Medical, Socialogical and environmental issues in cardiovascular disease epidemiology, prevention and rehabilitation.
Waist Circumference, Waist:Hip Ratio and Conicity Index in Hypertensive Elderly
Nitin J Mehta
Independent Researcher, Mumbai 400018

Epidemiological studies have shown that hypertension is present in 25% of urban and 10% of rural population of India [1]. Even though there is a difference of measurement methodology of blood pressure in these studies as compared to clinic based measurements, age specific prevalence rates in 1995 and 2002 showed no significant differences in the mean blood pressure levels in 60+ subjects. In a study [2] elderly persons totalling 214, showed hypertension to the extent of 19.1 %. Studies have indicated that hypertension is a major health problem among the elderly in our country [3,4,5] and there is an association of body fat and fat distribution with blood pressure [6].

In the present on going survey of senior citizens, out of 388 elderly male subjects 100 were reported to have hypertension, i.e. 25.77%. This time a cut off point of 55 yrs has been taken to define elderly people. Waist Circumference [WC], Hip circumference [HC], is measured, and Body Mass Index [BMI], Waist: Hip ratio [W/H ratio], Conicity Index [CI], was calculated by the standard equations.

The data presented show that HT subjects have greater overall high adiposity [BMI] central adiposity [WC, HC], central body fat distribution [WH ratio, CI]. A noteworthy observation is that NT and HT subjects have similar levels of obesity BMI values are up to 23 kg/m2, now that the debate is on to reduce this from 25kg/m2. [7]. This leads to WC, HC, and its ratio CI being better predictors of cardiovascular mortality [8], while others [9] have shown the opposite effects on the risk of cardiovascular diseases .WC is a simple non invasive and accurate predictor of risk of diabetes type 2 [10], effective measure of truncal adiposity in children and adolescents [11]. In doctor’s office [16], risk factors for CHD [12, 13], however, CI does not have any major advantage over WHR as a surrogate for abdominal adiposity [14]. Hazarika et al [14] reported the prevalence of HT to be 33.3% WH ratio <0.90 in 66%. And >0.90 to be in 33.4%, while Wang [16], reported consideration should be given to include this simple anthropometric measurement in health related fitness batteries conducted in physical education. Better understanding of adiposity and central body fat distribution as etiological factors can be obtained in prospective studies and determine the cut-off points with various indices of fat patterning as the risk factors of hypertension.
Table 1:  Anthropometric characteristics of apparently healthy and hypertensive elderly subjects.
Variables Normotensives (n=90) Hypertensives (n=100)
BMI [kg/m 22.08 22.80
Waist (cm) 72.4 77.2
Hip (cm) 78.3 80.6
Waist:hip ratio 0.92 0.95
Conicity Index 0.99 1.00
1. Gupta R: Recent trends in hypertension epidemiology in India. South Asian J Prev Cardiol 2003; 7: 90-100.
2. Mehta N.J.: Motivating successful aging: an experiment in Mumbai. Current advances in Atherosclerosis Research; 2003, 5, 253-263.
3. Dandekar K: The elderly in India. New Delhi. Sage Publications. 1996.
4. Kishor S, Garg B.S: Sociomedical problems of aged population in rural areas of Wardha District. Ind. J. Pub. Health, 1997; 41, 43-48.
5. Sharma et al: High prevalence of hypertension in desert based rural population of Rajasthan South Asian J Prev Cardiol, 2003; 7: 81-89.
6. Ghose et al: Comparison of anthropometric characteristics between normotensive and hypertensive individuals among a population of Bengalee Hindu elderly men in Calcutta, Ind J Royal Soc Health 2000; 120:100 –106.
7. Kurpad A V: Body composition and BMI composition in INDIA. NFI Bulletin: 2005, 26 [4], 1-4.
8. Welborn T A. et al; Waist – hip ratio is a dominant risk factor predicting cardiovascular death in Australia. Med J .Au; 2003, 179. 580-585.
9. Siedell J C. et. Al: Waist and hip circumference s have impediment and opposite effects of cardiovascular disease risk factors, The Qubec family study. Am J, Clin. Nutr, 2001, 74, 315-321.
10. Mamtani M.R. and Kulkarni H R : Predictive performance of anthropometric indexes of central obesity for the risk of diabetes type 2. Arch Med Res , 2005, 581-589.
11. Taylor R W et al : Evaluation of waist circumference to hip ratio and conicity index as screening tools for high trunk fat mass as measured by dual energy x- ray absorptiometry in children aged 3-19 y. Am J. Clin. Nutr., 200, 72 [2], 490-495.
12. Venkataramma, Reddy P C : Association of overall and abdominal obesity with CHD risk factors. Asia Pacific J Clin Nutr., 2002, 11 [1], 66-71.
13. Bose K, Macie- Taylor C G: Conicity Index and waist hip ratio and their relationship with Total cholesterol and blood pressure in the middle aged European and migrant Pakistani men. Ann Human Bio, 1998, 25 [1], 11-16.
14. Mantroz C S et al: Conicity Index as predictor of blood pressure levels, insulin and triglyceride concentration in healthy premenopausal women. Horm Metal, Res , 1996, 28[1], 32-34.
15. Hazarika et al: Hypertension in the rural population in Assam . Nat Med J India, 17 [6], 300-304.
16. Wang J : Waist circumference ; a simple and reliable tool that should be included as a part of physical examination in doctors office. Am J Clin Nutr., 2003, 78,902-903.
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