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The aim of this pioneer study in a rural community,maya,in ikorodu a suburb of lagos is to determine the prevalence of obesity and central obesity in a rural area.

BODY MASS INDEX,WAIST CIRCUMFERENCE,WAIST HIP RATIO AS PREDICTORS OF OBESITY AND ABDOMINAL OBESITY IN IKORODU:A COMMUNITY SURVEY.

ADEMOLU A. B1,ADEMOLU A.O2,IPADEOLA A 3,OGBERA A.1 CORRESPONDENCE TO DR ADEMOLU A.B (ademoluab@yahoo.com 08033575940)

  1. DEPARTMENT OF MEDICINE LAGOS STATE UNIVERSITY TEACHING HOSPITAL,(LASUTH)IKEJA,LAGOS.NIGERIA.
  2. DEPARTMENT OF PAEDIATRIC,OLABISI ONABANJO UNIVERSITY TEACHING HOSPITAL SAGAMU OGUN STATE.NIGERIA
  3. DEARTMENT OF MEDICINE UNIVERSITY COLLEGE HOSPITAL(UCH)IBADAN.OYO STATE.NIGERIA.

ABSTRACT

OBJECTIVE: The aim of this pioneer study in a rural community,maya,in ikorodu a suburb of lagos is to determine the prevalence of obesity and central obesity in a rural area.

METHODOLOGY

In this preliminary study,the weight,height,waist circumference and hip circumference of 52 participants living in lkorodu a surburb of Lagos was taken using standard measurement protocol.The study location is maya a rural community in lkorodu north local council development area.The participants were recruited following obtaining consent through their opinion leader.The measurement protocol used for waist circumference(WC) is that WC was taken at the umbilicus or navel level,this is the same as the United States(US)National Institute of Health(NIH)protocol for the measurement of waist circumference for the Multi-Ethnic study of Atherosclerosis(MESA)study. The measurement protocol used also require that anatomically the patient stands erect with the arms at the sides ,feets positioned close together ,and weight evenly distributed across the feet, this is the WHO STEPS protocol recommendation which was adopted in this study. The NHANES(United States National Health and Nutrition Examination Survey)III protocol was followed in taking the measurement at minimal expiration . By adopting the WHO STEPS protocol a stretch resistant tape was used with the tape held snugly,but not constricting and at a level parallel to the floor.Measurement was taken with the subject relaxed and taking natural breaths before the actual measurement was made .Prior to the measurement none of the participants ate or drank water or any other form of oral ingestion at least 4hours prior to taking the measurement. All the participants where on light clothings. The WHO STEPS protocol and NHANES III protocol both indicate that the hip circumference measurements should be taken around the widest portion of the buttocks.This was adopted in this study with the measurement taken with the tape parallel to the floor. In interpreting the measurements,the United State criteria for waist circumference cut offs associated with increased risk was used that is >102cm in men and >88cm in women,since in Africa no ethnic specific cut offs is determined yet.

RESULTS

The prevalence of obesity in ikorodu is 34.62%.The prevalence of obesity in male and female are 21.15% and 13.46%.The prevalence of central obesity in ikorodu using the waist circumference is 23.08%.The prevalence of central obesity in male and female using same waist circumference is 1.92% and 21.15%. The prevalence of central obesity in ikorodu using the waist hip ratio is 69.23%,the prevalence of central obesity in male and female using same measurement is 28.85% and 40.39%.The prevalence of underweight in ikorodu is 1.92%.

CONCLUSION

The prevalence of obesity in ikorodu is 34.62%.lncreased physical activity like sporting activity will help to reduce the incidence since 36.54% of the population is presently overweight.

