UMYU Scientifica

A periodical of the Faculty of Natural and Applied Sciences, UMYU, Katsina

ISSN: 2955 – 1145 (print); 2955 – 1153 (online)

ORIGINAL RESEARCH ARTICLE

Association between Anthropometric Indices of Obesity and lipid profile Parameters among Hypertensive Patients Attending some selected Hospitals in Kano Metropolis

*A. M Umar¹, N. S. Sadi², A. M. Gadanya², L. H. Adamu³, M. A. Gambo⁴, F. A Ismail¹. A. Murtala⁵

¹Department of Integrated Science, Faculty of Sciences Education, Federal University of Education, Kano, Nigeria.

²Department of Biochemistry, Faculty of Basic Medical Sciences, Bayero University, Kano, Nigeria.

³Department of Human Anatomy, Faculty of Basic Medical Sciences, College of Medicine and Allied Medical Sciences, Federal University Dutse, Jigawa, Nigeria

⁴Department of Integrated Science, Federal College of Education (Technical) Bichi, Kano, Nigeria

Department of Biochemistry, Faculty of Science and Computing, Baba-Ahmed University, Kano-Nigeria.

*Corresponding Author:

Umar Abdullahi Muhammad. Department of Integrated Science, Faculty of Sciences Education, Federal University of Education, Kano-Nigeria. Email: amumagashi@gmail.com ; phone number: +234-816 484 6220

ORCID NUMBERS OF AUTHORS

Umar Abdullahi Muhammad: https://orcid.org/0000-0002-6800-5081

Nasir Sirajo Sadi : https://orcid.org/0009-0008-4829-9423

Aisha Muhammad Gadanya : https://orcid.org/0009-0002-1298-2649

Lawan Hassan Adamu: https://orcid.org/0000-0003-4787-8294

Muhammad Ali Gambo: https://orcid.org/0009-0001-6484-0450

Faiza Aliyu Ismail : https://orcid.org/0009-0001-0081-0770

Aisha Murtala : https://orcid.org/0009-0008-0967-9044

Abstract

Hypertension is a growing global health issue, especially in low-income countries, with obesity as a key risk factor measured through indices like BMI, waist circumference, and waist-to-hip ratio. Assessing the relationship between lipid profiles (TC, TG, HDL-C, LDL-C) and these obesity measures is crucial for effective hypertension management. This study investigates the link between anthropometric indicators of obesity and lipid profile parameters in hypertensive patients who visit specific hospitals in Kano Metropolis, Nigeria. Between November 2024 and February 2025, 200 individuals aged 60 or older participated in a cross-sectional study involving interviews. Each participant's anthropometric indices were measured using techniques employed by trained professionals. The Body Composition Monitor (Karada Omron Scan) was used to measure the participants' weight, BMI, visceral fat, fat composition, muscle composition, and resting metabolism. Standard techniques were then applied to establish the remaining anthropometric data. Lipid parameters were measured using a lipid panel test apparatus. SPSS V 24. 00 was utilized for data analysis. The findings revealed a significant positive correlation between WC and BMI, visceral fat, hip circumference, and TC, HDL, TAG, and LDL-C levels (p < 0. 05), indicating that higher levels of atherogenic lipids are associated with increased obesity. This study also found a significant difference (p < 0. 05) in hip circumference, fat composition, muscle composition, and waist circumference between hypertensive patients and controls. The study demonstrates a notable association between anthropometric indices of obesity and adverse lipid profile parameters among hypertensive patients in the Kano Metropolis.

Keywords: Anthropometric Indices, Obesity, Lipid Profile, Hypertension, Cardiovascular Risk, Kano Metropolis

INTRODUCTION

The primary risk factor for cardiovascular disease (CVD) worldwide is hypertension. According to Wang et al. (2018), it causes around 9.4 million deaths globally each year. Recent studies indicate that nearly half of individuals with hypertension are unaware of their condition. According to Richardson et al. (2024), there is an unusually high incidence of hypertension among young people. Current estimates show that the prevalence of hypertension in Nigeria has been rising over the past few decades, with regional variations ranging from 22% to 44% (Ogungbe et al., 2024). However, rates of control, treatment, and awareness remain low. Only 29% of Nigerians with hypertension knew they had been diagnosed, 12% were receiving treatment, and only 3% had their condition under control, according to a 2021 meta-analysis (Ogungbe et al., 2024). More studies have reported slightly higher control rates. These poor control rates significantly increase the risk of outcomes such as myocardial infarction, strokes, heart failure, and kidney disease (Ogungbe et al., 2024).

