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Correlation of obesity indices and blood pressure
among overweight and obese females
Dr Khola Noreen1, Dr Fareeha Fawad 2,Dr Abdul Qadir Khokar
1
Bahria University Medical and Dental College, Karachi
2
3
3
Army Medical College, Rawalpindi
Bahria University Medical and Dental College, Karachi
ABSTRACT
Background: Overweight and obesity is defined as abnormal excessive accumulation of body
fat that impairs health and normal functions of body. The world wide obesity is increasing at an
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extremely alarming rate .The growing epidemic of obesity is responsible for parallel increase in
prevalence of obesity related hypertension .Hypertension is considered to be underlying risk
factors in development of cardiovascular disease.
Aims & Objective: Aim of this study is to find out relationship of obesity indices namely BMI,
WC and WHR with blood pressure and to find out which obesity measure is associated with
greater risk of hypertension.
Materials and Methods: The cross-sectional study was conducted on three hundred and forty
nine over weight and obese females at PNS Shifa Hospital, Karachi. Female between the ages
20-60 years were selected using simple random sampling. All females having BMI >23 kg/m2
were selected after making necessary exclusion. Anthropometric data was taken from every
individual according to standardized protocol. Descriptive statistics were used to calculate
mean and standard deviation for weight, height, BMI, waist and hip circumference. Spearman
correlation was used to find the correlation and odds ratio and 95% confidence interval was
calculated for all obesity indices. P value less than 0.05 was taken as significant.
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International Journal of Advancements in Research & Technology, Volume 4, Issue 3, April -2015
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Results: Basic descriptive statistics for subject data were expressed as means ± standard
deviations. The age of subjects ranged between 20 – 60 years with a mean 38.70 ± 5.44 years.
The odds ratio of developing hypertension with increase in obesity indices. The results
demonstrated that all obesity measures expect hip circumference showed significant
association with systolic Blood pressure (p< 0.05). Waist Circumference showed strong
correlation with systolic BP is stronger as compared to other obesity indices (p<0.001).
However, with regard to diasystolic BP, BMI showed strongest association while all other
obesity measures showed almost equal correlation.
Conclusion: The study indicates a positive association of Waist circumference with
hypertension. Measurement of waist circumference can serve as effective tool to identify
individual at high risk of developing cardio metabolic disorder.
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Keywords: Body Mass Index, Overweight, Obesity, Obesity indices
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International Journal of Advancements in Research & Technology, Volume 4, Issue 3, April -2015
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now considered as growing public health
INTRODUCTION
issues
Overweight and obesity is defined as
abnormal excessive accumulation of body
and
associated
with
increase
morbidity and mortality as well as increased
socioeconomic cost. 5
fat that impairs health and normal functions
of body. The world wide obesity is
Various
methods
increasing at an extremely alarming rate
assessment of and overweight and obesity
with prevalence almost doubled since
but mostly these methods are difficult to
1980.According to recent report of WHO,
use
1.9 billion adults aged 18 years and older
anthropometric measurements are most
were overweight and more than 600 million
practical and easy to use in clinical and
were reported to be obese in year 2014.1
epidemiological settings. 6, 7
The overweight and obesity has been
Body mass index (BMI) is a simple index use
labeled as major modifiable cardiovascular
for assessment of overweight and obesity.8
disease (CVD) risk factor by American Heart
BMI asses the overweight and obesity in
Association.2 The growing epidemic of
terms of height and weight .It is simple
obesity is responsible for parallel increase in
anthropometric tool and has been widely
prevalence of obesity related hypertension.
used
Hypertension is considered to be underlying
assessment of obesity.9 However, it does
risk
not
in
are
research
available
settings.
for
Simple
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factors
in
development
of
cardiovascular disease.3
as
surrogate
take
into
distribution
of
measurements
account
total
difference
body
fat
of
in
from
abdominal fat and corresponding risk of
According to data of Global burden of
disease 2010, CVD is leading cause of agestandardized deaths in Pakistan and it has
been projected that from 2010 to 2025 CVD
will be the major cause of population level
mortality among all causes of death.4 It is
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chronic diseases which differs in different
populations and ethnic groups. Moreover, it
does not differentiate whether excessive
body weight is due to increased body fat or
muscle
mass
and
may
lead
to
misclassification of level of obesity. 10 This is
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International Journal of Advancements in Research & Technology, Volume 4, Issue 3, April -2015
ISSN 2278-7763
the reason that WHO and International Task
23
METHODOLOGY
Force of obesity have purposed lowered
BMI cut off values for assessment of
overweight and obesity in Asians. .BMI Cut
offs for overweight and obesity is taken as
of 23 kg/m2 and 25 kg/m2 respectively.11-13
Cross
sectional
study
conducted
on
overweight and obese women of 15-60
years of age reporting at Dietitian OPD,
family OPD and during BMI Camp arranged
by registered dietitian through official
In addition to general level of obesity
written invitation to lady wives and
assessed
daughters of Residents of Shifa hospital
by
BMI,
abdominal
obesity
represented by waist circumference and
(Doctor’s Complex).
waist-hip ratio is independently associated
with
cardio
metabolic
risk
factor.
