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Year : 2020  |  Volume : 23  |  Issue : 1  |  Page : 12-16

Hip circumference correlates negatively with insulin resistance in type 2 diabetic patients

Department of Human Physiology, Bayero University, Kano, Kano State, Nigeria

Date of Submission14-Mar-2019
Date of Decision30-Apr-2019
Date of Acceptance30-Jun-2019
Date of Web Publication18-Mar-2020

Correspondence Address:
Dr. Nafisa Yusuf Wali
Department of Human Physiology, Faculty of Basic Medical Sciences, Bayero University, Kano, Kano State
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DOI: 10.4103/smj.smj_14_19

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Background: Body adiposity is a known factor in the development of insulin resistance. Not much is known on the association between insulin resistance and indices of obesity in type 2 diabetic African population. Objective: This study investigated the relationship between insulin resistance and anthropometric measurements in the black African population using the homeostasis model assessment of insulin resistance (HOMA-IR). Materials and Methods: A descriptive cross-sectional design was used to study a random sample of 183 type 2 diabetic patients and 96 nondiabetic controls. Anthropometric parameters were measured using an appropriate technique. Fasting blood glucose was estimated using a glucose oxidase method. Serum insulin level was estimated using enzyme-linked immunosorbent assay kits. Data were analyzed using the Statistical Package for the Social Sciences version 23.0. HOMA-IR score was used to determine insulin resistance. Results: Diabetic males had greater waist–hip ratio than their normal controls (percentage difference: −3.23, P = 0.02) while diabetic females had greater body mass index (BMI) (percentage difference: 7.62, P = 0.04) and waist circumference (percentage difference: 10.6, P = 0.001) than their normal controls. There were a negative correlation between hip circumference (HC) and insulin resistance in the type 2 diabetic patients and a positive correlation between BMI and insulin resistance in the nondiabetic controls. However, there was no significant correlation between other anthropometric parameters and insulin resistance in both the type 2 diabetic and control groups. Conclusion: HC has a negative correlation with insulin resistance in the black African type 2 diabetic patients. There is a need for further research in this area to reduce diagnostic costs in low-resource settings.

Keywords: Hip circumference, insulin resistance, type 2 diabetes

How to cite this article:
Wali NY, Gwarzo MI, Ibrahim SA. Hip circumference correlates negatively with insulin resistance in type 2 diabetic patients. Sahel Med J 2020;23:12-6

How to cite this URL:
Wali NY, Gwarzo MI, Ibrahim SA. Hip circumference correlates negatively with insulin resistance in type 2 diabetic patients. Sahel Med J [serial online] 2020 [cited 2020 Sep 28];23:12-6. Available from: http://www.smjonline.org/text.asp?2020/23/1/12/280937

  Introduction Top

Diabetes mellitus (DM) is a chronic disorder that alters carbohydrate, protein, and fat metabolism as a result of lack of insulin secretion due to either progressive or marked inability of the pancreatic β-cells to produce insulin or due to defects in insulin uptake and utilization by peripheral tissues.[1]

Obesity, especially visceral obesity, is an established risk factor for type 2 DM.[2],[3],[4] Data emerging over the past decades reported a global increase in the prevalence of obesity[5],[6] which has resulted in a similar increase in the number of persons leaving with type 2 DM.[7] There is currently a body of knowledge corroborating the fact that obesity is a major risk factor for insulin resistance in type 2 DM.[7],[8]

Anthropometries including measurement of height (HT), weight (WT), body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist–hip ratio (WHR) have served as simple, cheap, and noninvasive markers of obesity.[9] Specifically, BMI, a composite measurement that compares weight and height, defines people as overweight (preobese) if their BMI is between 25 and 29.99 kg/m2 and obese when it is up to 30 kg/m2.[10]

Type 2 DM has the strongest link with obesity compared to other public health problems.[11] Previous studies, especially in western and developed countries, have reported an association between obesity, insulin resistance, and development of type 2 DM.[12],[13] Although obesity is widely documented to be associated with type 2 DM, some studies have shown that truncal or central obesity is the major risk factor for the condition.[14],[15] However, few studies in the European population reported that the gluteofemoral adiposity which is measured by HC negatively correlates with insulin resistance. While there is an enormous body of literature on the interaction between obesity, insulin resistance, and type 2 diabetes among western population, not much is known in the black African population. This informed the need for this study which is aimed at studying the relationship between insulin resistance and indices of obesity in type 2 diabetic patients in Kano, Nigeria.

