|Year : 2012 | Volume
| Issue : 1 | Page : 8-12
Use of anthropometric indices as simple predictors of deranged lipid profile and at risk population for future cardiovascular events
Prashant Vishwanath1, Akila Prashant1, Anand Acharya1, MN Suma1, HS Kiran2, G Karthik3
1 Department of Biochemistry, JSS Medical College, JSS University, Mysore, India
2 Department of Medicine, JSS Medical College, JSS University, Mysore, India
3 Department of Biochemistry, Dr. B.R. Ambedkar Medical College, Rajiv Gandhi University, Bangalore, India
|Date of Web Publication||21-May-2012|
Department of Biochemistry, JSS Medical College, JSS University, Mysore
Source of Support: ICMR.STS 2010, Conflict of Interest: None
Context: Estimation of lipid profile requires fasting blood sample which needs a higher level of motivation. We were looking for simpler noninvasive tests or measurements that can be applied to larger population to predict lipid profile abnormality and at-risk population for future cardiovascular events. Aims: The aim was to measure anthropometric indices in relation to lipid profile and modifiable risk factors such as smoking and alcohol in a healthy young adult local population, and to assess the risk for future cardiovascular complications. Materials and Methods: The study was conducted on 500 young individuals (aged 18-30 years) across different sections of society in the local population. The lipid profile (total cholesterol, high density lipoprotein, low density lipoprotein, very low density lipoprotein and triglycerides) along with anthropometric indices like body mass index, waist circumference, and waist hip ratio was measured. Information on alcohol intake, smoking, and dietary habits was obtained through a prevalidated questionnaire. Data entry and all statistical analysis were done using statistical software Microsoft excel and Epi-info version 3.5.1. Results: BMI showed a significant correlation with total cholesterol (P = 0.0116), triglycerides (P = 0.0199), LDL cholesterol (P = 0.0284), and VLDL cholesterol (P = 0.0199). Smokers and alcoholics showed a significant increase in total cholesterol (P = 0.0062, P = 0.0009), triglycerides (P = 0.0437, P = 0.0317), LDL cholesterol (P = 0.0356, P = 0.0023), and VLDL cholesterol (P = 0.0437, P = 0.0317) respectively. Alcoholics showed a significant increase in waist hip ratio (P = 0.0082) when compared to the nonalcoholics. Conclusions: In agreement with other study our study reiterates the use of noninvasive anthropometric parameters as a screening tool for lipid profile abnormalities.
Keywords: Anthropometric indices, healthy individuals, lipid profile
|How to cite this article:|
Vishwanath P, Prashant A, Acharya A, Suma M N, Kiran H S, Karthik G. Use of anthropometric indices as simple predictors of deranged lipid profile and at risk population for future cardiovascular events. Int J Health Allied Sci 2012;1:8-12
|How to cite this URL:|
Vishwanath P, Prashant A, Acharya A, Suma M N, Kiran H S, Karthik G. Use of anthropometric indices as simple predictors of deranged lipid profile and at risk population for future cardiovascular events. Int J Health Allied Sci [serial online] 2012 [cited 2020 Jul 16];1:8-12. Available from: http://www.ijhas.in/text.asp?2012/1/1/8/96411
| Introduction|| |
Indians have considerably higher prevalence of premature coronary artery disease (CAD) and standardized mortality rates for CAD compared with Europeans, Chinese, and Malays. ,, A recent report from the study of health assessment and risk in ethnic groups (SHARE) indicates a significantly higher risk of cardiovascular events among South Asians compared with Europeans and Chinese.  Within the Indian subcontinent, a dramatic increase in the prevalence of CAD has been predicted in the next 20 years due to rapid changes in demography and lifestyle consequent to economic development. , Earlier studies in Asian Indians have shown that classical risk factors do not explain the excess of CAD seen in this ethnic group. ,,, It is also possible that the risk factors for CAD could differ considerably between native and migrant Indians because of differences in diet, physical activity, body weight, and lifestyle changes consequent to affluence and cultural changes consequent to migration. Studies on the prevalence and risk factors of CAD in native Indians within the subcontinent are, therefore, urgently needed, particularly since the population of India has crossed one billion.