INTRODUCTION

Obesity is fast becoming a worldwide epidermic.Though not a widely discussed disease during the times of Hippocrates,yet it is doubtless a disease that dated back to ancient times that is now increasingly gaining international recognition by way of increasing prevalence.In every region of the world,obesity doubled between 1980 and 2008,says Dr Ties boerma,Director of health statistics and information systems at WHO.Today,half a billion people (12% of the worlds population)are considered obese. The highest obesity levels are in the WHO Region of the Americas (26% of adults) and the lowest in the WHO South-East Asia Region (3% obese). In all parts of the world, women are more likely to be obese than men, and thus at greater risk of diabetes, cardiovascular disease and some cancers. Obesity is an excess of body fat(adipose tissue).It is an abnormal accumulation of body fat in proportion to body size.Obesity represents a state of excess storage of body fat.It is also defined as an excess body weight for height.The immediate cause of obesity is net energy imbalance. Although socio economic class and the prevalence of obesity are negatively correlated in most developed countries,this correlation is distinctly reversed in many relatively undeveloped areas.Available data from the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease(MONICA)project suggest obesity in Europe to be seen in 15% of men and 22% 0f women.(1) Following identification of leptin in 1994 in ob/ob mice through positional cloning,leptin was recognised as an anorexic hormone produced predominantly in white adipose tissue(also in placenta,skeletal muscle and stomach fundus).Its major role in body weight regulation is to signal satiety to the hypothalamus and,thus,reduce dietary intake and fat storage while modulating energy expenditure and carbohydrate metabolism to prevent further weight gain.Leptin effect on the arcuate nucleus melarnocortin system is now considered central to the regulation of feeding and metabolism.It is worth noting that many humans who are obese are not leptin deficient but rather leptin resistance. In Australia,the prevalence of obesity amongst Australian adults defined by body mass index,waist circumference and waist hip ratio was 20.8,30.5 and 15.8% respectively.(2) Studies from sub-Saharan countries also report increasing prevalence in urban and rural areas e.g. South Africa, Kenya, cameroun. In Nigeria,there is no national data on prevalence of obesity. There are three forms of obesity ,peripheral,central and a combination of both . Peripheral obesity is the accumulation of excess fat in the buttocks, hips and thighs, whereas central obesity is an excess accumulation of fat in the abdominal area. This is an especially dangerous place for fat to build up because it is closely located to the vital organs and their blood supply. The fat can then be released into the blood; this process is responsible for most of the negative health consequences associated with obesity, such as:Type 2 diabetes;Glucose intolerance;High blood pressure;Endometrial cancer;Artherosclerosis;Insulin resistance; Altered metabolic profile;Metabolic syndrome;Cardiovascular disease;Obesity-related lipid disorders (e.g. hypertriglyceridaemia; hypo-HDL-cholesterolaemia)(3). Sex differences in body composition are primarily attributable to the action of sex steroid hormones,which drive the dimorphisms during pubertal development.In men,a reduction in free testosterone levels is associated with an increase in fat mass and reduction in muscle mass,and both total and free testosterone levels are inversely associated with obesity(4).Central obesity is very common in elderly people because body fat is often redistributed to the abdominal region during the ageing process. On average, premenopausal women have half the abdominal fat of men; this is largely due to body shape. While women generally have a higher total and percentage body fat, it is more often located on their hips and thighs due to their pear-shaped bodies. Men naturally have an apple shape, and carry excess weight in their abdominal region(3). Abdominal obesity, also known as belly fat or clinically as central obesity, is excessive abdominal fat around the stomach and abdomen. It can also occur in both children and teenagers if either of their parents have Abdominal obesity.There is a strong correlation between central obesity and cardiovascular disease.(5) Abdominal obesity is not confined only to the elderly and obese subjects.(6) Abdominal obesity has been linked to Alzheimer’s Disease as well as other metabolic and vascular diseases.(7).Visceral and central abdominal fat and waist circumference show a strong association with type 2 diabetes.(8) Visceral fat, also known as organ fat or intra-abdominal fat, is located inside the peritoneal cavity, packed in between internal organs and torso, as opposed to subcutaneous fat’ which is found underneath the skin, and intramuscular fat’ which is found interspersed in skeletal muscle. Visceral fat is composed of several adipose depots including mesenteric, epididymal white adipose tissue (EWAT) and perirenal fat. An excess of visceral fat is known as central obesity, the “pot belly” or “beer belly” effect, in which the abdomen protrudes excessively.Abdominal obesity is more closely related with metabolic distractions connected with cardiovascular disease than was general obesity.Some studies indicate that visceral adiposity ,together with lipid disregulation and decreased insulin sensitivity (9) is related to the excessive consumption of fructose(10,11,12). Other environmental factors, such as maternal smoking, estrogenic compounds in the diet’ and endocrine-disrupting chemicals (hormones)may be important also.Lipotoxicity,hypercortisolism,dexamethasone and other steroids can also results in central obesity. Whilst precise, sophisticated techniques for measuring body fat distribution and body composition are available (13,14), they are generally not appropriate outside specific research settings. Simple anthropometric measurements have been used as surrogate measurements of obesity and have more practical value in both clinical practice and for large-scale epidemiological studies. Body mass index (BMI), which relates weight to height, is the most widely used and simple measure of body size, and is frequently used to estimate the prevalence of obesity within a population (15,16).BMI is the best indicator of underweight waist hip ratio should not be used for this measure. BMI has been found to be consistently associated with an increased risk of cardiovascular disease (CVD) and type 2 diabetes (17), yet this measurement does not account for variation in body fat distribution and abdominal fat mass, which can differ greatly across populations and can vary substantially within a narrow range of BMI (18). Excess intra-abdominal fat is associated with greater risk of obesity-related morbidity than is overall adiposity (19,20). Thus, measurements of waist circumference and waist–hip ratio (WHR) have been viewed as alternatives to BMI, with both measures regularly used in the clinical and research settings. Waist circumference has been shown to be the best simple measure of both intra-abdominal fat mass and total fat (21,22).In this study,obesity and central obesity is diagnosed and analysed in ikorodu using these parameters.

