so far , anthropometric variables and their relation to conventional coronary risk factors in railway employees have been inadequately studied in india . to assess anthropometric variables and their relation to coronary risk factors , this cross - sectional survey was carried out in solapur division of the central railway in the year 2004 . the purpose of this study was to examine the association of obesity with cad risk factors by different anthropometric variables . this particular section of the population was selected , as it comprises all classes of employees , including both sexes , sedentary and nonsedentary job workers of various socioeconomic groups , religions , and from different parts of india . this study was designed to investigate conventional cad risk factors and their relation to anthropometric variables among the solapur division railway employees . this study was conducted among the railway employees of solapur division of the central railway . a proforma was prepared that incorporated information regarding demography ( age and sex ) , anthropometric ( height in meter , weight in kilograms , waist and hip circumferences in centimeters ) variables , occupation ( sedentary or nonsedentary ) , physical examination ( pulse , blood pressure ) , clinical data ( history of diabetes hypertension , smoking , tobacco chewing , exercise ) , and biochemical investigations [ fasting blood sugar level ( bsl ) and complete lipid profile ] . anthropometric variables were calculated by using the above measurements for body mass index ( bmi ) , waist circumference ( wc ) , waist - to - hip ratio ( whr ) , waist - to - height ratio ( whtr ) , and abdominal volume index ( avi ) . all the eligible employees of both sexes underwent physical , anthropometric examination , and biochemical investigations according to the standard guidelines used earlier . a total of 995 railway employees participated in this cross - sectional survey with age  30 and  60 years . railway employees were chosen from railway stations , divisional railway mandal office , railway police force ( rpf ) and railway hospitals . according to the nature of their job , there were 872 men of whom 484 ( 55.5% ) were of age < 45 years and 388 ( 44.5% ) were of age  45 years . a total of 123 were females , 58 ( 48% ) were of age < 45 years and 65 ( 52% ) were of age  45 years . blood pressure was measured using a standard mercury sphygmomanometer under standard conditions as mentioned in cardiovascular survey methods . biochemical investigations were performed on an automated analyzer by using the kit provided by accurex biomedical pvt . ltd . ( iso 13485 : 2003 , iso 9001 : 2008 & ce certified mumbai , india ) . was measured by cholesterol oxidase ( chod) phenol + aminophenazone ( pap ) enzymatic colorimetric technique . triglyceride ( trg ) was measured by glycerol-3-phosphate oxidase ( gpo) peroxidase ( pod ) enzymatic technique . bsl fasting was done by glucose oxidase ( god )  peroxidase ( pod ) enzymatase by autoenzyme technique . each person was examined for height , weight , wc , and hip circumference without shoes and chappals with minimal clothing as per cardiovascular survey methods . bmi was calculated by formula of weight in kg / height m. whr was calculated by wc / hc in centimeters . avi was calculated using volume formulas for cylinder ( v = rh ) and vertical cone v = ( 1/3)rh . the formula developed was avi = [ 2 cm ( waist ) + 0.7 cm ( wc  hc)]/1000 , which estimates overall abdominal volume between symphysis of pubis and xiphoid appendix and theoretically includes intra - abdominal fat and adipose tissue volumes . a smoker in india consumes tobacco in the form of bidi / cigarettes and chewing tobacco . a person smoking one or more cigarettes or bidis per day at the time of study was considered as a smoker and one chewing tobacco currently , a tobacco chewer . in the present study , tobacco consumption in the form of smoking and in the form of tobacco chewing were grouped separately.physical activity according to the type of job were classified as , nonsedentary job ( moderate to heavy physical activity)sedentary job ( low physical activity ) 
 physical activity was classified into 2 levels , moderate to high physical activity was referred as nonsedentary ( rpf , drivers , gangmen , and others)low physical activity referred ( sedentary ) to people involved in office work , research work , and so on . a smoker in india consumes tobacco in the form of bidi / cigarettes and chewing tobacco . a person smoking one or more cigarettes or bidis per day at the time of study was considered as a smoker and one chewing tobacco currently , a tobacco chewer . in the present study , tobacco consumption in the form of smoking and in the form of tobacco chewing were grouped separately . physical activity according to the type of job were classified as , nonsedentary job ( moderate to heavy physical activity ) sedentary job ( low physical activity ) 
