Obesity and non-communicable disease in Malaysia: an imaging study of 6000 adults in the Malaysian Cohort Study

Lead Research Organisation: University of Oxford
Department Name: Population Health

Abstract

Excess body fat is a major cause of diabetes, heart attacks and strokes, worldwide. Body-mass index (BMI; defined as weight in kilograms divided by height in meters squared) is the basis of the World Health Organisation's definition of overweight and obesity, with a BMI of between 25 and 30 kg/m2 classified as overweight, and over 30 kg/m2 as obese. However, there is increasing evidence that levels of body fat for a given BMI may vary between populations, raising questions regarding universally applied BMI-based guidelines for overweight and obesity. Although BMI is frequently used in Malaysia to assess excess body fat, there have been no large-scale imaging studies with direct measurements of body fat and its distribution which would allow us to understand better the relationship between body composition and disease outcomes in this population.

From 2006-2012, The Malaysia Cohort study - initiated by the Malaysian government - recruited 106,527 adults aged 35 years or over. Participants completed a lifestyle questionnaire, underwent physical measurements, provided a blood sample and are now being followed for health events. In 6000 of The Malaysia Cohort participants, we will conduct whole-body Dual-energy X-ray Absorptiometry (DXA) imaging (which provides data on body fat distribution in addition to body fat percentage) using protocols established by the UK Biobank (a large cohort study co-ordinated by the Nuffield Department of Population Health, University of Oxford). This imaging sub-study will significantly enhance this national biomedical resource.

Using DXA imaging, this study will reliably assess the relationship between conventional measures for estimating body composition (including BMI, waist circumference and waist-hip ratio) with the absolute regional fat masses derived from the DXA measurements in the Malaysian population. It will then assess the relationship between these measures and risk of diabetes and cardiovascular disease, to inform public health guidance on the appropriate measure of excess body fat in this population, the ideal 'normal' range of these measures, and whether guidance should vary for the different ethnic groups in Malaysia. DXA imaging will also significantly enhance the potential of The Malaysia Cohort to investigate the genetic and environmental determinants of obesity in Malaysia, and the biological pathways through which it causes diabetes and cardiovascular disease.

Not all people who are overweight or obese suffer adverse consequence from their excess weight, in part due to differences in fat distribution. Indeed, as recently reported from The Malaysia Cohort, the prevalence of obesity (based on BMI) and type 2 diabetes is very divergent between the major ethnic groups in Malaysia (Malay, Indian and Chinese) and this is only partly explained by BMI. Therefore, a better understanding of the between-ethnic group risk, based on tissue and organ-specific fat depots, will enable more precise targeting of limited resources to those who will gain the most benefit.

Technical Summary

Although BMI is frequently used in Malaysia to assess excess body fat, there have been no large-scale imaging studies with direct measurements of lean mass and regional fat masses which would allow us to understand reliably the relationship between body composition and disease outcomes in this population. Such an imaging study would inform public health guidance on the appropriate measures of excess body fat in this population, the ideal 'normal' range of these measures, and whether guidance should vary for the different ethnic groups in Malaysia; understanding differences between ethnic groups is particularly important given the ethnic diversity of the Malaysian populations.

From 2006-2012, The Malaysian Cohort study - initiated by the Malaysian government - recruited 106,527 adults aged 35 years or over. Participants completed a lifestyle questionnaire, underwent physical measurements (including blood pressure, height, weight, hip and waist) and provided fasting blood and urine samples which were processed for long-term storage (half in -80C freezers and half in liquid nitrogen tanks). All participants are now being followed for health events. Baseline investigations included fasting blood glucose, fasting lipid profile, renal profile and full blood count, and re-surveys of a sample of the cohort are being conducted.

In 6000 of The Malaysian Cohort participants, we will conduct whole-body Dual-energy X-ray Absorptiometry (DXA) imaging (which provides data on body composition, details of fat distribution and body fat percentage) using protocols established by the UK Biobank (a large cohort study run by the Nuffield Department of Population Health, University of Oxford). This imaging sub-study will significantly enhance this national biomedical resource by focusing on factors directly relevant to the consequences of obesity along with opening up opportunities for international collaboration.

Planned Impact

Obesity is a major cause of diabetes and cardiovascular disease with a substantial impact on the health and economic prosperity of populations in Malaysia and the UK. However, the scientific evidence to understand the true burden of obesity on these conditions, and the best measures of excess body fat in different populations (especially among different ethnic groups) remains unclear. Our hypothesis is there are intrinsic differences in body composition between ethnic groups, and that extrapolating findings from studies in European/North American populations may underestimate the real burden of diabetes and cardiovascular disease attributable to excess fat in Asian populations.

