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THE RELATIONSHIP OF BODY MASS INDEX AND WAIST TO HIP RATIO MEASUREMENTS WITH BLOOD PRESSURE IN YOUNG ADULTS ATTENDING THE OUTPATIENT CLINIC OF THE FEDERAL MEDICAL CENTRE, OWERRI, IMO STATE
SUMMARY
Background
This study determined the relationship of body mass index (BMI) and waist-to-hip ratio (WHR) measurements with blood pressure in young adult patients attending the general outpatient clinic of Federal Medical Centre (FMC) Owerri. The study is intended to create awareness on the burden of non-communicable disease in this locality. Body mass index and waist to hip ratio were used in this present study to determine obesity for two main reasons. Firstly, due to simplicity and reproducibility of height, weight, hip and waist circumference measurements; secondly because both have been recognized as important indicators for estimating cardiovascular disease risk factors, in particular, their association with hypertension.
Patient and Methodology
A hospital based descriptive cross sectional study was carried out with a structured questionnaires administered on 482 eligible consenting young adult patients (16 to 40 years) attending the general outpatient clinic of FMC, Owerri between January and
March 2011. Body mass index (BMI) was calculated as body weight (BW) in kilograms (kg) divided by the square of the body height (BH) in meter (m2), while central obesity was calculated and defined on the basis of waist-to-hip ratio (WHR). The cut-off value of central obesity was considered >0.90 in males, normal value for females was <0.80. Blood pressure measurements were taken. The Seventh Report of Joint National
Committee on Prevention, Detection, Evaluation and Treatment of High blood pressure
(JNC-VII) criteria was used for classification.
Results:
Two hundred and ninety four females (61%) and 188 males (39%) participated in the study.
The mean age, BMI, WHR, systolic and diastolic blood pressure of all the participants
were 25±5.5 years, 22.7±3.5kg/m2, 0.82±0.04, 116.34±13.33mmHg and 75.90±9.90mmHg, respectively. The prevalence of hypertension was 12.7 %( 61 out of 482). Based on BMI classification, the prevalence of obesity was 3.7 percent (n =
18 out of 482), the prevalence was higher in females (n = 14, 4.7%) than in males (n = 4, 2.1%). Obesity status based on Waist-to-hip ratio (WHR) revealed an obesity prevalence of 39.4 percent (n = 190) with females having a higher prevalence (n = 174, 59.2%), than males (n = 16, 8.5%). BMI was found to correlate better than WHR with blood pressure (BP).
CONCLUSION
The prevalence of high blood pressure in the study population was 12.7%. The prevalence of obesity using body mass index was 3.7%. Assessment of obesity status using waist-to-hip ratio gave a prevalence of 39.4%. Body mass index had a strong linear relationship with diastolic blood pressure and correlated better than waist-tohip ratio in predicting hypertension risk in the study population.
This study highlights the importance of Family physicians making a diagnosis of Overweight and Obesity especially in young adults, by measuring their body mass index. Hence, counseling them on the need for weight reduction and maintenance of healthy weights and lifestyle pattern. Young people should also have their BP checked. This is a primary preventive measure targeted at the young adults. Studies are needed in this age group to determine which anthropometric measurement is a better predictor of hypertensive risk in the other geo-political regions of this country.
