Comparisons for Body Mass Index and BodyFat Percent Among Puerto Ricans, Blacks,Whites and Asians Living in the New YorkCity AreaJack Wang, John C. Thornton, Santiago Burastero, Judy Shen, Stacey Tanenbaum,Steven B. Heymsfteld, Richard N. Pierson, Jr.

AbstractWANG, JACK, JOHN C THORNTON,SANTIAGO BURASTERO, JUDY SOON, STACEYTANENBAUM, STEVEN B HEYMSFIELD ANDRICHARD N PIERSON JR. Comparisons for bodymass index and body fat percent among PuertoRicans, blacks, whites and Asians living in the NewYork City area. Obes Res. 1996;4:377-384.The latest data (NHANES III) from the NationalCenter for Health Statistics (NCHS) show that theblack population has the highest proportion of over­weight among all adult populations in the UnitedStates. The present study compared the body massindex (BMI) and body fat percent from dual-photonabsorptiometry in 1,324 healthy adults aged 18 to107 years recruited from four ethnic groups in theNew York City area; 523 whites, 280 blacks, 267Asians and 254 Puerto Ricans. Puerto Ricans had thelargest BMI and the largest percent of subjects withbody weight more than 120% of their ideal weight,and the largest fat percent of the four ethnic groups:76% of Puerto Rican males had fat percent abovethe median value for white males (fat percent =19.6%) and 95% of Puerto Rican females had fatpercent above the median for white females (fat per­cent =30.8%). Asians had the smallest BMI, but63% of them had fat percent above the median val­ues for whites in each gender. Puerto Ricans also hadthe largest waist-to-hip ratios among the four ethnic

Submitted for publication May 30, 1995.Accepted for publication in final form February 13,1996.From the Body Composition Unit, Department of Medicine, St. Lukes­Roosevelt Hospital Center, Columbia University, New York, NY.Reprint requests to J. Wang, Body Composition Unit, St. Lukes-RooseveltHospital Center, 1111 Amsterdam Avenue, New York, NY 10025.Copyright ©1996 NAASO.

groups. In blacks, the percent of subjects with fatpercent larger than the median for whites was slight­ly smaller than that for Puerto Ricans, 64 % and82% of males and females respectively. These resultsdiffer from the latest NCHS data and show thatPuerto Ricans in this sample are heavier and fatterthan blacks.

Key words: overweight, ethnicity, body mass index,body fat percent, Puerto Rican

IntroductionThe data reported from the National Center for

Health Statistics (NCHS) in the Center for DiseaseControl and Prevention show that the percent of over­weight adults in the United States remained stable atabout 25% of the total adult U.S. population between1960 and 1980. However, between 1980 and 1991, thisnumber increased to one-third of the adult population,with the largest proportion of overweight people foundamong black non-Hispanic females at 50% andMexican-American females at 48% (17, 21). and theblack population had a larger percent of females in thesevere overweight category than the Puerto Rican pop­ulation (22).

We have recently completed a body compositionevaluation in 1,324 adults from four different ethnicgroups living in the New York City area: whites, blacks,Asians and Puerto Ricans. We found that the proportionof overweight Puerto Ricans (the largest Hispanic popu­lation living in the Northeastern United States) exceededthat found in the black population. Furthermore, thePuerto Rican population also exhibited the highest bodyfat percent of the four ethnic groups. The prevalence ofoverweight and obesity in the Puerto Ricans living in

OBESITY RESEARCH Vol. 4 No.4 July 1996 377

Overweight in Four Ethnic Groups, Wang et al.

the New York City area has reached a level that may beconsidered epidemic. This report presents these find­ings.

Subjects and MethodsOne thousand three hundred twenty-four healthy

adult volunteers (Table 1) were recruited from four eth­nic groups in the New York City area; 523 whites, 280blacks, 267 Asians and 254 Puerto Ricans aged 18 to107 years were studied. Ethnicity was defined by thebackground of both parents and all grandparents; PuertoRicans were born in Puerto Rico, whites were ofEuropean origin, blacks were African Americans, andAsians included 9 Japanese, 6 Korean, 2 Filipinos with­out Hispanic background and 250 Chinese. All Asianswere born in Asia and had lived in the US from 6months to 50 years.

All subjects were self-selected normal volunteerswho participated in a sex and age stratified cross-sec­tional study of traditional and new methods in bodycomposition. Anthropometric data were also obtainedduring a single 4 to 5 hours I-day visit to the BodyComposition Unit at St. Luke's-Roosevelt HospitalCenter located in the upper west side of Manhattan.Posters, local newspapers, radio-stations, local commu­nity centers and a Census-Tract based mailing list pro­vided by Election Computer Services were used forrecruitment. All subjects were ambulatory and nonetook medication for chronic illness.

