Hubungan antara Rasio Lingkar Pinggang-Panggul dengan Risiko Penyakit Kardiovaskular menggunakan Persentase Framingham Risk Score pada Populasi di Pulau Lombok
DOI:
https://doi.org/10.29303/jku.v6i3.1.270Kata Kunci:
Penyakit kardiovaskular, obesitas abdominal, rasio lingkar pinggang-panggul, Framingham Risk Score.Abstrak
Latar Belakang: Penyakit kardiovaskular sampai saat ini masih menjadi masalah kesehatan di berbagai negara baik di negara maju maupun di negara berkembang. WHO pada tahun 2014 menyebutkan penyakit kardiovaskular merupakan penyebab kematian terbanyak dari penyakit tidak menular yaitu sekitar 37%. Salah satu penyebab terjadinya penyakit kardiovaskular adalah obesitas abdominal. Obesitas abdominal dapat diukur dengan mengetahui rasio lingkar pinggang-panggul. Kejadian penyakit kardiovaskular dapat diprediksi menggunakan Framingham Risk Score. Penelitian ini bertujuan untuk mengetahui hubungan antara rasio ligkar pinggang-panggul dengan risiko penyakit kardiovaskular menggunakan persentase Framingham Risk Score.
Metode: Penelitian ini meggunakan rancangan penelitian deskriptif analitik dengan pendekatan cross sectional. Penelitian dilaksanakan di Lombok Epicentrum Mall pada bulan Oktober 2015. Sebanyak 69 subjek berusia 50-74 tahun yang memenuhi kriteria inklusi diikutsertakan pada penelitian ini. Tingkat risiko penyakit kardiovaskular diestimasi berdasarkan Framingham Risk Score yang meliputi usia, jenis kelamin, merokok, tekanan darah sistolik, diabetes mellitus, kolesterol HDL, dan kolesterol total. Data dianalisis dengan uji korelasi Spearman.
Hasil: Hasil penelitian menunjukkan bahwa 94,2% subjek memiliki rasio lingkar pinggang-panggul yang tidak normal. Dalam kaitan dengan risiko penyakit kardiovaskular yang dihitung dengan persentase Framingham Risk Score, 62,3% berisiko rendah, 23,2% berisiko intermiediate, dan 14,5% berisiko tinggi. Berdasarkan uji korelasi Spearman diperoleh koefisien korelasi sebesar 0,390 dan signifikasni (p) sebesar 0,001.
Kesimpulan: Terdapat hubungan signifikan antara rasio lingkar pinggang-panggul dengan risiko penyakit kardiovaskular menggunakan persentase Framingham Risk Score pada populasi di Pulau Lombok.
Referensi
2. Artigao-Rodenas LM, Carbayo-Herencia JA, Divison-Garrote JA, Gil-Guillen VF, et al., 2013. Framingham Risk Score for Prediction of Cardiovascular Diseases: A Population-Based Study from Southern Europe. PLoS ONE, 8(9), pp.1–10. Available at : http://journals.plos.org/plosone/article/asset?id=10.1371/journal.pone.0073529.PDF [Accessed 4 Juni 2016].
3. ATP III Guideline. 2015. Management of Dyslipidemias : Principles and Guidelines. In: Y. Robert Li. Cardiovascular Disease ; From Molecular Pharmacology to Evidence-Based Therapeutics. SPi Publisher Services; Pondicherry, Inida. Pp 99-113.
4. Backer GGD. 2008. Risk factors and prevention of cardiovascular disease: a review. In : Ferrari R dan Hearse DJ. Risk Factor & Cardiovascular Disease. Dialogues in Cardiovascular Medicine - Vol 13 . No. 2. 2008. Pp 83-102. Available at : http://www.dialogues-cvm.com/document/DCVM48.pdf (Accessed on 6 Februari 2017).
5. Baena-Diez JM, Byram AO, Grau M, Fernandez CG, Solsona MV, et al., 2010. Obesity Is an Independent Risk Factor for Heart Failure: Zona Franca Cohort Study. Clin. Cardiol. 33, 12, 760–764 (2010). Available at : http://onlinelibrary.wiley.com/doi/10.1002/clc.20837/pdf (Accessed on 6 Februari 2017).
