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Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians


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The aim of this study was to investigate the relationship between body mass index (BMI) and body fat percentage (BF%) in Singaporean Chinese, Malays and Indians, and to determine the risk for selected comorbidities at various BMI categories and abdominal fat distributions, as assessed by waist circumference (WC). The study was a cross-sectional (population) design. In total, 4723 subjects participated in the National Health Survey of 1998 in which the risks were investigated. A selected subsample of 291 subjects participated in a detailed body composition study, where weight, height and WC were measured, as were blood pressure, total and high-density lipoprotein (HDL) cholesterol, serum triglycerides and fasting glucose. In the subsample, BF% was determined by means of a chemical four-compartment model. At any given BF% the BMI of Singaporeans was about 3 kg m−2 lower than that of Caucasians. There were slight differences in the BF%/BMI relationship between the three ethnic groups. For all the ethnic groups, it was found that at low categories of BMI (between 22 and 24 kg m−2) and WC (between 75 and 80 cm for women and between 80 and 85 cm for men), the absolute risks for having at least one of the aforementioned risk factors were high, ranging from 41 to 81%. At these same categories the relative risks were significantly higher compared to the reference category, odds ratios ranging from 1.97–4.38. These categories of BMI and WC were all far below the cut-off values of BMI and WC as currently recommended by the World Health Organization (WHO). The data from the current study, which includes evidence that not only risk factors, but also BF% are elevated at low BMI values, presents a strong case for lowering the BMI cut-off value for overweight and obesity among Singaporeans, from 25 kg m−2 and 30 kg m−2 to 23 kg m−2 and 27 kg m−2, respectively.