WHR (waist hip ratio) as risk factor irrespective of body mass index (BMI ) among patients of noninsulin dependent diabetes mellitus (NIDDM)

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1 ORIGINAL ARTICLE WHR (waist hip ratio) as risk factor irrespective of body mass index WHR (waist hip ratio) as risk factor irrespective of body mass index (BMI ) among patients of noninsulin dependent diabetes mellitus (NIDDM) Sweta T. Gamit 1*, Amit L. Gamit 2, Tinkal C. Patel 3, Parul Bhatt 4, Vipul P. Chaudhari 5 1,2 Assistant Professor, 3,4 Associate Professor, Department of Medicine, Government Medical College, Surat, 5 Assistant Professor, Department of Community Medicine, Government Medical College, Surat. ABSTRACT BACKGROUND: Type-2 diabetes mellitus has increased exponentially in urban populations and that even the underprivileged are not exempt. Changing societal structures and lifestyles are accelerating it. Proximate causes for this epidemic are excessive consumption of calories and declining physical activity, which leads to increasing in obesity, especially central obesity. MATERIAL & METHODS: A cross sectional study was conducted from October 2010 to October Waist Hip Ratio was correlated with the disease. Total 120 cases were studied. RESULTS: Out of 120 patients 88 (73.33%) are male and 32 (26.66%) are female. most common age period in which prevalence of diabetes found in each sub groups is 40-59years. Lean and Ideal body weight (IBW) patients are having abnormal WHR despite having BMI of <25. More than half (52.5%) of lean patients and 82.5% of IBW patients are having abnormal high WHR where as in obese group all patients (100%) are having abnormal WHR. CONCLUSION: Central obesity, as measured by the WHR, is importantly and independently associated with NIDDM irrespective of BMI. Key Words: WHR (waist hip ratio), body mass index (BMI ), noninsulin dependent diabetes mellitus (NIDDM) INTRODUCTION Type 2 Diabetes mellitus is one of the modern pandemics. It is estimated to affect 320 million people by the year 2020 worldwide. Diabetes today is an important single disease in the medical specialty and a chronic illness that requires continuing medical care and ongoing patient selfmanagement education and support to prevent acute complications and to reduce the risk of long-term complication. 1 Epidemiologic studies reveal that the prevalence of type 2 diabetes mellitus has increased exponentially in urban populations and that even the underprivileged are not exempt. Changing societal structures and lifestyles are accelerating the epidemic of Diabetes *Corresponding Author: Dr. Sweta T. Gamit 206, pancham residency, Opp., karan park row house, Kalpnachawla marg, adajan Surat Contact No: / drswetagamit30@gmail.com mellitus in South Asian countries. Proximate causes for this epidemic are excessive consumption of calories and declining physical activity, which leads to increasing in obesity, especially truncal obesity (high waist to hip ratio). Interaction of genetic predisposition, environmental influences, and multiple risk factors initiates a cascade that culminates in DM. 2 Weight plays a central role in the etiology and pathology of type 2 diabetes. The increased risk for type 2 diabetes in individuals with obesity is considerable. Lower Body mass index thresholds for overweight and obesity have been proposed for the Asia-Pacific region since this population appears to be at-risk at lower body weights for glucose and lipid abnormalities. 3,4 Interestingly, almost 80% of Indian Type 2 diabetic patients are non-obese whereas 60 80% of such diabetics in the West are obese. Clinical pattern and phenotype profile of patients with Type 2 diabetes (T2DM) are very different in India as well as in certain developing countries of Asia and Africa as compared to the West. 5 Increased visceral 68 Int J Res Med. 2017; 5(4); e ISSN: p ISSN:

