RELATIONSHIP BETWEEN DIETARY PATTERN AND ABDOMINAL

OBESITY AMONG UNIVERSITY EMPLOYEES AND THE

METABOLIC CONSEQUENCES OF ABDOMINAL OBESITY

Muhammad Abbas Dilawar and Muhammad Abbas

Department of Human Nutrition
Faculty of Nutrition Sciences
The University of Agriculture, Peshawar
September, 2019
ABSTRACT
A cross sectional study was carried out among university employees in order to
investigate the metabolic consequences of abdominal obesity. A total of 100 subjects
were randomly selected. Data regarding socioeconomic characteristics, anthropometric
measurements, dietary intake and biochemical test were collected. The data was
statistically analyzing using appropriate statistical tests in SPSS (version 21). The mean
age of the subjects was 46.4±9.1 years (male: ---------, female……) with means weight,
height, body mass index (BMI), and waist circumference of (87.7±12.3, 175.7±5.1,
28.4±3.9, 106.7±11.8) respectively. Gender wise differences were evident in means
89.23±12.2, 176.84±4.04, 28.55±3.97, 107.82±11.5 in males, and 79.44±9.3,
169.8±6.31, 27.63±3.53, 100.69±11.41 respectively in females. Three dietary patterns,
namely Plant based – Fish, Energy dense – animal based, High Carbs with chicken
were identified. Results on biochemical parameters showed that subjects with higher
WC were …………. times more at the risk of …………… compared to the normal
(p<0.01 A positive correlation was observed for animal based food with the weight and
waist circumference of the subjects while in case of carbohydrate intake a positively
associated was seen in term of Body mass index. On the other instance a negative
correlation was found for the plant based food with the age, weight, BMI and waist
circumference of the enrolled participant. The plant based foods had a negative
correlation with the fasting blood glucose level, hemoglobin, cholesterol, low density
lipo-protein as well as blood pressures consisting of systolic and diastolic reading. A
positively associated was also found for the animal based food with the fasting blood
glucose, hemoglobin, TGL as well as high density lipoprotein, on other side cholesterol
and high density lipoprotein showed a direct connection with the high carbohydrate
intake of the subjects. The study concluded that
 I. INTRODUCTION

Employees in any organization speak to a significant populace classification;

their personal satisfaction, wellbeing mindfulness and capacity to grasp sound practices
are relied upon to impact their profitability, maintain a strategic distance from NCD
event, lessen human services costs and thus improve the monetary status of the working
environment (Alzeiidan et al., 2016)

Abdominal obesity, also called central obesity, is a complex chronic disease of

elevated levels of fat deposition in the abdominal area of the body (Goldbacher et al.,
2005). It is considered as the main indicator of abdominal fat adiposity among adults.
Several methods can be used to identify abdominal adiposity such as magnetic
resonance imaging (MRI), computed tomography (CT), bioelectrical impedance, waist
circumference (WC) measurement and calculation of waist-hip ratio (WHR). Most of
these methods require qualified/skilled personnel and highly expensive instruments
with potential health risks. In such situation, physical measurements (such as WC
measurement) are considered as the best choices for identification of abdominal obesity
(Xu et al., 2012).

Of anthropometric indicators, WC has been shown as most closely related

measure of visceral adiposity (Hwang et al., 2008). WC has been observed as the most
widely used method as it is more convenient and economical (Han et al., 2006).
Different cut-offs have been used for identifying abdominal obesity. World Health
Organization defined abdominal obesity as WC greater than 102 cm in men and greater
than 88 cm in women (WHO, 1998). However, when the WHO criterion was followed
for Asian population, an underestimation of the pervasiveness of metabolic syndrome
or of the individuals at risk was suspected due to their small build (Tan et al., 2004).
Therefore, ethnic-specific cut-offs for men (WC > 90 cm) and women (WC > 80cm)
were introduced for South Asians people (Asian Indian, Chinese and Malaysian) by
International Diabetes Federation (IDF, 2006). The WHO International Diabetes
Institute of Western Pacific, International Association for the study of Obesity (IASO)
and International Obesity Task Force (IOTF) also recommended the modified criteria
for Asian population (WHO/IASO/IOTF, 2000).