6. Berger JS, Jordan CO, Lloyd-Jones D, Blumenthal RS. 2010. Screening for Cardiovascular Risk in Asymptomatic Patients. Journal of the American College of Cardiology 55:1169–77. Available at : http://content.onlinejacc.org/article.aspx?articleid=1142634 (Accessed on 25 November 2016).
7. Bitton A dan Gaziano T. 2010. The Framingham Heart Study’s Impact on Global Risk Assessment. Prog Cardiovasc Dis, 53(1), pp.68–78. Available at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904478/pdf/nihms213968.pdf [Accessed 4 Juni 2016].
8. Black HR. 1996. Cardiovascular Risk Factor. In Zaret BL., Moser M., & Cohen LS., Yale University School of Medicine; Heart Book pp 23-35. New York : Yale University School of Medicine.
9. Caballero B. 2005. Nutrition Paradox-Underweight and Obesity in Developing Countries. N Engl. J. Med. 352:1514-1516. Available at : www.ncbi.nlm.nih.gov/pubmed/15829531 [Accessed 5 Mei 2016].
10. Chia YC. 2011. Review of tools of cardiovascular disease risk stratification: interpretation, customisation and application in clinical practice. Singapore Med J 2011; 52(2) : 116. Available at : http://smj.sma.org.sg/5202/5202ra1.pdf [Accessed 5 Desember 2016].
11. Cristina A. 2012. Hubungan antara Gaya Hidup dengan Rasio Lingkar Pinggang-Panggul Orang Dewasa di Kecamatan Rumbia kabupaten Lampung Tengah 2010. Skripsi. Available at : http://www.lib.ui.ac.id/file?file=digital/20285108SAgnesia%20Christina.pdf [Accessed 4 Mei 2016].
12. Dahlan MS. 2013. Besar Sampel dan Cara Pengambilan Sampel dalam Penelitian Kedokteran dan Kesehatan. Edisi 3. Jakarta: Salemba Medika.
13. Dahlan MS. 2013. Statistik Untuk Kedokteran dan Kesehatan. Edisi 5. Jakarta: Salemba Medika
14. De Koning L, Merchant A, Pogue J, Anand SS. 2007. Waist Circumference and Waist-to-Hip Ratio as Predictors of Cardiovascular Events: Meta-Regression Analysis of Prospective Studies. European Heart Journal, 28(7), pp.850–856. Availbale at : http://eurheartj.oxfordjournals.org/content/ehj/28/7/850.full.pdf [Accessed 13 Mei 2016].
15. Dhaliwal SS, Welborn TA, Goh LGH, Howat PA. 2014. Obesity as Assessed by Body Adiposity Index and Multivariable Cardiovascular Disease Risk. PLoS ONE 9(4): e94560. Available at : http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0094560&type=printable (Accessed on 25 Desember 2016).
16. Diaz ME, Jimenez S, Garcia RG, Bonet M, Wong I. 2009. Overweight, Obesity, Central Adiposity and Associated Chronic Diseases in Cuban Adults. MEDICC review, 11(4), pp. 23–28. Available at: http://www.medicc.org/mediccreview/index.php?issue=10&id=118&a=va [Accessed on 6 Juni 2016].
17. Dorland WAN. 2010. Kamus Kedokteran Dorland. Edisi 31, EGC: Jakarta.
18. D'Agostino RB, Vasan RS, Pencina MJ, et. al. 2008. General Cardiovascular Risk Profile for Use in Primary Care. The Framingham Heart Study. Circulation 117:743-753. Available at : http://circ.ahajournals.org/content/117/6/743.long [Accessed on 25 Desemeber 2016].
19. D’Agostino RB, Pencina MJ, Massaro JM, dan Coady S. 2013. Cardiovascular Disease Risk Assesment : Insights From Framingham. Glob Heart 2013 March ; 8(1): 11–23 Available at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673738/pdf/nihms442532.pdf (Accessed on 6 Februari 2017).
20. ESC. 2013. ESH/ESC Guideline for the management of arterial hypertension. Europan heart journal (2013) 34. 2159-2219.
21. Flier JS, Flier EM. 2014. Biology of Obesity. In: J. Larry Jameson. Harrison’s Endocrinology. Second edition. New York: Mc Graw Hill pp 242-250.
22. Gani HBS, Wongkar D, dan Ticoalu SHR. 2013. Perbandingan Kadar Kolesterol High Density Lipoprotein Darah pada Wanita Obes dan Non Obes. , pp. 879-883. Available at : http://ejournal.unsrat.ac.id/index.php/ebiomedik/article/download/5473/4999 [Accessed 13 Mei 2016].
