studied 3, men in a cross-sectional research to determine the association between BMI and hip QCT measures, as well as to perform finite element analysis of hip QCT scans to offer a measure of hip strength during simulated falls.

Men with obesity have better hip strength, but they also have a higher impact-to-strength ratio, which means that despite having stronger bones, they have a higher chance of hip fracture The incidence of fracture declined with rising BMI and plateaued in men with obesity, according to a cohort study of 43, individuals aged 60 to 79 years from Norway.

After adjusting for BMI and other possible confounders, larger WC and waist-to-hip ratio were linked to an increased risk of hip fracture. When a low BMI is combined with abdominal fat, the risk of hip fracture skyrockets In , a meta-analysis of 12 prospective population-based cohorts was released approximately 60, individuals with a mean age of Men and women with a low BMI had a greater age-corrected risk of any type of fracture, whereas those with a higher BMI had a lower risk.

The increased risk, on the other hand, was not linear, and the gradient seemed steeper at lower BMI levels This point is similar to the relationship between BMI, WC, and BMD in our study. The decreased bone mass and increased risk of fragility fractures associated with obesity also suggest that we need to keep BMI and WC in a reasonable range.

The mechanisms behind the relationship between obesity and BMD are unclear. Increased static mechanical compliance due to excessive fat accumulation is one of the hypothesized reasons. Increased static mechanical stresses on the skeleton are caused by excessive fat accumulation and body weight, and when bone tissue recognizes the mechanical forces imposed by the body, it undergoes a series of changes 31 , Another probable cause is the replacement of osteoblasts in the bone marrow by adipocytes.

Because both osteoblasts and adipocytes are formed from mesenchymal stem cells in the bone marrow, enhanced lipogenic differentiation reduces osteogenic differentiation In addition to the aforementioned two possibilities, another possibility is that obesity-induced hypermetabolism caused by increased insulin signaling causes bone marrow stromal stem cells to age more quickly Furthermore, the more body fat a patient with obesity has, the higher the levels of different hormones such as estrogen 35 and insulin 36 , which are helpful to BMD by blocking bone resorption and boosting bone remodeling 37 , Nevertheless, when BMI exceeded a particular threshold of The reasons for the saturating effect of BMI on BMD remain to be fully understood.

Early in infancy, bone development trajectories and peak bone mass are defined, which might explain why adult BMD does not rise after a period of restricted growth 39 , Another cause for the occurrence of BMI saturation effects is a distinct bone—fat axis that exists in vivo between adipose and bone tissue 41 , connected by various bioactive chemicals and maintaining bone homeostasis.

According to existing research, bone and adipocytes are both derived from the same stem cell ancestor and are competitive, with an increase in excess fat leading to bone loss BMD diminishes with growing obesity in animals with obesity, according to experiments in animal models caused by high-fat diets 43 , Our findings are extremely relevant to the entire population since we used a nationally representative sample.

We were also able to undertake subgroup analyses of BMI, WC, and femoral neck BMD across gender and ethnicity, and find the saturation effect value of obesity on BMD because of our large sample size.

The fundamental weakness of the study is its cross-sectional design. The causal relationship between BMI, WC, and femoral neck BMD could not be determined. To understand the specific mechanism of the relationship between obesity and BMD, further fundamental mechanistic research and large sample prospective studies are required.

Fourth, due to the limitations of the NHANES database for race-based classification criteria, we are unable to provide the percentage of abdominally obese individuals in each group for all race-specific thresholds. Finally, we excluded participants with cancer and our findings cannot be applied to a specific group.

In conclusion, we discovered not only a significant positive connection between BMI, WC, and BMD, but also a BMI saturation value for femoral neck BMD. The studies involving human participants were reviewed and approved by NCHS Ethics Review Board.

YZ and JP designed the research. YZ collected and analyzed the data, and drafted the manuscript. YZ and JP revised the manuscript. All authors contributed to the article and approved the submitted version. This study was funded by the Guangxi Natural Science Foundation Project GXNSFBA and the Science and Technology Project, Guangxi, AD The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.

Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. BMD, bone mineral density; NAFLD, non-alcoholic fatty liver disease; BMI, body mass index; WC, waist circumference; NHANES, National Health and Nutrition Examination Survey; MEC, mobile examination center.

Ensrud K, Crandall C. Ann Internal Med ITC17— doi: CrossRef Full Text Google Scholar. Wright N, Looker A, Saag K, Curtis J, Delzell E, Randall S, et al. The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine.

J Bone Miner Res Off J Am Soc Bone Miner Res —6. Alejandro P, Constantinescu F. A Review of Osteoporosis in the Older Adult: An Update. Rheumatic Dis Clin North Am — Nomura S, Kitami A, Takao-Kawabata R, Takakura A, Nakatsugawa M, Kono R, et al. Teriparatide Improves Bone and Lipid Metabolism in a Male Rat Model of Type 2 Diabetes Mellitus.