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 Various investigations from different population have detailed expanding body
mass index (BMI)1 and expanding WC during the previous decades. In addition, it
appears that WC demonstrating stomach corpulence is expanding significantly more
quickly than BMI, and expanding waistlines or stomach heftiness are watched among
the fat as well as among ordinary weight subjects. These are disturbing discoveries, as
high WC is significantly more emphatically connected with mortality, metabolic
anomalies and social insurance costs than BMI. There is a dire need to create general
wellbeing procedures for early ID and anticipation of stomach stoutness, and hence we
should have the option to distinguish populace bunches in danger for expanding
waistlines. (Sarlio-Lähteenkorve et al., 2006)

A number of genetic, metabolic, physiological, behavioral, and social factors

have been shown responsible for abdominal obesity. However, recent findings have
exposed a strong link of abdominal obesity with the lifestyle factors, particularly diet
(Esmaillzadeh and Azadbakht (2008). In order to have an entirety view and to control
the potential confounding factors in diet, it has been recommended to evaluate dietary
pattern for the identification of dietary factors responsible for abdominal obesity.
Relying only on the dietary composition in terms of nutrients may not give clear picture
of the situation (Kant, 2004).

Metabolic syndrome (MS) is the most widely recognized metabolic issue in the
cutting edge world and is in charge of most cardiovascular events2 and a huge ascent in
cardiovascular mortality. The clinical significance of MS lies in recognizing people in
danger of cardiovascular malady and type 2 diabetes, empowering preventive way of
life interventions.4 Obesity adds to hypertension, high complete cholesterol (TC), low
high-thickness lipoprotein cholesterol (HDL-C) and hyperglycemia, which are related
with more noteworthy cardiovascular hazard. (Rossa et al., 2012)

Metabolic syndrome speaks to the nearness of a mix of interrelated hazard

variables including focal stoutness, insulin obstruction, dyslipidemia and hypertension.
Subjects with metabolic syndrome have generously expanded hazard for creating type 2
diabetes mellitus and cardiovascular sicknesses (CVD). Additionally, the general
mortality is higher among patients with metabolic syndrome, especially the mortality
related with CVD. This expansion in CV malady hazard has all the earmarks of being
autonomous of other significant and conceivably puzzling variables, for example,

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smoking and raised low-thickness lipoprotein cholesterol (LDL-C) levels (3). The
antagonistic impacts of metabolic syndrome are showed over the entire range of blood
glucose level status (i.e., patients having ordinary blood glucose levels, those having
disabled fasting blood glucose and those with straightforward diabetes mellitus)
(Barimah et al., 2009)

Several investigators have explained the association of key dietary patterns with
general and abdominal adiposity (Sichieri et al., 2002; Newby et al., 2003;
McNaughton et al., 2007; Esmaillzadeh et al., 2007). However, further investigations
are needed to get more details about the existing association of abdominal obesity and
eating habits. Studying the relationship between abdominal obesity and eating patterns
is of utmost importance for those populations who have higher predominance of
abdominal obesity because such people become more prone to co-morbidities
(Esmaillzadeh and Azadbakht, 2008).

Obesity in every form results in the occurrence of many chronic illnesses, such
as type 2 diabetes, cardiovascular disease, cancer and stroke (Hossain et al., 2007).
However, abdominal obesity has higher intensity and more types of health risks than
the generalized obesity, such as a higher risk of cardiovascular diseases, left ventricular
dysfunction, diabetes, hypertension and altered levels of lipoprotein (Ammar et al.,
2008; Lee et al., 2008). Comparatively, abdominal obesity is considered better
predictor of chronic illnesses than the generalized obesity. In central obesity, lipid
abnormalities (such as high TGL, low HDL and high LDL) are commonly seen. The
combination of these lipid abnormalities consequently increases the risk of chronic
diseases such as CVD’s, diabetes and hypertension. Besides, abdominal obesity has
also an association with a number of other contributing factors such as age, education,
smoking, race, obesity defined by BMI and high cholesterol (Freedman et al., 1995).