2 spine. Hip measurement was taken as maximum diameter at the greater trochanter. Waist to hip ratio (WHR) was calculated in each patient. Body mass index was calculated in kg/m 2 and based on BMI, the patients were divided into the following groups: Lean: BMI of < 18.5 Ideal body weight(ibw): BMI of Obese/overweight: BMI of 25 Minimum 40 patients were taken in each group. RESULTS Table: 1 Distribution of study population according to age, sex of fat in Indians lead to dyslipidemia, increased insulin resistance even with lesser Body Mass Index (BMI) as compared to western population [6].Studies in different parts of India has shown that Type 2 DM-lean patients had a marked lower incidence of hypertension, CAD, nephropathy and higher prevalence of retinopathy and a markedly higher incidence of peripheral neuropathy and infections. 7,8 Type 2 diabetes mellitus presents in a varied form in the Indian population compared to the west. Thus a need arises to further characterize and analyze its epidemiology in the Indian population especially in relation to markers of obesity; i.e., Body mass index, waist circumference and waist to hip ratio. MATERIAL AND METHODS This cross sectional study was carried out among purposively selected 120 patients of type 2 diabetes mellitus at Department of Medicine, New Civil Hospital, Surat during October 2010 to October Inclusions Criteria: K/C/O type-2 DM both male &female. Age > 18 years. Exclusions Criteria: Freshly detected case of type 2 Diabetes Patient who had abrupt onset of Diabetes with acute weight loss or require insulin at the time of diagnosis. Patients with diseases of exocrine pancreaspancreatitis, pancreatectomy, neoplasia, cystic fibrosis, hemochromatosis, fibrocalculous pancreatopathy(fcpd) Patients with endocrinopathiesacromegaly, cushing ssyndrome, glucagonama, pheochromocytoma, hyperthyroidism, somatostatinoma, aldosteronoma. Gestational diabetes mellitus(gdm) History and Clinical Examination: The detailed history was taken of patients enrolled in study. All findings were recorded on predesigned questionnaire. Anthropometric measurements including height (in cm.), weight(kg.),waist circumference, hip circumference were taken. Waist measurements were taken as abdominal circumference at midpoint between the costal margin and anterior superior iliac having Type 2 Diabetes. LEAN 69 Int J Res Med. 2017; 5(4); e ISSN: p ISSN: SEX Male Female AGE (YEARS) (72.5%) 11(27.5%) 5(12.5%) 23(57.5%) 12(30%) IBW 32(80%) 8(20%) 5(12.5%) 22(55%) 13(32.5%) OBESE 27(67.5%) 13(32.5%) 2(5%) 19(47.5%) 19(47.5%) Out of 120 patients 88 (73.33%) are male and 32 (26.66%) are female. In lean group, out of 40 patients 29(72.5%) are male and 11 (27.5%) are female. In IBW group, out of 40 patients 32(80%) are male and 8 (20%) are female. In Obese group, out of 40 patients 27(67.5%) are male and 13(32.5%) are female. Above table shows, most common age period in which prevalence of diabetes found in each sub groups is 40-59years. Higher diabetes risk is found in early age group 18-39yrs is 12.5% in lean & IBW as compared to 5% in obese. while there is no significant difference between 3 sub group at the age between 40-59yrs 57.5%, 55%, 47.5%respectively. In our study, higher 18-39yrs because of weight gain in early adulthood is related to a higher risk of type 2 diabetes than was later weight gain in both normal and overweight. 9

3 Table: 2 Distribution of study population according to Waist Circumference and Waist Hip Ratio. LEAN IBW OBESE Waist Circumference Male 90 >90 Waist Circumference Female 80 >80 Waist Hip Ratio Male < Waist Hip Ratio Female < WHR (waist hip ratio) as risk factor irrespective of body mass index WHR< 0.80 and remaining 7 (87.5%) are having WHR of In Obese group no female patient is having WHR< 0.80 and all 13(100%) are having WHR (37.5%) 2(7.4%) coincides with obesity. So, out of 40 lean 20(62.5%) 25(92.6%) patients; 21(52.5%) are having abnormal 2(25%) 0 WHR despite being a lean and in IBW 6(75%) 13(100%) patients33 (82.5%) patients are having 6(18.75%) 0 abnormal WHR where as in obese group 26(81.25%) 27(100%) all patients are having abnormal WHR. 1(12.5%) 0 DISCUSSION 7(87.5%) 13(100%) The prevalence of type 2 diabetes mellitus is rapidly rising all over the globe at an alarming rate. 1 Over the past 30 years, the status of diabetes has changed from being considered as a mild disorder of the elderly to one of the major causes of morbidity and mortality affecting the youth and middle aged people. 60 % to 80% of the diabetics in developed countries are obese whereas in India most patients fall in normal weight group and some even lean. 8 Since obesity does contribute in a considerable way to complications of diabetes, it is worthwhile to study if BMI has any implications on the complications of type 2 diabetes mellitus. 