Academic beneficiaries: These data produced by this imaging study will be analysed by epidemiologists, statisticians and disease specialists at the Universiti Kebangsaan Malaysia Medical Molecular Biology Institute (UMBI) and at the MRC Population Health Research Unit (part of the University of Oxford's Clinical Trial Service Unit & Epidemiological Studies Unit [CTSU]). The data would also be available for other researchers to use for their own investigations in accordance with our 'Data Access and Sharing Policy' (available at www.ctsu.ox.ac.uk), further benefitting researchers in the field.

Students beneficiaries: A key output from this project would include enhanced research collaboration between the UK and Malaysia, especially the training of young scientists and the development of research capacity in Malaysia. In particular, the Malaysian co-applicants' research group would gain expertise in the analysis and interpretation of DEXA data. Such knowledge transfer has the potential to lead to the establishment of new research programs at the Universiti Kebangsaan Malaysia (UKM) Medical Molecular Biology Institute. In parallel, the NDPH's DPhil program at the University of Oxford would provide opportunities to support the training of the next generation of Malaysian and UK epidemiologists with projects based on the rich data that would be available in the study (which would continue to be enhanced as larger numbers of health outcomes occur during prolonged follow-up).

General population: The ultimate aim of this project is to improve the health of the general public in Malaysia. The project aims to inform better health policy by providing reliable information on the impact of obesity on diabetes and cardiovascular disease, and better diagnostic and treatment options for the Malaysian population. It also aims to allow individuals to estimate more reliably their own risk of diabetes and cardiovascular disease, and raise public awareness of the steps individuals can take to reduce their risk of non-communicable disease.

Life sciences industry: This project will establish a shared resource and strengthen research capacity in the academic and life sciences industry in both Malaysia and the UK. It will do this through research and training of young scientists, and by enhancing The Malaysian Cohort Study. This cohort was initiated by the Malaysian government and will be a focal point of biomedical research and investment over the coming decade or more. The findings from this study will support translational advances in the management and prevention of obesity, diabetes and cardiovascular disease, some of which are likely to have commercial potential.

Publications

10 25 50
 
Description Research findings:
• Use of high standard Dual-energy X-ray Absorptiometry (DXA) technology quantified differences in regional fat and muscle mass in the largest multi-ethnic cohort to date
o The aim was to assess the relevance of obesity to diabetes and heart disease across Chinese, Malay and Indian ethnic groups in Malaysia
o This outcome will benefit not only Malaysia, but research and practice in Asia more generally
• Differences in body composition were particularly relevant to South Asian populations, where associations with blood sugar were much stronger for DXA-derived measures of adiposity than with crude measures of body size like body weight (standardised for height)
• Associations between body composition and risk factors for heart disease and diabetes were compared across samples from Malaysia and the UK and published in a high-impact journal
• Gender differences in fat and muscle mass were identified, suggesting further research was needed in female muscle mass especially for glycated haemoglobin (A1c) and the risk of diabetes
• Research on postmenopausal women identified that obesity was a risk factor for low bone mineral density, in contrast to previous research, and that associations did not vary across ethnic groups in Malaysia
• Research comparing physical activity and body composition identified that reductions in fat mass were weaker in Malaysia than in the UK, but that there were no differences across Asian sub-groups within Malaysia
• Research validated the use of DXA scans to quantify fat mass (compared to MRI scans) across different ethnic groups (Malay, Indian and Chinese) which had not been done before

Non-Research findings:
• This grant enabled comparative studies between the large-scale Malaysian Cohort and the large-scale UK Biobank cohort study. Many research projects comparing these datasets have been developed (detailed below).
• This grant enabled resource sharing and strengthened research capacity in both countries. Fortnightly meetings, three research trips, and two student placements in Malaysia have enabled knowledge transfer between the UK and Malaysian teams.
• An international online symposium was held for World Obesity Day in March 2022, spotlighting the research of the National University of Malaysia and its partnership with Oxford
Exploitation Route continuing the research, extending the collaboration
Sectors Communities and Social Services/Policy

