Obesity is a serious public health issue worldwide including the developing countries like China.1,2 It is well- established that childhood obesity is associated with many cardiovascular risk factors such as hypertension, dyslipidemia, metabolic syndrome, & Type 2 diabetes in children and in adults.3 In addition, obesity at childhood may track into adulthood.4 In the majority of studies, obesity is usually defined according to body mass index (BMI) cut-offs. However, BMI cannot provide information on the distribution of body fat.5 Central obesity, as assessed by waist circumference (WC), is more strongly associated with the risk of hypertension, dyslipidemia, Type 2 diabetes, cardiovascular disease, cancer and all-cause mortality than generalized obesity as defined by BMI.6,7

Insulin resistance is a pathological situation characterizedby a lack of physiological response of peripheral tissue to insulin action leading to the metabolic and hemodynamic disturbances known as the metabolic syndrome. The main feature of this condition include dyslipidemia, (high triglyceride and low high-density lipoprotein cholesterol levels) hypertension, glucose intolerance or Type 2 diabetes, hyperuricemia, or gout, abdominal obesity, hypercoagulability, and defect in the fibrinolytic system, hyperandrogenism, fatty liver, and an increased incidence of coronary heart disease.8 Aim and objectives of our study wasto identify the existence of general and central obesity by anthropometric measurements in the study population andto compare anthropometric parameters in the control and prediabetic subjects.

The present study was conducted in the Department of Physiology at IndexMedical College, Hospital & Research center, Malwanchal University Indore, during 2022-2023. Total 140 subjects in the age group range of 30 - 60 years attendingthe different medical outpatient departments (OPDs) were selected based on the inclusion and exclusion criteria. The fasting blood sugar, lipid profile, and fasting insulin biochemical investigation was done in the department of Biochemistry of the Institute. After written consent the anthropometric measurement including weight (kg), height (cm), BMI (kg/m2), WC (cm), hip circumference (cm), waist- hip ratio was recorded. The age below 30 years & above 60 years, fasting blood glucose >126 mg/dl & subjects taking hormonal therapy or hormonal contraceptive, lipid lowering drug and drug to control blood sugar level were excluded from the study.

Body Weight

The weight of each subject was recorded on the same platform beam balance, barefooted with the minimumclothing on the body. The subject was made to stand erecton the center of the platform without touching anything else weight was recorded in kilogram up to the accuracy of 100 g.The zero error was minimized to maximum; machine was checked repeatedly from time to time to avoid error.

Height

Using a vertical measuring rod, height was measured without shoes; the subject was made to stand on a flat floor with feetparallel and with heels, buttock, shoulder and back of head touching the rod. The head was held perfectly erect with the lower border of the orbit in the same horizontal plane as the external auditory meatus and arm hanging at the side in a natural manner. Metallic block was lowered gently to make contact with scalp and reading was taken.

BMI Calculation

BMI= Weight in kg

          Height inmeter2

The study comprised of 140 subjects aged 30 - 60 years attending the different medical OPDs in. According to ADA 2007 all the subjects having fasting serumglucose (FSG) <100 mg/dl were included in the control groups subjects having FSG ≥100-125 mg/dl categorized into prediabetic group.9

In the age range 30-40 years 29% men (31.2 ± 15 years) and 38% women (33.5 ± 4.3 years)

were studied, 48% men (45.1 ± 2.9 years) and 38% women (43.5 ± 2.7 years) werein the age

range 40-50 studied. In the age range 50 - 60 years23% men (54 ± 1.4 years) and 24% women (53.6 ± 1.5 years) were studies.

In prediabetic group 29% men (34.8 ± 3.74 years) and 38% women (34.3 ± 2.9 years) were studied in the 30-40 age range 48% men (47.3 years) were in the age range 40-50 years studied. In the age group, 50-60 years 23% men(56.7 ± 3.5 years) and 24% women (57.4 ± 3.5 years) were studied. Maximum numbers of prediabetic were in the age group of 40-50 years (Table 1).