METHODOLOGY

ln this preliminary study,the weight,height,waist circumference and hip ratio of 52 participants living in lkorodu a surburb of Lagos was taken using standard measurement protocol.The study location is maya a rural community in lkorodu north local council development area.It is a new site with a growing population estimate of three thousand(3000) due to influx of people from lagos metropolis due to increased cost and standard of living.The participants were recruited following obtaining consent from them through their opinion leader.The measurement protocol used for waist circumference(WC) is that WC was taken at the umbilicus or navel level,this is the same as the United States(US)National Institute of Health(NIH)protocol for the measurement of waist circumference for the Multi-Ethnic study of Atherosclerosis(MESA)study. However,published reports indicate that measurement of waist circumference made at the level of the umbilicus may underestimate the true waist circumference(23).The measurement protocol used also require that anatomically the patient stands erect with the arms at the sides ,feets positioned close together ,and weight evenly distributed across the feet, this is the WHO STEPS protocol recommendation which was adopted in this study. The NHANES III protocol(United States National Health and Nutrition Examination Survey) was followed in taking the measurement at minimal expiration (24). By adopting the WHO STEPS protocol a stretch resistant tape was used with the tape held snugly,but not constricting and at a level parallel to the floor.Measurement was taken with the subject relaxed and taking natural breaths before the actual measurement was made .Prior to the measurement none of the participants ate or drank water or any other form of oral ingestion at least 4hours prior to taking the measurement.All the participants where on light clothings. The WHO STEPS protocol and NHANES III protocol both indicate that the hip circumference measurements should be taken around the widest portion of the buttocks.This was adopted in this study with the measurement taken with the tape parallel to the floor. None of the female participants were pregnant and the weight were taken by using standard weighting scale and height was determined by measurement during the exercise with the shoes removed.The exercise lasted for 3hours.In interpreting the measurements,the United State criteria for waist circumference cut offs associated with increased risk was used that is >102cm in men and >88cm in women,since in Africa no ethnic specific cut offs is determined yet.

RESULTS

A total of 52 participants were recruited with age range of 25 to 72years.30(57.69%)were male while 22(42.31%)were female.14(26.92%)participants had normal weight,of these 11(21.15%)were male while 3(5.77%)were female. 19(36.54%)participants were overweight,of these 8(15.39%)were male while 11(21.15%)were female. 18(34.62%)participants were obessed,of these 11(21.15%)were male while 7(13.46%)were female(see table 1). Among the obesed population,14(77.8%)had class l obesity(body mass index 30.0-34.9),8(44.4%)males and 6(33.3%)females;3(16.7%)had class ll obesity,2(11.1%)female,1 male(5.6%);while 1(5.6%)had class lll obesity(body mass index >40.0)she was a 61years old lady with body mass index of 41.12,waist circumference of 100 and waist hip ratio of 1.1. By using the waist hip ratio to determine central abdominal obesity,36(69.23%)participants had central obesity,of these 15(28.85%)were male while 21(40.39%)were female.In contrast by using waist circumference only 12(23.08%)had central abdominal obesity,out of these only one(1.92%) was a male while11(21.15%)were female(see table 2). In all, only one female participants was underweight with a body mass index of 16.1,she had a waist circumference of 83 which is normal but a waist hip ratio of1.2 which suggest central abdominal obesity,though the waist circumference is more reliable. BMI_Table1 BMI_Table2