Endocrinology — PubMed Abstract CrossRef Full Text Google Scholar. Gajewska J, Weker H, Ambroszkiewicz J, Szamotulska K, Chełchowska M, Franek E, et al. Alterations in Markers of Bone Metabolism and Adipokines Following a 3-Month Lifestyle Intervention Induced Weight Loss in Obese Prepubertal Children.

Exp Clin Endocrinol Diabetes Off J German Soc Endocrinol German Diabetes Assoc — Villareal D, Shah K, Banks M, Sinacore D, Klein S. Effect of Weight Loss and Exercise Therapy on Bone Metabolism and Mass in Obese Older Adults: A One-Year Randomized Controlled Trial.

J Clin Endocrinol Metab —7. Jaacks L, Vandevijvere S, Pan A, McGowan C, Wallace C, Imamura F, et al. The Obesity Transition: Stages of the Global Epidemic.

Lancet Diabetes Endocrinol — Daniels SR. The Use of BMI in the Clinical Setting. Pediatrics Suppl 1 :S35— Turcato E, Bosello O, Di Francesco V, Harris TB, Zoico E, Bissoli L, et al.

Waist Circumference and Abdominal Sagittal Diameter as Surrogates of Body Fat Distribution in the Elderly: Their Relation With Cardiovascular Risk Factors. Int J Obes Relat Metab Disord — Gkastaris K, Goulis D, Potoupnis M, Anastasilakis A, Kapetanos G.

Obesity, Osteoporosis and Bone Metabolism. J Musculoskeletal Neuronal Interact 20 3 — Google Scholar. Barrera G, Bunout D, Gattás V, de la Maza M, Leiva L, Hirsch S. A High Body Mass Index Protects Against Femoral Neck Osteoporosis in Healthy Elderly Subjects.

Nutr Burbank Los Angeles County Calif — Ravn P, Cizza G, Bjarnason N, Thompson D, Daley M, Wasnich R, et al. Low Body Mass Index Is an Important Risk Factor for Low Bone Mass and Increased Bone Loss in Early Postmenopausal Women. Early Postmenopausal Intervention Cohort EPIC Study Group.

J Bone Miner Res Off J Am Soc Bone Miner Res —7. Engelen S, Robinson A, Zurke Y, Monaco C. Therapeutic Strategies Targeting Inflammation and Immunity in Atherosclerosis: How to Proceed?

Nat Rev Cardiol Rohm T, Meier D, Olefsky J, Donath M. Inflammation in Obesity, Diabetes, and Related Disorders. Immunity — Yeghiazarians Y, Jneid H, Tietjens J, Redline S, Brown D, El-Sherif N, et al.

Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation e56— Eddowes P, Sasso M, Allison M, Tsochatzis E, Anstee Q, Sheridan D, et al.

Accuracy of FibroScan Controlled Attenuation Parameter and Liver Stiffness Measurement in Assessing Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology — Burge R, Dawson-Hughes B, Solomon D, Wong J, King A, Tosteson A. Incidence and Economic Burden of Osteoporosis-Related Fractures in the United States, J Bone Miner Res Off J Am Soc Bone Miner Res — Hua Y, Fang J, Yao X, Zhu Z.

Can Waist Circumference be a Predictor of Bone Mineral Density Independent of BMI in Middle-Aged Adults? Endocr Connections — Kim Y, Kim S, Won Y, Kim S.

Clinical Manifestations and Factors Associated With Osteosarcopenic Obesity Syndrome: A Cross-Sectional Study in Koreans With Obesity. Calcif Tissue Int — Chen L, Liang J, Wen J, Huang H, Li L, Lin W, et al.

Is Waist Circumference a Negative Predictor of Calcaneal Bone Mineral Density in Adult Chinese Men With Normal Weight? Ann Trans Med Cui L, Shin M, Kweon S, Choi J, Rhee J, Lee Y, et al. Sex-Related Differences in the Association Between Waist Circumference and Bone Mineral Density in a Korean Population.

BMC Musculoskeletal Disord Ağbaht K, Gürlek A, Karakaya J, Bayraktar M. Circulating Adiponectin Represents a Biomarker of the Association Between Adiposity and Bone Mineral Density. Endocrine —9. Ma M, Feng Z, Liu X, Jia G, Geng B, Xia Y. The Saturation Effect of Body Mass Index on Bone Mineral Density for People Over 50 Years Old: A Cross-Sectional Study of the US Population.

Front Nutr Wiacek M, Skrzek A, Ignasiak Z, Zubrzycki I. The Changes of Bone Mineral Density in Relation to Body Mass Index and Aging Among Polish and Different Ethnic Women in the United States: Cross-Sectional Studies.

J Clin Densitom Off J Int Soc Clin Densitom — Morin S, Tsang J, Leslie W. Weight and Body Mass Index Predict Bone Mineral Density and Fractures in Women Aged 40 to 59 Years. Osteoporosis Int J Established as Result Cooperation between Eur Foundation Osteoporosis Natl Osteoporosis Foundation USA — Qiao D, Li Y, Liu X, Zhang X, Qian X, Zhang H, et al.