 physical activity was classified into 2 levels , moderate to high physical activity was referred as nonsedentary ( rpf , drivers , gangmen , and others ) low physical activity referred ( sedentary ) to people involved in office work , research work , and so on . cutoffs for high wc were > 85 cm for females and > 90 cm for males . cutoffs for high avi was calculated by receiver - operator characteristic ( roc ) curve 16.48 liter . diabetes mellitus ( dm ) : if a subject is a known diabetic on treatment with any bsl or if fasting bsl ( f - bsl ) 126 mg / dl . dyslipidemia was defined as if , t - cho  200 mg / dl , ldl , cholesterol  130 mg / dl , hdl , cholesterol 40 mg / dl , trg  150 mg / dl . hypertension was labeled if blood pressure  140 mmhg sbp and 90 mmhg dbp or known to be hypertensive on treatment with any blood pressure . the data were pooled , computerized , and analyzed by evaluation version of epi info . 6 [ ( epi info is public domain statistical software for epidemiology developed by centers for disease control and prevention ( cdc ) in atlanta , georgia ( usa ) ] . correlation of anthropometric variables and coronary risk factors in different age groups were determined using r and multiple linear regression analysis . roc curve is used to find out the cutoff point for particular value of a test as a diagnostic test . cutoff values of whtr and avi were calculated by using this curve as a tool for diagnosing central obesity . correlation ( r ) : r = 0.8 ( high correlation coefficient ) , r= 0.40.7 ( moderate correlation ) , and r= 0.3 and above ( low correlation coefficient ) . each person was examined for height , weight , wc , and hip circumference without shoes and chappals with minimal clothing as per cardiovascular survey methods . bmi was calculated by formula of weight in kg / height m. whr was calculated by wc / hc in centimeters . avi was calculated using volume formulas for cylinder ( v = rh ) and vertical cone v = ( 1/3)rh . the formula developed was avi = [ 2 cm ( waist ) + 0.7 cm ( wc  hc)]/1000 , which estimates overall abdominal volume between symphysis of pubis and xiphoid appendix and theoretically includes intra - abdominal fat and adipose tissue volumes . a smoker in india consumes tobacco in the form of bidi / cigarettes and chewing tobacco . a person smoking one or more cigarettes or bidis per day at the time of study was considered as a smoker and one chewing tobacco currently , a tobacco chewer . in the present study , tobacco consumption in the form of smoking and in the form of tobacco chewing were grouped separately.physical activity according to the type of job were classified as , nonsedentary job ( moderate to heavy physical activity)sedentary job ( low physical activity ) 
 physical activity was classified into 2 levels , moderate to high physical activity was referred as nonsedentary ( rpf , drivers , gangmen , and others)low physical activity referred ( sedentary ) to people involved in office work , research work , and so on . a smoker in india consumes tobacco in the form of bidi / cigarettes and chewing tobacco . a person smoking one or more cigarettes or bidis per day at the time of study was considered as a smoker and one chewing tobacco currently , a tobacco chewer . in the present study , tobacco consumption in the form of smoking and in the form of tobacco chewing were grouped separately . physical activity according to the type of job were classified as , nonsedentary job ( moderate to heavy physical activity ) sedentary job ( low physical activity ) 
 physical activity was classified into 2 levels , moderate to high physical activity was referred as nonsedentary ( rpf , drivers , gangmen , and others ) low physical activity referred ( sedentary ) to people involved in office work , research work , and so on . cutoffs for high wc were > 85 cm for females and > 90 cm for males . cutoffs for high avi was calculated by receiver - operator characteristic ( roc ) curve 16.48 liter . diabetes mellitus ( dm ) : if a subject is a known diabetic on treatment with any bsl or if fasting bsl ( f - bsl ) 126 mg / dl . dyslipidemia was defined as if , t - cho  200 mg / dl , ldl , cholesterol  130 mg / dl , hdl , cholesterol 40 mg / dl , trg  150 mg / dl . hypertension was labeled if blood pressure  140 mmhg sbp and 90 mmhg dbp or known to be hypertensive on treatment with any blood pressure . the data were pooled , computerized , and analyzed by evaluation version of epi info . 