Education

Healthcare

Leisure Activities

including Sports

Recreation and Tourism

Government

Democracy and Justice

Culture

Heritage

Museums and Collections

 
Description 1. Research on obesity and risk factors for CVD (including diabetes) has the potential to help inform public health policies for promoting healthy living and aging in at-risk groups from diverse ethnic backgrounds 2. This research should impact several SDGs, including SDG 3 on promoting good health and well-being and SDG 10 on reducing inequalities, particularly ethnic inequalities in the risk of diabetes and heart disease. 3. Research from this grant has highlighted important gender differences in body composition, risk factors for heart disease and diabetes, and bone mineral density. Networking and regular meetings has been developing the research skills of female statisticians on the Malaysian and Oxford teams, as well as their leadership skills of an international collaboration.
First Year Of Impact 2022
Sector Communities and Social Services/Policy,Education,Healthcare,Government, Democracy and Justice,Culture, Heritage, Museums and Collections
Impact Types Cultural

Societal

Policy & public services

 
Description • Reports from the work on this grant was given to the Ministry of Health in Malaysia in August 2023
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
Impact • The report showed results about the relevance of obesity as a risk factor for obesity and heart disease across the three main subgroups of ethnicity in Malaysia: Chinese, Malay and Indian. The report also indicated with measures of obesity from the DXA machine best predicted the odds of diabetes, hypertension and hypercholesterolemia in sex and ethnic-specific groups. The report then recommendation cut-off points in DXA-derived measures of obesity in sex and ethnic-specific groups that indicated elevated risk of these conditions to clinicians. • Several press releases and news articles from the research work were issued by the media in Malaysia: https://www.ukm.my/pkk/ukm-leads-the-study-of-obesity-and-non-communicable-diseases-with-the-university-of-oxford/ • UKM : https://www.ukm.my/news/Latest_News/ukm-terajui-kajian-obesiti-dan-penyakit-tidak-berjangkit-bersama-university-of-oxford/ • AWANI : https://www.astroawani.com/berita-malaysia/ukm-terajui-kajian-obesiti-penyakit-tidak-berjangkit-bersama-university-oxford-353495?fbclid=IwAR3vkJ0A7dZ0axabJs-eCPKEXKU-3AJHn27ZRYilAj1anInv62_hSssc5Is • The Star : https://www.thestar.com.my/news/education/2022/05/01/ukm-and-the-university-of-oxford-spearhead-study-on-obesity-and-ncds • Sinar Daily : https://www.sinardaily.my/article/172802/malaysia/national/ukm-to-lead-study-on-obesity-ncds-with-oxford-university • MRC Official Website: UK-Malaysia: https://www.ukm.my/umbi/ukmalaysia-oxford/
URL https://www.ukm.my/news/Latest_News/ukm-terajui-kajian-obesiti-dan-penyakit-tidak-berjangkit-bersama...
 
Description MRC UK-Malaysia Health Research Partnership
Amount £176,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start  
 
Description NDPH pump-priming; Assessment of the gut microbiome in rural India: a pilot study in the Indian Study of Healthy Ageing (ISHA) cohort study
Amount £41,000 (GBP)
Organisation University of Oxford 
Sector Academic/University
Country United Kingdom
Start  
 
Description WHO award: Enhancing Global Epidemiology Research Capacity to reduce the burden of non-communicable diseases
Amount £150,000 (GBP)
Organisation World Health Organization (WHO) 
Sector Public
Country Global
Start  
 
Description WHO award: Enhancing Global Epidemiology Research Capacity to reduce the burden of non-communicable diseases
Amount £150,000 (GBP)
Organisation World Health Organization (WHO) 
Sector Public
Country Global
Start  
 
Title Dual-energy X-ray absorptiometry (DXA) scans 
Description • The Dual-energy X-ray absorptiometry (DXA) scans funded by this grant have primarily been used in large numbers in Western populations. The validity of these scans has not been tested across multi-ethnic populations, which was one aim of this grant to assess 
Type Of Material Biological samples 
Year Produced 2023 
Provided To Others? Yes  
Impact • Magnetic Resonance Imaging (MRI) scans, the gold standard measurement for assessing regional fat mass, were performed on 100 participants that had DXA scans at the same time. The validity of the DXA scans was compared to the MRI data across subgroups of gender and Chinese, Malay and Indian ethnicities in the Malaysian population. This was done in collaboration with the University of Westminster, who are experts at quantifying estimates of fat mass from imaging scans. • Validity across ethnic groups was confirmed, although there appeared to be a systematic bias in the DXA estimates for women in the Malaysian data. This gender bias was then checked in a comparison of DXA-MRI data from a UK sample using a different make of DXA machine, and it was not found. This gender bias was then reported to the manufacturers of the DXA machine in Malaysia in order to calibrate their equipment. 
 
