TITLE: STUDY OF THE BODY CIRCUMFERENCE USING

BODY MASS INDEX (BMI) AND WAIST TO HIP RATIO (WHR)

AMONG UNDERGRADUATES IN EBONYI STATE, NIGERIA
BY COSMOS FAVOUR AMARA
2019/MD/11194
DEPARTMENT OF ANATOMY
FACULTY OF BASIC MEDICAL SCIENCES (FBMS)
ALEX EKWUEME FEDERAL UNIVERSITY NDUFU ALIKE
IKWO EBONYI STATE
SUPERVISED BY DR KENNETH ONWE TOCHUKWU AND
PROF EZEONU

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1.1 INTRODUCTION

1.1.1. BACKGROUND OF STUDY

Body circumference measurement is used in predicting body fatness. The body fat percentage is a
measure of fitness level, since it is the only body measurement which directly calculates a person's
relative body composition without regard to height or weight and this body fat prediction is done using
body circumference measurements like Mid arm, mid thigh, waist, and hip circumference are used more
frequently than others .The widely used body mass index (BMI) provides a measure that allows the
comparison of the adiposity of individuals of different heights and weights. Factors used to determine
body circumference are; Body Mass Index (BMI), waist circumference, hip circumference (hip to waist
ratio), height and weight e.t.c.

Body Mass Index (BMI) is a weight-to-height ratio used as a quick and easy guide to obesity
classification. BMI (weight (kg)/height (m) 2) is one of the most popular measures used to assess
overweight and obesity. BMI does not separate fat mass from muscle mass, but nevertheless, is highly
correlated with both adipose and muscle mass. The extent to which changes in BMI over time represent a
physiological effect of aging versus a secular rise in overweight and obesity is unclear, and it is important
to separate birth cohort effects from aging effects [Juhaeri et al., 2003].
Body Mass Index (BMI) is an important anthropometric index that is commonly used for body fat storage
status assessment and is used for body fat determination [Paknahad et al., 2008] According to a study
carried out to determine the sensitivity and specificity of BMI in US adult population, BMI had limited
diagnostic performance to identify individuals who were overweight, particularly for people with BMI
between 25 to 30 kg/m2, for men and elderly people. It has been found that BMI has a good specificity,
but a low sensitivity to diagnose obesity [Gahagan et al., 2011;Abel et al., 2008, 2007]. Hip
circumference, although directly correlated with waist circumference (and BMI), has been shown to be
inversely associated with blood glucose, blood pressure and lipids.[ Snijder et al., 2004]. It is also
associated with reduced risk of CVDs, all-causes and cardiovascular mortality, particularly when adjusted
for waist circumference. Another indicator is the waist circumference or abdominal adiposity, which is
associated with excess abdominal fat and total body fat. Abdominal adiposity is defined as a waist
circumference of ≥ 102 cm for men and ≥ 88 cm for women. The risk of cardiovascular disease (CVD)
and non-insulin dependent diabetes is high in men and women with abdominal adiposity [Zimmet et al.,
2005]. While BMI largely increases as adiposity increases, due to differences in body composition, it is
not an accurate indicator of body fat; for Body circumference also known as body girth is different for
individuals due numerous factors that can influence body circumference or girth. The individual has no
control over some of these factors, including developmental determinants, genetic makeup, gender, and
age. Other factors that influence body circumference over which the individual has potential control
include level of physical activity, diet, and some environmental and social factors. Body circumference
which predicts body fat could be determined by waist to hip ratio (WHR) and BMI which could gotten
from the height, weight, waist circumference, height circumference e.t.c

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 BMI and waist to hip ratio are among the most popular methods to measure obesity due to their
simplicity, ease of execution and low cost [Chan et al., 2003; Hu, 2008] but although body mass index
(BMI) is a common, inexpensive and simple method to categorize individuals as underweight, normal
weight, overweight, obese I and obese II. However, this method does not reflect body shape and fat
distribution. Waist to hip ratio (WHR) is a more recent and accurate method to measure body fat
distribution and can be used routinely. WHR is a more accurate measure of distribution of body fat
(abdominal fat) although it is less commonly used (Brown, 2009). It can be used to classify body types
into two main categories: Apple and pear. Apple shaped body type is more common among men and is
caused by abdominal obesity. Women usually accumulate fat around the hip and the thighs to develop a
pear shaped body type (Ashwell, 2009). Apple shaped fat distribution is considered more dangerous than
Pear shaped fat distribution because of the accumulation of fat in the deep abdominal area around the
visceral organs.

