Post on 18-Dec-2021
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OriginalArticle
AnEpidemiologicalStudyforAssessmentofSelectedLifestyleDisordersamong
UniversityStudentsatCentralGujarat,India1 1 2GeetikaMadanPatel ,DharaIZalavadiya ,AnkitaParmar
1 2AssociateProfessor, AssistantProfessor,DepartmentofPSM,ParulInstituteofMedicalSciencesandResearch,
ParulUniversity,Vadodara,Gujarat,India.
Correspondence:Dr.DharaZalavadiya,Email:dharaben.zalavadiya@paruluniversity.ac.in
Accessthisarticleonline
Website:
www.healthlinejournal.org
DOI:
10.51957/Healthline_211_2021
QuickResponseCode Howtocitethisarticle:
PatelG,ZalavadiyaD,ParmarA. Anepidemiologicalstudy for assessment of selected lifestyle disordersamongUniversitystudentsatCentralGujarat, India.Healthline.2021;12(2):21-27.
Abstract:
Introduction:Theprevalenceofoverweightandobesityamongchildrenandadolescentshasrisen
dramatically from just4% in1975 toover18% in2016.Therisk for thenon-communicablediseases
increases,withincreaseinBodyMassIndex(BMI).Objectives:Toprovideepidemiologicalinsightsinto
proportionofmalnutritioninformofunderweight/overweight,hypertensionandhighbloodsugarandto
analysetherelationbetweenanthropometricmeasureswithBloodPressureandBloodSugarlevelamong
University students.Method: A cross sectional study was conducted among newly admitted college
studentsoftheuniversityduring2018.Total3311students'datawerecollectedusingcase-recordform.
Data collection included information on socio-demographic profile from students, anthropometric
measurements,BloodpressuremeasurementandRandombloodsugar(RBS)check-up.Results:Themean
agewas18.7±1.2and19.17±1.6yearsamongmaleandfemalestudents,respectively.Outof3311students,
30.90%wereinunderweightcategoryand18.76%wereinoverweightorobesitycategoryaccordingto
BMI.AccordingtoWaist-Hipratio(WHR),20.6%malesand18.9%femaleshadsubstantiallyincreasedrisk
formetaboliccomplications.Around139(5.99%)malesand16(1.61%)femaleswerefoundtohavehigh
systolic bloodpressurewhile365 (15.7%)males and44 (4.4%) femaleswere inhighdiastolic blood
pressurecategory.Around1.06%hadRBS>140mg/dl.Therewaspositivecorrelationandstatistically
significantassociationbetweenBMIandWHRwithhighbloodpressure.Conclusions:Highprevalenceof
underweight,overweightandobesity,highWHR,highbloodpressureamongyouthpopulationdemands
earlyscreeningandinterventiontopreventmorbidityandmortalityinlaterlife.
Keywords:Lifestyle,Non-communicablediseases,Obesity,Overweight
Introduction:
Undernutrition coexisting with overweight and
obesityissignificanthealthchallengemanycountries.
InIndia,theshareofunderweightadultsisthehighest
globally,evenasthecountryexperiencesanongoing
rise in overweight/obesity due to urbanization,
improved economic conditions, the prevalence of[1]
sedentarylifestyles,anddietarychanges.
Non-Communicable diseases kill 41 million
peopleeachyearglobally. In termsofattributable
deaths,theleadingriskfactorgloballyishighblood
pressure to which 19% of global deaths are
attributed, followed by overweight/obesity and[2]raised blood glucose. Two thirds of premature
deathsinadultsareassociatedwithconditionsand[3]behaviorsofchildhoodandyouth.
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The prevalence of hypertension among
adolescentsis4.5%.Bytheageof15,morethan25%
of obese adolescents have early signs of diabetes.
Amongobeseyouth,70%haveatleastoneriskfactor[4]for cardiovascular disease by the age of 20.
Quantificationofelevatedriskforexposedgroupsof
individualsisimportanttoinformdecisionmakingon
individualhealth;aswellasimportantinputintoany
national or global strategy to improve population[5]healthandmakeprogress.
The present study was conducted with the
objectiveofprovidingepidemiologicalinsightsinto
proportion of malnutrition in form of under
nutrition/ obesity, high blood pressure, high blood
sugar level and to analyze the relation between
anthropometricmeasureswithBloodpressureand
blood sugar level among University students. The
university is Gujarat's one of the leading private
universitycoveringdiploma,undergraduateandpost
graduateprogramsincludingaround21facultieslike
medicine, pharmacy, engineering, arts, commerce,
managementandmanymore.