In spite of the fact that the etiology of Metabolic syndrome isn't completely
comprehended, explore has proposed that insulin opposition, heftiness, natural
elements and hereditary inclination, may assume real job in its pathogenesis. Despite
the fact that the definite pervasiveness of Metabolic syndrome is obscure, inquire about
recommends that it is expanding at disappointing rate around the world. what's more,
changes relying upon the definition utilized and ethnicity However constrained research
is accessible about Metabolic syndrome pervasiveness or its parts among

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representatives Studies demonstrated that Metabolic syndrome commonness was
contrasted concurring word related sort (Obeidat et al, 2012)

Prevalence of abdominal obesity has not been only reported from developed
countries but it is also affecting people of the developed or poor world. Recent studies
reported that pervasiveness of abdominal obesity is more common as compared to
generalized obesity in south Asian countries, such as 25% occurrence in Pakistan,
46.65% in India and 60% in Nepal (Jayawardena et al., 2013). In a Pakistani study,
Kamran et al. (2014) observed 74.7% prevalence of abdominal obesity in adults with
risk factors of coronary artery disease. In Peshawar, 56.6% adults were found to be
abdominally obese (Khan et al., 2015).

Currently, the overeating and less physical activities have greatly altered the
lifestyles of people around the globe. Excessive use of modern technologies for the
sake of comfort and time saving compel the people to live physically inactive life.
Consequently, alarming rates of abdominal obesity and the associated health risks are
prevalent in every segment of human life. People working in offices are suspected to be
more prone to abdominal obesity due to their less active lifestyle. Since no reliable
information in the study area exist, therefore the current study is planned to investigate
the relationship between prevaldietary pattern and abdominal obesity among university
employees. It was also aimed to explore the metabolic abnormalities, if any, of
abdominal obesity among the subjects.

Objectives of the study

1. To measure waist circumference for identification of abdominal obesity in

university employees.
2. To evaluate dietary pattern of subjects using food frequency questionnaire.
3. To investigate the metabolic consequences of abdominal obesity using some
biochemical tests, clinical examination and anthropometric measurements.
4. To observe the association of abdominal obesity with dietary pattern and the
measured metabolic variables.

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 II. REVIEW OF LITERATURE

Alzeidan et al., (2016) led an epidemiological examination on the Non-

Communicable Disease Risk Factors among Employees and Their Families of a Saudi
University to survey the commonness of non-communicable malady (NCD) hazard
factors among Saudi college workers and their families; to assess the cardiovascular
hazard (CVR) among the investigation populace in the accompanying 10years. 5,000
and 200 subjects were welcomed, of whom 4,500 took an interest in the examination,
giving a reaction pace of 87%. The mean time of members was 39.3±13.4 years. Most
of members revealed low organic product/vegetables utilization (88%), and physically
latent (77%). Multiple thirds of the accomplice were observed to be either overweight
or large (72%), where 36% were hefty, and 59% had stomach corpulence. Of the
complete associate, 22–37% were found to experience the ill effects of dyslipidemia,
22% either diabetes or hypertension, with rather low revealed current tobacco use
(12%). One fourth of members was evaluated to have >10% hazard to create
cardiovascular illness inside the accompanying 10-years.

Zhang et al. (2016) explored the associations of dietary patterns with obesity in
Southwest China. They analyzed data of 1604 adults (aged 18-80 years) extracted from
the National Nutrition Survey of China (2010-2012). Dietary intake data was obtained
by 24-hour dietary recall of 3 consecutive days. Measurement of weight, height and
WC were made with recommended methods. Dietary patterns were identified with
exploratory factor analysis. Associations of dietary patterns with obesity were explored
by logistic regression analysis. Three major dietary patterns were identified i.e.,
modern, traditional and tuber based on the key components. When potential
confounders were adjusted, subjects in the upper quartile of the modern pattern had an
elevated risk of generalized and central obesity. Whereas, subjects in the upper quartile
of tuber pattern had a lesser risk of general and central obesity but an increased risk of
underweight. They found that traditional dietary pattern was not significantly
associated with obesity. Besides, differences among dietary patterns were due to the
differences in socio-demographic characteristics. They concluded that both generalized
and central obesity had positive association with the modern dietary pattern and
negative association with the tuber dietary pattern.

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 Yu et al. (2015) analyzed a baseline cross-sectional data of the Chinese adults to
investigate relation of major dietary patterns with central and general obesity. Dietary
intake data of 474,192 adults (aged 30 to 79 years) was obtained through interviewing
and recorded in a questionnaire. Three major dietary patterns were extracted using
factor analysis with cluster analysis. After adjusting for potential confounders, lowest
body mass index (BMI) and WC was found in subjects having southern traditional
dietary pattern. Those subjects who followed the new affluence Western dietary pattern
were having the highest BMI and those with the northern traditional dietary pattern
were having the highest WC. A significantly greater risk of generalized obesity and
central obesity was noted with the consumption of southern traditional dietary pattern
using multivariable adjusted logistic models. Moreover, the prevailing associations
were modified by different lifestyle factors, such as alcohol consumption, smoking and
physical activity. They suggested further studies in order to explore the relationships of
diet with obesity.