Prevention of risk factors for cardiovascular diseases (CVD) such as obesity and dyslipidemia has been an important challenge in developing countries due to the westernization of diet and lifestyle changes.  One approach to preventing the condition was the identification of individuals at risk by screening with simple anthropometric measurements, followed by individualized counseling or treatment.  The anthropometric measurements of interest include waist circumference (WC),  waist-to-hip ratio (WHR),  waist--height ratio (WHtR),  skin fold thickness,  and body mass index (BMI).  These parameters were considered as measurements of obesity and part of diagnostic components of the metabolic syndrome. Interpretation of WC and other anthropometric parameters depends on ethnicity and cultural background, because adult anthropometry has been recognized as a biomarker of "early life." ,
Tobacco, mostly cigarette smoking, kills more than 440,000 people a year, making it more lethal than AIDS, automobile accidents, homicides, suicides, drug overdoses, and fires combined. It reduces life expectancy by 15--25 years and is the single most preventable cause of death. Smoking may be even more dangerous now than 30 years ago, most likely because the lower tar and nicotine levels in most cigarette brands cause people to inhale more deeply.
Moderate alcohol consumption is inversely associated with CVD and total death.  However, intake of more than 30 g of alcohol (that is, more than two drinks) per day is associated with an increased risk for hypertension.  Guidelines for alcohol consumption among patients with hypertension range from a limit of two to three drinks per day to complete abstention from alcohol.  These contradictory recommendations may reflect the paucity of information on the relation between alcohol consumption and risk for CVD among patients with hypertension.
Hence in this study we planned to study anthropometric indices in relation to lipid profile and modifiable risk factors such as smoking and alcohol in healthy young adult population and assess the risk for future cardiovascular complications.
| Materials And Methods|| |
Five hundred young individuals in the age group of 18--30 years undergoing routine health check examination in hospital and during health camps were included in the study. Majority of the subjects were literate and had at least education up to the level of secondary education. A lipid profile included total cholesterol, direct high density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides. All patients were on a 9- to 12-h fasting period before venous samples for lipid profile were drawn. Five milliliters of venous blood was drawn using aseptic precautions and serum was used for estimation of glucose and lipid profile. All tests were performed using Randox Daytona fully automated clinical chemistry analyzers and all quality control aspects were adhered to while performing the tests. VLDL cholesterol was calculated using the formula triglycerides/5.
Anthropometric indices were measured which included height in centimeters, weight in kilograms, waist circumference, waist-to-hip ratio, body mass index (BMI) along with a questionnaire which included total family income, dietary, family, and lifestyle habits like smoking and alcohol consumption. The study group was divided into four groups based on their BMI: group 1 (underweight) - BMI <18.5, group 2 (normal) - BMI 18.5-22.9, group 3 (overweight) - BMI 23-25, group 4 (obese) - BMI >25.
Arithmetic mean and standard deviation were estimated to assess the level of various lipid profile parameters. In order to test the significance of difference among four groups of obesity, analysis of variance was applied at 5% level of significance. Significance of difference, in various parameters between two categories of smoking and alcohol, was tested applying Student's t test at 5% level. Data entry and all statistical analysis were done using statistical software Microsoft excel and Epi-info version 3.5.1.
| Results|| |
Five hundred young individuals from the local population were included of which 70% were males and 30% were females. The frequency of obesity among the study group though not very high is quite significant (23%) as demonstrated in [Table 1].
|Table 1: The total number, percentage, and waist circumference of individuals in the four groups based on their body mass index|
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Total cholesterol, triglycerides, LDL was found to be high in overweight and obese category. Waist--hip ratio, in the fourth group is significantly increased when compared to the other three groups ( P = 0.0042). Thus [Table 2] indicates that total cholesterol, triglycerides, LDL cholesterol, and VLDL cholesterol are quite high in people with a BMI greater than 23.
