European Journal of Cardiovascular Medicine

Indicators of health that can be determined conveniently and at low cost continue to play a central role in the epidemiological and clinical assessment of the chronic and degenerative conditions that cause extensive morbidity and mortality. The currently unexplored indicators of disease are grip strength performance, maximal aerobic capacity and indices of body composition. The realm of the different anthropometric parameters of body composition especially Body Mass Index (BMI), Waist Circumference and Waist to Height ratio has largely been restricted to the measurement of abdominal obesity and estimating the risk of development of morbidities. A Body Shape Index is an anthropometric parameter calculated by dividing waist circumference by its estimate obtained from allometric regression of weight and height. BSA is the measured or calculated surface area of a human body which is an indicator of metabolic mass than body weight and is least affected by abnormal adipose tissue. Body Mass Index is a measure of body fat. Waist Circumference is a risk predictor stemming from abdominal obesity. The waist-to-hip ratio is another way of assessing abdominal obesity, and this measure correlates with cardiovascular risk. Grip strength performance is a direct and efficient measure of skeletal muscle status. It provides valuable information on the function and status of the musculoskeletal system. However, the measurement of grip strength performance also reveals crucial information about the overall health of the subject. Poor 

grip strength performance has been linked to mortality and morbidity, sarcopenia, and cachexia. While the focus of a large number of research based on grip strength was on quantifying the mortality risk in older adults [1,2,3].

BMI and waist circumference are commonly used parameters to define obesity and central adiposity. The threshold for increased cardiometabolic risks can differ according to gender and ethnicity, and lower BMI cutoffs are used for Asians, and the use of ethnicity and sex-specific Waist circumference cutoffs are recommended. Both BMI and WC are highly age-dependent in children and adolescents, and clinicians must refer to tables to determine gender- and age-dependent cutoffs. The waist-to-height ratio, calculated by dividing waist circumference by height, has recently gained attention as an anthropometric index for measuring central adiposity. Waist-to-height ratio is a more sensitive universal screening tool than BMI to detect health risks and is cheaper and easier to use. It was suggested that a waist-to-height ratio cutoff of 0.5 can be used in different sex and ethnic groups and that the same cutoff can be applied in children and adults. The message 'keep your waist circumference to less than half your height' may be particularly useful for public health as well as in clinical settings[4,5,6]. The present study was conducted to find relationship between BMI, Waist Hip ration and Handgrip endurance.

out of 90, 45 students were boys and remaining were girls. All the subjects aged between 18-21, who belongs to MBBS students of our institution.  The study design was ethically approved by the institutional ethical committee. An informed consent of the volunteers was taken on an approved proforma. All the participants were selected on the basis of inclusion and exclusion criteria. The students who were on medication or suffering from any ill-health were excluded from study. The students especially upper limb fractured or with limb deformity were excluded and the student with disorders like cardiovascular and respiratory were excluded. The subjects who had a BMI below 30 and those with no history of smoking or alcoholism were included in the study

Measuring of Height and Weight

The height was measured with stadiometer, without footwear and adjusted to nearing centimetre. We have used standardized weighing scale for measuring of weight of subjects in standing position and adjusted to nearing 0.1kg. We have used Quetlet’s index for calculating subjects Body Mass Index (BMI). We have categorised the subjects into 3 groups, that are underweight, Normal weight and overweight. In underweight group we have included the subjects with a BMI of less than 18.5(kg/m2), the subjects with a BMI which was between 18.5 to 24.99 (kg/m2) were classified as the normal weight group and the subjects BMI of between 25 to 29.99 (kg/m2) were classified as overweight[7,8].

Measurement of the hand grip Strength

In present study we have used a handgrip dynamometer to measure the handgrip strength and endurance of the dominant hand. The participants were advised to keep their hand on a table with the angle in the elbow being maintained at 90 degrees and they were asked to press the handle of the dynamometer with maximum strength. We followed standard protocol for measuring hand grip and endurance according to previous studies [9,10]. Measurement of waist and hip was taken in centimetres using stretch-resistant measuring tape. The waist circumference was measured approximately midpoint between the lower margin of last palpable rib and the top of the iliac crest, at the end of a normal expiration. The circumference around the widest portion of the buttocks was taken as hip circumference. Waist hip ratio was calculated by dividing the circumference of the waist to that of the hips in centimetres[11]. All the data were recorded and expressed in Mean +SD, SPSS software was used to analyses data. The significance level was set at p < 0.05 and it was considered as significant.

