Abstract
The prevalence of overweight and obesity in Japan is much lower than in Western countries: about 30% for Japanese men and 20% for Japanese women. Despite this low rate of obesity, the prevalence of metabolic abnormalities related to cardiovascular risk factors such as hypertension, dyslipidaemia, and diabetes is not lower in Japan than in Western countries. Visceral fat accumulation is also closely associated with metabolic abnormalities in the Japanese. Among the anthropometric variables, waist circumference is an indirect measure of abdominal fat accumulation. The waist circumference cutoff points for the Japanese have been proposed as 90 cm for women and 85 cm for men, which correspond to a 100-cm2 area of visceral fat at the umbilical level on computed tomography imaging. However, subcutaneous fat strongly influences waist circumference in relatively lean Japanese women, and waist circumference does not effectively predict the existence of metabolic syndrome. In relatively lean Japanese women, BMI rather than waist circumference is reported to be more strongly associated with metabolic syndrome and may be more appropriate as an index for total and abdominal fat accumulation. Normal weight is associated with increased cardiovascular risk factors in Japanese. The difference in the association between obesity and metabolic abnormalities in Asian and Western countries may be due to genetic factors, different lifestyles, or sensitivity to metabolic disorders of obesity. Japanese have more total body fat and visceral fat than Caucasian men with the same degree of obesity, and the difference in body fat distribution also contributes to these differences. Furthermore, there is a J-shaped relationship between waist circumference and subsequent risk for type 2 diabetes in relatively lean Japanese; lower pancreatic B-cell function may also increase the diabetes risk in very lean Japanese. Recently, nonalcoholic fatty liver disease has been reported to be closely associated with metabolic syndrome in Western and Asian populations. Not only fat accumulation in the visceral area, but fat accumulation in the liver may also contribute to the development of metabolic syndrome. Therefore, when we consider the association between obesity indices, such as waist circumference and BMI, and metabolic syndrome, we should consider the gender/ethnic differences of these associations, insulin deficiency, and fatty liver-associated insulin resistance.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- BMI:
-
Body mass index
- OECD:
-
Organisation for Economic Cooperation and Development
- MetS:
-
Metabolic Syndrome
- DXA:
-
Dual-energy X-ray Absorptiometry
- FM:
-
Fat mass
- CT:
-
Computed tomography
- IDF:
-
International Diabetes Federation
- ROC:
-
Receiver-Operator Characteristic
- FPG:
-
Fasting Plasma Glucose
- RR:
-
Rate ratio
- HOMA:
-
Homeostatic Model Assessment
- HR:
-
Hazard ratio
- NAFLD:
-
Nonalcoholic Fatty Liver Disease
- NASH:
-
Nonalcoholic Steatohepatitis
References
Adams LA, Waters OR, Knuiman MW, Elliott RR, Olynyk JK. NAFLD as a risk factor for the development of diabetes and the metabolic syndrome: an eleven-year follow-up study. Am J Gastroenterol. 2009;104:861–7.
André P, Balkau B, Vol S, Charles MA, Eschwège E; DESIR Study Group. Gamma- glutamyltransferase activity and development of the metabolic syndrome (International Diabetes Federation Definition) in middle-aged men and women: Data from the Epidemiological Study on the Insulin Resistance Syndrome (DESIR) cohort. Diabetes Care. 2007;30:2355–61.
Arberti KG, Zimmet P, Shaw J for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome–a new worldwide definition. Lancet. 2005;366:1059–62.
Asayama K, Sato A, Ohkubo T, Mimura A, Hayashi K, Kikuya M, Yasui D, Kanno A, Hara A, Hirose T, Obara T, Metoki H, Inoue R, Hoshi H, Satoh H, Imai Y. The association between masked hypertension and waist circumference as an obesity-related anthropometric index for metabolic syndrome: the Ohasama study. Hypertens Res. 2009;32:438–43.
Carey VJ, Walters EE, Colditz GA, Solomon CG, Willett WC, Rosner BA, Speizer FE, Manson JE. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses’ Health Study. Am J Epidemiol. 1997;145:614–9.
