“To study the comparison between Hip
Circumference (HC), Waist Circumference
(WC) and Waist to Hip Ratio (WHR) as
predictors of Type 2 Diabetes”
Submitted by:
Namrata Nasit
(Enrolment no.:12sptpt11053)
Heena Pandya
(Enrolment no.:12sptpt11054)
6th Semester, July, 2015
Guided by:
Dr. Nivedita Chopra (MSPT)
Lecturer, SOPT, RKU
I
CERTIFICATE
This is to certify that the project work entitled “To study the comparison between Hip
Circumference (HC), Waist Circumference (WC) and Waist to Hip Ratio (WHR) as
predictors of Type 2 Diabetes” has been undertaken and written under my
supervision and it describes the original research wor
work
k carried out by Ms. Namrata
Nasit and Heena Pandya registered at RK University under 6th semester, Degree of
Bachelors of Physiotherapy.
Signature of Guide
Name: Dr. Nivedita Chopra
Degree: MSPT
Designation: Lecturer
II
II
DECLARATION
We hereby certify that we are the authors of this project work. We certify to the best of
our knowledge, our project does not infringe upon anyone’s copyright nor violate any
proprietary rights and that any ideas, techniques, quotations, or any other material from
the work of other people included in our project published or otherwise, are fully
acknowledged in accordance with the standard referencing practices. We declare that
this is a true copy of our project, including any fi
final
nal revisions, as approved by our
project review committee.
Signature of candidate
Signature of candidate
Namrata Nasit
Heena Pandya
Enrolment no.: 12SPTPT11053
11053
Enrolment no.: 12SPTPT11054
11054
Date: 16/07/2015
Date: 16/07/2015
Place: Rajkot
Place: Rajkot
III
ACKNOWLEGEMENT
First and foremost we would like to thank our parents who are our living Gods and sister for
their valuable support and encouragement, blessing and love which has always been a source of
inspiration and strength in accomplishing this academic task.
Our heartfelt gratitude to almighty God who has guided us this far and to whom goes all the
honor and glory for the successful completion of this study.
We wish to express our regards to our Director Dr. Priyanshu Rathod, School of Physiotherapy,
R.K.University for his whole hearted guidance and meticulous suggestions in the completion of
this work and for all the facilities and support extended to us during this study. We are extremely
thankful for his constant encouragement and inspiration during the course of this study.
With due respect, We would like to express our sincere thanks to our guide Dr. Nivedita Chopra,
Lecturer, School of Physiotherapy, R.K.University, for her judicious information, expert
suggestions, valuable guidance, continuous support, incessant reassurance during every stage of
this work and interest shown in this dissertation without which this work would not have been
possible.
Our sincere thanks to Dr. Jagruti Pandya for taking keen interest in our study, guiding us
through the path, giving us support and motivation during the course of study.
We wish to express our thanks to Mr. Harshal, our librarian for their timely help in lending us
books and journals for our reference all the time.
IV
We shall fail our duties if we don’t acknowledge our Colleagues and Friends for their
suggestions and criticism while assisting us in this study.
Last but not the least we would like to thank all the Individuals in our study, without whom this
task would not have been possible.
Our sincere thanks to alll the contributors whose names we might have missed but who truly
tru
deserve our gratitude.
We would like to thank once again to all who have helped us all the while.
Name: Namrata Nasit
Name: Heena Pandya
V
LIST OF ABBREVIATIONS
1. WC : Waist Circumference
2. HC : Hip Circumference
3. WHR : Waist to hip ratio
4. BMI : Body mass index
ABSTRACT
Background: Abdominal obesity is increasingly recognized as a major risk factor for
type 2 diabetes [1]. Anthropometric measures of abdominal obesity appears to be more
strongly associated with metabolic risk factors [1]. WHR is generally taken to indicate an
excess of abdominal fat but is a poor measure of visceral mass[4][3].HC is an aggregate
measurement of the actual amount of total and abdominal fat accumulation and is a
crucial correlate of the complexities found among obese and over-weight patients[2].
Therefore recent studies have integrated the separate contribution of HC and WHR to
the glucose level and type 2 diabetes [3]. The need of this study is to identify the better
predictor of Type 2 Diabetes.
