BMI, Waist Circumference, and Metabolic Syndrome: Lessons from Japanese Perspectives

  • Masaru Sakurai
  • Tsuguhito Ota
  • Katsuyuki Miura
  • Hideaki Nakagawa
  • Shuichi Kaneko
  • Toshinari Takamura


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.


Cholesterol Obesity Alanine Triglyceride Gout 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Body mass index


Organisation for Economic Cooperation and Development


Metabolic Syndrome


Dual-energy X-ray Absorptiometry


Fat mass


Computed tomography


International Diabetes Federation


Receiver-Operator Characteristic


Fasting Plasma Glucose


Rate ratio


Homeostatic Model Assessment


Hazard ratio


Nonalcoholic Fatty Liver Disease


Nonalcoholic Steatohepatitis


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Masaru Sakurai
  • Tsuguhito Ota
  • Katsuyuki Miura
  • Hideaki Nakagawa
  • Shuichi Kaneko
  • Toshinari Takamura
    • 1
  1. 1.Department of Disease Control and HomeostasisKanazawa University Graduate School of Medical ScienceKanazawaJapan

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