Journal of Gerontology & Geriatric Medicine Category: Medical Type: Research Article
Discriminatory Ability of New and Traditional Anthropometric Indices for Hypertension and Diabetes in the Elderly
- Fabiane Aparecida Canaan Rezende1*, Andréia Queiroz Ribeiro2, Patrícia Feliciano Pereira2, Silvia Eloíza Priore2, João Carlos Bouzas Marins3, Sylvia Do Carmo Castro Franceschini2
- 1 Department Of Nutrition, Federal University Of Tocantins (UFT), Palmas, Tocantins, Brazil
- 2 Department Of Nutrition And Health, Federal University Of Viçosa (UFV), Viçosa, Minas Gerais, Brazil
- 3 Department Of Physical Education, Federal University Of Viçosa (UFV), Viçosa, Minas Gerais, Brazil
*Corresponding Author:
Fabiane Aparecida Canaan RezendeDepartment Of Nutrition, Federal University Of Tocantins (UFT), Palmas, Tocantins, Brazil
Tel:+55 3138992899,
Fax:+55 3138992541
Email:facrezende@uft.edu.br
Received Date: Jun 10, 2019 Accepted Date: Jun 17, 2019 Published Date: Jun 24, 2019
Abstract
Purpose
To investigate the association and discriminatory ability of new and traditional anthropometric indices for diabetes and hypertension in elderly.
Materials and methods
We conducted a cross-sectional population-based study of 62 elderly aged 60 years or more. Body Mass Index (BMI), Waist Circumference (WC), Hip Circumference (HC), Waist to Hip Ratio (WHR), Waist to Height Ratio (WHtR), Conicity Index (CI), Waist to Calf Ratio (WCR), Waist to Hip to Height Ratio (WHHR), Body Adiposity Index (BAI), A Body Shape Index (ABSI) and Body Roundness Index (BRI) were obtained. The outcomes were hypertension and diabetes. Poisson regression with robust variance estimator was used to estimate the prevalence ratios. Adjustors were age, sex, income, level educational, alcohol consumption, smoking status, physical activity and diet quality score. To assess discriminatory ability was used receiver operating characteristic curve.
Results
Most of the anthropometric indices were positively associated with both diabetes and hypertension. The prevalence of diabetes were increased more than 1.5-fold per SD increase for WCR and WHR (P <0.0001). Hip circumference showed an inverse association with diabetes. The areas under the curve were significantly greater than 0.5 (P <0.05). WCR (AUC: 0.67, 95% CI: 0.62-0.72), WHtR (AUC: 0.66, 95% CI: 0.61-0.72) and BRI (AUC: 0.66, 95% CI: 0.6z-0.72) showed discriminatory ability slightly higher for diabetes.
Conclusion
New anthropometric indices did not show stronger associations or better discriminatory ability than the traditional anthropometric indices for hypertension or diabetes in elderly individuals.
Keywords
Ability; Aging; Anthropometry; Cardiovascular risk factor; Discriminatory
INTRODUCTION
Anthropometric measurements are often used as proxies for total body fat and abdominal visceral adipose tissue in population studies [7,8]. Classically, waist circumference, waist to hip ratio and waist to height ratio are measures used to estimate the risk cardiometabolic related to central obesity [9]. Recently others indices, such as the waist to calf ratio [10], waist to hip to height ratio [11], body roundness index [12] and a body shape index [13] have been proposed as risk predictors, but these have not been studied in elderly.
The aim of this study was to investigate the association of new and classic anthropometric indices with diabetes and hypertension as well as their discriminatory ability.
