International Journal of Health Sciences and Research DOI: https://doi.org/10.52403/ijhsr.20210429 Vol.11; Issue: 4; April 2021 Website: www.ijhsr.org Original Research Article ISSN: 2249-9571

Comparison of Peak Expiratory Flow Rate between Android and Gynoid Pattern Obesity in Females

Shruti Shah1, Pratibha Gaikwad2

1MPT (Cardiovascular and Respiratory Sciences) Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India 2MPT (Cardiovascular and Respiratory Sciences) Associate Professor, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India

Corresponding Author: Shruti Shah

ABSTRACT

Title: Comparison of Peak Expiratory Flow Rate between Android and Gynoid Pattern Obesity in Females. Aim: To assess comparison of PEFR between Android and Gynoid Pattern Obesity in Females. Objectives: To assess Peak Expiratory Flow Rate in Android Pattern, Gynoid Pattern of Obesity in Females and compare Peak Expiratory Flow Rate between Android and Gynoid Pattern Obesity in Females. Methodology: 100 Female Obese Subjects with BMI> 30 in the Age Group between 20-40 yrs living a sedentary lifestyle were recruited with incidental sampling over the period of 1 year duration and allocated to Android (n = 50) and Gynoid (n = 50) groups on the basis of Adiposity Markers like BMI, Height, Weight, Waist Circumference (WC), Hip Circumference (HC), WHR - Waist Hip Ratio (WHR) and Waist to Height Ratio (WtHR). PEFR was recorded by taking 3 readings and the highest among them chosen. Results: Pearson correlation test and Linear Regression was done between PEFR & BMI, PEFR & WHR and PEFR & WHtR. Using an Unrelated t Test, results were found to be Significant (p < 0.05) between PEFR in Both the Groups. Conclusion: The study establishes that there is a difference in PEFR between Android and Gynoid Pattern of Obesity in Females and PEFR in Gynoid Pattern is 5% better than PEFR in the Android Pattern Obesity in Females.

Keywords: Obesity, Android, Gynoid, PEFR, BMI, WHR, WtHR, WC, HC.

INTRODUCTION relationship between the lungs, chest wall, WHO defines obesity as “A and diaphragm leading to respiratory muscle condition with excessive fat accumulation in inefficiency and reduction in Lung volumes the body to the extent that the health and and capacities. [9] In Obese individuals due well-being are adversely affected.”[1] to respiratory muscle inefficiency, Prevalence of obesity is 45.6% and is higher decreased functional reserve capacity and among women in India. [2,3,4,5,6,7] expiratory reserve volume, the demand for The effects of obesity on the ventilation and breathing workload are respiratory system are often increased. These often result in a underappreciated. [8] Respiratory function is ventilation-perfusion (V/Q) mismatch which determined by the complex interaction of is also a cause of alveolar hypoventilation. the lungs, chest wall, and respiratory [10] Obesity is believed to influence the muscles. In Obesity, there is excessive pulmonary function mechanically by accumulation of fat which alters the changing lung compliance, work of

International Journal of Health Sciences and Research (www.ijhsr.org) 236 Vol.11; Issue: 4; April 2021 Shruti Shah et.al. Comparison of peak expiratory flow rate between android and gynoid pattern obesity in females. breathing, and the elastic recoil. [11, 12, 13, 14] is associated with fewer medical The site of fat accumulation is crucial in complications and better lung function. [15] determining the effect of obesity on Adiposity markers like Body Mass respiratory system mechanics. [8] Index, Waist Circumference, Waist Hip Two distinct patterns of obesity are Ratio, and Waist Height Ratio help in better recognized in the general population: prediction of Body Fat between Android Central and Peripheral obesity. [15] Central and Gynoid Pattern. There is substantial fat distribution describes the distribution of evidence providing that fat distribution is a human mainly around the better predictor of cardiovascular disease trunk and upper body, in areas such as the than the degree of obesity. [21, 22, 23, 24, 25] abdomen, chest, shoulder, and nape of the BMI alone does not provide sufficient neck. [16] This pattern may lead to an "apple- information about the bodily distribution of shaped" body or Android obesity and is fat mass (FM). [20, 26] Thus, regional fat more common in males than in females. [17] distribution rather than overall fat volume In other cases, an ovoid shape forms has been considered to be more important in which does not differentiate between men understanding the link between obesity and and women. Generally, during early metabolic disorders. adulthood, females tend to have a more The size of a person's waist or waist peripheral fat distribution such that their fat circumference indicates . is evenly distributed over their body. Excess abdominal fat is a risk factor for However, it has been found that as females developing heart disease and other obesity age, bear children, and approach related diseases. The National Heart, Lung, , this distribution shifts towards and Blood Institute (NHLBI) classify the the android pattern of fat distribution [18] risk of obesity-related diseases as high if resulting in a 42.1% increase in android men have a waist circumference greater than body fat distribution in postmenstrual 102 cm (40 in) and women have a waist women. [17] This could potentially provide circumference greater than 88 cm (35 in). evolutionary advantages in child- bearing Various medical conditions are also females such as lowering a woman's center associated with elevated WC. These include of gravity making her more stable when cardiovascular diseases (atherosclerosis, carrying an offspring. [16] ischemic heart disease, stroke, Android fat distribution is contrasted hyperlipidemia, and hypertension), type 2 with ; fat around the mellitus, and metabolic syndrome. hips, thighs, and bottom, causing a "pear- [26, 27] shape”. [19] Peripheral obesity is more WHR is used as a measurement of common in women than men, with adiposity obesity, which in turn is a possible indicator located peripherally in the subcutaneous of other more serious health conditions. The tissue. [15] There are differences in android WHO states that abdominal obesity is and gynoid fat distribution among defined as a waist-hip ratio above 0.90 for individuals, which relates to various health males and above 0.85 for females or a body issues. People with android obesity have mass index (BMI) above 30.0. [28] Studies higher hematocrit and red blood cell count that focused on waist circumference (WC) and higher blood viscosity than people with found that elevated waist-to hip-ratio and gynoid obesity. Blood pressure is also abdominal height had a good correlation higher in those with android obesity. with impaired lung function. [20, 26, 29] Android body fat distribution is related to A person's waist-to-height ratio high cardiovascular disease and mortality (WHtR), also called waist to-stature ratio rate. [19] Android or abdominal obesity is (WSR) is defined as their waist associated with worsening lung function and circumference divided by their height, both respiratory symptoms. [20] Peripheral obesity measured in the same units. The WHtR is a

