Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

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I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 201 - 205

Waist Circumference, Body Mass Index, Hip Circumference and Waist-To-Hip Ratio in type 2 diabetes patients in Gorgan, Iran

ABDOLJALAL MARJANI

Dept of Biochemistry and Biophysics, Biochemistry and Metabolic Disorder Research Center, Gorgan Faculty of Medicine, Golestan University of Medical Sciences

Correspondence Address :
Dr. Abdoljalal Marjani, Gorgan Faculty of Medicine, Dept of Biochemistry
and Biophysics, Biochemistry and Metabolic Disorder
Research Center, Gorgan Faculty of Medicine, Golestan University
of Medical Sciences, Gorgan, Golestan province, Iran.
E-mail: abdoljalal@yahoo.com, Phone: +98(171)4421651
Fax: 4440225

Abstract

The present study was aimed to assess the anthropometric parameters of type 2 diabetic patients.

The anthropometric parameters were determined. The data were collected from the subjects with type 2 diabetes mellitus in Gorgan, Iran.

Insulin sensitivity, waist circumference, waist to hip ratio, fasting insulin and beta cell function were higher in males than in females, but the females had a higher body fat percent and hip circumference than the males. The waist circumference was found to correlate positively and significantly with BMI, the waist to hipratio and body fat percentage in diabetic females and males. There was a correlation between the waist circumference and hip circumference in diabetic females. The waist circumference very highly correlated with the body fat percent and the waist to hip ratio was likely to behave similarly in diabetes prediction.

The body mass index, despite having a lower correlation with waist circumference, appears to have the same ability to predict diabetes as do both the body fat percentage and the waist to hip ratio. Waist circumference appears to be a better predictor for diabetes risk than other parameters.

Keywords

Waist Circumference, Body Mass Index, Hip Circumference, Waist-To-Hip Ratio, type 2 diabetes, Gorgan

How to cite this article :

ABDOLJALAL MARJANI. WAIST CIRCUMFERENCE, BODY MASS INDEX, HIP CIRCUMFERENCE AND WAIST-TO-HIP RATIO IN TYPE 2 DIABETES PATIENTS IN GORGAN, IRAN. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2018 Nov 15 ]; 5:201-205. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=April&volume=5&issue=2&page=201-205&id=1262

Diabetes is a major public health problem that is approaching epidemic proportions in the whole world. This metabolic disease is one of the most common endocrine disorders affecting a nearly 6% of the world’s population (1).

The prevalence of type 2 diabetes mellitus varies from 1.2% to 14.6% in Asia, 4.6% to 40% in the Middle East, and 1.3% to 14.5 % in Iran (2), (3).

The overweight condition and obesity are frequently confirmed by calculating the body mass index (BMI). Higher BMI is collaborated with a higher risk of death by cardiovascular disease (4).

This risk elevates with additional abdominal adiposity, which is measured by the waist circumference (WC) (5).

Furthermore, some researchers reported that WC was strongly collaborated with the risk factors for the insulin-resistance syndrome in women (6).

A study found that a WC of 80 cm was a simpler logical choice to BMI for health promotion (7).

The expert panels at the National Institutes of Health (NIH), in recent times, suggested a WC≥88 cm in women and a WC≥102 cm in men with BMI≥25 kg/m2, to identify the increased relative risks for obesity unhealthiness (8).

However, other researchers reported that the effects of anthropometric variables on obesity unhealthiness were also different in Whites and Blacks, and that they depended on the studied risk factors (9), (10).

They have highlighted the need to evaluate these effects in different population groups (10). Although the dramatic worldwide increase in the incidence of obesity, and consequently, in the incidence of type 2 diabetes, has been recognized, the exact aetiological linkbetween these remains unclear. In a study on Chinese men and women, the hip circumference was found to positively collaborate with the incidence of type 2 diabetes (11).

In that study, however, neither the waist circumference nor BMI was considered. The prevalence of obesity has increased dramatically in industrialized and developing countries (12), (13).

The world Health Organization (WHO) has recently defined obesity as a disease (14).

Abdominal or central adiposity is considered to be the most important determinant of cardiovascular disease (CVD) and type 2 diabetes mellitus (DM) (15), (16).