MATERIAL AND METHODS
Data collection
Study population
Definition of diabetes and hypertension
Anthropometric data
Anthropometric indices |
Formulas |
A body shape index (m11/6.kg-2/3) [13] |
WC (m) ÷ (BMI (kg/m²)2/3 x Height (m)1/2) |
Body roundness index [12] |
364.2 - (365.5 x ε), where ε = |
Body adiposity index [16] (%) |
HC (cm) ÷ Height (m)1.5 - 18 |
Conicity index [17] |
WC (m) ÷ (0.109 x |
Body mass index (kg/m²) [15] |
Weight (kg) ÷ Height (m)² |
Waist to height ratio [18] |
WC (cm) ÷ Height (cm) |
Waist to calf ratio [10] |
WC (cm) ÷ CC (cm) |
Waist to hip ratio [15] |
WC (cm) ÷ HC (cm) |
Waist to hip to height ratio [11] |
WC (cm) ÷ HC (cm) ÷ Height (cm) |
Measurements of covariates
Food consumption was obtained through habitual dietary intake recall by the method of multiple passages [19]. Overall diet quality was assessed using Brazilian Healthy Eating Index Revised (BHEI-R). BHEI-R was measured from 12 components based on food groups totaling a maximum score of 100 points and a higher score represents a better dietary quality [20,21]. Physical activity was categorized in ‘yes’ or ‘no’; current smoking status in ‘smoker’, ‘ex-smoker’ or ‘never-smoker’ and alcohol consumption was dichotomized in ‘non-drinker’, ‘ex-drinker’ and ‘current drinker’.
Data analysis
In addition, we calculated the area under the Receiver Operating Characteristic (ROC) curve and 95% Confidence Intervals (CIs) to evaluate the discriminatory ability of anthropometric indices to identify elderly with diabetes and hypertension. In this study was observed that the prevalence of hypertension and diabetes was of 92.6% and 37.7% in obese elderly and 76.1% and 19.0% in non-obese elderly, respectively. Assuming ???? = 0.05, the statistical power in all analyses was >97,3% for hypertension and >98,8% for diabetes [24] (OpenEpi24: www.OpenEpi.com).
RESULTS
Variables |
Values |
Population size (n) |
537 |
Age (mean ± SD) |
69.7 ± 7.38 |
Female (%) |
50.1 |
Income (US$) (median, IQR) |
382.50 (255.00 - 877.50) |
Level educational <8 years (%) |
78.2 |
Current smokers (%) |
11.9 |
Physical inactivity (%) |
67.6 |
Current drinkers (%) |
37.4 |
Diet quality (BHEI-R) (mean ± SD) |
64.2 ±11.2 |
Hypertension (%) |
79.9 |
Diabetes (%) |
23.9 |
BMI ≥ 30 kg/m² (%) |
22.7 |
The most anthropometric variables were positively associated with both diabetes and hypertension, while the hip circumference showed an inverse association with diabetes. The prevalence of diabetes was increased more than 1.5-fold per SD increase for WCR and WHR (Table 3).
Anthropometric indices (n=537) |
Prevalence ratios and 95% confidence interval |
|
Hypertension¹ |
Diabetes² |
|
Bodymass Index (BMI) |
1.09 (1.05 - 1.13) |
1.31 (1.16 - 1.47) |
Waist Circumference (WC) |
1.09 (1.04 - 1.13) |
1.38 (1.22 - 1.56) |
Hip Circumference (HC)3 |
0.96 (0.89 - 1.03) |
0.64 (0.50 - 0.84) |
Waist to Hip Ratio (WHR) |
1.08 (1.03 - 1.13) |
1.55 (1.32 - 1.82) |
Waist to Height Ratio (WHtR) |
1.09 (1.05 - 1.14) |
1.41 (1.24 - 1.60) |
Waist to Calf Ratio (WCR) |
1.07 (1.03 - 1.11) |
1.52 (1.33 - 1.75) |
Waist to Hip To Height Ratio (WHHR) |
1.07 (1.02 - 1.11) |
1.46 (1.26 - 1.68) |
Conicity Index (CI) |
1.07 (1.03 - 1.12) |
1.39 (1.22 - 1.59) |
Body Adiposity Index (BAI) |
1.08 (1.04 - 1.12) |
1.23 (1.07 - 1.40) |
A Body Shape Index (ABSI) |
1.03 (0.98 - 1.07) |
1.22 (1.06 - 1.40) |
Body Roundness Index (BRI) |
1.08 (1.05 – 1.13) |
1.34 (1.20 - 1.50) |
§Standard Deviation (SD): BMI: 5.09 kg/m²; WC: 12.39 cm; HC: 10.04 cm; WHR: 0.07; WHtR: 0.08; WCR: 0.24; WHHR: 0.05; CI: 0.07; BAI: 6.7%; ABSI: 0.004 m11/6.kg-2/3 and BRI: 1.89.