International Journal of Health Sciences and Research (www.ijhsr.org) 237 Vol.11; Issue: 4; April 2021 Shruti Shah et.al. Comparison of peak expiratory flow rate between android and gynoid pattern obesity in females. measure of the distribution of body fat. relation with Obesity. The distribution of fat Higher values of WHtR indicate a higher induced by the weight gain affects the risks risk of obesity-related cardiovascular associated with obesity, and the kind of diseases and are correlated with abdominal disease that results. It is therefore useful, to obesity. [30] be able to distinguish between those at PEFR as a measurement of increased risk as a result of abdominal fat ventilatory function was introduced by distribution or Android obesity from those Hadorn in 1942 and was accepted in 1949 as with the less serious Gynoid fat distribution, an index of spirometry. [32] By definition, it in which fat is more evenly and peripherally is “The largest expiratory flow rate achieved distributed around the body. [39] To our with a maximally forced effort from a knowledge, no studies are been done to position of maximal inspiration, expressed compare the effects of Peak Expiratory in liters/min. It is effort dependent and Flow Rate between Android and Gynoid reflects mainly the caliber of the bronchi pattern of Obesity in Females between 20- and larger bronchioles, which are subjected 40 years. Pulmonary Function is measured to reflex bronchoconstriction. [33] The by PFT (Spirometry) which is expensive average PEFR of healthy young Indian and diagnosed only when symptomatic at a males and females is around 500 and 350 later stage. Peak Expiratory Flow Rate is an lpm respectively. The PEFR reaches a peak inexpensive and practical way to measure at about 18-20 years, maintains this level up Lung Function which can differenciate to about 30 years in males, and about 40 healthy Respiratory system from a diseased years in females, and then declines with age. one, detect early warning signs in at-risk [34] populations and can be used as an early About 15-20% of body fat for men intervention to prevent Cardiovascular and and 25% of body fat for women are Respiratory complications in Females. generally accepted as ‘normal’, but 10 to Prognostically, it can help us in assessing 20% of excess body fat over the [35] usual the degree/severity of disease and disability, values is generally considered to be evaluating the effectiveness of “obesity”. Obesity has a clear potential to treatment/exercise program and determining have a direct effect on respiratory wellbeing further treatment goals. It also helps young since it increases oxygen consumption and female adults establish the habit of periodic carbon dioxide production, while at the medical evaluation because disease and same time it stiffens the respiratory muscles, illness such as obesity and cardiovascular decreases PEFR and [36] increases the diseases can be identified in their earliest mechanical work of breathing. The stages when chances of successful treatment significant reduction in PEFR in obese are higher. [40] subjects may be explained based on an of Thus, this study is undertaken to accumulation of adipose tissue around the compare the effect of Peak Expiratory Flow rib cage, abdomen and in the visceral cavity Rate between Android and Gynoid Obesity that results in a shift in the balance of in Females. inflationary and deflationary pressure on the lungs as reported by J.T. Sharp et al. [37] AIM: To assess comparison of PEFR These obese subjects may also have limited between Android and Gynoid Pattern lung expansion and airflow because of the Obesity in Females. restricted downward movement of the diaphragm due to increased abdominal OBJECTIVES: adipose tissue leading to significantly 1) To assess Peak Expiratory Flow Rate in reduced PEFR. [38] Android Pattern of Obesity in Females. Previous studies have proved that 2) To assess Peak Expiratory Flow Rate in reduction in Pulmonary Function has a Gynoid Pattern of Obesity in Females.