In some studies carried out BMI and WHR shows it's significance in health conditions as obesity leads to
certain health conditions. In short, obese people have significantly higher chances of getting health-
related problems such as cardiovascular diseases (CVD) [Hwee et al., 2008]. Other studies have examined
the association between BMI and risk of total knee replacement among Chinese (Hokkien and Cantonese
dialect) in Singapore and concluded that BMI was a strong risk factor for total knee replacement [Leung
et al., 2015]. Correlation study between BMI and waist circumference in patients with metabolic
syndrome study showed that the presence of the overweight in men (BMI 25.84 kg/m2) and normal
weight in woman (BMI 21.62 kg/m2) corresponds with the increased volume of visceral tissue around
abdomen area with high chances to develop diabetes mellitus type 2 and CVD [Marcin et al., 2014]

1.1.2 STUDY HYPOTHESIS

We presume that there are significant variations in anthropometric measurements, including height,
weight, waist circumference, hip circumference (waist to hip ratio) and BMI, among undergraduate
students in Ebonyi State, Nigeria. This study will explore the relationships between these measurements,
providing insights into body composition and health status among the student population. The results of
this study may have implications for health promotion and disease prevention efforts in the region.

1.1.3 RESEARCH QUESTIONS

1. What is the pattern of Body Mass Index (BMI) among undergraduate students in Ebonyi State,
Nigeria and the prevalence of different BMI categories and the associated implications for health
and wellness in this population?
2. What is the range of variation in height, weight, waist circumference, and hip circumference
within the population of undergraduate students in Ebonyi State?
3. Is there a significant relationship between waist-to-hip ratio (WHR) and body mass index (BMI)
among the undergraduate students in this study?

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 4. What percentage of undergraduate students in this study have elevated waist-to-hip ratios ?
(showing or quantify the proportion of students in this population who have a WHR that is
considered unhealthy).
5. How are body mass index (BMI), height, weight, waist circumference, and hip circumference
related in terms of anthropometric measurement among undergraduate students in Ebonyi State?
6. Are there gender-specific differences in hip-to-waist ratio and body mass index (BMI) among
undergraduate students?
7. What are the health implications of variations in anthropometric measurements, particularly
those associated with overweight or obesity, in the undergraduate student population under study?
8. Are there any distinct patterns of body composition that may be influenced by height, weight,
waist circumference, and hip circumference among undergraduate students?
9. Here's a concise, formal paraphrase: "What is the role of height, weight, body mass index (BMI),
waist circumference, and hip circumference in determining body circumferences among male and
female undergraduate students?
10. What are the implications of the interplay between anthropometric measurements, body
composition, and health risks among undergraduate students in Ebonyi State?

1.14 SIGNIFICANCE OF STUDY

1. Health assessment: Measuring body circumference, specifically waist-to-hip ratio (WHR) and
body mass index (BMI), can provide valuable insights into the health status of undergraduate
students. Elevated WHR and BMI can indicate an increased risk of obesity and associated health
conditions.
2. Nutritional Assessment: This study can help to assess the nutritional status of undergraduate
students by examining the relationships between height, weight, waist circumference, hip
circumference, and BMI.
3. Body Composition analysis: analyzing waist and hip circumferences, along with height and
weight, provide insights into the distribution of body fat and lean mass. This information can help
to identify potential health implications associated with specific patterns of body fat distribution.
4. Health education and intervention: The findings of this study can inform the development of
health education programs and interventions to promote healthy lifestyles among undergraduate
students. This can include promoting healthy eating habits and physical activity to prevent or
manage health issues associated with body circumference.
5. Risk identification: Identifying elevated waist-to-hip ratios and body mass indexes can help to
identify individuals at risk for health conditions like cardiovascular disease, diabetes, and
metabolic disorders. This can help to intervene early and implement strategies to manage these
risks.
6. Gender Considerations: Gender-specific differences in body circumferences are important to
consider when developing health interventions for undergraduate students. This recognition of
gender-based differences can help tailor interventions to the unique needs of both men and
women.
7. Academic performance and wellbeing: A healthy waist-to-hip ratio and body mass index are
associated with improved overall well-being, which can positively impact academic performance.

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 The results of this study may have implications for the overall development of undergraduate
students in terms of both health and academic success.
8. Public Health Planning: The data obtained can be utilized in public health planning and policy
formulation. It provides a basis for developing strategies to address health challenges related to
body circumferences among undergraduate students in the region.