TABLENO1: - AGE WISE CLASSIFICATION OF STUDY POPULATION

In the present study, out of 42 subjects having BMI < 25,15 subjects (36%) showed, insulin resistance. Taking BMIas gold standard the study population was classified into normal weight (BMI 18.5-24.9 kg/m2) and overweight/obese (BMI > 25 kg/m2 categories).

In the control group 78% men  (22.8  ±  2.1  kg/m2), 66% women (23.4 ± 76 kg/m2) were

classified as normal weight. 22% men (26.5 ± 1.2 kg/m2) 34% women (26.8 ± 1.4 kg/m2) fell into overweight/obese group. Based on WC 55% (91.2 ± 7.6) subjects were identified as having central adiposity. Central adiposity was more common inwomen (79, WC 89.91 ± 81 cm) as compared to the men (32%, WC 94.4 ± 5.3 cm). In prediabetic group based on BMI (>25 kg/m2) 72% subjectswere showed general obesity     (26.9 ± 1.8 kg/m2). 68% men (27.1 ± 2.1 kg/m2) and 76% women (26.6 ± 1.7 kg/m2) fell into general obesity. Central adiposity was identified in 84% (97 ± 9.4 cm) prediabetic subjects 77% men (100.2 ± 9.9 cm) and 90% women (94.1 ± 7.0 cm). It was observed that BMI and WC were significantly higher (P < 0.001) in prediabetic subject (Table 2).

TABLENO.2 - MEAN VALUES OF ANTHROPOMETRIC PARAMETERS IN  STUDY POPULATION

An attempt has been made to compare anthropometric parameters of control group with prediabetic subjects it was observed that BMI and WC were significantly higher (P < 0.001) in prediabetic subject (Table 3).

TABLE NO.3 - COMPARISON OF ANTHROPOMETRIC PARAMETERS IN STUDY GROUP (STUDENT ΄t’ TEST)

Out of 52 prediabetic subjects define insulin resistantby Homa index. 38 subjects had general obesity (BMI >25 kg/m2) and 46 subjects exhibited abdominal obesity. General and abdominal obesity was identified invery few control subjects having insulin resistant (Table 4).

Table No.4 – COMPARISION OF ANTHROPOMETRIC PARAMETERS IN INSULIN RESISTANT                                                    STUDY POPULATION

Prediabetic subjects showed 4% insulin resistance at low-risk scale (<30), similar finding was reported by Mack et al. who studied fasting insulin level as a measure of insulin resistance in Type 2 diabetic patients and 42 control American blacks’ subjects, they reported insulin resistance in 5% control subjects despite englycemia.10

In the present study, 28% control subjects and 72% prediabetic subjects were categorized as obese based on BMI. The 79% control subjects and 84% prediabetic subjectswere categorized as having central obesity based on WC. Themean values of BMI (25.94 ± 2.61 kg/m2) and WC (94.15 ± 11.07 cm) of prediabetic subjects were significantly higher than the control subjects (23.69 ± 7.98 kg/m2, 87.45 ± 7.8 cm).

Robertson and Harmon reported that prolong Beta cell exposure to high glucose concentration impairs insulin gene transcription; leading to reduced insulin synthesis to development of Type 2 diabetes.11

Present study demonstrated that 88% subjects having abdominal adiposity exhibited insulin resistance, 73% subjects having (BMI >25 kg/m2) showed insulin resistance index (>2.6) correlation analysis showed significant positive correlation of WC and BMI with insulin resistance.

Katsuki et al. (2008) studied association of increased visceral fat and serum levels of triglycerides with insulin level of triglycerides with insulin resistance in 40 adult Japanes subjects. They reported association of increased visceralfat and serum level of triglyceride with insulin resistance;they suggested that visceral adipose tissue secretes adipocytokines and their circulating level correlates with development of insulin resistance.12.

