Introduction: The World Health Organisation (WHO) defines overweight and obesity as a condition in which an abnormal or excessive fat accumulation exists to an extent in which health and well-being are impaired. The most recent South African National Health and Nutrition Examination Survey (SANHANES) reported that the prevalence of overweight and obesity, according to body mass index (BMI) classification, in all South African women was significantly higher than in men (24.8% and 39.2% compared to 20.1% and 10.6% for women and men, respectively). Blood pressure is often increased in obese patients and is probably the most common co-morbidity associated with obesity. Currently approximately one third (30.4%) of the adult South African population has hypertension. Hypertension is responsible for a significant percentage of the high rates of cardiovascular disease and stroke in South Africa. Limited South African data are available regarding the agreement between the measures of adiposity, including BMI, waist circumference (WC) and percentage body fat (%BF), and the association with high blood pressure. Measures of adiposity were found in previous research to be ethnicity, age and gender specific. Measuring %BF to classify adiposity takes body composition into account and is a more physiological measurement of obesity than BMI. Objective: This study aimed to investigate the agreement between adiposity classified by BMI categories and %BF cut-off points, and the association between the different measures of adiposity and high blood pressure. Method: A representative sample of black women (n=435), aged 29 years to 65 years from Ikageng in the North West Province of South Africa were included in this cross-sectional epidemiological study. Socio-demographic questionnaires were completed. Pregnancy and HIV tests were performed and those with positive test results or those who declined HIV testing were excluded. Weight and height were measured and BMI was calculated. WC, %BF using dual-energy X-ray absorptiometry (DXA), and blood pressure were measured. Results: The prevalence of overweight (BMI 25.0 kg/m² – 29.9 kg/m²) was 24.4% and obesity (BMI ≥ 30kg/m²) was 52.4%. High blood pressure was found to be present in more than two thirds of the study participants (68.5%). In this study BMI, WC and %BF as measures of adiposity were significantly correlated. There were significant agreements between combined overweight/obesity that was defined by %BF (≥35.8% 29-45 years; ≥37.7% ≥50 years) and BMI ≥ 25kg/m² (ᵡ²=199.0, p<0.0001; κ=0.68, p<0.0001), and between the presence of high %BF and obesity only, that was defined by BMI ≥ 30 kg/m² (ᵡ²=129.1, p<0.0001; κ=0.48, p<0.0001). The effect size of the agreement between the WHO BMI category for combined overweight/obesity and %BF cut-off points according to the kappa value of κ=0.68 was substantial (κ range 0.61-0.80). The effect size of the agreement between the WHO BMI category for obesity only and %BF cut-off points according to the kappa value of κ=0.48 was moderate (κ range 0.41-0.60). No association was found between high blood pressure and BMI categorised combined overweight/obesity (ᵡ²=3.19; p=0.74), but a significant association was found between high blood pressure and BMI categorised obesity only (ᵡ²=4.10; p=0.043). A significantly increased odds ratio (OR) of high blood pressure existed in the obesity BMI category (OR=1.52; p=0.045) as opposed to the overweight/obesity BMI category (OR=1.51; p=0.075). There were significant associations between high blood pressure and WC ≥ 80cm (ᵡ²=10.9; p=0.001; OR=2.08; p=0.001), WC ≥ 92cm (ᵡ²=20.1; p<0.0001; OR=1.79; p=0.011) and %BF above the age-specific cut-off points (ᵡ²=6.61; p=0.010; OR=1.70; p=0.011). Discussion and conclusion: This study found that in a sample of black urban South African women significant agreements existed between adiposity defined by %BF cut-off points for combined overweight/obesity and both WHO BMI categorised combined overweight/obesity (BMI ≥ 25 kg/m2) and obesity only (BMI ≥ 30 kg/m2), respectively. A stronger agreement was found between WHO categorised combined overweight/obesity and %BF. Furthermore, this study concluded that the BMI category according to the WHO cut-off point for overweight/obesity had insufficient sensitivity to detect the presence of high blood pressure, and that the BMI category according to the WHO cut-off point for obesity alone could detect the presence of high blood pressure. The WHO BMI classification for obesity, in contrast to the WHO BMI classification for combined overweight/obesity, is therefore appropriate to classify these black South African women at increased risk for high blood pressure. The WC and %BF cut-off points used which were specific to ethnicity, age and gender, had significant associations with high blood pressure and have good capacity to detect high blood pressure. In this study abdominal obesity as defined by the South African cut-off point of WC ≥ 92 cm had a stronger association with high blood pressure, than the international cut-off point (WC ≥ 80 cm). The South African cut-off point is, therefore, more appropriate to screen black South African women for increased risk for high blood pressure. The study therefore concluded that a stronger agreement was found between WHO categorised combined overweight/obesity and %BF than with obesity only (BMI ≥ 30 kg/m2). To ensure consistency and accuracy, and to take body composition into consideration, it is recommended that, where possible, in clinical practice the appropriate WC and %BF cut-off points together with BMI categories should be used as measures of adiposity for diagnosis of overweight and obesity and to screen or detect an increased risk for high blood pressure. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2015