10 In our study, out of 120 patients, 40 patients are divided in each subgroup according to their BMI. Out of 120 patients 88 (73%) are males and 32 (27%) are females. Table:1 Sex distribution was also not significantly different in subgroups of previous studies conducted by Mukhayprana and V.Mohan. 11,12 Most common age period in which prevalence of diabetes found in each sub groups is 40-59years. Higher 18-39yrs is 12.5% in lean & IBW as compared to 5% in obese. while there is no significant difference between 3 sub group at the age between 40-59yrs 57.5%, 55%, 47.5%respectively. Study done by Anja Scheienkiewitz-POstsdam Study observation was weight gain in early adulthood between 25-40yrs is related to a higher risk and earlier onset of type 2 diabetes than is weight gain between 40 and 55yrs of age. In our study, higher 18-39yrs because of weight gain in early adulthood is related to a higher risk of type 2 diabetes than was later weight gain in 25(86.2%) 4(13.8%) 9(81.8%) 2(18.2%) 18(62%) 11(38%) 1(9%) 10(91%) Among Male patients belong to lean group, 86.2% are having waist circumference 90 cm. and 13.8 % are having waist circumference >90 cm. In IBW group, 37.5% male patients are having waist circumference 90 cm. and 62.5% are having waist circumference >90 cm. Out of 27 male patients of obese group, only 2(7.4%) patients is having waist circumference 90 cm. and remaining 25(92.6%) are having waist circumference >90 cm. Mean waist circumference in obese male is highest than others coinciding with their obesity. Among female patients belong to lean group 81.8% are having waist circumference 80 cm. and 18.2 %are having waist circumference >80 cm. In IBW group, 25% female patients are having waist circumference 80cm.and 75% are having waist circumference >80 cm. Out of 13 female patients of obese group, none is having waist circumference 80 cm. and all patients 13 (100%) are having waist circumference >80 cm. In females also those belong to obese group are having highest mean waist circumference than others. Among Male patients belong to lean group, 18(62%) are having WHR< 0.95 and 11(38 %) are having WHR In IBW group, 6(18.75%) male patients are having WHR 0.95 and 26(81.25%) are having WHR In Obese group no male patient is having WHR< 0.95 and all 27(100%) are having WHR 0.95 coincides with obesity. Among female patients belong to lean group only 1 is (9%) having WHR< 0.80 and remaining 10(91%) despite being a lean; are having WHR of In IBW group also only one female patient (12.5%) is having 70 Int J Res Med. 2017; 5(4); e ISSN: p ISSN:

4 both normal and overweight. 9 Excess conducted by Mukhayprana, the abnormal abdominal fat, assessed by measurement WHR was present in 48% of lean and 79% of waist circumference is independently of normal weight patients which was low associated with higher risk for diabetes in lean and normal weight patients mellitus and cardiovascular disease. 13 respectively as compared to our study. 12 Despite having lower prevalence of CONCLUSIONS obesity as defined by body mass In our study we found that lean and index(bmi), Asian Indians tend to have IBW patients are having abnormal greater waist circumference and waist to WHR in both gender despite having hip ratios 14 thus having a greater degree of BMI of <25. In our study 52.5% of lean central obesity. Again, Asian Indians have patients and 82.5% of IBW patients are more total abdominal and visceral fat for having abnormal high WHR where as in any given BMI 15 and for any given body obese group all 100% patients are fat they have increased insulin resistance. 16 having abnormal WHR. Central Moreover, they have lower levels of the obesity, as measured by the WHR, is protective adipokine adiponectin and have importantly and independently increased levels of adipose tissue associated with NIDDM. metabolites 17 In our study population 85% In our study 10(91%) female having of lean patients are having normal waist abnormal WHR in lean group. Thus circumference where as in obese group abnormal WHR is risk factor for 95% patients are having abnormal waist female. circumference coincides with their obese In our study, we reported that among body characteristics. [Table:2] Out of 13 lean and IBW patients despite of female patients of obese group, none is BMI<25 there is abnormal waist having waist circumference 80 cm. and circumference and abnormal WHR. all patients 13 (100%)are having waist Thus Central obesity, as measured by circumference >80 cm.