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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 31  |  Issue : 3  |  Page : 839-845

Epidemiology of metabolic syndrome in Menoufia University students


Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission17-Nov-2017
Date of Acceptance10-Jan-2018
Date of Web Publication31-Dec-2018

Correspondence Address:
Ghadeer M.M El Sheikh
Gamal Abdel Nasser Street, Shebin Al-Kom, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_791_17

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  Abstract 


Objective
The aim was to assess the prevalence of metabolic syndrome (MetS) and its associated risk factors in Menoufia University students.
Background
MetS is a growing public health concern worldwide. The rapid sociocultural transition associated with major changes in lifestyle and eating habits has been claimed for the rising rates of MetS among young adults and children, which is the leading cause of developing type II diabetes and cardiovascular diseases.
Participants and methods
A cross-sectional study was conducted during the academic year 2016/2017 at Menoufia University on 455 university students aged 18–25 years. The students were chosen from four faculties using multistage random sample. Anthropometric measurements were obtained. Blood pressure, fasting glucose level, and fasting lipid profile were also measured. MetS was diagnosed using adult treatment panel-III guidelines.
Results
The overall prevalence of MetS was 16.7%, which was more frequent among female students. The most prevalent MetS components were increased waist circumference (41.8%) followed by high triglyceride levels (40.2%) and reduced high-density lipoprotein-cholesterol levels (36.3%). The predisposing factors for having MetS included the following: being female, older than 20 years, obese, physically inactive, high levels of stress, and a positive family history of hypertension and diabetes.
Conclusion
MetS is considered as a public health problem among Menoufia University students. These findings indicate the need for health promotion and prevention programs directed toward the screening, diagnosis, and management of MetS among university students.

Keywords: central obesity, hyperlipidemia, insulin resistance, metabolic syndrome, university students


How to cite this article:
Mahrous OA, Anwar El Shazly HM, Badr SA, Ibraheem RA, Kasemy ZA, El Sheikh GM. Epidemiology of metabolic syndrome in Menoufia University students. Menoufia Med J 2018;31:839-45

How to cite this URL:
Mahrous OA, Anwar El Shazly HM, Badr SA, Ibraheem RA, Kasemy ZA, El Sheikh GM. Epidemiology of metabolic syndrome in Menoufia University students. Menoufia Med J [serial online] 2018 [cited 2019 Mar 25];31:839-45. Available from: http://www.mmj.eg.net/text.asp?2018/31/3/839/248764




  Introduction Top


Metabolic syndrome (MetS) is a great public health problem worldwide[1]. It is characterized by central obesity, elevated fasting blood glucose, dyslipidemia, and elevated blood pressure (BP)[2]. It is known that visceral obesity and the pattern of fat distribution have important implications on the risk of developing metabolic diseases, mainly type 2 diabetes mellitus and heart disease[3]. MetS was primarily described by Reaven[4] as a group of risk factors for diabetes and cardiovascular diseases that include obesity, dyslipidemia, hypertension, and impaired fasting glucose. Several groups have attempted to develop criteria for the diagnosis of MetS. The first attempt was made by the WHO in 1998, which defined MetS by the presence of insulin resistance as essential components of the syndrome, along with at least two of the following parameters: elevated BP, hypertriglyceridemia and/or reduced high-density lipoprotein-cholesterol (HDL-C), obesity [as measured by waist/hip ratio (WHR) or BMI], and microalbuminuria[5]. In 2001, the National Cholesterol Education Program (NCEP) published a new set of criteria that included waist circumference (WC), blood lipids, BP, and fasting glucose[6]. In 2005, the International Diabetes Federation (IDF) definition introduced abdominal obesity as a prerequisite for the diagnosis of MetS, with particular emphasis on waist measurement as a simple screening tool[7]. MetS is associated with lifestyle factors, including consumption of calorie-dense foods, sedentary lifestyle, smoking, alcohol consumption, and stress[8]. MetS in young adult has recently gained greater attention[9]. Most students who enter college are at a crucial transition period from adolescence to young adulthood. College students tend to be affected with the new environment and social influences that may led to unhealthy behaviours. Most specifically, the unhealthy behaviors have involved poor dietary habits and decreased physical activity. Any of these factors can contribute to weight gain and increase prevalence of MetS and its consequences[10]. This demonstrates how the college period is a prime opportunity for intervention by designing programs to prevent MetS, and educating students regarding exercise and healthy dietary choices[11]. There are limited published data on the prevalence of MetS among young adult in Egypt. The aim of this work was to assess the prevalence of MetS among Menoufia University students and identify potential risk factors that can be used for the prevention and management of MetS in young adults.


