Measurements of clinical variables

Waist circumference. Is the measurement of the abdominal girth in centimeters and will be measured in erect position with abdomen relaxed and arms aside and will be recorded over the unclothed relaxed abdomen at the smallest diameter between the coastal margin and the iliac crest of which >94 cm for men and >88 cm for women will be defined as central obesity. In addition, hip circumference in centimeter will be recorded over minimal clothing at the level of the greater trochanter (usually the widest diameter around the buttocks). Waist-hip ratio (WHR) is dimensionless measurement and will be calculated from waist circumference and hip circumference. A WHR ≥0.9 or ≥0.8 will indicate obesity. The sensitivity and specificity of waist-hip ratio of more than 85% compared to body mass index (BMI) in predicting obesity [28, 31].

Blood pressure measurement. A blood pressure (BP) reading will be measured by the conventional method by using a calibrated automated BP machine keeping with the 2018 AHA/ACC hypertension guideline for standard measurement of BP. The patient should be required to empty the urinary bladder prior to measurement, not to smoke, not take alcoholics or caffeine nor strenuous exercises within 30 minutes prior to measurement. Three BP readings will be taken in relaxed position 3 to 5 minutes apart per each reading and an average of the last two BP readings will be used. Blood pressure ≥ 140/90 mmHg will be defined as hypertension [2, 16, 32].