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 (17), (18).

A BMI ≥ 25 Kg/m2 is associated with increased morbidity, primarily from DM and CVD, while a BMI >30 Kg/m2 is collaborated with an elevated risk for both unhealthiness and mortality, the latter resulting mainly from diabetes, coronary heart disease, and stroke (19).

BMI does not express the body fat distribution, whereas the intra abdominal deposition of adipose tissue is a major contributor to the development of abnormally high blood pressure, insulin resistance, DM and dyslipidaemia (20).

Therefore, other anthropometric indices such as waist circumference (WC) have been used as options to determine the BMI. Waist circumference is increasingly being accepted as the best anthropometric indicator of abdominal adiposity and metabolic risk [21-23].

The identification of WC to discriminate the individuals who are at a significantly elevated risk for obesity-associated risk factors, is avaluable tool in clinical care and public health research. There are however, racial and ethnic effects on the relationship between the visceral adipose tissue and the metabolic risk factors (24), (25).

The present study was aimed to assess the anthropometric parameters of the male and female patients who were diagnosed with type 2 diabetes in Gorgan (South East of Caspian Sea), Iran.

Material and Methods

This study was performed in the Biochemistry and Metabolic Disorder Research Center of Gorgan (South East of Caspian Sea), Iran in 2009. We had a study group which included 200 patients of type-2 diabetes mellitus who were referred to the Department of Diabetes Center at the 5th Azar Hospital in the Golestan University of Medical Sciences. There were 122 women and 78 men. At the point of entry into the study, all the diabetic patients underwent a clinical and biochemical investigation. The data were collected by trained interviewers. The exclusion criterion was the coexistence of any other serious illness.

Type-2 diabetes mellitus was defined as nonketosis diabetes by assessing the medical history of the patient and current treatment with oral agent. None of the patients had micro vascular complications (diabetic nephropathy or retinopathy). The administration of insulin for glycaemic control was considered as an exclusion criterion. Venous blood samples were collected from all the subjects who came after a 12-h overnight fast. The samples were centrifuged for 10 minutes at 3000rpm. The serum was used for the analysis of fasting blood sugar in those who had type-2 diabetes mellitus. Fasting blood sugar levels were measured by a biochemical kit by using spectrophotometric techniques (Model JENWAY 6105 UV / VIS) at the Biochemistry and Metabolic Disorder Research Center (Faculty of Medicine).Weight was then measured, while the subjects were minimally clothed, without shoes, by using digital scales and this was recorded to the accuracy of 100g. Height was measured in the standing position without shoes by using a tape meter, while the shoulder was in a normal position. BMI was calculated as weight in kilograms, divided by height in squared meters. Those with a BMI of 25.0-29.9 Kg/m2 were classified as overweight, whilst those with a BMI ≥30 Kg/m2 were defined as obese. Subjects with a BMI greater than 45 Kg/m2 were considered as very obese (14).

Waist circumference was measured at the point halfway between the lower border of the ribs and the iliac crest in a horizontal plane (26), and hip circumference was measured at the widest level over the greater trochanters. The waist to hip ratio was calculated as the waist circumference divided by the hip circumference. Body fat content was calculated according to the method of Lean et al.(27) by using the following formula: Body fat % for men = [(0.567 × waist circumference in cm) + (0.101 × age in years)] − 31.8 Body fat % for women = [(0.438 × waist circumference in cm) + (0.221 × age in years)] − 9.4 Insulin resistance and β cell function were derived by using the HOMA method (28) by using the following formula: Insulin resistance (HOMA-IR) = fasting insulin (μ/ml) × fasting glucose (mmol/l) / 22.5 Beta cell function (HOMA-BF) = 20 × fasting insulin (μ/ml) / fasting glucose (mmol/l) − 3.5 The results were reported as mean± SD. The statistical analysis was done by using the SPSS- version 11.5 software. The results were evaluated by using the Independentsample ‘t’ test and the Pearson’s correlation coefficient test. Statistical significance was considered at P values <0.05.

