Risk factors for cardiovascular disease in obese adolescent male medical students

Objective: To find out cardiovascular risk factors in obese male medical students. Methods: Retrospective, crosssectional observational study of 411 obese male medical students. Period of study: 1 year (January 2013-January 2014). Results: Out of 411 obese male medical students 56% were hypertensive and 44% normotensive and 72% had a positive family history of Cardio Vascular Disease; 55%were leading a sedentary lifestyle and only 44% were exercising. About 24% of subjects were taking non-veg diet. Conclusions: Obese male medical students are at risk of developing cardiovascular diseases.


Introduction
Obesity is an independent risk factor for cardiovascular disease. Obesity is associated with an increased risk of morbidity and mortality as well as reduced life expectancy. The last two decades of the previous century have witnessed dramatic increase in health care costs due to obesity and related issues among children and adolescents.
Obesity is a medical condition in which excess body fat accumulates to the extent that it has an adverse effect on health, leading to reduced life expectancy and/or increased health problems [1]. It is defined by Body Mass Index (BMI) and further evaluated in terms of fat distribution via the waist-hip ratio and total cardiovascular risk factors. Body Mass Index (BMI) defines people as underweight when their BMI is <18.5 kg/m 2 , normal weight when BMI is between 18.5 kg/m 2 and 24.9 kg/m 2 Table 1 shows the percentage of Hypertension in obese medical students. Hypertension was found to be present in 56% subjects and 44% were having normal blood pressure.
A similar study from Slovakia [5] found out that prevalence of Pre-Hypertension was 22.1% and prevalence of Hypertension Stage-1 was 18%. These finding s are similar to our study.
Similar study from West Bank [6] found out that 26% of total students were Hypertensive. These results are less than our study; which could be due to different geographical location or, different lifestyle. In our study 55% students were leading a sedentary life while only 45% were exercising regularly. Another Study [6] found out that 56.5% students were leading sedentary life. These results are similar to our study. Similar study from Bengal [7] found out that 13% students from study group were hypertensive; which is much less than our study and it can be due to life style, local eating preferences and possibly genetic make-up. A similar study from Belgaum [8]; found out that prevalence of Pre-Hypertension was 51.8% and prevalence of Stage-1 Hypertension was 6.1%. These results are only a little higher than our study; mostly due to inclusion of similar age group. Study from Belgaum also found out that 70.03% students were leading sedentary life. These results are higher than our study.
A similar Indian study [9] observed that most of the students give up their sports activities and active lifestyle long before or during their school life, in their quest to pursue a medical career. They go on to lead a sedentary lifestyle with an addition of mental stress to get through the competitive medical entrance exam. These are some of the contributory factors which cannot be overlooked. A similar study [10] also observed an increasing prevalence of sustained hypertension in the obese younger age groups as compared to their lean counterparts-In our study 24% subjects were Nonvegetarian and 76% were vegetarian. In Delhi study [11] 15.2% vegetarians and 33.5% Non-vegetarians were found to be hypertensive. This can be attributed to local food habits and genetic makeup of people. A western study [12] found out that 16% vegetarians and 31.1% Non-vegetarians were hypertensive.Another western study from Oxford [13] found out that 41.3% of the Non-vegetarians were hypertensive These results are more than our study which can be due to Type of meat consumed and frequency of having Non-veg diet in Western population Family history of cardiovascular risk factors-Our study underlines the significance of family history as 57% subjects had a positive family history for cardiovascular disease. This association could be due to impairment in bar reflex sensitivity in hypertension which in part is genetically determined; these findings are similar to a western study [14]. Higher levels of angiotensinogen, cortisol and 18-OH corticosterone (seen in the offsprings of parents with high blood pressure) may also lead to abnormalities of glucocorticoid metabolism and the renin-angiotensin system as stated in a similar western study [15]. In a similar study [16] 47.79% students were leading a sedentary life. These results are less than our study. High prevalence of Hypertension in Belgaum study can be explained by the fact that a much higher percentage (70.03%) of their students of the study group were leading a sedentary life as compared to our study group.

Conclusion
Obesity is a major health hazard all over the world. It is becoming a major health threat among both the sexes and all age groups. Substantial proportions of young medical students are prehypertensive, hypertensive and obese.
Our results highlight the necessity to institute effective prevention and health promotion programs targeting younger age groups. Medical students are not representative of the general population, therefore the studies should be extended to young adult population and investigate the presence of obesity and major cardiovascular disease risk factors and their trends over time.
Unhealthy behavioural practices are present and may progress as students advance through medical college. Developing strategies targeting these risky behaviours and determining the causative factors are necessary measures to promote healthy life style among medical students.
Modifiable cardiovascular risk behaviours are widely prevalent among medical students and increase with years spent in the medical college. Promotion of supportive environment for strengthening student-based approaches and strategic delivery of health education is essential to target these risky behaviours among our future doctors.

Funding: None; Competing interest: None stated
What is already known?-Obesity is the major cause of cardiovascular morbidity throughout the globe.
What this study adds?-Young medical students are suffering from obesity and are at risk of developing cardiovascular diseases.
Funding: Nil, Conflict of interest: None initiated, Perission from IRB: Yes