6 [ ( epi info is public domain statistical software for epidemiology developed by centers for disease control and prevention ( cdc ) in atlanta , georgia ( usa ) ] . correlation of anthropometric variables and coronary risk factors in different age groups were determined using r and multiple linear regression analysis . roc curve is used to find out the cutoff point for particular value of a test as a diagnostic test . cutoff values of whtr and avi were calculated by using this curve as a tool for diagnosing central obesity . correlation ( r ) : r = 0.8 ( high correlation coefficient ) , r= 0.40.7 ( moderate correlation ) , and r= 0.3 and above ( low correlation coefficient ) . a total of 872 ( 87.63% ) were males and 123 ( 12.36% ) were females . all of them underwent physical examination , and anthropometric measurements for ht , wt , hc , and wc , but only 605 males and 95 females underwent biochemical investigations with a response rate of 69.15%in males and 77.23% in females . the subjects were 45 years of age ; 388 ( 53.35% ) males and 65 ( 52.84% ) females . high sbp was present in 290 ( 33.25% ) males and 32 ( 26.03% ) females . high dbp was present in 304 ( 34.86% ) males and 37 ( 30.08% ) females . physical inactivity was present in 767 ( 87.95% ) males and 102 ( 82.92% ) females . tobacco chewing was present in 178 ( 20.41% ) males and 12 ( 9.75% ) females . smoking was present in 151 ( 17.31 % ) males and 2 ( 1.62% ) females . high bmi was present in 172 ( 19.72% ) males and 73 ( 59.34% ) females . high wc was present in 412 ( 47.24% ) males and 98 ( 79.67% ) females . high whr was present in 504 ( 57.79% ) males and 90 ( 73.17% ) females . high whtr was present in 699 ( 80.16% ) males and 103 ( 83.73% ) females . high avi was present in 359 ( 41.16% ) males and 35 ( 28.45% ) females . dm was present in 51 ( 8.42% ) males and 2 ( 2.10% ) females . low hdl was present in 248 ( 40.99% ) males and 15 ( 15.78% ) females . high ldl was present in 117 ( 19.33% ) males and 23 ( 24.21% ) females . high t - cho was present in 151 ( 24.95% ) males and 34 ( 35.78% ) females . high trg was present in 275 ( 45.45% ) males and 19 ( 20% ) females [ table 1 ] . prevalence of coronary artery disease risk factors in both males and females , all the anthropometric variables were high . most prevalent obesity index in male population was high whtr . in female population , the most prevalent obesity index was high whtr . prevalence of overall and central obesity was comparatively more in female population for all the variables as shown in table 2 . mean age , bmi , and low hdl levels were comparatively higher in females , whereas mean sbp , dbp , trg , whr , wc , and whtr were comparatively higher in males . standard deviation values of quantitative data in male and female population are shown in table 3 . prevalence of obesity indices standard deviation values of quantitative data in male and female population total 65 females were with age  45 years and 58 with age < 45 years . in female population , high whr in age  45 years was present in 58 ( 47.15% ) . in females only high bmi was statistically significant in age  45 years with p value < 0.001 . males totalling 388 were of the age  45 years and 484 females were < 45 years of age . in male population , 45 years of age , a high whr was present in 262 ( 30.04% ) . a high bmi in age  45 years was present in 90 ( 10.32% ) . a high wc in age  45 years was present in 207 ( 23.73% ) . high avi in age  45 years was present in 279 ( 31.99% ) . in males , all anthropometric variables , such as whr , whtr , bmi , wc , and avi , were significantly raised , in the age group  45 years with p value < 0.001 . bmi had partial positive correlation ( moderate to low ) with coronary risk factors , such as age weight , sbp , dbp , f - bsl , t - cho , ldl cholesterol , trg , and other anthropometric variables . whr had partial positive correlation ( moderate to low ) with coronary risk factors , such as age , height , weight , sbp , dbp , f - bsl , total , trg , and other anthropometric variables . whtr had partial positive correlation ( moderate to low ) with coronary risk factors , such as age , weight , sbp , dbp , f - bsl , ldl cholesterol , trg , and other anthropometric variables . wc had partial positive correlation ( moderate to low ) with coronary risk factors , such as age , weight , height , sbp , dbp , f - bsl , trg , and other anthropometric variables . avi had partial positive correlation ( moderate to low ) with coronary risk factors , such as age , weight , height , sbp , dbp , f - bsl , trg , and other anthropometric variables [ table 4 ] . in male population , age  45 years had odds ratio of 2.15 with whtr and 1.95 with avi . sbp had an odds ratio of 2.0 with bmi , 1.47 with wc , and 1.48 with avi . correlation of anthropometric indices with coronary artery disease risk factors in female population , age  45 years had an odds ratio of 1.673 with bmi . sedentary job had an odds ratio of 2.0 with whr , 1.86 with wc , and 1.79 with whtr . sbp had an odds ratio of 1.48 with avi and dbp had an odds ratio of 1.34 with wc . we have found that age  45 years was better correlated with high values of bmi , wc , whr , whtr , and avi . high sbp , high dbp , and sedentary job were significantly and positively correlated with high values of bmi , wc , whr , whtr and avi . high values of bmi , wc , whr , whtr , and avi were negatively associated with physical inactivity . tobacco and smoking were negatively correlated with high values of bmi , wc , whr , and whtr . dm was statistically significant and positively associated with high values of bmi , wc , whr , whtr , and avi . in dyslipidemia low hdl was correlated with high values of whr , whtr , and avi , whereas ldl cholesterol , t - cho , and trg were correlated only with high bmi and high whtr in this population [ table 4 ] . in multiple regression analysis a model was utilized that included age , bmi , whr , whtr , wc , avi , sbp , dbp , plasma t - cho , trg , and smoking . this revealed age , whtr , and whr as an independent determinant of most of the cad risk factors in both genders . multiple regression analysis for whtr and whr showed that both of them were significantly associated with most of the cad risk factors , such as age  45 years , high sbp , high dbp , dm , low hdl , high ldl , high t - cho , and high trg [ table 5 ] . relation of anthropometric variables and coronary artery disease risk factors in males and females furthermore , the whr was the single independent variable to all or most of the cad risk factors by multiple regression analysis . multiple logistic regression analysis revealed whtr and whr were significantly associated with age ( p < 0.001 ) , bmi ( p < 0.001 ) dm ( p = 0.005 ) , sbp ( p < 0.001 ) , dbp ( p < 0.001 ) , low hdl in females , and high trg in males ( p < 0.001 ) [ figure 1 ] . bmi had partial positive correlation ( moderate to low ) with coronary risk factors , such as age weight , sbp , dbp , f - bsl , t - cho , ldl cholesterol , trg , and other anthropometric variables . whr had partial positive correlation ( moderate to low ) with coronary risk factors , such as age , height , weight , sbp , dbp , f - bsl , total , trg , and other anthropometric variables . whtr had partial positive correlation ( moderate to low ) with coronary risk factors , such as age , weight , sbp , dbp , f - bsl , ldl cholesterol , trg , and other anthropometric variables . wc had partial positive correlation ( moderate to low ) with coronary risk factors , such as age , weight , height , sbp , dbp , f - bsl , trg , and other anthropometric variables . avi had partial positive correlation ( moderate to low ) with coronary risk factors , such as age , weight , height , sbp , dbp , f - bsl , trg , and other anthropometric variables [ table 4 ] . in male population , age  45 years had odds ratio of 2.15 with whtr and 1.95 with avi . sedentary job had an odds ratio of 1.402 with bmi . sbp had an odds ratio of 2.0 with bmi , 1.47 with wc , and 1.48 with avi . correlation of anthropometric indices with coronary artery disease risk factors in female population , age  45 years had an odds ratio of 1.673 with bmi . sedentary job had an odds ratio of 2.0 with whr , 1.86 with wc , and 1.79 with whtr . sbp had an odds ratio of 1.48 with avi and dbp had an odds ratio of 1.34 with wc . we have found that age  45 years was better correlated with high values of bmi , wc , whr , whtr , and avi . high sbp , high dbp , and sedentary job were significantly and positively correlated with high values of bmi , wc , whr , whtr and avi . high values of bmi , wc , whr , whtr , and avi were negatively associated with physical inactivity . tobacco and smoking were negatively correlated with high values of bmi , wc , whr , and whtr . dm was statistically significant and positively associated with high values of bmi , wc , whr , whtr , and avi . in dyslipidemia low hdl was correlated with high values of whr , whtr , and avi , whereas ldl cholesterol , t - cho , and trg were correlated only with high bmi and high whtr in this population [ table 4 ] . in multiple regression analysis a model was utilized that included age , bmi , whr , whtr , wc , avi , sbp , dbp , plasma t - cho , trg , and smoking . this revealed age , whtr , and whr as an independent determinant of most of the cad risk factors in both genders . multiple regression analysis for whtr and whr showed that both of them were significantly associated with most of the cad risk factors , such as age  45 years , high sbp , high dbp , dm , low hdl , high ldl , high t - cho , and high trg [ table 5 ] . relation of anthropometric variables and coronary artery disease risk factors in males and females furthermore , the whr was the single independent variable to all or most of the cad risk factors by multiple regression analysis . multiple logistic regression analysis revealed whtr and whr were significantly associated with age ( p < 0.001 ) , bmi ( p < 0.001 ) dm ( p = 0.005 ) , sbp ( p < 0.001 ) , dbp ( p < 0.001 ) , low hdl in females , and high trg in males ( p < 0.001 ) [ figure 1 ] . conventional cad risk factors , such as physical inactivity , central obesity , hypertension , low hdl , age  45 years , and hypertriglyceridemia were highly prevalent in males , whereas physical inactivity , central obesity , hypertension , age  45 years , and hypercholesterolemia were highly prevalent in female population . compared to overall obesity , central obesity was better correlated with most of the cad risk factors . whtr was better predictive of cad risk factors than wc and whr in present study . cutoff value for whtr has not been calculated for the indian population , hence further studies are required for calculation in the indian context . in the present study , whtr was a powerful predictor of most of the cad risk factors , whereas whr , wc , and avi were next to it in a decreasing order . we have compared our results with various studies in which lin et al in a general population study reported that , whtr is a better indicator for predicting cvd risk factors than the other 3 indices ( bmi , wc , and whr ) in taiwan , which is comparable with our study . lin et al and hsieh et al also stated that whtr is a better predictor of most of the cad risk factors than whr , wc , and bmi . huang et al in a general population study in taiwan found that the 4 anthropometric indices ( bmi , wc , whr , and whtr ) are closely related to cardiovascular risk factors , which is comparable with our study . the results of misra et al indicated a high prevalence of diabetes , obesity , and dyslipidemia in urban slum population in northern india in middle age , particularly in females , which is comparable with our study . guerrero - romero et al in their study of 746 men and nonpregnant women randomly recruited from durango city in northern mexico , stated that avi is reliable and shown to be strongly related to igt and dm , which is comparable with our study , but they have not correlated the association with other cad risk factors , such as hypertension , dyslipidemia , and physical inactivity . in southern andhra pradesh , india , a study of randomly selected urban and rural population by venkatramana et al suggested that bmi and wc are better indicators of cad risk factors , which is partially comparable with our study as other anthropometric variables have not been used in their study . reeder et al in 5 canadian provinces ( alberta , manitoba , ontario , quebec , and saskatchewan ) general population study , found that wc was the measure of abdominal obesity most highly correlated with cardiovascular disease risk factors , which is partially comparable with our study . in omani population al - riyami and afifi , in their study among male adults aged 20 years and above in a community - based survey as a part of the national health survey , reported that current smokers were of low bmi compared with nonsmokers and exsmokers and currently light smokers were also of low bmi compared with exsmokers , which is comparable with our study . ledoux et al , in a canadian general population study stated that the wc and bmi correlate most closely with blood pressure and plasma lipids , which is comparable with the present study . onat et al , in a random sample of turkish general adult population , observed that the wc and whr were strongly associated with bmi and dbp and plasma trg in turkish women , which is similar to and comparable with our results . hsieh et al , in a study found that , the whtr and whr increased with age in both the genders , which is comparable with our results . rosmond et al , in a selected population study , reported that obesity ( bmi ) and centralization of body fat stores ( whr ) are differently associated with occupational factors as well as leisure time activities . hu et al reported that television watching and other sedentary behaviors are related to risk of obesity and type 2 dm in women . both these studies are comparable with the current study . slattery et al in a study of the us railroad population quoted that occupationally and leisure time physically inactive employees are at a higher risk of developing cad risk factors and cardiovascular death , which is consistent with the current study . several studies showed that smokers have , on an average , lower bmi than nonsmokers and that smoking cessation is often associated with weight gain . in the present study , whtr has been found to be significantly and positively associated with most of the cad risk factors , hence whtr can be used routinely as an anthropometric tool for prediction of cad risk factors in epidemiologic studies.