Method:
It was a cross sectional study including 4000
university studentsenrolled in the firstyearat the
university during 2018 academic year. Schedule of
health checkup was prepared for each and every
facultyinadvancetoensurequalityofcheckupand
maximum attendance of the students, after
discussion with respective principles. Per day
maximum60studentswerescheduled.Ifabsenton
particularday,studentswereallowedtojointhenext
batchof theircollege.At theendofdatacollection,
3328 students participated voluntarily in the
checkup.Afterdatacleaning3311student'sdatawasstavailableforanalysis.Asthestudyinvitedallthe1
year students enrolled during 2018-year, sampling
wasnotrequired.
Inclusion-exclusion criteria : All the students
enrolledfor1styear intheuniversity,gavewritten
consenttotakepartinthestudywereincludedinthest
healthcheckup.Studentswhoarenotin1 academic
year, not ready to give consent, drop outs, having
obviousskeletaldeformitieswereexcludedfromthe
study.
Permission was taken from institutional ethicl
committee prior to the data collection procedure.
Written consent was taken from the participants
beforedatacollection.Datawerecollectedusingcase
recordformwhichincludedstructuredquestionnaire
tocollectinformationonsocio-demographicprofile,
anthropometry and clinical profile including blood
pressure and Random blood sugar (RBS). Socio-
demographicprofilewasfilledupbystudentsafter
proper instruction under supervision of respective
faculties/teachers.
Medical checkuppart includedmeasurementof
Blood Pressure, Random blood sugar and
anthropometric measurement. Anthropometric
measurements, Blood pressure measurement and
RBScheckupweredonebytrainedhealthstaffand
recorded in the form.Trainedhealth staff included
team of fixed medical officers, staff nurse and
l a bo ra to r y t e chn i c i a n . An t h ropome t r i c
measurements included Height, Weight, Hip
circumferenceandWaistcircumference.Instruments
werecalibratedbeforeuse.Heightwasmeasuredto
the nearest 0.1 centimeter using stadiometer, and
weight was measured to the nearest 0.1 kilogram
usingaportablescale.Bothheightandweightwere
measured with shoes, coats, and other heavy
outerwear removed. Body Mass Index (BMI) was
calculated as the ratio ofweight to height squared2(kg/m ).BMI valueswere categorized according to
[6]WHO classification. Waist and hip circumference
weremeasuredaccordingtoguidelinegiveninWaist
CircumferenceandWaist-HipRatioReportofaWHO.
Data were categorized according to WHO cut-off[7]pointsforriskofmetaboliccomplications.
Blood pressure was measured using manual
sphygmomanometerbyauscultatorymethod. If the
student'ssystolicanddiastolicbloodpressurewere
normal, blood pressure was recorded. If the first
measurementwaselevated,thebloodpressurewas
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retakenafter rest for10minutes.Theprocesswas
repeated one more time if the blood pressure
remainedelevatedandstudentswerealsoreferredto
medicine department for further investigation and
management. Blood pressure was categorized[8]accordingtotheJointNationalcommittee(JNC-7)
classifications.RBSwasmeasuredusingglucometer
and results were recorded in mg/dl. Similarly,
studentsthosewhohadhighRBS(≥200mg/dl)value
atthetimeofstudywerealsoreferredtomedicine
department.Abloodglucose levelbetween79and
140mg/dl, 140and200mg/dlandmorethan200
mg/dl was considered normal, prediabetes and
diabetesrespectivelyaccordingtoAmericanDiabetes[9]AssociationCriteria.
Dataentryandanalysis :Dataentrywasdone in
university web portal from case record forms by
trainedhealth staff. Excel sheetwas assessed from
university web portal and used for data analysis.
Proportionandfrequencyforunderweight,obesity,
hypertension and risk for diabetes was calculated
using standard references. Correlation and
association were also checked between different
anthropometricparametersandbloodpressureand
diabetesrisk.
Results:
Around3311students'healthcheck-updatawere
available for analysis. Out of them 2319 (70.04%)
were males and 992 (29.96%) were females. The
meanagewithstandarddeviationwas18.7±1.2and
19.17±1.6 years amongmale and female students,
respectively.Meanvaluesforheight,weight,BMI,Hip
andwaistcircumferencemeasurementsaremorein
males as compared to females except mean RBS.
Therewas significant difference inmean values of
different measurements among males and female
students.(Table1)
Classification according to BMI& WHR: Out of23311students,621(18.76%)hadBMI≥25.0kg/m
andamongthem176(5.31%)wereobeseaccording
toWHOclassification.Around665(28.68%)males
wereunderweightand358(36.09%)femaleswerein
underweightcategory(Table2).Undernutritionwas
statisticallysignificantamongfemalesascompared
tomales(p<0.0001)whileoverweightandobesityis
statistically significant among males (19.75%) as
comparedtofemales(16.42%)(p=0.0278).
