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Are you lean-fat? Why having a low body-mass index may not mean you’re more healthy or less at risk of heart failure

South China Morning Post

發布於 2019年11月19日13:11 • Lily Canter life@scmp.com
  • A study shows Asian people who have a low BMI but accumulated fat around their midriff are more likely to suffer heart failure than obese people without a bulge
  • Researchers say governments should work on developing clear policies to prevent abdominal obesity
“Lean-fat” Asian people who have a low body-mass index but are wide around the middle are more at risk of hospital admission, or death, due to heart failure than obese people without a tummy bulge, a study has found. Photo: Alamy
“Lean-fat” Asian people who have a low body-mass index but are wide around the middle are more at risk of hospital admission, or death, due to heart failure than obese people without a tummy bulge, a study has found. Photo: Alamy

"Lean-fat" people in Asia " those who have a low body-mass index (BMI) but are wide around the middle " are at a higher risk of hospital admission for heart failure, and of death, than so-called obese-thin people, a study of 6,000 heart failure patients in 11 Asian regions has found.

These patients are also more likely to be women, have diabetes and be from low-income countries.

Researchers took data from patients in China (including Hong Kong and Taiwan), India, Malaysia, Thailand, Singapore, Indonesia, the Philippines, Japan and South Korea, in the first study of its kind.

Writing in the medical journal PLOS Medicine, the authors say governments must develop clear national policies to prevent abdominal obesity and promote a healthy BMI through "awareness, education and lifestyle modification".

A study of 6,000 heart failure patients in 11 Asian regions found patients were more likely to be women, have diabetes and be from low income countries. Photo: Alamy
A study of 6,000 heart failure patients in 11 Asian regions found patients were more likely to be women, have diabetes and be from low income countries. Photo: Alamy

Obesity poses a major global public health challenge. It affects 650 million people worldwide and has tripled in prevalence over the last 20 years " especially among young adults in low- and middle-income countries. China has the highest obesity rate in the world, with 46 per cent of adults and 15 per cent of children being obese or overweight, according to a September report in the journal The Lancet Global Health.

Asians are also at higher risk of adverse health effects at lower BMI points than international standards. The World Health Organisation (WHO) has recommended lower BMI cut-offs for the definition of obesity among Asians.

Obesity is a risk factor for heart failure, but Western studies have shown that those with a higher BMI have better outcomes.

This is known as the obesity paradox.

Little is known about the paradox in Asia, however, where patients are more likely to be lean than Western patients and have a lower BMI " below 24.5.

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Researchers, including Professor Carolyn Lam of medical centre National Heart Centre Singapore, examined the association between obesity and heart failure outcomes in Asia.

They examined 5,964 patients with symptomatic heart failure and reviewed outcomes, including hospital admission and death rates, a year later.

The researchers found that having a relatively low BMI (your body mass in kilograms divided by the square of your height in metres), but a relatively high waist-to-height ratio (waist circumference divided by height; ideally this should be 0.5 or lower) was associated with the worst outcomes regardless of the type of heart failure.

Professor Carolyn Lam examined the association between obesity and heart failure outcomes in Asia.
Professor Carolyn Lam examined the association between obesity and heart failure outcomes in Asia.

The "lean-fat" subgroup made up 14 per cent of the heart failure population in Asia, were more likely to be women (35 per cent), be from low-income countries (48 per cent) predominantly in South and Southeast Asia, and had the highest prevalence of diabetes (46 per cent).

These patients also had the highest risk of hospital admission or death due to heart failure "higher than the obese-thin group with high BMI and low waist-to-height ratio.

Heart disease kills seven times more women than breast cancer according to the WHO, and at least nine out of 10 women exhibit at least one risk factor for heart disease.

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Heart disease and stroke account for almost half of all female deaths in China, according to health care provider Siemens Healthineers Global " with no geographic, gender or socio-economic boundaries.

The researchers concluded that a different approach is needed to understand and manage heart failure, rather than simply relying on BMI measurements.

Copyright (c) 2019. South China Morning Post Publishers Ltd. All rights reserved.

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