Association of Obesity With Bone Mineral Density and Osteoporosis in Adults: A Systematic Review and Meta-Analysis. Public Health —8. Savva SC, Lamnisos D, Kafatos AG. Predicting Cardiometabolic Risk: Waist-to-Height Ratio or BMI: A Meta-Analysis.

Diabetes Metab Syndr Obes — Shen J, Nielson CM, Marshall LM, Lee DC, Keaveny TM, Orwoll ES. The Association Between BMI and QCT-Derived Proximal Hip Structure and Strength in Older Men: A Cross-Sectional Study. J Bone Miner Res —8. Søgaard AJ, Holvik K, Omsland TK, Tell GS, Dahl C, Schei B, et al.

Abdominal Obesity Increases the Risk of Hip Fracture. A Population-Based Study of 43, Women and Men Aged Years Followed for 8 Years. Cohort of Norway. J Intern Med — De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, et al.

Tenenhouse, Body Mass Index as a Predictor of Fracture Risk: A Meta-Analysis. Osteoporos Int —8. Lanyon LE. Control of Bone Architecture by Functional Load Bearing.

J Bone Miner Res 7 Suppl 2 :S— Hla MM, Davis JW, Ross PD, Wasnich RD, Yates AJ, Ravn P, et al. A Multicenter Study of the Influence of Fat and Lean Mass on Bone Mineral Content: Evidence for Differences in Their Relative Influence at Major Fracture Sites.

Am J Clin Nutr — Khan A, Qu R, Fan T, Ouyang J, Dai J. A Glance on the Role of Actin in Osteogenic and Adipogenic Differentiation of Mesenchymal Stem Cells. Stem Cell Res Ther Tencerova M, Frost M, Figeac F, Nielsen TK, Ali D, Lauterlein JL, et al. Obesity-Associated Hypermetabolism and Accelerated Senescence of Bone Marrow Stromal Stem Cells Suggest a Potential Mechanism for Bone Fragility.

Cell Rep — Costantini S, Conte C. Bone Health in Diabetes and Prediabetes. The Medical Ethics Committee of Youjiang Medical University for Nationalities approved this study All procedures are carried out with the full understanding and written consent of all participants.

The person in the test stands naturally and the height is measured by the height measurement to the nearest 0. In this study, body composition was measured using a Bioelectrical Impedance Analyzer Japan TANITA, MC Before the test, relevant data are input, such as name, height, age, sex, etc.

The subject removes all metal objects that come into contact with the body. In a quiet state, the subject bare feet step on the left and right foot electrodes. The BUA can reflect the change in BMD, and thus the BMD value is expressed and the corresponding T score is calculated.

Standard calibration is performed before each measurement, and the operation is performed by a fixed professional. For OP, the diagnostic criteria established by the World Health Organization are used and the T score T score is the value obtained by dividing the difference between the BMD of the measured person and the maximum bone mass of the healthy young person by the standard deviation is judged.

The measured data was exported by body composition analysis software by Health Fitness Central Station Management System V9 ACMEWAY Health Technology Co. The data was analyzed using IBM SPSS Statistics version 18 IBM SPSS Inc. Classification variables were analyzed using logistic regression analysis for possible influencing factors.

Comparison of Baseline Data between Male and Female of Zhuang Nationality in Southwest China. The detection rates of OP in men and women were The female OP detection rate is 2. The abnormal bone mass rate for female bone mass is Correlation Analysis between Bone Mineral Density, Body Fat Percentage, Visceral Fat Grade, Waist Circumference, and Waist-to-Height Ratio.

Table 1. Baseline data of different levels of obesity in normal, bone mass and osteoporotic levels groups in middle-aged and elderly people of Zhuang nationality in southwest China. Table 2. Correlation analysis of bone mineral density with BMI, body fat percentage, visceral fat grade, waist circumference, waist-to-height ratio.

Bone Mineral Density and Osteoporosis Detection Rate between Different Groups of Body Fat Percentage. Analysis of Risk Factors for the Reduction of Calcaneal Bone Mass in the Zhuang Population. Age, height, weight, waist circumference, waist-to-height ratio, body fat percentage, visceral fat grade, visceral fat grade group, waist-to-hip ratio grouping, and body fat percentage grouping were used as covariates, and forward step condition of logistic regression was used for the analysis.

In the same BMI group, the BMD of males in Zhuang was lower than that of the Jing nationality. Table 3. Results of bone mineral density and osteoporosis in different body fat percentages of middle-aged and elderly people in Zhuang. Table 4.

Multivariate the forward stepping-conditional Logistic regression analysis of risk factors for bone mass loss in male and female.

Variables entered in Model 1: Body mass index. Visceral fat grade male ; b. Variables entered in Model 2: Body mass index Visceral fat grade female. Table 5. Comparison of bone mineral density among middle-aged and elderly People of Zhuang and Jing nationality in southwest China. Figure 1.