1Model 1: Adjusted for age, sex, median income, level educational (<8 or ≥8 years), drinking status, smoking status, physical activity and diet quality score.
2Model 2: First model additionally for hypertension.
3Model 1 and 2: Additionally adjusted for waist circumference.
The Areas Under the Curve (AUCs) for each anthropometric measure were significantly greater than 0.5, but the discriminatory ability was lower for hypertension compared with diabetes. The indices that show discriminatory ability slightly higher were the WCR, WHtR and BRI for diabetes (Table 4).
Anthropometric indices (n=537) |
AUC (95% CI) |
|
Hypertension |
Diabetes |
|
Bodymass index |
0.61 (0.56 - 0.68) |
0.63 (0.57 - 0.70) |
Waist circumference |
0.62 (0.56 - 0.68) |
0.64 (0.58 - 0.69) |
Waist to hip ratio |
0.58 (0.51 - 0.64) |
0.60 (0.55 - 0.66) |
Waist to height ratio |
0.64 (0.59 - 0.70) |
0.66 (0.61 - 0.72) |
Waist to calf ratio |
0.61 (0.55 - 0.67) |
0.67 (0.61 - 0.72) |
Waist to hip to height ratio |
0.62 (0.56 - 0.68) |
0.65 (0.59 - 0.70) |
Conicity index |
0.61 (0.55 - 0.67) |
0.63 (0.58 - 0.68) |
Body adiposity index |
0.62 (0.56 - 0.67) |
0.61 (0.55 - 0.67) |
A body shape index |
0.55 (0.49 - 0.61) |
0.57 (0.51 - 0.62) |
Body roundness index |
0.64 (0.59 - 0.70) |
0.66 (0.61 - 0.72) |
DISCUSSION
The combination of excess body fat, mainly abdominal, with reduced muscle mass may produce more negative health outcomes and the sarcopenia phenotype or sarcopenic obesity are common in the older population [29]. In view of this, WCR could predict sarcopenic obesity since it is an index that assesses the disproportion between abdominal fat and leg muscle mass [10], but further studies are needed to verify this. In our study, hip circumference was inversely associated with diabetes. This is also supported in other studies with adults [30,31] and elderly [32]. There is evidence that a visceral and gluteofemoral adipose tissue has distinct intrinsic characteristics. Thigh and hip fat deposits have been positively linked with increased lipoprotein lipase, serum leptin and adiponectin activities, and negatively with the proinflammatory cytokines. As possible mechanisms to explain the ‘protective effect’ of gluteofemoral fat is a more passive metabolic activity that leads to visceral fat and fatty acids being stored for long time spans revealed by a lower concentration in the circulation [33].
The comparability of our results with those found in other studies is limited, because in our literature review, we did not find any study that compared the discriminatory ability of new and traditional anthropometric indices in the elderly population. Only a few studies [34-37] had investigated the association and discriminatory ability of BMI, WC, WHR and/or WHtR for cardiometabolic risk factors in the elderly population and the results were inconsistent. Corroborating findings from other studies [36,38,39], anthropometric indicators showed low discriminant power to diabetes and hypertension in the elderly.
There are a few limitations to our study. Firstly, the study has a cross-sectional design, so it limits to establish temporality between the predictors and the outcome. Secondly, the prevalence of diabetes and hypertension in the population might be underestimated in this study because the majority of study participants were of low education level. However, to minimize bias additionally medication records were considered to define chronic diseases. This study demonstrated that the recently proposed anthropometric indices showed no higher discriminatory ability than the indices traditionally used in population studies and in clinical practice. WCR seems to be a promising index in the evaluation of the elderly, but more studies are needed.
ACKNOWLEDGMENT
CONFLICT OF INTEREST
AUTHORS CONTRIBUTION
ETHICAL STANDARDS DISCLOSURE
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Citation:Rezende FAC, Ribeiro AQ, Pereira PF, Priore SE, Marins JCB, et al. (2019) Discriminatory Ability of New and Traditional Anthropometric Indices for Hypertension and Diabetes in the Elderly. J Gerontol Geriatr Med 5: 029.
Copyright: © 2019 Fabiane Aparecida Canaan Rezende, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