  Participants and Methods Top


This cross-sectional study was conducted on 455 university students aged 18–25 years old during the academic year 2016/2017 at Menoufia University. The study protocol was approved by the ethical committee of Faculty of Medicine, Menoufia University. A written informed consent was obtained from each participant. The eligible participants were selected from four faculties of the university using multistage random sample. The list of all names of faculties was obtained from Menoufia University Administration Office. The university faculties were stratified into practical and theoretical faculties. Two faculties were randomly selected from each group. The selected faculties were Faculty of Science, Faculty of Agriculture, Faculty of Law, and Faculty of Commerce. In each faculty, students were stratified into four different academic years. From each year, a cluster of students was randomly chosen. A pilot study was done on 57 university students, who were excluded from the analysis later on, aiming at testing the validity of the questionnaire and to reveal any modifications or additions needed, exploring the various obstacles that could be met in implementation of this study, and estimating the time needed to collect the required data. Each participant completed a self-administered questionnaire including sociodemographic data, family history of cardiac diseases, hypertension, diabetes, smoking, and dietary habits. Participants completed the questionnaire under the supervision of the research team after explanation of the research objectives. Socioeconomic level of the participants was classified according to the scoring system of Ibrahim and Abd El-Ghaffar, 1990. This scoring system involved father's and mother's education and occupation, family size, and income. The score of family income was modified to be as follows: more than sufficient = 3, sufficient = 2, and less than sufficient = 1. Scores of all parameters were added, and the scoring system was based on three socioeconomic level (SE levels): high = 9–12, middle = 5 to less than 9, and low = less than 5. In addition, the short version of the International Physical Activity Questionnaire was used to assess level of physical activity, where all types of activities were considered. Students were asked to think about all the vigorous and moderate activities that they had done in the previous 7 days. Vigorous physical activities are those that take hard physical effort and make a person breathe much harder than normal. Moderate activities refer to activities that take moderate physical effort and make a person breathe somewhat harder than normal. Participants were classified into three categories, inactive, moderately active, and highly active, according to the International Physical Activity Questionnaire Research Committee[12]. Perceived stress scale (PSS) was used as a psychological instrument for measuring the perception of stress among the students. PSS scoring was based on that each item is rated on a five-point scale ranging from never (0) to almost always (4). Positively worded items are reverse scored (4, 5, 7, and 8), and the ratings are summed. Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher perceived stress. Scores ranging from 0 to 13 would be considered low stress. Scores ranging from 14 to 26 would be considered moderate stress. Scores ranging from 27 to 40 would be considered high perceived stress. All participants included in the study underwent physical examination. Body weight was measured using digital scale. Calibration was done every morning before starting the work using a standard weight. Weight was taken without shoes and in light clothing. Reading was measured to the nearest 0.5 kg. Height assessment was done using a tape measure permanently fixed to a wall without shoes and recorded to the nearest 0.5 centimeters. BMI was calculated for each respondent. BMI classifications used were underweight (<18.5), normal (18.5–24.9), overweight (25.0–29.9), and obese (≥30.0) according to WHO classification[13]. WC was measured using a nonstretchable tape measure at the point halfway between the lower border of ribs and the iliac crest in a horizontal plane on a light clothed abdomen and recorded to the nearest 0.5 cm. Hip circumference (HC) was measured using a nonstretchable tape measure at the level of maximum posterior extension of the buttocks. WHR was calculated by dividing WC by HC. BP was measured by a trained nurse using digital sphygmomanometer after the participant had rested for at least 15 min. Two consecutive measurements were obtained 5 min apart, and the average of the two readings was recorded. A well-trained nurse collected a 5 ml venous blood sample from each participant after 12 h of fasting into a sterile tube with clot activator for the measurement of serum lipids and glucose. Blood samples were immediately placed in an icebox for a period not exceeding 3 h. The samples were transported to the Central Laboratory at the Faculty of Medicine. Blood samples were centrifuged and analyzed immediately after separation. Analyses for fasting blood lipids, including triglycerides (TG), HDL-C, and total cholesterol, and fasting blood glucose were carried out by enzymatic colorimetric test, using spectrophotometer (Jenway, Keison International Ltd., Chelmsford, UK). MetS was defined according to the adult treatment panel-III (ATP-III) guidelines as the presence of any three of the following five factors: elevated WC (>102 cm in males and >88 cm in females), hypertriglyceridemia (TG >150 mg/dl), reduced HDL-C (<40 mg/dl in males and <50 mg/dl in females), elevated BP (systolic BP >130 mmHg and/or diastolic BP >85 mmHg or use of antihypertensive drugs), and elevated fasting blood glucose greater than 100 mg/dl or on treatment for diabetes.