Moraes et al. (2015) conducted an epidemiological cross-sectional study to

assess central obesity as an independent predictor of hypertension in Brazilian adults.
Sampling of 2471 subjects were carried out through the three-stage cluster sampling
technique. Subjects were considered hypertensive if using anti-hypertensive drugs or a
blood pressure measure of ≥ 140 SBP and ≥ 90 diastolic. Poisson regression was used
to estimate crude occurrence ratio and adjusted incidence ratio of central obesity. They
found a higher occurrence of hypertension in both males (32.8%) and females (44.5%).
A reliable association of central obesity with the outcomes was seen in both males and
females. They suggested interventional activities to prevent and control central obesity
and hypertension; and consequently, to prevent the health risks of heart diseases and
stroke.

Matsuzawa (2014) reviewed the role of visceral fat in the occurrence of obesity,
metabolic syndrome and heart problems. He stated that the metabolic risk factors,
including hyperglycemia, hypertension and dyslipidemia, have been highly associated
with metabolic syndrome, but still further work is needed to clearly define the
diagnostic criteria for the syndrome. He indicated that accumulation of visceral fat had
a critical role in the progression of metabolic risk factors. The role of adipocytokines,
particularly adiponectin, was discussed in detail. Since reduction in visceral fat through

6
lifestyle changes had been declared effective to control CVD’s, therefore he suggested
further exploration of the metabolic risk factor associated with the accumulation of
visceral fat.

Wohlfahrt et al. (2014) studied the effects of general and central obesity
measures on longitudinal changes in ventricular-arterial mechanics among adults. They
selected a total of 1402 subjects from a community-based population. The Echo-
Doppler echocardiography of the subjects was carried out twice with a time space of 4
years in order to determine heart health. They found that effective arterial (Ea)
elastance was reduced by 3% with enhanced blood pressure control in 4 years. While,
End systolic (Ees) and End diastolic (Eed) elastances were raised by 14% and 8%,
respectively. An association between higher weight loss and higher decrease in Ea was
observed in both sexes. When Ea change was adjusted, a correlation between weight
gain and increase in Eed was noted in both genders. They reported an association of the
central obesity with higher age-dependent raised Ees in only women. Central obesity
was found to be a poor predictor of changes in Ea or Eed. They concluded that weight
gain had an association with increases in diastolic stiffness of left ventricle and with a
decrease in arterial stiffness. They suggested weight loss strategies in order to
effectively prevent heart failure.

Cheserik et al., (2014) has done a cross sectional investigation on Disparities in

the occurrence of Metabolic Syndrome (MS) and its Components Among University
Employees by Age, Gender and Occupation. By and large commonness of MS was
6.1%, higher in males (5.1%) than females (1.1%), and expanded with age. The most
predominant MS parts in all specialists were hypertension (37.9%) and
hypertriglyceridemia (20.8%), relating rates in mens were 28.3% and 16.1% while
females had a commonness of 9.6% and 4.7%. After modification for age, managerial
work was related (p<0.05) with expanded hypertension (chances proportion (OR)
=1.474; 95% certainty interim (CI), 1.146-1.896) and hyperglycemia (OR=1.469; 95%
CI, 1.082-1.993) in male specialists, and with hypertension (OR=1.492; 95% CI, 1.071-
2.080) in females. Be that as it may, pervasiveness of hypertriglyceridemia was lower
(OR=0.390; 95% CI, 0.204-0.746) in female executives contrasted with those in
scholastics. Weight, MS and decreased High Density Lipoprotein (HDL) cholesterol

7
predominance was not extraordinary (p>0.05) between the two occupations in both
genders.

He et al., (2014) directed an exploration to assess the predominance of

overweight and corpulence among college personnel and staffs in China. Contingent
upon the references utilized (China and WHO, separately), the general pervasiveness of
overweight, including corpulence of the subjects was 36.1% and 25.5%, the
commonness of stoutness was 5.3%, and 1.5%, individually, the predominance of
overweight, including heftiness among the male subjects was 46% and 32.5%,
individually, the predominance of overweight, including weight among the female
subjects was 21% and 14.1%, separately, A fascinating perception made was that the
general predominance of overweight was expanded with age.

