Diagnostic property of anthropometric indicators in the prediction of high body fat estimated by DXA in hypertensive women

Propriedade diagnostica dos indicadores antropométricos na predição do excesso de gordura corporal estimado por meio do DXA em mulheres hipertensas

Camila Tomicki Aline Mendes Gerage Raphael Mendes Ritti-Dias Diego Augusto Santos Silva Tânia Rosane Bertoldo Benedetti About the authors

Abstract

Excess body fat is an important risk factor for the development of arterial hypertension. he aim of this study was to verify the diagnostic performance of anthropometric indicators in the prediction of excess body fat estimated by Dual-energy Radiometric Absorptiometry (DXA) in hypertensive women. A cross-sectional study with 71 hypertensive women (57.9 ± 10.1 years; 77.8 ± 15.1 kg; 156.8 ± 5.2 cm) was carried out. he anthropometric indicators analyzed were: Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR) and Conicity Index (C Index). Body fat measured by DXA was used as the reference method. Descriptive statistics and ROC curve were used for data analysis. Comparing the anthropometric indicators with the percentage of total fat estimated by DXA, significant differences were observed in BMI, WC and WHR (P <0.05). In relation to the percentage of trunk fat, a difference was identified in BMI and WC (P <0.05). Among the anthropometric indicators analyzed, BMI (0.83), WC (0.79) and WHtR (0.80) had the largest areas under the ROC curve in relation to excess body fat determined by DXA. he cutoff points were conservative in relation to those suggested in literature. Anthropometric indicators BMI (24.72 kg/m2), WC (87.81 cm) and WHtR (0.55) can be adopted in the evaluation of excess body fat in hypertensive women, since they demonstrated to be good predictors when confronted with DXA.

Key words
Key words; Body fat distribution; Sensitivity and specificity; Women

Resumo

O excesso de gordura corporal é importante fator de risco para o desenvolvimento e agravamento da hipertensão arterial. Objetivou-se verificar o desempenho diagnóstico dos indicadores antropométricos na predição de excesso de gordura corporal estimado por meio do absortometria radiológica de dupla energia (DXA) em mulheres hipertensas. Realizou-se estudo transversal com 71 mulheres hipertensas (57,9 ± 10,1 anos; 77,8 ± 15,1 kg; 156,8 ± 5,2 cm). Os indicadores antropométricos analisados foram: Índice de Massa Corporal (IMC), Circunferência da Cintura (CC), Relação Cintura-Quadril (RCQ), Relação Cintura-Estatura (RCEst) e Índice de Conicidade (IC). A gordura corporal mensurada por meio da DXA foi utilizada como método de referência. Utilizou-se estatística descritiva e curva ROC para a análise dos dados. Comparando os indicadores antropométricos com o percentual de gordura total estimado pelo DXA, observou-se diferenças significativas no IMC, na CC e na RCEst (P < 0,05). Em relação ao percentual de gordura de tronco, identificou-se diferença no IMC e na CC (P < 0,05). Dos indicadores antropométricos estudados, o IMC (0,83), a CC (0,79) e a RCEst (0,80) tiveram as maiores áreas sob a curva ROC quando comparados a RCQ (0,50) e ao IC (0,55). Os pontos de corte se mostraram conservadores em relação àqueles sugeridos pela literatura. Os indicadores antropométricos IMC (24,72 kg/m2), CC (87,81 cm) e RCEst (0,55) podem ser adotados na avaliação do excesso de gordura corporal em mulheres hipertensas, uma vez que demonstraram ser bons preditores quando confrontados com DXA.

Palavras-chave
Antropometria; Distribuição da gordura corporal; Sensibilidade e especificidade; Mulheres

INTRODUCTION

Excess body fat is an important risk factor for the development and progression of several chronic non-communicable diseases, including arterial hypertension11 Gerage AM, Benedetti TR, Farah BQ, Santana F da S, Ohara D, Andersen LB, et al. Sedentary Behavior and Light Physical Activity Are Associated with Brachial and Central Blood Pressure in Hypertensive Patients. PLoS One 2015;10(12):e0146078.. Increased body fat stimulates the renin-angiotensin aldosterone system and sympathetic nerve activity, in addition to a physical compression in kidneys, causing changes in intrarenal hemodynamic behavior and impairments in sodium excretion, which together contribute to increase blood pressure22 Hall ME, Carmo JM do, Silva AA da, Juncos LA, Wang Z, Hall JE. Obesity, hypertension, and chronic kidney disease. Int J Nephrol Renovasc Dis 2014;7:75-88..

