ARTICLE INFO

Article Type

Original Research

Authors

Angourani   P (*)
Heydari   M (1)
Karimi   Z (2)
Ebrahimof   S (3)
Mehrzadi   M (2)






(*) Institute of Nutrition & Food Technology, Nutrition Sciences & Food Technology Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(1) 1Janbazan Medical & Engineering Research Center, Tehran, Iran
(2) Institute of Nutrition & Food Technology, Nutrition Sciences & Food Technology Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(2) Institute of Nutrition & Food Technology, Nutrition Sciences & Food Technology Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
(3) 3“Student Research Committee” and “Institute of Nutrition & Food Technology, Nutrition Sciences & Food Technology Faculty”, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Correspondence

Article History

Received:  December  9, 2013
Accepted:  August 3, 2014
ePublished:  November 6, 2014

BRIEF TEXT


… [1-4] Obesity is a very dangerous factor in chronic diseases such as type 2 diabetes, cardiovascular diseases, and some cancers [5]. Adipose tissue is an important endocrine tissue that through hormone secretion can make the body resistant to insulin and enhance the risk of diabetes [6]. … [7, 8] In the populations with the high risk of diabetes, weight loss can reduce the risk of diabetes [9]. Body mass index (BMI) is one of the best and the most applicable obesity indices [10]. … [11-15] Abdominal obesity leads to metabolic disorders such as insulin resistance and hyperinsulinemia, diabetes, increase in triglycerides, and blood pressure; and it is more dangerous than accumulation of fat in other parts of body [16]. … [17-30] As an endocrine organ, adipose tissue makes the obese persons expose to the diabetes risk more than normal people [31]. Veterans are at risk of obesity and diabetessince they have a special life and different problems such as amputation, low physical activity, and using various medications.

Increase in BMI is an independent factor for diabetes. Obesity is the most important factor for diabetes [11]. Waist circumference is the best index in diabetes prediction [12-15]. There are a fewresearches about the veterans’ problems in Iran.

The aim of this study was to investigate the correlation between general obesity (Body Mass Index) and abdominal obesity (waist circumference) and type 2 diabetes in male Iranian veterans.

This is a case control study.

The veterans referred to weight disorders clinic of Sasan Hospital, Iran, in 2011-13 were studied.

135 type 2 diabetic male veterans (diabetic group) and 203 non-diabetic male veterans (non-diabetic group) were selected using available sampling method. The inclusion criteria were age more than 30 and less than 70 years, informed consent for the study, no type 1 diabetes or kidney, heart, and liver with edema, and no use of corticosteroid medications during the study. Patients, who needed surgery or hospitalization during the study were excluded from the study.

Age, educational level, physical activities in a month before the study, and disability status were recorded on a checklist. Diabetes was defined based on the fasting blood sugar equal or more than 126mg/dl, or 2-hour blood sugar equal or more than 200mg/dl, or using blood sugar-lowering medications [17]. Weight was recorded with weight-measuring machine attached to a stadiometer with 100g accuracy, when the subject was less clothing. Height was recorded without shoes and with 0.5cm accuracy (Seca; Germany). Disabled persons’ weights were measured by digital weight measuring machine specific for disabled persons (Seca; Germany). Heights of persons, who were not able to stand were recorded by measuring the distance between the tips of the longest fingers of both hands in the full open hands as perpendicular to the body. Waist circumference size between the lowest rib and the iliac crest at the end of normal expiration was measured using tape meter with 0.5cm accuracy.BMI was computed by dividing weight (kg) by the square of height. To measure BMI of veterans with amputation, their weights were assumed by adding weight of the amputated limb (based on the tables of weight percent of limbs of the total body) [18]. Data were analyzed using SPSS 17 software and Student-T (to compare the mean values) and Chi-square (to compare the frequencies) tests. Logistic regression analysis method was used to investigate the effects of obesity indices (waist circumference and BMI) on the risk of diabetes.

274 persons (81.1%) aged between 30 and 50years. 190 persons (56.2%) were high-school graduates or lower educational levels. 244 persons (72.2%) had no sport activities. 195 persons (78.6%) had no physical disability. 127 persons (37.6%) were overweight. 145 persons (42.9%) were obese. The groups were homogeneous in age, physical activity, educational level, and physical disabilities and there was no significant difference (Table 1). There were significant differences between diabetic and non-diabetic groups in mean weight (96.0±22.7kg and 86.8±20.0kg), mean waist circumference (111.2±15.1cm and 100.8±15.3cm), and mean BMI (32.3±7.6kg/m² and 29.1±6.5kg/m²), respectively. The effect of waist circumference on the risk of diabetes was significant. Body mass index showed no significant effect on the risk of type 2 diabetes.