The Effect of BMI on Bone Mineral Density of Zhuang and Comparison with Other Ethnic Groups. With the increasing incidence of osteoporosis and obesity, OP common complications, cardiovascular diseases and other chronic diseases caused by obesity seriously affect the health and quality of life of middle-aged and elderly people [7].

However, the effect of obesity on bone density remains controversial [3] [8]. The amount of fat includes the amount of VFG and the amount of subcutaneous fat [9]. BMI can indirectly reflect the degree of fatness and thinness.

In this study, the above indicators were used to evaluate the effect of obesity on BMD. Previous studies have suggested that the amount of fat has a protective effect on BMD [10] [11]. This study also showed that the BMD of the middle-aged and elderly people in Zhuang is positively correlated with BMI.

The BMI in the normal bone mass group is higher than that in the osteoporosis group, which is consistent with previous studies [12]. Multivariate conditional regression analysis showed that BMI was a protective factor for normal bone mass [13]. Small and middle-aged people are more likely to suffer from osteoporotic fractures than those with high height and high body weight [12].

However, studies found that obese people are more stressed on the vertebral body, and spinal fractures are more likely to occur when the bone density decreases [13]. This was also found in our research data not show.

Comparing the research data of Zhuang and Jing and Han, high BMI also has a protective effect on BMD of Jing and Han people, which is consistent with the above conclusions.

Under the same BMI group, BMD of male and female groups in Zhuang was lower than that of Jing and Han nationalities Figure 1. The BMD of female in Zhuang was significantly different from that of Jing female. Because Zhuang and Jing belong to the same branch genetically, the possible reasons are presumed: Zhuang people live in hilly areas.

Rice, corn and vegetables are their mainly food, while Jing people live on the coast for a long time with seafood such as fish and shrimp. This seafood is rich in protein and calcium ions, which are beneficial to increase the bone density of the Jing people and slow down their bone loss.

Effect of Abdominal Obesity on Bone Mineral Density of Middle-Aged and Elderly People in Zhuang. Recently, it has been found that obesity also has an adverse effect on bone.

The bone density changes with the effects of fat on sugar, fat metabolism and endocrine in different parts [14]. When the local fat is excessively accumulated and the bone metabolism is increased, the bone loss of the relative parts is increased [15]. As the age increases, fat can be redistributed, the accumulation of visceral and abdominal fat increases, and abdominal obesity occurs [16].

This study found that the effect of abdominal obesity on BMD in Zhuang female is not obvious, and the increase in female WtHR may lead to a decrease in bone density. The WC, WtHR and VFG of the Zhuang male normal bone group were higher than those of the osteoporosis group.

The BMD was positively correlated with abdominal obesity index WC, WtHR, VFG. However, after adjusting the age, body mass, height and other factors, using multivariate conditional logistic regression analysis showed that visceral fat grade was significantly associated with calcaneal bone mass loss and independent of bone mass loss of traditional risk factors.

In the male population, the risk of bone mass loss was significantly higher in individual with visceral fat grade over high , which was 9. Although fat has a certain protective effect on BMD, VFG over high is associated with bone mass loss, hyperglycemia, hyperlipemia, hypertension and coronary heart disease.

Therefore, reducing VFG accumulation, proper physical exercise, and avoiding abnormal abdominal obesity can effectively delay bone mass loss and other chronic diseases [17].

The effect of body fat percentage on the BMD of Zhuang female is larger than that of male. The small decrease of BFP can decrease the bone density, which may be related to the load of fat and bone tissue and the promotion of estrogen production [18].

The muscle mass ratio is consistent with the BFP. The higher the BFP, the higher the muscle mass, and the lower the incidence of osteoporosis, which is consistent with the study [19] [20].

Within a certain range, the greater the mechanical stimulation produced by exercise, the stronger the effect on bone promotion [21] [22] , which is related to the effect of osteoblasts and bone marrow stem cells on motor stimuli response and muscle strength [23] [24].

Therefore, high body fat ratio can cause many chronic diseases, so proper diet and proper physical activity are the main factors to maintain normal BFP and bone health [25] [26] [27]. The BMD of middle-aged and elderly people in Zhuang decreased with age, and increased with the increase of BMI and body fat percentage.

Among them, body fat percentage has a greater effect on female BMD than males, and proper abdominal obesity can increase male BMD. Therefore, it is recommended that male Zhuang people in southwest China can increase the amount of fat in the normal weight range, but to avoid excessive visceral fat, and women should maintain normal body fat rate.

Both men and women should strengthen physical exercise and the reasonable diet to prevent or slow bone loss. In the past, although many studies have studied the relationship between obesity and BMD by using BMI, but at the same time, it was rare to study the relationship between several obesity evaluation indicators and BMD.

This study clarifies the correlation between different obesity evaluation indexes and BMD, to provide a certain degree of innovation in assessing the relationship between fat content, fat distribution and bone density. However, this study only studied the Zhuang population, and this conclusion may not apply to Han or other people.