1.1.5 SCOPE OF STUDY

1. Geographical scope: This study will be conducted exclusively among undergraduate students
within the geographical boundaries of Ebonyi State, Nigeria specifically at Federal University
Ndufu Alike Ikwo, Ebonyi State.
2. Population scope: The target population of this study will consist of undergraduate students from
various academic disciplines and levels of study within Federal University Ndufu Alike Ikwo
(FUNAI) in Ebonyi State. The study will consider participants' age, gender, and academic year as
potential variables.
3. Anthropometric measurement: This study will collect data on participants' weight, height, waist
circumference, hip circumference, and body mass index. These measurements will then be used
to assess body circumference and composition among undergraduate students.
4. Gender consideration: The scope of this study includes a gender-specific analysis to examine
potential differences in body circumferences between male and female students. This approach
recognizes the need to consider gender-specific health issues when assessing body composition.
5. Data collection method; Data will be collected through standard anthropometric measurements
and self-reported surveys or questionnaires, following ethical guidelines to ensure the privacy and
informed consent of all participants. The methods used will be carefully designed to ensure
validity and reliability of the data collected.
6. Health education implication: The study aims to identify potential areas of intervention for health
promotion based on the findings. This includes strategies to encourage healthy lifestyles among
undergraduate students. The study will contribute to the existing literature on body composition
and its implications for health
7. Data analysis and visualization: It involves the analysis of collected data using statistical methods
to explore relationships between different variables, such as height, weight, waist circumference,
hip circumference, waist-to-hip ratio (WHR), and body mass index (BMI). This will allow for
robust interpretation of the data and a more comprehensive understanding of body composition.
8. Limitation: The study will acknowledge any potential limitations, such as biases or sample size
constraints, that could affect the general results.

1.1.6 AIM

The aim is to comprehensively examine and analyze the body circumferences of undergraduate students
in Ebonyi State. The study will use a combination of standardized anthropometric measurements and
statistical analysis to draw conclusions on the health implications of different body circumferences.

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1.1.7 OBJECTIVES OF STUDY

1. Assessment of body composition: The study will acknowledge any potential limitations, such as
biases or sample size constraints, that could affect the generalizability of the results.
2. Exploration of relationship: The study will explore the relationships between different
anthropometric measures, such as the correlation between WHR and BMI, and how these
relationships may be influenced by factors such as gender and age.
3. Identification of health indicators: The study will identify health indicators, such as the
prevalence of elevated WHR and BMI, within the undergraduate population. It will also assess
the potential health risks associated with variations in body circumferences, such as increased risk
of cardiovascular disease, type 2 diabetes, and other health conditions.
4. Gender specific analysis: The study will conduct a gender-specific analysis to investigate any
differences in body circumferences between male and female undergraduates, recognizing the
importance of considering gender-specific health factors.
5. Health education and intervention strategies: The study aims to provide insights that can inform
the design of health education programs and interventions to promote the overall health and well-
being of undergraduate students in Ebonyi State.
6. Contribution to local health: The study will contribute to the local understanding of health
patterns and behaviors related to body circumferences, which may be under-researched in the
context of Ebonyi State, Nigeria.
7. Inform public health planning: The study will provide data that can inform public health planning
and policy formulation, contributing to the development of strategies to address health challenges
associated with body circumferences among undergraduate students in Ebonyi State.

1.2 MATERIALS AND METHOD

1.2.1 MATERIALS

 Measuring tools: Body composition measuring tools like anthropometry tape for the hip and waist
circumference, stadiometer for height and calibrated weighing scale for weight.
 Data collection tools: Data collection will be carried out using standardized data recording sheets
or digital devices, which will ensure that all data is accurately captured and stored for analysis.
 Computers and Software: Computers or tablets for data analysis and storage. Statistical software
for analyzing collected data (e.g., SPSS, R, Excel).
 Research Participants: A sample of undergraduates students in FUNAI Ebonyi State, Nigeria
who are willing to participate in the study.
 Research ethics approval: To ensure that the study adheres to ethical guidelines and safeguards
participants' rights, this study will seek approval from an ethics committee or IRB.

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  Research Plan and Protocol: A detailed research plan outlining the study's objectives, methods,
and procedures.
 Funding and Budget: Budget for research expenses, participant incentives (if applicable), and
equipment purchase or rental.
 Documentation and Recording: Notebooks or digital devices for recording observations, notes,
and research progress.
 Consent Forms: Informed consent forms for participants to sign, indicating their voluntary
participation in the study.
 Literature and References: Access to relevant books, scientific journals, and online databases for
literature review and reference.