Outof3311studysubjects,664(20%)students
were found to be substantially increased risk for
metabolic complications as per their WHR
measurements. According to waist circumference
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Table1:Meanvaluesofbasicmeasurementsinmaleandfemalestudents
Variable
Weight(kg)
Height(cm)2BMI(kg/m )
Waistcircumference(cm)
Hipcircumference(cm)
WHR
SBP(mmHg)
DBP(mmHg)
RBS(mg/dl)
Total
57.57±13.90
164.47±9.12
21.25±4.93
77.85±12.78
93.26±10.47
0.83±0.099
116.84±11.7
76.72±8.08
93.1±15.3
Male
60.57±13.63
168.17±7.27
21.44±5.00
80.28±12.59
93.87±10.44
0.86±0.095
119.26±11.32
78.02±7.99
91.49±14.37
Female
50.54±11.86
155.81±6.85
20.82±4.72
72.19±11.33
91.84±10.40
0.79±0.09
111.19±10.56
73.70±7.49
96.78±16.77
p-value(Independentsamplet-test)
<0.0001
<0.0001
0.0009
<0.0001
<0.0001
<0.0001
<0.0001
<0.0001
<0.0001
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measures,163 (4.9%) students were found to be
substantially increased risk for metabolic
complications(Table3).
ClassificationaccordingtoBloodpressure&RBS:
According to JNC-7 blood pressure categorization,
around139(5.99%)malesand16(1.61%)females
werefoundtohavehighsystolicbloodpressure(SBP)
while365(15.7%)malesand44(4.4%)femaleswere
in high diastolic blood pressure (DBP) category
(Table 4). Frequency of high blood pressure was
higheramongmalesascomparedtofemalestudents
(p<0.0001).
Outof3311students,373(11.3%)studentshad
RBSvaluelessthan79md/dl.Around2903(87.7%)
had RBS values between 79 to 140mg/dl and 35
(1.06%)hadRBSmorethan140mg/dl.Therewasno
Pateletal LifestyledisordersamongUniversitystudents....
Classification
Underweight
Normalweight
Pre-obese
Obeseclass-I
Obeseclass-II
Obeseclass-III
BMI(kg/m2)
<18.50
18.50-24.99
25.00-29.99
30.00-34.99
35.00-39.99
≥40.0
Total(%)
1023(30.90)
1667(50.35)
445(13.44)
131(3.96)
35(1.06)
10(0.30)
3311
Male(%)
665(28.68)
1196(51.57)
330(14.23)
101(4.36)
19(0.82)
8(0.34)
2319
Female(%)
358(36.09)
471(47.48)
115(11.59)
30(3.02)
16(1.61)
2(0.20)
992Total
Table2:ClassificationofstudentsaccordingtoBMI
Table3:Classificationofstudentsaccordingtowaistcircumference,WHRandriskformetaboliccomplicationasperWHOclassification
Cut-offpoints(M)
Males(%)Cut-off
points(F)Female(%)
Riskofmetabolic
complication
Waist >94cm 166(7.2) >80cm 140(14.1) Increased
Waist
WHR
Total
>102cm 87(3.8) >88cm 76(7.7) Substantiallyincreased
>0.90cm 477(20.6) >0.85cm 187(18.9) Substantiallyincreased
2319 992
Table4:ClassificationofstudentsaccordingtoBloodpressure
Category
Optimal
Prehypertension
Stage-1HT
Stage-2HT
Total
SBP(mmHg)
<120
120-139
140-159
≥160
Total(%)
1652(49.89)
1504(45.42)
132(3.99)
23(0.69)
3311
Male(%)
946(40.79)
1234(53.21)
118(5.09)
21(0.91)
2319
Female(%)
706(71.17)
270(27.21)
14(1.41)
2(0.20)
992
DBP(mmHg)
<80
80-89
90-99
≥100
Total(%)
1544(46.63)
1358(41.01)
363(10.96)
46(1.39)
3311
Male(%)
898(38.72)
1056(45.54)
332(14.32)
33(1.42)
2319
Female(%)
646(65.12)
302(30.44)
31(3.13)
13(1.31)
992
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significant difference for being prediabetics
(RBS>141)amongmalesandfemales(p=0.06).Only
2studentswerefoundtohaveRBS>200mg/dl.
Obesity, BP and RBS (correlation): There was
positiveandsignificantcorrelationofSBPwithWaist
circumference (r=0.32), WHR (r=0.16) and BMI
(r=0.29) (p<0.0001). Similarly, DBP was positively
andsignificantlycorelatedwithWaistcircumference
(r=0.27), WHR (r=0.12) and BMI (r=0.26)
(p<0.0001).RBSvalueswereweaklycorrelatedwith
BMI (r=0.052), waist (r=0.007), WHR (r=-0.0016),
SBP(r=0.06)andDBP(r=0.04).