Singh and Shen (2013) evaluated the independent effects of abdominal obesity
and chronic stress on cardiac autonomic regulation and cardiovascular reactivity. They
assessed cardiovascular activity of 122 students who were involved in two different
stressful undergraduate laboratory tasks. They indicated that increased abdominal
adiposity was a significant predictor of mean arterial pressure (MAP) and blunted SBP.
Whereas, no direct association of chronic stress was found with cardiovascular
reactivity. Also, abdominal obesity was significantly associated with chronic stress.
The overall obesity (measured by body mass index) alone and with chronic stress had
effects on blunted cardiovascular reactivity. They concluded that abdominal obesity
might obstruct in increasing appropriate cardiovascular responses during acute stress.

Xu et al. (2012) examined the relationship of visceral adiposity with metabolic

biomarkers (glucose and lipids) among Chinese abdominally obese adults. They also
investigated WC to be a good indicator of visceral fat. Based on WC, they selected 155
obese or overweight adults. Fasting blood sample was taken from subjects for the
analyses of lipid profile and glucose levels. They found a significant relationship
between WC and visceral adiposity. WC had a significant inverse association with
HDL-cholesterol level (P<0.01). WC and visceral adiposity had positive association
with hemoglobin A1c, insulin concentrations and glucose. They concluded that excess
visceral fat can be related with an adverse lipid profile and glucose concentration. Also,
waist circumference may be a fair predictor of visceral adiposity.

8
 Rossa et al., (2012) led a cross sectional examination on Metabolic syndrome in
laborers in a college clinic. To decide the predominance of MS and factors identified
with its advancement in medical clinic laborers. Of the 740 specialists, 72.4% were
female and mean age was 34.9±9.5 years; 27.8% worked the morning shift, 20.3% the
evening shift, 34.1% available time, and 17.8% the night move. As to instructive level,
86.6% had completed secondary school or school. Abdomen outline was high in
55.4%. By and large MS pervasiveness was 12.8%, 16.2% in guys and 11.6% in
females. Strategic relapse investigation demonstrated a free relationship among MS and
the accompanying factors: rudimentary instruction, time of work >10 years, available
time move, and age gathering.

Obeidat et al., (2012) led an investigation in jordan so as to evaluate Predictors

of Metabolic Syndrome among Employees. A sum of 491 workers (344 men and 147
ladies matured 20 - 65 years) took an interest in this investigation. Information
concerning fasting plasma glucose level, lipid profile, pulse, anthropometric
estimations and 24-dietary reviews were acquired. Metabolic syndrome commonness
was 36.3% (38.7% among men and 30.6% among ladies). Various strategic relapse
examination results demonstrated that the chances proportion of Metabolic syndrome
was expanded in more seasoned ages (OR: 3.0; 95% CI: 1.43 - 6.47; p < 0.01) and
smokers (OR: 2.6; 95% CI: 2.58 - 4.22; p < 0.01). With height 1 unit in the weight list
(BMI), danger of Metabolic syndrome expanded by 30% (95% CI: 22.9% - 38.4%; p <
0.01) and an increase1 mg/day in dietary iron admission, the danger of Metabolic
syndrome expanded 2.4% (95% CI: 0.07% - 4.3%; p < 0.01).

Rezazadeh and Rashidkhani (2010) determined the association of major dietary

patterns with both generalized and central obesity in Iranian women. They selected 460
women of age 20 to 25 years for the cross-sectional study. Food intake record of
subjects was obtained through the semi-quantitative food frequency questionnaire.
Anthropometric measurements included height, weight and waist circumstance (WC).
Body mass index (BMI) was also calculated for defining generalized obesity (BMI ≥30
kg/m2). Central obesity was defined as WC ≥88 cm. The main dietary patterns were
identified with factor analysis. Logistic regression analysis was used to assess the
association of major dietary patterns with generalized and central obesity. The two
main dietary patterns extracted were termed as healthy dietary pattern and unhealthy

9
dietary pattern. When adjusted for confounders, both generalized and central obesity
were more likely to be prevalent among the subjects who had relatively higher score of
unhealthy dietary pattern. In contrast, the subjects having the higher score of healthy
dietary pattern were less likely to have generalized or central obesity. They concluded
that a dietary pattern having more vegetables, fruits, poultry and low-fat dairy products
might be inversely associated with the pervasiveness of obesity. Also, a dietary pattern
having more soft drinks, processed meats, sweets, snacks, processed juice and refined
grains might be directly associated with the occurrence of obesity.