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3) To compare Peak Expiratory Flow Rate IV. Sample Size: 50 in Each Group between Android and Gynoid Pattern (Android and Gynoid) Obesity in Females. N = 4PQ / R2 P = Proportion = 0.5 Operational Definitions: Q = (P-Q) = 0.5 1. Obesity: A condition with excessive fat R = Error = 0.1 accumulation in the body to the extent V. Sampling Technique: Purposive that the health and well-being are Sampling adversely affected. [1] VI. Duration of Study: 6-9 Months 2. Android Obesity: It is the distribution of VII. Method of selection of study subjects: adipose tissue around the abdomen, Inclusion Criteria: chest, shoulder and nape of the neck  Female subjects between 20 and 40 related to high cardiovascular disease years and mortality rate. [16, 19]  Female subjects with Obesity with BMI 3. Gynoid Obesity: It is the distribution of > 30 adipose tissue around the hips, thighs  Female subjects with a Sedentary and bottom related to low cardiovascular lifestyle disease and mortality rate. [19]  Individuals willing to participate in the 4. Physically Inactive: Adults are classified study as inactive if they did not report any sessions of light to moderate or vigorous Exclusion criteria: leisure-time physical activity of at least  Known cases of Respiratory and Cardiac 10 minutes a day. [61] disorders  Thoracic and Abdominal MATERIALS & METHODS  Pregnancy and Postpartum period about I. Type of study design: Cross sectional 8-10 weeks Study Design  Smokers, Alcohol and Tobacco II. Setting (Location of Study): consumption Physiotherapy Department, Tertiary Care Hospital VIII. Materials: III. Study Population: Female subjects 1. Peak Expiratory Flow Rate with Obesity > 30 2. Weighing Scale 3. Measuring Tape

Figure 1: Picture showing materials - a) Weighing Scale, b) PEFR, c) Measuring Tape

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IX. METHODOLOGY c) BMI: Calculated using Quetelet’s  Institutional ethics committee approval formula (BMI = weight in kilograms / was taken. height in meter square). [62]  Sample Size of 100 was selected and d) Waist Circumference (WC): In erect Selection of participants was done posture with the feet apart by 25 to 30 depending upon the inclusion and the cm on light clothing, using a measuring exclusion criteria and appropriate tape at the level of umbilicus. [53] sampling technique. e) Hip Circumference (HC): Measured at  Female subjects with Obesity coming to the widest part of the buttocks with the the Physiotherapy OPD for Weight legs and feet together. [62] Management and relatives f) Waist Hip Ratio (WHR): Calculated by accompanying them who had Obesity dividing WC by HC. [62] were taken for the study. g) Waist to Height Ratio (WHtR):  They were explained about the study in Calculated by dividing WC by Height. the language they understand. [62]  Informed consent was taken.  Participants assessment was taken as follows: 1. Demographic data: Name, Age, Gender 2. Adiposity Markers: BMI - Height, Weight, Waist Circumference, Hip Circumference, WHR - Waist Hip Ratio, WtHR - Waist to Height Ratio 3. Peak Expiratory Flow Rate: Three Readings

Adiposity Markers to classify into Android and Gynoid Obesity: a) Height (H): Measured to the nearest 0.5 cm with the help of a height scale. [62] b) Weight (W): Measured by a weighing

scale in kilograms without shoes, and Figure 2: Therapist measuring Subject’s Height with subjects wearing light weight clothes. [62]

Figure 3: Therapist measuring Subject’s Waist Circumference Figure 4: Therapist measuring Subject’s Hip Circumference

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Peak Expiratory Flow Rate:  Statistics Analysis was carried out using Recorded using Wright’s mini peak appropriate technique. flow meter (Clement & Clarke, UK) in standing position. After adequate rest, Parameters studied were: subjects were instructed to take a deep  PEFR breath and exhale as forcefully as possible  Adiposity Markers in one single blow into the instrument. Three satisfactory readings were taken. IX. Data Collection Tool: Peak Expiratory Sufficient care was taken to ensure that a Flow Rate (PEFR) tight seal is maintained between the lips and mouthpiece. The highest among the three RESULTS & DISCUSSION were considered as the Peak Expiratory DATA ANALYSIS: [62] Flow Rate.  All data analysis was performed using GraphPad Prism 8.3.1 software.  All the numerical data was tested for Normal Distribution and the data followed normal distribution pattern. Pearson Correlation, a parametric test was used to find out the correlations between variables.  Linear Regression was then performed among the variables.  Unrelated t test was used to compare Peak Expiratory Flow Rate between Android and Gynoid Pattern Obesity in Females.  All tests were performed considering 95% confidence intervals and significance at 0.05. Figure 5: Subject using PEFR device  Bar charts and Graphs were used for INTERPRETATION visual representation of the analyzed BMI [63] data. Obese Type 1 (Obese) 30 – 40 Obese Type 2 (Morbid Obese) 40 – 50 Obese Type 3 (Super Obese) > 50 Observation 1: Classification of BMI According to Type in Android Group Waist Circumference: >88 cm - Indicated Graph 1: Classification of BMI Acc to Type Obesity-related cardiovascular diseases and in Android Group was correlated with Abdominal obesity. [20, 27] Hip Circumference: > 91cm - Indicated cardiovascular and coronary heart diseases in women. [64] WHR: > 0.85 – Indicated Android Obesity. [28] < 0.85 – Indicated Gynoid Obesity. [28] WHtR: > 0.5 - Indicated Obesity-related cardiovascular diseases and was correlated with Abdominal obesity. [30] PEFR: Normal Range: 0 - 500 L/min.

