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JCDR - Obesity, Body mass index, Fasting blood sugar.

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Originalarticle/research
Year:2010 Month:December Volume:4 Issue:6 Page:34213424

AStudyOfBodyMassIndexInHealthyIndividualsAndItsRelationshipWith FastingBloodSugar
VITTALBG*,PRAVEENG**,DEEPAKP*** *MDBiochemistry,**MDCommunitymedicine,***MDPharmacology

CorrespondenceAddress: Dr.VittalBG, AssistantProfessor, DepartmentofBiochemistry, GovernmentMedicalCollege, Hassan573201, Karnataka MobileNo:09141400766 Email:vittal.bg@gmail.com

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Abstract Backgroundandobjectives:Obesityisaglobalepidemicandisontherise.Itisdefinedasabodymass index(BMI)whichisequaltoormorethan30.Itisoneofthemodifiableriskfactorsoftype2diabetes.This studywasundertakentoassesstheassociationbetweenBMIandfastingbloodsugar(FBS)andalsoto verifywhetherBMIincreaseswithage. SubjectsandMethods:Thisprospectivestudyincluded400healthyadultindividualswhomettheinclusion criteria. Fasting blood samples were collected to measure FBS by the glucose oxidase method. Thirty individualswereexcludedfromthestudy,astheirbloodglucoselevelswereinthediabeticrange. Results:Among370individuals,apositivecorrelationwasobserved(Pearsonscorrelationcoefficientr=+ 0.26)betweenBMIandFBS.TherewasastepwiseincreaseinthemagnitudeofBMIwithanincreasein ageindecades.AlthoughtheincreaseinmeanFBSwasobservedwithage,astatisticallysignificant(p= 0.00093)increaseinmeanFBSwasobservedonlyinthe4thdecadeoflife. Interpretation and conclusions: The observed positive correlation between BMI and FBS reiterates the diabetogeniceffectofadiposetissueandemphasizestheimportanceofthemaintenanceofnormalBMIto preventtheearlyonsetofdiabetes. Keywords:Obesity,Bodymassindex,Fastingbloodsugar. Howtocitethisarticle: VITTALBG,PRAVEENG,DEEPAKP.ASTUDYOFBODYMASSINDEXINHEALTHYINDIVIDUALSAND ITSRELATIONSHIPWITHFASTINGBLOODSUGAR.JournalofClinicalandDiagnosticResearch[serial online]2010December[cited:2013Oct8]4:34213424.Availablefrom http://www.jcdr.net/back_issues.asp?issn=0973 709x&year=2010&month=December&volume=4&issue=6&page=34213424&id=990 Introduction Body mass index (BMI) is a good measure of general adiposity. It is defined as the weight in kilograms, divided by the square of the height in meters (kg/m2).(1) A person can be categorized as underweight if his/herBMIis18.5,asnormalweightifhis/herBMIisintherangeof18.524.9,asoverweightifhis/her BMIisbetween25to29.9andasobeseifhis/herBMIis30.(2)AraisedBMIvalueisanestablishedrisk factorforischaemicheartdisease,strokeandcarcinomas.(3) Obesity is one of the most important modifiable risk factors in the pathogenesis of type 2 diabetes. The mechanismbywhichobesityinducesinsulinresistanceispoorlyunderstood.Adipocytessecreteanumber of biological products (leptin, TNFalfa, free fatty acids, resistin, and adiponectin) that modulate insulin secretion,insulinactionandbodyweightandmaycontributetoinsulinresistance.(4)Apositivecorrelation isassumedtoexistbetweenBMIandfastingbloodsugar(FBS)levels. Globalepidemicobesity"globesity"israpidlybecomingamajorpublichealthproblemintheworldandis ontherise.Inmanypopulations,theaverageBMIhasbeenrisingbyafewpercentperdecade,thusfuelling theconcernabouttheeffectsofincreasedadiposityonhealth.(5) ThisstudywasundertakentodeterminethecorrelationbetweenFBSandBMIinanadulthealthyIndian populationandalsotocheckwhetherBMIincreaseswithage. MaterialandMethods ThisprospectivestudywasconductedatSriChamarajendraHospital,ateachinghospitalwhichisaffiliated totheHassanInstituteofMedicalSciences,duringMayAugust2010. AfterobtainingpermissionfromtheInstitutionalEthicalCommittee,normalhealthyindividualsattendingthe hospital for routine health checkup were included in the study. Paediatric, pregnant, psychiatric and