Correlation between abdominal obesity and
Inclusion criteria for study participants
include disease free healthy overweight and
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CVD is evident by various researches and it
has been proved that abdominal obesity
correlate more strongly with obesity related
health risk factors than overall obesity.14
obese females of age group 20-60 years,
with BMI more than 23 kg/m2 and with no
underlying co morbid associated with
obesity. Exclusion criteria include females
with syndromal obesity, polycystic ovaries
Several studies have been carried out in this
and those on pharmacotherapy for obesity.
regard in various populations but there is
Total three seventy three females full filled
dearth of literature on this study in our part
the eligibility criteria, out of these, twenty
of the world. Aim of this study is to
four don’t full fill the inclusion criteria were
compare the relationship of obesity indices
excluded and rest of three forty nine
namely body mass index (BMI), waist
females were enrolled after taking the
circumference (WC) and waist hip ratio
informed consent. All selected females
(WHR) with blood pressure and to find out
underwent physical examination in order to
which obesity measure is associated with
obtain anthropometric data.
greater risk of hypertension.
Weight was measured in minimum clothing
to the nearest 0.1 kg using a weight scale
with calibration done after every 25
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24
readings. Height was recorded in the erect
and obesity. Normal weight BMI > 18.5 - 23
position, back and hips touching the wall
kg/m. Overweight BMI 23 - 25 kg/m2 and
without shoes to the nearest 0.1 cm using
BMI > 25 kg/m2 is taken for Obese.
wall
mounted
stadiometers.
Waist
circumference was measured according to
standardized protocol given in WHO STEPS.
Waist circumference as per Asian cut off for
females < 80cm and hip circumference < 90
cm is taken as normal.15
As per this protocol waist circumference is
measured by
placing
measuring
approximately at mid of upper border of
iliac crest and lower margin of last palpable
rib. According to WHO STEPS protocol
hip circumference should be recorded
STATISTICAL ANALYSIS
tape
at
the widest portion of the buttocks. Precise
Data was analyzed using statistical package
for
social
sciences
(SPSS)
20.0.Descriptive statistics were used to
calculate mean and standard deviation for
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measurement of waist hip ratio depends on
accurate measurement of waist and hip
circumference which depends on correct
positioning and tightness of measuring
tape. Position should be parallel to the level
of floor from which measurement is taken
version
weight,
height,
BMI,
waist
and
hip
circumference. Spearman correlation was
used to find the correlation and odds ratio
and 95% confidence interval was calculated
for all obesity indices. P value less than 0.05
was taken as significant
and it should not pull tightly in order to
RESULTS
avoid constriction 15.Systolic blood pressure
(SBP) and diastolic blood pressure (DBP)
measurements
were
taken
following
Basic descriptive statistics for subject data
standard procedure. Hypertension was
were
defined according to the Seventh Report of
deviations. The age of subjects ranged
the Joint National Committee (JNC-7)
between 20 – 60 years with a mean 38.70 ±
recommendation (SBP ≥ 140 mmHg and/or
5.44 years. BMI was 26.34 ± 5.12 kg/m2,
DBP ≥ 90 mmHg).16 BMI is categorized as
with mean systolic blood pressure 125.75 ±
per Asian cut off for classifying overweight
8.18 mmHg and Diastolic Blood Pressure
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expressed
as
means ± standard
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25
80.15 ± 9.54 mmHg. The odds ratio of
Circumference with systolic BP is stronger
developing hypertension with increase in
as compared to other obesity indices
obesity indices is shown in Table 2 .The
(p<0.001).
results (Table 3) has demonstrated that all
diasystolic BP, BMI showed strongest
obesity measures expect hip circumference
association while all other obesity measures
showed significant association with systolic
showed
Blood pressure (p<0.05) .The results also
contrast to SBP, Hip circumference also
demonstrated that association of Waist
showed correlation with DBP (p< 0.05)
However,
almost
with
equal
regard
correlation.