23. Goh LGH, Dhaliwal SS, Welborn TA, Lee AH, Della PR. 2014. Anthropometric Measurements of General and Central Obesity dan The Prediction of Cardiovascular Disease Risk in Mowan : A Cross-Sectional Study. BMJ Open; 4;e004138. Availale at : http://www.ncbi.nml.nih.gov/pmc/articles/PMC3918987/pdf/bmjopen-2013-004138.pdf [Accessed 11 November 2016].
24. Grundy SM. 2006. Metabolic Syndrome: Connecting and Reconceiling Cardiovaskuler and Diabetes World. J Am Coll Cardiol. 47:1093-1110. Available at : www.ncbi.nlm.nih.gov/pubmed/16545636 [Accessed 13 Mei 2016].
25. Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V. 1999. AHA/ACC Scientific Statement: Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations: A Statement for Healthcare Professionals from the American Heart Association And the American College of Cardiology. J Am Coll Cardiol, 34(4), pp.1348–1359. Available at: https://content.onlinejacc.org/pdfaccess.ashx?ResourceID=2864785&PDFSource=13 [Accessed 3 Juni 2016].
26. Handajani A, Roosihermiatie B, Maryani H. 2010. Faktor-Faktor yang Berhubungan dengan Pola Kematian pada Penyakit Degeneratif di Indonesia. pp 1-12. Available at : http://www.ejournal.litbang.depkes.go.id [Accessed 4 Mei 2016].
27. Hansson GK. 2005. Inflammation, Atherosclerosis, and Coronary Artery Disease. N Engl J Med (2005); 352: 1685-95. Available at : http://web.mit.edu/hst527/www/readings/Lecture%2014/Hansson%20GK.pdf [Accessed 12 Agustus 2016].
28. Ho-Pham LT, Lai TQ, Nguyen MTT, Nguyen TV. 2015. Relationship between Body Mass Index and Percent Body Fat in Vietnamese: Implications for the Diagnosis of Obesity. PLoS ONE, 10(5), pp.1–13. Available at : http://journals.plos.org/plosone/article/asset?id=10.1371/journal.pone.0127198.PDF [Accessed 13 Mei 2016].
29. Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. 2007. Designing Clinical Research. 3rd edition. Philadelphia: Lippincott Williams & Wilkins. p.1-386.
30. Kabir DSP, Dash AK, dan Das BC. 2012. Abdominal Obesity, an Independent Cardiovascular Risk Factor in Indian Subcontinent: A Clinico Epidemiological Evidence Summary. Journal of Cardiovascular Disease Research; 2:pp. 199-205. Available at : http://www.jcdronline.org/sites/default/files/JCDR_2_4_2.pdf [Accessed 11 November 2016].
31. Kaila B dan Raman M. 2008. Obesity: A Review of Pathogenesis and Management Strategies. Canadian Journal of Gastroenterology, 22(1), pp.61–68. Available at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659122/pdf/cjg22061.pdf [Accessed 4 Mei 2016].
32. Kanjilal S, Rao VS, Mukherjee M, Natesha BK, Renuka KS, et al. 2008. Application of Cardiovascular Disease Risk Prediction Models and Relevance of Novel Biomarkers to Risk Stratification in Asian Indians. Vascular Health and Risk Management. 4(1) pp 199-211. Available at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464770/pdf/vhrm-0401-199.pdf [Accessed 11 November 2016].
33. Kaulgud RS, Deshpande GV, Kamath V, Joshi RR, Swamy M, dan Vijayalakshmi PB. 2013. Correlation Between Body Fat Components and Coronary Heart Disease Risk Scores. International Journal of Biomedical Research. 04 (04), pp 179-185. Available at : http://www.ssjournals.com/index.php/ijbr/article/viewFile/821/817 [Accessed 4 November 2016].
34. Kaur S, Sharma A, dan Singh HJ. 2015. Waist-Related Anthropometric Measures: Simple and Useful Predictors of Coronary Heart Disease in Women. National Journal of Physiology, Pharmacy & Pharmacology Vol 5 Issue pp. 60 – 64. Available at : http://www.scopemed.org/fulltextpdf.php?mno=164940 (Accessed on 25 Desember 2016).