 Data analysis was done. Table 1: % of Individuals in each Type in Android Group

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Type of % of Individuals in each Type in Android Obesity Group Type 1 72% Type 2 24% Type 3 4%

Inference: The study shows that majority of the population in the Android group belonged to type 1 and minority in Type 3.

Observation 2: Classification of BMI Acc to Type in Gynoid Group Graph 2: Classification of BMI Acc to Type in Gynoid Group

Table 2: % of Individuals in each Type in Gynoid Group Type of % of Individuals in each Type in Gynoid Obesity Group Observation 3: Correlation between Type 1 76% Type 2 20% PEFR and BMI in Both the Groups Type 3 4% Graph 3 & 4: Correlation between PEFR & BMI in Android and Gynoid Group Inference: The study shows that majority of the population in Gynoid group belonged to type 1 and minority in Type 3.

Table 3: Values of correlation between PEFR & BMI in lower the range of PEFR) in the Android Android and Gynoid Group Parameters Values of Android Values of Gynoid Group. Group Group  Using a Pearson product moment R -0.29 -0.14 95% confidence -0.5323 to -0.02153 -0.4033 to 0.1432 correlation test on the data (r = -0.14, df Interval =48), the results were not significant (p P value 0.0178 0.1648 Significance Yes No > 0.025 for a one-tailed test). This Number of samples 50 50 means there is a positive correlation between PEFR and BMI (the higher the Inference: BMI, the higher the range of PEFR) in  Using a Pearson product moment the Gynoid Group. correlation test on the data (r = -0.29, df =48), the results were significant (p < Observation 4: Correlation between 0.025 for a one-tailed test). This means PEFR and WHR in Both the Groups there is a negative correlation between Graph 5 & 6: Correlation between PEFR & PEFR and BMI (the higher the BMI, the WHR in Android and Gynoid Group

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Table 4: Values of correlation between PEFR & WHR in the higher the range of PEFR) in the Android and Gynoid Group Parameters Values of Android Values of Gynoid Android Group. Group Group  Using a Pearson product moment R -0.08096 0.3177 95% confidence -0.3514 to 0.2019 0.04314 to 0.5476 correlation test on the data (r = 0.31, df Interval =48), the results were not significant (p P value 0.2881 0.0123 Significance No Yes < 0.025 for a one-tailed test). This Number of samples 50 50 means there is a negative correlation between PEFR and WHR (the higher the Inference: WHR, the lower the range of PEFR) in  Using a Pearson product moment the Gynoid Group. correlation test on the data (r = -0.08, df =48), the results were significant (p > Observation 5: Correlation between 0.025 for a one-tailed test). This means PEFR and WHtR in Both the Groups there is a positive correlation between Graph 7 & 8: Correlation between PEFR & PEFR and WHR (the higher the WHR, WHtR in Android and Gynoid Group

Table 5: Values of correlation between PEFR & WHtR in  Using a Pearson product moment Android and Gynoid Group Parameters Values of Android Values of Gynoid correlation test on the data (r = -0.17, df Group Group =48), the results were not significant (p R -0.1768 0.02702 95% confidence -0.4338 to 0.1068 -0.2532 to 0.3031 > 0.025 for a one-tailed test). This Interval means there is a positive correlation P value 0.1096 0.4261 Significance No No between PEFR and WHtR (the higher Number of samples 50 50 the WHtR, the higher the range of PEFR) in the Android Group. Inference:

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 Using a Pearson product moment means there is a positive correlation correlation test on the data (r = 0.02, df between PEFR and WHtR (the higher =48), the results were not significant (p the WHtR, the higher the range of > 0.025 for a one-tailed test). This PEFR) in the Gynoid Group.