Decoda Study Group, Nyamdorj R, Qiao Q, Lam TH, Tuomilehto J, Ho SY, Pitkäniemi J, Nakagami T, Mohan V, Janus ED, Ferreira SR. BMI compared with central obesity indicators in relation to diabetes and hypertension in Asians. Obesity (Silver Spring). 2008;16:1622–35.
De Fronzo RA. Lilly lecture 1987. The triumvirate: beta-cell, muscle, liver. A collusion responsible for NIDDM. Diabetes. 1988;37:667–87.
De Fronzo RA, Ferrannini E, Simonson DC. Fasting hyperglycemia in non-insulin-dependent diabetes mellitus: contributions of excessive hepatic glucose production and impaired tissue glucose uptake. Metabolism. 1989;38:387–95.
Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat percent relationship. Obes Rev. 2002;3:141–6.
Devers MC, Campbell S, Shaw J, Zimmet P, Simmons D. Should liver function tests be included in definitions of metabolic syndrome? Evidence from the association between liver function tests, components of metabolic syndrome and prevalent cardiovascular disease. Diabet Med. 2008;25:523–9.
Doi Y, Ninomiya T, Hata J, Yonemoto K, Arima H, Kubo M, Tanizaki Y, Iwase M, Iida M, Kiyohara Y. Proposed criteria for metabolic syndrome in Japanese based on prospective evidence: the Hisayama study. Stroke. 2009;40:1187–94.
Fabbrini E, Magkos F, Mohammed BS, Pietka T, Abumrad NA, Patterson BW, Okunade A, Klein S. Intrahepatic fat, not visceral fat, is linked with metabolic complications of obesity. Proc Natl Acad Sci USA. 2009;106:15430–5.
Folsom AR, Kushi LH, Anderson KE, Mink PJ, Olson JE, Hong CP, Sellers TA, Lazovich D, Prineas RJ. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women’s Health Study. Arch Intern Med. 2000;160:2117–28.
Fukushima M, Usami M, Ikeda M, Nakai Y, Taniguchi A, Matsuura T, Suzuki H, Kurose T, Yamada Y, Seino Y. Insulin secretion and insulin sensitivity at different stages of glucose tolerance: a cross-sectional study of Japanese type 2 diabetes. Metabolism. 2004;53:831–5.
Ge K. Body mass index of young Chinese adults. Asia Pac J Clin Nutr. 1997;6:175–9.
Hara K, Matsushita Y, Horikoshi M, Yoshiike N, Yokoyama T, Tanaka H, Kadowaki T. A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population. Diabetes Care. 2006;29:1123–4.
Hamaguchi E, Takamura T, Sakurai M, Mizukoshi E, Zen Y, Takeshita Y, Kurita S, Arai K, Yamashita T, Sasaki M, Nakanuma Y, Kaneko S. Histological course of nonalcoholic fatty liver disease in Japanese patients: tight glycemic control, rather than weight reduction, ameliorates liver fibrosis. Diabetes Care. 2010;33:284–6.
Hsieh SD, Muto T. The superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med. 2005;40:216–20.
Huxley R, James WP, Barzi F, Patel JV, Lear SA, Suriyawongpaisal P, Janus E, Caterson I, Zimmet P, Prabhakaran D, Reddy S, Woodward M. Ethnic comparisons of the cross- sectional relationships between measures of body size with diabetes and hypertension. Obes Rev. 2008;9:53–61.
Iso H, Kiyama M, Naito Y, Sato S, Kitamura A, Iida M, Konishi M, Sankai T, Shimamoto T, Komachi Y. The relation of body fat distribution and body mass with haemoglobin A1c, blood pressure and blood lipids in urban Japanese men. Int J Epidemiol. 1991;20:88–94.
Ito H, Nakasuga K, Ohshima A, Maruyama T, Kaji Y, Harada M, Fukunaga M, Jingu S, Sakamoto M. Detection of cardiovascular risk factors by indices of obesity obtained from anthropometry and dual-energy X-ray absorptiometry in Japanese individuals. Int J Obes Relat Metab Disord. 2003;27:232–7.
Kadowaki T, Sekikawa A, Murata K, Maegawa H, Takamiya T, Okamura T, El-Saed A, Miyamatsu N, Edmundowicz D, Kita Y, Sutton-Tyrrell K, Kuller LH, Ueshima H. Japanese men have larger areas of visceral adipose tissue than Caucasian men in the same levels of waist circumference in a population-based study. Int J Obes (Lond). 2006;30:1163–5.