This cross-sectional study found an association between waist circumference, waist height ratio, body fat percentage, visceral fat, and bone mineral density in middle-aged and elderly people, although its causal relationship remains unknown.

Furthermore, the subjects of this study are township residents with average living standards, and the research results cannot represent the situation of urban residents with better living standards.

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article. S; No. The research team thanked the participants in this study.

The authors declare no conflicts of interest regarding the publication of this paper. and Fang, X. Journal of Biosciences and Medicines, 10, and Cheverud, J.

Journal of Bone and Mineral Research, 34, and Onambélé, G. Nutrients, 11, Article No. and Gagnon, C. PLOS ONE, 16, e and Mielnik, P. BMC Musculoskeletal Disorders, 22, Article No. Journal of Orthopaedic Surgery and Research, 17, Article No. and Migliaccio, S.

Frontiers in Endocrinology, 10, Article and Hind, K. Osteoporosis International, 30, and Speakman, J. The American Journal of Clinical Nutrition, , and Cheng, Q. Archives of Osteoporosis, 13, Article No. and van der Schouw, Y. and Garcez-Leme, L. Acta Ortopédica Brasileira, 26, and Gong, C.

Frontiers in Endocrinology, 13, Article and Hardouin, P. Bone, ,

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LeWine, MD , Chief Medical Editor, Harvard Health Publishing A person's waist-to-hip ratio may be a better tool than body mass index BMI for predicting chronic health problems, according to a study published online Sept. Research health conditions Check your symptoms Prepare for a doctor's visit or test Find the best treatments and procedures for you Explore options for better nutrition and exercise Learn more about the many benefits and features of joining Harvard Health Online ».

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The relationship between the two measurements is referred to as the waist-to-hip ratio WHR. There are two main forms of adipose tissue, as classified in terms of their location within the body: subcutaneous fat is deposited beneath the skin, whilst visceral fat is located around the organs.

Adipose tissue in the hips, thighs and buttocks is usually subcutaneous, whereas fat stored abdominally tends to be mostly visceral. Why this link between central obesity and multiple serious health conditions should exist is not yet fully understood.

It is also linked with impaired regulation of cholesterol and abnormal cardiovascular function. It is quite possible that these and other mechanisms are implicated in what is likely to be a multifactorial process.

Medical imaging techniques such as computerized tomography CT and magnetic resonance imaging MRI are currently the only means by which to determine unequivocally whether abdominal fat is subcutaneous or visceral.

However, extensive research has confirmed that increased waist circumference is a strong indicator of the presence of excessive deposits of visceral adipose tissue. The World Health Organization WHO advocates the use of a standardized procedure for measuring WC and WHR:.

Clothing and other items that might interfere with the measurement should first be cleared from the waist and hip area.

The subject is then asked to stand upright with arms relaxed at the side, feet evenly spread apart at approximately shoulder width, and body weight evenly distributed. The waist measurement should be made at the midpoint between the top of the iliac crest upper edge of the main pelvic bone and the lower margin of the last palpable rib in the mid axillary line lowest point of the ribcage that can be located by touch along the side of the body.

It may be necessary for the clinician performing the measurement to identify these regions by touch prior to placing the measuring tape. Once the location of the waist has been determined, a stretch resistant tape is passed around the subject.

It should be wrapped snugly around the body, but not to the point of depressing or pinching the underlying skin. In order to ensure that the abdominal muscles are relaxed, the subject is asked to take two or three consecutive natural breaths and the measurement is made at the end of the last natural expiration outward breath.

Hip circumference is measured in a similar manner, with the tape being passed around the hips at the widest circumference of the buttocks. In both cases it is important that the tape measure be kept level and parallel to the floor whilst the measurement is made.

If you wish to measure your own WC or WHR, the same procedure can be followed at home, although it can be difficult to make sure the measuring tape is correctly aligned without assistance.

Once the readings have been obtained, WHR can be calculated by simply dividing waist circumference WC by hip circumference HC.

The units of measurement used are not important, so long as they are consistent between measurements. According to the World Health Organization, a waist circumference greater than 37 inches for men and For WHR, the upper limit is considered to be 0.

WHR should be considered in combination with the absolute waist circumference WC. A cross-sectional research of the American population found a link between BMI and BMD Another study by Wiacek et al.

indicated that among Polish women aged 40—79 years, there was a significant positive correlation between BMI and BMD Morin et al. noted that low BMI not only predicted the development of osteoporosis leading to osteoporosis, but also predicted an increased risk of fracture A recent meta-analysis showed that adults with high BMI have higher lumbar BMD and femoral neck BMD compared to healthy weight individuals BMI and WC are often congruent.

However, people with normal BMI but large WC have a higher risk of developing metabolic diseases A cohort study based on 44, women and men mean age 70 years in Sweden comprehensively assessed the relationship between body composition and fracture risk.

