ReviewEthnic differences in body composition and the associated metabolic profile: A comparative study between Asians and Caucasians
Introduction
By the year 2025, 300 million people will have diabetes and among them more than 100 million people live in Asia [1]. This region combines a high proportion of the world's population with rapidly rising diabetes prevalence rates [2] due to the pronounced demographic, epidemiologic and socioeconomic changes in recent decades [3]. The increase of diabetes in Asia differs from that reported in other parts of the world: it has developed in a shorter time (3–5-fold increase within 30 years), in a younger age group (45–64 years old), and in people with a lower body-mass index (BMI) compared to that in Western countries [3].
BMI is significantly correlated with adiposity [4], [5] and can predict body fat percentage adequately as long as age and gender are taken into account [6]. Excess adiposity (body fat) has been shown to be an independent risk factor for diabetes, cardiovascular disease, dyslipidaemia and hypertension [7]. The phenomenon in Asians, is most likely due to a higher percentage of body fat accumulation at a given BMI level compared to Caucasians [8], as pointed out by a series of comparative studies from Deurenberg et al. [9], [10], [11]. Hence, the relationship between body fat percentage and BMI is ethnic-specific [12]. Increased body fat percentage may affect individuals differently due to differences in genetic make-up, intra-uterine (developmental) environment, or dietary and physical activity patterns [8].
Section snippets
Body composition
Numerous comparative studies reported that for the same BMI, age and gender, Asians had a higher body fat percentage compared to Caucasians. The studies were performed among South Asian Indians/Pakistani [13], [14], [15], [16], [17], [18], East Asian Hong Kong Chinese [19], Japanese [20], Korean women [21] and Taiwanese [22] as well as Southeast Asian Indonesian [23], Singaporean [11] and Philipino [24]. Some studies reported no differences [11], [25], [26].
For the same BMI as Caucasians, the
The metabolic profile associated with the “unfavourable” body composition in Asians
The “unfavourable” body composition in Asians implicates some metabolic consequences. As Asians were found to have a higher risk to develop the metabolic syndrome at a relatively lower BMI [3], they were identified as metabolically obese but normal body weight (MONW) [35]. The existence of a subgroup of normal-weight individuals displaying an obesity-related phenotype was first proposed in 1981 by Ruderman et al. [36]. These individuals might be characterized by hyperinsulinemia and/or insulin
General discussion
Evidence showed that the high prevalence of metabolic disease in Asia was partly explained by an unfavourable body composition. However, there is a lack of understanding of the ethnic-specific nature of the association between the various components of body composition and morbidity sequelae [17]. For example, in contrast with Caucasians, the higher BMI, body fat percentage, visceral fat and intramyocellular lipid in Asian Indians did not correlate with insulin sensitivity [13], but waist to
Conclusion
The difference in body fat percentage between Asians and Caucasians is dependent on the region/ethnicity. It is most pronounced in South (Indians), followed by Southeast (Malay) and than East Asian (Chinese/Japanese). In general, Asians tend to store more fat in abdominal regions.
Genetic variation in lean body mass and fat mass may predispose individuals in different ethnicities to a different muscularity and adiposity. The interaction with other genes or the environment, both prenatal and
Contributors
As the first author, Siti Wulan is responsible for most of the writing of the manuscript.
Klaas Westerterp and Guy Plasqui, as supervisors of Ms. Siti Wulan, have contributed by discussing the content of the paper, as well as reviewing and correcting the manuscript.
Competing interests
The authors have no conflicts of interest.
Provenance and peer review
Commissioned and externally peer reviewed.
Acknowledgements
This work was supported by the Directorate General Higher Education, Ministry of National Education of Indonesia.
References (86)
Diabetes mellitus: perspective from the Asia-Pacific region
Diabetes Res Clin Pract
(2000)- et al.
Epidemic obesity and type 2 diabetes in Asia
Lancet
(2006) - et al.
Cardiovascular disease risk factors in 2 distinct ethnic groups: Indian and Pakistani compared with American premenopausal women
Am J Clin Nutr
(1999) - et al.
Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index
Am J Clin Nutr
(2000) - et al.
Postprandial lipid metabolism and insulin sensitivity in young Northern Europeans, South Asians and Latin Americans in the UK
Atherosclerosis
(2001) - et al.
Higher liver fat content among Japanese in Japan compared with non-Hispanic whites in the United States
Metabolism
(2009) - et al.
Adipose tissue in muscle: a novel depot similar in size to visceral adipose tissue
Am J Clin Nutr
(2005) - et al.
The “metabolically-obese,” normal-weight individual
Am J Clin Nutr
(1981) - et al.
Genome-wide association and replication studies identified TRHR as an important gene for lean body mass
Am J Hum Genet
(2009) - et al.
Associations between birth weight and later body composition: evidence from the 4-component model
Am J Clin Nutr
(2008)
Fetal programming of body dimensions and percentage body fat measured in prepubertal children with a 4-component model of body composition, dual-energy X-ray absorptiometry, deuterium dilution, densitometry, and skinfold thicknesses
Am J Clin Nutr
Programming of lean body mass: a link between birth weight, obesity, and cardiovascular disease?
Am J Clin Nutr
Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort
Am J Clin Nutr
The MTHFR gene polymorphism is associated with lean body mass but not fat body mass
Hum Genet
Upward weight percentile crossing in infancy and early childhood independently predicts fat mass in young adults: the Stockholm Weight Development Study (SWEDES)
Am J Clin Nutr
Genetic and environmental determination of tracking in subcutaneous fat distribution during adolescence
Am J Clin Nutr
Fat and carbohydrate intake modify the association between genetic variation in the FTO genotype and obesity
Am J Clin Nutr
Physical activity attenuates the body mass index-increasing influence of genetic variation in the FTO gene
Am J Clin Nutr
The common rs9939609 gene variant of the fat mass- and obesity-associated gene FTO is related to fat cell lipolysis
J Lipid Res
Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections
Diabetes Care
The use of BMI and waist circumference as surrogates of body fat differs by ethnicity
Obesity (Silver Spring)
Accuracy of body mass index in diagnosing obesity in the adult general population
Int J Obes (Lond)
Validation of skinfold thickness and hand-held impedance measurements for estimation of body fat percentage among Singaporean Chinese, Malay and Indian subjects
Asia Pac J Clin Nutr
Epidemiology of metabolic syndrome in Asia
Asia Pac J Clin Nutr
The impact of body build on the relationship between body mass index and percent body fat
Int J Obes Relat Metab Disord
Differences in body-composition assumptions across ethnic groups: practical consequences
Curr Opin Clin Nutr Metab Care
Differences in body composition between Singapore Chinese, Beijing Chinese and Dutch children
Eur J Clin Nutr
Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship
Obes Rev
Relation of triglyceride stores in skeletal muscle cells to central obesity and insulin sensitivity in European and South Asian men
Diabetologia
Insulin resistance and body fat distribution in South Asian men compared to Caucasian men
PLoS One
Asian Indians have enhanced skeletal muscle mitochondrial capacity to produce ATP in association with severe insulin resistance
Diabetes
BMI, fat and muscle differences in urban women of five ethnicities from two countries
Int J Obes (Lond)
Body size, body composition and fat distribution: comparative analysis of European, Maori, Pacific Island and Asian Indian adults
Br J Nutr
Lower BMI cut-off value to define obesity in Hong Kong Chinese: an analysis based on body fat assessment by bioelectrical impedance
Br J Nutr
Korean and Caucasian overweight premenopausal women have different relationship of body mass index to percent body fat with age
J Appl Physiol
Low body mass index but high percent body fat in Taiwanese subjects: implications of obesity cutoffs
Int J Obes Relat Metab Disord
Differences in the relationship between body fat and body mass index between two different Indonesian ethnic groups: the effect of body build
Eur J Clin Nutr
Ethnic differences in visceral adipose tissue and type 2 diabetes: Filipino, African-American, and white women
Obes Res
Differences in the relationship between BMI and percentage body fat between Japanese and Australian-Caucasian young men
Br J Nutr
Body fat measurement among Singaporean Chinese, Malays and Indians: a comparative study using a four-compartment model and different two-compartment models
Br J Nutr
Defining obesity by body mass index in the Thai population: an epidemiologic study
Asia Pac J Clin Nutr
Differences in body composition and cardiovascular and type 2 diabetes risk factors between migrant and British-born British Pakistani women
Am J Hum Biol
Cited by (220)
Low Phase Angle and Skeletal Muscle Index Increase Hospital-Acquired Infections During Stroke Rehabilitation
2024, Journal of the American Medical Directors AssociationBariatric surgery in adults with obesity and diabetes mellitus: a network meta-analysis
2024, Cochrane Database of Systematic Reviews