Aim: To determine whether there is strength of association of WC, HC and WHR with
type 2 diabetes in both gender.
Methodology:
Study design: Cross-Sectional Observational study. Inclusion criteria: 40-60 year old
males with Type 2 Diabetes. Sample size: 30 Sampling technique: Convenient
sampling. Study setting: Different Clinics of Rajkot.
Results and Discussion: Hip circumference is higher in females as compared to waist
circumference and waist circumference is higher in males as compared to Hip
circumference in individuals with type 2 diabetes.
Conclusion: On the basis of result of the present study, it has been concluded that HC
is higher in females and WC is higher in males with type 2 diabetes.
Keywords : Waist circumference, Hip circumference, waist to hip ratio, type 2 diabetes
VI
TABLE OF CONTENTS
Sr. No.
TITLE
Page No.
1.
INTRODUCTION
1
2.
AIMS & OBJECTIVES
7
3.
REVIEW OF LITERATURE
11
4.
METHODOLOGY
14
5.
RESULTS
21
6.
DISCUSSION
31
7.
CONCLUSION
35
8.
SUMMARY
37
9.
BIBLIOGRAPHY
39
10.
ANNEXURES
42
VII
VIII
LIST OF GRAPH
Graph.
no.
Graph title
Page
no.
5.1
Within group comparison of WC between obtained value and
normal value in female.
23
5.2
Within group comparison of HC between obtained value and
normal value in female.
24
Within group comparison of WC and HC of obtained value in
5.3
female.
25
5.4
Within group comparison of WHR between Obtained Value and
Normal value in female
26
5.5
Within group comparison of WC between obtained value and
normal value in male.
27
5.6
Within group comparison of HC between obtained value and
normal value in male.
28
5.7
Within group comparison of WC and HC of obtained value in
male
29
5.8
Within group comparison of WHR between Obtained Value and
Normal value in male
30
IX
LIST OF TABLE
Table.
no.
Table title
Page
no.
5.1
Within group comparison of WC between obtained value and
normal value in female.
23
5.2
Within group comparison of HC between obtained value and
normal value in female.
24
Within group comparison of WC and HC of obtained value in
5.3
female.
25
5.4
Within group comparison of WHR between Obtained Value and
Normal value in female
26
5.5
Within group comparison of WC between obtained value and
normal value in male.
27
5.6
Within group comparison of HC between obtained value and
normal value in male.
28
5.7
Within group comparison of WC and HC of obtained value in
male
29
5.8
Within group comparison of WHR between Obtained Value and
Normal value in male
30
X
LIST OF FIGURES
Figure.
no.
Figure title
Page no.
4.1
Materials used in the study.
17
4.2
Measurement of waist circumference.
19
4.3
Measurement of hip circumference
20
XI
INTRODUCTION
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
1
INTRODUCTION
Inrecent years, considerable attention hasbeen given to the role of adiposity in the
development of chronic diseases, leadingto speculations that some forms of fat
distribution may be more important in thecausation of cardiovascular diseases than
Others2.
Clinical evidence suggests that the association of diabetes with central obesity is
stronger than the association with general fat. Studies using computed tomography and
magnetic resonance imaging have provided further evidence to support that central
obesity, visceral adipose tissue, and upper-body non visceral fat are the major
contributors to the metabolic complications. Central obesity has beenassociated with
decreased glucose tolerance, alterations in glucose insulin homeostasis, reduced
metabolic clearance of insulin, and decreased insulin stimulated glucose disposal6.
Abdominal obesity is increasingly recognized as a major riskfactor for diabetes type 2.
Anthropometric measures of abdominalobesity [e.g. hip circumference (HC), waist
circumference (WC), waist-to-hip ratio(WHR)] appear to be morestrongly associated
with metabolic risk factors1.
Hoorn studied that the waist-to-hip ratio (WHR) and not body mass index (BMI) is an
important independent predictor of incident diabetes result indicates that fat distribution
may be a better predictor for progression to type 2 diabetes than is BMI, which is also
suggested by studies that examined the WHR or the waist-to-thigh ratio (WTR).
In particular, the accumulation of visceral fat is assumed to play an important role in the
etiology of diabetes by overexposing the liver to free fatty acids, resulting in insulin
resistance and hyperinsulinemia5.
