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International Journal of Research and Review Vol.7; Issue: 9; September 2020 Website: www.ijrrjournal.com Review Article E-ISSN: 2349-9788; P-ISSN: 2454-2237 A Body Shape Index (ABSI) - Is It Time to Replace Body Mass Index? Snigdha Sharma1, Pradeep Bokariya2, Ruchi Kothari3 1Third (2) MBBS student, Mahatma Gandhi Institute of Medical Sciences, SEVAGRAM, Wardha (Maharashtra) - 442102 2Associate Professor, Department of Anatomy, Mahatma Gandhi Institute of Medical Sciences, SEVAGRAM, Wardha (Maharashtra) - 442102 3Associate Professor, Department of Physiology, Mahatma Gandhi Institute of Medical Sciences, SEVAGRAM, Wardha (Maharashtra) - 442102 Corresponding Author: Snigdha Sharma ABSTRACT aspect of ABSI has also been delved into, with reference to findings or recommendations of Obesity has been typically quantified in terms of exploration already done. The rationale behind Body Mass Index (BMI) and waist this review was to provide a thorough circumference (WC) is used as a risk indicator quintessence of the research carried out in the supplementary to BMI, but the high correlation field of surrogate markers of adiposity with an of WC with BMI makes it hard to isolate the attempt to summarize the previous concepts as added value of WC. Though, BMI is widely well as recent perspective about the value of used as a measure of overweight and obesity, it ABSI. To enable a nippy glance for the readers, underestimates the prevalence of the two, we have also tabulated a chronological account leading to the underdiagnosis of patients at risk of researches on BMI and ABSI conducted and there are data questioning BMI reliability across the globe over a period of 18 years! To and indicating that it provides a false diagnosis sum up, we lay down prospective research of body fatness. In such a scenario, the directives related to ABSI as well as offer importance of including central adiposity in perspectives to stimulate further research quantifying the cardiovascular risk was inquiry into its potential usefulness as an highlighted and a new anthropometric measure, anthropometric measure for a better and the A Body Shape Index (ABSI) was developed accurate assessment of cardiovascular risk. So which outperformed former standard measures the authors here have made an attempt to of abdominal obesity in predicting mortality present a robust Review on ABSI and tried to risk. thrust upon the contention that it is high time to Substantial research on ABSI has been carried replace BMI with ABSI. out both nationally and globally. In the current article, we provide an overview of the standard Keywords: Body Shape Index, Body Mass measures of abdominal obesity which have been Index, obesity, Waist Circumference employed for over the years. Extensive Medline, Web of Science and Pubmed search was INTRODUCTION adopted to congregate research pertaining to World Health Organization (WHO) ABSI and was later penned down to compile states that overweight and obesity are this review. The authors have highlighted the increasing in prevalence and is the fifth role of BMI and its major limitations in the first worldwide cause of death among risk part of this writing. Then the growing significance and advantages of ABSI in clinical factors, behind high blood pressure, tobacco context have been briefly described, followed by use, high blood glucose, and physical the discussion on the earlier and currently inactivity. In high and middle-income accepted opinions for ABSI based on the studies countries, the prevalence of overweight and in the past and recent times. The prospective obesity among the adult population already International Journal of Research and Review (ijrrjournal.com) 303 Vol.7; Issue: 9; September 2020 Snigdha Sharma et.al. A Body Shape Index (ABSI) - Is it time to replace body mass index? exceeds 50%, and occupies third place as weight are easy and inexpensive to measure. risk factors causing death, behind high World Health Organization (WHO), the US blood pressure and tobacco use.1 Guidelines Preventive Services Task Force and the published by the USA National Institutes of International Obesity Task Force15 define Health considered overweight and obesity overweight as a BMI between 25.0 and as the second leading cause of preventable 29.9 kg m−2 and obesity as a death in the USA, behind smoking.2 Obesity BMI⩾30.0 kg m−2. These cutoffs are very is defined as an excess accumulation of useful in epidemiological studies. Despite body fat, with the amount of this excess fat its wide use, BMI is only a proxy measure actually being responsible for most obesity- of body fatness and does not provide an associated health risks.3 Obesity is known to accurate measure of body composition. increase the risk of cardiovascular diseases These BMI-based obesity guidelines have and type 2 diabetes at the same time as been accompanied by doubt as to the imposing functional limitations in a number validity of BMI as an indicator