In this context, accurate control of excess body fat becomes important among hypertensive individuals, since disease control and the success of pharmacological or non-pharmacological interventions can be mediated by changes in this variable33 Sociedade Brasileira de Cardiologia. V Diretrizes Brasileiras de Hipertensão Arterial. Arq Bras Cardiol 2007;89(3):e24-79.. his may be even more relevant in women who are naturally more prone to accumulation of fat in certain body regions due to hormonal issues44 Panazzolo DG, Silva LHA da, Leão LMCSM, Aguiar LGK. Efeitos da terapia hormonal da menopausa sobre a gordura corporal. Med HUPE-UERJ 2014;13(1):47-53.. In addition, the reduction in estrogen production observed in women with advancing age increases the sympathetic nervous activity and impairs endothelial function, hindering blood hypertension control55 Silva HB, Bortolotto LA. Hipertensão arterial na mulher. Rev Bras Med 2002;59(5):359-367..

Dual-energy radiological abortometry (DXA) evaluates the amount and distribution of body fat with high degree of accuracy, objectivity and reproducibility when all the measurement procedures recommended by the manufacturer are adopted66 Ellegârd LH, Áhlén M, Korner U, Lundholm KG, Plank LD, Bosaeus IG. Bioelectric impedance spectroscopy underestimates fat-free mass compared to dual energy X-ray absorptiometry in incurable cancer patients. Eur J Clin Nutr 2008;63(6):794-801.,77 Lohman M, Tallroth K, Kettunen JA, Marttinen MT. Reproducibility of dual-energy x-ray absorptiometry total and regional body composition measurements using different scanning positions and definitions of regions. Metabolism 2009;58(11):1663-8.. However, it is not always accessible in middle- and low-income countries. hus, simpler procedures, involving more accessible techniques and measures, with lower operational costs, such as anthropometric indicators88 Peer N, Steyn K, Lombard C, Gwebushe N, Levitt N. A high burden of hypertension in the urban black population of Cape Town: he Cardiovascular Risk in Black South Africans (CRIBSA) Study. PLoS One 2013;8(11):e78567., may be more applicable and, therefore, it is important to evaluate whether such measures are sensitive and specific in the prediction of excess body fat when compared to DXA, which has been used as an alternative in the validation of diagnostic methods of excess body fat in population studies based on doubly indirect techniques, such as anthropometric indicators99 Rech CR, Ferreira LA, Cordeiro BA, Vasconcelos FAG; Petroski EL. Body composition estimates using dual-energy X-ray Absorptiometry. Rev Bras Cienc Mov 2007;15(4):87-98.. In apparently healthy women, Body Mass Index (BMI) in conjunction with Waist Circumference (WC) and Conicity Index (CI) appear to be the best anthropometric indicators in predicting excess body fat1010 Gomes MA, Rech CR, Gomes MBA, Santos DL. Correlação entre índices an-tropométricos e distribuição de gordura corporal em mulheres idosas. Rev Bras Cineantropom Desempenho Hum 2006;8(3):16-22., but it is still unclear if this method applies to hypertensive women.

Therefore, the aim of this study was to verify the diagnostic performance of anthropometric indicators [(Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR) and Conicity Index (C Index)] in the prediction of excess body fat estimated by DXA in hypertensive women.

METHODOLOGICAL PROCEDURES

Recruitment

Women diagnosed with high blood pressure were recruited for a possible participation in a Randomized Clinical Trial (NCT02257268) linked to a behavior change program. he analyses of this cross-sectional study involved part of the baseline assessments performed for the clinical trial.

Participants were recruited through advertisements in local media, distribution of leaflets in hospitals and in the vicinities of the University of Pernambuco, Recife, Brazil, in 2014.

The study was approved by the Committee of Ethics in Research with Human Beings of the Federal University of Santa Catarina under protocol No. 811,266. After being informed about the aims and procedures of the study, all participants signed the free and informed consent form (TCLE) in compliance with Resolution 466/12 of the National Health Council.

