Weight (pounds) 90 110 130 150 170 190 210 230 250 270 290 310 330 350 2 , 1 1 6'6, 1 I, , 1 I I II ' , 1 I I II 1 1 I, , 1 I I I, , I 1 I I Underwei�ht 11BMI < 185 I /•BMI > I 1.9 I _ 1 I 6'3., 1 1 1 I , i 1 I 1 I, , 1 1 1, , 1 1 I I , , . 1 1 1I, , I 1 1 I1 1 , , 1 1 1 I n, , 1 1 1 1 , , 1 1 1 1 )1.8 5'1e1 c n 1 1 0, , 1 1 1 Cm 1 I, , 1 1 1 I3 1 1 1 1 01 1 C s I 1 1 1 l1 1 : ' 1 I 3, 1 I �) , 1 I') 1.7 1,-, 1 5'71 :I ''i 1 1I )I '), , I , , I, , 1 , , I , , 11 1.6 ' , 1 5'3t --, 1 , 1 , I1, 11I11 1.5 4'1e1 I· 40 50 60 70 80 90 100 110 120 130 140 150 160 Weight (kg) FIGURE 48-1 Chart for estimating body mass index (8M I). To find the 8Ml category for a particular subject, locate the point at which the height and weight intersect. (Al-Badri, 2015; Yang, 20r16). Conversely, adiponectin has antiinflammatory and insulin-sensitizing roles and is negatively regulated by fat mass. As one example of the discordant efects of these adipokines, gestational diabetes is associated with lower adiponectin but higher leptin levels. Placental production of these adipokines is also important and related to fetal growth • Metabolic Syndrome Given its multifaceted endocrine and paracrine functions, the detrimental efects of excessive adipose tissue are not surprising (Cornier, 201r1; Gilmore, 2015). Obesity interacts with inherited factors to cause insulin resistance. This resistance is characterized by impaired glucose metabolism and a predisposition to type 2 diabetes. Insulin resistance also causes several subclinical abnormalities that predispose to cardiovascular disease and accelerate its onset. The most important among these are type 2 diabetes, dyslipidemia, and hypertension, which are constituents of the metabolic syndrome. Criteria to define this syndrome are found in Table 48-1 (Alberti, 2009). Waist circumference is the preferred measurement for screening, but any three of five factors listed are suicient to diagnosis the metabolic syndrome. N otably, most patients with type 2 diabetes have metabolic syndrome according to these criteria. Also, obese women with hypertension typically demonstrate elevated plasma insulin levels. hese are even higher in women with central obesity (Fu, 2015). he National Health Nutrition Examination Survey (NHANES) of the Centers for Disease Control and Prevention documented an overall 34-percent prevalence of the metabolic syndrome in the United States by 2012 (Moore, 2017). As expected, the prevalence rose with age. It was 20 percent for those aged 18 to 29 years and was 36 percent for those aged 30 to 49 years.