A high WHR is generally taken to indicate an excess ofvisceral or abdominal fat,
however, it can also be due to asmaller hip circumference. Therefore, recent
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
2
studieshave investigated the separate contributions of waist andhip circumferences to
the glucose levels and type IIdiabetes.3
As the glucose test is invasive, relativelyexpensive, time consuming and not easy to
apply to mass-screening programmes, several other diagnostic tools, including obesity
indicators such as waist circumference (WC)and body mass index (BMI), have been
proposed and appliedin diabetes prevention programmes4.
Diabetes increases dramatically worldwide as aconsequence of changes in lifestyle,
including physical inactivity and unhealthy diet. Physical inactivityand obesity have been
well recognized as major lifestylerelated risk factors for diabetes4.
Type 2 diabetes mellitus is characterized by 4 major metabolic abnormalities: obesity,
impaired insulin action, insulin secretory dysfunction, and increased endogenous
glucose output9.
In this article, studies for comparison betweenHC, WC and WHR in their relation to the
incidence andprevalence of type II diabetes in adults were reviewed4.
Lifestyle intervention to prevent non-communicable diseasesincluding diabetes has
been included in the 2008–2013Action Plan (World Health Organization, 2008). One of
theobjectives of this plan is to develop simple strategies toidentify those at risk and
provide them with early lifestyleinterventions4.
Lifestyle changes and treatment with metformin both reduced the incidence of diabetes
in persons at high risk. The lifestyle intervention was more effective than metformin11.
WHR measures central fat deposition but is a poormeasure of visceral fat mass,
particularly in lean individuals4.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
3
Waist circumference isan aggregate measurement of the actualamount of total and
abdominal fat accumulationand is a crucial correlate of thecomplexities found among
obese and overweight patients.
Cutoff values for WCwere 85 and 80 cm for men and women, respectively; the
corresponding WHRs were 0.88 and0.81, respectivel8.
Unlike the BMI, waistcircumference is not profoundly influencedby height and is
therefore a better predictorof some cardiovascular diseases.Waist circumference has
also been shown tobe more correlated with levels of abdominal visceral adipose tissue2.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
4
NEED OF THE STUDY
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
5
NEED OF THE STUDY
1) Need of this study was to develop simple strategies to identify those at risk
of type 2 diabetes mellitus and provide them with early life style
interventions
2) To study the magnitude of the association among anthropometric measure
and type 2 diabetes mellitus in Rajkot population.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
6
AIMS AND OBJECTIVES
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
7
AIMS
•
The aim of this study was to investigate the independent associations of waist
and hip circumferences and waist to hip ratio with type 2 diabetes in Rajkot
population.
OBJECTIVES
•
To measure Waist Circumference and find out the strength of association with
type 2 diabetes.
•
To measure Hip Circumference and find out the strength of association with type
2 diabetes.
•
To measure Waist Hip ratio and find out the strength of association with type 2
diabetes.
•
To find out better predictor of type 2 diabetes among WC, HC, WHR in both
gender.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
8
HYPOTHESIS
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
9
HYPOTHESIS
Null hypothesis:
There is no significant difference between HC, WC and WHR as a predictor of type 2
diabetes.
Alternative hypothesis:
There is significant difference between HC, WC and WHR as a predictor of type 2
diabetes.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
10
REVIEW OF LITERATURE
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
11
REVIEW OF LITERATURE
•
Jacqueline M Dekker et al. (2015) Large hip and thigh circumferences are
associated with a lower risk of type 2 diabetes, independently of BMI, age,
and waist circumference, whereas a larger waist circumference isassociated
with a higher risk5
•
Statistical analysis by Qiao and Nyamdorj (2010) showed that WC or WHR
discriminate the cases with diabetes in a better way than BMI4.
•
Lawrence de Koning et al.(2007) have concluded that WHR and WC are
significantly associated with the risk of incident CVD events1.
