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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 12  |  Issue : 2  |  Page : 174-178

Estimation of prevalence of metabolic syndrome among 1st year medical students of a medical college in North Karnataka, India


1 Department of Physiology and Biochemistry, JN Medical College, Belagavi, Karnataka, India
2 JN Medical College, Belagavi, Karnataka, India
3 College of Jundiai, Jundiai, Brazil
4 Democritus University of Thrace, Alexandroupoli, Greece

Date of Web Publication4-Jun-2019

Correspondence Address:
Dr. Vanishree Jabannavar
Department of Biochemistry, JN Medical College, Kaher, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_13_19

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  Abstract 


BACKGROUND: Metabolic syndrome is a growing concern as it predisposes to cardiovascular comorbidities and type 2 diabetes mellitus. Medical students lead fairly sedentary lifestyle. Early detection of metabolic syndrome and follow-up would help in preventing complications. The objective of the study was to determine the prevalence of metabolic syndrome in healthy medical students of JN Medical College and to compare the prevalence among male and female students.
METHODOLOGY: A cross-sectional observational study was conducted from January 2018 to July 2018 involving 120 students, of which 67 (55.83%) were female and 53 male (44.17%). The study was conducted using the criteria for metabolic syndrome defined by international diabetes federation. Data for height, weight, body mass index, waist circumference, fasting blood glucose, serum cholesterol, serum triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein were collected. Data were analyzed using SSPS version 20.0. Comparison of physiological parameters was done using independent t-test, and prevalence was estimated using Chi-square test. P < 0.05 was considered as statistically significant.
RESULTS: Metabolic syndrome was observed in 10.83% of sample population comprising 11.94% female and 9.43% male population. The prevalence among females was found to be more than males but not statistically significant (P = 0.66). The prevalence of individual parameters for metabolic syndrome were abdominal obesity (59.17%), raised TG (2.50%), reduced HDL (38.33%), raised blood pressure (BP) (systolic BP [SBP] – 20.83% and diastolic BP – 28.33%), and raised blood glucose (5.83%). In terms of gender analysis, 46.27% females and 28.30% of male had lower HDL values (P = 0.04). SBP was higher in 37.74% male when compared to 7.46% female (P = 0.0001).
CONCLUSION: The study concludes that the overall prevalence of metabolic syndrome was found to be 10.83%. The prevalence among female (11.94%) was more than male (9.43%) population but not found to be statistically significant. Early detection of metabolic syndrome would help bring about attitude and lifestyle changes to prevent the progression of disease and its complication.

Keywords: High-density lipoprotein, medical students, metabolic syndrome, waist circumference


How to cite this article:
Teli A, Jabannavar V, Adorno I, Gayatri G S, Lampis F, Patil P. Estimation of prevalence of metabolic syndrome among 1st year medical students of a medical college in North Karnataka, India. Indian J Health Sci Biomed Res 2019;12:174-8

How to cite this URL:
Teli A, Jabannavar V, Adorno I, Gayatri G S, Lampis F, Patil P. Estimation of prevalence of metabolic syndrome among 1st year medical students of a medical college in North Karnataka, India. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2019 Jun 20];12:174-8. Available from: http://www.ijournalhs.org/text.asp?2019/12/2/174/259633




  Introduction Top


Metabolic syndrome is a group of vascular and metabolic risk factors, including insulin resistance, dyslipidemia, and hypertension. Metabolic syndrome is associated with the risk of developing Type 2 Diabetes Mellitus (TDM), polycystic ovary syndrome, fatty liver, asthma, sleep disorders, cancer, and cardiovascular disease (CVD).[1] In the US and South Asia, about a quarter of the adult population has metabolic syndrome. The prevalence increases with age, with racial and ethnic minorities being particularly affected. Central obesity, physical inactivity, and stress are three of the most important risk factors, which can lead to the development of metabolic syndrome.[2]

The international diabetes federation (IDF) defined metabolic syndrome as the presence of central obesity along with any two of the following five conditions:

  1. Raised triglycerides (TG): ≥150 mg/dL, or on specific treatment for this lipid abnormality
  2. Reduced high-density lipoprotein (HDL) cholesterol: <40 mg/dL in males, <50 mg/dL in females, or specific treatment for this lipid abnormality
  3. Raised blood pressure (BP): systolic BP (SBP) ≥130 or diastolic BP (DBP) ≥85 mm Hg, or on treatment of previously diagnosed hypertension
  4. Raised fasting plasma glucose (FPG): >100 mg/dL, or previously diagnosed type 2 diabetes mellitus (T2DM)
  5. If body mass index (BMI) is >30 kg/m2, central obesity can be assumed and waist circumference does not need to be measured.[2]


There is a rising prevalence of obesity and metabolic syndrome in India and other South Asian countries thereby increasing the rate of mortality and morbidity due to CVD and T2DM.[3],[4] The metabolic syndrome is seen in approximately about one-third of urban South Asians.[5] Approximately 30% of Asian Indian children and adolescents seem to have insulin resistance, and many seem to exhibit features of metabolic syndrome.[6] Since obesity and metabolic syndrome may continue into adulthood leading to CVD and T2DM, these clinical entities need to be recognized early in the life course for effective prevention of the same.[7]

Medical students spend most of their day dealing with their studies: attending lectures at the college, having hospital postings, and studying for their practical and theoretical examinations. Thereby, there are significant time pressures on students that may prevent adoption of a healthy lifestyle leading to a sedentary life. Moreover, their diet is characterized by the frequent and big consumption of unhealthy food. Unhealthy or junk food is a term for food that contains a large number of calories from sugar or fat with little fiber, protein, vitamins, or minerals[2] and therefore increases the risk of obesity.

Chronic stress in the work environment has been recently reported to be associated with the metabolic syndrome. According to some studies, early detection and follow-up interventions for the metabolic syndrome at the workplaces are promising.[8] The high demands of the educational system, the antagonism between the students and the difficulty of the examinations can lead to the development of stress.[9] All these show that medical students nowadays are especially prone to metabolic syndrome.

The detection of the metabolic syndrome at an early age and a follow-up intervention is the best way to deal with it at its earliest and minimize its symptoms. The follow-up interventions may include lifestyle modifications consisting of regular exercise and dietary modification.[10] Thus, this study was intended to investigate the prevalence of metabolic syndrome among young healthy 1st year medical students.

Objectives

  1. To estimate the prevalence of metabolic syndrome in young healthy 1st year medical students of JN Medical College
  2. To compare the prevalence of metabolic syndrome among male and female students.



  Methodology Top


The present study is a cross-sectional observational study that was conducted among 1st year medical students with age ranging from 17 to 23 years attending JN Medical College, Belagavi. The mean age was found to be 20 years. The sample size estimated was 120, which was calculated with the following formula: prevalence of metabolic syndrome is 22%,[2] with precision of 10% and confidence level of 99%; so, n = Z2 PQ/d2, where P = 22%, Q = 78% (100–22), d = 10, Z = 2.58 (99% CI), n = 114 ≈ 120. The study was conducted from January 2018 to July 2018.

This study received institutional approval from the ethical committee, and participants gave their written informed consent.

The individuals included were those willing to participate in the study, and those already diagnosed with hypertension, diabetes mellitus, and students with any other medication which would affect the parameters and not willing to participate in the study were excluded.

The study was done according to the criteria for metabolic syndrome defined by IDF.[2],[11] IDF recommends that the threshold for waist circumference to define abdominal obesity in people of Asian origin should be ≥90 cm for men and ≥80 cm for women and any two of the following: TG ≥150 mg/dl, HDL <40 mg/dl for men, <50 mg/dl for women, BP ≥130/85 mmHg, and FPG ≥100 mg/dl.

The height was measured using height meter and the weight with the standardized scale. The waist circumference was measured using an inch tape immediately above the iliac crest as defined by National Cholesterol Education Program-Adult Treatment Panel III guidelines.[12] The BMI was calculated as weight/height in meter square (Quetelet's index).[13] The BP was taken after giving rest for 5 min and then recorded in the supine position from the right arm. Three readings were taken with 1 min of interval between each measurement, and best of three was considered. Blood samples (blood glucose and lipid profile) were collected from the antecubital vein, in the early morning, after a minimum of 12 h of fasting period, in a supine position then sent for estimation. Serum TG, Cholesterol, HDL, and LDL were estimated as per instruction manual provided by kit (ERBA – Diagnostic Germany), and FPG was estimated by glucose oxidase – peroxidase method end point colorimetric method.[14]

The statistical analysis was processed using SPSS write IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp.). Independent t-test and Chi-square test were applied for comparison of parameters and metabolic syndrome between male and females. Statistical significance was set at 5% level (P < 0.05).


