Original Research Article
Assessment of Body Mass Index and Waist Hip
Ratio for development of Type II Diabetes in rural
area of RRMCH, Bangalore Shyam AC1, Damayanthi M N1
Abstract: Background: Diabetes is a syndrome characterized by chronic hyperglycaemia and relative deficiency of insulin. In urban population its figure are quoted to be high. Now in rural area incidence of diabetes is increasing. Methodology: Study setting: Rural field practice area, Ittamadu. Study population: All adults above 20 yrs of age. Study design: Cross Sectional study. Study duration: Two months. Sampling technique: Purposive sampling. Sample size: 165 subjects. Study variables: Socio‐demographic profile, measurement of height, weight, waist circumference, hip circumference. Results: Out of 165 subjects 33% of the participants are males 23.6% of them are pre‐obese and 11.5% are obese, which was more for females. 9.1% of the male participants have Waist to Hip ratio of >1 while 48.2% of female have Waist to Hip ratio of >0.8. Conclusion: Indian Dia‐
betes Risk Score is an appropriate tool in the Community to identify the risk groups for the development of Type II Diabetes, which were used to identify the risk factors with respect to Body Mass Index and Waist To Hip ratio for the development of Type II Diabetes.
Introduction
Objectives
Diabetes is a silent disease. The prevalence of Type II Diabetes is increasing in the developing coun‐
tries. The present trends indicate that more than 60% of the world’s population of people with diabetes will be in India (1). The strongest contributors for Type II diabetes are preventable lifestyle factors and there are stud‐
ies conflicting about the im‐
portance of Body Mass Index (BMI) and Waist to Hip Ratio (WHR) (2). There are inadequacies in primary health care, which are not designed to cope up with the present challenges of Non – Com‐
municable diseases. With this ob‐
jective in mind, the present study was an effort to assess the risk fac‐
tors with respect to BMI and WHR for the development of Type II Di‐
abetes Mellitus in rural areas and to come up with some interven‐
tions, which will help the commu‐
nity as a whole. The objectives of the study were: 1. To identify the risk factors (BMI & WHR) for type II diabetes among the study population. 2. To study the socio‐demo‐
graphic profile of the study sub‐
jects. Materials and
Methods
This study was conducted by the Department of Community Medicine in rural field practice area, Ittamadu, Ramanagara Dis‐
trict, Karnataka State. It was a cross sectional study conducted for the duration of two months. All the adults above 20 years of age were included for the study with their consent who attended the Health Centre as out‐ patients. It was a purposive sampling where the sample size came to 165 partic‐
ipants. Pre‐ structured question‐
naire were used for the collection of the data. The study variables in‐
cluded were socio‐demographic profile, measurement of height in centimeters, weight in kilograms, waist circumference in centime‐
ters, hip circumference in centime‐
ters using standard measure‐
ments, physical activity, and fam‐
ily history of Diabetes. Anthropometric measurements: Recording of weight for each indi‐
vidual were carried out by using adult weighing machine, with light clothing, without shoes after emptying the bladder. Subjects stood upright with their weight evenly distributed on both feet and looked straight ahead. Weight was recorded to the nearest kilogram. Height was measured to the near‐
est centimeter using non‐flexible measuring tape. The subjects was asked to stand upright without shoes against the wall with eyes di‐
rected forward and heels together. Waist circumference was recorded by using a non‐elastic measuring tape. The point mid‐way between the coastal margin and iliac crest in Department of Community Medicine, RRMCH, Kambipura, Mysore Road, Bangalore. Correspondence to Dr Shyam AC ([email protected]) Received: 03‐11‐2013 Accepted: 30‐01‐2014 1