Description Co-Chair, World Health Organization (WHO) Reference Group on Global Health Statistics 
Organisation World Health Organization (WHO)
Country Global 
Sector Public 
PI Contribution ongoing collaboration
Collaborator Contribution WHO award: Enhancing Global Epidemiology Research Capacity to reduce the burden of non-communicable diseases
Impact Research Group on Global Health Statistics
Start Year 2021
 
Description DXA scans compared to the MRI scans 
Organisation University of Malaysia
Country Malaysia 
Sector Academic/University 
PI Contribution During the grant, a new collaboration (NC) was fostered between the collaborators in Malaysia and the University of Westminster when working on the validation study of the DXA scans compared to the MRI scans. • A new collaboration (NC) was also fostered between additional researchers at the University of Oxford and the National University of Malaysia that resulted in the offer of sending over wearable accelerometers for the Malaysian team to try out for a new potential pilot study.
Collaborator Contribution • All research that has been published and is in preparation has a joint first author from both UK and Malaysia, and a joint senior author from UK and Malaysia. • The topics of all research placements that have occurred between Oxford MSc students going to Malaysia were jointly discussed and decided by both the Malaysian and UK teams. • The online international webinar in March 2022 featured equal number of speakers from both UK and Malaysia.
Impact The collaboration between Oxford and UKM is still continuing beyond the grant. Two MSc placements at UKM have been confirmed for summer 2024, and contributions in-kind from Oxford to UKM are being used to test out a pilot study extending the research topics from the grant with accelerometers.
Start Year 2022
 
Description MRC UK_Malaysia Health Research Partnership 
Organisation University Kebangsaan Malaysia Medical Centre
Country Malaysia 
Sector Hospitals 
PI Contribution Collaboration with Universiti Kebangsaan Malaysia. Funding from MRC UK-Malaysia Health Research Partnership. Title: Obesity and non-communicable disease in Malaysia: an imaging study of 6000 adults in the Malaysian Cohort Study. The collaboration will facilitate an imaging sub-study of 6000 participants of the Malaysian Cohort Study.
Collaborator Contribution academic partnership
Impact ongoing
Start Year 2019
 
Description Office for National Statistics (ONS)-Multiuniversity collaboration 
Organisation London School of Economics and Political Science (University of London)
Country United Kingdom 
Sector Academic/University 
PI Contribution academic collaboration
Collaborator Contribution academic collaboration
Impact n/a
Start Year 2020
 
Description Office for National Statistics (ONS)-Multiuniversity collaboration 
Organisation Swansea University
Country United Kingdom 
Sector Academic/University 
PI Contribution academic collaboration
Collaborator Contribution academic collaboration
Impact n/a
Start Year 2020
 
Description Office for National Statistics (ONS)-Multiuniversity collaboration 
Organisation University College London
Country United Kingdom 
Sector Academic/University 
PI Contribution academic collaboration
Collaborator Contribution academic collaboration
Impact n/a
Start Year 2020
 
Description Office for National Statistics (ONS)-Multiuniversity collaboration 
Organisation University of Leicester
Country United Kingdom 
Sector Academic/University 
PI Contribution academic collaboration
Collaborator Contribution academic collaboration
Impact n/a
Start Year 2020
 
Description 1. Online international webinar for World Obesity Day in March 2022, hosted by the National University of Malaysia (UKM) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 1. Online international webinar for World Obesity Day in March 2022, hosted by the National University of Malaysia (UKM) and featuring research talks from approximately half UK researchers working on the grant, and half Malaysian researchers working on the grant. Approximately 80 people attended.
Year(s) Of Engagement Activity 2022
 
Description 2. Malaysian team visited Oxford in July 2022 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 2. Malaysian team visited Oxford in July 2022 for 2 days and met with a range of researchers from Nuffield Department of Population Health (at the department) to discuss collaborations with other large-scale datasets utilised within the department.
a. There were 4 team members from Malaysia that met with approximately 12 members of NDPH over 8 different sessions.
b. The Malaysian team then attended the annual UK Biobank scientific conference.
Year(s) Of Engagement Activity 2022
 
Description 9th Regional Conference On Molecular Medicine (RCMM) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Developing blood-based longitudinal studies:the challenge and opportunity
Year(s) Of Engagement Activity 2023
 
Description Developing blood-based longitudinal studies 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Need LARGE studies, with blood samples, around the world (with resurveys & tracked for cause-specific mortality and morbidity follow-up)
Year(s) Of Engagement Activity 2023
 
