Displaying publications 1 - 20 of 29 in total

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  1. Validity of body composition methods across ethnic population groups
    Deurenberg P, Deurenberg-Yap M
    Acta Diabetol, 2003 Oct;40 Suppl 1:S246-9.
    PMID: 14618484
    Most in vivo body composition methods rely on assumptions that may vary among different population groups as well as within the same population group. The assumptions are based on in vitro body composition (carcass) analyses. The majority of body composition studies were performed on Caucasians and much of the information on validity methods and assumptions were available only for this ethnic group. It is assumed that these assumptions are also valid for other ethnic groups. However, if apparent differences across ethnic groups in body composition 'constants' and body composition 'rules' are not taken into account, biased information on body composition will be the result. This in turn may lead to misclassification of obesity or underweight at an individual as well as a population level. There is a need for more cross-ethnic population studies on body composition. Those studies should be carried out carefully, with adequate methodology and standardization for the obtained information to be valuable.
  2. The Southeast Asian Nutrition Surveys
    Deurenberg P, Siong TE
    Asia Pac J Public Health, 2016 07;28(5 Suppl):6S-7S.
    PMID: 27303070 DOI: 10.1177/1010539516653883
  3. Validity of deuterium oxide dilution for the measurement of body fat among Singaporeans
    Deurenberg-Yap M, Deurenberg P
    Food Nutr Bull, 2002 Sep;23(3 Suppl):34-7.
    PMID: 12362808
    Body fat percent (BF%) was measured in 108 adult Chinese, 76 Malays, and 107 Indians in Singapore by densitometry, deuterium oxide dilution (hydrometry), dual energy x-ray absorptiometry (DXA) and a chemical four-compartment model (BF%4c). The hydration of the fat-free mass (FFM) was calculated. Subjects ranged in age from 18 to 69 years and their body mass index ranged from 16 to 40 kg/m2. BF%4c for the various subgroups were: Chinese females (33.5 +/- 7.5%), Chinese males (24.4 +/- 6.1%), Malay females (37.8 +/- 6.3%), Malay males (26.0 +/- 7.6%), Indian females (38.2 +/- 7.0%) and Indian males (28.1 +/- 5.5%). Biases were found between BF%4c and BF% measured by 2-compartment models (hydrometry, densitometry, DXA), with systematic underestimation by DXA and densitometry. On a group level hydrometry had the lowest bias while DXA gave the highest bias. When validated against BF%4c, 2-compartment models were found to be unsuitable for accurate measures of body fat due to high biases at the individual level and the violation of assumptions of constant hydration of FFM and density FFM among the ethnic groups. On a group level the best 2-compartment model for measuring body fat was found to be hydrometry.
  4. Is a re-evaluation of WHO body mass index cut-off values needed? The case of Asians in Singapore
    Deurenberg-Yap M, Deurenberg P
    Nutr Rev, 2003 May;61(5 Pt 2):S80-7.
    PMID: 12828197
    This paper describes body composition and dietary intakes of the three major ethnic groups residing in Singapore and how these are related to cardiovascular risk factors in these groups. When the relationship between body mass index (BMI, kg/m2) and body fat percentage was studied, Singaporeans were found to have higher percentage of body fat compared with Caucasians with the same BMI. At BMIs that are much lower than WHO-recommended cut-off values for obesity, both the absolute and relative risks of developing cardiovascular risk factors are markedly elevated for all three ethnic groups. The excessive fat accumulation and increased risks at lower BMIs signal a need to re-examine cut-off values for obesity among Chinese, Malays, and Indians.
  5. Fulltext Validation of skinfold thickness and hand-held impedance measurements for estimation of body fat percentage among Singaporean Chinese, Malay and Indian subjects
    Deurenberg P, Deurenberg-Yap M
    Asia Pac J Clin Nutr, 2002;11(1):1-7.
