Designing a gender-specific colour-coded waist circumference measuring tape- The Mishra’s Metabolic & Cellular Optimisation Risk Evaluation Dual Tape’ (M-CORE dual tape) as a public health innovation Tool for nutritional Screening in adults

Abstract

Abstract

Background: India, like many developing nations, experiences a ‘Double burden’ of malnutrition.  Although Body Mass Index (BMI) is the standard method for classifying individuals' nutritional status, its user-friendliness and cardiometabolic risk prediction have come under scrutiny. Therefore, the search for alternative, scientifically tenable, simple, inexpensive, and easy-to-use and interpret screening tools, such as M-CORE dual tape, is underway.

Objectives:

1. To evaluate the association between waist circumference and Body Mass Index (BMI), derive gender specific waist circumference categories corresponding to Indian Council of Medical Research (ICMR) BMI classifications, and determine the diagnostic performance of the defined categories in detecting the nutritional status of studied individuals.


2. To develop a sex-specific colour-coded waist circumference measuring tape (M-CORE dual tape) for rapid nutritional screening.

Methods: A community-based cross-sectional study using a population-proportionate sampling technique was conducted to enroll 528 adults from six villages in the rural field practice area of the Department of Community Medicine, of R.D. Gardi Medical College, Ujjain, Madhya Pradesh, using data collected under the Community Adoption Programme for Postgraduates (CAPP), a unique community-oriented academic initiative of the institution. Under this programme, postgraduate students adopted villages and conducted comprehensive community health surveys, including anthropometric assessment and screening for abdominal obesity. Height, weight, waist circumference, and hip circumference. Body Mass Index (BMI) was calculated and classified according to the Indian Council of Medical Research (ICMR) guidelines. Waist circumference values were stratified into percentiles, and the association between waist circumference percentile categories and BMI categories was evaluated. The relationship was further examined using the Chi-square test, one-way Analysis of Variance (ANOVA), and binary logistic regression. The diagnostic performance of waist circumference and BMI for identifying overweight and obesity was assessed using Receiver Operating Characteristic (ROC) curve analysis, and the findings were used to develop/propose a gender-specific colour-coded waist circumference measuring tape: ‘Mishra’s M-CORE dual tape’ for nutritional screening.

Results: Among 528 participants, 232 (43.9%) were male, and 296 (56.1%) were female. The average ages were 49.59 (± 16.66) for males, 51.58 (± 16.75) for females, and 48.06 (± 16.43) overall. The waist circumference percentile categories for the overall study population, as well as for male and female participants, showed very strong associations with ICMR-based BMI grades. This was determined using the Fisher–Freeman–Halton Test (p < 0.001, 0.05, and 0.001) and one-way ANOVA (p < 0.001). In the regression analysis, the findings for the overweight and obese categories were significant (odds ratio of 5.83 - 56.00, p < 0.05- 0.001). The ROC (Receiver Operating Characteristic) analysis yielded positive results, with AUCs ranging from 0.53 to 0.75 across all nutritional grade categories based on county-specific (India) BMI and the proposed waist circumference categories (grades). The analysis placed particular emphasis on gender-specific waist circumference measurements, which were found to have predictive potential (AUC) near equal and at some places better than their corresponding BMI.  

 For males, the proposed categories(grades) are < 74 cm: severely thin, 74–77 cm: Mildly thin, 77–83cm: Normal, 83–90 cm: Overweight, 90-100 cm: Obesity grade 1, and> 100 cm: Obesity grade 2. For females, ≤76 cm: Severely thin, 76–79cm: Mildly thin, 79–84cm: Normal, 84–90cm: Overweight, 90- 96 cm: Obesity grade 1, and> 96 cm: Obesity grade 2.

Conclusion: Based on the above observations, a gender-specific colour-coded, simple-to-use waist circumference measuring tape (The Mishra’s M-CORE dual tape) is proposed for further testing and recommendation for use in different healthcare settings.