35. Kementerian Kesehatan RI. Infodatin : Situasi Kesehatan Jantung. 2014. Available at: http://www.depkes.go.id/download.php?file=download/pusdatin/infodatin/infodatin-jantung.pdf [Accessed 22 Mei 2016].
36. Khanna R, Kapoor A, Kumar S, Tewari S, Garg N, Goel PK. 2013. Metabolic Syndrome and Framingham Risk Score : Observations From a Coronary Angiographic Study in Indian Patients. 137(2), pp.295–301. Available at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657852/ [Accessed 5 Juni 2016].
37. Kopelman PG. 2000. Obesity as a Medical Problem, Nature_Obesity_Review, 404(April), pp.635–643. Available at : https://www.ncbi.nlm.nih.gov/pubmed/10766250 [Accessed 13 Mei 2016].
38. Koscinski. 2014. Assessment of Waist-to-Hip Ratio Attractiveness in Women : An Anthropometric of Digital Silhouttes. 43(5), pp 989-997. Available at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050298/pdf/10508_2013_Article_166.pdf [Accessed 4 Mei 2016].
39. Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G. 2010. Mechanism of Obesity-Induced Hypertension. Hypertension Research (2010) 33, 386-393. Available at: http://www.nature.com/hr/journal/v33/n5/pdf/hr20109a.pdf [Accessed 9 Juni 2016].
40. Larquemin LP, Oppert JM, Clement K, Hainault I, Basdevant A, et al., 2004. Adipose Angiotensinogen Secretion, Blood Pressure, and AGT M235T Polymorphism in Obese Patients. Obesity Research Vol. 12 No. 3 March 2004. Available at : http://onlinelibrary.wiley.com/doi/10.1038/oby.2004.63/pdf (Accessed on 6 Februari 2017).
41. Libby P dan Ridker PM. 2004. Inflammation and Atherosclerosis: Role of C-Reactive Protein in Risk Assessment. Am J Med. 2004;116: 9-16 http://lib.ajaums.ac.ir/booklist/CDJ-2_March-2004_20.pdf [Accessed 12 Agustus 2016].
42. Lloyd-Jones DM. 2010. Cardiovascular Risk Prediction: Basic Concepts, Current Status, and Future Directions. Circulation, 121(15), pp.1768–1777. Availbale at : http://circ.ahajournals.org/content/circulationaha/121/15/1768.full.pdf [Accessed 13 Juli 2016].
43. Mahan, Adair, Popkin B.M. 2002. Ethnic Differences in The Association Betwen Body Mass Index and Hypertension. Am J Epidemiology. 155:346-353. Available at : http://aje.oxfordjournals.org/content/155/4/346.long [Accessed 4 Juni 2016].
45. Mathew B, Francis L, Kayalar A, Cone J. 2008. Obesity: Effects on Cardiovascular Disease and Its Diagnosis. Journal of the American Board of Family Medicine, 21(6), pp.562–8. Available at: http://www.jabfm.org/content/21/6/562.full [Accessed 4 Mei 2016].
46. Mishra N, Sharma MK, Chandrasekhar M, Suresh M, Prasad SV, Kondam A. 2012. Central Obesity and Lipid Profile in North Indian Males. pp.291–294. Available at : http://www.ijabpt.org/applied-biology/central-obesity-and-lipid-profile-in-north-indian-males.pdf [Accessed 13 Mei 2016].
47. Misra A, Chowbey P, Makkar BM, Vikram NK, Wasir JS, et al. 2009. Consensus Statement for Diagnosis of Obesity, Abdominal Obesity and the Metabolic Syndrome for Asian Indians and Recommendations for Physical Activity, Medical and Surgical Management. Journal of the Association of Physicians of India VOL. 57 pp: 163-170. Available at : http://www.japi.org/february_2009/R-1.pdf [Accessed 11 November 2016].
48. Moy FM, Atiya AS, dan Wong ML. 2008. Framingham Risk Scores and Anthropometric Measurements in Predicting Cardiovascular Risks Among Malay Men. Malaysian Journal of Nutrition, 14(1), pp.57–63. Available at : http://eprints.um.edu.my/4529/1/Framingham_risk_scores_and_anthropometric_measurements_in.pdf [Accessed 4 Mei 2016].