[table:2]in Ibw the WHR, is importantly and group 35% are having normal waist independently associated with NIDDM circumference, 65% of IBW patients and Funding: Nil. 15% of lean diabetics are having abnormal Conflict of interest: None. waist circumference despite having body REFERENCES mass index of <25. [Table:2] Body 1. International Diabetes Federation Composition of Asian Indians when Diabetes Atlas. Unwin N, Whiting D, Compared with Caucasians they had less Gan D, Jacqmain O, Ghyoot G, BMI, muscle mass and waist editors. IDF Diabetes Atlas. 4 th ed. circumference but high total fat, waist to Belgium: International Diabetes hip ratio and truncal skin folds [18]., In our Federation; P study out of 40 lean patients; 52.5% are 2. Wild S, Roglic G, Green A, Sicree R, having abnormal WHR despite being a King H. Global prevalence of diabetes: lean and in IBW patients 82.5% patients Estimates for the year 2000 and are having abnormal WHR where as in projections for Diabetes Care obese group all patients are having 2004;27: Popkin BM. abnormal WHR. [Table:2] Among female 3. The Shift in Stages of the.nutrition patients belong to lean group only 1 Transition in the Developing World patient is having WHR 0.80 and Differs from Past Experiences!. Public remaining 10 despite being a lean ;are Health Nutr 2002;5: having waist to hip ratio >0.80 [Table:2]. 4. Mohan V, Deepa M, Deepa R, Genetic factors that determine body fat Shanthirani CS, Farooq S, Ganesan A, distribution and glucose metabolism have et al. Secular trends in the prevalence to be fully elucidated for the better of diabetes and impaired glucose understanding of the biochemical and tolerance in urban South India-the molecular mechanisms behind the Chennai Urban Rural Epidemiology aetiopathogenesis of diabetes. In study 71 Int J Res Med. 2017; 5(4); e ISSN: p ISSN:

5 Study (CURES-17). Diabetologia et al.clinical profile of lean NIDDM in 2006;49: South India. Diabetes Res ClinPract 5. Ramachandran A, Snehalatha C, Vijay 1997;38: V. Low risk threshold for acquired 12. PrabhuMUkhyaprana, diabetogenic factors in Asian Indians. sudhavidyasagar,shashikiranu;clinical Diabetes Res ClilnPract 2004;25:189- profile of type 3 diabetes mellitus and 95. body mass index-is there any 6. Nakagami T, Qiao Q, Carstensen B, correlation?calicut Med J 2004;2:e3 Nhr-Hansen C, Hu G, Tuomilehto J, et 13. Harrison s principles of internal al. Age, body mass index and type 2 medicine seventeenth edition(2275- diabetes association modified by 2304) ethnicity. Diabetologia 2003;46: Ramachandran A, Snehalatha C, 70. ViswanathanV,Viswanatha M, Haffner 7. Epidemiology of type 2 diabetes: SM. Risk of non insulin dependent Indian scenario; V. Mohan, S. diabetes mellitus conferred by obesity Sandeep, R. Deepa, B. Shah* & C. and central adiposity in different ethnic Varghese; Indian J Med Res 125, groups: a comparative analysis March 2007, pp between Asian Indians, Mexican 8. Alberti KGMM, Zimmet PZ. Americans and Whites. DiabetesRes Definition, diagnosis and classification ClinPract1997; 36: of diabetesmellitus and its 15. Raji A, Seely EW, Arky RA, complications.part 1.Diagnosis and Simonson DC. Body fat distribution classification of diabetesmellitus and insulin resistance in healthy Asian provisional report of a WHO Indians and Caucasians.J consultation.diabet Med 1998;15:539 ClinEndocrinolMetab2001; 86 : Anja Schienkiewitz, Mattias B Chandalia M, Abate N, Garg A, Schulze, Kurt Hoffman,Anja Kroke, Stray-Gunderson J, Grundy SM. and Heiner Boeing.Body mass index Relationship between generalized and history and risk of type 2 upper body obesity to insulin diabetes:results from the European resistance in Asian Indian men. J Prospective Investigation in to cancer ClinEndocrinolMetab1999; 84 : and Nutrition(EPIC)-Potsdam 35. Study1 2 3.Am J Clin Nutr August Abate N, Chandalia M, Snell PG, 2006 vol.84 no Grundy SM. Adipose tissue 10. Insulin resistance. A multifaceted metabolites and insulin resistance in syndrome responsible for NIDDM, nondiabetic Asian Indian men. J obesity, hypertension, dyslipidemia, ClinEndocrinolMetab2004; 89 : and atherosclerotic cardiovascular 5. disease. AU DeFronzo RA; 18. MIsraA,VikramNk, et al. Waist FerranniniE SO Diabetes Care 1991 circumference cut off points and action Mar;14(3): levels for Asian Indians for 11. Mohan V, Vijayaprabha R, Rema M, identification of abdominal obesity.int Premlatha G, Poongothai S, Deepa R, J obesity(london) 2006;30: Int J Res Med. 2017; 5(4); e ISSN: p ISSN: