Overweight male personnel of the Japan Self-Defense Forces with body mass indices of 23.0–24.9 and obesity-related metabolic disorders
Environ Health Prev Med
Overweight male personnel of the Japan Self-Defense Forces with body mass indices of 23.0-24.9 and obesity-related metabolic disorders
Hidenari Sakuta 0 1 2
Takashi Suzuki 0 1 2
0 H. Sakuta (&) Department of Internal Medicine, Self-Defense Forces, Sendai Hospital , 1-1 Minaminometate, Miyagino-ku, Sendai 983-0041 , Japan
1 T. Suzuki Department of Research and Laboratory, Self-Defense Forces Central Hospital , Tokyo , Japan
2 H. Sakuta Department of Internal Medicine, Self-Defense Forces Central Hospital , Tokyo , Japan
Objectives To assess the validity of the criterion of overweight for Asian people that is recommended by Western Pacific Region of the World Health Organization. Methods We carried out a cross-sectional analysis of the association between the criterion of overweight for ethnic Asian people-body mass indices (BMI) of 23.0-24.9 kg/ m2-and the presence of obesity-related metabolic disorders among middle-aged Japanese men (n = 974, age range 51-59). Results The odds ratios (95% confidence interval) of overweight to those with normal weight (BMI \ 23.0 kg/ m2) were 1.61 (1.11-2.33) for the presence of impaired glucose tolerance, 1.95 (1.30-2.93) for hypertension, 2.22 (1.63-3.03) for hypercholesterolemia, 2.83 (2.02-3.97) for hypertriglyceridemia, and 2.06 (1.06-4.00) for hyperuricemia. Overweight was not associated with the presence of type 2 diabetes or with high c-glutamyl transrease in the present study (odds ratios: 1.09 and 1.05, respectively). Adjustment for age, rank, and lifestyle factors affected the results only slightly.
Conclusions Based on these results, we conclude that the
Asian criterion of overweight appears to be rational in
terms of its association with obesity-related metabolic
disorders in male personnel of the Japan Self-Defense
Forces in their fifties.
Dyslipidemia Hypertension Obesity-related disorders occur at a much lower body mass index (BMI) in ethnic Asian populations than in ethnic
Caucasian ones [
]. The Western Pacific Regional Office
of the World Health Organization (WHO) has
recommended lowering the BMI cutoff levels for Asian people to
23.0 for overweight and 25.0 for obesity . The validity
of the new criteria has been supported by several reports.
For example, among ethnic Korean and Chinese
populations, ‘‘overweight’’ subjects (23.0–24.9 kg/m2) have been
found to show a tendency toward an increased incidence of
hypertension, dyslipidemia, and type 2 diabetes (Korean
]; Chinese studies: [
]). Among ethnic
Japanese, Shiwaku et al.  demonstrated the correlation
between overweight and obesity-related metabolic
parameters, including systolic blood pressure (SBP), cholesterol,
triglycerides, and glucose. An association between the BMI
category that is close to the Asian criterion and the
presence of obesity-related disorders has also been shown
in ethnic Japanese [
]. To date, however, very few
studies have assessed the new criterion of overweight for
Asian people (BMI of 23.0–24.9 kg/m2) and the presence
of obesity-related metabolic disorders among the Japanese
6, 10, 15
In the study reported here, we analyzed the association
between the Asian criterion of overweight and the presence
of obesity-related disorders among middle-aged Japanese
men. Age and lifestyle factors were adjusted for in the
The study cohort consisted of middle-aged (age range 51–
59 years) male personnel of the Japan Self-Defense
Forces (JSDFs) undergoing the retirement health check-up
at the JSDFs’ Central Hospital in 1999–2000. The BMI
was calculated as [(weight, kg)/(height, m)]2. The
participants were categorized as obese (BMI C 25.0 kg/m2),
overweight (BMI 23.0–23.9 kg/m2) and normal weight
(BMI \ 23.0 kg/m2), according to the criteria for Asian
]. Information on lifestyle factors, including
smoking habits, vegetable intake, ethanol consumption,
physical activity [
], rank in the JSDFs, and present and
past history of illness, were obtained using a
self-completion questionnaire [
]. Vegetable intake was assessed
by the self-rating scale and classified into four categories:
poor intake, common intake, relatively rich intake, and
rich intake. Each category of vegetable intake was given
an ordinal number, and this was designated as the
vegetable intake score. Average daily ethanol consumption
rate was calculated from the type of beverage and daily
consumption of each alcoholic beverage. Seniority in
terms of rank in the JSDFs was categorized as previously
Blood samples were collected after a 12-h overnight fast
from an antecubital vein. Serum total cholesterol,
triglycerides, uric acid and c-glutamyl transferase were measured.
An oral 75 g glucose tolerance test was given after an
overnight fast. Blood pressure was measured after resting
in a sitting position using a mercury sphygmomanometer.
The diagnosis of diabetes and impaired glucose
tolerance (IGT) was made according to the criteria of the WHO
]. The diagnosis of hypertension was made based upon
each individual’s medical history or by the patient taking
medication for hypertension (C140/90 mmHg) based on
the criteria of the Seventh Report of Joint National
Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure [
diagnosis of hypercholesterolemia, hypertriglyceridemia, and
hyperuricemia was based upon each individual’s medical
history and laboratory data: subjects with a total cholesterol
level [5.7 mmol/L (220 mg/dL) were diagnosed with
hypercholesterolemia, those with a triglyceride level
C1.7 mmol/L (150 mg/dL) were diagnosed with
hypertriglyceridemia, those with a uric acid level C0.48 mmol/L
(8.0 mg/dL) were diagnosed with hyperuricemia, and those
with a c-glutamyl transferase level C70 IU/L were
diagnosed with high c-glutamyl transferase. The subjects gave
informed consent. The study protocol was approved by the
ethics committee of JSDFs’ Central Hospital.