Kato M, Takahashi Y, Inoue M, Tsugane S, Kadowaki T, Noda M, JPHC Study Group. Comparisons between anthropometric indices for predicting the metabolic syndrome in Japanese. Asia Pac J Clin Nutr. 2008;17:223–8.
Kashihara H, Lee JS, Kawakubo K, Tamura M, Akabayashi A. Criteria of waist circumference according to computed tomography-measured visceral fat area and the clustering of cardiovascular risk factors. Circ J. 2009;73:1881–6.
Ko GT, Chan JC, Woo J, Lau E, Yeung VT, Chow CC, Wai HP, Li JK, So WY, Cockram CS. Simple anthropometric indexes and cardiovascular risk factors in Chinese. Int J Obes Relat Metab Disord. 1997;21:995–1001.
Kondo T, Abe M, Ueyama J, Kimata A, Yamamoto K, Hori Y. Use of waist circumference and ultrasonographic assessment of abdominal fat distribution in predicting metabolic risk factors in healthy Japanese adults. J Physiol Anthropol. 2009;28:7–14.
Lee DS, Evans JC, Robins SJ, Wilson PW, Albano I, Fox CS, Wang TJ, Benjamin EJ, D’Agostino RB, Vasan RS. Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk: the Framingham Heart Study. Arterioscler Thromb Vasc Biol. 2007a;27:127–33.
Lee JS, Kawakubo K, Mori K, Akabayashi A. Effective cut-off values of waist circumference to detect the clustering of cardiovascular risk factors of metabolic syndrome in Japanese men and women. Diab Vasc Dis Res. 2007b;4:340–5.
Matsuzawa N, Takamura T, Kurita S, Misu H, Ota T, Ando H, Yokoyama M, Honda M, Zen Y, Nakanuma Y, Miyamoto K, Kaneko S. Lipid-induced oxidative stress causes steatohepatitis in mice fed an atherogenic diet. Hepatology. 2007;46:1392-403.
Matoba Y, Inoguchi T, Nasu S, Suzuki S, Yanase T, Nawata H, Takayanagi R. Optimal cut points of waist circumference for the clinical diagnosis of metabolic syndrome in the Japanese population. Diabetes Care. 2008;31:590–2.
Meisinger C, Doring A, Thorand B, Heier M, Lowel H. Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg cohort study. Am J Clin Nutr. 2006;84:483–9.
Ministry of Health, Labour, and Welfare. Available at: http://www.mhlw.go.jp/ (in Japanese). Accessed September 28, 2009.
Misu H, Takamura T, Takayama H, Hayashi H, Matsuzawa-Nagata N, Kurita S, Ishikura K, Ando H, Takeshita Y, Ota T, Sakurai M, Yamashita T, Mizukoshi E, Yamashita T, Honda M, Miyamoto K, Kubota T, Kubota N, Kadowaki T, Kim HJ, Lee IK, Minokoshi Y, Saito Y, Takahashi K, Yamada Y, Takakura N, Kaneko S. A liver-derived secretory protein, selenoprotein P, causes insulin resistance. Cell Metab. 2010;12:483–95.
Miyatake N, Wada J, Matsumoto S, Nishikawa H, Makino H, Numata T. Re-evaluation of waist circumference in metabolic syndrome: a comparison between Japanese men and women. Acta Med Okayama. 2007;61:167–9.
Nakamura H, Ito H, Egami Y, Kaji Y, Maruyama T, Koike G, Jingu S, Harada M. Waist circumference is the main determinant of elevated C-reactive protein in metabolic syndrome. Diabetes Res Clin Pract. 2008;79:330–6.
Nakamura S, Takamura T, Matsuzawa-Nagata N, Takayama H, Misu H, Noda H, Nabemoto S, Kurita S, Ota T, Ando H, Miyamoto K, Kaneko S. Palmitate induces insulin resistance in H4IIEC3 hepatocytes through reactive oxygen species produced by mitochondria. J Biol Chem. 2009;284:14809–18.