    PMID: 11890632
    Body fat percentage (BF%) was measured in 298 Singaporean Chinese, Malay and Indian men and women using a chemical four-compartment model consisting of fat, water, protein and mineral (BF%4C). In addition, weight, height, skinfold thickness and segmental impedance (from hand to hand) was measured. Body fat percentage was predicted using prediction equations from the literature (for skinfolds BF%SKFD) and using the manufacturer's software for the hand-held impedance analyser (BF%IMP). The subjects ranged in age from 18-70 years and in body mass index from 16.0 to 40.2 kg/m2. Body fat ranged from 6.5 to 53.3%. The biases for skinfold prediction (BF%4C-BF%SKFD, mean +/- SD) were -0.4+/-3.9, 2.3+/-4.1 and 3.1+/-4.2 in Chinese, Malay and Indian women, respectively, the Chinese being different from the Malays and Indians. The differences were significant from zero (P < 0.05) in the Malays and Indians. For the men, the biases were 0.5+/-3.8, 0.0+/-4.8 and 0.9+/-4.0 in Chinese, Malays and Indians, respectively. These biases were not significantly different from zero and not different among the ethnic groups. The biases for hand-held impedance BF% were -0.7+/-4.5, 1.5+/-4.4 and 0.4+/-3.8 in Chinese, Malay and Indian women. These biases were not significantly different from zero but the bias in the Chinese was significantly different from the biases in the Malays and Indians. In the Chinese, Malay and Indian men, the biases of BF%IMP were 0.7+/-4.6, 1.9+/-4.8 and 2.0+/-4.4, respectively. These biases in Malay and Indian men were significantly different from zero and significantly different from the bias in Chinese men. The biases were correlated with level of body fat and age, and also with relative arm span (arm span/height) for impedance. After correction, the differences in bias among the ethnic groups disappeared. The study shows that the biases in predicted BF% differ between ethnic groups, differences that can be explained by differences in body composition and differences in body build. This information is important and should be taken into account when comparing body composition across ethnic groups using predictive methods.
  6. Bone status measured by quantitative ultrasound: a comparison with DXA in Thai children
    Srichan W, Thasanasuwan W, Kijboonchoo K, Rojroongwasinkul N, Wimonpeerapattana W, Khouw I, et al.
    Eur J Clin Nutr, 2016 08;70(8):894-7.
    PMID: 26508460 DOI: 10.1038/ejcn.2015.180
    BACKGROUND/OBJECTIVES: Quantitative ultrasound (QUS) is used to measure bone quality and is known to be safe, radiation free and relatively inexpensive compared with dual-energy X-ray absorptiometry (DXA) that is considered the gold standard for bone status assessments. However, there is no consensus regarding the validity of QUS for measuring bone status. The aim of this study was to compare QUS and DXA in assessing bone status in Thai children.

    SUBJECTS/METHODS: A total of 181 Thai children (90 boys and 91 girls) aged 6 to 12 years were recruited. Bone status was measured by two different techniques in terms of the speed of sound (SOS) using QUS and bone mineral density (BMD) using DXA. Calcium intake was assessed by 24 h diet recall. Pearson's correlation, κ-statistic and Bland and Altman analysis were used to assess the agreement between the methods.

    RESULTS: There was no correlation between the two different techniques. Mean difference (s.d.) of the Z-scores of BMD and SOS was -0.61 (1.27) that was different from zero (P<0.05). Tertiles of Z-scores of BMD and QUS showed low agreement (κ 0.022, P=0.677) and the limits of agreement in Bland and Altman statistics were wide.

    CONCLUSIONS: Although QUS is easy and convenient to use, the SOS measurements at the radius seem not appropriate for assessing bone quality status.

  7. The paradox of low body mass index and high body fat percentage among Chinese, Malays and Indians in Singapore
    Deurenberg-Yap M, Schmidt G, van Staveren WA, Deurenberg P
    Int. J. Obes. Relat. Metab. Disord., 2000 Aug;24(8):1011-7.
    PMID: 10951540
    OBJECTIVE: To study the relationship between body fat percentage and body mass index (BMI) in three different ethnic groups in Singapore (Chinese, Malays and Indians) in order to evaluate the validity of the BMI cut-off points for obesity.
    DESIGN: Cross-sectional study.
    SUBJECTS: Two-hundred and ninety-one subjects, purposively selected to ensure adequate representation of range of age and BMI of the general adult population, with almost equal numbers from each ethnic and gender group.
    MEASUREMENTS: Body weight, body height, sitting height, wrist and femoral widths, skinfold thicknesses, total body water by deuterium oxide dilution, densitometry with Bodpod(R) and bone mineral content with Hologic(R) QDR-4500. Body fat percentage was calculated using a four-compartment model.
