Share This Article:

Performance of waist circumference relative to BMI in predicting risk of obesity and hypertension among affluent Indian adults

Abstract Full-Text HTML Download Download as PDF (Size:149KB) PP. 16-22
DOI: 10.4236/health.2013.58A3003    3,803 Downloads   5,769 Views   Citations


In view of the fact that Asians have higher abdominal fat at lower levels of body mass index (BMI), measures of abdominal adiposity such as waist circumference (WC) and waist to hip ratio (WHR) were investigated as predictors of hypertension. Data on BMI, WC, WHR and blood pressure (BP) were recorded through a cross-sectional study on 419 urban adults (210 men and 209 women; aged 30-60 years) in Pune, India. Abdominal obesity was higher among women than men (35.9% vs. 32.4%). However, age adjusted mean systolic BP (124.3 ± 15.1 mmHg vs. 114.7 ± 17.2 mmHg), diastolic BP (82.9 ± 10.5 mmHg vs. 76.4 ± 10.7 mmHg) and prevalence of hypertension (34.3% vs. 21.5%) was significantly higher (p < 0.01) among men than among women. Although both WC and WHR increased with increase in BMI, correlation coefficient of BMI with WC was significantly (p < 0.01) higher than that with WHR in both sexes, suggesting that WC could be better for assessing adiposity. In men, odds ratio [OR (95% CI) = 2.19 (1.08-4.45)] for hypertension was significant (p < 0.05) only for those in highest tertile of WC while it was significant (p < 0.01) even in the middle tertile in case of women [8.24 (2.67-25.43) for higher and 5.71 (1.82-17.89) for middle tertile]. Optimal cutoff for identifying obesity and hypertension showed significant (p < 0.01) area under curve (AUC) and sensitivity for WC than WHR in both sexes. The risk cutoffs were lower compared to those proposed by the World Health Organization especially for men, but were comparable with reported Asian studies. Thus, it was evident that WC performed better than BMI and WHR for assessing the risk of hypertension and may be used as a simple, convenient and inexpensive screening tool in epidemiological studies.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Rao, S. and Parab-Waingankar, P. (2013) Performance of waist circumference relative to BMI in predicting risk of obesity and hypertension among affluent Indian adults. Health, 5, 16-22. doi: 10.4236/health.2013.58A3003.