The study found that fat distribution has a very strong effect on BMD and fracture risk and suggests that for optimal bone loss and fracture prevention, both men and women should avoid low BMI while having a high degree of central obesity abdominal obesity.

In past studies, obesity has not only been shown to be associated with BMD, but has also been found to correlate with bone quality and fracture risk. Shen et al. studied 3, men in a cross-sectional research to determine the association between BMI and hip QCT measures, as well as to perform finite element analysis of hip QCT scans to offer a measure of hip strength during simulated falls.

Men with obesity have better hip strength, but they also have a higher impact-to-strength ratio, which means that despite having stronger bones, they have a higher chance of hip fracture The incidence of fracture declined with rising BMI and plateaued in men with obesity, according to a cohort study of 43, individuals aged 60 to 79 years from Norway.

After adjusting for BMI and other possible confounders, larger WC and waist-to-hip ratio were linked to an increased risk of hip fracture. When a low BMI is combined with abdominal fat, the risk of hip fracture skyrockets In , a meta-analysis of 12 prospective population-based cohorts was released approximately 60, individuals with a mean age of Men and women with a low BMI had a greater age-corrected risk of any type of fracture, whereas those with a higher BMI had a lower risk.

The increased risk, on the other hand, was not linear, and the gradient seemed steeper at lower BMI levels This point is similar to the relationship between BMI, WC, and BMD in our study. The decreased bone mass and increased risk of fragility fractures associated with obesity also suggest that we need to keep BMI and WC in a reasonable range.

The mechanisms behind the relationship between obesity and BMD are unclear. Increased static mechanical compliance due to excessive fat accumulation is one of the hypothesized reasons. Increased static mechanical stresses on the skeleton are caused by excessive fat accumulation and body weight, and when bone tissue recognizes the mechanical forces imposed by the body, it undergoes a series of changes 31 , Another probable cause is the replacement of osteoblasts in the bone marrow by adipocytes.

Because both osteoblasts and adipocytes are formed from mesenchymal stem cells in the bone marrow, enhanced lipogenic differentiation reduces osteogenic differentiation In addition to the aforementioned two possibilities, another possibility is that obesity-induced hypermetabolism caused by increased insulin signaling causes bone marrow stromal stem cells to age more quickly Furthermore, the more body fat a patient with obesity has, the higher the levels of different hormones such as estrogen 35 and insulin 36 , which are helpful to BMD by blocking bone resorption and boosting bone remodeling 37 , Nevertheless, when BMI exceeded a particular threshold of The reasons for the saturating effect of BMI on BMD remain to be fully understood.

Early in infancy, bone development trajectories and peak bone mass are defined, which might explain why adult BMD does not rise after a period of restricted growth 39 , Another cause for the occurrence of BMI saturation effects is a distinct bone—fat axis that exists in vivo between adipose and bone tissue 41 , connected by various bioactive chemicals and maintaining bone homeostasis.

According to existing research, bone and adipocytes are both derived from the same stem cell ancestor and are competitive, with an increase in excess fat leading to bone loss BMD diminishes with growing obesity in animals with obesity, according to experiments in animal models caused by high-fat diets 43 , Our findings are extremely relevant to the entire population since we used a nationally representative sample.

We were also able to undertake subgroup analyses of BMI, WC, and femoral neck BMD across gender and ethnicity, and find the saturation effect value of obesity on BMD because of our large sample size.

The fundamental weakness of the study is its cross-sectional design. The causal relationship between BMI, WC, and femoral neck BMD could not be determined. To understand the specific mechanism of the relationship between obesity and BMD, further fundamental mechanistic research and large sample prospective studies are required.

Fourth, due to the limitations of the NHANES database for race-based classification criteria, we are unable to provide the percentage of abdominally obese individuals in each group for all race-specific thresholds. Finally, we excluded participants with cancer and our findings cannot be applied to a specific group.

In conclusion, we discovered not only a significant positive connection between BMI, WC, and BMD, but also a BMI saturation value for femoral neck BMD. The studies involving human participants were reviewed and approved by NCHS Ethics Review Board.

YZ and JP designed the research. YZ collected and analyzed the data, and drafted the manuscript. YZ and JP revised the manuscript.

All authors contributed to the article and approved the submitted version. This study was funded by the Guangxi Natural Science Foundation Project GXNSFBA and the Science and Technology Project, Guangxi, AD The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.

Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

BMD, bone mineral density; NAFLD, non-alcoholic fatty liver disease; BMI, body mass index; WC, waist circumference; NHANES, National Health and Nutrition Examination Survey; MEC, mobile examination center.

Ensrud K, Crandall C. Ann Internal Med ITC17— doi: CrossRef Full Text Google Scholar. Wright N, Looker A, Saag K, Curtis J, Delzell E, Randall S, et al. The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine.