1.2.2 METHODS

 Anthropometric measurement: conduct or carry out measurements of body circumference

including hip circumference, waist circumference, weight and height.
 Data analysis: Data analysis will be conducted using statistical techniques such as t-tests,
correlation analysis, ANOVA, and regression analysis. These techniques will allow for the
examination of relationships between variables, as well as changes in body composition over
time.
 Data management: A robust data management system will be implemented to securely store and
organize the collected data, maintaining its confidentiality and integrity.
 Ethical considerations: Ethical guidelines will be followed throughout the research, including
obtaining informed consent and IRB approval.
 Statistical Software: Utilize statistical software packages (e.g., SPSS, R) to analyze data and
generate meaningful results and statistical reports.
 Data visualization: The study's results will presented in the form of clear and informative data
visualizations, such as graphs and charts.
 Literature review: The study will be informed by a thorough literature review of existing research
on the topic, which will inform the study design and contextualize the findings.

1.3 STUDY LOCATION

Alex Ekwueme Federal University Ndufu Alike Ikwo, Ebonyi State Nigeria.

1.4 STUDY DESIGN: Descriptive study

 Study population: This research is to be carried out at Federal University University Ndufu Alike
Ikwo Ebonyi State in Nigeria and should comprise of individuals who are randomly selected.
 Data analysis: Use statistical software to develop population-specific regression models and
conduct regression analysis to assess the influence of IOT on students within Ebonyi State.
 Sampling strategy: Randomly select a representative sample of individuals from the Ebonyi
population using FUNAI in Ebonyi State. Also there is inclusion of individuals of different ages,
sexes, to ensure the representativeness of the sample.

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  Data collection: Data on the body circumference us collected by measuring the difference part of
the body required to determine the body circumference (like height, weight, waist circumference,
hip circumference e.t.c)

1.5 SAMPLE SIZE DETERMINATION

 Research objectives: The research objectives include exploring allometric relationships, assessing
body circumference indicators, and examining gender and age differences. The required sample
size will be influenced by the expected differences between groups and the statistical power
needed to detect those differences.
 Sample determination: Statistical power is a key consideration in determining the study's sample
size. Power analysis will be conducted, taking into account factors such as the desired level of
power, the desired level of significance, and the expected effect size. The results of the power
analysis will be used to determine the necessary sample size.
Sample size formula; ( 1− p )
N ×[Z 2 × p × ]
e2
Sample ¿(n ¿)=¿
¿

Where;
N = Population size,
Z = Critical value of the normal distribution at the required confidence level,
p = Sample proportion,
e = Margin of error
 Precision and confidence level: The desired level of precision and confidence in the study
findings will influence the necessary sample size. A higher level of precision or a narrower
confidence interval will require a larger sample size.
 Feasibility and resources: When determining the sample size, feasibility considerations such as
available time, personnel, and financial resources must be taken into account. It is important to
strike a balance between the ideal sample size and the practical realities of the study.
 Population variability or diversity: Population variability will also influence the sample size
required for the study. Higher variability will generally require a larger sample size to ensure
adequate statistical power and detect significant differences or associations.

1.6 ANTHROPOMETRIC MEASUREMENT

 Height: Here's a concise, formal, and shorter paraphrase: "Height will be measured using a
stadiometer to calculate Body Mass Index (BMI).

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  Weight: Weight will be measured using a calibrated scale to provide a baseline measurement of
overall body mass.

Body Mass Index (BMI): BMI will be calculated by dividing the participant's weight (kg) by the
square of their height (m2). While BMI can provide an initial estimate of body composition, it
has limitations and should be interpreted in conjunction with other measurements.
 Waist circumference: The waist circumference will be measured using anthropometric tape at
narrowest point between lower costal (10th rib) border and iliac crest around the abdomen with
the arm slightly abducted.
 Hip circumference: Hip circumference is to be measured at the level of the greatest posterior
protuberance of the buttocks using anthropometry tape.
 Waist to Hip ratio (WHR): The waist and hip circumference measured from individuals are
calculated using the formula = Waist/Hip to 2 decimal places)

1.7 STUDY CRITERIA

 Participants Status: Participants should be student of AE FUNAI

 Age Range: Age range of 15-29
 Gender: Male and Female
 Geographical Location: Participants should be based in Ebonyi or specifically Federal University
Ndufu Alike Ikwo Ebonyi State, Nigeria.
 Health Status: Participants should be in good health and free from any medical conditions that
might significantly impact their body composition or ability to engage in exercise routines.
 Consent: Participants must provide informed consent to voluntarily participate in the study.