•
Ford et al. (2007) support the use of waist circumference as a measure of
obesity to predict health risk. Among their arguments are that waist
circumference has been shown to be a good or better predictor than body mass
index of the metabolic syndrome, diabetes, cardiovascular disease, and all-cause
mortality;
•
Dr. Clegg (2007) suggested that hormones made by the ovaries may be critical
in determining where fat is deposited."Given the difference in gene expression
profiles, a female fat tissue won't behave anything like a male fat tissue and vice
versa,"
•
Marieke B Snijder et al. (2003) have concluded that Large hip and thigh
circumferences are associated with a lower risk of type 2 diabetes, independently
of BMI, age, and waist circumference3
•
Chamukuttan Snehalatha et al.(2003) have reviewed the Cutoff values for WC
were 85 and 80 cm for men and women, respectively; the corresponding WHRs
were 0.88 and 0.81 respectively. The cutoff values for WC and WHR were lower
in women than in men
•
Journal List J Clin Invest v.104(6); 1999 suggested that Type 2 diabetes
mellitus ischaracterized by 4 major metabolic abnormalities: obesity, impaired
insulin action, insulin secretory dysfunction, and increased endogenous glucose
output (EGO). Although there is substantial evidence that the first 3 of these
abnormalities are present in most individuals before the onset of diabetes.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
12
•
Okosun et al. (1998) have conducted a study on various populations and
concluded that waist circumference is positively correlated with fasting blood
glucose level and also substantial reduction in glucose level if waist size is
decreased.2
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
13
METHODOLOGY
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
14
Methodology
Study design: Cross-Sectional Observational study.
Sample size: 60
Sampling technique: convenient sampling.
Study setting:‘life span hospital’, ’kansagara hospital’ and tramba village.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
15
CRITERIA FOR SELECTION
INCLUSION CRITERIA
1. Age between 40 to 60 years
2. Established cases of type 2 diabetes
3. Both Males and Females
EXCLUSION CRITERIA:
1. Pregnancy
2. Diabetes with hypo or hyper thyroidism.
3. Tuberculosis
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
16
MATERIALS USED IN THE STUDY
Pen
Paper
Non elastic measuring tape
Figure no. 4.1: Materials used in the study
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
17
METHOD
In this study, the study population was taken from various hospitals of Rajkot viz. ‘life
span hospital’, ’kansagara hospital’ and tramba village. Participants were selected
based on inclusion criteria. A detailed procedure was informed to them and ethically
proved informed consent form was filled up by the participants. A brief questionnaire
regarding health habits, medical history and current medication was administrated.
•
Waist circumference was measured between the midpoint of lower rib and iliac
crest.
•
Hip circumference was measured at the higher point of the buttocks.
•
Waist hip ratio were calculated by taking ratio of waist and hip.
•
Mean of 3 readings was recorded for each anthropometric measure.
Procedure:
Participant’s position:
•
Standing with normal base of support
•
For waist circumference the part was exposed
•
Hip circumference was measured with minimal clothing and
removing unnecessary items like wallet, mobile etc.
Examiner’s position:
•
Half kneeling, facing the anterior part of the body.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
18
Figure no. 4.2: Measurement of Waist Circumferance
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
19
Figure no. 4.3: Measurement of Hip Circumferance
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
20
RESULTS
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
21
RESULTS
An observational study was performed in which waist circumference; hip circumference
and waist to hip ratio were assessed in established cases of type 2 diabetes in both
genders between 40 to 60 years of age.
Results were analyzed comparing the mean values within groups.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
22
Graph no. 5.1: Within
ithin group comparison of WC between obtained value and
normal value in female.
Comparision of WC (cm) in female
99.84
80
normal value
obtained value
After obtaining this result we have found that WC is higher in female
females
s having type 2
diabetes.
Table no. 5.1: Within
ithin group comparison of WC between obtained value and
normal value in female.
WC
Normal value
80
Obtained value
99.84
“To study the comparison between Hip Circumference (HC), Waist Circ
Circumference
umference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
23
Graph no. 5.2: Within
ithin group comparison of HC between obtained value and
normal value in female.
Comparision of HC (in) females
109.7
107.6
Normal value
Obtained value
This result also shows higher HC in ffemales with type 2 diabetes.
Table no. 5.2:
.2: Within group comparison of H
HC
C between obtained value and normal
value in female.
HC
Normal value
107.6
Obtained value
109.7
“To study the comparison between Hip Circumference (HC), Waist Circ
Circumference
umference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
24
Graph no. 5.3: Within
ithin group comparison of WC and HC of obtained value in
female.