Screening

As inclusion criteria, the following requirements were observed: age equal to or greater than 40 years, report of medical diagnosis of blood hypertension (systolic / diastolic blood pressure ≥ 140/90 mmHg) controlled by the use of antihypertensive medication for at least three months prior to the start of the study, not having diabetes and other cardiovascular diseases, physical limitations, and not being regularly enrolled in any physical activity program.

Demographic and Clinical Data

By means of a face-to-face individual interview, adopting an anamnesis form prepared by the researchers, demographic information (age and income) and those related to the use of antihypertensive drugs were collected.

Anthropometric measurements

Body weight (BW) was measured with barefoot participants, dressed in light clothing, using a digital scale (Welmy®, São Paulo, Brazil) with precision of 0.1 kg. Height (HEI) was obtained by means of a stadiometer connected to the scale, with accuracy of 0.1 cm.

WC was measured using an inelastic tape measure (Sanny®, São Paulo, Brazil), with precision of 0.1 cm, at the point of the smallest circumference between thorax and hip. Using the same tape measure, the hip circumference (Q) was measured in the widest area of the hips and in the largest protrusion of the buttocks. For all anthropometric measurements, the procedures described by the International Society for the Advancement of Kinanthropometry (ISAK)1111 Stewart, A.; Marfell-Jones, M.; Olds, T.; Ridder, H. International Standards for Anthropometric Assessment. International Society for the Advancement of Kinanthropometry; 2011. were used.

From BW, HEI, WC and Q scores, BMI (BMI = BW (kg) / HEI2 (m)), WHR [WHR = WC (cm) / Q (cm)], WHtR (WHtR = WC (cm) / HEI (cm)] and CI [CI = WC (m) / 0.109 V BW (kg) / HEI (m)] were calculated1212 World Health Organization. Global status report on noncommunicable diseases 2010: Description of the global burden of NCDs, their risk factors and determinants. Geneva: World Health Organization; 2011.

13 World Health Organization. Waist circumference and waist-hip ratio: report of WHO expert consultation. Geneva: World Health Organization; 2011.

14 American Heart Association. hird Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002;106(25):3143-421.

15 Hsieh SD, Muto T. he superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med 2005;40(2):216-220.
-1616 Valdez R. A simple model-based index of abdominal adiposity. J Clin Epidemiol 1991;44(9):955-6..

In order to classify participants according to anthropometric indicators, the cutoff points proposed in literature were considered: adequate BMI <25 kg / m2 and inadequate ≥ 25 kg / m2, adequate WC <88 cm and inadequate ≥ 88 cm1313 World Health Organization. Waist circumference and waist-hip ratio: report of WHO expert consultation. Geneva: World Health Organization; 2011., adequate WHR <0.85 cm and inadequate ≥0.85 cm1414 American Heart Association. hird Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002;106(25):3143-421., adequate WHtR ≤ 0.50 and inadequate ≤ 0.5015 and adequate CI <1.18 and inadequate ≥ 1.181616 Valdez R. A simple model-based index of abdominal adiposity. J Clin Epidemiol 1991;44(9):955-6..

Body Fat Measured through DXA

DXA with full-body scanner (Lunar Prodigy DXA, model NRL 41990, GE® Lunar, Madison, WI) was used to evaluate total body and trunk fat (% FDXA) (criterion method). he participant was asked to lie down on the table in dorsal decubitus position, along a standard longitudinal line, remaining motionless during the measurement. The procedure lasted about five to 10 minutes for each participant and was performed by the same evaluator, with experience in this type of measurement, who previously calibrated the device according to manufacturer’s recommendations.

Participants were recommended to follow the routine procedures before the evaluation in order not to cause measurement errors: to maintain the diet of the last days, not to smoke, to not drink alcohol in the 24 hours before the test, to maintain the routine medication and not to change the hydration standard1717 Rech CR, Petroski EL, Silva RCR, Silva JCN. Indicadores antropométricos de excesso de gordura corporal em mulheres. Rev Bras Med Esporte 2006;12(3):119-24..

