The Relationship between Body Mass Index (BMI) and Waist Circumference (WC) to fasting blood glucose level based on medical check up result of PT. X Regional Jakarta Employees Year 2016

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International Seminar on Global Health (ISGH) 2017 Stikes Jenderal Achmad Yani Cimahi

The Relationship between Body Mass Index (BMI) and Waist Circumference (WC) to fasting blood glucose level

based on medical check up result of PT. X Regional Jakarta Employees Year 2016

1

Susilowati

^*

,

²

Budiman,

³

Ari Nurhayati Syabaniarti

1,2,3

Public Health Study Programme,

School of Health Sciences Jenderal Achmad Yani, Cimahi, Indonesia

*

Email: [email protected]

Abstract

BMI indicate body weight in relation to height and are useful for providing a measure of overweight and obesity in adult populations. Waist circumference used as a surrogate estimate of abdominal fat.

The increased prevalence of obesity is associated to the increased incidence of Type 2 Diabetes Mellitus. Indonesia ranks seventh the prevalence of diabetes worldwith with 12,191,564 diabetics in 2013 and predicted to increase up to 21,257,000 in 2030. Jakarta is one of the highest obesity prevalence provinces based on BMI. Cross sectional used as research design to analyze secondary data on medical check up result of PT. X Regional Jakarta employees year 2016. Data were analyzed by univariate, bivariate with Chi Square Test and Spearman Rank Correlation Test. The BMI mean obtained at 26,49 kg/m². There was a relationship between BMI to fasting blood glucose level (r = 0.082, p value = 0.0001) with weak relation and positive pattern. There was also a relationship between Waist Circumference to fasting blood glucose level with p value = 0.01; PR = 1.47 (95%CI:

1.21-1.80). PT. X Regional Jakarta is expected to consider the medical check up results in designing preventive/health promotion programs in workplace.

Keywords: Body Mass Index (BMI), Diabetes, fasting blood glucose level, obesity, Waist Circumference (WC)

Introduction

The prevalence of overweight and obesity continues to increase rapidly. Obesity has become a global pandemic and declared by the World Health Organization (WHO) as the biggest chronic health problem in adults. In 2014, more than 1.9 billion adults aged 18 years and older were overweight. Of these over 600 million adults were obese. Overall, about 13% of the world‘s adult population (11% of men and 15% of women) were obese. 39% of adults aged 18 years and over (38% of men and 40% of women) were overweight. The worldwide prevalence of obesity more than doubled between 1980 and 2014.¹⁹

The prevalence of obesity based on BMI in Indonesia was 15.4% and the national prevalence of abdominal obesity in population over 15 years was 26.6%. Jakarta Province is one of the highest obesity prevalence provinces based on BMI, for both men and women, above the national prevalence and the highest prevalence of abdominal obesity in Indonesia at 39.7%.²

The increase of overweight and obesity prevalence is associated to a sharp increase in the incidence of Type 2 Diabetes Mellitus. According to the International Diabetes Federation (IDF) survey in 2015, there were 415 million adults suffering from diabetes worldwide, a four-fold increase of 108 million people from the 1980s. By 2040, it is estimated that the number will be up to 642 million. Nearly 80% of people with Diabetes Mellitus live in low and middle income countries. By 2015, the percentage of adults with Diabetes Mellitus was 8.5% (1 in 11 adults suffering from Diabetes Mellitus).¹⁰

The development of Diabetes Mellitus in Southeast Asia is seen rapidly compared to other regions. The prevalence of Diabetes Mellitus among adults in the Southeast Asian region increased from 4.1% in the 1980s to 8.6% in 2014 (96 million adults suffering from Diabetes Mellitus), 60%

of men and 40% of women with diabetes died before the age of 70 years.

Indonesia is a country in Southeast Asia that has a high prevalence of Diabetes Mellitus and ranked seventh after China, India, United States, Brazil, Russia and Mexico. The number of diabetics in Indonesia in 2013 was 12,191,564 and the number is expected to increase to 21,257,000 by 2030.⁴.

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Body mass Index (BMI)

Fasting Blood Sugar Levels Waist Circumference

(WC)

Diabetes Mellitus is a serious public health problem because the number of sufferers continues to increase. In 2013, one of the world's largest health burden is Diabetes Mellitus, which is about 612 billion dollars. Direct losses from Diabetes Mellitus include emergency care, hospitalization, medical services, laboratory tests, medication and temporary care. Indirect losses include premature mortality, loss of working days affecting lost income, personal losses and unaccountable things such as pain and sickness. 1.5 million out of 3.7 million deaths worldwide in 2012 is caused by Diabetes Mellitus.¹⁰

Glucose tolerance disorder and Diabetes Mellitus were higher in obese than non-obese people..

