?he Internaticnal Seminar

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?he Internaticnal Seminar

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The Relationship Between Waist Circumference and Diabetes Mellitus Type 2In The Instattation Outpatient A.Wahab.Sjahrani

Hospital Samarinda

Setianingsih,

H.1)

and Suryanugraha, M.

R.2)

1) The Department of Anatomy and Histology, Faculty of Medicine Hang Tuah University, Surabaya, Indonesia

2) student of Faculty of Medicine, The Hang Tuah university, Surabaya, Indonesia E-mail

:

dr.arfanayya

@

gmail.com

Abstract

Waist circumference can be used as an indicator

of

abdominal obesity, whereas abdominal obesity

will

^be followed by an increase

of

body mass index

(BMI).

Both

of

these can cause discruption

of

insulin sensitivity which can lead to diabetes mellitus _{type 2.} This research aims to know the influence of waist circumi-erence to diabetes mellitus type 2. The sampling was

caried

out

in

clinical interna

of

A.Wahab.sjahranie hospital. The method used was analytic crossectional study by comparing patients with diabetes mellitus type

2

and, without diabetes mellitus type 2. The data analysis used bivariat analysis, and tested by chi-square test. The result of this research showed a significant relationship between waist circumference which is more than 80 cm in f'emale and more than 90 cm in male with incidence of diabetes mellitus type 2. Conclusion : waist circumference can ail'ect the incidence of diabetes mellitus type 2.

Keywords : waist circumference, diabetes mellitus, abdominal obesity

Introduction

Obesity has become a major worldwide

epidemic

affecting more than 300 million people. It is

an important

risk factor for

diabetes

mellitus,

type

2,

^a

chronic

disor-

der ofcarbohydrate, fat, and protein metabolism.

From the clinical

perspective, _visceral adipose

tissue is known to

^generate diabetogenic substances

(De

Fronzo, 2OO4) and,

as

such,

may

be

Clinical evidence

suggests

that the

association

of

diabetes

with central obesity is stronger than

the association

with

^general

fat.

Studies

using

computed tomography

and magnetic

resonance

imaging

have

provided further evidence to ^support that

central Et

al.l990;

Jensen

MD,

2006).Central obesity has been associated

with

decreased glucose tolerance, alterations

in ^glucose insulin

homeostasis,

reduced

metabolic clearance

of insulin,

and decreased insulin-stimulated glucose disposal.

In addition, studies that have analyzed, the association

of

anthropometric measures

and

abdominal

visceral

fat have found waist circumference

to

be a better measure

of

central obesity because

it is a

better predictor

of abdominal visceral fat obtained with

computed

more informative than total fat for

diagnostic evaluation.

The

standard epidemiologic translation

of these important clinical facts uses

anthropometric measures.

Waist

circum-ference and waist have been used

as

measures

of

central obesity (where visceral adipose tissue

is

stored), and body mass index (kg/m,) has been used as a measure of general obesity (Molarius A, Seidell JC., 1998).

obesity, visceral adipose tissue, and

upper-body

nonvisceral fat are the major contributors to

the

metabolic complications

(Despres

Jp, Moorjani

S,

Lupien

^pJ,

tomography than the waist/hip

ratio,

so that

it

can be easily _measured and interpreted ((Molarius

A,

Seidell JC., 1998; Rankinen T,

Kim

SY, perusse L, et al.,

lggg;

Hill

JO, Sidney S, Lewis CE, et

al.,

1999). However,

waist circumference cannot distinguish

abdominal subcutaneous fat, total abdominal fat, and total body fat, and

it

is strongly correlated with body mass index. Body mass index has been shown

to

be a good indicator

of

general fat (fat areas

in

the arm, thigh, and waist using computed tomography scans), muscularity (muscle area

95

in the thigh), and frame size

(bone area

in

thighs) Seidell JC, Bjorntorp P, Sjostrom L, et a1.,1989).