Following an overnight fast, body weight was mea-

sured to ±0.2 kg, height to ± 0.5cm, total body fat per­cent was measured bI: dual-photon absorptiometry(DPA) using either 53Gd (Lunar DP4) or X-ray(Lunar-DPX) as the photon source (25, 26). The differ­ences between the two systems were rationalized by alinear regression equation: fat percent by DPX = 2.21 +0.95 x fat percent by DPA (36). The intensity of the153Gd source used in DPA system was corrected withground beef standard calibrations as described previous­ly (41). Circumferences at waist and hip were measuredas described by Steinkamp et al. (39). All measurementswere taken with the subject in a hospital gown and with­out shoes. Methods of recruitment and measurementshave been described in detail elsewhere (43).

Body mass index (BMI) was calculated as the ratioof body weight to squared stature (kg/m2). The percentof ideal body weight was calculated by using the Weightand Height Table of Metropolitan Life InsuranceCompany (28).

To confirm that the Puerto Rican subjects recruitedfor this study were representative of the general popula­tion of Puerto Ricans living in the New York City area,we surveyed body weight and stature at two f-day streetfestivals in the East Harlem area in New York Citywhere the Puerto Rican population is concentrated. Twohundred twenty one Puerto Rican adults were measuredby our staff using the same methods described aboveexcept that the latter group of volunteers were in theirsummer street clothes and low heeled-shoes (less than 1inch) (Table 1).

Table 1. Age, weight and height of whites, blacks, Asians and Puerto Ricans

Age (year) Weight (kg) Height (ern)Sex Ethnicity N Mean SO Mean SO Mean SO

Male White 214 49.7 18.2 77.4 12.1 175.2 6.9Black 127 51.4 18.4 80.1 14.6 174.5 7.3Asian 123 52.3 18.1 67.2 9.7 169.7 6.3Puerto-Rican 122 49.1 14.8 77.8 15.4 168.4 6.7

*Puerto-Rican 97 54.1 15.7 78.1 15.9 168.7 7.5

Female White 309 52.1 18.3 61.4 9.9 162.6 6.8Black 153 51.0 17.2 75.4 17.0 162.4 6.7Asian 144 52.1 16.8 54.3 8.5 157.0 6.7Puerto-

Rican 132 51.1 16.4 70.1 14.2 155.4 6.4*Puerto-

Rican 124 59.1 19.8 70.4 15.6 156.1 7.0

*Peurto Ricans recruited from street festivals.

378 OBESITY RESEARCH Vol. 4 No.4 July 1996

Overweight in Four Ethnic Groups, Wang et al.

The study was approved by the St, Luke's-RooseveltHospital Institutional Review Board. All subjectsrecruited for the laboratory studies (not those recruitedat street festivals) gave informed consent.

Statistical AnalysisDifferences in age, BMI, and fat percent between

the four ethnic groups were determined by ANDYA foreach sex separately. Multiple comparisons were per­formed using Fisher's protected least significant differ­ence procedure. We did include ethnicity in our modelsbecause ethnicity was the purpose of our analysis.Because the mean ages of the two groups of PuertoRicans were different, an analysis of covariance withage as the covariate was used to test the hypothesis thatthe mean BMI's for the two groups of Puerto Ricans areequal. The level of significance for all statistical testswas set at 0.05. Statistical calculations were performedusing STATA (Computing Resource Center, SantaMonica, CA) and SAS(SAS Institute Inc., Cary, NC)software packages.

ResultsTable 1 shows age, weight and height for each eth­

nic group recruited for the laboratory measurements andthe Puerto Ricans surveyed for weight and stature atstreet festivals. There were no significant differences in

age distribution among any of the eight subgroupsrecruited for the laboratory measurements. A '1'2 testwas used to test the hypothesis that percentages of sub­jects in each decade of age for the four ethnic groupswere equal. Separate analyses were performed for malesand females. The data were consistent with the hypothe­sis of homogeneous age distributions among the fourethnic groups for males and females. (This result is con­sistent with the sampling plan described in the studyprotocol which called for recruiting equal numbers ofsubjects in each decade of age for all eight subgroups.)

There were no significant differences in agebetween any of the eight subgroups recruited for the lab­oratory measurements. The Puerto Ricans surveyed forweight and stature at street festivals were significantlyolder than the Puerto Ricans recruited for the laboratorystudies (p =0.001).