Obesity causes insulin resistance, ie insulin the body can not work properly causing impaired glucose tolerance and Type 2 Diabetes Mellitus .

The high prevalence of Diabetes Mellitus and obesity as well as a large cost burden for Diabetes Mellitus requires prevention efforts through identification of risk factors at an early stage for the prevention of Diabetes Mellitus. Obesity, particularly abdominal obesity, as an important risk factor for the onset of Diabetes Mellitus can be identified by Computed Axial Tomography or Magnetic Resonance Imaging, but the cost is expensive and impractical.⁷

An alternative way of identifying cheaper and more practical abdominal obesity is by using anthropometric measures that include waist circumference measurements and waist hip ratio measurements. Both variables have been validated by measurement of abdominal fat by Dual X- Ray Absorptiometry and Computed Axial tomography as well as showing can predict incidence of disease and mortality. ⁷

The distribution of body fat is more appropriate as a Diabates Mellitus counterpart compared to obesity based on BMI. BMI measurements can not show the body fat distribution. Adipose of the upper body measured through waist hip ratio has a stronger association with Diabetes Mellitus.⁶

The Indonesians' threshold is said to be obese if BMI value >27.0 kg/m² and is a high risk group suffer from Type 2 Diabates Mellitus.¹³ If BMI is greater than 35 kg/m², the risk of Type 2 Diabetes Mellitus will increase over 10 years by 80-fold compared with BMI less than 22 kg/m². Recent data from NHANES survey in The United States has shown an increased risk of Type 2 Diabetes Mellitus at all times up to 6-10-fold in 18-year-old individuals with BMI greater than 35 kg/m² compared with individuals with BMI less than 18.5 kg/m² (average difference of 6-7 years from overall life expectancy).³

Method

This study aims to know the relationship between Body Mass Index (BMI) and Waist Circumference (WC) to fasting blood glocose level based medical check up result of PT. X Regional Jakarta employees year 2016.

Independent Variables Dependent Variables

Figure 1. Conceptual Framework

Cross-sectional studies were used to determine the association of risk factors and disease effects by measuring risk factors and effects simultaneously in individuals of a population at one time. Each respondent was only observed once and the measurement of respondent variable was done during the examination without follow-up. Risk factors studied were Body Mass Index (BMI) as an indicator

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data collection.

The population in this study were 2.963 (all employees) of PT. X Regional Jakarta who underwent medical check up in 2016. Total sample technique was used to obtain samples from all employees who stated obese based on BMI and abdominal obesity after medical check up. After data processing, there were seven fallen respondents. There was no fasting blood glucose level data of three respondents and no WC measurement data of four respondents. Thus, the total sample included were 2,956 medical check results.

Results

1. BMI, WC, fasting blood glucose level and age overview based on medical check up result of PT. X Regional Jakarta employees year 2016

From the results of data processing, there where 1.225 obese respondents based on BMI, and 184 of them were categorized suffering from Diabetes Mellitus. Univariate analysis was done by using statistical test to see the distribution of independent variables BMI and WC.

Table 1. Frequency distribution of BMI, WC, fasting blood glucose and age based on medical check up result of PT. X Regional Jakarta employees year 2016

Variables N Minimum Maximum Mean Median Standard Deviation

BMI 2956 15,2 48,7 26,49 26,22 3,86

WC 2956 54 136 89,00 89,00 9,68

Fasting glucose level

blood 2956 61 481 108,82 98,00 39,84

Ages 2956 35 56 48,92 49,00 4,814

2. Gender overview based on medical check up result of PT. X Regional Jakarta employees year 2016

Univariate analysis was done by using statistical test to see the distribution of gender as independent variable.

Table 2. Distribution of gender based on medical check results of PT. X Regional Jakarta employees year 2016

Gender Frequency (n) Percentage (%)

Male 2502 84,6

Female 454 15,4

Total 2956 100

Based on Table 2, it was known that most respondents were male (84,6%), while 454 respondents were female (15,4%).

3. The relationship between BMI and fasting blood glucose level based on medical check up result of PT. X Regional Jakarta employees year 2016

Table 3. The relationship between BMI and fasting blood glucose level based on medical check up result of PT. X Regional Jakarta employees in 2016

Variable R R² Line Equation p value

BMI 0,082 0,007 FBG Level = 86,37 + 0,848 BMI 0,0001

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From the results of the analysis can be concluded that there was a weak relation with positive pattern between BMI with fasting blood glucose levels. This means that the higher BMI the higher fasting blood glucose levels. Determinant coefficient value 0.007 indicates that BMI affects fasting blood sugar levels of 0.7% and the rest 99.3% fasting blood glucose level are influenced by other variables.