  Materials and Methods Top

Study design

The study used a descriptive cross-sectional design and carried out in the diabetic clinic of Murtala Muhammad Specialist Hospital, Kano, Nigeria. Participants were recruited by simple random sampling method.

Sample size determination

The sample size was estimated using the Fisher's formula for estimating the minimum sample size for descriptive studies.[16]

Inclusion criteria

Type 2 diabetic patients who were 30 years and above.

Exclusion criteria

Hypertensive patients, those with signs of endocrine disorders and chronic illnesses, patients on insulin, and those on other treatments that could affect weight and insulin resistance such as metformin were excluded from the study.

Ninety six-nondiabetic age, weight and height-matched apparently individuals served as controls.

Ethical consideration

Ethical clearance (protocol no: MAC/SUB/12A/P-3/VI/1075 dated 23rd April 2013) and permission for the study were sought and obtained from the Ethical Committee of Aminu Kano Teaching Hospital, Kano, and the Hospitals Management Board, Kano State, respectively. Informed consent was obtained from each participant before enrolling for the study. The study complied with other relevant guidelines of 2013 Helsinki's declaration.

Data collection

Patients were interviewed using structured interviewer-administered questionnaires. Bathroom scale (Model Hamason, China) was used to measure weights of participants, and their heights were measured using stadiometer (Echukson®, Hamason, China). Participants' HC was measured using measuring tape at the maximum extension of the buttocks to the nearest 0.1 cm.[17] Their abdominal (waist) circumference was measured using the measuring tape at the approximate midpoint between the lower margin of the last palpable rib and the top of the iliac crest. The measurement was made at minimal respiration to the nearest 0.1 cm.[18] About 5 ml of blood was drawn into plain bottles from each of the participants between 8 and 10 am after an overnight fast and following all universal precautions. Collected blood samples were centrifuged and stored in a refrigerator at −20°C until all required samples were collected and ready for analysis.

Fasting serum glucose was estimated using a glucose oxidase method.[19] Serum insulin level was estimated using enzyme-linked immunosorbent assay (Insulin [Human] ELISA Kit, Taipei City, Taiwan) kits, and spectrophotometer EX Labsystem was used to measure the absorbance of the samples.

Data analysis

Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM SPSS Statistics for Windows, version 22. (IBM Corp., Armonk, NY). The mean and standard error (SE) was used to summarize quantitative variables. Student's t-test was used to compare quantitative variables, and the Pearson correlation was used to determine the relationship between insulin resistance and anthropometric parameters. Homeostasis model assessment of insulin resistance (HOMA-IR) score was used to determine insulin resistance in the study participants, where participants who scored 1 were considered 100% sensitive and those who scored >1 were considered to have insulin resistance. In this study, HOMA-IR was calculated using the formula, HOMA-IR = (fasting glucose in mmol/L × fasting insulin U/L)/22.5, where the constant 22.5 is a normalizing factor (normal fasting insulin of 5 U/mL × the normal fasting glucose of 4.5 mmol/L typical of a normal healthy individual = 22.5).[20]

  Results Top

More than half (57.40%) of the type 2 diabetic patients were female while males constituted 42.60%. The age of the type 2 diabetic patients ranges from 30 years to 81 years, with a mean and SE of 54.09 ± 0.93 years. Similarly, participants in the nondiabetic group were aged between 30 years and 85 years, and the mean age ± SE. was 50.27 ± 1.42 years. There is no significant difference between the study and control groups among both males and females (P = 0.93).

The anthropometric parameters in male diabetic patients and their matched nondiabetic controls were similar except for the WHR that was higher in diabetic patients (percentage difference: −3.23, P = 0.03). However, when compared in females, BMI (percentage difference: 7.62, P = 0.05) and WC (percentage difference: 10.60, P = 0.04) were higher in female diabetic patients than their matched controls, as shown in [Table 1].
Table 1: Anthropometric parameters of the respondents

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The mean serum insulin levels (±SE) were 4.49 ± 0.01 and 4.46 ± 0.01 for the nondiabetic and diabetic participants, respectively, and the difference was statistically significant (P = 0.05). The mean value of HOMA-IR was higher in the diabetic group (1.85 ± 0.04) compared to the nondiabetic group (0.93 ± 0.02), and the difference was also statistically significant (percentage difference = −98.92, P = 0.00), as shown in [Table 2].
Table 2: Mean Insulin and Glucose levels of the subjects

