The Lancet: In China, more than one-third of people are in the pre-diabetes stage, and the BMI health value standard may need to be rewritten!

‍‍Weight gain is a recognized risk factor for diabetes
.

However, it is still a controversial topic when the Chinese people's body mass index (BMI, kg/m2) needs weight intervention
.

 In 1993, the WHO defined obesity as a BMI exceeding 30
.

However, subsequent evidence suggests that Asians are more likely to develop diabetes than whites with lower BMI
.

In 2013, the British medical institution lowered the BMI warning value of Chinese people to 27.
5 to remind Chinese people to pay attention to weight and screen for diabetes earlier
.

At this year's European Obesity Conference, a large-scale study showed that when the BMI of Chinese is 26.
9, the risk of diabetes is the same as that of whites with a BMI of 30
.

And this phenomenon still exists after removing the interference of socioeconomic status and smoking status
.

 doi: 10.
1016/S2213-8587(21)00088-7.
Whether the lower BMI cut-off point of the non-white population is caused by differences in body composition, biochemical characteristics, life>
.

But what is certain is that Asian populations need to intervene in weight changes earlier
.

Unfortunately, the current relevant mainstream guidelines do not clearly distinguish between races.
This approach ignores the differences between the East and the West, as well as the interference of other factors such as the economy
.

The “one size fits all” approach is no longer suitable for the current society, we urgently need more detailed research to guide clinical practice
.

In response to this problem, an international team composed of people from many countries recently published their research results in The Lancet
.

They found that the upper limit of healthy BMI for the East Asian population, including the Chinese, should be lower than the current upper limit of normal value!This study covers 57 low- and middle-income countries, with a total of 685,616 adults over the age of 25
.

The blood glucose and glycosylated hemoglobin of these people were tested and classified according to the BMI value: underweight (<18.
5), normal (18.
5-22.
9), high-normal (23.
0-24.
9), overweight (25.
0-29.
9), obesity ( ≥30)
.

A total of 8001 Chinese were included, with an average age of 52.
5 years, an average BMI value of 23.
5, and diabetes patients accounted for 8.
5%
.

Overall, overweight accounted for 27.
2%, obesity accounted for 21.
0%, and the proportion of both in diabetic patients was higher, 31.
6% and 41.
4%, respectively
.

Regardless of men and women, the prevalence of diabetes has risen linearly with the increase of BMI
.

  Globally, people with a normal high BMI have a significantly higher risk of diabetes than normal people even though they are not overweight
.

This phenomenon is most obvious in East Asia, where the risk of normal high-value East Asian men is 1.
90 times that of ordinary people, and East Asian women are 1.
53 times that of ordinary people
.

Among the overweight people, East Asians are still the most susceptible to diabetes.
Among them, the risk is 2.
84 times higher for men and 2.
18 times for women
.

Among obese people, the East Asian population is equally arrogant in the world.
The risk is 3.
93 times for men and 3.
18 times for women
.

Researchers also found that this phenomenon has nothing to do with wealth and education and other factors.
East Asians are veritable "sugar-prone physiques
.
"
More importantly, when the BMI threshold of East Asian men is around 23.
8, the sensitivity and specificity of screening for diabetes is about 60%, and East Asian women are similar
.

China currently limits the upper limit of the normal value of BMI to 23.
9, which means that if implemented according to this standard, more than 40% of diabetic patients cannot realize the need to lose weight before getting sick, and are mistaken for their weight as "completely normal"
.

  Even with the current loose standards in China, the weight of Chinese people is not optimistic
.

According to statistics, China's per capita BMI level was 24.
4 in 2018, which is already in the overweight range, and the obesity rate is close to 10%
.

From 2010 to 2018, the average annual per capita BMI increased by nearly 0.
1
.

In recent years, the growth of per capita BMI in China has shown a slowdown, but rural women still show a continuous growth trend, and have surpassed urban women by 2018
.

Correspondingly, the study found that the average increase in BMI of people with lower education level is greater than that of people with higher education level
.

 doi: 10.
1016/S0140-6736(21)00798-4.
The weight distribution of Chinese residents also has obvious geographical distinctions
.

The average BMI of northerners is more than 2 units higher than that of southerners
.

Similarly, the prevalence of obesity between North China and South China is more than three times different
.

Consistent with this, the prevalence of diabetes in the north of my country is significantly higher than that in the south.
For example, the prevalence of diabetes in Inner Mongolia is as high as 19.
9%, while that in Guizhou is only 6.
2%.

.

Studies have shown that being overweight during adolescence may lead to an increased risk of metabolic diseases in the future
.

At present, more than one-third of the population in China is in the pre-diabetes stage, and the importance of early intervention is self-evident
.

 doi: 10.
1016/S2213-8587(21)00045-0.
However, the weight status of children and adolescents in China is not optimistic
.

Among children under 6 years of age, the rates of overweight and obesity reached 6.
8% and 3.
6%, respectively; among the school-age groups from 6 to 17 years old, this proportion increased to 11.
1% and 7.
9%
.

And this trend is still getting worse.
These overweight and obese adolescents and children will be the "main force" of diabetes in China in the future
.

In order to promote a healthy life>
.

 It can be seen from that weight loss for the whole people is the general trend
.

More importantly, the maintenance of body weight should not be satisfied only below the upper limit of normal.
BMI should preferably be within 23.
0, which is also the health goal advocated by the WHO
.

In addition, adding "diabetes warning value" to the current Chinese standards is also worth a try
.

References 1.
Rishi Caleyachetty, et al.
Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study.
Lancet Diabetes Endocrinol.
2021 Jul;9(7):419-426.
doi : 10.
1016/S2213-8587(21)00088-7.
2.
Yongze Li, et al.
Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study.
BMJ.
2020 Apr 28;369:m997 .
doi: 10.
1136/bmj.
m997.
3.
Felix Teufel, et al.
Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685616 adults.
Lancet 2021; 398: 238-48.
4.
Limin Wang, et al.
Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18.
Lancet.
2021 Jul 3;398(10294):53-63.
doi: 10.
1016/S0140-6736(21)00798-4.
5.
Xiong-Fei Pan, et al.
Epidemiology and determinants of obesity in China.
Lancet Diabetes Endocrinol.
2021 Jun;9(6) :373-392.
doi: 10.
1016/S2213-8587(21)00045-0.
Author | Official Mizuki Editor | Jessica‍‍