Table 2 shows BMI, body fat percent and WHR foreach ethnic group by gender. Among the four ethnicgroups, Puerto Ricans had the largest mean BMI andAsians had the smallest mean BMI. The rank orderingfor the mean BMI values showed an order of PuertoRican > black> white > Asian for both genders (p =0.0001). Although Table 1 shows that the Puerto Ricansrecruited at street festivals were significantly older thanthose recruited for detailed laboratory measurements,there were no significant differences in BMI between

Table 2. Body mass index (BMI), body fat percent measured by DXA and waist-to-hip ration (WHR) inadult whites, blacks, Asians and Puerto Ricans

BMI Body fat percent WHRSex Ethnicity Mean SD Mean SD Mean SD

Male White 25.2 3.3 19.6 6.7 0.937 0.041Black 26.3 4.3 22.0 7.9 0.964 0.052Asian 23.3 2.9 21.3 6.4 0.928 0.048*Peurto Rican 27.4 4.7 24.8 8.3 0.976 0.033Puerto Rican 27.5 4.4

Female White 23.3 3.7 30.8 8.9 0.799 0.045Black 28.5 5.9 38.2 9.6 0.859 0.055Asian 22.0 3.1 31.9 6.6 0.826 0.056*Puerto Rican 29.4 5.9 40.2 7.1 0.897 0.049Puerto Rican 29.2 6.0

*Puerto Ricans Recruited from street festivals.BMI in males and females: Puerto Rican> black> white> Asian (p > 0.01), no significant differences between the two

groups of Puerto Ricans in each gender.Fat percent in males: Puerto Ricans> blacks and Asians> whites (p =0.0(01), no differences between blacks and Asians.Fat percent in females: Puerto Ricans> blacks> Asians and whites (p =0.0001), no differences between Asians and whites.WHR in males: Puerto Ricans and blacks >whites and Asians (p =0.0001), no differences between Puerto Ricans and

blacks,nor between whites and Asians.WHR in females: Puerto Ricans> blacks> Asians> whites (p =0.0(01).

OBESITY RESEARCH Vol. 4 No.4 July 1996 379

Overweight in Four Ethnic Groups, Wang et al.

Number of subjects as percent of total by ethnicitySex ethnicity >120% ideal >median fat%

weight in Whites

Table 3. Percent of subjects in blacks, Asians, andPuerto Ricans with body weight exceeding 120%of ideal weight and with body fat percent exceed­ing the median fat percent in whites

Ideal weight percent =100% * (Weight/ideal weight fromWeight and Height Table of Metropolitan Life InsuranceCompany).Body fat percent was measured by DXA.Median fat percent in white males =19.4%.Median fat percent in white females = 30.6%.

the two groups for either gender. Analysis of covariancewas done to compare BMI adjusting for age within eachgender. There were no significant correlations betweenage and BMI in either gender of the two groups ofPuerto Ricans. Although the Puerto Ricans measured atstreet festivals were significantly older than those mea­sured in the laboratory, since the differences in meanBMI between the two groups for both genders were notsignificant, therefore age would not have affected thecomparisons for BMI between the two groups.

Table 2 shows that Puerto Ricans of both gendershad the largest body fat percent of the four ethnicgroups, a mean of 24.8% in males and 40.2% infemales. Mean fat percent in black males was signifi­cantly smaller than in Puerto Rican males, but was notsignificantly different from the mean for Asian males.White males had the smallest body fat percent of all theeight subgroups. White and Asian females had similarmean fat percent. Black females had significantly largerfat percent than the white and Asian females, but fatpercent was even larger in the Puerto Rican females.

Table 2 also shows that female Puerto Ricans hadthe largest mean WHR of the eight subgroups (p =0.0001); male Puerto Ricans and blacks had similarmean WHR, which were significantly larger than themeans for white and Asian males (P=0.0001).

The age distribution was used to divide the sampleinto three approximately equal age categories, young,

middle, and old. An analysis of variance with unequalcell sizes (general linear modeling) was used to test forthe effects of age category, ethnic group, and age cate­gory by ethnic group interaction. Separate analyses wereperformed for males and females. There was no signifi­cant age category by ethnic group interaction for any ofthe variables. Therefore, the main effects of ethnicgroups can be interpreted. The results of these analyseswere consistent with the interpretations given in theabove paragraphs; therefore, they are not given.