In present study total 90 students were involved, 45 students were boys and 45 students were girls. There was significant mean difference between male and females in case of height, weight, waist circumference, hip circumference, WHR, right hand grip and left-hand grip with gender. We have tabulated all parameters of height, weight, waist circumference, hip circumference, WHR, right hand grip and left-hand grip with gender. There was significance difference and positive correlation was observed for right hand grip in male students with weight, BMI and WHR. In female students, no significant correlation was observed (Table 2). Significant and positive correlation was also observed for left hand grip in male and female students with height. Result of correlation of left-hand grip strength with several anthropometric measures for males and females were tabulated (Table 3). The average of overall height subject was 164.05+10.25cm, weight was 60.51+11.88kg, BMI was 22.39+1.37 kg/m², Waist circumference was 45.66+12.67cm, Hip Circumference was 53.55+17.6 cm, weight and hip ratio was 0.86+0.07, Right hand grip strength (Kg) 30.31+6.74, Left hand grip strength (Kg) 28.07+6.74.

Table-1: Anthropometric measurements of male and female subjects (Mean±SD)

Table-2: Correlation coefficient (r) of Right-Hand grip strength with anthropometric measures for males and females.

Table-3: Correlation coefficient (r) of Light Hand grip strength with anthropometric measures for males and females.

The Body Mass Index has served us well as a proxy for obesity for many years, but it has always been recognised that it does not differentiate between the muscular and the overweight, except at very high BMIs. Healthy weight for height is usually defined as a BMI between 18.5 and 25 kg/m², overweight as equal to or more than 25 and less than 30, and obesity as a BMI of equal to or more than 30. The ratio of the waist circumference -to-height was originally proposed more or less simultaneously as a way of assessing shape and monitoring risk reduction. Both proposers suggested that WHtR values above 0.5 should indicate increased health risk. A simple index such as WHtR is a good proxy for central obesity and has great practical advantages. The use of WHtR circumvents such problems because the adjustment of waist circumference for height means that the same boundary values are suitable for both ethnic groups. Here we summarise the evidence that WHtR is a good predictor for morbidity and mortality and then discuss the practical aspects[12]. Measurement of handgrip strength is a simple, non-invasive easily administrable yet effective measure which provides useful information about strength and disabilities related to it.20,21 Adult population of younger age group has greater muscle strength and in turn works effectively so they are considered as the backbone of a nation. Dominant hand is used more in routine life. Muscles of forearms and hands are used for everyday activities and sporting events providing gripping power[11,13]. The present 

study was conducted to find and comparison study on relationship between Waist to Hip ratio, Handgrip endurance and BMI in young adults.

In present study there was significant mean difference between male and females in case of height, weight, waist circumference, hip circumference, WHR, right hand grip and left-hand grip with gender. There was significance difference and positive correlation was observed for right hand grip in male students with weight, BMI and WHR. In female students, no significant correlation was observed. Significant and positive correlation was also observed for left hand grip in male and female students with height. Result of correlation of left-hand grip strength with several anthropometric measures for males and females were tabulated.

In study of Erum Afaq[11]conducted in 91 subjects, 32 (35%) male and 59 (65%) female students. Significant mean differences were found for height, weight, waist circumference, hip circumference, WHR, right hand grip and left hand grip in both genders. Significant and positive correlation was observed for right hand grip in male students with weight, BMI and waist hip ratio. In female students, no significant correlation was observed for right hand grip. Height showed significant and positive correlation with left hand grip in both genders while waist and hip circumference showed negative but significant correlation with left hand grip in males. Erum Afaq [11] concluded in their study dominant handgrip strength had positive correlations with some variables. Our present study in corelation with this study.

In the study of Maryam RS [14] conducted in 650 students, In all the subjects, the components of body composition were negatively associated with cardiorespiratory fitness. BMI was negatively related to abdominal endurance, but no significant relationship was observed between BMI and other body composition components. There was a significant positive relationship between the components of body composition and handgrip strength. Body fat percentage and BMI were positively associated with flexibility, while WHR was not related to flexibility. Yu Q et al[15] study conducted in diabetic subjects results shown under different risk factors, BMI cutoff points were affected greatly. Especially for diabetes, the cutoff value was apparently larger than others were. WHR increased with age in both genders. From a general view, male WHR was slightly larger than female. In the male, WHR cutoff point was near 0.88 with a tiny change, as for in the female was near 0.86. in their study the cutoff values of sensitivity and specificity are relatively good and false positives rate is relatively low. BMI cutoffs values of overweight and obesity are 24.5 kg/m² and 29.0 kg/m², WHR cutoff values of the male are 0.88, the female is 0.86.