    RESULTS: Compared with body fat percentage (BF%) obtained using the reference method, BF% for the Singaporean Chinese, Malays and Indians were under-predicted by BMI, sex and age when an equation developed in a Caucasian population was used. The mean prediction error ranged from 2.7% to 5.6% body fat. The BMI/BF% relationship was also different among the three Singaporean groups, with Indians having the highest BF% and Chinese the lowest for the same BMI. These differences could be ascribed to differences in body build. It was also found that for the same amount of body fat as Caucasians who have a body mass index (BMI) of 30 kg/m2 (cut-off for obesity as defined by WHO), the BMI cut-off points for obesity would have to be about 27 kg/m2 for Chinese and Malays and 26 kg/m2 for Indians.
    CONCLUSIONS: The results show that the relationship between BF% and BMI is different between Singaporeans and Caucasians and also among the three ethnic groups in Singapore. If obesity is regarded as an excess of body fat and not as an excess of weight (increased BMI), the cut-off points for obesity in Singapore based on the BMI would need to be lowered. This would have immense public health implications in terms of policy related to obesity prevention and management.
  8. Physical Activity of Malaysian Primary School Children: Comparison by Sociodemographic Variables and Activity Domains
    Wong JE, Parikh P, Poh BK, Deurenberg P, SEANUTS Malaysia Study Group
    Asia Pac J Public Health, 2016 Jul;28(5 Suppl):35S-46S.
    PMID: 27257293 DOI: 10.1177/1010539516650726
    This study describes the physical activity of primary school children according to sociodemographic characteristics and activity domains. Using the Malaysian South East Asian Nutrition Surveys data, 1702 children aged 7 to 12 years were included in the analysis. Physical activity was reported as a total score and categorized into low, medium, and high levels based on Physical Activity Questionnaire for Older Children. Higher overall activity scores were found in boys, younger age, non-Chinese ethnicity, and normal body mass index category. Sex, age, and ethnicity differences were found in structured or organized, physical education, and outside-of-school domain scores. Transport-related scores differed by age group, ethnicity, household income, and residential areas but not among the three physical activity levels. Participation of girls, Chinese, and older children were low in overall and almost all activity domains. Sociodemographic characteristics are important factors to consider in increasing the different domains of physical activity among Malaysian children.
  9. Differences in Body Build in Children of Different Ethnic Groups and their Impact on the Prevalence of Stunting, Thinness, Overweight, and Obesity
    Poh BK, Wong JE, Norimah AK, Deurenberg P
    Food Nutr Bull, 2016 Mar;37(1):3-13.
    PMID: 26769039 DOI: 10.1177/0379572115626025
    The prevalence of stunting, thinness, overweight, and obesity among children differs by ethnicity. It is not known whether differences in body build across the ethnic groups influence the interpretation of nutritional parameters.
  10. Fulltext Body fat measurement among Singaporean Chinese, Malays and Indians: a comparative study using a four-compartment model and different two-compartment models
    Deurenberg-Yap M, Schmidt G, van Staveren WA, Hautvast JG, Deurenberg P
    Br J Nutr, 2001 Apr;85(4):491-8.
    PMID: 11348564 DOI: 10.1079/bjn2000276
    This cross-sectional study compared body fat percentage (BF%) obtained from a four-compartment (4C) model with BF% from hydrometry (using 2H2O), dual-energy X-ray absorptiometry (DXA) and densitometry among the three main ethnic groups (Chinese, Malays and Indians) in Singapore, and determined the suitability of two-compartment (2C) models as surrogate methods for assessing BF% among different ethnic groups. A total of 291 subjects (108 Chinese, seventy-six Malays, 107 Indians) were selected to ensure an adequate representation of age range (18-75 years) and BMI range (16-40 kg/m2) of the general adult population, with almost equal numbers from each gender group. Body weight was measured, together with body height, total body water by 2H2O dilution, densitometry with Bodpod and bone mineral content with Hologic QDR-4500. BF% measurements with a 4C model for the subgroups were: Chinese females 33.5 (sd 7.5), Chinese males 24.4 (sd 6.1), Malay females 37.8 (sd 6.3), Malay males 26.0 (sd 7.6), Indian females 38.2 (sd 7.0), Indian males 28.1 (sd 5.5). Differences between BF% measured by the 4C and 2C models (hydrometry, DXA and densitometry) were found, with underestimation of BF% in all the ethnic-gender groups by DXA of 2.1-4.2 BF% and by densitometry of 0.5-3.2 BF%). On a group level, the differences in BF% between the 4C model and 2H2O were the lowest (0.0-1.4 BF% in the different groups), while differences between the 4C model and DXA were the highest. Differences between the 4C model and 2H2O and between the 4C model and DXA were positively correlated with the 4C model, water fraction (f(water)) of fat-free mass (FFM) and the mineral fraction (f(mineral)) of FFM, and negatively correlated with density of the FFM (D(FFM)), while the difference between 4C model and densitometry correlated with these variables negatively and positively respectively (i.e. the correlations were opposite). The largest contributors to the observed differences were f(water) and D(FFM). When validated against the reference 4C model, 2C models were found to be unsuitable for accurate measurements of BF% at the individual level, owing to the high errors and violation of assumptions of constant hydration of FFM and D(FFM) among the ethnic groups. On a group level, the best 2C model for measuring BF% among Singaporeans was found to be 2H2O.