Results

The study sample consisted of 122 females and 78 males. The mean duration of diabetes mellitus in the type-2 diabetes mellitus patients was 1.5 years (range 1-3 years). The baseline characteristics of the type-2 diabetic patients by sex are shown in (Table/Fig 1). The mean ages of the femaleand male patients among the type2 diabetics was 53.74±9.54 and 53.51±9.49 years, respectively. A number of differences were found between the two subjects. The indices of insulin sensitivity (HOMA-IR), waist circumference, the waist to hip ratio, fasting insulin and HOMA-beta cell function were higher in males than in the female subjects (p<0.05), but the females had a higher body fat percent (p<0.05) and hip circumference than the male subjects. The males and females were of the same age, BMI and HOMA-IR (p>0.05) (Table/Fig 1).

*P<0.05, statistically significant The waist circumference correlated positively and significantly with BMI, the waist to hip ratio and body fat percent in diabetic females (r=0.233, r=0.696 and r=0.892, p<0.05) and males (r=0.280, r=0.756 and r=0.931, p<0.05) (Table 2). There was a correlation between the waist circumference and the hip circumference in the diabetic females also (r=0.449, p<0.05) (Table 2).There was no correlation between the waist circumference and other parameters in diabetic males and females [insulin sensitivity (HOMA-IR), fasting insulin, fasting glucose and HOMA-beta cell function] (Table 2).There was no correlation between the waist circumference and the hip circumference in the diabetic males (Table/Fig 2).P<0.05, statistically significant.

Discussion

Obesity is associated with many metabolic risks; however, only few studies on obesity-related disorders have been conducted in Asia as compared to the western countries (29). Studies in Iran have shown an increasing prevalence of obesity, which is expected to rise in the future due to increasing urbanization (30). Most studies examining the risk of adverse health conditions which are associated with fat location have been based on data from Europe or the United States, and only little information on the lesser developedcountries are available. A recent consultation by a World HealthOrganization (WHO) expert group suggested that Asians have different associations between body mass indexes, the percentage of body fat and the health risk of type 2 diabetes as compared to the European populations (31).

On the other hand, studies among other populations showed waist circumference alone (32), or together with body mass index (33), to be good predictors of type 2 diabetes mellitus. The World Health Organization (21) has explained that waist circumference is the easiest and most efficient anthropometric index to be used in many studies because it measures fatness and fat location.

In the present study, we determined waist circumference, body mass index, body fat percent, hip circumference, fasting glucose, fasting insulin, insulin resistance (HOMA-IR), HOMA-beta cell function and waist to hip ratio in males and females among the type 2 diabetic patients.
The main findings of this study are:
1. Type 2 diabetic patients had significantly increased waist circumference, body mass index, HOMA-beta cell function and fasting insulin among the males when compared to the diabetic females; but, body fat percent was significantly increased only in the diabetic females. The data on the diabetic subjects showed that the body fat percent was higher in females than in males, thus suggesting the increased adiposity of females which overrode the effect of metabolism alterations. 2. In the present study, we investigated the relationships between waist circumference and some anthropometric indices in males and females among the type 2 diabetic patients in Gorgan. Our results showed that there was a correlation between waist circumference and some of these indices. Among the anthropometric indices, waist circumference had a correlation with body mass index, body fat percent and the waist to hip ratio in both the sexes. There was also a correlation between the waist circumference and the hip circumference among the female type 2 diabetic patients. The correlation between waist circumference and body mass index, body fat percent and the waist to hip ratio were almost similar in both the sexes. None of the other indices showed any relationship with the waist circumference.

Our data showed that waist circumference would be a good predictor of diabetes in the future. The reasons for the correlation of the waist circumference with body mass index, the waist to hip ratio and body fat percent in our diabetic male and female patients and the hip circumference in the females and not in the males; were of interest. The diabetic patients in our study were obese. In the patients with type 2 diabetes in Gorgan, who were also obese, the waist circumference was not correlated with age, fasting glucose, fasting insulin, insulin secretion and insulin resistance. Several publications on the relationship between the anthropometric markers and type 2 diabetes mellitus, but with the best anthropometric index of fat location remains controversial. These controversies may be explained in part by the differences in the body composition and fat distribution among the different racial groups (10), (21), (34) and sexes [35-39]; such as, the Japanese women have a higher abnormal waist circumference than the men (40). Many studies have found that waist circumference is strongly correlated with BMI (37), (38), (41), (44) and the percentage of body fat (42), (43).