Hamer M and Batty GD[16] conducted with cross-sectional data from the UK Biobank study (n = 9,652, age 55.4 ± 7.5 years, 47.9% men). Measures included BMI, WHR, and total fat mass as ascertained from bioimpedance. After adjustment for a range of covariates, higher levels of all obesity measures were related to lower gray matter volume: BMI per 1 SD (β coefficient −4,113, 95% confidence interval [CI] −4,862 to −3,364), WHR (β coefficient −4,272, 95% CI −5,280 to −3,264), and fat mass (β coefficient −4,590, 95% CI −5,386 to −3,793). The combination of overall obesity (BMI ≥30 kg/m²) and central obesity (WHR >0.85 for women, >0.90 for men) was associated with the lowest gray matter compared with that in lean adults. In hypothesis-free testing with a Bonferroni correction, obesity was also related to various regional brain volumes, including caudate, putamen, pallidum, and nucleus accumbens. No associations between obesity and white matter were apparent. This study conducted the combination of heightened BMI and WHR may be an important risk factor for gray matter atrophy.

Hu, F., Yu, R., Han, F. et al.[17] study conducted cross-sectional study analyzed 5049 Chinese rural adults with essential hypertension. The prevalence of overweight, general obesity, central obesity and increased AS were 26.88%, 3.39%, 63.85% and 44.01%, respectively. Multivariate logistic regression analysis indicated that BMI levels were negatively associated with the prevalence of increased AS. When BMI was instead treated as a categorical variable divided into tertiles, the same relationship was observed (P for trend < 0.001). Inversely, WHR levels were positively associated with the prevalence of increased AS. Compared to subjects without central obesity, those with central obesity had a higher prevalence of increased AS. Linear regression models indicated similar results in the correlation between BMI or WHR levels and baPWV levels. There were no interactions in terms of age and blood pressure on the relationship between BMI or WHR levels and the prevalence of increased AS or baPWV levels.

Andreacchi, A.T[18] study in obesity prevalence varied by measure: BMI (29%), WC (42%), WHR (62%), and %BF (73%). BMI and WC were highly correlated with %BF (r ≥ 0.70), while WHR demonstrated a weaker relationship with %BF, with differences by sex (r = 0.29 and r = 0.46 in females and males, respectively). There were significantly increased RR and RD for all measures and health care services, for example, WC-defined obesity was associated with an increased risk of hospitalization (RR: 1.40, 95% CI: 1.28–1.54 and RD per 100: 2.6, 95% CI:1.9–3.3). Age-stratified results revealed that older adult groups with obesity demonstrated weak or no associations with HCU. Rufaii AA[19] study in 365 subjects, the mean age, waist circumference, waist to hip ratio and body mass index of the participants were 22.5 (±2.20) years, 79.36 (±10.4) cm, 0.81 (±0.06), and 22.48 (±4.50) kg/m² respectively. The prevalence of obesity based on body mass index, waist circumference and waist to hip ratio was found to be 6.3%, 17.6% and 25.5% respectively. Significant relationship was found between waist circumference and body mass index (r = 0.81; p< 0.001), and between waist to hip ratio and body mass index (r = 0.25; p< 0.001). and this study concluded Body mass index was related to waist circumference, as well as to waist to hip ratio. The prevalence of obesity based on waist to hip ratio was highest among female undergraduates in a Nigerian university. Awareness on the importance of waist to hip ratio as indicator of risk of obesity should be created among female undergraduates in Nigerian Universities and by extension among the women population in general

The present study finding may be helpful to add knowledge in research of relationship between BMI, Waist to Hip ratio and Handgrip endurance. This knowledge may help in understanding the bodyweight changes and maintains in metabolic deceases like diabetes and this finding may be also helpful in practice of sports medicine

1. S S, Kothari R, Mittal G, Gopani M, A P, Bokariya P, Vemparala SS, Tamrakar S, S A, A B. Exploring the Relationship Between the Indices of Body Composition With Grip Strength Performance and Peak VO2. Cureus. 2023 Jun 23;15(6):e40874. doi: 10.7759/cureus.40874. PMID: 37492808; PMCID: PMC10363579..