As

expected, epidemiologic studies have demonstrated

that these three obesity indicators are strong

and consistent

predictors of

^diabetes

mellitus, type

^2- However, despite the clear,

clinical

difference between visceral

and other forms of fat, little

epidemiologic difference would be expected in the relations of diabetes with body mass index versus waist circumference (Ford

ES, Mokdad AH, Giles WH.,

2003). Several studies

have shown that waist

circumference

is a

better predictor

of

diabetes mellitus, type

2,

than body mass

index, but

^these

^findings are

inconclusive

(Wei M,

Gaskill SP, Haffner SM, et al., 1997; Stevens J, Couper

D,

Pankow J, et al., 2001).

While

other studies provide evidence that waist/hip ratio has less influence towards body mass index (Ohlson

LO,

Larsson

B,

Bjomtorp P, et al., 1988; Cassano PA, Rosner B, Vokonas PS, et a1.'

1992).In addition, the ability ofthese obesity indicators to predict diabetes may differ by ethnicity, age, and sex (Resnick

HE, Halter JB, ^Valsania P, et al.,

1998;

Haffner SM, Mitchell BD, Hazuda HP, et al., 1991). For example, among Asian populations, central obesity ^has become

a

^more consistent predictor

of

diabetes than

total

obesity (Cassano

PA,

Rosner

B,

Vokonas PS, et al., 1992; Boyko EJ, Fujimoto

WY,

Leonetti

DL,

et al.'

Visceral adiposity and risk of type 2

^{diabetes: a}

prospective study among ^Japanese Americans. Diabetes Care 2000),

while

general obesity has become a better predictor among White US populations and Europeans

(Chan JM, Rimm EB, Colditz CA, et

^{a1., 19941'}

Spiegelman D, Israel RG, Bouchard C, et al., 1992)-

To study the

^magnitude

of the

association among different obesity indicators

in

multiethnic populations comprising studies worldwide, we performed a analysis

of published studies that reported the

association between obesity and incident diabetes

in

certain area.

This study aims to know the

relationship

of

waist circumference of male and female diabetes and the non diabetes ones

in a certain area

(A.Wahab.Sjahranie hospital).

Material

and Methods Methods

We

studied

male

and f-emale aged

30-80

^years, who participated

in

the Data

from

an Epidemiological Study

in clinicai intema of

A.Wahab.Sjahranie hospital.

All participants signed an infbrmed consent, and

the

protocol was

approved

try an ^ethics

committee. The samples were taken from the patients who came

to

the

clinical interna of

A.Wahab.Sjahranie

hospital

from January

to July

2011. Every patient was measured the

waist circumference and

weight, so the total

^sarnples were}O7 male aad ¹⁷⁸ female.

The categories

of

obesity

in

this study are

:

both male diabetes and

non

diabetes

have waist

circumference

more than 90 cm. Both female

diabetes

and

non diabetes have waist circumference more than 80 cm.

Measurement technique

Waist Circumference {WC) is actually a perimeter, which provi<les an estimate

of body gifih at

the

level of

the abdomen.

Dilferent

anatomic landmarks have been ^used

to

^determine

^the

exact location

for

measuring

$/C

in difl'erent

clinical

studies. including

1)

midpoint belween the iowest

rib pd

^the

iliac

crest;

2)

the umbilicus; 3) narrowest (minimum) or widest (maximum) WC; 4) just below the lowest

rib;

and 5)

just

_atrove the

iliac

cresl

The

specific

site

used

to

measure

WC

int'luences the absolute

WC

value that is ohtained (Goodman-Gruen D,

B arrett-Connor

E.

1996).

Results

waist circumference *

DATA

Crosstab

a.4 cells (14.3"/0) have expected count less than minimum expected count is 3.53.

Symmetric Measures

a.Not assuming the null hypothesis.

b.Using the asymptotic standard error assuming the null hypothesis.

c.Based on normal approximation.

Chi-Square Tests

Value df

\symp. Sig.

12-sided) Pearson ChFSqu

Likelihood Ratio Linear-by-Linear Association N of Valid Cases

ot t.ooo"

004.396 5.696 385

18 18

't

.000 .000 .o17

Discussion

The relationship

of

waist circumference

with

incident diabetes was confirmed

in our

study

by a

significant value

p ₌

0.000. There

is

a relationship between waist circumference

with

incident

of

diabetes mellitus type ^2- This research showed a significant result for men whose

waist

circumference

more than 90 cm and

women

whose

waist circumference more than 80

cm with

an incident

of

diabetes mellitus type 2.