Nakamura Y, Turin TC, Kita Y, Tamaki S, Tsujita Y, Kadowaki T, Murakami Y, Okamura T, Ueshima H. Associations of obesity measures with metabolic risk factors in a community-based population in Japan. Circ J. 2007;71:776–81.
Narisawa S, Nakamura K, Kato K, Yamada K, Sasaki J, Yamamoto M. Appropriate waist circumference cutoff values for persons with multiple cardiovascular risk factors in Japan: a large cross-sectional study. J Epidemiol. 2008;18:37–42.
Nishimura R, Nakagami T, Tominaga M, Yoshiike N, Tajima N. Prevalence of metabolic syndrome and optimal waist circumference cut-off values in Japan. Diabetes Res Clin Pract. 2007;78:77–84.
Obesity in Asia Collaboration. Is central obesity a better discriminator of the risk of hypertension than body mass index in ethnically diverse populations? J Hypertens. 2008;26:169–77.
Ohkubo T, Kikuya M, Asayama K, Imai Y. A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population. Diabetes Care. 2006;29:1986–7.
Ohnishi H, Saitoh S, Akasaka H, Mitsumata K, Chiba M, Furugen M, Furukawa T, Mori M, Shimamoto K. Incidence of hypertension in individuals with abdominal obesity in a rural Japanese population: the Tanno and Sobetsu study. Hypertens Res. 2008;31:1385–90.
Oizumi T, Daimon M, Wada K, Jimbu Y, Kameda W, Susa S, Yamaguchi H, Ohnuma H, Kato T. A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population. Circ J. 2006;70:1663.
Oka R, Kobayashi J, Yagi K, Tanii H, Miyamoto S, Asano A, Hagishita T, Mori M, Moriuchi T, Kobayashi M, Katsuda S, Kawashiri MA, Nohara A, Takeda Y, Mabuchi H, Yamagishi M. Reassessment of the cutoff values of waist circumference and visceral fat area for identifying Japanese subjects at risk for the metabolic syndrome. Diabetes Res Clin Pract. 2008;79:474–81.
Oka R, Miura K, Sakurai M, Nakamura K, Yagi K, Miyamoto S, Moriuchi T, Mabuchi H, Yamagishi M, Takeda Y, Hifumi S, Inazu A, Nohara A, Kawashiri MA, Kobayashi J. Comparison of waist circumference with body mass index for predicting abdominal adipose tissue. Diabetes Res Clin Pract. 2009;83:100–5.
Oka R, Miura K, Sakurai M, Nakamura K, Yagi K, Miyamoto S, Moriuchi T, Mabuchi H, Koizumi J, Nomura H, Takeda Y, Inazu A, Nohara A, Kawashiri MA, Nagasawa S, Kobayashi J, Yamagishi M. Impacts of visceral adipose tissue and subcutaneous adipose tissue on metabolic risk factors in middle-aged Japanese. Obesity (Silver Spring). 2010;18:153–60.
Organisation for Economic Co-operation and Development (OECD) Health Data 2008, Available at: http://www.oecd.org/els/health/data Accessed September 28, 2009.
Ota T, Takamura T, Hirai N, Kobayashi K. Preobesity in World Health Organization classification involves the metabolic syndrome in Japanese. Diabetes Care. 2002;25:1252–3.
Ota T, Sakurai M, Takamura T, Yamagami K. Cut-off point of body mass index to detect metabolic abnormality in Japanese. J Jpn Soc Study Obes. 2006;11:317–22 (in Japanese).
Sakurai M, Miura K, Takamura T, Ota T, Ishizaki M, Morikawa Y, Kido T, Naruse Y, Nakagawa H. Gender differences in the association between anthropometric indices of obesity and blood pressure in Japanese. Hypertens Res. 2006;29:75–80.
Sakurai M, Takamura T, Ota T, Ando H, Akahori H, Kaji K, Sasaki M, Nakanuma Y, Miura K, Kaneko S. Liver steatosis, but not fibrosis, is associated with insulin resistance in nonalcoholic fatty liver disease. J Gastroenterol. 2007;42:312–7.
Sakurai M, Takamura T, Miura K, Kaneko S, Nakagawa H. BMI may be better than waist circumference for defining metabolic syndrome in Japanese women. Diabetes Care. 2008;31:e12.