Barimah et al., (2009) did a cross sectional investigation so as to assess the

predominance of Metabolic Syndrome Among Qassim University Personnel in Saudi
Arabia. The information incorporated all male college staff of various ages and
professions. 560 people took an interest in this investigation with a reaction pace of
85%. For all members, the information gathered were sociodemographic attributes,
previous history or getting medicine for diabetes or hypertension, smoking
propensities, physical movement, and estimations important to recognize metabolic
syndrome. Commonness of metabolic syndrome was 31.4%. The predominance was
found to demonstrate a relentless increment with expanding age, BMI and serum
cholesterol. General heftiness estimated by BMI was the most widely recognized
segment related with the syndrome where 75% of members experienced overweight
and corpulence. Members with high-thickness lipoprotein beneath defensive level
comprised 73.6%, while those with absolute cholesterol and TGL above clinically
ordinary level established 60.0% and 46.4% separately. Raised fasting plasma glucose
and hypertension were the least normal. After change, factors observed to be related
with metabolic syndrome were being a Saudi national, smoking, not doing normal
exercise, being large having all out serum cholesterol over 180 mg/dl, and age bunches
over 40 years.

Esmaillzadeh and Azadbakht (2008) investigated the relations between dietary

patterns and obesity in a cross-sectional study among Iranian women. A total of 486
females of age 40 to 60 years were selected for the study. Physical measurements
included waist circumference, weight and height for identification of central and
general obesity. Dietary intake data was obtained through Food Frequency
Questionnaire for determining the dietary pattern of subjects. Three main dietary

10
patterns, including healthy pattern, Iranian pattern and western pattern were extracted
from the dietary intake data using factor analysis. Subjects with healthy dietary pattern
score had fewer chances to be generally and centrally obese; while those with western
dietary pattern had greater chances to be generally or centrally obese. When potential
confounders were controlled, even then both dietary patterns had significant
associations with both central and general obesity. However, the Iranian dietary pattern
had no significant association with both general and central obesity. They suggested
further studies to probe the reported associations in detail.

Despre´s et al. (2008) reviewed the contribution of the abdominal obesity and
metabolic syndrome in global cardio-metabolic risk. They stated that insulin resistance
is the most prevalent form of metabolic abnormalities linked to abdominal obesity,
particularly with excessive visceral or intra-abdominal adiposity. It had been observed
that a negative feature of visceral obesity is the inability of subcutaneous adipose tissue
to properly use the extra dietary energy. Consequently, fat accumulation occurs in
visceral adipose tissues. They indicated that visceral obesity can partly lead to
dysmetabolic state and partly to metabolic syndrome. They emphasized that abdominal
obesity can be best identified with measurement of WC as compared to body mass
index. They suggested that global risk of cardio-metabolic state should be diagnosed
with a wide range of markers such as visceral obesity, metabolic syndrome and insulin
resistance.

Kee et al. (2008) used the data of the Third National Health and Morbidity
Survey (NHMS-III, 2006) in order to determine the predominance of abdominal
obesity in relation to different socio-demographic characteristics of Malaysian
individuals aged ≥ 18 years. They measured WC of 32,900 subjects. The overall
predominance of abdominal obesity was 17.4%. The mean values of waist
circumference in males and females were 84.0 cm and 80.3 cm, respectively. The
associated risk factors of abdominal obesity included being woman, of age group 50 to
59 years, being housewives, subjects having primary education and ever married. They
suggested immediate actions to revise national health policies. Also, urgent programs
should be initiated to prevent abdominal obesity in public particularly the people who
are at risk.

