fatty acid analysis. Total and individual fatty acids were quantified according to standard methods by gas chromatography with 60 meter capillary column and flame ionization detector. The most common saturated fatty acids in Iranian fast foods is stearic acid (C18:0) which ranged from 14.0% to 20.9%. Saturated fatty acid content in calbas was sig- nificantly higher than that found in other groups. Trans fatty acids constitute almost 23.6% to 30.6% of total fatty acids of these products. The most common TFA in these fast foods was elaidic acid (C18:1 9t). Total cis unsaturated fatty acid content of tested fast foods varied from 25.3 %( in sausage) to 46.8(in calbas) with oleic acid (C18:1 9c) followed by linoleic acid (C18:2) being the most common fatty acids in these products. This study showed higher TFAs contents in commercially available fast foods compared to the amounts recom- mended by dietary guidelines in Iran. Further studies must assess the effects of these fatty acids on human health.
Objectives: To evaluate dietary zinc and other divalent minerals intake among the population of Jiangsu Prov- ince. Methods: 3,867 subjects aged 4-89 years were representatively sampled in two urban and six rural areas of Jiangsu Province. Dietary intake was assessed using 24-hour recalls on three consecutive days. Insufficient zinc intake was calculated based on the Chinese Dietary Reference Intakes. Results: Overall, the percentage of sub- jects with insufficient intake of zinc was 22.9%, with a declining trend with age. Except for the group ≥50 years, mean zinc intake of all other groups were below the age- and sex- specific Recommended Nutrition Intakes (RNI). Approximately 2/3rds of the subjects ≤17 years of age had insufficient zinc intakes. Compared with the age group below 11 years, risk of insufficient zinc intake increased in the adolescents aged 11-17 years (OR: 2.10, 95% CI: 1.86-2.36), but decreased in adults aged 18-49 years and ≥50 years (OR: 0.76, 95% CI: 0.66-0.8; OR:0.55, 95%CI: 0.47-0.64). Mean intake of iron, copper, magnesium and selenium met the Chinese DRIs re- spectively, except for selenium in females. The prevalence of insufficient intake of copper, magnesium and sele- nium was 37.2%, 22.8% and 29.3%, respectively, while the overall prevalence of insufficient iron intake was only 3.4%. Conclusion: Dietary zinc intake of the Jiangsu Province population does not generally meet the Chi- nese RNI. Children and adolescents in particular have a higher risk of insufficient zinc intake.
Women participating in a wide range of competitive sports are at higher risk of developing eating disorders, menstrual irregularities and osteoporosis, which are generally referred to as the ‘female athlete triad’. The objec- tive of this study was to determine the prevalence of female athlete triad and factors associated with this condi- tion among athletes participating in different sports. A total of 67 elite female athletes aged between 13-30 years participated in the study and were subdivided into the ‘leanness’ and ‘non-leanness’ groups. Eating disorders were assessed using a body image figure rating and the Eating Disorder Inventory (EDI) with body dissatisfac- tion (BD), drive for thinness (DT), bulimia (B) and perfectionism (P) subscales. Menstrual irregularity was as- sessed with a self-reported menstrual history questionnaire. Bone quality was measured using a quantitative ul- trasound device at one-third distal radius. Prevalence of the female athlete triad was low (1.9%), but the preva- lence for individual triad component was high, especially in the leanness group. The prevalence of subjects who were at risk of menstrual irregularity, poor bone quality and eating disorders were 47.6%, 13.3% and 89.2%, re- spectively, in the leanness group; and 14.3%, 8.3% and 89.2%, respectively, in the non-leanness group. Since the components of the triad are interrelated, identification of athletes at risk of having any one component of the triad, especially those participating in sports that emphasise a lean physique, is an important aid for further diag- nosis.
Many studies in Asia have demonstrated that Asian populations may require lower cut-off levels for body mass index (BMI) and waist circumference to define obesity and abdominal obesity respectively, compared to western populations. Optimal cut-off levels for body mass index and waist circumference were determined to assess the relationship between the two anthropometric- and cardiovascular indices. Receiver operating characteristics analysis was used to determine the optimal cut-off levels. The study sample included 1833 subjects (mean age of 44 + 14 years) from 93 primary care clinics in Malaysia. Eight hundred and seventy two of the subjects were men and 960 were women. The optimal body mass index cut-off values predicting dyslipidaemia, hypertension, diabetes mellitus, or at least one cardiovascular risk factor varied from 23.5 to 25.5 kg/m2 in men and 24.9 to 27.4 kg/m2 in women. As for waist circumference, the optimal cut-off values varied from 83 to 92 cm in men and from 83 to 88 cm in women. The optimal cut-off values from our study showed that body mass index of 23.5 kg/m2 in men and 24.9 kg/m2 in women and waist circumference of 83 cm in men and women may be more suit- able for defining the criteria for overweight or obesity among adults in Malaysia. Waist circumference may be a better indicator for the prediction of obesity-related cardiovascular risk factors in men and women compared to BMI. Further investigation using a bigger sample size in Asia needs to be done to confirm our findings.