J Bone Miner Res Off J Am Soc Bone Miner Res —6. Alejandro P, Constantinescu F. A Review of Osteoporosis in the Older Adult: An Update. Rheumatic Dis Clin North Am — Nomura S, Kitami A, Takao-Kawabata R, Takakura A, Nakatsugawa M, Kono R, et al.

Teriparatide Improves Bone and Lipid Metabolism in a Male Rat Model of Type 2 Diabetes Mellitus. Endocrinology — PubMed Abstract CrossRef Full Text Google Scholar. Gajewska J, Weker H, Ambroszkiewicz J, Szamotulska K, Chełchowska M, Franek E, et al. Alterations in Markers of Bone Metabolism and Adipokines Following a 3-Month Lifestyle Intervention Induced Weight Loss in Obese Prepubertal Children.

Exp Clin Endocrinol Diabetes Off J German Soc Endocrinol German Diabetes Assoc — Villareal D, Shah K, Banks M, Sinacore D, Klein S. Effect of Weight Loss and Exercise Therapy on Bone Metabolism and Mass in Obese Older Adults: A One-Year Randomized Controlled Trial.

J Clin Endocrinol Metab —7. Jaacks L, Vandevijvere S, Pan A, McGowan C, Wallace C, Imamura F, et al. The Obesity Transition: Stages of the Global Epidemic. Lancet Diabetes Endocrinol — Daniels SR.

The Use of BMI in the Clinical Setting. Pediatrics Suppl 1 :S35— Turcato E, Bosello O, Di Francesco V, Harris TB, Zoico E, Bissoli L, et al.

Waist Circumference and Abdominal Sagittal Diameter as Surrogates of Body Fat Distribution in the Elderly: Their Relation With Cardiovascular Risk Factors. Int J Obes Relat Metab Disord — Gkastaris K, Goulis D, Potoupnis M, Anastasilakis A, Kapetanos G.

Obesity, Osteoporosis and Bone Metabolism. J Musculoskeletal Neuronal Interact 20 3 — Google Scholar. Barrera G, Bunout D, Gattás V, de la Maza M, Leiva L, Hirsch S. A High Body Mass Index Protects Against Femoral Neck Osteoporosis in Healthy Elderly Subjects.

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Baseline data of different levels of obesity in normal, bone mass and osteoporotic levels groups in middle-aged and elderly people of Zhuang nationality in southwest China.

Table 2. Correlation analysis of bone mineral density with BMI, body fat percentage, visceral fat grade, waist circumference, waist-to-height ratio. Bone Mineral Density and Osteoporosis Detection Rate between Different Groups of Body Fat Percentage. Analysis of Risk Factors for the Reduction of Calcaneal Bone Mass in the Zhuang Population.

Age, height, weight, waist circumference, waist-to-height ratio, body fat percentage, visceral fat grade, visceral fat grade group, waist-to-hip ratio grouping, and body fat percentage grouping were used as covariates, and forward step condition of logistic regression was used for the analysis.

In the same BMI group, the BMD of males in Zhuang was lower than that of the Jing nationality. Table 3. Results of bone mineral density and osteoporosis in different body fat percentages of middle-aged and elderly people in Zhuang. Table 4. Multivariate the forward stepping-conditional Logistic regression analysis of risk factors for bone mass loss in male and female.

Variables entered in Model 1: Body mass index. Visceral fat grade male ; b. Variables entered in Model 2: Body mass index Visceral fat grade female. Table 5. Comparison of bone mineral density among middle-aged and elderly People of Zhuang and Jing nationality in southwest China.

Figure 1. The Effect of BMI on Bone Mineral Density of Zhuang and Comparison with Other Ethnic Groups. With the increasing incidence of osteoporosis and obesity, OP common complications, cardiovascular diseases and other chronic diseases caused by obesity seriously affect the health and quality of life of middle-aged and elderly people [7].

However, the effect of obesity on bone density remains controversial [3] [8]. The amount of fat includes the amount of VFG and the amount of subcutaneous fat [9].

BMI can indirectly reflect the degree of fatness and thinness. In this study, the above indicators were used to evaluate the effect of obesity on BMD. Previous studies have suggested that the amount of fat has a protective effect on BMD [10] [11].

This study also showed that the BMD of the middle-aged and elderly people in Zhuang is positively correlated with BMI. The BMI in the normal bone mass group is higher than that in the osteoporosis group, which is consistent with previous studies [12]. Multivariate conditional regression analysis showed that BMI was a protective factor for normal bone mass [13].

Small and middle-aged people are more likely to suffer from osteoporotic fractures than those with high height and high body weight [12]. However, studies found that obese people are more stressed on the vertebral body, and spinal fractures are more likely to occur when the bone density decreases [13].

This was also found in our research data not show. Comparing the research data of Zhuang and Jing and Han, high BMI also has a protective effect on BMD of Jing and Han people, which is consistent with the above conclusions.

Under the same BMI group, BMD of male and female groups in Zhuang was lower than that of Jing and Han nationalities Figure 1. The BMD of female in Zhuang was significantly different from that of Jing female.