Description Festival of Tomorrow 2024 - It took place at the Deanery CE Academy, Swindon over half-term and was open to all ages 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Schools
Results and Impact Organised games and activities relating to statins and health: "Make Sam Well" (a cardboard cut-out of a human body with our main organs and arteries with 'bad 'cholesterol velcro-ed along the arteries. The participant had to answer questions relating to cardiovascular health correctly in order to remove the cholesterol. There were different sets of questions for different ages.), "Don't Lose Your Balls" (a team activity for adults and older children (15+) - answering questions about living a healthy life and the role of statins in staying healthy and voting for the correct answer by putting the balls in one of three buckets, balls in the wrong bucket are removed and the team with the largest number of balls at the end is the winner) and the Clinical Trials board (a self-teaching interactive board introducing the concepts of randomized controlled trials and meta-analyses and how these contribute to our knowledge of safety and efficacy of statin medication). Facilitated "DataLand" which uses Lego to explain what data are, collecting, showing and combining data. This was originally aimed at primary school children but can be used with all ages.
Year(s) Of Engagement Activity 2023
 
Description Global Richard Doll Consortium conference 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Meeting of principal investigators of large (>100K participants) prospective cohort studies to:
Shared international expertise and results
Develop future leaders in NCD epidemiology
Discover important differences between populations
Year(s) Of Engagement Activity 2023
 
Description Global insights on obesity and vascular mortality 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Need bigger, long-term prospective studies in many populations
Year(s) Of Engagement Activity 2023
 
Description HDRUK - Molecules to health records 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Large blood-based epidemiological studies are needed around the world to understand the effects of important risk factors for major causes of premature death in diverse populations
Year(s) Of Engagement Activity 2022
 
Description HDRUK Regional Meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Introducing the Molecules to electronic health records driver programme. The challenge and opportunity of linking multiple layers of molecular and other data with e-health records
Year(s) Of Engagement Activity 2023
 
Description HDRUK Strategy and Infrastructure Group meeting 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Describing the worksteram on developing blood-based longitudinal studies in diverse populations to HDRUK community.
Year(s) Of Engagement Activity 2024
 
Description King's College London ED& I event: What about a PhD? 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact King's College London ED& I event: What about a PhD?
Year(s) Of Engagement Activity 2021
 
Description Oxford Population Health - 10th anniversary symposium 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Insights from large prospective studies in diverse populations
Year(s) Of Engagement Activity 2023
 
Description The Data Game 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Public Engagement activity. 'The Data Game' with primary school children at Pegasus School, Blackbird Leys. This is a game that uses Lego to introduce the concepts of conducting a fair trial, data collection, the reporting of results and amalgamation of the data with those from other trials.
Year(s) Of Engagement Activity 2020
 
Description Training session on statistical analysis 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact 4. Oxford senior research fellow visited UKM over one week in May 2023 to run training session on statistical analysis.
a. Continued to build collaboration, assess the quality of the data and future projects, and assess the set up of student placements.
b. Approximately 40 Malaysian students attended the training session on statistical analysis led by the Oxford researcher.
Year(s) Of Engagement Activity 2023
 
Description UKM ongoing collaboration 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 3. Oxford Principal investigators from the grant and a senior research fellow visited UKM in September 2022 over one week to discuss the ongoing collaboration and provide a series of research talks and training sessions in epidemiology and statistics for students and staff across UKM.
a. Oxford team learned about the facilities of the UKM team and how the data was collected, and ongoing future collaborations were discussed.
b. Two research seminars and one training session in statistics were provided by the Oxford team to approximately 100 Malaysian students.
c. Discussions of ongoing work between the Oxford team and approximately a dozen of the Malaysian research team working on the grant occurred over multiple days.
Year(s) Of Engagement Activity 2022
 
Description UMBI - Halving premature mortality: thinking big, keeping it simple 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Large-scale genetic data available through international academic-industry partnership
Year(s) Of Engagement Activity 2022
 
Description WHO/University of Geneva - Global Health Forum 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Global Richard Doll Consortium - enhancing global epidemiology research to reduce the burden of premature death
Year(s) Of Engagement Activity 2022,2023
 
Description Women in Sciences 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact Trinity, Jesus and Wadham Colleges hosted Women in Sciences outreach event for female Year 12 students interested in studying a science at university. This year we are running it as a residential over three days to enable us to include students from far away state schools in the NE and Wales. Deborah Malden presented at this event.
Year(s) Of Engagement Activity 2020
 
Description World Obesity Day conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presenting Global insights on BMI and premature mortality - monitoring the different and evolving effects of adiposity in many populations. Bringing together researchers interested in adiposity to give a global perspective.
Year(s) Of Engagement Activity 2023