[2529 ] the other parameters of coronary artery risk [ c - reactive protein ( crp ) , homocysteine , and others ] have not been done in the present study because of limitations of study to conventional cad risk factors and resource limitations . other cad risk factors , such as hyperhomocysteinemia , have not shown a robust utility in chd risk stratification , and there are no clinical trial data showing that intervention to lower homocysteine levels reduces chd events . measurement of homocysteine levels should be reserved for individuals with atherosclerosis at a young age or out of proportion to established risk factors . elevations in acute - phase reactants , such as fibrinogen or crp , may reflect overall atherosclerotic burden or extravascular inflammation that could potentiate atherosclerosis or its complications . crp measured by high - sensitivity assay , adds predictive information to that derived from established coronary artery risk factors , such as cholesterol . elevated levels of the acute - phase reactant crp and fibrinogen may merely reflect ongoing inflammation rather than a direct etiologic role for crp in cad . in the present study , the prevalence of metabolic syndrome ( using atp iii criteria modified for indians ) was 25.17% in males and 27.35% in females . among all the components of metabolic syndrome , high wc was most prevalent in females and systolic hypertension in males . in the current study , the most common cad risk factor was truncal obesity in the solapur division railway employees . generalized obesity , overweight , and central obesity problem was more prevalent in subjects with age  45 years , sedentary job , physical inactivity , and female gender . there was a significant lack of physical activity and exercise among sedentary job workers , leading to overweight and obesity . generalized obesity , overweight , and central obesity were significantly correlated with cad risk factors , such as age  45 years , dyslipidemia , hypertension , dm , and physical inactivity . central obesity measured by whtr was strongly correlated with majority of cad risk factors than whr , wc , and avi . these observations serve to underline the central role of overweight / obesity and the additive deleterious effects of abdominal obesity in the pathogenesis of lipid and carbohydrate metabolism , leading to chd and type 2 dm , and hypertension . the present study shows a disturbing burden of coronary risk factors mainly truncal obesity , physical inactivity , hypertension in a sample population of railway employees . there is an urgent need to undertake population - based measures to reverse the trend . out of all the anthropometric variables , whtr was significantly and positively associated with most of the cad risk factors , hence whtr can be used routinely as an anthropometric tool for prediction of cad risk factors in epidemiologic studies . by preventing obesity and overweight , a substantial part of chd mortality may be prevented because a majority of the cad risk factors are strongly correlated with anthropometric indices . we concluded that weight control should be an integral part of the prevention of cardiovascular disease . turn in obesity express highway probably lies in lifestyle modifications , going back to a traditional lifestyle with a judicious use of modern technology .
background and objectives : anthropometric variables and their relation to conventional coronary artery disease ( cad ) risk factors in railway employees have been inadequately studied in india . 
 this cross - sectional survey was carried out in the solapur division of the central railway in the year 2004 , to assess the anthropometric variables in railway employees and their relation to conventional cad risk factors.materials and methods : a total of 995 railway employees , with 872 males and 123 females participated in this cross - sectional study . 
 all subjects underwent anthropometric measurements , fasting lipid profile , and blood sugar level . 
 various anthropometric indices were calculated for body mass index ( bmi ) , waist circumference ( wc ) , waist - to - hip ratio ( whr ) , waist - to - height ratio ( whtr ) , and abdominal volume index ( avi ) . 
 statistical analysis was done by epi info 6 statistical software.results:compared to all other obesity indices , whtr was most prevalent in both genders . 
 high whtr was present in 699 ( 80.16% ) males and 103 ( 83.73% ) females . 
 age 45 years , high systolic bp , high diastolic bp , low hdl , high triglyceride , and diabetes mellitus were positively correlated with high bmi , high wc , high whr , high whtr , and high avi . 
 high bmi , high wc , high whr , high whtr , and high avi were negatively associated with physical inactivity.conclusions:over all , anthropometric variables in both genders were significantly deranged in subjects with coronary risk factors . 
 compared to all other anthropometric variables , whtr was statistically significantly associated with a majority of coronary artery risk factors . hence we recommend inclusion of whtr as a parameter of obesity to predict coronary artery disease risk factor along with wc , whr , and bmi in epidemiologic studies .