Please cite this article in press as: Moy FM, Loh DA. Cardiometabolic risks profile of normal weight obese and multi-ethnic women in a developing country. Maturitas (2015), http://dx.doi.org/10.1016/j.maturitas.2015.04.011 ARTICLE IN PRESS G Model MAT-6395; No. of Pages 5 Maturitas xxx (2015) xxx–xxx Contents lists available at ScienceDirect Maturitas jo u r n al hom ep age: www.elsevier.com/locate/maturitas Cardiometabolic risks profile of normal weight obese and multi-ethnic women in a developing country Foong Ming Moy ∗ , Debbie Ann Loh Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur 50603, Malaysia a r t i c l e i n f o Article history: Received 4 February 2015 Received in revised form 17 April 2015 Accepted 20 April 2015 Available online xxx Keywords: Cardiometabolic risks Normal weight obesity Body fat Women a b s t r a c t Objectives: To determine the prevalence of normal weight obesity among multi-ethnic women in Penin- sular Malaysia and examine its associations with cardiometabolic risks and lifestyle behaviours. Methods: This was a cross-sectional study involving women recruited via multi-stage sampling from six states in Malaysia. Anthropometric and body composition analysis were performed. Normal weight obese (NWO) was defined as normal body mass index for Asians and the highest tertile of % body fat (BF). Biochemical measurements included fasting lipid and blood glucose levels. Metabolic syndrome was diagnosed based on the Harmonization criteria. Participants completed self-reported questionnaires that included physical activity, smoking, alcohol consumption, fruit and vegetable intake and sleep duration. Main outcome measure: Body mass index, %BF, cardiometabolic risk factors, lifestyle behaviours. Results: A total of 6854 women were recruited and the prevalence of NWO was 19.8% (95% CI: 17.3–22.5). NWO was more prevalent among the Indians and older women. NWO women had higher odds for abdom- inal obesity (OR: 2.64, 95% CI: 1.73–4.04), hypertriglyceridemia (2.51, 1.47–4.29) and hypertension (1.63, 1.15–2.31) compared to women with lower % body fat after adjusted for age and ethnicity. The prevalence of metabolic syndrome among NWO women was 5.4% (95% CI: 3.0–9.8). None of the lifestyle behaviours were significantly associated with NWO. Conclusions: Women with NWO had cardiometabolic abnormalities including abdominal obesity, dyslip- idaemia and increased blood pressure. Health promotion efforts should include NWO women who may be oblivious of their deleterious health risks. © 2015 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Cardiovascular disease (CVD) remains the leading cause of death in women worldwide with one in three of all female deaths due to CVD or stroke [1]. Approximately 81% of all cardiovascular mor- tality in women occurs in low- and middle-income countries. The misconception that CVD is a ‘man’s disease has now been dispelled with women accounting for over half of CVD deaths, however, ini- tial presentation of coronary artery diseases in women often surface 10 to 20 years later than men [2]. This under-recognition and differ- ences in clinical presentation of CVD in women calls for the need to raise awareness and identify cardiometabolic risk factors in both premenopausal and postmenopausal women including the rising obesity trend towards the prevention of CVD. ∗ Corresponding author. Tel.: +60 3 7697 6657. E-mail addresses: moyfm@ummc.edu.my, moyfmspm@gmail.com (F.M. Moy). Globally, overweight and obesity is estimated to contribute to 44% of diabetes burden and 23% of ischaemic heart disease [3]. Obe- sity is a state of excessive adipose tissue, precariously linked to adverse health outcomes [4,5]. The widely-used body mass index (BMI) does not differentiate between fat and lean mass [4]. This may result in under-diagnosis of individuals at risk of obesity-related diseases more so, when the onset of co-morbidities such as type 2 diabetes in Asian populations present at lower BMI compared to Caucasians at a similar weight [6]. Normal weight obesity (NWO) defined as the combination of normal BMI with high body fat [7] is receiving increased attention. Individuals with normal BMI but high body fat may have increased risks for CVD [8]. A normal BMI therefore does not necessarily imply protection from consequences of increased body fat. NWO might be a key factor in the emerging worldwide epidemic of obesity, metabolic syndrome, diabetes, and coronary artery disease. Adipose tissue in abdominal obesity, visceral adiposity and ectopic fat are considered as an endocrinal organ orchestrat- ing key pathophysiological pathways in inflammation and lipid http://dx.doi.org/10.1016/j.maturitas.2015.04.011 0378-5122/© 2015 Elsevier Ireland Ltd. All rights reserved.