37.6% of the veterans were overweight and 42.9% of them were obese (80.5% totally). 67% of the veterans with chemically injuries, referring to Baqiyatollah Hospital, Iran, were overweight or obese [19]. More than a half of 106 veterans from Isfahan (Iran) [20] and 83 studied veterans and disabled persons [21], have been overweight and obese. 35.6% of 55721 US veterans have been obese (BMI≥30) [22]. In Dallas, USA, overweight and obese have been reported for 35 and 38% of the veterans, respectively [23]. Relative frequencies of overweight and obese factors in veterans, in the USA, are 44.5 and 27.7%, respectively; and in non-veteran adult persons, they are 34.6 and 22.8%, respectively [24]. In persons aged between 40 and 69 years, the prevalence of obesity in the urban and rural areas of Iran has been reported 40 and 26%, respectively [25].In persons with diabetes, mean weight, BMI, and waist circumference were significantly more than the non-diabetic persons were. Several studies are consistent with the result [28-30]. The more important finding was direct and more powerful correlation between abdominal obesity and the risk of the type 2 diabetes than BMI. Other studies have reported different results. The risk of diabetes in the obese persons with mean age 45.4 years is by 3.6 more than the persons with BMI less than 25 [31]. An increase in BMI by 1kg per square of the height (equivalent to 2.4 to 2.9kg weight increase) can increase the risk for diabetes by 25% [30]. In non-obese persons with normal weight (18.5≤BMI≤25), the risk of diabetes in the upper half of the BMI domain has been by 2 to 3 times more than its lower part [32]. A more important finding has been reported a direct and more powerful correlation between abdominal obesity (WC) and the risk of type 2 diabetes which is similar to the other studies [33].… [34-36]

Specific solutions, aimed at weight and abdominal fat reduction, ought to be noted by the administrators in the treatment of the Iranian veterans.

Adjustment of some intervening factors and lack of possibility of more precise measurement methods for obesity and abdominal obesity were of the limitations of this study.

There is a correlation between waist circumference and the risk of type 2 diabetes. Nevertheless, BMI has no effect on the risk of type 2 diabetes.

The researchers feel grateful to the veterans and personnel of weight disorders clinic of Sasan Hospital.

Non-declared

All procedures were approved by JanbazanBiomedical Engineering Research Center.

The research was funded by the Iranian Foundation of Martyrs and Veterans Affairs.