Variables of fasting blood glucose level will increase by 0.848 mg/dL for each 1 kg/m² BMI increased.

4. The relationship between Waist Circumference (WC) and fasting blood glucose level based on medical check up results of PT. X Regional Jakarta employees year 2016 Based on statistical test result, p value = 0.01. It can be concluded there was a relation between WC and Diabetes Mellitus on respondents. PR = 1,472 (95%CI: 1,21-1,80) showed that abdominal obesity respondents had 1.5 times higher risk of Diabetes Mellitus compared with non abdominal obesity.

Table 4. The Relation between Waist Circumference (WC) and fasting blood glucose level based on medical check up results of PT. X Regional Jakarta employees year 2016

Waist Circumference (WC)

Diabetes Melitus PR

(95% CI)

p value

DM Non DM Total

n % N % N %

Abdominal Obesity 234 14,7 1359 85,3 1593 100,0 1,472 0,0001 Non Abdominal 136 10,0 1227 90,0 1363 100,0 (1,207-1,796)

Obesity

Total 370 12,5 2586 87,5 2956 100,0

Discussion

1. The overview of BMI, WC and fasting blood glucose level based on medical check up result of PT. X Regional Jakarta employees in 2016

This study has shown that there was respondent who has minimum BMI at 15.2 kg/m² that indicates underweight (BMI <17.0 kg m²) and maximum BMI at 48,7 kg/m² that indicates overweight (BMI> 27.0 kg/m²). The respondents in this study has shown BMI mean at 26.49 kg/m² or that the average respondents have mild/fat overweight. Monitoring of nutritional status of adults is very important and needs to be implemented continuously because nutritional problems due to underweight and overweight are very risky to certain diseases and affect work productivity.⁹

If BMI is greater than 35 kg/m², the risk of Type 2 Diabetes Mellitus will increase over 10 years by 80-fold compared with BMI value less than 22 kg/m². Recent data of NHANES survey in the United States has shown an increased risk of Type 2 Diabetes Mellitus at all times up to 6- 10-fold in 18-year-old individuals with BMI greater than 35 kg/m² compared to individuals with BMI less than 18.5 kg/m² (average difference of 6-7 years from overall life expectancy).³

This study has shown that there was respondent who has minimum WC at 54 cm and maximum WC at 136 cm. The respondents in this study has shown WC Mean at 89.00 cm. Waist circumference is categorized to be high risk in men ≥90 cm and women ≥80 cm. Fat in the abdominal or visceral areas is closely associated with an increased risk of Type 2 Diabetes Melitus and cardiovascular disease. This disease is preceded by a syndrome called metabolic syndrome with symptoms of hypertension, impaired glucose tolerance and dyslipidemia.⁹

The overview of fasting blood glucose level in this study has shown that there was respondent who has minimum fasting blood glucose level at 61 mg/dL and maximum fasting blood sugar level at 481 mg/dL. The respondents in this study showed a fasting blood sugar level Mean at 108.82 mg/dL. According to ¹ and ¹¹, one of the diagnostic criteria of Diabates Mellitus is someone who has classic Diabetes Mellitus symptoms plus has fasting plasma blood glucose ≥126 mg/dL (7.0

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deasese risk. People with Diabetes Mellitus face an increased risk of developing cardiovascular, cerebrovascular, peripheral vascular disease and ultimately largely ending with death.⁶

Respondents who were categorized as having normal blood glucose should keep their diet and physical activity to avoid the risk of Diabetes Mellitus. Prevention activities should be an important activity to prevent new cases of Diabetes Mellitus. A person who has already suffered Diabetes Mellitus is incurable and vulnerable to compassion and not least ending in death.

2. The overview of relationship between BMI and fasting blood glucose level based on medical check up result of PT. X Regional Jakarta employees in 2016

Based on p value = 0.01, p value <0.05 from Tabel 3, there was a relation between BMI to fasting blood glucose level. Correlation coefficient (correlation power) r = 0,08 has shown that Spearman correlation value between two variables was positive with weak correlation. Positive correlation means the greater the value of a variable (BMI), the greater the value of other variables (fasting blood glucose level).

