A study warns of health risks


In a recent study published in the journal NutrientsAnd Researchers assessing the nutritional intake of women carrying Cinderella’s weight in Japan.

Stady: Underweight young Japanese women with a “Cinderella weight” are at risk of malnutrition, including vitamin deficiencies. Image credit: michaelheim/Shutterstock.com


Overweight and obesity are well-established risk factors for cardiovascular disease and are frequently investigated, while underweight is often overlooked in physical examinations. The term “Cinderella weight” means a body mass index (BMI) of 18.0.

Malnutrition among women carrying Cinderella weight can be complicated by risks associated with nutritional deficiencies, including osteoporosis, menstrual irregularities, and infertility. Babies born to underweight mothers have a low birth weight, which increases the risk of cardiovascular disease, diabetes and nutritional deficiencies, and thus affects growth and development.

about studying

In the current exploratory study, researchers assessed health risks among young women of the ‘Cinderella weight’ category in Japan.

The team examined the percentage and characteristics of underweight women ages 20 to 39 who attended health screenings at their workplaces between August 2022 and September 2022. Next, they examined muscle strength, body composition, and responses to a food frequency questionnaire (FFQ), Protein biosynthesis, and serum vitamin levels among 44 individuals with BMI values ​​<17.5 ages 20-39 years, plus 12 females ages 40-65 years, who attended outpatient diet assessment clinics between November 2022 and February 2023.

The team investigated the presence of intentional weight loss, fever, and anorexia. Pregnant women and patients with anorexia were excluded from the analysis.

The Department of Health Administration provided anonymous data for age, sex, and BMI for men ages 20-39 attending health screenings. Nonspecific data on age, sex, body mass index, blood pressure, grip strength, glycated hemoglobin (HbA1c), lymphocyte count, and cholesterol were obtained from female outpatients between the ages of 20 and 39 years.

For 56 females undergoing secondary screening, BMI, age, sex, weight, height, BMI at age 20 years, grip strength, blood pressure, skeletal mass index (SMI), percent body fat, and blood data, Including hemoglobin (haemoglobin), HbA1c, free thyroxine (FT4), thyroid stimulating hormone (TSH), C-reactive protein (CRP), prealbumin, lymphocyte count, cholesterol, albumin, vitamin B1, acid Folate, vitamin B12, and vitamin D levels, from health records.

Diversity of dietary intake was assessed using a dietary diversity score (DDS). CONUT scores were determined to screen undernourished individuals based on cholesterol levels, albumin, and lymphocyte counts.


The medical reports of 643 female employees and 1457 males were analyzed. The proportion of underweight females was significantly greater than that of males at 17% and 4.5%, respectively.

Notably, the percentages of extremely underweight females and males with a BMI of less than 17.5 were 5.9% and 1.4%, respectively. Among the underweight females, hand grip strength (23 vs 26 kg), cholesterol levels (178 vs 195 mg/dL), and lymphocyte counts were significantly lower compared to the 116 overweight women.

Decreased lymphocyte counts, as well as cholesterol and albumin levels, were observed among 32%, 59%, and 34% of the participants, respectively. In terms of dietary patterns, 32% of underweight females missed breakfast, and 50% had low DDS scores.

In addition, total energy intake (TEI) and intake of carbohydrates, fiber, calcium and iron were lower among 90% of the participants. Deficiencies of folic acid, vitamin B, vitamin B12, and vitamin B1 were observed among 98%, 14%, 25%, and 4.60% of individuals, respectively.

In all, 75% and 91% of individuals aged 40–65 years and 20–39 years, respectively, met the Global Leadership Initiative on Malnutrition (GLIM) criteria for undernutrition. Body mass index, age, HbA1c, and blood pressure were significantly greater among overweight individuals than among underweight individuals, while grip strength was significantly lower among underweight participants than among healthy participants. Overweight and those who are overweight.

Lymphocyte counts and cholesterol levels were significantly lower among the underweight individuals. Missing breakfast was observed more commonly among younger participants at 32% and 17% in individuals 20-39 years of age and those over 40 years of age, respectively.

DDS scores were significantly greater for breakfast non-breakers. The TEI was 1,600 calories, which was comparable to total energy expenditure (TEE). Protein intake was lower among individuals between the ages of 20 and 39 and among those over the age of 40 at 32% and 17%, respectively.

Carbohydrate intake was also lower among the young and middle-aged, at 89% and 58%, respectively. Dietary fiber intake was lower among those 20-39 years old (95%) and among those over 40 years old at 95% and 83%, respectively.

Levels of omega-3 fatty acids and polyunsaturated fatty acids (PUFA) were lower among participants ages 20 to 39 (34% and 30%) and those over 40 (25% and 25%), respectively. . Similarly, iron and calcium intake was low among individuals ages 20 to 39 and among those ages 40 and older.


The results of the study suggest that young and underweight Japanese women may be at risk of malnutrition. In addition to body mass index, decreases in nutritional biomarkers have been observed among underweight individuals, such as lymphocyte counts, grip strength, and blood cholesterol.

Young underweight females exhibit anemia (16%), lower albumin levels (34%), higher HbA1c levels (36%), lower lymphocyte counts (32%), lower cholesterol (59%), and slightly higher CONUT scores ( 25%).

In addition to reduced food intake, lower TEI, skipping breakfast, decreased food variety and intake of carbohydrates, protein, dietary fiber, omega-3 and n-6 ​​PUFAs, calcium and zinc, deficiencies of vitamin B1, B12, D, and folic acid were observed among underweight women. .

Maliciously targeting “Cinderella’s weight” increases the risk of infertility, menstrual irregularities, cardiovascular disease, osteoporosis, and glucose intolerance. However, weight reduction did not mitigate or accelerate glucose intolerance but did imply malnutrition among young women.

Journal reference:

  • Iizuka, K., Sato, H., Kobae, K., et al. (2023). Underweight young Japanese women with “Cinderella weight” are at risk of malnutrition, including vitamin deficiencies. Nutrients 15. doi: 10.3390/no 15092216


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