ANTHROPOMETRIC CHARACTERISTICS OF SOME LIMB AND BODY CIRCUMFERENCES IN MALES AND FEMALES WITH TYPE 2 DIABETES MELLITUS

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1 PROCEEDINGS OF THE BALKAN SCIENTIFIC CONFERENCE OF BIOLOGY IN PLOVDIV (BULGARIA) FROM 19 TH TILL 21 ST OF MAY 2005 (EDS B. GRUEV, M. NIKOLOVA AND A. DONEV), 2005 (P ) ANTHROPOMETRIC CHARACTERISTICS OF SOME LIMB AND BODY CIRCUMFERENCES IN MALES AND FEMALES WITH TYPE 2 DIABETES MELLITUS Baltadjiev A 1 *, Sivkov S 1, Vladeva S 2, Baltadjiev G 1 1 Department of Anatomy, Histology and Embryology, 2 Clinic of Endocrinology, Medical University Plovdiv ABSTRACT. The aim of the present study is to measure some limb and body circumferences in male and female patients with type 2 diabetes mellitus and establish their correlation with the course and prognosis of the disease in both genders. The study included 118 female (mean age = 63.6 yrs.) and 67 male (mean age = 64.9 yrs.) patients with type 2 diabetes mellitus. All subjects were of Bulgarian ancestry. The following circumferences were measured: arm relaxed (right, in the middle), arm contracted, forearm, waist, hip, thigh and leg. Waist/hip ratio and waist/thigh ratio were calculated. The between-gender comparison of the circumference of contracted arm show no statistically significant difference but the circumference of relaxed arm significantly greater in females than in males. No statistically significant betweengender difference is found in the waist and thigh circumference with a tendency to greater absolute values of the waist in males than in females. The hip circumference is significantly greater in females than in males, the thigh circumference is greater in females with difference reaching moderate significance, and the forearm circumference is significantly greater in males. WHR and WTR are greater in males than in females. The lipid profile variables cholesterol, triglycerides, HDLcholesterol are slightly higher in females than in males with difference reaching statistical significance only for HDL-cholesterol (p=0.0019). Cholesterol and triglycerides levels are within normal limits and HDL-cholesterol level at the lower limit of the norm. The data of the study show that females with type 2 diabetes mellitus have greater limb and body circumferences the male patients. The risk of poor course of diabetes is greater in males because of the tendency to greater waist circumference and higher values of WHR. High values of waist circumference and WHR are associated with high risk and poor prognosis, while high values of hip and thigh circumferences and WHR indicate more favorable prognosis. 159

2 Baltadjiev A, Sivkov S, Vladeva S, Baltadjiev G KEY WORDS: type 2 diabetes mellitus, hip circumference, waist circumference, thigh circumference, waist/hip ratio, waist/thigh ratio INTRODUCTION Metric examinations of body and limb circumferences are important for predicting and evaluating the risk of development of type 2 diabetes mellitus. The great prognostic value of the waist, hip and thigh circumferences and the ratio between them, i.e., waist/hip ratio (WHR) and waist/thigh ratio (WTR) is especially pointed out (Snijder et al. 2003, Wei Me et al. 1997). They have greater prognostic value than BMI and limb circumferences. These measurements are quite important in studying the fat tissue distribution in human body. The values of the visceral fat tissue, which has crucial role in the development and prognosis of type 2 diabetes mellitus, correlate highly with the waist circumference and the thigh and hip measurements with the muscle mass. The muscle mass is one of the places of insulin resistance as well as main target of the insulin action (Snijder et al. 2003, Ezenwaka 2002). The aim of the present study is to examine some limb and body circumferences in males and females with type 2 diabetes mellitus and establish their relationship with the development and prognosis of type 2 diabetes mellitus in both genders. MATERIAL AND METHODS Patients with type 2 diabetes mellitus were examined. The females were 118 (mean age 63.6 yrs.) and males were 67 (mean age 64.9 yrs.). All patients were of Bulgarian ancestry. The following circumferences were measured: arm relaxed (right, in the middle), arm contracted (right, at the greatest diameter), forearm (right, proximal), waist (between the 12 th rib and the iliac crest), hip (between the widest part of the gluteal region and the pubic symphysis), thigh (right, proximal third) and leg (right, the greatest circumference). WHR and WTR were calculated. The following laboratory variables were also tested: cholesterol, triglycerides, HDLcholesterol. The results obtained were analyzed statistically using SPSS and INSTAT for Windows. The level of significance was determined as low (p 0.05), moderate (p ) and high (p<0.001). RESULTS The limbs and body circumferences of the males with type 2 diabetes mellitus are shown in Table 1 and those of the female patients in Table 2. The between-gender comparison of the circumference of contracted arm show no statistically significant difference (p 0.05) but the circumference of relaxed arm significantly greater in females than in males (p<0.001). No statistically significant between-gender difference is found in the waist and thigh circumference (p>0.05) with a tendency to greater absolute values of the waist in males than in females. The hip circumference is significantly greater in females than in males (p<0.001), the thigh circumference is greater in females with difference reaching moderate significance, and the forearm circumference is significantly greater in males (p<0.001). 160