Descriptive data were expressed as the mean ± SD.
Since the distribution of c-glutamyl transferase was
skewed, the analysis for c-glutamyl transferase was carried
out using the logarithm of c-glutamyl transferase, and the
results were transformed back to the original scale. Thus,
geometric means were used for c-glutamyl transferase. The
95% confidence interval (95% CI) of the geometric mean
was found by taking the antilogarithm of the 95% CI of the
logarithm of c-glutamyl transferase. Mean values between
multiple pairs of groups were compared by applying
Fisher’s protected least-significant difference (PLSD) post
hoc test, if there was a significant difference in one-way
analysis of variance (ANOVA). A logistic regression
analysis was performed with metabolic disorder as the
dependent variable. In an adjusted analysis model, age,
daily number of cigarettes smoked, frequency of exercise
strenuous enough to work up perspiration, daily ethanol
consumption rate, and the rank in JSDFs were included as
independent variables. The analyses were performed with
the statistical program STATVIEW ver. 5.0 (SAS Institute,
Mean age was similar between the subjects with a normal
body weight, those who were overweight, and those who
were obese (Table 1). Mean (SD) BMI of the study
population was 23.6 (2.4) kg/m2. The prevalence rate of
obesity and overweight was 28 and 32%, respectively. No
significant differences were observed between the three
groups in terms of frequency of exercise strenuous enough
to work up perspiration, vegetable intake, daily ethanol
consumption, daily number of cigarettes smoked, or rank in
Levels of fasting plasma glucose, 2-h plasma glucose
(OGTT), SBP, total cholesterol, triglycerides, uric acid,
and c-glutamyl transferase were higher among overweight
subjects than among normal weight subjects, respectively
Prevalence rates of metabolic diseases among the study
population were 14.6% for type 2 diabetes, 22.6% for IGT,
20.9% for hypertension, 41.2% for hypercholesterolemia,
35.5% for hypertriglyceridemia, and 6.4% for
hyperuricemia. Overweight subjects showed a higher prevalence rate
of IGT, hypertension, hypercholesterolemia,
hypertriglyceridemia, and hyperuricemia (Table 3). Prevalence rates of
type 2 diabetes or high levels of c-glutamyl transferase
were not elevated among overweight subjects. Adjustment
P values for normal weight subjects. Values given in parenthesis are the standard deviations
* P = 0.015
a Ethanol consumption of abstainers was considered to be 0 mL/day; the number of cigarettes smoked by non-smokers was regarded to be 0/day
for the calculation of mean (SD) values
* P \ 0.05, ** P \ 0.001 versus normal weight subjects
Subjects who were under medication were included in the analysis model
Values are given as the arithmetic mean, with the standard deviation given in parenthesis, with the exception of c-glutamyl transferase for which
the geometric mean is given with the 95% CI given in square parenthesis
for age, rank in JSDFs, and lifestyle factors little affected
The prevalence rates of obesity (28%) and overweight
(32%) among the population studied (male, mean age
53 years) were similar to those reported for middle-aged
civilian Japanese men (mean age 52 years) (32 and 24%,
]. Obesity-related metabolic disorders,
including IGT, were more prevalent among the overweight
subjects than among the normal weight ones (Table 3).
To date, several published studies have reported an
association between ‘‘overweight’’ and obesity-related
metabolic disorders among the Japanese [
results of the present reported here support these findings.
To our best knowledge, this is the first report of an
association between overweight and IGT among Japanese
Shiwaku et al. [
] reported that SBP and serum
triglycerides are higher among overweight Japanese men
(BMI 23.0–24.9 kg/m2) than those with a normal weight,
which is consistent with our findings. In contrast, our
results in terms of total cholesterol and fasting plasma
glucose levels differed somewhat from those of Shiwaku
et al. [
]. Total cholesterol and fasting glucose levels were
not elevated among overweight men in their study, whereas
they were elevated among the overweight men of our
study. This apparent discrepancy may partly be explained
by the difference in the age range of the study population
] vs. 51–59 years (present study)]. Since
Type 2 diabetes
Impaired glucose tolerance
High c-glutamyl transferasea
prevalence rates of obesity-related disorders are
agedependent, the association would be weakened if the age of
the population studied covers wide range.
A limitation to the present study is its cross-sectional
design. Although age and lifestyle factors were taken
into account in the logistic regression analysis model,
other factors may have affected the results. The results of
our study on JSDFs personnel cannot be extrapolated to
the Japanese general population because the association
between BMI and metabolic disorders is suggested to be
affected by the age and gender of the individuals of the
population under study [
]. In addition, since the
population studied consists of physically active personnel
with a possibly decreased ratio of fat to lean mass,
individual BMIs may have been overestimated. Another
limitation of the present study may be the lack of other
obesity indices. Since BMI is not a direct index of body
fat, more direct indices of body fat should be evaluated
for further investigation using computed tomography,
magnetic resonance imaging, and dual-energy X-ray
In conclusion, male personnel of the JSDFs in their
fifties who satisfy the criterion of overweight for Asian
people showed higher prevalence rates of hypertension,
hypercholesterolemia, hypertriglyceridemia, and
hyperuricemia, but not those of diabetes or high c-glutamyl
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