We chose to categorize %FDXA by performing distribution into percentiles. The final quartile (75th percentile) was used as the reference value to classify excess body fat, i.e., women who presented value equal or greater to the 75th percentile (%FDXA ≥ 47.6) were diagnosed with excess body fat, and women who presented values below the 25th percentile (%FDXA <42) were considered without excess body fat.

Statistical analysis

Variables were expressed as mean, standard deviation, minimum value and maximum value. After categorizing participants according to the cutoff points suggested for each one of the anthropometric indicators, the Student’s t test for independent samples was used to compare the fat percentage estimated by DXA between groups. Receiver Operator Characteristic Curve (ROC) analysis was performed to calculate the sensitivity and specificity among anthropometric indicators (BMI, WC, WHR, WHtR, CI) in relation to the criterion measure (%FDXA) and for comparison of the area under the curve, in the identification of excess body fat, considering a 95% confidence interval. Sensitivity and specificity values not less than 60% and area under the ROC curve not less than 50% were criteria used for selection of cutoff points1818 Almeida RT, Almeida MMG, Araujo TM. Obesidade abdominal e risco cardiovascular: desempenho de indicadores antropométricos em mulheres. Arq Bras Cardiol 2009;92(5):375-80.. Analyses were performed using the SPSS software (Statistical Package for Social Sciences) version 22.0.

RESULTS

he general characteristics of the sample, composed of 71 hypertensive women, were presented in Table 1.

Table 1
General characteristics, body fat and anthropometric indicators of hypertensive women (n = 71).

Table 2 shows the comparison of the total and trunk fat percentage estimated by DXA according to the classification of participants based on the cutoff points proposed for each of the anthropometric indicators (BMI1212 World Health Organization. Global status report on noncommunicable diseases 2010: Description of the global burden of NCDs, their risk factors and determinants. Geneva: World Health Organization; 2011., WC1313 World Health Organization. Waist circumference and waist-hip ratio: report of WHO expert consultation. Geneva: World Health Organization; 2011., WHR1414 American Heart Association. hird Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002;106(25):3143-421., WHtR1515 Hsieh SD, Muto T. he superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med 2005;40(2):216-220., and Conicity Index1616 Valdez R. A simple model-based index of abdominal adiposity. J Clin Epidemiol 1991;44(9):955-6.). Comparing the total fat percentage estimated by DXA, a statistically significant difference was observed between groups classified according to BMI, WC and WHtR (P <0.05).

Table 2
Total and trunk fat percentage estimated by DXA according to the classification of participants based on cutoff points proposed for the anthropometric indicators (n = 71).

In relation to the trunk fat percentage, a difference was identified between groups classified according to BMI and WC (P <0.05). he group of women classified with inadequate BMI and WC presented higher total and trunk fat percentage in comparison to the group with adequate indicators. In addition, the total fat percentage was higher for the group with inadequate WHtR in relation to the group with this indicator within criterion considered adequate.

In the analysis of the areas under the ROC curve, it was observed that BMI, WC and WHR were more sensitive and specific in the identification of women with excess body fat when compared to the other anthropometric indicators. When the areas under the ROC curves were compared with one another, a statistically significant difference (P <0.05) was observed in anthropometric indicators BMI, WC and WHR, respectively (Table 3).

Table 3
Diagnostic properties of anthropometric indicators to detect excess body fat in relation to the criterion measure (%FDXA).

Through the analysis of the ROC curve, two of the anthropometric indicators are below the reference line (WHR and CI), that is, they are indicators with low discriminatory power for excess body fat estimated by means of DXA (Figure 1).

Figure 1
Area under the ROC curve of anthropometric indicators to predict excess body fat in hypertensive women

DISCUSSION

The main findings of the present study indicated that BMI, WC and WHtR were more discriminatory in measuring excess body fat compared to WHR and CI in hypertensive women. hese results show that not only the indicator of generalized obesity (BMI), but also indicators of central obesity (WC, WHtR), can be used to diagnose excess body fat in hypertensive women. In women not diagnosed with chronic diseases, BMI and WC also proved to be good predictors of excess body fat1010 Gomes MA, Rech CR, Gomes MBA, Santos DL. Correlação entre índices an-tropométricos e distribuição de gordura corporal em mulheres idosas. Rev Bras Cineantropom Desempenho Hum 2006;8(3):16-22..