Sample size calculation

The sample size was calculated using Epi Info (2000), (Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia (US)) program depending on both the total number of Menoufia University students, which was 76 385 students during the academic year (2016–2017), and past review of literature of Al-Isa et al.[14], who estimated the prevalence of MetS on Kuwaiti students and found that the prevalence of MetS was 14.8%. The sample size has been calculated at power 80% and 95% CI. So the calculated sample size was 525 students. To overcome attrition, 50 students were added to the sample size giving a final sample size of 575. After exclusion of students included in the pilot study (57 students), the sample became 518 students. A total of 63 students were excluded from the study: 23 students refused to participate and 40 questionnaires were incomplete, resulting in a response rate of 88%, giving a final sample of 455 students as participants in this work.

Statistical analysis

Statistical presentation and analysis of the present study was conducted with SPSS Version 23 (IBM Corp., Armonk, New York, USA). Data were expressed as mean, SD, frequency, and percentage. The Student's t-test was used for comparison of quantitative data and χ2-test was used for comparison of qualitative data. Z-test was used to compare between two proportions. Odds ratio (ORs) was computed to assess the strength of association between independent risk factors and the dependent outcome (MetS) along with their 95% CI. P value less than 0.05 was considered statistically significant.


  Results Top


The total number of students was 455, with 239 (52.5%) male and 216 (47.5%) female students. Their overall mean age was 20.71 ± 1.7 years (range = 18–25 years). Number of urban participants was 261 (57.4%). Overall, 47% of participants were of moderate socioeconomic status. Most students were nonsmokers (362; 79.6%). Positive family history of hypertension, diabetes, and heart disease was reported in 30.8, 28.4, and 25.3% of the students, respectively. Obese students represented 18.5% of the study population [Table 1]. The prevalence of MetS using NCEB ATP-III criteria was 16.7%, affecting 76 students [Figure 1]. At least one MetS component was found in 184 participants (40.5%), two MetS components were present in 103 participants (22.6%), three MetS components were found in 50 participants (11.0%), and four or more components of MetS were present in 26 participants (5.7%) [Table 2]. The most frequent component of MetS was the increased WC (41.8%) followed by hypertriglyceridemia (40.2%) and low levels of HDL-C (36.3%) whereas elevated fasting blood glucose was the least frequent component (10.1%). Female students had a significantly higher prevalence of increased WC (49.5%) and low levels of HDL-C (41.2%) than male students (34.7 and 31.8%, respectively) [Figure 2]. Participants with MetS had a significantly higher body weight, BMI, WC, HC, WHR, TG, and reduced HDL-C levels [Table 3]. MetS was significantly more common in female than in male students (OR = 1.77, 95% CI = 1.07–2.91). The older aged participants were at more risk to develop MetS (OR = 2.59, 95% CI = 1.24–5.40). MetS was most prevalent in individuals with high socioeconomic level, as it was found in 28.7% of individuals from high social class, whereas it was present only in 14.4% of individuals from low social class. The MetS prevalence was significantly increased with increasing BMI as it was high among obese participants (28.6%) compared with 21.8% of overweight and 10.1% of normal weight participants. Smoking was not significantly associated with the presence of MetS. Moreover, higher levels of physical activity were significantly associated with reduced risk of MetS among the participants. Positive family history of diabetes and hypertension was a significant risk for MetS. Regarding dietary habits, MetS was most common in individuals with high consumption of snacks, fast food, and soft drinks. Moreover, the levels of stress, both moderate stress and perceived stress, carry a significant risk of MetS among the studied participants with OR of 2.95 and 1.94, respectively [Table 4].
Table 1: Baseline characteristics of the participants

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Figure 1: Prevalence of metabolic syndrome among the studied group.

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Table 2: Clustering of risk factors for metabolic syndrome in study population

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Figure 2: Prevalence of metabolic syndrome components among the studied group by sex.

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Table 3: Mean±SD of the anthropometric measurements and biochemical laboratory investigations of the studied group as risk factors for metabolic syndrome

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Table 4: Associations of metabolic syndrome with potential risk factors