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 1 | DEC 2013 – FEB 2014 | Page: 14
the mid‐axillary line with widest point around the greater trochan‐
ter, measured in centimetres. The point around the hip at the level of symphysis pubis and the greatest gluteal protuberance was consid‐
ered for measuring the Hip cir‐
cumference, measured in centime‐
tres. Body Mass Index (BMI) was calcu‐
lated by using the formula weight in kilograms divided by height square in meters. Waist to Hip ra‐
tio was calculated by waist meas‐
urement divided by height circum‐
ference Scoring for type of physical activ‐
ity and overall assessment of risk factors for the development of type II Diabetes were assessed by using the tool of Indian Diabetes Risk Score (IDRS) as developed by Mohan et al(3). The cut‐off consid‐
ered for BMI and WHR were as per the guidelines of IDRS. The data was analyzed using SPSS version 19. No ethical issues were in‐
volved as no interventions were carried out; however, verbal con‐
sent was obtained to collect the data from the participants. Results
Out of 165 adult participants, 55 (33.3%) of them were males and 110 (66.7%) were females. Most of the participants were in the age group of 30‐50years (mean age ±SD= 48.51±21.29). (Table1) The main occupation was agriculture, belonging to class III socio‐eco‐
nomic status (according to Modi‐
fied B G Prasad classification). Anthropometric measure‐
ments of the studied subjects in‐
cludes the mean weight ±SD= 50.52 ±13.9, mean BMI ±SD=50.52 ± 13.9, mean waist ±SD= 74.79 ± 13.5 ,mean hip circumference ±SD= 84.05 ±14 and mean waist hip ratio ±SD= 0.899 ±0.259. 65% of the studied population were in normal range of BMI, 24% of them were in pre‐obese, and 11.5% were obese. Pre‐obese and obese was more in females than among the males (Table 2). Male participants (9.1%) have WHR of >1 (Cut off WHR for men >1) while 48.2% of female study have WHR of 0.8 (Cut off WHR for women > 0.8) (Table 3). 41.8% of them were at moderate risk for the development of type II Diabetes .This was found to be more for fe‐
male participants (46.3%) than the males (38.1%). (Table 4). This study reveals a simplified way for identifying the risk factors (BMI & WHR) for the development of Type II diabetes in rural area. BMI has been conventionally used to classify overweight and obesity. Distribution of the respondents ac‐
cording to BMI showed that 76.4% of the male respondents had normal BMI (19‐24), 18.2% were pre‐obese (25‐29) and 5.4% were obese while, 59.1% of the females had normal BMI (19‐24), 26.3% were pre‐obese and 14.5% were obese. Shobha Malini (2) quotes Table 1: Age and sex wise distribution of the study subjects
Age (yrs)
Male(%)
Female(%) Total
20‐30 30‐40 40‐50 >50 Total
04(13.3) 03(13.6) 13(44.8) 35(41.7) 55(33.3)
26(86.7) 19(86.4) 16(55.2) 49(58.3) 110(66.7) 30 22 29 84 165
Table 2: Distribution of the respondents according to Body Mass Index based on Indian Diabetes Risk Score (IDRS)
BMI(IDRS)
Male (%) Female (%) Total (%)
<18.50 (underweight) 18.5‐24.99 (normal range) 25‐29.99 (pre‐obese) >30above (obese) Total
00(00) 42(76.4) 10(18.2) 03(5.4) 55(100)
00(00) 65(59.1) 29(26.3) 16(14.5) 110(100) 00(00) 107(65) 39(24) 19(11) 165(100)
Table 3: Waist Hip ratio (WHR) among the study population Waist Hip ratio
Male (%) Female (%)
0.7 0.8 0.9 >1 Total
04(7.3) 11(20) 35(63.6) 05(9.1) 55 22(20) 53(48.2) 32(29.1) 03(2.7) 110
Table 4: Risk of type II Diabetes based on IDRS among the study population (n=165) Score >60 (very high risk) 30‐50 (moderate risk) <30 (low risk) Total Male(%) 16(29.1) 18(32.7) 21(38.1) 55 ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 1 | DEC 2013 – FEB 2014 Discussion
Female(%) 35(31.8) 51(46.3) 24(21.8) 110 Total 51(30.9) 69(41.8) 45(27.3) 165 15 that 44% of the study population were having BMI between 21‐25 which is normal , 40% were pre‐
obese and 10% were in range of 31‐
