Are the thigh circumference, waist-to-thigh circumference ratio and serum creatinine better markers of type II diabetes than the body mass index?

Abstract

Overweight and obesity, associated with type 2 diabetes have been characterized by Body Mass Index, waist circumference or waist-to-hip ratio. However, because of the limitation of the Body Mass Index in expressing fat distribution and the fact that visceral obesity has been more implicated in type 2 diabetes than subcutaneous fat, other diabetes markers are being investigated. A hospital-based case control study, using convenience sampling techniques, sought to determine the most appropriate surrogate makers of type 2 diabetes, among Ghanaian diabetics, using thigh circumference, waist-to-thigh ratio, waist circumference, Body Mass Index, plasma creatinine and lipid profile. The 134 diabetics and 70 control subjects were enrolled. Demographics were gathered and anthropometric variables considered were; body weight, measured with scale (Hospibrand ZT-120, England), waist circumference and thigh circumference, measured with a measuring tape (Gay Mills, WI), while height measured with stadiometer (Fischer Scientific). About 5 mL of overnight fasting venous blood sample were drawn for biochemical assays: Plasma glucose, total cholesterol, high density lipoprotein, low density lipoproteins and triglycerides were determined by enzymatic methods and the creatinine assessment based on the Jaffé reaction, were all done on COBAS Intergra 400 Plus auto analyzer (Germany). Data were analysed using Graph Pad Prism version 5.0 (Graph Pad Software, San Diego, California). Continuous variables expressed as Mean±SD. Subjects compared using unpaired t-tests, one-way ANOVA followed by the Bonferroni test for multiple comparisons. Total body weight, waist circumference, waist-to-thigh ratio and triglycerides were significantly elevated in the diabetic subjects, while High density lipoprotein was significantly reduced. Considering gender and the diabetics compared to control group, there was no significant difference in plasma creatinine levels. Though Waist Circumference (WC), Waist-to- Thigh Ratio (WTR) and Body Mass Index (BMI) were significantly higher in the diabetics as compared to the controls, only WC and WTR predicts dysglycaemia in a linear regression analysis. Waist circumference and waist-to-thigh circumference ratio were better markers of type 2 diabetes in individuals, who are moderately obese than BMI.