  11. Fulltext Association of energy intake and physical activity with overweight among Indonesian children 6-12 years of age
    Harahap H, Sandjaja S, Soekatri M, Khouw I, Deurenberg P
    Asia Pac J Clin Nutr, 2017 12 10;27(1):211-216.
    PMID: 29222901 DOI: 10.6133/apjcn.032017.05
    BACKGROUND AND OBJECTIVES: Indonesia is currently facing double burden malnutrition in children. As overweight and obesity are due to a disturbed energy balance, this study aimed to assess the association of total energy intake and physical activity with the prevalence of overweight among Indonesian children.

    METHODS AND STUDY DESIGN: The data used for this analysis were from 1143 children, 6-12 years old, that participated in the South East Asian Nutrition Survey (SEANUTS). Physical activity (PA) was measured using pedometers for 2 consecutive days and was categorized low, moderate and high. Child nutritional status was categorized based on body mass index for age z-scores (BAZ) into normal weight (-2 SD ≤BAZ≤1 SD) or overweight (BAZ >1 SD). Energy intake was calculated from a one day 24 hour recall and compared to the Indonesian recommended dietary allowance (RDA) for energy.

    RESULTS: Children with low PA had higher risk (ODDs 3.4, 95% CI: 2.0, 6.0) of being overweight compared to children who had high PA. Children with moderate PA and energy take >100% RDA had higher risk (ODDs 4.2, 95% CI 1.9, 9.3) of being overweight than children with high PA and energy intakes ≤100% RDA.

    CONCLUSIONS: Low physical activity independently or moderate physical activity and high energy intake are risk factors for Indonesian children to get overweight. Program intervention such as increasing physical activity at school and home is needed to reduce overweight among children.

  12. Fulltext The effect of socio-demographic variables and dairy use on the intake of essential macro- and micronutrients in 0.5-12-year-old Indonesian children
    Widodo Y, Sandjaja S, Sumedi E, Khouw I, Deurenberg P
    Asia Pac J Clin Nutr, 2016;25(2):356-67.
    PMID: 27222420 DOI: 10.6133/apjcn.2016.25.2.09
    To study the associations between nutrient intake, dairy intake and socioeconomic variables.
  13. Fulltext Daily physical activity and screen time, but not other sedentary activities, are associated with measures of obesity during childhood
    Lee ST, Wong JE, Shanita SN, Ismail MN, Deurenberg P, Poh BK
    Int J Environ Res Public Health, 2015 Jan;12(1):146-61.
    PMID: 25546277 DOI: 10.3390/ijerph120100146
    Childhood obesity is related to low physical activity level and a sedentary lifestyle. The aim of this study was to assess the physical activity level and sedentary behaviour of Malaysian children aged 7 to 12 years and to examine their association with body mass index (BMI), BMI-for-age Z-score (BAZ), body fatness (%BF) and waist circumference (WC). A total of 1736 children, representing all ethnic groups were recruited from six regions of Malaysia. Anthropometric measurements included body weight, height and waist circumference. Body fat percentage (%BF) was assessed using bioelectrical impedance. Physical activity was assessed by a physical activity questionnaire (PAQ) in all children and by pedometers in a subsample (n = 514). PAQ score and pedometer step counts were negatively associated with BMI, BAZ, %BF and WC after adjusting for covariates. Screen time was positively associated with BAZ and WC. However, other sedentary activities were not significantly related with any anthropometric indicators. Strategies to promote active living among children in Malaysia should focus not only on increasing physical activity but also emphasise reduction in sedentary behaviours.
    MESH: screen time
  14. Assessing Body Fat of Children by Skinfold Thickness, Bioelectrical Impedance Analysis, and Dual-Energy X-Ray Absorptiometry: A Validation Study Among Malay Children Aged 7 to 11 Years
    Noradilah MJ, Ang YN, Kamaruddin NA, Deurenberg P, Ismail MN, Poh BK
    Asia Pac J Public Health, 2016 Jul;28(5 Suppl):74S-84S.
