222
-
Upload
mebiostatistician -
Category
Documents
-
view
380 -
download
2
description
Transcript of 222
Analysis of “Body Mass Index” in MedicalAnalysis of “Body Mass Index” in Medical
Students at Nishtar Medical College, MultanStudents at Nishtar Medical College, Multan
byby
M. NadeemM. Nadeem**, A. Hanif, A. Hanif****, Sh.M. Faheem, Sh.M. Faheem******, ,
S. M. AwaisS. M. Awais********
** 22ndnd year medical student (Nishtar Medical college) year medical student (Nishtar Medical college)
** Biostatistician: Department of Orthopaedic Surgery,Biostatistician: Department of Orthopaedic Surgery,
King Edward Medical University/Mayo Hospital LahoreKing Edward Medical University/Mayo Hospital Lahore
****** Final year medical student (King Edward Medical University)Final year medical student (King Edward Medical University)
******** Sitar-e-Imtiaz & Sitar-e-Imtiaz & Pro-Vice Chancellor, and Prof. Orthopaedic
Surgery,King Edward Medical University, Lahore, Pakistan
ABTRACT: Obesity is an abnormal growth of the adipose tissue. Over weight is
usually due to obesity and causes a large number of diseases. It decreases the
pregnancy rates, low birth rates, low implantation rates, follicle development,
oocyte numbers and increases gonadotropin requirements. BMI is expressed in
term of weight divided by square of height on the basis of BMI, obesity is divided
into different classes; normal range (18.5-24.99), below normal range ( < 18.5 ),
pre-obesity (25-29.99), obesity class I (30-34.99), obesity class II (35-39.99),
obesity class III (above 40).STUDY DESIGN: It was a descriptive cross-sectional
study. RESULTS: 504 students were analyzed during February 2007 to May
2007, to assess the age group, sex distribution along with body mass index.
There were 269 males (53.4%) students and 235 female (46.6%) students. 67
students represented their age above or equal 20 years and 437 students were
below 20 years. Moreover we analyzed there were 102 (44 males and 58
females) students having BMI below normal range, 358 students (193 males and
165 females) of normal range and there were 44 students (29 males and 12
females) with obesity including all three classes.
INTRODUCTIONINTRODUCTION
Obesity is an abnormal growth of the adipose tissue. It is the
prevalent form of malnutrition. It affects children and adults. It is one of the
significant contributors to ill health. It is a key risk factor in natural history of other
chronic and non communicable diseases (1) Greater BMI, weight and body
surface area (BSA)associate with wider retinal venules, while greater BMI and
large waist circumference associate with narrower retinal arterioles(3) . BMI
associate with bacteria count (4). There is a weak correlation between BMI and
early complications following hip replacement surgery, and there also seems to
be a correlation between the operating surgeon and early complications (5).
Over weight is usually due to obesity and causes a large number of diseases.
Obesity is a detriment to human which is reflected in increased morbidity and
mortality. The Framingham Heart Study in United States showed a dramatic
increase in sudden death among men more than 20% over weight (1). It
decreases the pregnancy rates, low birth rates, low implantation rates, follicle
development, oocyte numbers and increases gonadotropin requirements (2).
Obesity is expressed in term of body mass index (BMI) (1). BMI is expressed in
term of weight divided by square of height. On the basis of BMI, obesity is
divided into different classes; normal range(18.5-24.99),below normal range( <
18.5 ), pre-obesity (25-29.99), obesity class I (30-34.99), obesity class II (35-
39.99), obesity class III (above 40).
Medical student population is considered the most ideal population all over the
world. It was expressed from the present study that they had also abnormal BMI.
Medical education may alter physicians' earlier stereotypes of obesity. Present
study was carried out at the Nishtar Medical College Multan during year 2007.