Because Zhuang and Jing belong to the same branch genetically, the possible reasons are presumed: Zhuang people live in hilly areas. Rice, corn and vegetables are their mainly food, while Jing people live on the coast for a long time with seafood such as fish and shrimp.

This seafood is rich in protein and calcium ions, which are beneficial to increase the bone density of the Jing people and slow down their bone loss. Effect of Abdominal Obesity on Bone Mineral Density of Middle-Aged and Elderly People in Zhuang. Recently, it has been found that obesity also has an adverse effect on bone.

The bone density changes with the effects of fat on sugar, fat metabolism and endocrine in different parts [14]. When the local fat is excessively accumulated and the bone metabolism is increased, the bone loss of the relative parts is increased [15].

As the age increases, fat can be redistributed, the accumulation of visceral and abdominal fat increases, and abdominal obesity occurs [16]. This study found that the effect of abdominal obesity on BMD in Zhuang female is not obvious, and the increase in female WtHR may lead to a decrease in bone density.

The WC, WtHR and VFG of the Zhuang male normal bone group were higher than those of the osteoporosis group. The BMD was positively correlated with abdominal obesity index WC, WtHR, VFG.

However, after adjusting the age, body mass, height and other factors, using multivariate conditional logistic regression analysis showed that visceral fat grade was significantly associated with calcaneal bone mass loss and independent of bone mass loss of traditional risk factors.

In the male population, the risk of bone mass loss was significantly higher in individual with visceral fat grade over high , which was 9. Although fat has a certain protective effect on BMD, VFG over high is associated with bone mass loss, hyperglycemia, hyperlipemia, hypertension and coronary heart disease.

Therefore, reducing VFG accumulation, proper physical exercise, and avoiding abnormal abdominal obesity can effectively delay bone mass loss and other chronic diseases [17].

The effect of body fat percentage on the BMD of Zhuang female is larger than that of male. The small decrease of BFP can decrease the bone density, which may be related to the load of fat and bone tissue and the promotion of estrogen production [18]. The muscle mass ratio is consistent with the BFP.

The higher the BFP, the higher the muscle mass, and the lower the incidence of osteoporosis, which is consistent with the study [19] [20]. Within a certain range, the greater the mechanical stimulation produced by exercise, the stronger the effect on bone promotion [21] [22] , which is related to the effect of osteoblasts and bone marrow stem cells on motor stimuli response and muscle strength [23] [24].

Therefore, high body fat ratio can cause many chronic diseases, so proper diet and proper physical activity are the main factors to maintain normal BFP and bone health [25] [26] [27].

The BMD of middle-aged and elderly people in Zhuang decreased with age, and increased with the increase of BMI and body fat percentage. Among them, body fat percentage has a greater effect on female BMD than males, and proper abdominal obesity can increase male BMD.

Therefore, it is recommended that male Zhuang people in southwest China can increase the amount of fat in the normal weight range, but to avoid excessive visceral fat, and women should maintain normal body fat rate.

Both men and women should strengthen physical exercise and the reasonable diet to prevent or slow bone loss. In the past, although many studies have studied the relationship between obesity and BMD by using BMI, but at the same time, it was rare to study the relationship between several obesity evaluation indicators and BMD.

This study clarifies the correlation between different obesity evaluation indexes and BMD, to provide a certain degree of innovation in assessing the relationship between fat content, fat distribution and bone density.

However, this study only studied the Zhuang population, and this conclusion may not apply to Han or other people. This cross-sectional study found an association between waist circumference, waist height ratio, body fat percentage, visceral fat, and bone mineral density in middle-aged and elderly people, although its causal relationship remains unknown.

Furthermore, the subjects of this study are township residents with average living standards, and the research results cannot represent the situation of urban residents with better living standards.

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article. S; No.

The research team thanked the participants in this study. The authors declare no conflicts of interest regarding the publication of this paper. and Fang, X. Journal of Biosciences and Medicines, 10, and Cheverud, J. Journal of Bone and Mineral Research, 34, and Onambélé, G.

Nutrients, 11, Article No. and Gagnon, C. Why is the hip-waist ratio important? Medically reviewed by Daniel Bubnis, M.

How to calculate waist-to-hip ratio What is a healthy ratio? Impact on health How to improve the ratio Considerations Conclusion Waist-to-hip ratio, also known as waist-hip ratio, is the circumference of the waist divided by the circumference of the hips.

How to calculate waist-to-hip ratio. Share on Pinterest Waist circumference should be measured just above the belly button. What is a healthy ratio? Share on Pinterest The hips should be measured at the widest part of the hips.

Impact on health. How to improve the ratio. Share on Pinterest Reducing portion size and exercising regularly are recommended to improve waist-to-hip ratio.

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This study may offer some encouragement, after finding that the effects of being overweight may have been… READ MORE. BMI vs waist-to-hip ratio.

What do experts think about BMI vs. Why is BMI controversial? How to take your WHR. The bottom line. How we reviewed this article: History.

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