In addition, in comparing the fat percentage estimated by DXA according to groups classified based on cutoff points recommended in literature for each of the anthropometric indicators, it was identified that, in fact, when classification was based on BMI1212 World Health Organization. Global status report on noncommunicable diseases 2010: Description of the global burden of NCDs, their risk factors and determinants. Geneva: World Health Organization; 2011., WC1313 World Health Organization. Waist circumference and waist-hip ratio: report of WHO expert consultation. Geneva: World Health Organization; 2011. and WHtR1515 Hsieh SD, Muto T. he superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med 2005;40(2):216-220., groups (adequate and inadequate) significantly differed for total fat percentage. Regarding the trunk fat percentage, there was also a difference between groups when analyzed according to BMI and WC classification. These indicators have been accepted as simple measures used to evaluate the amount and distribution of body fat and also as useful indicators to provide important information to predict the presence of blood hypertension1919 Silva ARA, Dourado KF, Pereira PB, Lima DSC, Fernandes AO, Andrade AM, et al. Razão TG/HDL-c e Indicadores Antropométricos Preditores de Risco para Doença Cardiovascular. Rev Bras Cardiol 2012;25(1):41-9.,2020 Jeppesen J, Hein HO, Suadicani P, Gyntelberg F. Triglyceride concentration and ischemic heart disease: an eight-year follow-up in the Copenhagen Male Study. Circulation 1998;97(11):1029-36..

BMI consists of an anthropometric indicator widely used in the general population to identify obesity and related health risks1212 World Health Organization. Global status report on noncommunicable diseases 2010: Description of the global burden of NCDs, their risk factors and determinants. Geneva: World Health Organization; 2011., corroborating the findings of the present study that identified higher specificity and sensitivity values, as well as greater area under the ROC curve for this indicator. In the present study, the best cutoff point for BMI to diagnose excess body fat was 24.7 kg / m2, close to the cutoff point proposed by the World Health Organization1212 World Health Organization. Global status report on noncommunicable diseases 2010: Description of the global burden of NCDs, their risk factors and determinants. Geneva: World Health Organization; 2011., which is ≥ 25.0 kg / m2.

However, there are controversies about using the same cutoff point for adults and older individuals in order to detect excess body fat, since changes in body composition due to the aging process should be considered2121 Silveira EA, Kac G, Barbosa LS. Prevalência e fatores associados à obesidade em idosos residentes em Pelotas, Rio Grande do Sul, Brasil: classificação da obesidade segundo dois pontos de corte do índice de massa corporal. Cad Saúde Pública 2009;25(7):1569-77.,2222 Lipschitz DA. Screening for nutritional status in the elderly. Prim Care 1994;21(1):55-67..

WC is mainly correlated with the distribution of visceral adipose tissue and, therefore, such an anthropometric indicator has been recommended for the specific evaluation of abdominal obesity2323 Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk? evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obes Rev 2011;12(9):680-7.. Recent studies have highlighted the increase in abdominal obesity in the Brazilian female population2424 Martins IS, Marinho SP. O potencial diagnóstico dos indicadores da obesidade centralizada. Rev Saúde Pública 2003;37(6):760-7.,2525 Olinto MTA, Nacul LC, Dias-da-Costa JS, Gigante DP, Menezes AMB, Macedo S. Níveis de intervenção para obesidade abdominal: prevalência e fatores associados. Cad Saúde Pública 2006;22(6):1207-15.. In this study, it was observed that the best cutoff point for predicting excess body fat was 87.8 cm. This finding is in line with the proposal of the United States National Institute of Health2626 National Institutes of Health, National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 1998;6(2):S51-S209., and by the World Health Organization1313 World Health Organization. Waist circumference and waist-hip ratio: report of WHO expert consultation. Geneva: World Health Organization; 2011., used in most western countries recommends for women WC ≥ 88 cm as the best cutoff point for identifying health risks.