Observation 6: Linear Regression in Both the Groups

Table 5: Values of Linear Regression between PEFR with BMI, WHR & WHtR in Android and Gynoid Group PEFR & BMI PEFR & WHR PEFR & WtHR Values of Values of Values of Values of Values of Values of Parameters Android Group Gynoid Group Android Group Gynoid Group Android Group Gynoid Group R2 0.08886 0.01982 0.006554 0.1009 0.03127 0.00073 95% confidence -0.05530 to - -0.03598 to -0.0001859 to - 1.757e-005 to -0.0004249 to -0.0001726 to Interval Slope 0.002026 0.01232 0.0001046 0.0002450 9.995e-005 0.0002080 P value 0.0355 0.3295 0.5762 0.0246 0.2193 0.8522 Significance Yes No No Yes No No Number of samples 50 50 50 50 50 50

Inference: Linear Regression between significant (p < 0.025 for a one-tailed PEFR and BMI test) in the Gynoid Group.  Using Linear Regression test on the data Linear Regression between PEFR and (r2 = 0.08, df =48), the results were WHtR significant (p < 0.025 for a one-tailed  Using Linear Regression test on the data test) in the Android Group. (r2 = 0.03, df =48), the results were not  Using Linear Regression test on the data significant (p > 0.025 for a one-tailed (r2 = 0.01, df =48), the results were not test) in the Android Group. significant (p > 0.025 for a one-tailed  Using Linear Regression test on the data test) in the Gynoid Group. (r2 = 0.0007, df =48), the results were Linear Regression between PEFR and not significant (p > 0.025 for a one- WHR tailed test) in the Gynoid Group.  Using Linear Regression test on the data (r2 = 0.006, df =48), the results were not Observation 9: Unpaired T Test between significant (p > 0.025 for a one-tailed PEFR in Both the Groups test) in the Android Group. Graph 9: Unpaired T Test between PEFR in  Using Linear Regression test on the data Both the Groups (r2 = 0.10, df =48), the results were

Table 6: Mean Values of PEFR in Android and Gynoid Group Parameters Values R2 0.08886 Inference: 95% confidence Interval Slope 1.996 to 54.00  Using an Unrelated t Test on the data (t P value 0.04452 Significance Yes = 2.137, df = 98)the results were found Number of samples 50

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to be Significant (p < 0.05 for a one- insulin resistant. This in turn results in tailed hypothesis) hyper-insulinemia, which might be the  The Null hypothesis can therefore be starting point for most of other metabolic rejected. This means that there is a derangements. [69] difference in Peak Expiratory Flow Rate Truncal obesity is associated with between Android and Gynoid Obesity in high blood insulin levels, which also Females. increases the activity of lipoprotein lipase  The PEFR in the Gynoid Group is 5.6% and fat storage and may indirectly cause better than PEFR in the Android Group. overeating. Fat cells from the upper body seem to be functionally different from fat DISCUSSION cells in the lower body. Primarily by The results of the present study, (increase in the size of cells) of Comparison of PEFR between Android and the existing cells, whereas lower body fat Gynoid Obesity in Females in the age group deposition is by (increase in the of 20-40 years implies that Obesity number of cells). Reducing the number of detriments the lung functions in Young cells in the lower body hyperplastic depot is Females having an Android pattern of Fat difficult compared to reduce truncal obesity distribution more when compared to Gynoid where there is increase in the size of pattern. Various mechanisms were adipocytes. This may explain the weight speculated for them, which were as follows: loss difficulties of many women with lower body obesity. [65] Observations 1, 2: Represent The present study was carried out in classification of BMI According to Type females having an Android pattern of Fat in Both the Groups. distribution and those having Gynoid Type. Graphs 1, 2 & Tables 1, 2 show that Obesity may lead to intra-abdominal the Maximum no of the subjects belonged to adipose accumulation, which exerts a load Type 1 obesity and the minimum in Type 3 on cardiac and respiratory muscles obesity. This suggests that young Females especially the diaphragm, which may cause are mostly Over-weight and in Class 1 dyspnea. [66] Accumulation of adipose tissue Obesity i.e. with corrective and preventive around the abdomen, visceral cavity, and measures, they can come into the Normal around rib cage may produce an imbalance BMI Category. Thus, making Screening an between inflationary and deflationary important part of the assessment in this age pressure on the lungs leading to a reduction group of 20-40 years and reducing the in PEFR. The probable reason for a decrease comorbidities associated with Obesity. in PEFR in obese may be the fat deposition There is conclusive evidence that in the abdomen which may resist the Obesity located in the central abdominal movement of the diaphragm and in turn, parts of the body is statistically associated reduce the vertical diameter of the thoracic with several metabolic derangements such cavity. Due to this compliance of the lungs as insulin resistance, hyperinsulinemia, non- and the thoracic cavity may decrease and insulin-dependent diabetes mellitus, increases the load on muscles of respiration, hyperlipidemia, and hypertension. The leading to a reduction in lung volumes and mechanism might be due to lipolytically flow rates, especially PEFR. [67] Thus it is sensitive abdominal depots providing excess evident from the present study that obesity free fatty acids to a muscle tissue that has a significantly affects the pulmonary decreased capacity for their oxidation. The functions which may give rise to long term excessive exposure of tissues to fatty acids complications and may lead to early impairs insulin function and increases blood morbidity and mortality. [68] insulin levels. All this ultimately results in reduced insulin sensitivity making a person