49. Murray RK, Granner DK, dan Rodwell VW. 2009. Biokimia Harper. Edisi 27. Jakarta : EGC
50. Natalia, Hasibuan, dan Hendro, 2014. Hubungan Obesitas dengan Hipertensi pada Penduduk Kecamatan Sintang, Kalimantan Barat. eJKI Vol. 2, No. 3, Desember 2014. Available at : http://journal.ui.ac.id/index.php/eJKI/article/viewFile/4498/3430 (Accessed on 6 Februari 2017).
51. National Institutes of Health. 2001. ATP III Guideline At-A-Glance Quick Desk Reference: Framingham Point Score. Available at : https://www.nhlbi.nih.gov/files/docs/guidelines/atglance.pdf [Accessed 4 Mei 2016].
52. National Obesity Observatory. 2009. Body Mass Index as a Measure of Obesity. Available at : https://www.noo.org.uk/securefiles/161015_2219//noo_BMI.pdf [Accessed 4 Mei 2016].
53. Nicolic SB, Abhayaratna WP, Leano R, Stowasser M, Sharman JE. 2014. Waiting a Few Extra Minutes Before Measuring Blood Pressure Has Potentially Important Clinical and Research Ramifications. Journal of Human Hypertention: 28, 56-61. Available at : http://www.nature.com/jhh/journal/v28/n1/pdf/jhh201338a.pdf [Accessed 09 November 2016].
54. Notoadmodjo. 2010. Metodologi Penelitian Kesehatan. Jakarta : PT Rineka Cipta
55. Packard RRS dan Libby P. 2008. Inflammation in Atherosclerosis: From Vascular Biology to Biomarker Discovery and Risk Prediction. Clinical Chemistry. 2008; 54: 24-38. http://clinchem.aaccjnls.org/content/clinchem/54/1/24.full.pdf [Accessed 12 Agustus 2016].
56. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia, 2013. Pedoman Tata Laksana Dislipidemia. Available at : http://www.inaheart.org/upload/file/Pedoman_tatalksana_Dislipidemia.pdf [Accessed 13 Mei 2016].
57. Poerier P, Giles TD, Bray GA, Hong Y, Stern JS, et al., 2006. Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss. Circulation. 2006;113:898-918. Available at : http://circ.ahajournals.org/content/113/6/898 (Accessed on 6 Februari 2017).
58. Re RN. 2009. Obesity-Related Hypertension. The Ochsner Journal 9:133–136, 2009. Available at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096270/pdf/i1524-5012-9-3-133.pdf (Accessed on 6 Februari 2017).
59. Riset Kesehatan Dasar. 2013. Status Gizi Dewasa. Available at : http://www.depkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf [Accessed 4 Mei 2016].
60. Ross R. 1999. Atherosclerosis - an Inflammatory Disease, N Eng J Med ; 340: 115–26. Available at : http://www.indiana.edu/~k662/articles/athero/athero%20ross.pdf [Accessed 12 Agustus 2016].
61. Schisterman EF dan Whitcomb BW. 2004. Coronary Age as Risk Factor in The Modified Framingham Risc Score. BMC Medical Imaging 2004, 4:1. Available at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC415549/pdf/1471-2342-4-1.pdf (Accessed on 25 November 2016).
62. Selvarajah S, Kaur G, Haniff J, Cheong KC, Hiong TG, et al., 2014. Comparison of the Framingham Risk Score, SCORE and WHO/ISH Cardiovascular Risk Prediction Models in an Asian Population. International Journal of Cardiology, 176(1), pp.211–218. Available at: https://www.researchgate.net/publication/264287403_Comparison_of_the_Framingham_Risk_Score_SCORE_and_WHOISH_cardiovascular_risk_prediction_models_in_an_Asian_population [Accessed 11 Agustus 2016].
63. Sherwood, 2009. Fisiologi Manusia dari Sel ke Sistem. Jakarta : EGC
64. Simonds SE, Pryor JT, Ravussin E, Greenway FL, Dileone R, et al., 2014. Leptin Mediates the Increase in Blood Pressure Associated with Obesity. Cell 159,1404–1416. Available at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259491/pdf/main.pdf (Accessed on 6 Februari 2017).