of dangerous of subjects translating into a reduced quality obesity. Muscle and fat accumulation are of life as well as life expectancy.4-5 Obesity not distinguished by BMI.16 is typically quantified in terms of Body Though, BMI is widely used as a Mass Index (BMI), on exceeding threshold measure of overweight and obesity, but values, it is considered a leading cause of underestimates the prevalence of both premature death worldwide.6 Waist conditions, defined as an excess of body fat circumference (WC) is used as a risk leading to the underdiagnosis of patients at indicator supplementary to BMI, but the risk. A study established that 29% of high correlation of WC with BMI makes it subjects classified as lean according to BMI hard to isolate the added value of WC. (BMI<25.0 kg m−2) and 80% of subjects A Body Shape Index (ABSI) is an classified as overweight according to actual anthropometric parameter calculated by BMI (BMI⩾25.0 kg m−2 and dividing waist circumference (WC) by its <30.0 kg m−2), had a Body Fat percentage estimate obtained from allometric regression (BF%) well within the obesity range. of weight and height.7 ABSI was designed However, 0.2 and 1.0% of the subjects with to be minimally associated with weight, a BF% in the lean or overweight range, height and body mass index (BMI) so that it respectively, was misclassified as obese can be used together with BMI to according to the BMI values which indicates unscramble the independent contribution of that there is a high degree of WC and BMI to cardio-metabolic outcomes. misclassification in the diagnosis of obesity Waist circumference (WC) has been used to in clinical practice, which results in the indicate the presence of abdominal obesity, underdiagnosis of patients at risk and, with WC above threshold forming one therefore, missed opportunities to treat this criterion for diagnosis of metabolic life-threatening condition.17 syndrome.8,9 However, there was found a There are data questioning BMI high correlation (0.8–0.9) between BMI and reliability and indicating that it provides a WC or WC-derived measures such as WC/H false diagnosis of body fatness.18,19 There is ratio and body roundness index bound the also data indicating that regional fat utility of these measures beyond BMI.10-14 distribution, but not total body fat stores, are related to metabolic disturbances and health BODY MASS INDEX (BMI) - ROLE risks20. It has however been demonstrated AND LIMITATIONS that WHO standards of BMI are not suitable Body mass index (BMI) is the most for the evaluation of body fat with based on frequently used diagnostic tool in the ethnicity. Similar has been found with current classification system of obesity. It respect to associations between BMI and has the advantage that a subject's height and mortality. Suppose BMI provides reliable International Journal of Research and Review (ijrrjournal.com) 304 Vol.7; Issue: 9; September 2020 Snigdha Sharma et.al. A Body Shape Index (ABSI) - Is it time to replace body mass index? information concerning body fatness and other studies investigated the relationship taking into account detrimental effects of fat between body fat and stature-adjusted body excess on health and mortality, it is not yet mass with a view to obtain a simple index to clear why the BMI-mortality relationship is identify the overweight or obese members U-shaped, suggesting high mortality in both of the community28. In such studies, BMI lean and obese humans. 21-23 emerged as the overpowering favorite as There is evidence that whereas despite its convenience and popularity, higher fat mass is associated with greater some researchers still consider BMI a risk of premature death, higher muscle mass relatively crude index of adiposity, reduces risk and BMI does not distinguish predominantly due to the fact that it fails to between muscle and fat accumulation nor quantify body composition. does it distinguish between fat locations, Healthy adults indeed can be when central or abdominal fat deposition misdiagnosed by BMI as overweight or which is thought to be particularly death- obese, if fat mass is verified by a criterion defying. Waist circumference (WC) has method.29 For instance, a slender-framed emerged as a leading complement to BMI female with significant excess fat may for indicating obesity risk. Several studies appear as a false negative, and a muscular showed that WC predicted mortality risk male as a false positive. A multination better than BMI. WHO report summarized European cohort, stratifying by BMI evidence for WC as an indicator of disease category transformed the curve of mortality risk suggesting that WC could be used as an risk as a function of WC from U-shaped to alternative to BMI. 24-25 For a given height more linear.30 and weight, high ABSI may correspond to a There appears to be little research greater fraction of visceral fat compared to into whether BMI is a valid and reliable peripheral tissue.
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