    PMID: 27073201 DOI: 10.1177/1010539516641505
    This study aims to validate skinfold (SKF) and bioelectrical impedance analysis (BIA) against dual-energy X-ray absorptiometry (DXA) in determining body fat percentage (BF%) of Malay children aged 7 to 11 years. A total of 160 children had their BF% assessed using SKF and BIA, with DXA as the criterion method. Four SKF equations (SKFBray, SKFJohnston, SKFSlaughter, and SKFGoran) and 4 BIA equations (BIAManufacturer, BIAHoutkooper, BIARush, and BIAKushner) were used to estimate BF%. Mean age, weight, and height were 9.4 ± 1.1years, 30.5 ± 9.9 kg, and 131.3 ± 8.4 cm. All equations significantly underestimated BF% (P < .05). BIA equations had reasonable agreement with DXA and were independent of BF% with BIAManufacturer being the best equation. Although BIA underestimates BF% as compared with DXA, BIA was more suitable to measure BF% in a population that is similar to this study sample than SKF, suggesting a need to develop new SKF equations that are population specific.
  15. Physical activity pattern of Malaysian preschoolers: Environment, barriers, and motivators for active play
    Lee ST, Wong JE, Ong WW, Ismail MN, Deurenberg P, Poh BK
    Asia Pac J Public Health, 2016 07;28(5 Suppl):21S-34S.
    PMID: 27026634 DOI: 10.1177/1010539516638155
    Children's physical activity has been correlated with child characteristics and social or physical environment. This study aimed to compare preschoolers' physical activity among various sociodemographic characteristics and to determine barriers, motivators, and environmental factors for active play. A total of 835 preschoolers were included in this analysis. Time spent on active play, quiet play, and screen time was reported by parents. Boys spent significantly more time on active play and screen time than girls. Time spent on quiet play was highest in East Coast Peninsular Malaysia and lowest in Sarawak. Some 40% of children achieved active play recommendation while 27% exceeded daily screen time recommendation. Most parents reported that their child played actively in the house area; and that the main barrier and motivator to active play were safety and child's enjoyment, respectively. These findings demonstrate that sociodemographic characteristics and environment should be considered in designing physical activity intervention programs.
    MESH: screen time
  16. Anemia and Iron Deficiency in Vietnamese Children, 6 to 11 Years Old
    Le Nguyen Bao K, Tran Thuy N, Nguyen Huu C, Khouw I, Deurenberg P
    Asia Pac J Public Health, 2016 07;28(5 Suppl):94S-102S.
    PMID: 27052301 DOI: 10.1177/1010539516641506
    In a population sample of 385 children, 6 to 11 years old, venous blood parameters-hemoglobin (Hb), ferritin, red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), C-reactive protein (CRP), and α1-acid glycoprotein (AGP)-were determined to get insight into the iron status. The prevalence of anemia was 11.4%; 5.6% had iron deficiency (ID), whereas 0.4% had ID anemia. Correction for inflammation based on CRP and AGP did not markedly change the overall prevalence of ID and ID anemia. Stunted children had lower Hb and ferritin values compared with nonstunted children, and thin children had lower values compared with normal-weight or overweight and obese children. Many nonanemic children had alert values for RBC, MCV, MCH, and MCHC. It is concluded that although the prevalence of anemia is of the magnitude of a mild public health problem, the iron status of many nonanemic children is borderline, as indicated by a high number of children with low values for red blood cytology.
  17. The Effect of Breakfast Type on Total Daily Energy Intake and Body Mass Index Among Thai School Children
    Purttiponthanee S, Rojroongwasinkul N, Wimonpeerapattana W, Thasanasuwan W, Senaprom S, Khouw I, et al.
    Asia Pac J Public Health, 2016 07;28(5 Suppl):85S-93S.
    PMID: 27183975 DOI: 10.1177/1010539516647774
    The study investigated the association between breakfast types consumed, daily energy intake, and body mass index for age Z-score (BAZ). Cross-sectional data from 1258 children aged 7 to 12.9 years were analyzed for breakfast type, nutrient intakes, BAZ, and proportion of overweight or obesity. Analysis of covariance was used to compare energy and nutrient intakes, BAZ, and proportion of overweight/obese children between breakfast groups. Only 19% of children had adequate energy intake from breakfast. Those consuming snacks had a significantly lower BAZ (Z = -0.73), with 5% of them being overweight/obese. Those consuming beverages and desserts had the lowest total daily energy intake (1314 kcal) and lowest protein intake (8.4 g). The results suggest that breakfast type is associated with daily energy intake and BAZ. Most breakfasts are not adequate. School-based nutrition education programs involving families, teachers, and health professionals can contribute to improve this situation.