Any excessive accumulation or abnormal amount of fat that indicates a health concern is referred to as overweight or obesity (Ayogu et al., 2022; WHO, 2024). Excessive fat accumulation and associated health risks characterize obesity, a complex illness. Despite being a preventable and treatable issue, 39% of people worldwide suffer from obesity (WHO, 2024). Since the risk of non-communicable diseases rises with body mass index, obesity and overweight are linked to more deaths globally (WHO, 2024). Research indicates that among the leading causes of death are conditions associated with obesity, such as hypertension, type 2 diabetes, and cardiovascular disease (CDC, 2017). In 2019, the prevalence of obesity in Nigeria was 9.9% for women, 10.3% for girls, 8.3% for boys, and 6.5% for men. According to the report, 18.2% of women, 16.7% of girls, and 10.3% of boys are overweight (World Obesity, 2019).

A variety of anthropometric measurements and indices can be used to define obesity. The question of which obesity metric best predicts CVD has been the subject of growing conjecture in recent years (Wang et al., 2018). Previous research on this topic remains debatable, though. Numerous epidemiologic studies on obesity often employ the body mass index (BMI). However, several studies have revealed that it cannot discriminate between body fat and lean body mass (Khashayar et al., 2017). Some studies indicate that centralized measures of obesity, such as waist circumference (WC), waist-to-hip ratio (WHR), or waist-to-height ratio, are statistically superior to body mass index (BMI) in identifying cardiovascular risk factors in both men and women (Wang et al., 2018). Others have discovered that central obesity markers and BMI perform similarly for both sexes and all ages. Additionally, several new anthropometric indices have been created recently, such as the new hip index (HI) and the body shape index (ABSI), which have been demonstrated to be additional to BMI and other known risk factors (Krakauer & Krakauer, 2016). To make our results more distinctive and complete, we therefore included more indices in our present study than in earlier ones, such as height, weight, BMI, HI, ABSI, WC, hip circumference (HC), WHR, and WHtR.

A variety of anthropometric measurements and indices can be used to define obesity. The question of which obesity metric best predicts CVD has been the subject of growing discussion in recent years (Wang et al., 2018). Previous research on this topic is still debatable, though. Numerous epidemiologic studies on obesity frequently employ the body mass index (BMI). However, many studies have found that it is unable to distinguish between lean body mass and body fat (Khashayar et al., 2017). In order to identify cardiovascular risk factors in both men and women, several studies have established statistical evidence that centralized obesity measurements, such as waist circumference (WC), waist-to-hip ratio (WHR), or waist-to-height ratio (WHtR), are superior to BMI (Wang et al., 2018). Others have discovered that central obesity markers and BMI perform similarly for both sexes and all ages. In addition, a number of new anthropometric indices have been developed recently, including the body shape index (ABSI) and the new hip index (HI), which have been shown to be complementary to BMI and other established risk factors (Krakauer & Krakauer, 2016). To make our results more complete, we therefore included more indices in our present study than in earlier ones, including height, weight, WC, hip circumference (HC), WHR, WHtR, BMI, HI, and ABSI.

. Although the relationship between obesity and hypertension has been well-documented, this study uniquely examines the role of new anthropometric indices, such as ABSI and HI, in predicting lipid abnormalities in hypertensive patients. When combined with traditional measurements, these indices may improve risk stratification and management of hypertensive patients in clinical settings. Therefore, this study aims to assess the new anthropometric indices of obesity and their relationship with lipid profiles among hypertensive patients attending selected hospitals in Kano Metropolis.

MATERIALS AND METHOD

Target Population

The study was an observational, cross-sectional study. Hypertensive subjects were selected by simple random probability sampling method from patients (males and females) attending the hypertensive clinic of some selected hospitals in the Kano metropolis (Murtala Muhammad Specialist Hospital, Sheik Muhammad Jidda, Sir Muhammad Sunusi General Hospital, Muhammad Abdullahi Wase Specialist Hospital), Kano State, Nigeria. The study subjects comprised hypertensive patients and apparently healthy subjects between the ages of 20 and 70 years whose weight falls into normal, obese, or overweight groups.

Inclusion and Exclusion Criteria

The patients studied were those diagnosed as hypertensive. The hypertensive status of the patients was defined as described. Systolic blood pressure (SBP) of 140 mmHg or higher and diastolic blood pressure (DBP) of 90 mmHg or higher are defined by the Seventh Joint National Committee on Detection, Evaluation, and Treatment of Hypertension (JNC-VII) of the United States. The study excluded pregnant women, breastfeeding moms, women on hormone replacement therapy or oral contraceptives, and those who declined to provide their permission.

Sample Size Determination

The sample size was determined in accordance with Fisher’s formula (Babandi et al., 2017), with the following resource equation.

\[n = \frac{\ Z^{2}pq}{d^{2}}\]

Where;

n = minimum sample size required in a population

Z = standard normal deviation, usually at 1.96, which corresponds to 95% confidence interval

P =Hypertension prevalence rate in a previous study 32.8% (Adeloye et al., 2015).

q = proportion of failure = (1- p)

d = degree of accuracy, which is chosen as 5 % (0.05)

\[n = \frac{\ Z^{2}pq}{d^{2}} = \frac{\ {(1.96)}^{2}*(0.328)*(1 - 0.328)}{{(0.05)}^{2}} = 154\]

154 will be the minimum sample size

Therefore, 200 participant were recruited for the whole study.

Ethical Approval.

The Kano State Ministry of Health granted ethical approval (SHREC/2024/5791, NHREC/17/03/2018). Participants provided their informed consent after being fully informed about the study.

Administration of Questionnaires

Data on the socioeconomic and demographic features of the subjects, such as their nutritional condition, food frequency questionnaire, knowledge, attitude, and habits, were gathered using a structured questionnaire. A re-structure validated FAO-UN questionnaire was adopted and administered to collect Data on the subjects' socioeconomic and demographic features, such as their nutritional condition, food frequency questionnaire, knowledge, attitude, and habits, were gathered using a structured questionnaire.

Determination of Blood Pressure

Trained medical professionals and nurses used a mercury sphygmomanometer to monitor blood pressure (BP) while seated.

Lipid profile

Lipid parameters were measured using a lipid panel test equipment. This test system measures triglycerides, HDL, and cholesterol in whole blood, plasma, and serum using lipid panel test strips. The formula LDL = TC – HDL– [Trig/5] can then be used to determine the LDL cholesterol based on the results obtained for other parameters. The professional analyzer CardioChek Plus offers the quantifiable result. Each box of test strips included a MEMo Chip, which needs to be correctly put into the analyzer before any tests can be conducted.

Anthropometric Measurements

The Body Composition Monitor measured the study participants' weight, BMI, visceral fat, fat composition, muscle composition, and resting metabolism. The majority of conventional anthropometric indices (height, weight, WC, HC, WHR, WHtR, and BMI) and a few recently created anthropometric indices (HI and ABSI) are included in our study to produce more trustworthy results.

Weight in light clothing was measured in kilograms (precision 0.01 kg), while height without shoes was recorded in centimeters (accuracy 1.0 cm). Participants stood without bulky outerwear, with their pockets emptied and their breaths out slowly, and their waist circumference was measured at a level point halfway between the iliac crest and the lower rib edge (accuracy 1 cm). With an accuracy of 1 cm, HC was measured as the maximal circumference over the buttocks. Weight divided by height squared (kg/m²) was used to compute BMI. WC divided by HC was used to compute the waist-to-hip ratio (WHR).

Statistical Analysis

IBM SPSS Advanced Statistics version 24.0 (SPSS Inc., Chicago, IL) was used to analyze the data. The mean and standard deviation or, if applicable, the median and range were used to represent numerical data. Frequencies and percentages were used to express qualitative data. To investigate the relationship between qualitative variables at P < 0.05, the chi-square test, confidential interval, and odd ratio were employed.

RESULTS

Socio-demographic Data

Table 1 shows the socio-demographic data of the study subjects. Among the study population, 128 (64%) were female and 72 (36%) were male, almost (80%) of the participants were hypertensive. Majority of the participants (80%) were within the age of 45-70 years in which (80%) were hypertensive. In general, the following traits were present in the majority of participants: married (92%), female (64%), secondary education (58%), civil servant (38%), income less than #18000 per month (40%) and number of children 9- above (38%).