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JCDR - Obesity, Body mass index, Fasting blood sugar.

diabeticsubjectswereexcludedfromthestudy.Thestudygroupincluded400personsoftheagegroupof 2160 years. After obtaining the informed consent, the age, sex, height and weight of the subjects were recorded.Weightwasrecordedtonearest0.5kgandheightwasrecordedtonearest0.5cm.Fasting(812 hoursofovernightfasting)venousbloodsampleswerecollectedbyvenipunctureofthemediancubitalvein inavacutainerandwerecentrifugedtoseparatetheplasma.Fastingplasmaglucoselevelswereestimated bytheGlucoseoxidasemethodbyusinganERBATransasiafullyautomatedanalyser. TheBMIforeachsubjectwascalculatedbyusingthestandardformulai.e.,weightinkilogramsdividedby heightinsquaremeters.1Allthevariablesincludingage,sex,height,weight,BMIandFBSfromstudygroup weretabulatedandanalysedstatistically.Pearsonscorrelationcoefficientwasusedtofindthecorrelation betweenFBSandBMI.StudentsttestwasusedtocheckthestatisticalsignificanceofthechangesinBMI andFBSwithrespecttoage. Results Fourhundredapparentlyhealthysubjectswhomettheinclusionandtheexclusioncriteriawereincludedin the study. Thirty members were excluded from the study population as their fasting blood glucose levels wereinthediabeticrange.Ofthe370members,289(78.1%)weremenand81(21.9%)werewomen.The studyincludedsubjectswhowereintheagegroupof21to60years.Themeanageofthemalesubjects was37.9810.51yearsandthemeanageofthefemalesubjectswas36.410.11years. (Table/Fig1):Ageandsexdistributionofstudypopulation ThemeanFBSofthestudypopulationwas90.7010.71mg/dlandthemeanBMIwas25.13.38.The PearsonscorrelationcoefficientbetweenFBSandBMIofthestudypopulationwaspositive(r=+0.26). (Table/Fig2):MeanBMIandmeanFBSofdifferentagegroups TherewasastepwiseincreaseinthemagnitudeofBMI,withanincreaseinageindecades.Althoughan increaseinthemeanFBSwasobservedoverdecades,astatisticallysignificantincreaseinmeanFBSwas observed(p=0.00093)onlyinthe4thdecadeoflifei.e.,astheagegroupincreasedfromthe3rdtothe4th decadeoflife. Discussion In the present study, BMI showed a positive correlation with FBS (Pearsons correlation coefficient r = + 0.26). A positive correlation between BMI and blood sugar was also reported by other studies.(6),(7) Ethnicityaffectstheassociationbetweenobesityanddiabetesandthatprobablyexplainsthedifferentlevels ofassociationbetweenobesityandbloodglucoselevelswhichareobservedinvariousstudies.(8) ThemeanBMIofdifferentagegroupsshowedanincreasingtrendoverthedecadesandanincreasein mean BMI was found to be more marked from the 3rd to the 4th decade. The prevalence of obesity, as measured by BMI, is high in many countries all over the world and is rising. It is mainly attributed to the changinglifestylesanddietaryhabits.(5),(9) MeanFBSincreasedwithincreasingageandwithincreasingBMI.SignificantincreaseinmeanFBSwas observedduringthe4thdecadeoflife. The mechanism by which obesity induces insulin resistance is poorly understood, but a number of mechanismshavebeensuspectedtobeinvolved.Obesitycausesperipheralresistancetoinsulinmediated glucoseuptakeandmayalsodecreasethesensitivityofthebetacellstoglucose.(10)Thesechangesare largely reversed by weight loss, leading to a fall in blood glucose concentrations towards normal levels. Weightgainprecedestheonsetofdiabetesconversely,weightlossisassociatedwithadecreasedriskof type2diabetes.(11),(12) Theadministrationofresistin,anadipocytederivedhormone,decreaseswhiletheneutralizationofresistin increasesinsulinmediatedglucoseuptakebytheadipocytes.Thus,resistinmaybeahormonethatlinks obesitytodiabetes.(4)Leptinisproducedbyadipocytesandissecretedinproportiontotheadipocytemass. Itsignalsthehypothalamusaboutthequantityofstoredfat.Studiesinhumansandanimalshaveshownthat leptin is associated with obesity and insulin resistance.(13) The deficiency of adiponectin, an adipocyte derivedhormone,playsaroleinthedevelopmentofinsulinresistanceandsubsequently,type2diabetes. (14) Retinolbindingprotein4,freefattyacids,tumournecrosisfactoralpha,plasminogenactivatorinhibitor1, interleukin1 beta, uncoupling protein 2 and obestatin are also implicated in the adipose tissue induced pathogenesisoftype2diabetes.(15) BMI is a good measure of adiposity however, the relationship between actual body fat and BMI differs between ethnic groups, and as a consequence, the cut off points for the overweight status and obesity basedonBMI,willhavetobeethnicityspecific.(16) Conclusion TheobservedpositivecorrelationbetweenBMIandFBSreiteratestheeffectofadiposetissueinimpairing bloodglucoseregulationandemphasizestheimportanceofthemaintenanceofnormalBMI. Theeffectsofincreasingobesity,asindicatedbyanincreaseinBMIoverthedecadesinapopulationcan bedisastrous,asitcanleadtoenormoushealthcosts.Hence,awarenessneedstobecreatedinchildren rightfromtheschoolage,aswellasamongsttheparentsofthesechildren,inordertohaveanappreciable impactinpreventingordelayingtheonsetoftype2diabetesinlaterlife. Limitationsofthestudy: Our study did not take into account the other indices of obesity like waist hip ratio and abdominal circumference. Recommendations: Werecommendthatfurtherstudiesmustbecarriedoutonalargersamplesizewiththemeasurementof waisthipratioandabdominalcircumferenceascomparativeindicators. References 1. 2. HuF.Obesityepidemiology.Oxford:Oxforduniversitypress,20088797 World Health Organization Obesity: Preventing and Managing the Global Epidemic. World Health OrganizationGeneva,Switzerland,1997786987