  18. Fulltext Erratum to "Radial Quantitative Ultrasound and Dual Energy X-Ray Absorptiometry: Intermethod Agreement for Bone Status Assessment in Children"
    Chong KH, Poh BK, Jamil NA, Kamaruddin NA, Deurenberg P
    Biomed Res Int, 2015;2015:318739.
    PMID: 26146617 DOI: 10.1155/2015/318739
  19. Fulltext Radial quantitative ultrasound and dual energy x-ray absorptiometry: intermethod agreement for bone status assessment in children
    Chong KH, Poh BK, Jamil NA, Kamaruddin NA, Deurenberg P
    Biomed Res Int, 2015;2015:232876.
    PMID: 25922831 DOI: 10.1155/2015/232876
    Aim. To validate a radial quantitative ultrasound (QUS) system with dual energy X-ray absorptiometry (DXA), a criterion technique in bone status assessment among children. Methods. Bone health was evaluated using a radial QUS system (Sunlight Omnisense 8000P) to measure the speed of sound (SOS) at one-third distal radius of the nondominant hand and DXA (Hologic QDR) was used to assess whole body bone mineral density (BMD). Results. Some 29.9% of the children were grossly misclassified according to quartiles of BMD and radial SOS. Poor agreement was observed between Z-scores of radial SOS and whole-body BMD (mean difference = 0.6 ± 0.9; 95% limits of agreement = -1.4 to 2.6). With a cut-off value of -1.0, radial SOS yielded satisfactory sensitivity (80%) and specificity (93%) for the detection of children with low BMD. Conclusion. The observed poor agreement in the present study suggests that radial QUS and DXA are not comparable and hence are not interchangeable in evaluating bone status of the children.
  20. Relationships between indices of obesity and its co-morbidities in multi-ethnic Singapore
    Deurenberg-Yap M, Chew SK, Lin VF, Tan BY, van Staveren WA, Deurenberg P
    Int. J. Obes. Relat. Metab. Disord., 2001 Oct;25(10):1554-62.
    PMID: 11673781 DOI: 10.1038/sj.ijo.0801739
    OBJECTIVE: To investigate the effect of body mass index (BMI) and body fat distribution as measured by waist-to-hip ratio (WHR) on the cardiovascular risk factor profile of the three major ethnic groups in Singapore (Chinese, Malay and Indian people) and to determine if WHO recommended cut-off values for BMI and WHR are appropriate for the different sub-populations in Singapore.
    DESIGN: Cross-sectional population study.
    SUBJECTS: A total of 4723 adult subjects (64% Chinese individuals, 21% Malay individuals and 15% Indian individuals) were selected through a multi-staged sampling technique to take part in the National Health Survey in 1998.
    MEASUREMENTS: Data on socio-economic status (education level, occupation, housing type) and lifestyle habits (smoking and physical activity), body weight, body height, waist and hip circumferences and blood pressure measured using standardised protocols. Fasting venous blood samples were obtained for determination of serum total cholesterol (TC), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), triglycerides (TG). Venous blood samples were taken for 2 h oral glucose tolerance test (2 h glu).
    RESULTS: Absolute and relative risks for at least one cardiovascular risk factor (elevated TC, elevated TC/HDL ratio, elevated TG, hypertension and diabetes mellitus) were determined for various categories of BMI and WHR. At low categories of BMI (BMI between 22 and 24 kg/m(2)) and WHR (WHR between 0.80 and 0.85 for women, and between 0.90 and 0.95 for men), the absolute risks are high, ranging from 41 to 81%. At these same categories the relative risks are significantly higher compared to the reference category, ranging from odds ratio of 1.97 to 4.38. These categories of BMI and WHR are all below the cut-off values of BMI and WHR recommended by WHO.
    CONCLUSIONS: The results show that, at relatively low BMI and WHR, Singaporean adults experience elevated levels of risks (absolute and relative) for cardiovascular risk factors. These findings, in addition to earlier reported high percentage body fat among Singaporeans at low levels of BMI, confirm the need to revise the WHO cut-off values for the various indices of obesity and fat distribution, viz BMI and WHR, in Singapore.
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