[1] WHO/IASO/IOTF. (2000) The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia Pty Limited.
[2] Deurenberg, P., Yap, N. and van Staveren, W.A. (1998) Body mass index and percent body fat: A meta analysis among different ethnic groups. International Journal of Obesity and Related Metabolic Disorders, 22, 1164-1171. doi:10.1038/sj.ijo.0800741
[3] James, W.P., Chunming, C. and Inoue, S. (2002) Appropriate Asian body mass indices? Obesity Reviews, 3, 139. doi:10.1046/j.1467-789X.2002.00063.x
[4] Deurenberg, P., Deurenberg-Yap, M. and Guricci, S. (2002) Asians are different from Caucasians and from each other in their body mass index/body fat percent relationship. Obesity Reviews, 3, 141-146. doi:10.1046/j.1467-789X.2002.00065.x
[5] Banerji, M.A., Faridi, N., Atluri, R., Chaiken, R.L. and Lebovitz, H.E. (1999) Body composition, visceral fat, leptin and insulin resistance in Asian Indian men. The Journal of Clinical Endocrinology & Metabolism, 84, 137-144. doi:10.1210/jc.84.1.137
[6] Raji, A., Seely, E.W., Arky, R.A. and Simonson, D.C. (2001) Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. The Journal of Clinical Endocrinology & Metabolism, 86, 5366-5371. doi:10.1210/jc.86.11.5366
[7] Reddy, K.S., Prabhakaran, D., Shah, P. and Shah, B. (2002) Differences in body mass index and waist hip ratios in north Indian rural and urban populations. Obesity Reviews, 3, 197-202. doi:10.1046/j.1467-789X.2002.00075.x
[8] WHO Expert Consultation. (2004) Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363, 157-163. doi:10.1016/S0140-6736(03)15268-3
[9] Esmaillzadeh, A., Mirmiran, P. and Azizi, F. (2004) Waist to hip ratio is a better screening measure for cardiovascular risk factors than other anthropometric indicators in Tehranian adult men. International Journal of Obesity and Related Metabolic Disorders, 28, 1325-1332. doi:10.1038/sj.ijo.0802757
[10] Lean, M.E.J., Han, T.S. and Morrison, C.E. (1995) Waist circumference as a measure for indicating need for weight management. British Medical Journal, 311, 158-161. doi:10.1136/bmj.311.6998.158
[11] Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo, J.L. et al. (2003) The 7th report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. The Journal of the American Medical Association, 289, 2560-2572. doi:10.1001/jama.289.19.2560
[12] Altman, D.G. (1991) Practical statistics for medical research. Chapman & Hall, London.
[13] Gupta, R. (1999) Hypertension in India—Definition, prevalence and evaluation. Journal of the Indian Medical Association, 97, 74-80.
[14] Banerji, M.A., Lebowitz, J., Chaiken, R.L., Gordon, D., Kral, J.G. and Lebovitz, H.E. (1997) Relationship of visceral adipose tissue and glucose disposal is independent of sex in black NIDDM subjects. American Journal of Physiology, 273, E425-E432.
[15] Misra, A., Vikram, N.K., Gupta, R., Pandey, R.M., Wasir, J.S. and Gupta, V.P. (2006) Waist circumference cutoff points and action levels for Asian Indians for identification of abdominal obesity. International Journal of Obesity, 30, 106-111. doi:10.1038/sj.ijo.0803111
[16] McNeely, M.J., Boyko, E.J., Shofer, J.B., Newell-Morris, L., Leonetti, D.L. and Fujimoto, W.Y. (2001) Standard definitions of overweight and central adiposity for determining diabetes risk in Japanese Americans. The American Journal of Clinical Nutrition, 74, 101-107.
[17] Gupta, R., Deedwania, P.C., Gupta, A., Rastogi, S., Panwar, R.B. and Kothari, K. (2004) Prevalence of metabolic syndrome in an Indian urban population. International Journal of Cardiology, 97, 257-261. doi:10.1016/j.ijcard.2003.11.003
[18] Gopalan, C. (1998) Obesity in the Indian Urban “middle class”. NFI Bulletin, 19, 1-4.
[19] Stranges, S., Wu, T., Dorn, J.M., Freudenheim, J.L., Muti, P., Farinaro, E., Russell, M., Nochajski, T.H. and Trevisan, M. (2004) Relationship of alcohol drinking pattern to risk of hypertension: A population based study. Hypertension, 44, 813-819.
[20] Lovejoy, J.C. (2003) The menopause and obesity. Primary Care, 30, 317-325. doi:10.1016/S0095-4543(03)00012-5
[21] Lofgren, I., Herron, K., Zern, T., West, K., Patalay, M., Shachter, N.S., Koo, S.I. and Fernandez, M.L. (2004) Waist circumference is a better predictor than body mass index of coronary heart disease risk in overweight premenopausal women. Journal of Nutrition, 134, 1071-1076.
[22] Han, T.S., McNeil, G., Seidell, J.C. and Lean, M.E. (1997) Predicting intra-abdominal fatness from anthropometric measures: The influence of stature. International Journal of Obesity and Related Metabolic Disorders, 21, 587-593. doi:10.1038/sj.ijo.0800446
[23] Snehalatha, C., Vishwanathan, V. and Ramachandran, A. (2003) Cutoff values for normal anthropometric variables in Asian Indian adults. Diabetes Care, 26, 1380-1384. doi:10.2337/diacare.26.5.1380
[24] Wildman, R.P., Gu, D., Reynolds, K., Duan, X. and He, J. (2004) Appropriate body mass index and waist circumference cutoffs for categorization of overweight and central adiposity among Chinese adults. The American Journal of Clinical Nutrition, 80, 1129-1136.
[25] Lin, Y.-W., Lee, L.-T., Chen, C.-Y., Lo, H., Hsia, H.-H., Liu, I.-L., Lin, R.S., Shau, W.Y. and Huang, K.C. (2002) Optimal cut off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan. International Journal of Obesity and Related Metabolic Disorders, 26, 1232-38. doi:10.1038/sj.ijo.0802040
[26] Cheung, Y.B., Low, L., Osmond, C., Barker, D. and Karlberg, J. (2000) Fetal growth and early post natal growth are related to blood pressure in adults. Hypertension, 36, 795-800. doi:10.1161/01.HYP.36.5.795

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.