Annaswamy Raj et al. studied body fat distribution and insulin resistance in 128 healthy Asian Indians and 12 Causasians aged 20-65 years. The study was designed. To examine the relation of insulin sensitivity of visceral fat and lipid profile they reported that significantly elevated fasting insulin and fasting glucose, lower glucose disposition rate greater total abdominal fat and visceral fat in Asian Indian. Contributing to decreased insulin sensitivity and insulin resistance. They suggested that even at lower BMI Asian Indians are profoundly insulin resistance and increased total abdominal fat which may explain their predilection for increased diabetes and coronary heart disease in the present study out of 42 having BMI <25. 15 subjects (36%) showed insulin resistance.13

A good positive correlation was found between prediabetic state and metabolic syndrome, positive association between FSG, BMI, abdominal obesity, and dyslipidemia with development of insulin resistance signified that persistent hyperglycemia and dyslipidemia might lead to a development of insulin resistance. Appropriate interventionin the form of weight reduction, changes in dietary habits andincreased physical activity could greatly help to prevent, or at least delay the onset of diabetes and thus reduce the burdendue to non-communicable diseases in India.14.

This study has important implications for identificationof subjects at higher risk for future Type 2 diabetes and suggested that mass screening of prediabetic subjects and aggressive risk modification and close follow-up should be considered for prediabetic subjects with metabolic syndrome.

1. Xi B, Liang Y, He T, Reilly KH, Hu Y, Wang Q, et al. Secular trends in the prevalence of general and abdominal obesity among Chinese adults, 1993-2009. Obes Rev 2012;13:287-96.
2. Liang YJ, Xi B, Song AQ, Liu JX, Mi J. Trends in general & abdominal obesity among Chinese children and adolescents 1993-2009. Pediatr Obes 2012;7:355-64.
3. Freedman DS, Katzmarzyk PT, Dietz WH, Srinivasan SR, Berenson GS. Relation of body mass index and skinfold thicknesses to cardiovascular disease risk factors in children: The
4. Bogalusa Heart Study. Am J Clin Nutr 2009;90:210-6.
5. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med 1993;22:167-77.
6. Janssen I, Shields M, Craig CL, Tremblay MS. Prevalence and secular changes in abdominal obesity in Canadian adolescents and adults, 1981 to 2007-2009. Obes Rev 2011;12:397-405.
7. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004;79:379-84.
8. Bigaard J, Frederiksen K, Tjønneland A, Thomsen BL, Overvad K, Heitmann BL, et al. Waist circumference and body composition in relation to all-cause mortality in middle-aged men and women. Int J Obes (Lond) 2005;29:778-84.
9. Henefeld M. The metabolic syndrome: Roots, myths, and facts. In: Hanefeld M, Leonhardt W, editors. The MetabolicSyndrome. Jena: Gustar Fishcher; 1997. p. 13-24.
10. ADA Clinical Practice Recommendations. Position statement. Diabetes Care 2007;30:1.
11. Mack R, Skurnick B, Sterling-Jean Y, Pedra-Nobre M, Bigg D. Fasting insulin levels as a measure of insulin resistance inAmerican blacks. J Med 2003;34:31-8.
12. Robertson RP, Harmon JS. Pancreatic islet beta-cell and oxidative stress: The importance of glutathione peroxidase. FEBS Lett 2007;581:3743-8.
13. Katsuki A, Sumida Y, Murashima S, Murata K, Takarada Y,Ito K, et al. Serum levels of tumor necrosis factor- are increased in obese patients with noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1998;83:859-62.
14. Raji A, Seely EW, Arky RA, Simonson DC. Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. J Clin Endocrinol Metab. 2001;86:5366-71.
15. Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007;125:217-30.
16. Pradeepa R, Mohan V. Epidemiology of type 2 diabetes in India. Indian J Ophthalmol. 2021 Nov;69(11):2932-2938. doi: 10.4103/ijo.IJO_1627_21. PMID: 34708726; PMCID: PMC8725109.
17. Evert,MichelleDennison,ChristopherD.Gardner,W.TimothyGarvey,KaHei Karen Lau, Janice MacLeod, Joanna Mitri, Raquel F. Pereira, Kelly Rawlings, Shamera Robinson, LauraSaslow,SachaUelmen,PatriciaB.Urbanski,WilliamS.Yancy;NutritionTherapyforAdultsWithDiabetesorPrediabetes:AConsensusReport. Diabetes Care