Impact of waist circumference on red blood cells size in obese adults

Babitha R., RGunasekaran Ramanathan


Background: Obesity is a chronic disease of multifactorial origin. Major cause for obesity is imbalance between energy intake and energy expenditure. One among the important public health problem in developing countries is increase in the prevalence of obesity. Obesity can be general obesity and central obesity. The central obesity is more dangerous than general obesity, since the central obesity reflects abdominal visceral fat, which acts as an endocrine organ and release several pro inflammatory cytokines, which leads to oxidative stress which in turn causes anisocytosis (variation in the size of the RBCs). Waist circumference indirectly measures this abdominal obesity. This study is aimed at finding the impact of Waist circumference on RBC size in obese adults.

Methods: This study was done in 100 subjects in the age group 25 to 50 years (50 control with normal waist circumference and 50 obese subjects with increased waist circumference) of Annapoorana Medical college hospitals. Patients with anaemia, malnutrition, and other chronic diseases who are RBCs may show anisocytosis were excluded. Waist circumference was measured. Peripheral smear was prepared and stained with leishman’s stain. Smear was focused under oil immersion objective, and the image was captured using a digital camera. Image was transferred to the computer system and RBC diameter was measured using UTHSCA image tool software. Variation in size of the RBCs between control and subjects was compared using Pearson’s product moment correlation coefficient and Paired sample t test.

Results: The variation in the size of RBCs (anisocytosis) was more in subjects with increased waist circumference when compared with subjects of normal waist circumference. By using Pearsons product moment correlation coefficient, significant r value of 0.5 and 0.7 were got in male subjects and female subjects respectively. Comparing waist circumference and anisocytosis using Paired sample t test, significant p value of ˂ 0.05 was got in male and female obese subjects.

Conclusions: The oxidative stress caused by the cytokines released by the adipocytes causes decreased deformability of RBCs and cause anisocytosis, which further causes complications.



Central obesity, Abdominal visceral fat, Waist circumference, Adipokines, Oxidative stress, Peripheral smear, Image tool, Anisocytosis

Full Text:



Olusanya JO, Omotayo OA. Prevalence of obesity among undergraduate students of Tai Solarin University of Education, Ijagun, Ijebu-Ode. Pak J Nutr. 2011;10:940-6.

Patil SP, Sukumaran S, Bhate A, Mukherji A, Chandrakar S. Correlation of Blood Sugar with Waist Circumference and Body Mass Index in an Indian Population Global Journal of Pharmacology 2012;6(1):08-11.

Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. New Engl J Med. 2008;359:2105-20.

Kovesdya CP, Czirac ME, Rudasc A, Ujszaszic A, Rosivall L, Novakc MK. Et al. Body Mass Index, Waist Circumference and Mortality in Kidney Transplant Recipients. American Journal of transplantation. 2010;10:2644-51.

Yishai Levy MD. it's not only the overweight: it's the visceral Fat. IMAJ. 2010;12:231-2.

World Health Organisation (WHO) Global Health Observatory (GHO). Available: gho/ ncd/ risk_factors/ overweight/ en/. Accessed 31 July 2014.

Cazzola R, Rondanelli M, Russo-Volpe S, Ferrari E, Cestaro B. Decreased membrane fluidity and altered susceptibility to peroxidation and lipid composition in overweight and obese female erythrocytes. Journal of lipid research. 2004;45(10):1846-51.

Kumar PN, peripheral blood examination, Laboratory. Haematology. 2005;11:83-90.

Kumar SNS, Dutt AR, Maruthy KN, Nadig D, Dsouza NDR. A Simple imaging method for demonstrating red cell sizes to life sciences students. National Journal of Basic Medical Sciences. 2011; I(3):133-6.

Kovesdya CP, Czirac ME, Rudasc A, Ujszaszic A, Rosivalld L, Novakc M, et al. Body Mass Index, Waist Circumference and Mortality in Kidney Transplant Recipients. American Journal of Transplantation. 2010;10:2644-51.

Vincent HK, Taylor AG. Biomarkers and potential mechanisms of obesity-induced oxidant stress in humans. International Journal of Obesity. 2006;30:400-18.

Fonseca-Alaniz MH, Takada J, Alonso-Vale MI, Lima FB. Adipose tissue as an endocrine organ: From theory to practice. J. Pediatr. 2007;83(Suppl. 5):192-203.

Little C, O’Brien PJ. An intracellular GSH-peroxidase with a lipid peroxide substrate. Biochem Biophys Res Commun. 1968;31:145-50.

Austin H, Austin JMJr, Partridge EE, Hatch KD, Shingleton HM. Endometrial cancer, obesity and body fat distribution. Cancer research 1991;51(2):568-72.

Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. for the Cholesterol and Recurrent Events (CARE) Trial Investigators. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation. 2008;117:163-8.

Singh K, Singh S. Impact of Obesity on Malondialdehyde and Certain Antioxidants in North Indian Obese Punjabi Population. Research Journal of Pharmaceutical, Biological and Chemical Sciences. RJPBCS. 2015;6(4):1383-89.

Madhikarmi NL, Murthy KRS, Rajagopal G, Singh PP. Lipid peroxidation and antioxidant status in patients with type 2 diabetes in relation to obesity in Pokhara - Nepal Journal of Diabetology. 2013;1:3:1-8.

Kowalczyk E, Kowalski J, Błaszczyk J, ´dzin´ ski, Ciec ´wierz LGJ, Sienkiewicz M. Estimation of cell membrane properties and erythrocyte red-ox balance in patients with metabolic syndrome. Mol Biol Rep. 2012;39:11113-8.

Zeghari PP, Ziegler O, Donner M, Drouin M. Hyperinsulinemia is related to erythrocyte membrane fluid-ity changes in obese nondiabetic women. J. Clin. Endocrinol. Metab. 1996 ;81:2912-8.

Curatola G, Ferretti G, Bertoli E, Ootti M, bartolotta E, Piorgi G. Changes of Membrane Fluidity in Erythrocytes of Obese Children: A Spin Label Study. Pediatric Research. 1987;22(2):141-4.

Block G, Dietrich M, Norkus EP, Morrow JD, Hudes M, Caan B, et al. Factors associated with oxidative stress in human populations. Am. J. Epidemiol. 2002;156:274-85.

Hermsdorff HH, Barbosa KB, Volp AC, Puchau B, Bressan J, Zulet MA, et al. Gender-specific relationships between plasma oxidized low-density lipoprotein cholesterol, total antioxidant capacity, and central adiposity indicators. Eur. J. Prev. Cardiol. 2014;21(7):884-91.

Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557-67.

Formigueira X, Cantón A. Obesity: epidemiology and clinical aspects. Best Pract Res Clin Gastroenterol. 2004;18:1125-46.

Cazzola R, Rondanelli M, Russo-Volpe S, Ferrari E, Cestaro B. Decreased membrane fluidity and altered susceptibility to peroxidation and lipid composition in overweight and obese female erythrocytes. Journal of Lipid Research 2004; Volume 45: 1846-51.