Wc Hc Ratio

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The waist-hip ratio, namely waist circumference (WC) divided by hip circumference (HC), has been referred to in thousands of articles, generally as a correlate and predictor either of health conditions such as cardiovascular disease and diabetes, or of amounts of visceral and subcutaneous abdominal fat. It has been argued that combining WC and HC as a ratio is inappropriate, and yet their individual roles can only be fully elucidated if considered jointly. Whereas WC is positively associated with cardiovascular disease, diabetes and premature mortality, the opposite is true of HC. With health-related measures taken as dependent variables, the present novel approach establishes that WC and HC are far better treated as separate independent variables in multiple regression equations than as their ratio. This necessarily produces closer fits to data. One should then allow for variations in height, or some other such measure of general body size, by including this in the regression equations. The widespread concern with the ratio seems to have distracted attention from HC, for this is discussed notably less often than WC. Given that other body parts, such as the thighs, may share relevant properties with the hips, measurements of these could perhaps replace HC.

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The use of computed tomography (CT) and magnetic resonance imaging (MRI) in measuring VF provides valid and reliable estimates2,7,8. However, they are expensive and require professional skills and exposure to radiation7,8. These are not favourable for global and daily use. There is another device known as bioelectrical impedance analysis (BIA) for estimating body composition (e.g., body fat and muscle mass)9. Compared to CT and MRI, it is safest, less expensive, noninvasive and simple2,7. Nevertheless, it also requires little competency to operate. In addition, BIA outputs are affected by several factors, such as ethnicity, environment, phase of the menstrual cycle, dehydration, and underlying medical conditions9,10.

Meanwhile, there should be a simple method that is less expensive and reliable to equally estimate VF levels in low-resource settings for clinical practice and epidemiological studies. Several studies2,3,4,10,11,12,13,14, including the World Health Organization (WHO)15,16, have recommended the use of BMI, HC and WC for assessing adiposity. Another indicator, such as WHR, has also been proposed due to the effect of age, gender, and ethnic disparities on BMI2,3,4,14 and the low accuracy in identifying central obesity2,3,4,10 in some populations. Recently, a new index called WHtR has gained popularity and has been used extensively for assessing the risks of cardiometabolic diseases, adiposity and metabolic syndrome10,17,18. It provides accurate information about adiposity status by considering height, gender and ethnicity disparities10,19.

The majority of these studies that reported the cut-off values of the abovementioned anthropometric indices are largely based on data from Asian, European and American populations3,10,20,21,22. These might not be accurately useful to other populations. Therefore, it is necessary to find appropriate cut-off values of each anthropometric index for the assessment of adiposity in Africa with different ethnicities, especially in Sub-Saharan Africa (SSA). Henceforth, considering the burden of visceral adiposity in Ghana among diabetic patients1,2, this multihospital-based study was designed to compare the five adiposity anthropometric indices and their associations with VF levels determined by BIA as the reference standard to identify the best diagnostic index for assessing VF levels among diabetic patients in the Volta Region, Ghana.

The physical assessments of diabetic patients included height, body weight, WC, HC, fasting blood sugar (FBS), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Weight was measured in a patient lightly dressed without shoes to the nearest 0.1 kg using a portable digital scale. Height was measured to the nearest 0.1 cm according to a standard method using a tape measure attached firmly to the wall. WC was measured at the umbilical position during the exhalation state while standing with a light dress and recorded to the nearest 0.1 cm. The HC was measured around the widest circumference of the buttock and recorded to the nearest 0.1 cm. The FBS, SBP and DBP data were retrieved from the patients' folders. BMI was calculated as weight (kg) divided by squared height (m2). WHR and WHtR were calculated by dividing WC (cm) by HC (cm) and height (cm), respectively. The BIA (Omron BF-511; Omron Healthcare Co., Ltd., Kyoto, Japan) was used to calculate the impedance of the body of each diabetic patient by imputing the age, gender and height9. The BIA estimates the body composition by allowing a small painless low-level electrical current through different kinds of body tissue9. The procedures were as follows: each patient was asked to step barefoot onto the BIA while on the ground and hold the display unit, which was the BIA handlers with both hands. While standing vertically, the patient was asked to extend the arms parallel to the floor at the same level as the shoulder. The BIA generated the VF value for each diabetic patient, which was used as the reference standard in the study.

The likely reasons are as follows: first, individuals with shorter heights have remarkably greater quantities of body fat compared to taller heights with the same BMI4,14. Second, individuals with similar WCs but different heights do not have the same quantities of body fat3,4. Third, being short in stature was associated with a higher accumulation of VF compared to being tall3,14. Additionally, studies have reported WC as a cardiometabolic risk factor compared to weight4,14. Finally, height alone predicts hypertension and diabetes, and the percentage of body fat associated with WC is an independent risk factor for cardiovascular disease4.

The strengths of this study exist in the study population, and it provides information for further study. Second, the measurements of the anthropometric variables were carried out by trained research assistants through dual assessments per a standard protocol to reduce recall and social desirability bias. Nonetheless, this study has some limitations. First, the diabetic patients were enrolled from one region out of sixteen regions in Ghana and limited to the selected hospitals; therefore, care should be taken when generalizing the findings. Second, information on diet, physical activity and lifestyle were not included in the analysis due to their scarcity; hence, adjusting for these covariates might affect the results of the regression analysis. Third, some of the biochemical and hemodynamic data were not available and recorded for all patients due to their appointment times. Furthermore, the five adiposity anthropometric indices were not analysed, presented and discussed according to gender using different cut-off values due to the insignificance of the analysed data according to gender. Finally, the use of BIA as the reference standard in this study was not classified according to gender9; therefore, care should be taken when deducing and generalizing the findings to the population.

In the absence of BIA in low-resource settings for clinical practice and epidemiological studies, WHtR was shown to have overpowered BMI, HC, WC and WHR in identifying diabetic patients with high VF levels. Therefore, the Ghana Health Service could recommend WHtR as a better diagnostic index for assessing VF levels due to its high predictive capacity.

I thank the management of the health facilities for their esteemed contribution to the data collection. I am very grateful to all diabetic patients who took their precious time to participate in the study.

L.S.T. conceptualized and designed the study. L.S.T. coordinated and participated in the data collection. L.S.T. drafted and wrote the manuscript. The author reviewed the manuscript for intellectual content and approved the final manuscript.

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The overall aim of the expert consultation was to review the scientific evidence and make recommendations on the issues related to waist circumference and waist-hip ratio. It focused particularly on issues related to methods of measurement; variations by sex, age and ethnicity; predicting risks of cardiovascular disease (CVD) and diabetes, and of overall mortality and relationship with BMI in predicting disease risks.

Adiponectin protein and some variations in its gene, ADIPOQ have recently been associated with cancer because they regulate glucose and lipid metabolism as well as anti-apoptotic and anti-inflammatory proteins.

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