  Results Top


Of 120 individuals, 53 (44.16%) were males and 67 (55.83%) were females. The mean age was found to be 20 years (age range: 17–23 years) [Table 1]. Considering that this study used the criteria established by the IDF for diagnosing metabolic syndrome, the prevalence of metabolic syndrome was found to be 10.83% [Table 2] comprising of 9.43% (5) of males and 11.94% (8) females with a total of 13 students suffering from metabolic syndrome. The prevalence of individual parameters for metabolic syndrome were abdominal obesity (59.17%), raised TG (2.50%), reduced HDL (38.33%), raised BP (SBP – 20.83% and DBP – 28.33%), and raised blood glucose (5.83%) [Figure 1].
Table 1: Comparison of males and females with mean age and body mass index by independent t-test

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Table 2: Prevalence of metabolic syndrome in study respondents

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Figure 1: Prevalence of various parameters in study respondents

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According to [Table 1] when comparing gender, it can be observed that females show higher prevalence for abnormal waist circumference, TG, and HDL levels. Moreover, males have higher prevalence for abnormal levels of FPG and BP, systolic and diastolic. The only parameters that had statistically significant difference between the both were SBP, 37.74% in males to 7.46% in females (P = 0.0001), and HDL levels, 46.27% in females to 28.30% in males (P = 0.04) [Table 3]. Even though females have a higher prevalence of metabolic syndrome over males, the difference between them is not statistically significant (P = 0.66), as can be seen in [Table 4].
Table 3: Statistical difference in prevalence of metabolic syndrome and its individual components in males and females

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Table 4: Comparison of males and females with mean scores of other parameters by independent t-test

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  Discussion Top


The present study was undertaken on 1st year medical students aged between 17 and 24 years. The prevalence of metabolic syndrome was estimated as 10.83% comprising of 9.43% for males and 11.94% for females with a total of 13 students suffering from metabolic syndrome. About 12.5% of the students had every value within normal range; so, of the 107 students without metabolic syndrome, 92 of them have at least one variable above or below normal values [Table 3].

A similar study led by Kanitkar et al., on metabolic syndrome in 250 medical students with a age group between 18 and 27 years, showed a prevalence of 22%. The prevalence was found to be more compared to our study as this study considered all undergraduates and postgraduates students wherein we restricted our study to only 1st year medical students. Furthermore, the same study showed abdominal obesity as the most prevalent risk factor (53% for men and 57.8% for women) which is in accordance with our study where waist circumference was the most prevalent risk factor for women (65.67%) and the second most prevalent for men (50.94%) coming behind BMI (56.6%). Furthermore, the same study had a very similar prevalence for low HDL levels in women 43.7%, as compared to our study with 46.27%.[2]

The prevalence of metabolic syndrome for men and women was found to be 9.43% and 11.94%, respectively, in the present study. The prevalence between men and women was not statistically significant. Similar study led by Ruano Nieto et al. also found the prevalence to be higher in women 68% compared to men 32%, in a total of 73 (8.2%) of diagnosed students with metabolic syndrome.[15] Ford conducted a study on US adults aged between 20 and 19 years and showed that the prevalence of metabolic syndrome was 21.8% in men and 14.6% in women; even though the prevalence was more in men than that in women, it was not statistically significant.[16] Another study led by Ogbera stated the same prevalence for both the sexes.[17]


  Conclusion Top


The study concludes that the prevalence of metabolic syndrome was 10.83% among 1st year medical students with 9.4% in men and 11.94% in women. About 76.6% of students showed at least one risk factor for developing metabolic syndrome. Given the large sample population having at least one risk factor, it is important to promote healthy lifestyle. Early detection and hence early prevention of the condition and awareness to the young individuals helps them to remain stay fit and healthy.

Limitation

Small sample size; the results of which cannot be generalized.