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Observation 3: Shows Correlation greater quantities of pro-inflammatory between PEFR and BMI in Both the cytokines than does subcutaneous adipose Groups tissue. [73, 74] Through these mechanisms, From Graphs 3, 4 and Table 3, using excess visceral obesity is hypothesized to a Pearson product-moment correlation test cause insulin resistance and an atherogenic on the data (r = -0.29, df = 48), the results profile. Obesity itself and especially the were significant (p < 0.025 for a one-tailed pattern of body fat distribution have test). This means there is a negative independent effects on PEFR in young adult correlation between PEFR and BMI (the females. As adipose tissue accumulates in higher the BMI, the lower the range of excess amounts a variety of alterations and PEFR) in the Android Group. King GG et adaptations in cardiorespiratory structure also observed a strong relationship between and function occur even in the absence of body mass index and both lung volume and co-morbidities. Hence, obesity may affect airway caliber in obese individuals which the heart and lungs through its influence on reflects that, with increasing body mass known risk factors such as dyslipidemia, index, airways were narrower than expected hypertension, glucose intolerance, based on the reduction in lung volume, obstructive sleep apnea/hypoventilation. [75] suggesting that there were structural [69] or Using a Pearson product moment- functional changes in the airways. correlation test on the data (r = -0.14, df = According to a study, obesities 48), the results were not significant (p > which prevail on the upper half of the body, 0.025 for a one-tailed test). This means and which are hypersthenic, (excessive there is a positive correlation between PEFR muscle tone) hypermetabolic, (increased and BMI (the higher the BMI, the higher the rate of metabolic activity often abnormal) range of PEFR) in the Gynoid Group. hyperemic, (excess of blood in a body part) Obesities, which are predominant on the and orthohydropexic; the fat overload there lower half of the body are hyposthenic, (tall, is accompanied by muscular hypertrophy thin) hypometabolic, (abnormally low generally linked to a robust skeleton. The metabolic rate) hypohemic, (too little blood) predominance of the aqueous anabolism and hyperhydropexic (non-sugar concerns the blood much more than it does antidiabetes). The circulatory system there the interstitial plasma. Vital prognosis is is secure from plethora as aqueous above all linked to the circulatory hyperanabolism (promoting metabolic consequences of the plethora: red activity) is not effected towards the hypertension, premature atherosclerosis, circulating blood but towards the interstitial cardiorenal and cerebral failure, etc. Red plasma. Hypertension there is rare, hypertension is indeed a usual contingent, independent of the degree of manifestation, precocious, and parallel to obesity and then identical - in its the extent of fat overload. Hyperglycemia determination and evolution - to the pale and diabetes are frequent and they also hypertension of thin persons and subjects of follow the development of adipose normal weight. Glycoregulation hypertrophy. [70] disturbances are also rare and independent An excess of abdominal fat is of fat overload. Complications are directly considered unfavorable, because visceral fat linked to this latter and its mechanical is thought to be more metabolically active, consequences. [70] A gynoid obesity profile, causing dysmetabolism of fatty acids and where adipose tissue accumulates around increased influx of free fatty acids into the the hips, is thought to protect against CVD. splanchnic circulation. [71, 72] Moreover, [76, 77] adipose tissue has the same features as The primary factors that affect PEFR endocrine organs in terms of secreting are the strength of the expiratory muscles cytokines, and visceral adipocytes secrete generating the force of contraction, the

