EVALUATION OF WAIST CIRCUMFERENCE, WAIST-TO-HIP RATIO, AND WAIST-HEIGHT RATIO AS INDICATORS OF OBESITY AMONG ADOLESCENTS IN GAZA STRIP-PALESTINE

Background: Waist circumference is not a routine measurement in clinical practice. Overweight and obesity prevalence among adolescents are increasing worldwide and may be associated with increased risk for the development of chronic diseases in adulthood. The associated lipid abnormalities and insulin concentrations also correlate with waist circumference. BMI gives no indication of the distribution of body fat, in children. The importance of this study resulted from a high needy population to assess the level of obesity among condoned age group. Data on the prevalence of abdominal obesity in Palestinian adolescents is limited, obscuring the potential magnitude of the problem. Therefore, the purpose of this study is to estimate prevalence for waist circumference (WC), waist-to-hip ratio (WHR), waist-height ratio (WHtR) and body mass index (BMI) of Palestinian adolescents aged 12-14 years.
Methods: This cross sectional study was conducted in the prep schools among adolescent’s students who aged from 12- 14 years in the Gaza strip. The study included a population-representative sample of pupils, with a response rate of 97% (680/700). Univariate and bivariate analyses were performed with SPSS version 20.0.
Results: Distribution among age and sex in 12-years old males were 117 (33.4%), female were 103 (31.2%); 13-years male were 100 (28.6), females were 111 (33.6%); 14-years males were 133 (38.0%), females were 116 (35.2%), median of weight and BMI among female was higher than male (Z= -2.729, P= 0.006; Z= -3.668, P= 0.001; respectively). Female was higher also in WC, HC, and WHtR (Z= - 6.501, P= 0.001; Z=-11.718, P= 0.001; and Z= -7.383, P= 0.001; respectively), but male were higher than female regarding WHR (Z= = -7.144, P= 0.001). The difference of anthropometric measurements according to increase in age from 12 to 14 years resulted in significant differences of height, weight, BMI, WC, HC (F= 90.237, P= 0.001; X2= 91.947, P= 0.001; X2= 27.195, P= 0.001; X2= 42.826, P= 0.001; and X2= 65.651, P= 0.001; respectively). The differences due to change of region, and anthropometric measurements for participants from the village were lower than ones from city or camp in WC, HC, and WHR measurements (X2= 73.642, P= 0.001,X2= 9.886, P= 0.007; and F= 112.10, P= 0.001; respectively). The other hand, WHR was moderately correlated with WC and WHtR, and poorly correlated with BMI (rs= 0.476, P=0.001; rs= 0.553, P= 0.001; and rs= 0.122, P=0.001; respectively). Finally, the comparisons of anthropometric measurements with neighbouring countries for female of 14 years old, revealed differences between Palestinians and Egyptians in most measurements, while slight differences appeared between Palestinians and Lebanese.
Conclusion: Our results recommend the need to incorporate waist circumference into routine clinical practice, in addition to traditional measurements of BMI. Relatively few health care professionals routinely measure WC; efforts are needed to promote the measurement of this important anthropometric parameter as a “vital sign” in pediatric primary care practice. The findings of this study provide updated and useful information that further strengthens our understanding of the obesity epidemic among adolescents in the Gaza Strip-Palestine and sheds light on the importance of using WC or WHtR for monitoring the trends of abdominal obesity in clinical practice.