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  Discussion Top


The main finding of the present study was a MetS prevalence of 16.7%, which was in line with Al-Isa et al.[14], who estimated the prevalence of MetS in 431 Kuwaiti adolescents aged 10–19 years and found that the prevalence of MetS was 14.8% using IDF criteria. Moreover, this was in concordance with Mattsson et al.[15] who collected their data from 2182 healthy young adults in Finland, and the prevalence of MetS was 13.0% using the NCEP criteria and 14.9% using the IDF criteria. The rates found in the present study were higher than those of Al Dhaheri et al.[16] who revealed a MetS prevalence of 6.8% among 555 Emirati female college students aged 17–25 years. In addition, Sabir et al.[17] found that the prevalence of MetS among 1012 Sudanese university student aged 16–25 years was 8.4% using IDF criteria and 7.5% using NCEP ATP-III criteria. Clearly, the prevalence of MetS could differ between studies depending on the MetS cluster used, design method, different tools used for diagnosis, target population, and participant's lifestyle. Study on the components of MetS showed that central obesity was the most prevalent component (41.8%) of MetS among the students (34.7% male vs. 49.5% female students). This result was consistent with that of Abolfotouh et al.[18] who reported that central obesity was the most common metabolic abnormality among Saudi students as it was prevalent in 42.2% of them. However, this result was lower than that of Obeidat et al.[19] who conducted their study on 630 Jordanian adult participants and found that prevalence of increased WC in the total sample was 71.6%. The reasons behind the increasing obesity among young adults are numerous. The great changes that have occurred in the pattern of life, including unhealthy eating habits, physical inactivity, and smoking, have contributed to more overweight and obese individuals. In the present study, hypertriglyceridemia was the second most prevalent criterion, with a frequency of 40.2%, which was in agreement with Obeidat et al.[19] who found that prevalence of hypertriglyceridemia in their study was 50.2%. However, this result was higher than that of Ahmed et al.[20] who found that elevated TG were present in 28.4% in their studied population. Other metabolic abnormalities include also low HDL-C levels, which were prevalent in 36.3% of the studied population. This result was in agreement with Sabir et al.[17] who found that the prevalence of low HDL-C levels in their study was 41.4%. The criterion for MetS that had the lowest prevalence in this study was high fasting blood glucose levels (10.1%), which was in agreement with Al Dhaheri et al.[16] who found that the prevalence of impaired fasting glucose among their study population was 9.7%. On the contrary, this result was lower than Jain et al.[9] who conducted their study in India on 668 medical students and found that the prevalence of impaired fasting glucose among their study population was 18.1%. In this study, prevalence of MetS in female students was higher than that in male students (20.8 and 13%, respectively), which agreed with Zafar et al.[21] who conducted their study among 2982 Indians and found that the syndrome was more prevalent among female (13.8%) than in male (9.6%) individuals. However, this study's findings contradict the finding of Sawant et al.[22]. Although the exact explanation of such sex variations is not entirely clear, it has been reported that females are less active compared with males. With respect to age, a statistically significant association was observed between magnitude of MetS and increasing age, ranging from 8.4% in the group of individuals less than 20 years to 19.3% in those aged 20 years or older, a result that was in line with rates found by Roos et al.[23] in Arabic women. Regarding participant's residence, the study findings showed that urban residence was associated with higher prevalence of MetS. This result agreed with Li et al.[24] who found that individuals living in urban areas were more likely to have MetS than those living in rural areas. However, this result was not in accordance with the study by Ismael et al.[25] in which residence was not associated with MetS. The increasing prevalence of MetS in urban areas might be contributed to the urbanized lifestyle. Social class is a strong risk factor for having MetS. In the present study, there was a significant positive relation between socioeconomic status and MetS. This result was in consistence with Rafique et al.[26] who reported that in Bangladesh, MetS was noticed to be significantly more prevalent among upper socioeconomic standard (SES) compared with lower SES. On the contrary, Riediger and Clara[27] had found that there was an inverse relation of both household income and SES with MetS in their study. The reason for increasing prevalence of MetS among those with high SES is that they had much more ability and opportunity to consume high-calorie foods causing metabolic changes. Regarding physical activity, participants with low level of physical activity had significantly higher rate of MetS. This result was in agreement with Buckland et al.[28] who found that MetS prevalence tended to decrease when physical activity increased. In this study, consumption of fast food was significantly associated with MetS. This result was consistent with Asghari et al.[29] who reported that positive associations were found between fast food consumption and increased risk of abdominal obesity and hypertriglyceridemia. Moreover, there was a significant association between high consumption of soft drinks and the occurrence of MetS. This result was in line with Dhingra et al.[30] who found that there was a 48% higher prevalence of MetS among those who consumed soft drinks frequently than individuals with infrequent soft drink consumption. This result might be contributed to the fact that higher consumption of fast food and soft drinks is accompanied with increased serum TG, decreased HDL levels, higher insulin levels, and the risk of insulin resistance.


  Conclusion Top


The prevalence of MetS was high in Menoufia University students. So, adoption of preventive lifestyle modifications is recommended to avoid development of MetS among young adult.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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