The literature has shown that WHtR is a good discriminator of abdominal obesity related to cardiovascular risk factors1616 Valdez R. A simple model-based index of abdominal adiposity. J Clin Epidemiol 1991;44(9):955-6.. In the present study, the best cutoff point for the detection of excess body fat in women was 0.55, similarly to the recommendation of literature, which suggests values equal to or higher than 0.5 for both sexes1616 Valdez R. A simple model-based index of abdominal adiposity. J Clin Epidemiol 1991;44(9):955-6.,2727 Félix-Redondo FJ, Grau M, Baena-Díez JM, Dégano IR, León AC, Guembe MJ, et al. Prevalence of obesity and associated cardiovascular risk: the DARIOS study. BMC Public Health 2013;13(1):542.. The study by Rodrigues et al.2828 Rodrigues SL, Baldo MP, Mill JG. Association of waist-stature ratio with hypertension and metabolic syndrome: population-based study. Arq Bras Cardiol 2010;95(2):186-91. determined cutoff points for WHtR in Brazilians and the cutoff point suggested for women (0.54) was close to that found in the present study.

The above results indicate that the cutoff points for BMI, WC and WHtR were conservative in relation to the cutoff points adopted in literature. he cutoff points found for WHR and CI, as well as the area of the ROC curve, suggest that both anthropometric indicators are not the most adequate for diagnosing excess body fat in hypertensive women due to their low sensitivity and specificity. On the other hand, according to literature, WHR is an anthropometric indicator that is also associated with visceral fat, being an acceptable index of intra-abdominal fat2929 Pitanga FJG, Lessa I. Indicadores antropométricos de obesidade como instrumento de triagem para risco coronariano elevado em adultos na cidade de Salvador (Bahia). Arq Bras Cardiol 2005;85(1):26-31.. The cutoff point for this indicator suggested in this study was 0.88 cm. A study conducted with Brazilian women over 50 years reported the same cutoff point2929 Pitanga FJG, Lessa I. Indicadores antropométricos de obesidade como instrumento de triagem para risco coronariano elevado em adultos na cidade de Salvador (Bahia). Arq Bras Cardiol 2005;85(1):26-31., differing from the cutoff point recommended in literature, 0.851515 Hsieh SD, Muto T. he superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med 2005;40(2):216-220.. In turn, CI is another anthropometric option that provides information on body fat distribution. A study comparing CI to other anthropometric indicators found that it is a good predictor for the identification of visceral fat3030 Pitanga FJG, Lessa I. Indicadores antropométricos de obesidade como discrimi-nadores de risco coronariano elevado em mulheres. Rev Bras Cineantropom Desempenho Hum 2006;8(1):14-21., which, to a certain extent, contradicts the findings of the present study. In addition, the value of 1.18 is recommended in studies1717 Rech CR, Petroski EL, Silva RCR, Silva JCN. Indicadores antropométricos de excesso de gordura corporal em mulheres. Rev Bras Med Esporte 2006;12(3):119-24.,2929 Pitanga FJG, Lessa I. Indicadores antropométricos de obesidade como instrumento de triagem para risco coronariano elevado em adultos na cidade de Salvador (Bahia). Arq Bras Cardiol 2005;85(1):26-31. as the best cutoff point in the prediction of excess body fat; however, in the present study, the cutoff point found was 1.27.

The discrepancy among studies may be related to the population in question, since, in the present study, only hypertensive women were analyzed. Gomes et al.1010 Gomes MA, Rech CR, Gomes MBA, Santos DL. Correlação entre índices an-tropométricos e distribuição de gordura corporal em mulheres idosas. Rev Bras Cineantropom Desempenho Hum 2006;8(3):16-22. suggest, for example, that CI is a good indicator for preliminary diagnosis of health risks in populations not yet diagnosed with any chronic disease.

This study presents some limitations that should be considered in the interpretation of results, for example the sample heterogeneity regarding age and the fact that the sample is not representative, which limits the possibility of extrapolation of results. However, the use of DXA as a reference standard is a strong point of the study. Another point to be emphasized is that other studies involving hypertensive populations have assessed “the power” of anthropometric indicators in predicting cardiovascular risk or blood hypertension, but few have proposed to investigate whether these indicators are, in fact, sensitive in the prediction of overweight.

CONCLUSION

Based on the above results, it was concluded that anthropometric indicators BMI, WC and WHtR can be used to diagnose excess body fat in hypertensive women, being thus important measures of the effect of pharmacological and non-pharmacological interventions in this population. In addition, due to their high sensitivity and specificity, simplicity and low operating costs, these methods are more affordable for the monitoring of the health status of hypertensive women.