3 Antropometric characteristcs of some limb WHR and WTR are greater in males than in females (Table 3). The variables of the lipid profile cholesterol, triglycerides, HDL-cholesterol are slightly higher in females than in males (Table 4) with difference reaching statistical significance only for HDL-cholesterol (p=0.0019). Cholesterol and triglycerides levels are within normal limits and HDL-cholesterol level at the lower limit of the norm. DISCUSSION The study findings show that in most cases the limb and body circumferences are significantly greater in females than in males (p<0.001). The circumference of relaxed arm is significantly greater in females than in males, while the betweengender difference in contracted arm circumference is short of statistical significance (p>0.05). The arm circumference in contraction increases with 3 cm in males and with 2 cm in females. This indicates greater contribution of the muscles to the arm circumference in males. The between-gender difference in the waist circumference is short of statistical significance but the males show a tendency to greater values. This suggests greater risk in the course of diabetes mellitus in males. WHR and WTR are better prognostic index (Lev-Ran, Hill, 1987) in the course of type 2 diabetes mellitus than the single circumferences of the waist, hip and thigh. WHR has greater prognostic value than WTR (Snijder et al. 2003, Wei Me et al. 1997). In our study both ratios have greater values males. High values of waist circumference are associated with high risk and poor prognosis, while great hip and thigh circumferences indicate lower risk and better prognosis. In the analysis of the hip circumference findings the gender characteristics should be taken into consideration. In females the form of the bony pelvis and gluteal fat tissue have greater contribution while in males the bony pelvis form and muscle mass are determining factors. The great muscle mass in the thigh and gluteal region correlate negatively with the glucose metabolism as the muscles are the site of insulin resistance, which is the major pathogenic mechanism in type 2 diabetes mellitus (Snijder et al., 2003). The hip and thigh circumferences reflect also the distribution of the subcutaneous fat tissue (Lopatynski et al., 2003). We find higher values of the lipid profile variables in the females but the difference is statistically significant only for HDL-cholesterol (p=0.0019). HDL-cholesterol shows a tendency to shift to the lower referent limit, which is associated with greater atherogenic risk and poorer prognosis for type 2 diabetes mellitus (Okosun et al., 2000). CONCLUSION The data of the study show that females with type 2 diabetes mellitus have greater limb and body circumferences the male patients. The between-gender differences are short of statistical significance in small number of variables. The risk of poor course of diabetes is greater in males because of the tendency to greater waist circumference and higher values of WHR. High values of waist circumference and WHR are associated with high risk and poor prognosis, while high values of hip and thigh circumferences and WHR indicate more favorable prognosis

4 Baltadjiev A, Sivkov S, Vladeva S, Baltadjiev G REFERENCES SNIJDER, MARIEKE, B, 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. Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study1 3. Am J Clin Nutr 2003;77; EZENWAKA, CE, OFFIAH, NV. Abdominal obesity in type 2 diabetic patients visiting primary healthcare clinics in Trinidad, West Indies. Scan J Prim Health Care 2002 Sep; 20(3): LEV-RAN, A., HILL, LR. Different body-fat distributions in IDDM and NIDDM. Diabetes Care 1987 Juli-Aug; 10(4): OKOSUN, IS, LIAO, Y., ROTIMI. CN, CHOI. S, COOPER. RS. Predictive values of waist circumference for dyslipidemia, type 2 diabetes and hypertension in overweight White, Black, and Hispanic American adults. J Clin Epidemiol 2000 Apr; 53(4): LOPATYNSKI. J., MARDAROWICZ. G., SZCZESNIAK, G. A comparative evaluation of waist circumference, waist-to-hip ratio, waist-to-height ratio and body mass index as indicators of impaired glucose tolerance and as risk factors for type-2 diabetes mellitus. Ann Univ Mariae Curie Sklodowska 2003; 58(1): WEI, M., GASKILL, SP, HAFFNE,R SM, STERN, MP. Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (NIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans. Obes Res 1997 Jan 5(1):

5 Antropometric characteristcs of some limb Table 1. Limb and body circumferences in males with type 2 diabetes mellitus Variable N Mean SD Maximum Minimum Arn relaxed Arm contracted , Forearm Waist Hip Thigh , Leg Table 2. Limb and body circumferences in females with type 2 diabetes mellitus Variable N Mean SD Maximum Minimum Arm relaxed Arm contracted Forearm Waist Hip Thigh Leg

6 Baltadjiev A, Sivkov S, Vladeva S, Baltadjiev G Table 3. Waist/hip and waist/thigh ratio in males and females Variable Male Female WHR WTR Table 4. Lipid profile variables in patients with type 2 diabetes mellitus Variable Men Women Mean SD Mean SD Cholesterol 4,955 1,43 5,292 1,39 Triglycerides 1,875 1,71 1,920 0,92 HDL-cholesterol 0,978 0,28 1,307 0,41 164

Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study 1 3

Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study 1 3 Marieke B Snijder, Jacqueline M Dekker, Marjolein Visser, Lex