In a study, when hip circumference was modeled alone, no significant association was found with diabetes in both men or women; after adjustment for age, body mass index, and waist circumference, a greater hip circumference was found to be associated with the reduced odds of developing diabetes (44), but this was not in agreement with our results when compared to the diabetic females. Some researchers have suggested that the abdominal fat localization is more important than the total amount of body fat or subcutaneous adipose tissue in the prediction of type 2 diabetes. They also reported that the predictive effect of the waist circumference was equal to the combined effect of the waist circumference and the body mass index (45). Ford et al.(46) showed the role ofwaist circumference as a measure of obesity to predict health risk. Their arguments were that waist circumference has been shown to be a good or better predictor than the body mass index of the metabolic syndrome, diabetes, cardiovascular disease, and all-cause mortality; it provides information about the health risk. However, others have noted that the substitution of body mass index by waist circumference as an indicator of the risk for diabetes may be an oversimplification (47), (48).

Many counterarguments which exist are that, waist circumference is strongly correlated to body mass index (45), (46), (50), (51); waist circumference does not differentiate between subcutaneous fat and visceral fat; it has not been shown that a consistent association exists between waist circumference and visceral fat after the adjustment for body mass index; and that the body fat distribution was different across different races and sexes (47), (49), [52-54].

In the present study, the waist circumference was found to have a weaker correlation with the body mass index than the body fat percent and the waist to hip ratio in the male and female diabetic patients. Stevens et al. (55) showed that the waist circumference had a better discriminatory performance for diabetes than did the body mass index or the waist to hip ratio. However, more recently, the waist circumference alone has been suggested as being a more practical measure of intra-abdominal fat mass and the total body fat. Indeed, waist circumference had been found in some studies to be more closely correlated with the level of abdominal visceral adipose tissue than was the waist to hip ratio [56-58].

The Framingham study suggested that the waist predicted mortality better than other anthropometric measures (59). Waist circumference was also found to be associated with diabetes, stroke and coronary heart disease (60).

It is reported that waist circumference is the best anthropometric correlate of the amount of visceral adipose tissue (56). A longitudinal study revealed that the change in waist was a better predictor of the change in the visceral adipose tissue (61).

Waist circumference captures information on the general as well as the abdominal obesities, including both the abdominal subcutaneous fat and the visceral adipose tissue (62).

The measure of obesity that takes into account the increased risk of obesity related illnesses because of the accumulation of abdominal fat is desirable. An increased waist circumference is most likely to be associated with elevated risk factors because of its relationship with visceral fat accumulation, and the mechanism may involve an excessive exposure of the liver to fatty acids (63).The abdominal visceral adipose tissue deposition is associated with an increase in the portal free fatty acid concentration, which leads to plasma disturbances such as hyperinsulinaemia [56, 64].

Thus, waist circumference reflects total body fat (BMI) and abdominal fat distribution [65-66]. In conclusion, the present study demonstrated consistently strong associations of the waist circumference, body mass index and the waist to hip ratio in both the sexes (and hip circumference in females) with type 2 diabetes. Waist circumference was very highly correlated with body fat percent and the waist to hip ratio likely to behave similarly in diabetes prediction. The body mass index, despite a lower correlation with the waist circumference, appears to have the same ability to predict diabetes as do both the body fat percent and the waist to hip ratio. Waist circumference appears to be a better predictor for diabetes risk than other parameters.

Acknowledgement

The author would like to thank the personnel at the Biochemistry and Metabolic Research Center and the Diabetes Center of the Golestan University of Medical Sciences for providing for their cooperation and assistance in the handling of the experiments.