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JCDR - Obesity, Body mass index, Fasting blood sugar.

Prospective Studies Collaboration, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, HalseyJ,QizilbashN,CollinsR,PetoR.Bodymassindexandcausespecificmortalityin900000 adults:collaborativeanalysesof57prospectivestudies.TheLancet2009373(9669):108396. SteppanCM,BaileyST,BhatS,BrownEJ,BanerjeeRR,WrightCM,PatelHR,AhimaRS,LazarMA. Thehormoneresistinlinksobesitytodiabetes.Nature2001409(6818):30712. WHOGlobalInfoBaseteam.Surveillanceofchronicdiseasesandriskfactors:Countryleveldataand comparableestimates.Geneva:WorldHealthOrganisation,2005. Adamu GB, Geoffrey CO, Bala GS, Ibrahim SA, Sani SH, Tambaya MA. Relationship between random blood sugar and body mass index in an African population. Int J Diabetes & Metabolism 200614:1445. JhanghorbaniM,HedleyAJ,JonesRB,GilmourWH.Istheassociationbetweenglucoseleveland all causes and cardiovascular mortality risk dependent on body mass index? Med. J. Islamic RepublicIran19926:20512. DiazVA,MainousAG,BakerR,CarnemollaM,MajeedA.Howdoesethnicityaffecttheassociation betweenobesityanddiabetes?DiabetMed.200724(11):1199204. PelletierDL,RahnM.Trendsinbodymassindexindevelopingcountries.FoodandNutritionBulletin 199819(3):22339. DeFronzo RA, Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 199114(3):17394. Felber JP. From obesity to diabetes. Pathophysiological considerations. Int J Obes Relat Metab Disord199216(12):93752. Knowler WC, Pettitt DJ, Saad MF, Charles MA, Nelson RG, Howard BV, Bogardus C, Bennett PH. ObesityinthePimaIndians:itsmagnitudeandrelationshipwithdiabetes.AmJClinNutr.199153(6 Suppl):1543S51S. Niswender KD, Magnuson MA. Obesity and the beta cell: lessons from leptin. J Clin Invest. 2007 117(10):27536. KadowakiT,YamauchiT,KubotaN,HaraK,UekiK,TobeK.Adiponectinandadiponectinreceptors ininsulinresistance,diabetes,andthemetabolicsyndrome.JClinInvest.2006116(7):178492. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes.Nature2006444(7121):8406. Deurenberg P, Yap M. The assessment of obesity: methods for measuring body fat and global prevalenceofobesity.BestPractResClinEndocrinolMetab.199913(1):111.

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TablesandFigures [Table/Fig1][Table/Fig2]

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