DISCUSSION

This study is the pioneer study of obesity and central obesity in ikorodu.The prevalence of obesity in ikorodu is 34.62%.The prevalence of obesity in male and in female are 21.15% and 13.46%.Higher class of obesity are commoner in females according to this study. The prevalence of central obesity in ikorodu using the waist circumference is 23.08%.The prevalence of central obesity in male and female using same is 1.92% and 21.15%. The prevalence of central obesity in ikorodu using the waist hip ratio is 69.23%,the prevalence of central obesity in male and female using same measurement is 28.85% and 40.39%.The prevalence of underweight in ikorodu is 1.92%. It can be inferred from this study that waist hip ratio as a predictor of central obesity overestimates both in the general population and genderwise ,compared to waist circumference which is a better predictor(25).In this study,waist hip ratio overestimates central obesity in the general population three fold than the waist circumference ( 69.23% compared to 23.08% stated by waist circumference).Genderwise,it can also be inferred that though waist hip ratio as a predictor of central obesity is less reliable compared to waist circumference yet when used, it is a more reliable predictor in female than in males as it overestimated central obesity with respect to waist circumference only two fold in female(40.39% as against 21.15% stated by waist circumference) compared to fifteen fold in male(28.85% as against 1.92% stated by waist circumference). In a study,strengths of associations and discrimination statistics suggested that waist hip ratio was the best predictor of cardiovascular events and mortality in patients with type-2 diabetes and body mass index the worst (26).In the second MONICA study(MONItoring trends and determinants in CArdiovascular disease (MONICA) survey from 1987-1992.) it was noted that Waist circumference and waist hip ratio, both of which are used as indicators of abdominal obesity, seem to measure different aspects of the human body: waist circumference reflects mainly the degree of overweight whereas WHR does not.(27). In rotterdam,the proportion of mortality attributable to large waist circumference among never smoking men was three fold the proportion attributable to high body mass index.Among never smoking women and ex- and current smokers,cetegories of large study fatness did not predict increased mortality.(28). Successful weight management requires a life-long commitment to a healthy lifestyle, which is focused on eating healthy foods and keeping physically active in a way that is both sustainable and enjoyable. The following ideas may help those wanting to lose weight,try to eat lots of fruit, vegetables, wholegrain breads and cereals ,reduced-fat dairy foods, lean meats and meat alternatives such as eggs, dried beans, lentils and nuts.Moderate amounts of healthy fats such as olive and canola oils, nuts and avocado and remember to drink plenty of water each day, include only small amounts of foods high in saturated fat, sugar and salt.It is also advised to keep physically active eat only when hungry- getting too hungry can lead to overeating ,eat slowly and stop eating once comfortably full,if emotional eating is a concern, think about other activities that make you feel better as eating only provides short-term comfort.(29). Pharmacological agents currently used in management of obesity include centrally acting appetite suppressants drug phentermine;peripherally acting drugs that reduce fat absorption like orlistat,these drugs causes reduction in total cholesterol,low density lipoprotein and triglycerides and elevation in high density lipoproteins.Drugs that increase energy expenditure like ephedrine and caffeine are also used.Fluoxetine,topiramate and bupropion are also used in medical management of obesity.Rimonabant also causes weight loss.Bariatrc surgery is also used in morbid obesity especially when body mass index is greater than 35 and it has been reported to ameliorate or resolve comorbidities of obesity like type II diabetes mellitus,hypertension,dyslipidaemia ,heart failure and so on.(30)

CONCLUSION

The prevalence of obesity in ikorodu is 34.62%.lncreased physical activity like sporting activity will help to reduce the incidence since 36.54% of the population is presently overweight. Since obesity is assuming a worldwide dimension with its associated risk factor,morbidity and mortality,an urgent step doubtless is needed to curb its incidence.Since the anorexic hormone leptin plays a major role in feeding and metabolism, I suggest that more studies have to be done to evaluate the use of leptin in human subjects both prophylactically in overweight patients as primary prevention of obesity and therapeutically in obese patients for the management of obesity. An international panacea to this emerging epidermic of obesity presently ravaging the world is urgently needed. ACKNOWLEDGEMENT:I appreciate the efforts of Professor Mohammed Shakir who read and correct the abstract of this article. DISCLOSURE: None.

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