Original Article An Epidemiological Study for Assessment ...

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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:[email protected]

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.

HealthlineJournalVolume12Issue2(April-June2021)

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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

Pateletal LifestyledisordersamongUniversitystudents....

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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


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


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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