Data regarding consecutive 504 students was analyzed. Obesity causes a lot of
health problems. So, it is necessary to overcome its causes, so that it can be
reduced. It's necessary to foment preventive ways against overweight in young
adult life because in this age it's possible to revert the higher blood pressure
levels and other disorders
LITERATURE REVIEW
Bakr EM, Ismail NA, Mahaba HM ( 2002): described that this cross sectional
study was carried out to assess the nutritional status of medical students and to
determine its relation to their life style. The study involved 317 students at, Am
Shams University. Anthropometric measurements such as weight, height, mid-
arm circumference, triceps skin fold thickness and body mass index were
measured. The study revealed that 41.3% of the students were of normal weight
while 9.5% of the sample was underweight, 36.9% were overweight and 12.5%
were obese. The mean mid upper arm circumference (MUAC) and mid arm
muscle circumference (MAMC) of males was significant higher than that of
females, while the mean triceps skin fold (TSF) of females was significant higher
than that of males. Obese individuals eat more during watching television and
during feeling of stress compar ed to non-obese. We concluded that about half of
medical students were overweight and obese. The most important life style
factors responsible for obesity were longer time spent using computer, eating
more during time of stress and snacking between meals. Also, genetic factors
played an important role in development of obesity.
Nieradko-Iwanicka B (2005): described that this work was concerned with an
approach to teaching of obesity as a civilization-related disease to medical
students. Brainstorming, snowball discussion, careful reading of medical texts,
evidence-based medicine, and practicals on how to measure BMI and WHR were
exploited. Analysis of medical histories to disclose risk factors of ischemic heart
disease and polymetabolic syndrome X are proposed.
Chow VT, Phoon MC (2003): described that, leptin is a peptide hormone that
plays a key role in the regulation of body weight and composition. Overweight
individuals generally demonstrated higher circulating leptin concentrations than
healthy-weight and underweight participants. The differences in mean leptin
levels between underweight and overweight males (P = 0.006), as well as
between healthy-weight and overweight males (P = 0.011) were statistically
significant. Comparison tests of leptin levels between healthy-weight and
underweight females were highly significant (P = 0.001). Highly significant linear
correlations between BMI and the logarithm of leptin concentration were
observed in the female (r = 0.44) and male (r = 0.36) groups. The findings also
corroborate evidence that adiposity determines leptin levels.
Rasheed P, Abou-Hozaifa BM, Khan A (1994): described that The prevalence of
obesity was examined among Saudi female medical and nursing students. The
analysis was made on 222 students whose ages ranged from 18-25 years. The
prevalence rate of obesity by body mass index was found to be 30.6% with more
girls falling in the Grade I (26.1%) than the Grade II (4.5%) category. Using the
skin fold measurement as a standard, a smaller proportion (16.8%) of students
was observed to be obese indicating variation in the sensitivity of the two indices
as measures of body fatness. The prevalence of obesity in these young Saudi
women was notably high.
Wiese HJ, Wilson JF, Jones RA, Neises M (1992): described that the purpose of
this study was to develop and evaluate an educational intervention designed to
modify the stigma held by first-year medical students towards obese patients...
Analysis of students' attitudes toward obese patients five weeks and one year
after the course indicates that the intervention was effective.. One year after the
course, the intervention group was significantly more likely to rate genetic factors
as important in obesity and less likely to blame the obese for their conditions.
Cowan GS, Smalley MD, Defibaugh N, Cowan KB, Hiler ML, Sehnert W, James
S (1991): described that cultural indoctrination throughout childhood largely
defines adult value systems including stereotypic attitudes towards the obese. It
is possible that medical education may alter physicians' earlier stereotypes of
obesity. We conclude that obesity appears to carry a burdensome degree of
societal prejudice, as reflected by negative stereotypes, which is largely
unaffected by undergraduate or postgraduate medical education.
Gümez-Sandoval JC, Moreno-Altamirano L, Méndez-Vargas R, Alba-Leonel A,
Argotte-Roumagnere A, Aparicio-Cabrera A (1990): described that there is
evidence of an association between obesity and hypertension.. We found that in
males, the 21.89% was overweight or obese and in females, the 25.98% was in
this range. The blood pressure was greater in males. The prevalence ratio was
greater than 1 in all cases. The observations founded suggest that the
mechanism that protect females in young adult life are nulified by the overweight.
It's necessary to foment preventive ways against overweight in young adult life
because in this age it's possible to revert the higher blood pressure levels..