Introduction: The World Health Organisation (WHO) defines overweight and obesity as a condition in which an abnormal or excessive fat accumulation exists to an extent in which health and well-being are impaired. The most recent South African National Health and Nutrition Examination Survey (SANHANES) reported that the prevalence of overweight and obesity, according to body mass index (BMI) classification, in all South African women was significantly higher than in men (24.8% and 39.2% compared to 20.1% and 10.6% for women and men, respectively). Blood pressure is often increased in obese patients and is probably the most common co-morbidity associated with obesity. Currently approximately one third (30.4%) of the adult South African population has hypertension. Hypertension is responsible for a significant percentage of the high rates of cardiovascular disease and stroke in South Africa. Limited South African data are available regarding the agreement between the measures of adiposity, including BMI, waist circumference (WC) and percentage body fat (%BF), and the association with high blood pressure. Measures of adiposity were found in previous research to be ethnicity, age and gender specific. Measuring %BF to classify adiposity takes body composition into account and is a more physiological measurement of obesity than BMI. Objective: This study aimed to investigate the agreement between adiposity classified by BMI categories and %BF cut-off points, and the association between the different measures of adiposity and high blood pressure. Method: A representative sample of black women (n=435), aged 29 years to 65 years from Ikageng in the North West Province of South Africa were included in this cross-sectional epidemiological study. Socio-demographic questionnaires were completed. Pregnancy and HIV tests were performed and those with positive test results or those who declined HIV testing were excluded. Weight and height were measured and BMI was calculated. WC, %BF using dual-energy X-ray absorptiometry (DXA), and blood pressure were measured. Results: The prevalence of overweight (BMI 25.0 kg/m² – 29.9 kg/m²) was 24.4% and obesity (BMI ≥ 30kg/m²) was 52.4%. High blood pressure was found to be present in more than two thirds of the study participants (68.5%). In this study BMI, WC and %BF as measures of adiposity were significantly correlated. There were significant agreements between combined overweight/obesity that was defined by %BF (≥35.8% 29-45 years; ≥37.7% ≥50 years) and BMI ≥ 25kg/m² (ᵡ²=199.0, p<0.0001; κ=0.68, p<0.0001), and between the presence of high %BF and obesity only, that was defined by BMI ≥ 30 kg/m² (ᵡ²=129.1, p<0.0001; κ=0.48, p<0.0001). The effect size of the agreement between the WHO BMI category for combined overweight/obesity and %BF cut-off points according to the kappa value of κ=0.68 was substantial (κ range 0.61-0.80). The effect size of the agreement between the WHO BMI category for obesity only and %BF cut-off points according to the kappa value of κ=0.48 was moderate (κ range 0.41-0.60). No association was found between high blood pressure and BMI categorised combined overweight/obesity (ᵡ²=3.19; p=0.74), but a significant association was found between high blood pressure and BMI categorised obesity only (ᵡ²=4.10; p=0.043). A significantly increased odds ratio (OR) of high blood pressure existed in the obesity BMI category (OR=1.52; p=0.045) as opposed to the overweight/obesity BMI category (OR=1.51; p=0.075). There were significant associations between high blood pressure and WC ≥ 80cm (ᵡ²=10.9; p=0.001; OR=2.08; p=0.001), WC ≥ 92cm (ᵡ²=20.1; p<0.0001; OR=1.79; p=0.011) and %BF above the age-specific cut-off points (ᵡ²=6.61; p=0.010; OR=1.70; p=0.011). Discussion and conclusion: This study found that in a sample of black urban South African women significant agreements existed between adiposity defined by %BF cut-off points for combined overweight/obesity and both WHO BMI categorised combined overweight/obesity (BMI ≥ 25 kg/m2) and obesity only (BMI ≥ 30 kg/m2), respectively. A stronger agreement was found between WHO categorised combined overweight/obesity and %BF. Furthermore, this study concluded that the BMI category according to the WHO cut-off point for overweight/obesity had insufficient sensitivity to detect the presence of high blood pressure, and that the BMI category according to the WHO cut-off point for obesity alone could detect the presence of high blood pressure. The WHO BMI classification for obesity, in contrast to the WHO BMI classification for combined overweight/obesity, is therefore appropriate to classify these black South African women at increased risk for high blood pressure. The WC and %BF cut-off points used which were specific to ethnicity, age and gender, had significant associations with high blood pressure and have good capacity to detect high blood pressure. In this study abdominal obesity as defined by the South African cut-off point of WC ≥ 92 cm had a stronger association with high blood pressure, than the international cut-off point (WC ≥ 80 cm). The South African cut-off point is, therefore, more appropriate to screen black South African women for increased risk for high blood pressure. The study therefore concluded that a stronger agreement was found between WHO categorised combined overweight/obesity and %BF than with obesity only (BMI ≥ 30 kg/m2). To ensure consistency and accuracy, and to take body composition into consideration, it is recommended that, where possible, in clinical practice the appropriate WC and %BF cut-off points together with BMI categories should be used as measures of adiposity for diagnosis of overweight and obesity and to screen or detect an increased risk for high blood pressure. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2015