International Journal of Health Sciences and Research (www.ijhsr.org) 246 Vol.11; Issue: 4; April 2021 Shruti Shah et.al. Comparison of peak expiratory flow rate between android and gynoid pattern obesity in females. elastic recoil pressure of the lungs, and the oxygen consumption [78, 85, 88, 89] which was airway size. Accumulation of fat in and attributed to the fact that increased fat around the ribs, the diaphragm, and the deposition in between the muscles and ribs abdomen results in a reduction in chest wall might have increased the metabolic demand. compliance.[78] Zerah et al.,[79] studied [78] airway resistance in mild, moderate, and Further, breathing mechanics morbidly obese individuals and confirmed involve contraction and descend of the that both respiratory resistance and airway diaphragm during inspiration to increase the resistance rose significantly with the level of vertical diameter of the thorax and obesity. These findings suggest that in intrathoracic negativity. In this connection, addition to the elastic load, obese trunk obesity is more important than the individuals must overcome increased airway overall adipose tissue represented by BMI. resistance resulting from a reduction in lung WC, as a measure of abdominal fat volumes due to obesity. deposition, is therefore, reported to have Since we got a positive correlation more consistent predictability for pulmonary of PEFR with Gynoid obesity, it could mean function than BMI that does not distinguish that people with gynoid obesity present with between fat mass and muscle mass. [78] a greater strength of expiratory muscles thus In the Gynoid Group, using a generating a greater force of contraction and Pearson product-moment correlation test on yielding a higher PEFR value when the data (r = 0.31, df =48), shows that the compared to those of the Android type. results were not significant (p < 0.025 for a one-tailed test). This means there is a Observation 4: Shows Correlation negative correlation between PEFR and between PEFR & WHR in Android and WHR (the higher the WHR, the lower the Gynoid Group range of PEFR). This negative association Graphs 5, 6 & Table 4, represent of PEFR with obesity markers particularly Pearson product-moment correlation test on WC and WHR is representing primary the data (r = -0.08, df =48), the results were restrictive lung function pattern. This significant (p > 0.025 for a one-tailed test). restrictive pattern may be the result of This means there is a positive correlation limited diaphragmatic decent or could be between PEFR and WHR (the higher the because of diminished rib cage movement WHR, the higher the range of PEFR) in the and thoracic compliance due to fat Android Group. High WC is supposed to deposition in the chest wall. Both of these hinder the diaphragm expansion, which mechanisms lead to restricted respiratory controls the respiratory activity. Increased movement. [20] Further, significantly higher abdominal mass or abdominal adiposity values of WHR shown by the pre-obese and restricts the descent of the diaphragm into obese groups of a study were due to the the abdominal cavity which causes the result of decreased physical activity and incomplete expansion of the chest and thus sedentary life style of these subjects as it is the lungs, therefore increasing the thoracic reported that, increased physical activity is pressure. [80, 81] All these lead to a reduction related to lower WHR in young adult men of chest wall compliance, [82, 83] increased and women [90] and we noticed a similar respiratory effort due to added weight of association too since our subjects also lived breathing as the increased fat mass loads the a sedentary lifestyle with decreased physical respiratory apparatus that affects airway activity. closure. [78, 80, 84, 85, 86] All these lead to a negative impact on gaseous perfusion Observation 5: Shows Correlation whereas abdominal fat deposition causes between PEFR and WHtR in Both the respiratory muscle dysfunction. [87] Another Groups study explained that obesity increased the

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Graphs 7, 8 & Table 5, show that PEFR & WHR and with PEFR & WHtR. In using a Pearson product moment-correlation the Gynoid Group, the results were test on the data (r = -0.17, df =48), the significant between PEFR & WHR and results were not significant (p > 0.025 for a were not significant between PEFR & BMI one-tailed test) in the Android Group and (r and with PEFR & WHtR. = 0.02, df =48) the results were also not From Graph 9 & Table 6, it is seen significant (p > 0.025 for a one-tailed test) that using an Unrelated t-Test on the data (t in the Gynoid Group. This means there is a = 2.137, df = 98) the results were found to positive correlation between PEFR and be Significant (p < 0.05 for a one-tailed WHtR (the higher the WHtR, the higher the hypothesis) between mean values of PEFR range of PEFR) in both the Groups. in Android and Gynoid Group. The Null According to Malhotra, et al. [91] the heavier hypothesis can therefore be rejected. This the person, the need for oxygen will means that there is a difference in Peak increase. Increased oxygen demand must be Expiratory Flow Rate between Android and met by a ventilation system, which will Gynoid Obesity in Females. improve respiratory function and PEFR. The Gynoid PEFR is better by 5.6% than waist-height ratio, in principle, is a good Android PEFR. PEFR is influenced by measure to represent the waist gender, body surface area, obesity, physical circumference in relation to another easily activity, posture, environment & racial measurable body proportion so that differences [98, 99, 100, 101] and also by distortions based on the body frame size in individual’s physical. The elementary different populations are removed [92] factors upon which PEFR values depend are Height, Weight, and Chest circumference voluntary effort, the strength of the are the main determinant factors of PEFR expiratory muscles, generating the force of among the physical parameters. [93, 94] The contraction, lung volume and airway size, previous studies have proved that it is a and elastic recoil strength of the lungs. [88, good parameter of central obesity and an 100,102, 103] Although, it’s an established fact increase of which indicates the risk for that forced expiratory volume over 1 sec cardiometabolic disorders [95] The results of (FEV1) is more efficient and accurate than a study also suggests that it can serve as a PEFR for indicating airway obstruction. good marker in pulmonary function study. However, PEFR due to its portability, cost- [41] However, the different studies carried by effectiveness, feasibility, and simplicity of Joshi et al., [96] Saxena Y et al. [97] noticed a maneuver, has made it preferable over negative relation between adiposity markers FEV1. [104] The Mini Peak Flow Meter is a and lung function parameters other than useful instrument that is widely used for PEFR. Variation in the results could be ambulatory PEFR measurement. [104] since not many studies have assessed the Increased central adiposity in correlation of PEFR and WHtR in Android women has been associated with relative and Gynoid female subjects between the androgen excess, [45] which could be seen in ages of 20-40 years. Android Females and thus could yield lesser PEFR values when compared to their Observations 6, 7: Represent values of Gynoid counterparts. Excess weight on the the Linear Regression between PEFR anterior chest wall due to obesity lowers with BMI, WHR & WHtR in Android chest wall compliance and respiratory and Gynoid Group & Unpaired T-Test muscle endurance with an increase in work between PEFR in Both the Groups of breathing and airway resistance. [15, 27, 105] Table 5 shows the Linear Regression Furthermore, the buildup of adipose tissue test on the data: In the Android Group, the in the anterior abdominal wall and in the results were significant between PEFR & intra-abdominal visceral tissue hinders BMI and were not significant between diaphragmatic movement, diminishes basal