Obesity, BP and RBS (Association): There was
significant association between BMI ≥ 25.0 kg/m2
andhypertension(SBP>139mmHgandorDBP>89
mmHg) (Chi-square=129.6, p<0.0001). Similarly,
there was significant association between Obesity
according to waist circumference (male>95 cm,
female>80cm)andHypertension(Chi-square=81.2,
p<0.0001). Obesity according to WHR (male>0.90
and female>0.85) and Hypertension also showed
significantassociation(Chi-square=26.8,p<0.0001).
Beinghighriskfordiabetes(RBS>140mg/dl)did
not show significant association with any of the
obesitycriterialikeWHR(Chi-square=1.1,P=0.29)or
BMI(Chi-square=1.67,p=0.19).Similarly,therewas
noassociationbetweenhypertensionandbeinghigh
riskfordiabetes(Chi-square=0.86,p=0.35).
Discussion:
Inpresentstudy,Prevalenceofunderweightwas
30.90%.AccordingtoNationalNutritionMonitoring
Bureau (NNMB) report, only two-thirds of the
recommendedcaloriesareconsumedbyadolescent
boys and girls, which result in high prevalence of[10]undernutrition. Barrier function of body is
compromised by undernutrition, which results in
lowerimmunity,easyentryandgrowthofpathogens
inthebody.Infectionacceleratedbyundernutrition
again causes changes in dietary intake, food
absorptionandlossesofendogenousnutrients.That
ultimately result in malnutrition infection vicious[11]cycle. Underweightwassignificantlymorefrequent
amongfemalesascomparedtomalesinpresentstudy
findings.Again,higherrateofundernutritionamong
girls increases morbidity and mortality associated
with pregnancy and child birth. That leads to the[12]intergenerationalcycleofmalnutrition.
Ontheotherhand,Prevalenceofoverweightand
Obesity was 13.44% and 5.32% in present study.
Similarresultwasreportedas15.1%overweightand
5.2% obesity in University Students from 22[ 1 3 ]Countries. Overweight and obesity was
significantly higher among males (19.75%) as
compared to females (16.42%).Number of studies
from Asia also shows that male gender is more[13-16]associatedwithoverweightandobesity.
Large number of students, 45.42%were in Pre
hypertension category, 4.68% had high SBP and
12.35%hadhighDBPinpresentstudy.Frequencyof
high blood pressure was higher among males as
compared to female students. NFHS-4 data also
shows that hypertension ismore prevalent among
adultmales (13.6%) as compared to adult females[17](8.8%). Bloodpressuredifferenceamongmaleand
females are detectable during adolescence and
persistthroughadulthood.Inallethnicgroups,men
tend to have higher mean blood pressure than[18]women. Among premenopausal females, lower
level of blood pressure have been explained by
protectiveeffectofestrogenandotherlifestylehabits[19]likesmokingandalcohol.
Data from Framingham Heart Study, which
followedstudysubjectsfor30 years,showedthatSBP
shows linear increase between the ages of 30 and
84 yearsorover.TheFraminghamHeartStudyalso
showed that cardiovascular risk is continuously,
positivelyandindependentlyassociatedwithrising[20]Bloodpressure. Thus,studentsinprehypertension
category todaymaybe inhypertensioncategory in
later life with increased risk of cardiovascular
complications.
There was positive and significant correlation
betweenWaist circumference,WHR and BMI with
SBP and DBP blood pressure values. There was
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significantassociationbetweenhighBMIandHT,high
WaistcircumferenceandHTandhighWHRandHTin
present study. Similar relationship has been
documented in var ious s tudies between[21-24]anthropometryandBloodpressure. RBSvalues
wereweaklycorrelatedwithobesityintermsofBMI
andWHR.Similarresultisdocumentedbystudydone[25]inruralareaofTelanganastate.
Conclusion:
According to WHR, 20.6% males and 18.9%
females had substantially increased risk for
metaboliccomplications.Around18.76%hadBMI≥2
25kg/m and57.77%were inPrehypertensionor
hypertensioncategory.Outof3311subjects,1.06%
hadRBS>140mg/dl.All thesestudentsareathigh
risk for future NCDs and chronic diseases. On the
otherhand,highnumberofunderweight (30.90%)
students are at risk of morbidity and mortality
associatedwithundernutrition.Therewaspositive
correlation between BMI, WHR and high blood
pressure.
Datapointoutstheopportunitytoeducateyouth
andtheirparentsatearlystageoflife.Youngadultis
an important age-group and any corrective health
measureswillhelpnotonlyimprovetheirindividual
health but could also have a lasting impact in the
communityandalsotowardsbreakingaviciouscycle
of intergenerational malnutrition and preventing/
delaying lifestyle associated morbidities/mortality
laterinlife.
Declaration:
Funding:Nil
ConflictofInterest:Nil
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