Acknowledgment

We extend our sincere gratitude to Dr. Ravi Ghatanatti, Assistant Professor, Department of Cardiothoracic and Vascular Surgery, J N Medical College, Belagavi, Karnataka, India, for helping us in choosing this topic which is significant as it is more prevalent in the present scenario. We thank Dr Sanjay Mishra Scientist – Grade II Dr. PKBSRC, KLE Academy of Higher Education and Research, Belagavi, for helping us in laboratory work and Mr S B Javali, Associate Professor in statistics, USM-KLE, International Medical College for helping us in statistical work. We would also like to thank the foreign students Isabella Adorno and Fillipos Lampis who had come as a part of elective postings to department of Physiology for helping us in doing the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bodor JN, Rice JC, Farley TA, Swalm CM, Rose D. The association between obesity and urban food environments. J Urban Health 2010;87:771-81.  Back to cited text no. 1
    
2.
Kanitkar SA, Kalyan M, Digvijay P, More U, Karkrani AL, Gaikwad A, et al. Metabolic syndrome in medical students. JIMSA 2015;28:14-5.  Back to cited text no. 2
    
3.
Mohan V, Rao GH. Type 2 Diabetes in South Asians. 1st ed. New Delhi: South Asian Society on Atherosclerosis and Thrombosis; 2007.  Back to cited text no. 3
    
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Prasad DS, Kabir Z, Dash AK, Das BC. Abdominal obesity, an independent cardiovascular risk factor in Indian subcontinent: A clinico epidemiological evidence summary. J Cardiovasc Dis Res 2011;2:199-205.  Back to cited text no. 4
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Misra A, Khurana L. The metabolic syndrome in South Asians: Epidemiology, clinical correlates and possible solutions. Int Diabetes Monitor 2009;21:92-101.  Back to cited text no. 5
    
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Misra A, Misra R, Wijesuriya M, Banerjee D. The metabolic syndrome in South Asians: Continuing escalation and possible solutions. Indian J Med Res 2007;125:345-54.  Back to cited text no. 6
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Prasad DS, Kabir Z, Dash AK, Das BC. Childhood cardiovascular risk factors in South Asians: A cause of concern for adult cardiovascular disease epidemic. Ann Pediatr Cardiol 2011;4:166-71.  Back to cited text no. 7
    
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Leutzinger J, Pirner M, Landschulz W, Nevins RL, Sullivan S, Silberman C. Metabolic syndrome and worksite health promotion. Am J Health Promot 2006;21:1-11, iii.  Back to cited text no. 8
    
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Chandola T, Brunner E, Marmot M. Chronic stress at work and the metabolic syndrome: Prospective study. BMJ 2006;332:521-5.  Back to cited text no. 9
    
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Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association's strategic impact goal through 2020 and beyond. Circulation 2010;121:586-613.  Back to cited text no. 10
    
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Alberti KG, Zimmet P, Shaw J. Metabolic syndrome – A new world-wide definition. A consensus statement from the international diabetes federation. Diabet Med 2006;23:469-80.  Back to cited text no. 11
    
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Wang J, Thornton JC, Bari S, Williamson B, Gallagher D, Heymsfield SB, et al. Comparisons of waist circumferences measured at 4 sites. Am J Clin Nutr 2003;77:379-84.  Back to cited text no. 12
    
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Borch-Johnsen K. The metabolic syndrome in a global perspective. The public health impact – Secondary publication. Dan Med Bull 2007;54:157-9.  Back to cited text no. 13
    
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Trinder P. Determination of blood glucose using an oxidase-peroxidase system with a non-carcinogenic chromogen. J Clin Pathol 1969;22:158-61.  Back to cited text no. 14
    
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Ruano Nieto CI, Melo Pérez JD, Mogrovejo Freire LE, De Paula Morales KR, Espinoza Romero CV. Prevalence of metabolic syndrome and associated risk factors in medical students of universidad central Del ecuador. J Endocrinol Diab 2015;2:10.  Back to cited text no. 15
    
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Ford ES. Prevalence of the metabolic syndrome defined by the international diabetes federation among adults in the U.S. Diabetes Care 2005;28:2745-9.  Back to cited text no. 16
    
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Ogbera AO. Prevalence and gender distribution of the metabolic syndrome. Diabetol Metab Syndr 2010;2:1.  Back to cited text no. 17
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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