Combining general and central measures of adiposity to identify risk of hypertension: a cross-sectional survey in rural India

Rathina Srinivasa Ragavan, Jordan Ismail, Roger G. Evans, Velandai K. Srikanth, Matthew Kaye, Rohina Joshi, Kavumpurathu R. Thankappan, Clara K. Chow, Michaela A. Riddell, Brian Oldenburg, Ajay Mahal, Kartik Kalyanram, Kamakshi Kartik, Oduru Suresh, Nihal Thomas, Gomathyamma K. Mini, Pallab K. Maulik, Simin Arabshahi, Amanda G. Thrift

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1 Citation (Scopus)


Aim: In three socioeconomically diverse regions of rural India, we determined the optimal cut-offs for definition of overweight, the prevalence of overweight, and the relationships between measures of overweight and risk of hypertension. Subjects and methods: Villages were randomly sampled within rural Trivandrum, West Godavari, and Rishi Valley. Sampling of individuals was stratified by age group and sex. Cut-offs for measures of adiposity were compared using area under the receiver operating characteristic curve. Associations between hypertension and definitions of overweight were assessed by logistic regression. Results: Of 11 657 participants (50 % male; median age 45 years), 29.8 % had hypertension. Large proportions were overweight as defined by body mass index (BMI) ≥ 23 kg/m2 (47.7 %), waist circumference (WC) ≥ 90 cm for men or ≥ 80 cm for women (39.6 %), waist-hip ratio (WHR) ≥ 0.9 for men or ≥ 0.8 for women (65.6 %), waist-height ratio (WHtR) ≥ 0.5 (62.5 %), or by BMI plus either WHR, WC or WHtR (45.0 %). All definitions of overweight were associated with hypertension, with optimal cut-offs being at, or close to, the World Health Organization (WHO) Asia-Pacific standards. Having overweight according to both BMI and a measure of central adiposity was associated with approximately twice the risk of hypertension than overweight defined by only one measure. Conclusions: Overweight, as assessed by both general and central measures, is prevalent in rural southern India. WHO standard cut-offs are appropriate in this setting for assessing risk of hypertension. However, combining BMI with a measure of central adiposity identifies risk of hypertension better than any single measure. The risk of hypertension is significantly greater in those centrally and generally overweight than those overweight by a single measure.

Original languageEnglish
Pages (from-to)249-256
Number of pages8
JournalObesity Research and Clinical Practice
Issue number3
Publication statusPublished - May 2023


  • Body mass index
  • Hypertension
  • India
  • Prevalence
  • Waist-hip ratio

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