|Table 2: Comparison of lipid profile parameters, LDL/HDL, TC/HDL, and waist-to-hip ratio in four groups based on body mass index|
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Total cholesterol values in smokers were high compared to nonsmokers ( P = 0.0062). The mean pack years smoked by the smokers was 3.6 ± 1.2. The pack year was calculated using the formula: pack years = (packs smoked per day) × (years as a smoker). The total cholesterol, LDL, and VLDL cholesterol as well as the waist-hip ratios were significantly higher in alcoholics ( P = 0.0009, P = 0.0023, P = 0.0317, and P = 0.0082 respectively) when compared to the nonalcoholic population [Table 3]. Alcohol use was measured by both frequency and intensity. The frequency of alcohol consumption was measured as days per month (grouped into none, 1-2, and 3 or more). The intensity of alcohol consumption as measured by frequency of bingeing (times per month when drank five or more drinks, grouped as none, 1-2, and 3 or more). In our study all the alcoholics belonged to the moderate drinking category i.e., 1-2.
|Table 3: Comparison of lipid profile parameters and waist-to-hip ratio between smokers and nonsmokers, alcoholics, and nonalcoholics|
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| Discussion|| |
Majority of the subjects were literate with degree or diploma (both included 73%). This denotes a high literacy and greater awareness of these subjects to screening of risk factors which is essential to prevent future complications due to lifestyle or anthropometric indicators.
Our study is in agreement with the previously published findings that the levels of total cholesterol, triglycerides, LDL cholesterol, VLDL cholesterol were significantly higher in overweight and obese individuals.  An increase in total cholesterol, LDL cholesterol, and triglycerides in overweight and obese individuals also supports the view that a simple calculation of BMI can act as a screening indicator of the future risk of cardiovascular or other ischemic complications. It is also well accepted that different anthropometric indices like waist circumference, waist hip ratio, and BMI are equally good in predicting cardiovascular risk.  In our study a positive correlation was seen when BMI, waist-hip ratio, and waist circumference was compared with total cholesterol, triglycerides, and LDL cholesterol. This indicates that any anthropometric index can be used as a screening test for predicting future cardiovascular risk. Studies have shown that LDL/HDL ratio or cholesterol/HDL ratio are better indicators than lipoproteins itself in indicating cardiovascular risk. , However, in our study the levels of HDL cholesterol did not show significant difference between the four groups of obesity.
Smokers did not show a significant increase in the waist hip ratio when compared to the nonsmokers; however alcoholics showed a significant increase in the waist hip ratio when compared to the nonalcoholics. Alcohol represents an important source of energy. As a result of the caloric content of the alcohol as well as its appetite-enhancing effects moderate amounts of alcohol enhance energy intake. Experimental evidence from several metabolic studies showed a suppression of lipid oxidation by alcohol and thus the enhancement of a positive fat balance. The nonoxidized fat is preferentially deposited in the abdominal area. The experimental metabolic evidence suggests that the consumption of moderate amounts of alcohol has to be accounted for in the energy-balance equation and may represent a risk factor for the development of a positive energy balance and thus weight gain. 
This study in agreement with other studies has shown an association between anthropometric indices and lipid profile markers. This strong association may help us to make use of simple anthropometric indices as a screening tool in the society for prediction of future cardiovascular complications. Alcohol consumption and smoking has positively correlated with abnormal lipid profile indicating dyslipidemia in them and possible future risk of cardiovascular events. The major limitation of the study was that the subjects were recruited for the study from a single center. The results of this pilot study should not be extrapolated to larger population due to its limitation. However, the results of this study can be used to conduct larger multicentric studies to prove or disprove the findings.
| Conclusions|| |
Dyslipidemia has been identified as a single or combined risk factor for the development of cardiovascular, renal, metabolic disorders. Identifying early dyslipidemia in young adults and taking corrective measures then would help reduce the cardiovascular disease burden. Contrary to the notion that obesity is a disease that mainly affects the higher socioeconomic strata we have shown that it is present across all sections of society equally. Hence, intense measures like education about diet and exercise has to be initiated at all levels of society. Identifying dyslipidemia early in the adult life and taking corrective measures can prevent or prolong the onset of cardiovascular diseases. There is a strong association of anthropometric indices like BMI, waist circumference and waist hip ratio with abnormal lipid profile. Simple noninvasive, economic measurements like BMI, waist circumference or waist hip ratio can be used as screening tools to predict future risk for cardiovascular events.
| Acknowledgment|| |
This study was supported by ICMR-STS 2010.