Comparision between obtain value of WC and
HC (cm) in female
109.7
99.84
WC
HC
After observing this we found that a female with larger hip circumference are more at
risk for developing type 2 diabetes
diabetes.
Table no. 5.3: : Within
ithin group comparison of WC and HC of obtained value in
female.
WC & HC
Obtained value
WC
99.84
HC
109.7
“To study the comparison between Hip Circumference (HC), Waist Circ
Circumference
umference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
25
Graph no. 5.4:: Within group comparison of WHR between obtained value and
normal value in female.
Comparision between normal value and
obtained value of WHR
0.89
0.81
Normal value
obtained value
After observing this we found that a female with type 2 diabetes also having increased
WHR.
Table no. 5.4:
.4: Within group comparison of WHR between obtained value and
normal value in female.
WHR
Normal value
0.81
Obtained value
0.89
“To study the comparison between Hip Circumference (HC), Waist Circ
Circumference
umference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
26
Graph no. 5.5: Within
ithin group comparison of WC between obtained value and
normal value in male.
Comparision of WC(cm) in male
116.1
80
normal value
obtain value
Result shows the higher WC iin male with type 2 diabetes.
.5: Within group comparison of WC between obtained value and
Table no. 5.5:
normal value in male.
WC
Normal value
80
Obtained value
116.1
“To study the comparison between Hip Circumference (HC), Waist Circ
Circumference
umference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
27
Graph no. 5.6: Within
ithin group comparison of HC between obtained value and
normal value in male.
Comparision of HC (cm) in male
115.9
103.7
normal value
obtain value
n male with type 2 diabetes.
After observing this we found that HC is also high iin
Table no. 5.6:
.6: Within group comparison of HC between obtained value and normal
value in male.
HC
Normal value
103.7
Obtained value
115.9
“To study the comparison between Hip Circumference (HC), Waist Circ
Circumference
umference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
28
Graph no. 5.7: Within
ithin group comparison of WC and HC of obtained value in male.
Comparision between WC and HC (cm) in
male
116.1
115.9
WC
HC
The above graph shows comparison of WC and HC by the obtained values from the
sample. This graph shows WC is higher than the HC in male. This result shows higher
the waist in male are more att risk for developing type 2 diabetes.
After obtaining these results, this was found that Hip circumference is higher in females
as compared to waist circumference and waist circumference is higher in males as
compared to Hip circumference in individuals with type 2 diabetes.
Table no. 5.7: : Within
ithin group comparison of WC and HC of obtained value in male.
WC & HC
Obtained value
WC
116.1
HC
115.9
“To study the comparison between Hip Circumference (HC), Waist Circ
Circumference
umference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
29
Graph no. 5.8:
.8: Within group comparison of WHR between obtained value and
normal value in male.
Comparision between normal value and
obtained value of WHR
0.96
0.88
Normal Value
Obtained Value
After observing this we found that a male with type 2 diabetes also having increased
WHR
Table no. 5.8:
.8: Within group comparison of WHR between obtained value and
normal value in male.
WHR
Normal value
0.88
Obtained value
0.96
.
“To study the comparison between Hip Circumference (HC), Waist Circ
Circumference
umference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
30
DISCUSSION
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
31
DISCUSSION
Fat distribution, apart from overall obesity, is an important risk factor for type II diabetes
and cardiovascular diseases. Most studies use the waist-to-hip ratio (WHR) for
measuring fat distribution, or simply the waist circumference because the waist
circumference alone is more strongly correlated to visceral fat than the WHR.
Visceral fat has been shown to be strongly correlated to components of the metabolic
syndrome, and is generally assumed to be a causal factor by releasing free fatty acids
into the portal vein.
A high WHR is generally taken to indicate an excess of visceral or abdominal fat,
however, it can also be due to a smaller hip circumference.
Therefore, recent studies have investigated the separate contributions of waist and hip
circumferences to blood glucose levels and type II diabetes.(3)
In the present study, we showed that the body circumference ratios are better predictors
of future type 2 diabetes5.
We observe that the male with higher the waist are more at risk of developing type 2
diabetes.