Ford et al. (2003), support the use of

^waist

circumference as a measure

of

obesity to predict health

risk. Among their arguments are that

^waist

circumference has been shown

to

be

a

good

or

better

predictor than body mass index of the

metabolic syndrome, diabetes, cardiovascular disease,

and

all- cause

of mortality

due

to the

metabolic syndrome;

it

provides information about health

risk

as

well

as body mass

index;

and

it is

conceptually easy

to

measure,

although it does require some training

and standardization. However, based

on the result of

the study,

it is

reasonable that waist circumference

it

used as an indicator

of risk for

cardiovascular disease and diabetes mellitus type 2 (Molarius

A,

Seidell JC., 1998;

Seidell JC, Bjorntorp P, Sjostrom L, et a1.,1989; Janssen

I,

Heymsfield

SB, Allison DB, et al., 2002).

Some counterarguments states

that waist

circumference is strongly correlated

to body

mass

index (Ford et

^al., 2003;

Wei M, Gaskill

SP,

Haffner SM, et

a1., 1997:, CODA Study group, 2004); waist circumference can not differentiate between subcutaneous fat and visceral fat;

it

has not shown a consistent relationship between waist circumference

with

visceral fat based on age and body mass

index;

and

body fat distribution which

may be

different

across

racial, sex, and age ((Molarius

A, Seidell JC., 1998;

Hill

JO, Sidney S,

trwis

CE, et al.

1999; Janssen

I,

Heymsfield

SB, Allison DB, et

^al., 2002;

Molarius A, Seidell JC,

Sans

S, et al.,

^1993;

Duncan

BB,

Chambless

LE,

Schmidt

MI,

et a1., 1995) strata.

Other indicators have been suggested

to

describe fat

distribution associated with abdominal

obesity

(Molarius A, Seidell JC.,

^1998).

For

example, the subscapular/triceps

skinfold ratio has been used

to describe central versus peripheral obesity. The waist/hip ratio and the waist/thigh ratio have been used to identify upper versus

lower body

obesity.

In ^addition,

^other

indicator, such as waist/height ratio, conicity index, and abdominal

to midthigh

^girth, have been developed on the basis

of a

variety

of

criteria. However, ratios are more

difficult

to interpret biologically, are less sensitive

to

weight gain, and have statistical limitations (Allison

DB, Paultre F, Goran MI, et

a1.,

1995).

Because relatively

few

studies have considered these indicators, we did not include them in our meta-analysis. However, some have argued against the use of waist/hip ratio as a measure

of

obesity because

of its

ambiguous biologic interpretation,

its

lesser sensitivity

to

weight gain, its greatff

variability

across age, sex, and ethnic groups,

and its greater computational complexity

^and interpretation

in a public

health context

(Molarius

A, Seidell JC., 1998).

Stevens

et al.

(2001), found

that

waist circumference had better discriminatory performance

for

diabetes than did body ^mass index or waist/hip ratio.

When comparing differences between obesity indicators across study-level characteristics,

we ^found that

the

present analysis had several limitations

included comparisons

of waist

circumference. Sparseness

of

studies

in

each category

did not allow us to

further

analyze the heterogeneity with a

multivariable approach.

Additional

heterogeneity

may be

derived

from diversity of design features,

clinical characteristics, and model assumptions.

Conclusions

In

conclusion, there

is a

relationship between waist circumference with incident of diabetes mellitus type 2.

This research showed a significant result for men whose

waist

circumference

more than 90 cm and

women

whose

waist circumference more than 80

cm with

an

incident of

^diabetes

mellitus type 2. Although

the clinical use

of

the waist circumference measurement

of

visceral

fat is

undeniable, the statistical

reality is

that

waist

circumference

and body

^mass

index are

very

highly

correlated

and likely to

happen

similarly

ⁱⁿ

diabetes prediction.

Waist

circumference, appears to have the same ability to predict diabetes as well as body mass index.

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