Table 3 shows weight as percent of ideal weight. Ofthe four ethnic groups, Puerto Ricans of both gendershad the largest percent of subjects with body weightlarger than 120% of their ideal weight; 75% of femalePuerto Ricans and 48% of male Puerto Ricans weighedmore than 120% of their ideal weight.

Using the median fat percent of white males at19.6% and of white females at 30.8% as cutoff points,we then calculated the percent of subjects with valuesexceeding these points for each of the other ethnicgroups of both genders. Table 3 shows that PuertoRicans of each gender had the largest percentage of peo­ple with values larger than the cut-point among all threegroups. More than three-quarters of Puerto Rican males(76%) and almost all Puerto Rican females (95%) hadbody fat percent greater than the median value of whitesof both genders. Black and Asian males had similar per­centages (64% and 63%) with fat percent greater thanthe white median. Among the females, 82% of blackshad fat percent greater than the median for whitefemales. Figures 1 and 2 show percentage of subjectsaccording to fat percent in each subgroup.

DiscussionBody mass index is the simplest method for grading

obesity. BMI between 20 and 25 kg/m2 are classified asnormal (4). Subjects with BMI > 25 kg/m2 are consid­ered overweight, with increased risk of mortality, andsubjects with BMI > 30 kg/m2 are considered obese andhave increased risks of diseases related to obesity (4).According to the latest NCHS report, these defmitionsare shifted upward: subjects with BMI > 27.8 kg/m2 areconsidered overweight, and subjects with BMI > 31.1kg/m2 are considered severe obesity (21). The meanBMI in Puerto Ricans in our study was larger than 25kg/m2 in each sex (27.4 kg/m2 for males and 29.2kg/m2 for females). By comparison with theMetropolitan Life Weight and Height Tables (28), abouthalf of the male and three-fourths of the female PuertoRicans had body weights exceeded 120% of their idealweights. However, neither BMI nor ideal weight candistinguish between overweight due to muscularity, andobesity due to fatness (31). BMI has been used by anumber of investigators for estimating body composi-

White 30%Black 41% 64%Asian 11% 63%Puerto Ricans 48% 76%

White 30%Black 72% 82%Asian 15% 63%Puerto Ricans . 7~% 95%

Female

Male

380 OBESITY RESEARCH Vol. 4 No.4 July 1996

Overweight in Four Ethnic Groups, Wang et al.

30

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tion in the past But many recent studies have demon­strated the reliability of BMI for estimating body fat.content. Our recent study results show that Asians havesmaller BMI values than whites of the same sex, but, ata fixed BMI, Asians have larger fat percent than whites(43). Therefore measurements of body fat are more spe­cific for identifying fatness than any weight-to-statureindex.

The choice of methods to measure body fat hasbecame more complex during the past decade. The threetraditional methods for estimating body fat are based onunderwater weighing, and the measurements of totalbody potassium and total body water measurements(3,10,29). These methods rely on assumptions of con­stant chemical content of the fat-free mass (FFM), nowshown to be affected by sex, age and race(8,9,13,18,24,27,30,41-43). In the present study body fatwas measured by dual photon absorptiometry, which isindependent of these assumptions, being based on rela­tive attenuation measurements for the whole bod~ usingphotons of two different energies, either a 53-Gdsource in the previous model, or an X-ray tube in thecurrent model (25,26). Both systems were calibrated bybiological materials in which fat was measured by directchemical analysis (36,41). Although these systems havelimitations when applied to obese subjects (37), they arenot affected by sex, age and race for measuring body

fat. These systems provide measures of fat and FFMwithout using any of the traditional assumptions of con­stancy of water, potassium or density of FFM (25,26).

The majority of the Hispanic population in theUnited States are Mexican American, Cuban or PuertoRican. More than 60% of the Hispanic population of 18million is Mexican American, 90% of whom live in thesouthwestern states. The second largest group is PuertoRicans (2.5 million), 13% of the total Hispanic popula­tion based on the 1988 USA Census Report (40). Three­quarters of these Puerto Ricans live in New York, NewJersey and Connecticut (6). The Hispanic population isthe fastest growing minority group in the United States,and Puerto Ricans form the fastest growing segment ofthe Hispanic population, especially in the New YorkCity area (6).

Significant differences between whites and MexicanAmericans in body fatness and anthropometric variableshave been well recognized (2,14-16,23,33,34,38),Mexican Americans being more obese and having amore centralized adiposity (2), and thus an unfavorabledistribution of adipose tissue with regard to proclivityfor diabetes mellitus and hypertension, compared withnon-Hispanic whites. Socioeconomic status is a signifi­cant factor in body composition in early and middlechildhood (5), but genetic factors may play the principalrole in determining the distribution of adipose tissue

OBESITY RESEARCH Vol. 4 No.4 July 1996 381

Overweight in Four Ethnic Groups, Wang et al.