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The study observed that fasting blood sugar is significantly correlated with HOMA-IR score in both type 2 diabetic patients (r = 1.0, P = 0.001) and controls (r = 0.99, P = 0.001) [Table 3]. However, when the participants were separated by sex, fasting blood sugar was the only factor that was found to be significantly correlated with HOMA-IR among both male (r = 0.99, P = 0.001) and female diabetic patients (r = 0.99, P = 0.001) and in male (r = 0.98, P = 0.001) and female controls (r = 0.99, P = 0.001), as shown in [Table 4]. Interestingly, HC (r = −0.15, P = 0.03) and BMI (r = 0.21, P = 0.03) were the only anthropometric parameters that were observed to be significantly correlated with HOMA-IR score in the diabetic and nondiabetic groups, respectively [Table 3]. In the same vein, when the participants were separated by sex, none of the anthropometric parameters were significantly correlated with the HOMA-IR score in both the diabetic and nondiabetic groups, as depicted in [Table 4].
Table 3: Relationship between homeostasis model assessment of insulin resistance and anthropometric parameters of diabetic patients and nondiabetic controls

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Table 4: Relationship between anthropometric parameters of type 2 diabetic patients and controls by sex

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  Discussion Top

This study observed a statistically significant difference in WHR between male type 2 diabetic patients and their matched controls. The study also observed a significant difference in the BMI and WC between female diabetic patients and their matched controls and the figures being higher in the diabetic group. These findings are consistent with the findings of several investigators that measurements of obesity (BMI, WC, and WHR) are associated with risk of developing type 2 DM.[2],[3],[4] The higher WHR observed in the male diabetic group, and the higher WC among diabetic female subjects corroborates the findings of Anjana et al. that abdominal fat has higher risk of developing type 2 diabetes than BMI.[21] This is based largely on the rationale that increased visceral adipose tissue is associated with a range of metabolic abnormalities, including decreased glucose tolerance, reduced insulin sensitivity, and abnormal lipid profiles, which are risk factors for type 2 diabetes and cardiovascular diseases (CVDs).[22]

In this study, BMI correlated positively with insulin resistance in the nondiabetic controls. This is similar to a cross-sectional and longitudinal study done in Swedish normoglycemic men by Skarfors et al.[23] They found that the incidence for developing type 2 diabetes was higher in those with the highest BMI than those with the lowest BMI after 10 years of follow-up. This is an established fact that obesity is a very strong risk factor for the development of type 2 DM.

This study also observed a negative correlation between insulin resistance and HC in the diabetic patients, indicating that the greater the HC, the lower the insulin resistance or the greater the insulin sensitivity. The WHR is a factor of WC and HC. While the WC measures the abdominal adiposity, the HC measures the peripheral adiposity which also takes into account the muscles and the bones of the buttocks and hips. Therefore, visceral obesity will not be appreciated well without determining HC. Cameron et al., in their study, the Influence of Hip Circumference on the Relationship between Abdominal Obesity and Mortality, concluded that the effect of central obesity on mortality risk is seriously underestimated without adjustment for HC.[24] They also suggested that not only WC but also HC may be important inclusions in CVD risk prediction models. The study is also similar to that of Snijder et al., who observed that HC, although directly correlated with WC (and BMI), is inversely associated with blood glucose, blood pressure, and lipids.[25] Snijder et al. reported that large hip and thigh circumferences are associated with a lower risk of type 2 diabetes, independently of BMI, age, and WC, whereas a larger WC is associated with a higher risk.[26] This could also be explained by the fact that the gluteofemoral subcutaneous adipose tissue acts as a metabolic sink entrapping excess free fatty acids.[27] Dowling et al. in their study suggest that an increase in the lipoprotein lipase activity in the gluteofemoral fat results in an increase in the catabolism of triglycerides and their storage in the adipose tissue which will reduce the concentration of circulating free fatty acids in the blood.[28] They also suggest that the gluteofemoral fat is less lipolytic releasing less free fatty acids in the circulation and therefore will have less effect in the causation of metabolic diseases compared to the visceral fat since free fatty acids interfere with intracellular insulin signaling and increase hepatic gluconeogenesis and hence insulin resistance.[29] Conway, in his study, found that greater HC is associated with increased insulin sensitivity with reduced insulin concentration in the plasma and hence reduction in the risk of type 2 DM.[30]


The sample size is small especially with respect to comparison between males and females because of sexual dimorphism in fat distribution and free fatty acid metabolism among black African population.

  Conclusion Top

This study found a higher WHR in male diabetic patients and higher BMI and WC in female diabetic patients. HC is the only parameter that correlated with insulin resistance in the type 2 diabetic patients.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4]


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