1.8 DATA ANALYSIS

 Data Cleaning and Preparation: The data will be inspected for errors, missing values, and outliers.
Any issues with data quality will be addressed through data cleaning procedures. The data will
then be organized and structured for analysis.
 Descriptive statistics: Descriptive analysis would involve calculating the mean, median, and
standard deviation of data collected on the influence of IOT on students based on age and level.
Chats or graphs could be created to visualize data collected.
 Inferential statistics: Inferential statistics involve using sample data to draw conclusions about the
entire population. Also, sample data or data collected could be used to estimate data collected on
the influence of IOT on students. Sample data could be used to test hypotheses about the
relationship between upper extremity bone length and stature.
 Data or information visualization: The relationship between the internet of things and it's
influence on students will be visually represented through scatter plots and correlation
coefficients. Data visualization identify the strength and direction of the relationship between the
two variables.

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 Data interpretation: The results of the analyses will be interpreted to answer the research
questions and hypotheses. The findings will be discussed and any practical implications for
estimating stature from upper extremity long bones will be identified.
 Reporting and Presentation: The findings will be clearly and concisely reported, with tables and
figures to illustrate the key results. The implications of the study will be discussed and the results
will be compared to the existing literature.
 Statistical software: SPSS, excel or R are statistical software for analyzing the data and
interpreting the results. Complex statistical analysis can be carried out as well as creation of
visualization of data collected.
 Ethical considerations: The study will adhere to ethical guidelines for data handling and analysis,
including the protection of participant confidentiality.
 Critical evaluation or review: "Collaboration with an expert in statistics or data analysis is
recommended to ensure the accuracy and validity of the analyses.

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Juhaeri, Stevens J, Jones DW, Arnett D. Associations of aging and birth cohort with body mass index in a
biethnic cohort. Obes Res. 2003; 11:426–433. [PubMed: 12634441]

Paknahad Z, Mahboob S, Omidvar N, Ebrahimi E, Ostadrahim A and Afiatmilani SH. Body mass index
and its relationship with hematological indices in Iranian women. Pak J Nut, 2008; 7(2): 377–380.

Abel, R.C., K.S. Virend, S.J. Justo, J.T. Randal, R.B. Kent, L.C. Maria, G.A. Thomas, K. Josef, A.B.
John and L.J. Francisco, 2008. Accuracy of body mass index to diagnose obesity in the US adult
population.Int. J. Obes. (Lond), 32: 959-966.

Snijder MB, Zimmet PZ, Visser M, Dekker JM, Seidell JC, Shaw JE. Independent and opposite
associations of waist and hip circumferences with diabetes, hypertension and dyslipidemia: the AusDiab
Study. Int J Obes Relat Metab Disord 2004;28:402–409.

Gahagan, S., R.M. Kliegman, R.E. Behrman, H.B. Jenson and B.F. Stanton, 2011. Overweight and
obesity Nelson textbook of paediatrics 19th edition, Philadelphia, Pa: Saunders Elsevier. Chap., 44.

Zimmet PK, Alberti KG, Ríos MS. A New International Diabetes Federation (IDF) Worldwide Definition
of the Metabolic Syndrome: the Rationale and the Results. Rev Esp Cardiol. 2005; 58(12): 1371-1376

Chan, D.C., G.F. Watts, P.H. Barrett and V. Burke, 2003. Waist circumference, waist to hip ratio and
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Hu, F.B., 2008. Measurements of adiposity and body composition. In: Huf, ed. Obesity Epidemiology.
New York City, Oxford University Press, pp: 55-56.
Brown, P., 2009. Waist circumference in primary care. Primary Care Diabetes, 3: 259-261

Ashwell, M., 2009. Obesity risk: Importance of the waistto-height ratio. Nurs. Stand., 23: 49-54.

Hwee, L.W., B.C. Yin, C.L. Wai, B.T. Chee, H.C. Mun, C.L. Shu, Y.F. Kok, F. David, M. David, L. Nan
and T. Julian, 2008. The association of body mass index with health-related quality of life: an exploratory
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Leung, Y.Y., J.C. Allen, M. Noviani, L.W. Ang, R. Wang, J.M. Yuan and W.P. Koh, 2015. Association
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Marcin, G., G. Joanna, E. Marlena, A. Adam and J.Roman, 2014. Correlation between body mass index
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