REFERENCES

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    Gerage AM, Benedetti TR, Farah BQ, Santana F da S, Ohara D, Andersen LB, et al. Sedentary Behavior and Light Physical Activity Are Associated with Brachial and Central Blood Pressure in Hypertensive Patients. PLoS One 2015;10(12):e0146078.
  • 2
    Hall ME, Carmo JM do, Silva AA da, Juncos LA, Wang Z, Hall JE. Obesity, hypertension, and chronic kidney disease. Int J Nephrol Renovasc Dis 2014;7:75-88.
  • 3
    Sociedade Brasileira de Cardiologia. V Diretrizes Brasileiras de Hipertensão Arterial. Arq Bras Cardiol 2007;89(3):e24-79.
  • 4
    Panazzolo DG, Silva LHA da, Leão LMCSM, Aguiar LGK. Efeitos da terapia hormonal da menopausa sobre a gordura corporal. Med HUPE-UERJ 2014;13(1):47-53.
  • 5
    Silva HB, Bortolotto LA. Hipertensão arterial na mulher. Rev Bras Med 2002;59(5):359-367.
  • 6
    Ellegârd LH, Áhlén M, Korner U, Lundholm KG, Plank LD, Bosaeus IG. Bioelectric impedance spectroscopy underestimates fat-free mass compared to dual energy X-ray absorptiometry in incurable cancer patients. Eur J Clin Nutr 2008;63(6):794-801.
  • 7
    Lohman M, Tallroth K, Kettunen JA, Marttinen MT. Reproducibility of dual-energy x-ray absorptiometry total and regional body composition measurements using different scanning positions and definitions of regions. Metabolism 2009;58(11):1663-8.
  • 8
    Peer N, Steyn K, Lombard C, Gwebushe N, Levitt N. A high burden of hypertension in the urban black population of Cape Town: he Cardiovascular Risk in Black South Africans (CRIBSA) Study. PLoS One 2013;8(11):e78567.
  • 9
    Rech CR, Ferreira LA, Cordeiro BA, Vasconcelos FAG; Petroski EL. Body composition estimates using dual-energy X-ray Absorptiometry. Rev Bras Cienc Mov 2007;15(4):87-98.
  • 10
    Gomes MA, Rech CR, Gomes MBA, Santos DL. Correlação entre índices an-tropométricos e distribuição de gordura corporal em mulheres idosas. Rev Bras Cineantropom Desempenho Hum 2006;8(3):16-22.
  • 11
    Stewart, A.; Marfell-Jones, M.; Olds, T.; Ridder, H. International Standards for Anthropometric Assessment. International Society for the Advancement of Kinanthropometry; 2011.
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    World Health Organization. Global status report on noncommunicable diseases 2010: Description of the global burden of NCDs, their risk factors and determinants. Geneva: World Health Organization; 2011.
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    World Health Organization. Waist circumference and waist-hip ratio: report of WHO expert consultation. Geneva: World Health Organization; 2011.
  • 14
    American Heart Association. hird Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002;106(25):3143-421.
  • 15
    Hsieh SD, Muto T. he superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med 2005;40(2):216-220.
  • 16
    Valdez R. A simple model-based index of abdominal adiposity. J Clin Epidemiol 1991;44(9):955-6.
  • 17
    Rech CR, Petroski EL, Silva RCR, Silva JCN. Indicadores antropométricos de excesso de gordura corporal em mulheres. Rev Bras Med Esporte 2006;12(3):119-24.
  • 18
    Almeida RT, Almeida MMG, Araujo TM. Obesidade abdominal e risco cardiovascular: desempenho de indicadores antropométricos em mulheres. Arq Bras Cardiol 2009;92(5):375-80.
  • 19
    Silva ARA, Dourado KF, Pereira PB, Lima DSC, Fernandes AO, Andrade AM, et al. Razão TG/HDL-c e Indicadores Antropométricos Preditores de Risco para Doença Cardiovascular. Rev Bras Cardiol 2012;25(1):41-9.
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Publication Dates

  • Publication in this collection
    May-Jun 2017

History

  • Received
    06 Apr 2017
  • Accepted
    25 May 2017
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