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 Balkau et al. (2007) conducted a longitudinal study to know the outcomes of
changes in abdominal circumference on cardio-metabolic abnormalities. They used
NCEP criteria for defining cardio-metabolic factors. Age-adjusted logistic regression
was used to study the improvement and incidence of cardio-metabolic factors at P <
0.05. They found the prevalent abdominal obesity to be 10% and 15% among men and
women, respectively. High blood pressure was found to be prevalent among 48% and
30% in men and women, respectively; whereas metabolic syndrome was found to be
8% and 7%. They reported that WC was increased by 3 cm and 4 cm among men and
women, respectively. Age had no significant relationship with waist changes among
women. WC was decreased in those men who decreased their alcohol intake. Smoking
was negatively associated with waistline circumference. A decrease in waistline
circumference was observed with increase in physical activity. All the cardio-metabolic
factors were significantly worsening with an increase in waist periphery. They
concluded that changes in waistline periphery might affect the cardio-metabolic factors
with an increase in physical activity.

Despre´s (2006) discussed the relationship of abdominal obesity with metabolic

syndrome and its related cardio-metabolic risk factors. Abdominal obesity is highly
prevalent among western populations due to their less physical activity and intake of
high-energy foods. predominance of abdominal obesity had also been reported in
developing countries due to urbanization of people. Waistline periphery, in
combination of a co-morbidity, can easily explore the cardio-metabolic risk factors
associated with abdominal obesity. Therefore, waistline circumference should be a
standard diagnosing factor of cardiovascular risk in clinical practice. Changes in
lifestyle were strongly suggested for reduction of cardio-metabolic risks associated
with abdominal obesity.

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 III. MATERIALS AND METHODS

STUDY DESIGN AND SUBJECT ENROLLEMENT

It was a cross-sectional study carried out in Gomal University, Dera Ismail

Khan. A total of 100 University employees (both genders) irrespective of their official
status were randomly selected in the study using convenient sampling methods.

The inclusion criteria for enrollment of subjects were those currently employed,
and free from any chronic apparent disability or deformity. Aim of the study was
clarified to each subject to get their willingness for inclusion in the study and an
informed consent was signed from them.

Data Collection

1. PHYSICAL ASSESSMENT

i. Measurement of waist circumference

Waistline circumference of all the subjects was measured for subjects’

screening. The midpoint between the last rib and the iliac crest, at the end of expiration,
was taken as site for measurement of waistline periphery (in centimeters) with a
measuring tape. The recommended cut-offs of WC for South-Asian people was used to
identify abdominal obesity (IDF, 2006). A waist circumference > 90 cm for men and >
80cm for women the criteria for the identification of subjects at the risk of central
obesity.

ii. Measurement of weight and height

Weight (in kilograms) and height (in centimeters) was measured by WHO
recommended procedures (WHO, 1995). An already calibrated weight measuring scale
was used to measure weight to the nearest 0.01 kg. For height measurement, a wall
mounted height measuring device was used. Weight was measured in light clothing.

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iii. Calculation of Body Mass Index

The measured weight and height of each subject was used to calculate his/her
Body Mass Index (BMI) as follows:

BMI (Kg/m2) = Weight (Kg) / Height (m2)

Using the WHO cut-offs, the BMI will serve as a defining criterion for different
forms of malnutrition among subjects.

2. SOCIO-DEMOGRAPHIC DATA

Subjects’ were asked for their name, age, gender, employment status, education,
family size and monthly household income.

3. ANALYSIS OF DIETARY PATTERN

Food frequency questionnaire (FFQ) was used to gather information about

frequency of foods consumed in a week. Based on similar nutrients contents, all the
food items were grouped into different food groups. Two major dietary patterns,
“healthy” and “unhealthy”, were identified from food groups using factor analysis.

4. BIOCHEMICAL AND CLINICAL ASSESSMENT

Blood samples of all the subjects was collected in the morning after a 12-hour
fast using the WHO guidelines for drawing blood (WHO, 2010). The collected blood
samples was used to measure metabolic biomarkers of serum glucose and lipid
including fasting blood glucose, hemoglobin A1c (HbA1c), TGL, total cholesterol and
low- and high-density lipoprotein cholesterols. Measurement of blood pressure will
also be carried out.

STATISTICAL ANALYSIS OF DATA

All the collected information was statistically analyzed by Statistical Package

for Social Sciences (SPSS 21). Descriptive statistics like mean with standard deviation
(SD) and frequency with percentages were determined for all variables. Appropriate
statistical tests were used to compare mean values at significance level of p < 0.05.
Relationship of central obesity with physical, socio-demographic, dietary, biochemical
and clinical variables was evaluated with regression and correlation analysis.

14