TABLE OF CONTENTS
Title i
Declaration ii
Dedication iii
Acknowledgement iv
Certification v
Table of contents vi
List of Tables x
List of figures xi
List of Abbreviations and Acronyms xii
Summary 1
Chapter One 3
1.0 Introduction 3
1.1 Rationale of study 5
1.2 Aim 6
1.3 Objectives 6
Chapter Two 8
2.0 Literature Review 8
2.1 Historical trends in Obesity 8
2.2 Definition of Obesity 9
2.3 Aetiology of Obesity 12
2.3.1 Diet 13
2.3.2 Sedentary lifestyle 13
2.33 Genetics 14
2.3.4 Medical and Psychiatric Illness 15
2.3.5 Social determinants 15
2.4 Pathophysiology 19
2.5 Epidemiology 20
2.6 Classification 21
2.7 Complication of Obesity 21
2.8 Management of Obesity 23
2.9 Hypertension 25
2.9.1 Definition and classification of hypertension 26
2.9.2 Aetiology of Hypertension 27
2.9.3 Diagnosis 27
2.9.4 Prevention of Hypertension 28
2.9.5 Management of Hypertension 30
Lifestyle Modifications 30
Medications 31
2.10 Relationship of body mass index and waist to hip ratio with blood
pressure. 32
Chapter Three 40
3.0 Materials and Method 40
3.1 Study Location 40
3.2 Study population 41 3.3 Study design 41
3.4 Sample size determination 41
3.5 Sample Technique 42
3.6 Inclusion criteria 42
3.7 Exclusion criteria 43
3.8 Method of data collection 43
3.8.1 Anthropometrical measurements 43
3.8.2 Blood pressure measurements 44
3.9 Method of data analysis 45
Chapter Four 46
4.0 Results 46
4.1 Social demographic characteristics of participants 46
4.2 Age and sex distribution of the study population 48
4.3 BMI distribution of the study population 51
4.4 Life style behavior of participants 52
4.5 Prevalence of high blood pressure among young adults attending FMC
Owerri 53
4.6 Prevalence and pattern of obesity among young adults attending FMC
Owerri 57
4.7 Relationship between BMI and blood pressure of young adults 58
4.8 Pattern of body mass index and blood pressure Classification 61
4.9 Relationship between WHR and blood pressure among young adults 62
4.10 Pattern of waist to hip ratio and Blood pressure 65
4.11 Comparative analysis of obesity based on BMI, WHR and its
relationship with blood pressure 68 Chapter Five 70
5.0 Discussion 70
5.1 The Relationship between BMI and Blood Pressure in young adults 73
5.2 The Relationship between WHR and Blood Pressure in young adults 74
5.3 Limitations 75
5.4 Conclusions 76
5.5 Recommendations 77
References 78
CHAPTER ONE
1.0 Introduction
The relationship between excess weight and diseases has been recognized over time.1 Obesity has been particularly recognized as a major independent risk factor for cardiovascular disease.2 This is because increased body fat is accompanied by profound changes in the physiological and metabolic functions of the body, which are directly dependent on the degree of excess weight and on its distribution around the
body.
Casual blood pressure (BP) is the most frequent measurement undertaken among adults in general or family practice.3 Several studies have reported a relationship between obesity and hypertension.4
Obesity is defined as an excess of adipose tissue.5 Every individual needs an amount of body fat for energy, heat insulation, and shock absorption. However excessive deposition of fat in the body is dangerous.6
The prevalence of overweight and obesity in most developed countries and in urban areas of many less developed countries has been increasing markedly over the past twenty years.7
There are a number of health hazards associated with obesity, these include diabetes, hypertension, cardiovascular disease, arthritis, anaesthesia risk, respiratory problems, breast cancer, menstrual abnormalities, ovarian dysfunction along with poor social image and rejection.8 Approximately 60%of persons in the USA have metabolic syndrome as defined by the Third Report of the National Treatment Panel.9 Also epidemiological studies begun in the 1970, indicate that adiposity contributes to the increased incidence and/or death from cancers of the colon, endometrium, kidney
(renal cell), oesophagus (adenocarcinoma), pancreas, gall bladder and liver.10
The World Health Organization (WHO) has updated recommendations for action to governments, international agencies and concerned partners in the public and private sectors, as there is a need to assess the burden and determinants of the problem in various populations for effective control measures.11
Nigeria, as a developing country, like other developing countries is facing ‘double burden’ of disease. While efforts are made to prevent and control infectious diseases, such as, vaccine-preventable diseases (e.g. measles, polio, hepatitis), those related to water and sanitation (e.g. gastroenteritis and malaria) non communicable diseases (NCDs), such as, cardiovascular disease, hypertension and diabetes are also posing health burden.12
Globalization, increasing urbanization, changes in traditional family structures and life styles, directly affect dietary and physical activity patterns and ultimately increase the risk of such diseases.13