Marieke B Snijder et al. (2015)have found the same that higher waist circumference is
associated with higher risk of type 2 diabetes.5
Gabriela Vazquez et al. (2007)demonstrated consistently strong associations of body
6
mass index, waist circumference, and waist/hip ratio with incident diabetes.
Q Qiao et al. (2009) also suggested that the evidence based on the prospective studies
equallyfavoured all anthropometric measures of BMI, WC, WHRand the waist-to-stature
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
32
ratio. But most of the cross-sectionalstudies showed that WC or WHR discriminate
better thecases with diabetes.4
IkeS. Okosunet al. (1998) concluded that Substantial reduction in hypertension and
diabetes in men and women is achievable if the waist size is decreased in these
populations.
Lawrence de Koning et al (2007) suggested that WHR and WC are significantly
associated with the risk of incident CVD events.
After observing the result we have found that Hip circumference is higher in females
compared to waist circumference in type 2 diabetes
Dr. Clegg (2007)found that hormones made by the ovaries may be critical in
determining where fat is deposited.
In humans, men are more likely to carry extra weight around their guts while premenopausal women store it in their butts, thighs and hips.
For men is that belly, or visceral, fat has been associated with numerous obesity-related
diseases including diabetes and heart disease.
Women, on the other hand, are generally protected from these obesity-related disorders
until menopause, when their ovarian hormone levels drop and fat storage tends to shift
from their rear ends to their waists.
This is reason that why women in the sample data are shows higher hip circumferences
compare to waist circumference.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
33
LIMITATIONS OF THE STUDY
•
The study sample size is small
•
Age limitation (40-60 year were taken)
•
Correlation with limited investigative measures
FURTHER RECOMMENDATION
•
Need to correlate with menstruation time in female and glucose levels to find
stronger association.
•
Different population with larger sample size should be assessed.
•
Can be assessed with trial protocol given to the sample population and observe
any change in the diabetes level with anthropometric values differ in individual.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
34
CONCLUSION
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
35
CONCLUSION
Large waist circumference are associated with higher risk of type 2 diabetes in male
and female because WC is more predictable of visceral fat mass but female with higher
hip circumference are also more prone to type 2 diabetes as their hormonal level
changes.
So, females with higher hip circumference may be at a higher risk for developing type 2
diabetes and males with higher waist circumference may be at a higher risk for
developing type 2 diabetes
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
36
SUMMARY
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
37
SUMMARY
Abdominal obesity is increasingly recognized as a major riskfactor for type 2 diabetes.
Compared with anthropometric measures of abdominalobesity [e.g. waist circumference
(WC), waist-to-hip ratio(WHR),] appear to be morestrongly associated with metabolic
risk factors1.
30 males and 30 females were included for the study. Outcome measures were WC,
HC and WHR.
The data was then tabulated and subjected to statistical analysis of the mean for
outcome measures. After the analysis the data the following inference were drawn:
1. Hip circumference is higher in females compared to waist circumference due to
the role of hormonal level. So, females with higher hip circumference are at a
higher risk for developing type 2 diabetes in present and also after changes in
hormonal level.
2. Waist circumference is higher in males compared to Hip circumference. So,
males with higher waist circumference are at a higher risk for developing type 2
diabetes due to visceral fat mass is better predictable with WC.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
38
BIBILOGRAPHY
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
39
BIBILOGRAPHY
1. Lawrence de Koning, Anwar T. Merchant, Janice Pogue and Sonia S. Anand.
(2007).
Waist circumference and waist-to-hip ratio as predictors of
cardiovascular events: meta-regression analysis of prospective studies.European
Heart Journal 28: 850–856.
2. Ike S. Okosun, Richard S. Cooper, Charles N. Rotimi, Babatunde Osotlmehin,
Terrence forrester. (1998) Association of Waist Circumference With Risk of
Hypertension and Type 2 Diabetes in Nigerians, Jamaicans, and African
Americans. Diabetes care 21: Number 11.
3. MB Snijder, PZ Zimmet, M Visser, JM Dekker, JC Seidell and JE Shaw.(2004)
Independent and opposite association of waist and hip circumferences with
diabetes, hypertension and dyslipidemia : the AusDiab Study.International
Journal of Obesity 28:402–409.