35(obese). Similar observations were quoted by Ramachandra et al (4)where the prevalence of glucose intolerance increases with in‐
creased obesity . Waist Hip ratio was found to be greater risk factor for type II diabe‐
tes than general obesity. Many studies have reported the same. Czernichow S (5) and Sayeed et al(6) reports that WHR was the best predictor of cardio vascular events and morbidity in patients with type II and BMI the worst. In our study 48.2% of the female pop‐
ulation had WHR of > 0.8 while 9.1% of the male population had WHR > 1.0 which indicates that the female study group were at higher risk of developing Type II Diabetes ( Mean waist hip ratio ±SD= 0.899 ±0.259) than males.Cassell et al(7) study in South India showed that gene association may affect the susceptibility of weight gain in In‐
dians. WHR is strongly associated with Insulin resistant and Diabetes mellitus. This might explain a shift towards female predominance in adding to more percentage of WHR. Indian Diabetes Risk Score is an appropriate tool in the Commu‐
nity to identify the risk groups for the development of Type II Diabe‐
tes, which is being used widely. By adopting the similar tool, we were able to identify in our study that 41.8% of the study population were at risk of developing Type II diabetes in the rural area. This in‐
crease in proportion could be be‐
cause of changes in the life style practices. Similar observation was quoted by Ketherine Shirey (8). Student’s t –test was statistical sig‐
nificant in terms of age, BMI & WHR (p< 0.0001) The data from one part of the community cannot be generalized to another because of variations seen in environmental factors, which is one of the limitations of this study. Further investigations are required to strengthen the study. The challenges lie in improving the awareness among the public on the risk factors for diabetes. This points towards an urgent need of developing community based intervention program in ru‐
ral areas that adopts comprehen‐
sive preventive and promotive strategies. The involvement of PHC’s will also strengthen the surveillance of risk factors for Non‐ Communica‐
ble diseases in rural settings. Acknowledgements
We gratefully thank the team of Dept. of Community Medicine, RRMCH, Staffs of PHC Ittamadu, and the study subjects for the com‐
pletion of this study. References
1. Ambady Ramachandran, Snehalatha C. Diabetes in South –East Asia: An update for 2013 for the IDF Diabetes Atlas. Diabe‐
tes Research and Clinical Practice. 2013; pgs1‐ 7 2. Shobha Malini, A Sahu. Assessment of risk factors for de‐
velopment of Type II Diabetes Mellitus among working women in Berhampur Orissa. Ind Jr of Community Medicine. 2009 July; 34(3): 232‐236 3. V Mohan, R Deepa, M Deepa, et al. A Simplified Indian Di‐
abetes Risk Score for screening for Undiagnosed Diabetic Subjects. JAPI. Vol 53, Sept 2005; pg 759‐763. 4. Ramachandra A, Snehalatha C. High prevalence of Diabe‐
tes and impaired glucose tolerance in India: Na‐
tional Urban Diabetes Survey. Diabetologia. 2001 Sept; 44(9):1094‐
101 5. Czernichow S, Kengne AP. Comparison of waist to hip ra‐
tio and other obesity indices as predictors of cardiovascular dis‐
ease risk in people with type II DM: a prospective cohort study from ADVANCE. Eur J Cardiovascular Prev Rehabili .2011Apr; 18(2):312‐9. 6. Sayeed M A, Mahtab H. Prevalence of diabetes and im‐
paired fasting glucose in urban population of Bangladesh. Bangla‐
desh Med Res Counc Bulletin. 2007Apr; 33(1):1‐12. 7. Cassell P G, Neverova et al. An un‐coupling protine ‐2 gene variant associated with raised MI Diabetologia. 1999; 42; 688‐
92 [Pubmed]. 8. Ketherine Shirey. Comparisons of waist circumference, waist hip ratio and body mass index and their associations with type II Diabetes in rural & urban India. Directed by Dr Nadine Sa‐
hyoun, Associate Professor, Department of Food Science and Nu‐
trition, 2011
.
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