References

1.
Adeghate E, Schattner P, Dunn E. An update on the etiology and epidemiology of diabetes mellitus. Ann N Y Acad Sci 2006; 1084:1-29.
2.
Azizi F, Guoya MM, Vazirian P, Dolatshati P, Habbibian S. Screening for type 2 diabetes in the Iranian national programme: a preliminary report. East Mediterr Health J 2003; 9:1122-7.
3.
Azizi F, Gouya MM, Vazirian P, Dolatshahi P, Habibian S. The diabetes prevention and control programme of the Islamic Republic of Iran. East Mediterr Health J 2003; 9:1114-21.
4.
Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, Hennekens CH, Speizer FE. Body weight and mortality among women. N Engl J Med 1995;333:677–85.
5.
Peiris AN, Sothman MS, Hoffman RG, Hennes MI, Wilson CR, Gustafson AB, Kissebah AH. Adiposity, fat distribution and cardiovascular risk. Ann Intern Med 1989;110:867–72.
6.
Edwards KL, Austin MA, Newman B, Mayer A, Krauss RM, Selby JV. Multivariate analysis of insulin resistance syndrome in women. Arterioscler Thromb 1994;14:1940–5.
7.
Han TS, Van Leer EM, Seidell JC, Lean ME. Waist circumference as a screening tool for cardiovascular risk factors: evaluation of receiver operating characteristics (ROC). Obes Res 1996;4:533–47.
8.
National Institute of Health/National Heart Lungs and Blood. Clinical guidelines on the identification, evaluation, and treatment of over-weight and obesity in adults. The evidence report. Obes Res 1998;6:51S–209S.
9.
Resnick HE, Valsania P, Halter JB, Lin X. Differential effects of BMI on diabetes risk among black and white Americans. Diabetes Care 1998;21:1828–35.
10.
Okosun IS, Liao Y, Rotimi CN, Choi S, Cooper RS. Predictive values of waist circumference for dyslipidemia, type 2 diabetes and hyper tension in overweight White, Black, and Hispanic American adults. J Clin Epidemiol 2000;53:401–8.
11.
Wang SL, Pan WH, Hwu CM, et al. Incidence of NIDDM and the effects of gender, obesity and hyperinsulinaemia in Taiwan. Diabetologia 1997;40:1431–8.
12.
Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP. The continuing epidemic of obesity in the United States. JAMA 2000; 284: 1650-1.
13.
Popkin BM, Paeratakul S, Zhai F, Ge K. A review of dietary and environmental correlates of obesity with emphasis on developing countries. Obes Res 1995; Suppl 2: 145s-153s.
14.
World Health Organization. Prevention and Management of the Global Epidemic of Obesity. Report of the WHO Consultation on Obesity. WHO: Geneva, 1998 (Technical Report Series, No. 894).
15.
Megnien JL, Denarie N, Cocaul M, Simon A, Levenson J. Predictive value of waist-to-hip ratio on cardiovascular risk events. Int J Obes Relat Metab Disord 1999; 23: 90-7.
16.
Williams SR, Jones E, Bell W, Davies B, Bourne MW. Body habitus and coronary heart disease in men. A review with reference to methods of body habitus assessment. Eur Heart J 1997; 18: 376-93.
17.
WHO MONICA Project. Geographical variation in the major risk factors of coronary heart disease in men and women aged 35-64 years. World Health Stat Q. 1988; 41: 115-40.
18.
Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995; 122: 481-6.
19.
Iribarren C, Sharp DS, Burchfiel CM, Petrovitch H. Association of weight loss and weight fluctuation with mortality among Japanese American men. N Engl J Med 1995; 333: 686-92.
20.
Kopelman PG. Obesity as a medical problem. Nature 2000; 404: 635- 43.
21.
Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva, World Health Organization, 1995 (WHO Technical Report Series, No. 854).
22.
Ledoux M, Lambert J, Reeder BA, Despres JP. Correlation between cardiovascular disease risk factors and simple anthropometric measures. Canadian Heart Health Surveys Research Group. CMAJ 1997; 157: S46-53.
23.
Lemos-Santos MG, Valente JG, Goncalves-Silva RM, Sichieri R. Waist circumference and waist-to-hip ratio as predictors of serum concentration of lipids in Brazilian men. Nutrition 2004; 20: 857-62.
24.
Misra A, Wasir JS, Vikram NK. Waist circumference criteria for the diagnosis of abdominal obesity are not applicable uniformly to all populations and ethnic groups. Nutrition 2005; 21: 969–976.