McClamrock HD (2007): described that excess weight is associated with
decreased pregnancy rates, lower birth rates, lower implantation rates, and the
possibility of decreased follicle development and oocyte numbers as well as an
increased gonadotropin requirement in patients undergoing in vitro fertilization or
intracytoplasmic sperm injection.
A. D. Patel and M. Albrizio (2006): described that the purpose of this study was to
evaluate the relationship between body mass index and early complications
following total hip replacements. Out of Five hundred and fifty patients, fifty-six
patients (10.2%) had an early complication following hip replacement surgery.
Forty-four patients (8%) had a major local complication. Overall, there did seem
to be a weak correlation between BMI and the rate of complications, with a p
value of 0.104. A correlation was also found between the surgeon and presence
of complications with a p value of 0.736. There is a weak correlation between
BMI and early complications following hip replacement surgery, and there also
seems to be a correlation between the operating surgeon and early
complications,
Ohe K, Hachiya Y, Takahashi Y, Oda S, Takahara K. (1992): described that for
the purpose of evaluating the significance of obesity in a young population as a
risk factor toward various chronic diseases. The following results were obtained.
(1) The average obesity index of the students showed a progressive and
significant increase in the past 13 years from 1979 to 1991. (2) A close
correlation between the obesity index and serum GPT was recognized This
finding was intensified in 142 obese students with an obesity index of over 10%,
but it was not seen in the remaining non-obese students. (3) The correlation
between the obesity index and serum GPT was found solely in the group of
students with constant obesity; (4) Systolic blood pressure was related to the red
blood cell count rather than to the obesity index. (5) No particularly close
correlation to serum cholesterol was found with any of 10 representative items
examined in this physical checkup, From the above findings, it can be concluded
that constant obesity in students is related to liver dysfunction,
AIM AND OBJECTIVE
To study the medical student’s population in Nishtar Medical College Multan
during February through May, 2007 for the following aims and objectives
1- Gender distribution
2- Age distribution
3- Frequency of different obesity classes
4- Frequency of different obesity classes with sex
5- Frequency of different obesity classes with age and sex
MATERIAL AND METHODS:
STUDY SAMPLE
504 medical students of 1st year, 2nd years, 3rd years and house officers of both
sexes were included in this study of BMI
PLACE OF STUDY
This study was conducted in Nishtar Medical College Multan during, February to
May 2007.
STUDY DESIGN
A descriptive cross-sectional study.
ANALYSIS
SPSS 11.5 for analysis.
METHODS
1. Classification of BMI used in this study (Mushtaq Ahmad. Esstials of
Medical Biochemistry, 7th edition 2001.Merit Publishers;110-115.)
1- Below normal range (less than 18.5)
2- Normal range (18.5 to 24.5)
3- Pre-obesity or overweight (25 to 29.9)
4- Obesity (equal and more than 30)
2. Weight was measured using kg weight scale.
3. Height was determined using a length measuring tape in cm.
4. The BMI calculating formula was weight in kg divided by square of height
in meter.
RESULTS:
Table 1: Gender Frequency Distribution
Frequency Percent
Male 269 53.4
Female 235 46.6
Total 504 100.0
The above table shows that the ratio of male students is more than that of
the female students i.e. 53.4% and 46.6% respectively.
Table 2: Frequency Distribution for age
Gender Total Percent
Male Female
Age Above 20 53 14 67 13.3
Below= 20 216 221 437 86.7
Total 269 235 504 100
According to the table 2 there are 437 students i.e. 86.7% with age below or
equal 20 years and the rest of the students i.e. 13.3% have age above 20 years.
Table 3: Frequency Distribution for BMI
Frequency Percent
Below Normal Range 102 20.3
Normal Range 358 71.0
Above Normal Range 44 8.7
Total 504 100.0
71% people investigated as normal, 20.2% having range below 18.5 and the rest
of the people are above normal range (showing over weight).
Table 4: Cross tabulation for AGE vs. Gender
Gender Total Percent
Male Female
AGE <18.5 44 58 102 20.3
18.5-24.5 193 165 358 71
More than 24.5 32 12 44 8.7
Total 269 235 504 100
There are 71% persons between the ranges of 18.5-24.5 in which males are
more i.e. 193.