Sakurai M, Takamura T, Miura K, Kaneko S, Nakagawa H. Middle-aged Japanese women are resistant to obesity-related metabolic abnormalities. Metabolism. 2009a;58:456–9.
Sakurai M, Miura K, Takamura T, Ishizaki M, Morikawa Y, Nakamura K, Yoshita K, Kido T, Naruse Y, Kaneko S, Nakagawa H. J-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes: an 8-year follow-up of relatively lean Japanese individuals. Diabet Med. 2009b;26:753–9.
Sato A, Asayama K, Ohkubo T, Kikuya M, Obara T, Metoki H, Inoue R, Hara A, Hoshi H, Hashimoto J, Totsune K, Satoh H, Oka Y, Imai Y. Optimal cutoff point of waist circumference and use of home blood pressure as a definition of metabolic syndrome: the Ohasama study. Am J Hypertens. 2008;21:514–20.
Shimajiri T, Imagawa M, Kokawa M, Konami T, Hara H, Kyoku I, Sone E, Ishigame M, Kikuoka H. Revised optimal cut-off point of waist circumference for the diagnosis of metabolic syndrome in Japanese women and the influence of height. J Atheroscler Thromb. 2008;15:94–9.
Sone H, Tanaka S, Iimuro S, Oida K, Yamasaki Y, Ishibashi S, Oikawa S, Katayama S, Ito H, Ohashi Y, Akanuma Y, Yamada N. Waist circumference as a cardiovascular and metabolic risk in Japanese patients with type 2 diabetes. Obesity (Silver Spring). 2009;17:585–92.
Stefan N, Kantartzis K, Machann J, Schick F, Thamer C, Rittig K, Balletshofer B, Machicao F, Fritsche A, Häring HU. Identification and characterization of metabolically benign obesity in humans. Arch Intern Med. 2008;168:1609–16.
Tabata S, Yoshimitsu S, Hamachi T, Abe H, Ohnaka K, Kono S. Waist circumference and insulin resistance: a cross-sectional study of Japanese men. BMC Endocr Disord. 2009;9:1.
Takimoto H, Yoshiike N, Kaneda F, Yoshita K. Thinness among young Japanese women. Am J Public Health. 2004;94:1592–5.
The Examination Committee of Criteria for Metabolic Syndrome. The definition and criteria of metabolic syndrome. J Jpn Soc Int Med. 2005;94:794–809 (in Japanese).
The Examination Committee of Criteria for “Obesity Disease” in Japan, Japan Society for Study of Obesity. New criteria for ’obesity disease’ in Japan. Circulation J. 2002;66:987–92.
Tripathy D, Carlsson M, Almgren P, Isomaa B, Taskinen MR, Tuomi T, Groop LC. Insulin secretion and insulin sensitivity in relation to glucose tolerance: lessons from the Botnia Study. Diabetes. 2000;49:975–80.
Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005;81:555–63.
Wei M, Gaskill SP, Haffner SM, Stern MP. Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (NIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans–a 7-year prospective study. Obes Res. 1997;5:16–23.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63.
Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, Zimmet P, Son HY. Epidemic obesity and type 2 diabetes in Asia. Lancet. 2006;368:1681–8.
Yoshida D, Toyomura K, Fukumoto J, Ueda N, Ohnaka K, Adachi M, Takayanagi R, Kono S. Waist circumference and cardiovascular risk factors in Japanese men and women. J Atheroscler Thromb. 2009;16:431–41.
Yoshiike N, Matsumura Y, Zaman MM, Yamaguchi M. Descriptive epidemiology of body mass index in Japanese adults in a representative sample from the National Nutrition Survey 1990–1994. Int J Obes Relat Metab Disord. 1998;22:684–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Sakurai, M., Ota, T., Miura, K., Nakagawa, H., Kaneko, S., Takamura, T. (2012). BMI, Waist Circumference, and Metabolic Syndrome: Lessons from Japanese Perspectives. In: Preedy, V. (eds) Handbook of Anthropometry. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1788-1_121
Download citation
DOI: https://doi.org/10.1007/978-1-4419-1788-1_121
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-1787-4
Online ISBN: 978-1-4419-1788-1
eBook Packages: MedicineMedicine (R0)