Mean Fat % for Whites ---;>

30 -

-I

60

----- Whites (301)

-- Blacks (148)

--- Asians (141)

--Puerto Ricans (132)

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(2,14,15,34,38,44). Socioeconomic status is inverselyrelated to stature in Hispanics (7,23,33). The ethnicancestry of Mexican Americans is predominantlyEuropean and American Indian, but Puerto Ricans differin having an additional Black component to their ances­try. Since body composition differs between blacks andwhites (8,14,27,42), differences between MexicanAmericans and Puerto Ricans are expected. SinceMexican Americans represent the majority of theHispanic population in the United States, most bodycomposition studies in Hispanic population have beendone in Mexican Americans. Reference data for bodycomposition in Puerto Ricans are very limited. A reportbased on the Hispanic Health and Nutrition ExaminationSurvey (NHANES II 1982-1984) by Kuczmarski (20)shows that among men, Puerto Ricans and blacks hadsimilar percentages of individuals overweight (25.7%vs. 26.3%), but the Puerto Ricans had a smaller preva­lence of severe overweight than the blacks (7.9% vs.10.4%). Among women, Puerto Ricans had smaller per­centages of overweight and severely overweight indi­viduals than blacks (39.8% vs. 45.1% for overweight,15.2% vs. 19.7% for severe overweight).

The data presented in this report were obtained fromself-selected healthy adults from four different ethnicgroups living in New York City who participated in across-section, age stratified study for several markers of

body composition by measurements of underwaterweighing, body potassium, exchangeable sodium, dualphoton absorptiometry, anthropometries, a serum chem­istry screen, and a physical examination. The purpose ofthe Rosetta body composition project was to comparedifferent techniques for measuring body composition.Although methods of recruitments used in this studyincluded posters, local newspapers, radio stations, localcommunity centers and a Census-Tract based mailinglist provided by Election Computer Services, subjectswere completely self-selected and were based on a first­come, first-served order, not based on a sampling framefor epidemiological purposes. Meetings at local commu­nity centers had the highest recruitment rate, followedby participant referral. Census-Tract based mailing listservice gave the lowest recruitment rate at less than0.5%.

Comparisons between our study population and thatof NHANES III (17,21) for BMI by age and sex showsimilar age-adjusted values for blacks of each sex, butour whites have smaller BMI means than those ofNHANES III, especially for females (25 vs. 26 for men;and 23 vs. 26 for females). The weight and stature sur­vey at the street festivals confirmed that the recruitmentof Puerto Ricans for the present detailed laboratorystudies is representative of Puerto Ricans living in NewYork City; both overweight and obesity are more com-

382 OBESITY RESEARCH Vol. 4 No.4 July 1996

Overweight in Four Ethnic Groups, Wang et al.

mon among Puerto Ricans.The literature suggests that race and ethnicity are con­

sidered as factors in evaluating obesity and symptomsrelated to overweight. Both fatness and adipose tissuedistribution may influence treatment, and affect the esti­mate of future risk. For instance, the prevalence ofhypertension among the Hispanic population in NewYork City is considerably higher than that of whites(1,32). It has also been suggested that subjects withupper body obesity as indicated by the waist-to-hip cir­cumferences ratio have a significantly greater risk ofdeveloping diabetes and hypertension (12,20). The pre­sent study shows that Puerto Ricans living in the NewYork City area not only have the largest mean fat per­cent but also the largest mean waist-to-hip ratio of thefour studied ethnic groups. Data on diseases associatedwith abnormal body composition in Puerto Ricans havebeen suggested (5,11,35). Barrios et al. (1) reported thatPuerto Ricans living in the South Bronx area of NewYork City have a much greater level of unrecognizedand inadequately treated hypertension than the averageAmerican population. Although the rates of death fromstroke, kidney disease, and coronary artery disease havedeclined significantly in the United States during thepast three decades, the decline is slower in Hispanicsthan in blacks (11). These observed epidemiologicalproblems in the Puerto Rican population living in NewYork City may be related to this newly observed epi­demic level of obesity.

AcknowledgmentsWe would like to express our sincere gratitude to

Dr. Alex F. Roche for his in-depth comments and sug­gestions in this manuscript.

Supported by NIH DK-37352.

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