26.
World Health Organisation. Defining the problem of overweight and obesity. In: Obesity: Preventing and Managing the Global Epidemic. Report of a WHO consultation. World Health Organisation, Geneva, 1997; 7–16.
26.
Dalton M, Cameron AJ, Zimmet PZ, Shaw JE, Jolley D, Dunstan DW, Welborn TA; AusDiab Steering Committee. Waist circumferencewaist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. J Intern Med 2003; 254: 555-63.
27.
Lean MEJ, Han TS, Decuenberg P: Predicting body composition by densitometry from simple anthropometric measurements. Am J Clin Nutr 1996; 63: 4 –14.
28.
Matthews DR, Husker JP, Rudenski AS, NaylorBA,TreacherDF,Turner RL: Homeostasis model assessment: Insulin resistance and beta cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.
29.
Hsieh SD, Muto T. Metabolic syndrome in Japanese men and women with special reference to the anthropometric criteria for the assessment of obesity: Proposal to use the waist-to-height ratio. Prev Med 2006; 42: 135-9.
30.
Azizi F, Allahverdian S, Mirmiran P, Rahmani M, Mohammadi F. Dietary factors and body mass index in a group of Iranian adolescents: Tehran lipid and glucose study-2. Int J Vitam Nutr Res 2001; 71: 123-7.
31.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.
32.
Reeder BA, Senthilselvan A, Despres JP et al. The association of cardiovascular disease risk factors with abdominal obesity in Canada. Canadian Heart Health Surveys Research Group. CMAJ 1997;157 (suppl 1):S39-S45.
33.
Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr 2005;81:555-63.
34.
Okosun IS, Tedders SH, Choi S, Dever GEA. Abdominal adiposity values associated with established body mass indexes in white, black and Hispanic Americans. A study from the Third National Health and Nutrition Examination Survey. Int J Obes 2000;24:1279
35.
Onat A, Sansoy V, Uysal O¨. Waist circumference and waist-to-hip ratio in Turkish adults: interrelation with other risk factors and association with cardiovascular disease. Int J Cardiol 1999; 70: 43.
36.
Ho SC, Chen YM, Woo JLF, Leung SSF, Lam TH, Janus ED. Association between simple anthropometric indices and cardiovascular risk factors. Int J Obes 2001;25:1689.
37.
Dobbelsteyn CJ, Joffres MR, MacLean DR, Flowerdew G, for the Canadian Heart Health Surveys Research Group. A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys. Int J Obes 2001;25:652.
38.
Tanaka K, Kodama H, Sasazuki S, et al. Obesity, body fat distribution and coronary atherosclerosis among Japanese men and women. Int J Obes 2001;25: 191.
39.
Ito H, Nakasuga K, Ohshima A, et al. Detection of cardiovascular risk factors by indices of obesity obtained from anthropometry and dual-energy X-ray absorptiometry in Japanese individuals. Int J Obes 2003;27:232.
40.
Arai H, Yamamoto A, Matsuzawa Y, Saito Y, Yamada N, Oikawa S, Mabuchi H, Teramoto T, Sasaki J, Nakaya N, Itakura H, Ishikawa Y, Ouchi Y, Horibe H, Shirahashi N, Kita T. Prevalence of Metabolic Syndrome in the General Japanese Population in 2000. J Atheroscler Thromb, 2006, 13(4): 202–208
41.
Grinker JA, Tucker KL, Vokonas PS, Rush D. Changes in patterns of fatness in adult men in relation to serum indices of cardiovascular risk: the Normative Aging Study. Int J Obes 2000;24:1369.
42.
Oliveira CL, Veiga GV, Sichieri R. Anthropometric markers for cardiovascular disease risk factors among overweight adolescents. Nutr Res 2001;21:1335.
43.
Wang J, Thornton JC, Bari S, et al. Comparisons of waist circumferences measured at 4 sites. Am J Clin Nutr 2003;77:379.
44.
Snijder MB, Dekker JM, Visser M, et al. Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study. Am J Clin Nutr 2003; 77:1192–1197
45.
Wei M, Gaskill SP, Haffner SM, et al. Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (nIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans—a 7-year prospective study. Obes Res 1997;5: 16–23.
46.