Obesity was thought to be the direct result of sedentary lifestyle and chronic ingestion of excess calories, but now evidence for strong genetic influences on the development of obesity are available.14 Adopted children demonstrate a close relationship between their body mass index and that of their biological parents.15
Adipose tissue is of two main types, the subcutaneous and visceral. Subcutaneous adipose tissue is that between the skin and muscle, whereas visceral adipose tissue is found mainly in abdominal cavity.16 Abdominal visceral adipose tissue is more metabolically active than abdominal subcutaneous adipose, as they have a high lipolytic activity and release large amounts of free fatty acid. Ideal measurement of adiposity should therefore consider both the amount and site of deposition of the adipose.16
Many methods of estimating total body fat have been developed and include imaging methods such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), which are able to distinguish between subcutaneous and visceral abdominal adipose tissue. Both are however expensive for large-scale epidemiological studies. Definitions for reporting healthy weight, overweight, and obesity have therefore been based historically, on anthropometric rather than clinical measures of adiposity. 5, 16
1.1 Rationale of Study
My observation while working in the general outpatient clinic of the Federal Medical Centre Owerri is that systemic hypertension is one of the most common noncommunicable disease (NCD) presenting there with co-morbidities of various sorts. There has been increase in mortality as a result of the complications of hypertension which includes cerebrovascular accidents, cardiac failure and end stage renal disease. These complications are preventable with early intervention, by adoption of a healthy lifestyle and pharmacological means. Globalization, increasing urbanization, changes in traditional family structures and lifestyle, directly affect dietary and physical activity patterns and ultimately increase the risk of hypertension and this is a critical health issue.
The exponential unabated rise in the prevalence of overweight and obesity and their associated risk factors in both developed and developing countries has become a source of concern now than it has ever been in the past. 17
There is a rising trend in overweight and obesity in children and adolescents in developing countries generally and it is widely recognized that childhood obesity is the root cause of adult obesity and cardiovascular disease.15
Thus, this study determined the relationship of body mass index and waist to hip ratio measurements with blood pressure in young adults attending the general outpatient clinic of Federal Medical Center (FMC) Owerri. Most of the studies done on this subject in this region were focused on adults. The study was intended to create awareness on the burden of non-communicable disease in this locality; it is a primary preventive measure. A simple inexpensive anthropometric index, such as waist circumference, or body mass index, is said to be useful to health care providers in the clinical office setting because of its high predictive power to identify individuals with cardio metabolic risk factors who may have heightened risk of cardiovascular disease (CVD).18
The result of this study shall add more information to the existing body of knowledge relating obesity indicators to blood pressure in Nigeria. It shall enhance the role of Family Physicians to advocate for promotive and preventive measures to reduce the burden of Obesity and Hypertension. The current practice of pharmacological and nonpharmacological intervention in managing hypertension will be enhanced by the result of this study. It will also form a basis for future counseling, policy making, planning strategies, implementation and monitoring of intervention programmes aimed at young adults. The result of this study shall be primarily sent to the National Postgraduate Medical College of Nigeria and also made available to the departmental library for use by other family physicians later. This study is an answer to a call for health promotion targeted at youths.
1.2 AIM
The study examined the Body Mass Index profile, waist to hip ratio measurements and its relationship with blood pressure of young adults attending the general outpatient clinic of Federal Medical Centre Owerri, in order to establish which of the two anthropometric indices is a better predictor of hypertension in the population.
1.3 OBJECTIVES
- To determine the prevalence of high blood pressure and obesity in the study population.
- To determine the relationship between Body Mass Index and blood pressure in young adults.
- To determine the relationship between waist to hip ratio measurements and blood pressure in young adults.
THE RELATIONSHIP OF BODY MASS INDEX AND WAIST TO HIP RATIO MEASUREMENTS WITH BLOOD PRESSURE IN YOUNG ADULTS ATTENDING THE OUTPATIENT CLINIC OF THE FEDERAL MEDICAL CENTRE, OWERRI, IMO STATE