| References|| |
|1.||Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J 1996;48:343-53. |
|2.||Hughes K, Yeo PP, Lun KC, Sothy SP, Thai AC, Wang KW, et al. Ischaemic heart disease and its risk factors in Singapore in comparison with other countries. Ann Acad Med Singapore 1989;18:245-9. |
|3.||Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: The Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet 2000;356:279-84. |
|4.||Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in the developing countries. Circulation 1998;97:596-601. |
|5.||McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991;337:382-6. |
|6.||Ramachandran A, Snehalatha C, Latha E, Satyavani K, Vijay V. Clustering of cardiovascular risk factors in urban Asian Indians. Diabetes Care 1998;21:967-71. |
|7.||Pais P, Pogue J, Gerstein H, Zachariah E, Savitha D, Jayprakash S, et al. Risk factors for acute myocardial infarction in Indians: A case-control study. Lancet 1996;348:358-63. |
|8.||Yamada M, Wong FL, Kodama K, Sasaki H, Shimaoka K, Yamakido M. Longitudinal trends in total serum cholesterol levels in a Japanese cohort, 1958-1986. J Clin Epidemiol 1997;50:425-34. |
|9.||Paccaud F, Schlüter-Fasmeyer V, Wietlisbach V, Bovet P. Dyslipidemia and abdominal obesity: An assessment in three general populations. J Clin Epidemiol 2000;53:393-400. |
|10.||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;53:401-8. |
|11.||Snehalatha C, Viswanathan V, Ramachandran A. Cutoff values for normal anthropometric variables in Asian Indian adults. Diabetes Care 2003;26:1380-4. |
|12.||Hsieh SD, Yoshinaga H, Muto T. Waist-to-height ratio, a simple and practical index for assessing central fat distribution and metabolic risk in Japanese men and women. Int J Obes Relat Metab Disord 2003;27:610-6. |
|13.||Durnin JV, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: Measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974;32:77-97. |
|14.||Vikram NK, Misra A, Pandey RM, Dudeja V, Sinha S, Ramadevi J, et al. Anthropometry and body composition in northern Asian Indian patients with type 2 diabetes: Receiver operating characteristics (ROC) curve analysis of body mass index with percentage body fat as standard. Diabetes Nutr Metab 2003;16:32-40. |
|15.||Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97. |
|16.||Maclure M. Demonstration of deductive meta-analysis: Ethanol intake and risk of myocardial infarction. Epidemiol Rev 1993;15:328-51. |
|17.||Fuchs FD, Chambless LE, Whelton PK, Nieto FJ, Heiss G. Alcohol consumption and the incidence of hypertension: The atherosclerosis risk in communities study. Hypertension 2001;37:1242-50. |
|18.||Thadhani R, Camargo CA Jr, Stampfer MJ, Curhan GC, Willett WC, Rimm EB. Prospective study of moderate alcohol consumption and risk of hypertension in young women. Arch Intern Med 2002;162:569-74. |
|19.||Cugnetto ML, Saab PG, Llabre MM, Goldberg R, McCalla JR, Schneiderman N. Lifestyle factors, body mass index, and lipid profile in adolescents. J Pediatr Psychol 2008;33:761-71. |
|20.||Gruson E, Montaye M, Kee F, Wagner A, Bingham A, Ruidavets JB, et al. Anthropometric assessment of abdominal obesity and coronary heart disease risk in men: The PRIME study. Heart 2010;96:136-40. |
|21.||Panagiotakos DB, Toutouzas PK. Importance of LDL/HDL cholesterol ratio as a predictor for coronary heart disease events in patients with heterozygous familial hypercholesterolemia: A 15 year follow up (1987 - 2002). Curr Opinion Med Res 2003;19:89-94. |
|22.||Packard CJ, Ford I, Robertson M, Shepherd J, Blauw GJ, Murphy MB, et al. The PROSPER Study Group: Plasma lipoproteins and apolipoproteins as predictors of cardiovascular risk and treatment benefit in the Prospective study of pravastatin in the elderly at risk (PROSPER). Circulation 2005;112:3058-65. |
|23.||Suter PM. Is alcohol consumption a risk factor for weight gain and obesity? Crit Rev Clin Lab Sci 2005;42:197-227. |
[Table 1], [Table 2], [Table 3]