Ford ES, Mokdad AH, Giles WH. Trends in waist circumference among U.S. adults. Obes Res 2003;11:1223–31.
47.
Molarius A,
48.
Seidell JC. Selection of anthropometric indicators for classification of abdominal fatness—a critical review. Int J Obes Relat Metab Disord 1998;22:719–27. Seidell JC, Bjorntorp P, Sjostrom L, et al. Regional distribution of muscle and fat mass in men—new insight into the risk of abdominal obesity using computed tomography. Int J Obes 1989;13:289–303.
49.
Janssen I, Heymsfield SB, Allison DB, et al. Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr 2002;75:683–8.
50.
Ohlson LO, Larsson B, Svardsudd K, et al. The influence of body fat distribution on the incidence of diabetes mellitus: 13.5 years of follow- up of the participants in the study of men born in 1913. Diabetes 1985;34:1055–8.
51.
CODA Study group, Duval SJ. The association of BMI and waist circumference with diabetes in an international context: the CODA (Collaborative Study of Obesity and Diabetes in Adults) project. Presented at the American Diabetes Association 64th Scientific Sessions, Orlando, Florida, June 4–8, 2004.
52.
Hill JO, Sidney S, Lewis CE, et al. Racial differences in amounts of visceral adipose tissue in young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) Study. Am J Clin Nutr 1999;69:381–7.
53.
Molarius A, Seidell JC, Sans S, et al. Waist and hip circumferences, and waist-hip ratio in 19 populations of the WHO MONICA Project. Int J Obes Relat Metab Disord 1993;23: 116–25.
54.
Duncan BB, Chambless LE, Schmidt MI, et al. Correlates of body fat distribution. Variation across categories of race, sex, and body mass in the Atherosclerosis Risk in Communities Study. Ann Epidemiol 1995;5:192–200.
55.
Stevens J, Couper D, Pankow J, et al. Sensitivity and specificity of anthropometrics for the prediction of diabetes in a biracial cohort. Obes Res 2001; 9:696–705.
56.
Pouliot M-C, Despre´s J-P, Lemieux S, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994; 73: 460–8.
57.
Despres JP, Prud’homme D, Pouliot MC, Tremblay A, Bouchard C. Estimation of deep abdominal adipose-tissue accumulation from simple anthropometric measurements in men. Am J Clin Nutr 1991; 54: 471–7.
58.
Ferland M, Despres JP, Tremblay A, et al. Assessment of adipose tissue distribution by computed axial tomography in obese women: association with body density and anthropometric measurements. Br J Nutr 1989; 61: 139–48.
59.
Higgins M, Kannel W, Garrison R, Pinsky J & Stokes III J: Hazards of obesity–the Framingham experience. Acta Med. Scand. Suppl. 1988; 723, 23–36.
60.
Dey DK, Rothenberg E, Sundh V, Bosaeus I & Steen B: Waist circumference, body mass index, and risk for stroke in older people: a 15 year longitudinal population study of 70- year-olds. J. Am. Geriatr Soc 2002; 50, 1510–1518.
61.
Lemieux S, Prud’homme D, Tremblay A, Bouchard C & Despres JP. Anthropometric correlates to changes in visceral adipose tissue over 7 years in women. Int. J. Obes. Relat. Metab. Disord. 1996; 20, 618– 624.
62.
Vadstrup ES, Petersen L, Sorensen TI & Gronbaek M. Waist circumference in relation to history of amount and type of alcohol: results from the Copenhagen City Heart Study. Int. J. Obes. Relat. Metab. Disord. 2003; 27, 238– 246.
63.
Despres JP, Lemieux S, Lamarche B, Prud’homme D, Moorjani S, Brun LD, Gagne C, Lupien PJ. The insulin resistance-dyslipidemic syndrome: contribution of visceral obesity and therapeutic implications. Int J Obes Relat Metab Disord 1995; Suppl 1: S76-86.
64.
Larsson B, Svardsudd K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G. Abdominal adipose tissue distribution, obesity and risk of cardiovascular disease and death: 13 year follow-up of participants in the study of men born in 1913. BMJ 1984;288:1401–4.
65.
Han TS, Van Leer EM, Seidell JC, Lean ME. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ 1995;31:1401–5.
66.
Lean ME, Hans TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ 1995;311:158–61.

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