Abstract Body (Do not enter title and authors here): Background
BMI is a modifiable risk factor for stroke and heart disease. However, there is limited or no data on the association of BMI with adverse outcomes and the absence of data on Black, South Asian, and Arab populations. Thus, national, and global recommendations for BMI cutoffs to prevent obesity-related complications among minority populations are debatable.
Aims
This review aimed to identify a holistic estimate of the optimal BMI cutoffs at which cardiovascular adverse outcomes could be predicted amongst south Asian populations.
Methods
A systematic search was conducted in PubMed, Google Scholar, and Cochrane database to identify community-based studies that reported BMI cut-off values for individuals in South Asian countries from 2004 onward. To determine ethnicity-specific BMI cut-offs for obesity equivalent to the BMI threshold for obesity in White populations (≥30 kg/m²), a random-effects meta-analysis was performed for data associated with type 2 Diabetes. The pooled estimate of cut-off points was calculated, with studies weighted by the inverse variance of their individual estimates.
Results
We included 7 studies, comprising a total of 143,380 participants from South Asian countries. The pooled estimate for the BMI cutoff associated with type 2 diabetes, equivalent to a BMI of 30.0 kg/m² in White populations, was 23.3 kg/m²(95% CI: 22.0-24.6). Summary receiver operating characteristic (SROC) curves were created using a linear regression model to summarize the studies' ROC curves. The highest Youden index indicated that the optimal BMI cut point for hypertension and dyslipidaemia among South Asian males was 23.3 kg/m² (95% CI: 22.2-24.6) and 24.3 kg/m² (95% CI: 21.2-27.4), respectively. For South Asian females, the optimal BMI cut point for hypertension was 24.0 kg/m²(95% CI: 22.9-25.2) and for dyslipidaemia was 24.7 kg/m² (95% CI: 23.0-25.9).

Conclusion
Revisions to BMI cutoffs specific to different ethnicities are necessary to ensure that minority ethnic groups receive proper clinical monitoring. This will help enhance the prevention, early diagnosis, and timely management of cardiovascular risk factors.