Table 1: Socio-demographic Features of Participants with and Without Hypertension

Anthropometric results

Table 2 indicates the distribution of anthropometric variables in hypertensive and control individuals as follows: comparing the status of the individuals, there were no statistically significance differences at p<0.05 in the anthropometric indices except hip, fat composition, and muscle composition, which showed statistical difference at p<0.05.

Table 2: Anthropometric Parameter Comparison of Participants with and Without Hypertension

Lipid Profile Parameters

Table 3 shows the descriptive statistics with mean, SD, t-value, and p-value of Lipid Profile parameters among hypertensive and non-hypertensive patients. It was found that there was no statistical difference p > 0.05 among hypertensive and Control individuals. But when stratified into male and female, LDL shows significant difference between male hypertensive and Control, and in females at p <0.05, only TAG exhibits a meaningful difference.

Table 3: Lipid Profile Parameters for the Hypertensive and Control Individuals Attending Selected Hospitals in Kano Metropolis

Values are expressed as mean± SD; mean values having different superscripts in the same row are significantly different at (p<0.05)

Correlation results between biochemical parameters and anthropometric indices

Table 4 presents the results of the correlation between the anthropometric indices with the biochemical parameters in hypertensive and control individuals. All anthropometric indices correlated significantly with cholesterol, body fat, hip, and BMI. BMI had the highest correlation coefficient with body fat, visceral fat with cholesterol, and LDL; Weight also had the highest correlation with cholesterol, HDL, LDL, and BMI, while CI had the lowest.

Table 4: Correlation between Biochemical Parameters and Anthropometric Indices in Hypertensive and Control Individuals Attending Selected Hospitals in the Kano Metropolis

DISCUSSION

This study was conducted on patients attending some selected hospitals (Murtala Muhammad Specialist Hospital, Muhammad Abdullahi Wase Teaching Hospital, Sheik Muhammad Jiddah General Hospital, and Sir Muhammad Sunusi General Hospital) in the Kano metropolis. Most participants were women and married, with the highest percentage having primary education.

In hypertensive and normotensive, there is a difference in most of the anthropometric indices between hypertensive patients and normotensive individuals, including both overall and abdominal obesity indicators. These results suggested that hypertension is linked to obesity in both males and females, which is consistent with previous studies that both overall and abdominal obesity are significantly associated with hypertension (Nguyen et al., 2008; He et al., 2009). It has been proposed that leptin, renin-angiotensin-aldosterone axis activation, and structural artery anomalies are the mechanisms behind this connection (Nguyen and Lau, 2012). Numerous long-term investigations, such as the Framingham Heart Study, have also demonstrated the negative impact of waist circumference and BMI on the risk of hypertension (Wang et al., 2018). In the normotensive category, an increase in WC is similarly linked to high risk, according to the NIH (US), which has shown that there is a graded increase in health risk with an increase in BMI (NIH 1998). Moreover, additional research revealed that it might potentially be connected to the gene variant (Baudrand et al., 2015; Skrypnik et al., 2017). Fortunately, the incidence of hypertension can be reduced by dietary changes, nutritional knowledge, attitude, and practice, increased physical activity, endurance, and endurance-strength exercise, and the fact that obesity is a modifiable factor (Skrypnik et al., 2015 and 2016; Szulinska et al., 2016).

Without taking age into account, the current study demonstrates a substantial correlation between BMI and hypertension. Numerous studies that show an increase in BMI causes blood pressure to rise to confirm these findings (Wilsgaard et al., 2000; Droyvold et al., 2005; Wang et al., 2018). However, when age increased in females, the association between HI and hypertension became more pronounced. Moreover, some research continues to show that elevated HC is a risk factor for multi-metabolic illnesses (Liu et al., 2008). There are two possible explanations for this outcome. First, because HC has a positive correlation with both BMI and WC, it provides some information on both overall and abdominal obesity (Wang et al., 2010). Second, research has shown that women who are more gravid are consistently at higher risk of developing metabolic syndrome (Xu et al., 2014). Given these findings, it should be a top priority to urge women with high HC and men with high BMI to pay more attention to hypertension recommendations. Additionally, in order to detect and treat elderly hypertensive patients early, healthcare facilities should improve screening and surveillance for those at-risk segments.