This is in line with research conducted by ⁵. Research conducted in July 2012 has shown that there was a relation between BMI and fasting blood glucose level in Type 2 Diabetes Mellitus patient with p <0.001 and Spearman correlation 0.459 which indicated positive with medium correlation strength. This result was also in line with research conducted by ¹² in ―Waist Circumference Having the Strongest Relationship with Blood Glucose Levels‖ has shown BMI variable p value

<0,05 with positive correlation coefficient. In other words, there was a significant positive relationship between BMI and blood glucose levels. The higher BMI the higher blood glucose level, the lower BMI the lower blood glucose level. This was consistent with the theory of ¹⁴, that the risk factor of Type 2 Diabetes Mellitus is obesity which includes changes in lifestyle from traditional to western lifestyle, overeating, and sedentary lifestyle.

3. The relationship between Waist Circumference (WC) and fasting blood glucose level based on medical check result of PT. X Regional Jakarta employees year 2016

Based on p value = 0.01, p value <0.05 from Table 4, there was a relationship between WC and fasting blood glucose level. Correlation coefficient (correlation power) r = 0,10 has shown that Spearman correlation value between two variables were positive with weak correlation power.

Positive correlation means the greater the value of a variable (WC), the greater the value of other variables (fasting blood glucose level).

This is in line with research conducted by conducted by ⁸ that indicated WC positively correlated with blood glucose level.

The correlation test between BMI, WC and blood glucose level showed that the two independent variables were statistically significant. When viewed from the correlation coefficient Spearman where the relation between WC and fasting blood glucose level has the highest correlation coefficient of 0.104 compared to the correlation coefficient between BMI with fasting blood glucose level of 0.082. The correlation coefficient close to 1 indicates that there was a stronger relationship between WC and fasting blood glucose level compared to the relationship between BMI and fasting blood glucose level.

The results of the study were as stated by ¹² that measuring WC is recommended. Measurement of WC alone can replace the ratio of WC and BMI as a single risk factor for all cases of morbidity.⁷ Reduced abdominal circumference significantly decreases cardiovascular risk factors, metabolic syndrome including Type 2 Diabetes Mellitus, impaired glucose tolerance, hypertension and dyslipidemia despite unchanged weight.⁹ Increased WC, especially in abdominal or android obesity, can lead to insulin resistance that can cause Diabetes Mellitus.¹⁵ In abdominal obesity occurs insulin resistance in the liver resulting in increased Free Fatty Acid (FFA) and oxidation. FFA causes glucose metabolism, both oxidatively and non- oxidatively, to interfere with peripheral tissue glucose. Increased FFA in obese people generally occurs due to adipose tissue lipolysis process more often than normal people. An increase in the amount of visceral (abdominal) fat has a positive correlation with hyperinsuline and is negatively correlated with insuline sensitivity. Abdominal obesity was significantly associated with dismetabolic syndrome (dyslipidemia, hyperglycemia, hypertension), which is based on insulin resistance.¹⁷

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Conclusion

From ―The relationship between Body Mass Index (BMI) and Waist Circumference (WC) to fasting blood glucose level based on medical check up result of PT. X Regional Jakarta employees Year 2016‖, it can be concluded as follows:

1. There where 1.225 obese respondents based on BMI, and 184 of them were categorized suffering from Diabetes Mellitus.

2. There was a weak relationship with positive pattern between BMI and fasting blood glucose level. This means that the higher BMI the higher fasting blood glucose level. Determinant coefficient value 0.007 indicates that BMI affects fasting blood glucose levels of 0.7% and the rest 99.3% fasting blood sugar levels are influenced by other variables. Variables of fasting blood glucose levels will increase by 0.848 mg/dL for each 1 kg/m² BMI increased.

3. There was a relationship between WC and Diabetes Mellitus on respondents. PR = 1,47 (95%

CI: 1,21-1,80) showed that abdominal obesity respondents had 1.5 times higher risk of Diabetes Mellitus compared to non abdominal obesity. Correlation coefficient (correlation power) r = 0,10 has shown that Spearman correlation value between two variables were positive with weak correlation power. Positive correlation means the greater the value of a variable (WC), the greater the value of other variables (fasting blood glocose level).

4. The correlation test between BMI, WC and blood glucose level showed that the two independent variables were statistically significant. When viewed from the correlation coefficient Spearman where the relation between WC and fasting blood glucose level has the highest correlation coefficient of 0.104 compared to the correlation coefficient between BMI with fasting blood glucose level of 0.082. The correlation coefficient close to 1 indicates that there was a stronger relationship between WC and fasting blood glucose level compared to the relationship between BMI and fasting blood glucose level.

Acknowledgment

Sincerely thanks to The Head of School of Health Sciences Jenderal Achmad Yani, Cimahi, Indonesia and all of our colleagues at Public Health Study Programme for the supports.

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