Misclassification: Quad A and D Figure 1. ab. Scatterplots comparing - - PDF document

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Misclassification: Quad A and D Figure 1. ab. Scatterplots comparing - - PDF document

10/9/2018 Is Is BM BMI a valid lid mea measur ure of of obes obesity ity in in postmenopausal postmenopausal wo women? Postmenopausal Women With a Normal BMI Might Be Overweight or Even Obese 40% of women in USA are obese using BMI as


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Is Is BM BMI a valid lid mea measur ure of

  • f obes
  • besity

ity in in postmenopausal postmenopausal wo women?

Postmenopausal Women With a “Normal” BMI Might Be Overweight or Even Obese

  • 40% of women in USA are obese using BMI as index, but BMI is only a proxy for body fat
  • Actual body fat % of most postmenopausal women would classify them as obese, even with BMI < 30
  • Using whole body dual x‐ray absorptiometry scans to measure body fat, Banack et al studied and classified

1329 postmenopausal 53 – 85

  • Obesity defined as a BMI > 30 or body fat % > 35%, 38%, or 40%
  • Most of the women whose body fat percentage was 35% or more which = obesity and at a greater risk of
  • besity‐related health problems—had a BMI < 30

32.4% with 35% body fat had BMI > 30, 67.6% did not 44.6% with 38% body fat had BMI > 30 55.2% with 40% body fat had BMI > 30

Banack HR et al Menopause. 2018 March; 25(3): 307–313. doi:10.1097/GME.0000000000000989

Misclassification: Quad A and D

Figure 1. a–b. Scatterplots comparing BMI (kg/m2 ) with percent body fat (%). The black horizontal line represents BMI greater than 30 kg/m2 . The curved line represents a quadratic prediction line. The vertical line indicates percent body fat greater than 35% (Figure 1a) and 40% (Figure 1b). Participants in Quadrants A and D are misclassified, participants in Quadrants B and C are correctly classified. In Figure 1a, 0.26% of women are in quadrant A, 21% are in quadrant B, 34% are in quadrant C, and 44% are in quadrant D. In figure 1b, 3.7% are in quadrant A, 18% are in quadrant B, 64% are in quadrant C, and 14% in quadrant D.

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Defining Obesity:

35% cut = 24.8 38% cut = 26.5 40% cut = 27.1

Age Related Shift In Visceral Fat

Between 3rd and 7th decade

  • visceral fat ↑ 200% in men, ↑ 400% in women

1. Loss of muscle mass 2. Weight gain 3. Shift in peripheral to central fat pattern

Hunter, Int J Body Composit Res 2010: 103‐8

  • Ley. Am J Clin Nutr. 1992; 55(5): 950‐954

pre post pre post

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Intra‐abdominal adiposity closely correlates with abdominal obesity AND waist measurement correlates with intra‐abdominal adiposity and risk factors

To assess IAA, the simplest measure of abdominal obesity is waist circumference, which is strongly correlated with direct measurement of IAA by CT scan or MRI, considered to be the gold standard

Després JP et al, 2001; Pouliot MC et al, 2004

300 200 100 r = 0.80 60 80 100 120 IAA Waist circumference (cm) IAA (cm2)

IAA: intra‐abdominal adiposity; CT: computed tomography; MRI: magnetic resonance imaging

Lemieux in Kopelman (ed) , Management of obesity and related disorders, Dunitz: 2001. Lemieux Thromb Vasc Res 2001

  • Hypertriglyceridemia
  • Insulin resistance
  • Low HDL
  • hyperinsulinemia
  • Elevated apo B
  • Glucose intolerance
  • Increased small dense LDL
  • Impaired fibrinolysis
  • Inflammatory profile
  • Endothelial dysfunction

If the waist circumference is high, no matter what the BMI is, there will be concerns about cardiovascular risk, diabetes risk, and cardio‐ metabolic outcomes…. J Manson

Conclusion:

Obesity cutoff for menopausal women may be the upper threshold of normal BMI 24.9