Table 5: Cross tabulation for BMI vs. Gender vs. Age
Gender
TotalMale Female
Below or equal 20
Years of age
Range <18.537 56 93
18.5-24.5 157 153 310
Pre Obesity 22 12 34
Obesity 0 0 0
Total 216 221 437
Above 20 years
of age
Range <18.57 2 9
18.5-24.5 36 12 48
Pre Obesity 10 0 10
Obesity 0 0 0
Total 53 14 67
Grand Total 269 235 504
According to the above table, male students were more in both groups, (Age
below and equal 20 i.e. 437 and above 20 i.e. 67).
No female complaints as pre obesity in group of age above 20. While the normal
ranges are more than the other categories.
DISCUSSION
Obesity is due to abnormal distribution of fat. It affects adults more than children.
Male adults are sensitive as compare to the female adults. Due to the improper
and less information we are unable to represent the age, height and weight in
form of mean and standard deviation. The other important statistics have been
calculated and represented in the form of percentages and frequencies.
Moreover in the study of Bakr EM, Ismail NA, Mahaba HM ( 2002), 41.3% of the
students were the normal weight while 9.5% of the sample were underweight,
36.9% were overweight and 12.5% were obese, but present study showed that
71% were normal while 20.2% were below normal range and 8.75 were above
normal range. Female were more below normal range i.e. 11.5% than the male
i.e. 8.7%. Male were more in normal range i.e. 38.29 than that of female i.e. 32.7.
Above the normal range, male were 6.4% and female were 2.4% but obesity is
0% in both sex. Lastly, pre-obesity is more in male than female which is the first
step to be obese.
CONCLUSIONS:
The ratio of Pre-obesity was more in male students than that of
female. Present study included 53.4% male,46.6% female students below and
equal 20 years of age, BMI was normal in 71%, below normal in 20% and above
normal in 9%. The occurrence of BMI less than normal was more than two times;
as compared to BMI more than normal. In present study not a single case of
obesity was identified. Abnormal BMI occurs due to food factor, genetic factor
and hormonal factor. Abnormal BMI range in medical students indicates that their
food is not good. They are not provided balance diet in hostels.
RECOMMENDATIONS:
1.It is recommended to develop nutritional education and physical activities
programs to face the problem of increasing the rate of overweight and obesity.
2. Preventive programs for weight control and a healthy lifestyle among medical
students should be emphasized from young adulthood or perhaps earlier. Thus it
is necessary to foment preventive ways against overweight in young adult life
because in this age it is possible to revert the higher blood pressure levels and
other disorders. Federal, Provincial, Medical College and Hospital administration
need to acknowledge for more explicitly than ever before, the need to prevent the
overweight causes and to effective treatment of it.
3. It is important to note that in this study 20.3%students are underweight and
therefore need supplementation in their diet
4. Finally all of the level mentioned earlier is expected to improve their policies,
because obesity is a stair for causing the others severe diseases.
REFERENCE:
1. J.E. Park. Preventive & Social Medicine, 28th edition 2005-06.M/s
BANARSIDAS BHANOT; 298-300
2. Mc Clamrock HD. The great weight debate: Do elevations in body
mass index (BMI) exert a negative extraovarian effect on in vitro
fertilization outcome? Fertil Steril; 2007 Jun 29
3. Taylor B, Rochtchina E, Wang JJ,Wong TY, Heikal S,Saw SM,Mitchell P.
Body mass index and its effects on retinal vessel diameter in 6-year-
old children. Int J Obes (Lond); 2007 Jul 3.
4. Vagstrand K, Karin Lindross A, Birkhed D, Linne Y. Associations
between salivary bacteria and reported sugar intake and their
relationship with body mass index in women and their adolescent
children. International Journal of Obesity; 3 July 2007.
5. A. D. Patel and M. Albrizio. Relationship of body mass index to
early complications in hip replacement surgery
International Orthopaedics Journal, 8 September 2006.
6. Mushtaq Ahmad. Esstials of Medical Biochemistry, 7th edition
2001.Merit Publishers;110-115.
Author’s Group Photo
Left to Right: Prof. S. M. Awais, Sh. M. Faheem, M. Nadeem, Asif Hanif and Asim Butt