65. Soetiarto F, Rosalinda, dan Suhardi. 2010. Hubungan Diabetes Mellitus dengan Obesitas berdasarkan Indeks Massa Tubuh dan Lingkar Pinggang. Bul. Penelit. Kesehatan, Vol. 38, No. 1,2010: 36 – 42. Available at : http://ejournal.litbang.depkes.go.id/index.php/BPK/article/viewFile/121/185. [Accessed 13 Mei 2016].
66. Su TT, Amiri M, Hairi FM, Thangiah N, Dahlui M, Majid HA. 2015. Body Composition Indices and Predicted Cardiovascular Disease Risk Profile Among Urban Dwellers in Malaysia. BioMed Research International, 2015, p.174821. Available at: https://www.hindawi.com/journals/bmri/2015/174821/ [Accessed 5 Juli 2016].
67. Sudoyo AW, Setiyohadi B, Alwi I, Simadibrata M, Setiati S. 2009. Ilmu Penyakit Dalam. Jilid III. Edisi V. Jakarta : Interna Publishing
68. Sunarti dan Maryani E. 2013. Rasio Lingkar Pinggang dan Pinggul dengan Penyakit Jantung Koroner di RSUD Kabupaten Sukoharjo. pp 73-82. Available at : http://download.portalgaruda.org/article.php?article=80769&val=4892 [Accessed 4 Mei 2016].
69. Sundari E, Masdar H, dan Rosdiana D. 2015. Angka Kejadian Obesitas Sentral pada Masyarakat di Pekanbaru, pp 1-16. Available at : http://jom.unri.ac.id/index.php/JOMFDOK/article/viewFile/4866/4748 [Accessed 13 Mei 2016].
70. Susanto JP. 2015. Konsep Baru Renin Angiotensin System (RAS). CDK-225/ vol. 42 no. 2, th. 2015. Available at : http://www.kalbemed.com/Portals/6/08_225CPD-Konsep%20Baru%20Renin%20Angiotensin%20System.pdf. (Accessed on 6 Februari 2017).
71. Thaler MS. 2007. The Only EKG Book You’ll Ever Need. 5th edition. Philadelphia: Lippincott Williams & Wilkins. p.10-61.
72. Vitale C, Mendelsohn ME, dan Rosano GMC. 2009. Gender Differences in The Cardiovascular Effect of Sex Hormones, Nature Reviews Cardiology 6, 532-542. Available at : http://www.nature.com/nrcardio/journal/v6/n8/fig_tab/nrcardio.2009.105_F1.html [Accessed 1 Oktober 2016].
73. Welborn TA, Dhaliwal SS, dan Bennett SA. 2003. Waist-Hip Ratio is the Dominant Risk Factor Predicting Cardiovascular Death in Australia. Medical Journal of Australia, 179(11-12), pp. 580–585. Available at : https://www.mja.com.au/system/files/issues/179_11_011203/wel10182_fm-1.pdf [Accessed 4 Juni 2016].
74. Williams JS, Brown MS, dan Conlin, PR. 2009. Blood-Pressure Measurement. New England Journal of Medicine, 360(19), p.2034. Available at : http://www.nejm.org/doi/pdf/10.1056/NEJMvcm0800157 [Accessed 13 Mei 2016].
75. World Heart Organization. 2014. Global Status Report on Communicable Disease. Available at : http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf [Accessed 4 Mei 2016].
76. World Health Organization, 2006. Obesity and Overweight. Available at: http://www.mclveganway.org.uk/publications/who_obesity_and_overweight.pdf [Accessed 13 Mei 2016].
77. World Health Organization. 2008. Waist Circumference and Waist-Hip Ratio Report of a WHO Expert Conclution Geneva. Available at : http://apps.who.int/iris/bitstream/10665/44583/1/9789241501491_eng.pdf [Accessed 4 Mei 2016].
78. Wu S, Wang R, Jiang A, Ding Y, Wu M, Ma X, Zhao Y, He J. 2014. Abdominal Obesity and Its Association with Health-Related Quality of Life in Adults: A Population-Based Study in Five Chinese Cities. Health and Quality of Life Outcomes, 12(1), p.100. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061454/pdf/1477-7525-12-100.pdf [Accessed 12 Mei 2016].
79. Zhang. 2004. Trends in the Association betwen Obesity Sosioeconomic Status in US Adults. Obesity Research. 12:1622-1632. Available at : http://onlinelibrary.wiley.com/doi/10.1038/oby.2004.202/pdf [Accessed 4 Juli 2016].