International Journal of Health Sciences and Research (www.ijhsr.org) 248 Vol.11; Issue: 4; April 2021 Shruti Shah et.al. Comparison of peak expiratory flow rate between android and gynoid pattern obesity in females. lung expansion during inspiration, and with lifestyle, activity, medications, the closure of peripheral lung units, causing environment, emotional factors etc ventilation-perfusion abnormalities and arterial hypoxemia. [20, 31] Thus, PEFR in the SUGGESTIONS Android Type of fat distribution would be A Larger Sample Size should be affected more than the Gynoid Type as seen chosen. from the results of the present study. Interventional studies examining the Reduction of weight and its effect on CONCLUSION changes in Lung Function can be assessed From the present study, we conclude in future studies. that there is a correlation between PEFR and Factors contributing to Obesity like Android Obesity, PEFR and Gynoid Obesity comorbidities, genetics, sleep, food, and there is a difference in Peak Expiratory lifestyle, activity, medications, environment, Flow Rate between Android and Gynoid emotional factors etc should be included in Obesity in Females. The PEFR in the further studies. Gynoid Group is 5.6% better than PEFR in the Android Group. Acknowledgement: None Conflict of Interest: None CLINICAL IMPLICATIONS Source of Funding: None  Detect early warning signs in at-risk Ethical Approval: Approved populations. Ex. Obese subjects.  Diagnostic: Screening at Females for REFERENCES risk factors of Android and Gynoid 1. World Health Organization Tech Rep Obesity. Series, 854. Overweight adults. In: Physical  Prognostic: Assessment of status: The use and interpretation of degree/severity of disease and disability, anthropometry; 1995:312-4. 2. Pandey RM, Gupta R, Misra A, Misra P, evaluating the effectiveness of Singh V, Agrawal A, et al. Determinants of treatment/exercise program and urban-rural differences in cardiovascular determining further treatment goals. risk factors in middle-aged women in India:  Assessment of PEFR routinely in Young a cross-sectional study. Int J Cardiol. 2013; Females with Obesity to prevent 163:157–62. Cardiovascular and Respiratory 3. Deepa R, Sandeep S, Mohan V. Abdominal complications. obesity, visceral fat and type 2 diabetes- Asian Indian phenotype. In: Mohan V, Rao LIMITATIONS GHR, editors. Type 2 diabetes in South  A Small Sample Size was chosen due to Asians: epidemiology, risk factors and difficulty in finding the subjects prevention. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd; 2006. especially those with Type 3 Obesity. pp. 138–52.  The study design was cross-sectional 4. Misra A, Pandey RM, Devi JR, Sharma R, and hence did not include a follow up Vikram NK, Khanna N. High prevalence of assessment. The study did not assess diabetes, obesity and dyslipidaemia in urban factors that predict long-term outcome slum population in northern India. Int J for example, if reducing weight would ObesRelatMetabDisord. 2001; 25:1722-9. increase the PEFR value in the Female 5. Zargar AH, Masoodi SR, Laway BA, Khan Obese Subjects. AK, Wani AI, Bashir MI, et al. Prevalence  Additional factors that have been of obesity in adults: an epidemiological suggested to contribute to Obesity were study from Kashmir valley of Indian not included in this study like subcontinent. J Assoc India. 2000; 48:1170-4. comorbidities, genetics, sleep, food, 6. Shukla HC, Gupta PC, Mehta HC, Hebert JR. Descriptive epidemiology of body mass

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Appendix: CASE RECORD FORM Comparison of Peak Expiratory Flow Rate between Android and Gynoid Obesity in Females NAME: AGE: WEIGHT: HEIGHT: BMI: GRADE: WAIST CIRCUMFERENCE (WC): HIP CIRCUMFERENC (HC): WAIST TO HIP RATIO (WHR): WAIST TO HEIGHT RATIO (WtHR): PEAK EXPIRATORY FLOW RATE:

1. 2. 3. HIGHEST OF 3 READINGS

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International Journal of Health Sciences and Research (www.ijhsr.org) 254 Vol.11; Issue: 4; April 2021