4. Q Qiao and R Nyamdorj. (2010) Is the association of type II diabetes with waist
circumference or waist-to-hip ratio stronger than that with body mass
index.European Journal of Clinical Nutrition 64:30–34.
5. Marieke B Snijder, Jacqueline M Dekker, Marjolein Visser, Lex M Bouter, Coen
DA Stehouwer, Piet J Kostense, John S Yudkin, Robert J Heine, Giel Nijpels,
and Jacob C Seidell. (2003) Associations of hip and thigh circumferences
independent of waist circumference with the incidence of type 2 diabetes: the
Hoorn Study. American journal for Clinical Nutrition 77:1192–7.
6. Gabriela Vazquez, Sue Duval David R. Jacobs, and Karri Silventoinen. (2007)
Comparison of Body Mass Index, Waist Circumference, and Waist/Hip Ratio in
Predicting Incident Diabetes: A Meta-Analysis. Johns Hopkins Bloomberg School
of Public Health 29.
7. Dr. Clegg. (2014). Why men store fat in bellies, women on hips. Linkedin
13.
8. Chamukuttan Snehalatha, Vijay Viswanathan, Ambady Ramachandran. (2003)
Cutoff Values for Normal Anthropometric Variables in Asian Indian Adults.
Diabetes Care 26, Number 5
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
40
.
9. American Diabetes Association and National Institute of Diabetes.(2002) the
prevention or delay of type 2 diabetes. Diabetes care 25, number 4.
10. Diabetes Prevention Program Research Group. (2006) Reduction in the
incidence of type 2 diabetes with life style intervention or metformin. Diabetes
care 346(6): 393-403.
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
41
ANNEXURES
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
42
ANNEXURE 10.1
CONSENT FORM
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
43
ANNEXURE 10.2
DATA COLLECTION FORM
NAME: ____________________________________________________________
AGE: ________
GENDER: _____________
ADDRESS:_____________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________
SINCE HOW LONG SUFFERING FROM TYPE II DIABETES MALLITUS: ______________
DATE OF ASSESSMENT: ______________
OUTCOME MEASURES:
Waist circumference
(cm)
Hip circumference
(cm)
Waist to hip ratio
Reading 1
Reading 2
Reading 3
Average
Remarks:_____________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________
Signature of patient
Signature of researcher
Signature of witness
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
44
MASTER CHART
No.
Age
WC (Cm)
HC (Cm)
WHR
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
55
45
58
50
55
60
56
60
45
58
50
59
42
51
55
50
60
47
53
55
48
60
44
46
52
45
46
59
43
44
52
54
48
49
49
60
42
49
124
94
95.33
95.33
95
90.33
106.33
96
92.33
98
94
96
90
97.33
89
95.33
37.66
102
106
162
83
83
153
134
112
74.66
94.33
83.33
80
142
186
164
92.5
92.5
110.66
98.33
106.66
104.66
113
103.66
110.66
110
112.66
100.66
116
107
113.66
92.33
103.33
110.33
111.66
111
90.33
103
42.33
124
152
142
95
95
148
162
98
101
114.33
39.33
108
161
165
186
95.5
95.33
118.33
110.66
107
100.33
1.09
0.8
0.8
0.8
0.8
0.8
0.9
0.8
0.7
1.05
0.8
0.8
0.7
0.8
0.9
0.9
0.8
0.82
0.69
1.13
0.86
0.86
1.02
0.82
1.13
0.7
0.8
2.11
0.7
0.88
1.12
0.88
0.9
0.9
0.9
0.88
0.99
1.04
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
45
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
60
50
58
60
55
60
44
60
46
59
45
50
52
57
52
46
47
56
56
60
52
60
100.66
40
115.33
89
98
107.66
113.66
102.33
38
174
131
132
152
121
117
89
153
153
154
124
100.33
124
103
52
105
90.33
92.33
96.33
107
100.33
50
167
142
163
142
111
112
100
149
147
144
105
115.66
105
0.9
0.7
1
0.9
1.06
1.11
1.05
1.01
0.7
1.03
0.92
0.8
1.06
1.08
1
0.88
1.02
1.03
1.06
1.17
0.8
1.17
“To study the comparison between Hip Circumference (HC), Waist Circumference (WC) and Waist to Hip
Ratio (WHR) as predictors of Type 2 Diabetes”
46