to
In
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Table 1: Baseline characteristics of the study population
Variable
Mean
Standard Deviation
38.70
5.44
161.12
4.14
Weight( kg)
65.30
6.11
Body Mass Index(kg/m2)
26.34
5.12
Waist Circumference(cm)
80.56
7.13
Hip Circumference (cm)
89.17
6.17
Waist Hip ratio
0.90
2.13
Systolic Blood Pressure(mm/Hg)
125.75
8.18
Diastolic Blood Pressure(mm/Hg)
80.15
9.54
Age (years )
Height (cm)
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Table II: Odds-ratios for developing hyper tension with increasing obesity measures
Variable
OR
95% CI
Significance
Waist Circumference(cm)
1.18
1.11-1.21
0.001
Hip Circumference (cm)
1.05
1.02-1.11
0.02
Waist Hip ratio
1.02
1.0-1.12
0.01
BMI (Kg/m2)
1.09
1.05-1.21
0.01
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Table 111: Correlation between obesity indices and development of Hypertension
Variables
Systolic Blood
Diastolic Blood
Pressure(mm/Hg)
Pressure(mm/Hg)
Correlation
P value
Correlation
P value
Waist Circumference(cm)
0.840
0.001
0.510
0.05
Hip Circumference(cm)
0.213
0.09
0.543
0.03
BMI (Kg/m2)
0.512
0.049
0.744
0.001
Waist Hip ratio
0.622
0.01
0.315
0.05
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DISCUSSION
Pakistan is the sixth most populous country
Among all obesity indices, WC and BMI
in world and undergoing demographic and
were found to be significantly correlated
epidemiological transition. Average life
with SBP and DBP respectively. This finding
expectancy of Pakistani population has
supported the evidence on appropriateness
been increased with overall life expectancy
of measuring WC along with BMI in
is more in females as compared to males.
assessment of health risk factors associated
This increase in life expectancy has also
with obesity.20
increased the average time span for
exposure of Non Communicable Diseases
(NCD).
Evidence has proved that BMI and WC
when
used in conjunction gives better
17
estimation of abdominal
obesity
and
Pakistan is facing double burden of disease
associated health risk as compared BMI
while they continue to have burden of
alone.21
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infectious diseases along rapid upsurge in
Non
Communicable
diseases
including
Diabetes, hypertension, CVD, dyslipidemia,
cancers.
18
Hypertension is an emerging
public health issue of great concern.
According to
National
Health Survey
report, every third person, over the age of
Singhal et al while discussing the different
measures of assessment of obesity among
Asian women
22
stated that use of BMI
alone is not effective in classifying the level
of obesity as it may tend to underestimate
the level of obesity and may categorize
them as normal and added that BMI along
19
45 years has hypertension in our country .
with waist circumference is better method
The purpose of this study was to compare
of assessment as it take into consideration
the relationship of obesity indices with
the assessment of central obesity which is
blood pressure and to find out the measure
considered as a underlying risk factor for
associated with strong risk of developing
many chronic health problems associated
hypertension.
with obesity.23
The results of the present study also
revealed that the odds ratio of developing
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hypertension was comparatively greater
conducted on Indian adult population
with increasing WC than other obesity
showed that OR of developing Hypertension
measures (WC, WHR and BMI). The OR
is greater with Increasing BMI as compared
associated with 1.0 cm increase in WC was
to WC and WHR.28
1.18. Comparing values for a 1 kg/m²
increase in BMI was 1.09 . A similar increase
in WHR was associated with an odds ratio
of 1.02.
Study conducted in Hong Kong
Singaporean
30
women
29
and
found waist to
stature ratio as best anthropometric index
that is strongly associated with Cardio
Result of our study is also in accordance
vascular risk factors. Since present study
with the
have
was cross sectional, similar studies should
increased abdominal fat and adipose tissue
be replicated with large sample size with
that predisposes them to increased risk of
better
evidence
that
Asians
study
design
to
enhance
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chronic health problems and supported the
generalizibility. The study was conducted
fact that in addition to BMI (assess over all
only on females, further investigation
obesity), WC should be measured in order
involving all obesity indices and multiethnic
to categorize the individual according to
population are necessary for effective
health risk.24, 25
control and management of hypertension.
Recent researches have supported fact that
WC is strong marker of health risk as
compared to BMI Qibin, et al reported WC
is strong determinant of health risk as
compared to BMI
26
CONCLUSION
The study indicates a positive association of
. Result of most recent
Waist circumference with hypertension.
study have proved that WC is strong
Measurement of waist circumference can
predictor of cardio metabolic risk factor
serve as effective tool to identify individual
while other obesity indices and BMI and
at high risk of developing cardio metabolic
27
disorder. This study also suggests that
However, some studies in south Asians did
abdominal fat more strongly associated
not support this finding For instance study
with disease risk factor. This analysis
WHR have no value in this regard.
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highlights the need of community based
educational program to create health
awareness for necessary for effective
prevention
and
management
of
hypertension.
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