The primary findings of this study showed that, overall, obesity was linked to hypertension in both genders, which may mean that the distribution of body fat in women and the amount of body fat mass in men are closely related to hypertension (Wang et al., 2018). Previous research has shown that general obesity and partial obesity typically have similar relationships with hypertension in different genders, with some studies showing that general obesity has a stronger association with hypertension in both males and females (Kashayar et al., 2017), while other studies found that partial obesity had a stronger association with hypertension in both genders (Wang et al., 2018). Our findings suggested that the roles of overall obesity and partial obesity in hypertension in distinct genders may differ. Additional research is required to validate this hypothesis.

CONCLUSION

In conclusion, a significant high correlation between anthropometric indices and the lipid profile parameters was observed; hip circumference, Fat composition, Muscle composition, and waist show a significance difference between the hypertensive and control. Also, there is a gender difference in the level of TAG and LDL among the study participants.

FUNDING

Tertiary Education Trust Fund (TETFUND) provided funding for this study through the Institutional-Based Research (IBR) grant of the Federal University of Education, Kano, under the grant number (FCEK/GEN.311/Vol. VII).

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APPENDIX: QUESTIONNAIRE

QUESTIONNAIRE

Name: ___________________________________________________________

Height _______________ Weight _______________ BP__________________

BMI _______________ RM kcal________________ Sex: Male female

Body fat%____________ Muscle% ______________ Visceral fat ____________

Waist (cm)____________ Hip(cm)______________

SECTION A

Socio-demographic Characteristics of Respondents

1. Please indicate your age in appropriate ranges

15-24 years 25-34 years 35-44 years 44 and above

2. Marital Status

Married Divorced Widowed

1. Which of the following is your highest level of formal education?

Primary Secondary Tertiary education No formal education

2. Which of the following is the respondent’s husband highest level of formal education?

Primary Secondary Tertiary education No formal education

5. Occupational Status

Civil servant Self employed Not employed Student

6. Monthly income
< 50 000 50-100,000 101-150,000 >150,000

7. How many children do you have?

None 1-4 5-8 9 and above

SECTION B
Nutritional Knowledge
Tick to the answer that best suit you

1. Are you aware about the importance of Nutrition?

Yes No

2. Are you aware of consumption of balanced diet?

Yes No

3. Are you aware of the main food nutrients that you should consume daily (balanced diet); i.e. proteins, carbohydrates, fats, minerals and vitamins?

Yes No

4. Are you aware of the sources of main food groups that you should eat 3 main meals a day?

Yes No
5. Are you aware about the risk of overfeeding?

Yes No
6. Are you aware of potentially harmful foods?

Yes No
7. Are you aware of the risk of overweight?

Yes No
8. Are you aware of the foods for growth and development?

Yes No
9. Are you aware that the best source of information for nutrition is in the hospital?

Yes No

10. Do you have Any Problems with your Appetite, like not feeling hungry or feeling hungry all the time? Yes No

11. Have you tried to lose weight or control your weight by vomiting, taking diet, pills or laxatives, or not eating? Yes No

SECTION C

Nutritional Attitude and Practice

Please tick to the answer that best suits you.

Practice always = PA
Do not practice = DP
Practice rarely = PR

1. How often do you eat food substances that contain carbohydrate like starchy foods?

PA DP PR

2. How often do you eat bodybuilding foods like milk, egg, beans etc?

PA DP PR

3. How often do you eat fats and oil food substance from plant source?

PA DP PR 4. How often do you eat food substances that are rich in vitamins like fruits, vegetables, fortified milk, fortified margarine, eggs, liver and fish?

PA DP PR

5. How often do you drink eight and more glasses of fluids daily?

PA DP PR

6. How often do you plan and keep to a balance food menu?

PA DP PR

7. How often do you eat food substances rich in fiber/roughages like skin of fruits, wheat and grain?

PA DP PR

8. How often do you eat fried foods and other fattening foods or high calorie foods some of which are animal fats, butter and starchy foods?

PA DP PR

9. How often do you exercise?

PA DP PR

10. How often do you take vitamins and mineral supplements?

PA DP PR