TABLES and CHARTS

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CITIATION LINKS

[1]Malekzadeh R, Mohammadnejad M, Merhat S, Pourshams A, Etemadi A. Obesity pandemic: An Iranian perspective. Arc Iranian Med. 2005;8(1):1-7.
[2]World Health Organization. Obesity epidemic puts milions at risk from related diseases. Isr J Med Sci. 1997;33(10):706
[3]Hossain P, Kawar B, EL Nahas M. Obesity and diabetes in developing world: A growing challenge. N Engl J Med. 2007;356(3):213-5.
[4]Poulain M, Doucet M, Major GC, Drapeau V, Sériès F, Boulet LP, et al. The effect of obesity on chronic respiratory diseases: Pathophysiology and therapeutic strategies. Can Med Assoc J. 2006;174(9):1293-9.
[5]Hart CL, Hole DJ, Lawlor DA, Smith GD. Obesity and use of acute hospital services in participants of the Renfrew/Paisley study. J Pub Health. 2007;29(1):53-6.
[6]Bray GA. Medical concequences of obesity. J Clin Endocrinaol Metab. 2004;89(6):2583-9.
[7]Zimmet P, Alberti KG, Shaw J. Global and social implication of the diabetes epidemic. Nature. 2001;414(6865):782-7.
[8]
[9]Esteghamati A, Gouya MM, Abbasi M, Delavari A, Alikhani S, Alaedini F, et al. Prevalence of diabetes and impaired fasting glucose in the adult population of Iran: National Survey of Risk Factors for Non-Communicable Diseases of Iran. Diabetes Care. 2008;31(1):96-8.
[10]Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;334(18):1343-50.
[11]Shajari H, Shajari A, Sepahi MA, Mehrparvar AH, Roghani R, Nakhaei MH.. Relationship between arterial blood pressure and body mass index of school age children of southern region of Iran. Acta Med Iran. 2011;49(11):737-41.
[12]Nagaya T, Yoshida H, Takahashi H, Kawai M. Increases in body mass index, even within non-obese levels, raise the risk for Type 2 diabetes mellitus: A follow-up study in a Japanese population. Diabet Med. 2005;22(8):1107-11.
[13]Li S, Xiao J, Ji L, Weng J, Jia W, Lu J, et al. BMI and waist circumference are associated with impaired glucose metabolism and type 2 diabetes in normal weight Chinese adults. J Diabetes Complications. 2014;28(4):470-6.
[14]Wei M, Gaskill SP, Haffner SM, Stern MP. Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (NIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans: A 7-year prospective study. Obes Res. 1997;5(1):16-23.
[15]Stevens J, Couper D, Pankow J, Folsom AR, Duncan BB, Nieto FJ, et al. Sensitivity and specificity of anthropometrics for the prediction of diabetes in a biracial cohort. Obes Res. 2001;9(11):696-705.
[16]Ram J, Snehalatha C, Nanditha A, Selvam S, A Shetty S, Godsland IF, Johnston DG, Ramachandran A. Hypertriglyceridaemic waist phenotype as a simple predictive marker of incident diabetes in Asian-Indian men with prediabetes. Diabet Med. 2014;9.
[17]Alidousti M, Davoodi Gh. Correlation of body mass index (BMI) and waist-to-hip ratio with risk of acute myocardial infarction. Iran J Diabetes Metabol. 2004;4(1):91-8. [Persian]
[18]American Diabetes Association. Diagnosis and classification of diabetes melitus. Diabetes Care. 2010;33(Suppl 1):62-69.
[19]Charney P, Malone AM. ADA pocket guide to nutrition assessment. 2nd ed. Chicago: Amer Dietetic Assn; 2004.
[20]Ghoddousi K, Ghanei M, Bahaeloo Horeh S, Khoddami Vishteh H. Body mass index in veterans exposed to chemical warfare agents with chronic bronchiolitis. Iran J Endocrinol Metabol. 2007;9(3):285-90. [Persian]
[21]Sarraf Bank S, Malek Ahmadi M, Khosravi ZS, Ghiasvand R, Rezaei E, Sabouri J. The prevalence of obesity and overweight in Isfahan veterans. Health Sys Res. 2010;6(3):559-66. [Persian]
[22]Yaghoubi M, Esmailzadeh H, Yaghoubi Gh. Relationship between physical activity and prevalence of obesity and overweight in the disabled and veterans. J Mil Med. 2013;14(4):245-8. [Persian]
[23]Sparks JP, Bollinger M. A demographic profile of obesity in the adult and veteran US populations in 2008. Population Res Policy Rev. 2011;30(2):211-33.
[24]Siddiqui A, Pena Sahdala HN, Nazario HE, Mahgoub A, Patel M, Cipher D, Spechler S. Obesity is associated with an increased prevalance of advanced adenomatous colon polyps in male veteran population. Dig Dis Sci. 2009;54(7):1560-4.
[25]Nelson KM. The burden of obesity among a national probability sample of veterans. J Gen Intern Med. 2006;21(9):915-9.
[26]Rashidi A, Mohammadpour-Ahranjani B, Vafa MR, Karandish M. Prevalance of obesity in Iran. Obes Rev. 2005;6(3):191-2.
[27]Chavannes NH, Huibers MJ, Schermer TR, Hendriks A, van Weel C, Wouters EF, et al. Associations of depressive symptoms with gender, body mass index and dyspnea in primary care COPD patients. Fam Pract. 2005;22(6):604-7.
[28]Prinz P. Sleep, appetite and obesity: What is link?. PLoS Med. 2004;1(3):e61.
[29]Wannamethee S, Shaper A, Walker M. Overweight and obesity and weight change in middle aged men: Impact on cardiovascular disease and diabetes. J Epidemiol Community Health. 2005;59(2):134-9.
[30]Haluzík M, Parízková J, Haluzík MM. Adiponectin and its role in the obesity-induced insulin resistance and related complecations. Physiol Res. 2004;53(2):123-9.
[31]Nagaya T, Yoshida H, Takahashi H, Kawai M. Increases in body mass index, even within non-obese levels, raise the risk for Type 2 diabetes mellitus: A follow-up study in a Japanese population. Diabet Med. 2005;22(8):1107-11.
[32]Hosseinpanah F, Rambod M, Azizi F. Population attributable risk for diabetes associated with excess weight in Tehranian adults: A population-based cohort study. BMC Pub Health. 2007;7:328.
[33]Hart CL, Hole DJ, Lawlor DA, Davey Smith G. How many cases of Type 2 diabetes mellitus are due to being overweight in middle age? Evidence from the Midspan prospective cohort studies using mention of diabetes mellitus on hospital discharge or death records. Diabet Med. 2007;24(1):73-80.
[34]de Oliveira Alvim R, Mourao-Junior CA, de Oliveira CM, Krieger JE, Mill JG, Pereira AC. Body mass index, waist circumference, body adiposity index, and risk for type 2 diabetes in two populations in Brazil: General and Amerindian. PLoS One. 2014;9(6):e100223.
[35]Tulloch-Reid MK, Williams DE, Looker HC, Hanson RL, Knowler WC. Do measures of body fat distribution provide information on the risk of type 2 diabetes in addition to measures of general obesity? Comparison of anthropometric predictors of type 2 diabetes in Pima Indians. Diabetes Care. 2003;26(9):2556-61.
[36]Vazquez G, Duval S, Jacobs DR Jr, Silventoinen K.. Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis. Epidemiol Rev. 2007;29:115-28.
[37]Reaven GM. Syndrome X: 6 years later. J Intern Med Suppl. 1994;736:13-22.