Singh M. P. 1, Singh D 2
1Dr. Mahendra Pratap Singh, Assistant Professor, Department of Physiology, Amaltas Institute of Medical Sciences, Dewas (MP), India, 2Dr. Deepti Singh, Assistant Professor, Department of Paediatrics R.K.D.F. Medical College Hospital and Research Centre, Bhopal (MP), India
Address for Correspondence: Dr. Mahendra Pratap Singh, Assistant Professor, Department of Physiology Amaltas Institute of Medical Sciences, Dewas (MP), India. Address-A-1, Sonal Apartment, Old Agrawal Nagar, Near Agrasen Chowk, Sapna Sangeeta Main Road, Near Prestige Investigations, Indore (M.P) India. E-mail: drsinghmp1970@gmail.com
Abstract
Objective: To find out cardiovascular risk factors in obese male medical students. Methods: Retrospective, cross-sectional 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.
Key words: Obesity, medical students, Body Mass Index for age, hypertension
Manuscript received: 5th October 2016, Reviewed: 13th October 2016
Author Corrected: 20th October 2016, Accepted for Publication: 28th October 2016
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/m2, normal weight when BMI is between 18.5 kg/m2 and 24.9 kg/m2, overweight (pre-obese) when their BMI is between 25 kg/m2 and 30 kg/m2, and obese when it is greater than 30 kg/m2 [1]. BMI provides a simple, convenient measurement of obesity
Nowadays Young Medical Students are very prone to develop cardiovascular risk factors simply due to -lack of exercise, junk food, extended hours of Laptop or TV viewing, and stress of studies.
This sedentary lifestyle goes a long way in developing Obesity, Hypertension and Cardiovascular diseases in later years. of life, leading to cardiovascular morbidity and mortality. Very few studies worldwide have focused on young medical students. At this juncture of their life with proper advice they can adopt a healthy lifestyle, avoid cardiovascular risk factors and be able to serve the society well.
Methods
The present study was conducted at the Department of Physiology, Index Medical College, Hospital and Research Centre, Indore for duration of one year with male medical students who were studying in Index Medical College.
Study Design: Cross-sectional and observational study.
Study Population: Male medical students of Medical College.
Study Place: Department of Physiology, Index Medical College, Hospital & Research Centre, Indore.
Size of the study population: Total 411 male medical students were included after obtaining their written consent.
Inclusion criteria
1. All male medical students of age group 18 and above.
2. Who willingly provided their voluntary written consent for participation in the study.
Exclusion criteria
1. Students with known history of any cardiovascular condition.
2. Students not willing to provide their voluntary written consent.
Methodology
Each male medical student filled up a questionnaire regarding his age, diet and family history of cardiovascular disease. Body weight (to the nearest 0.5 kg) standing motionless, feet 15 cm apart with minimum outwear (as culturally appropriate) and no footwear.
Height (to the nearest 0.5 cm) with subject standing erect against a vertical surface with head in Frankfurt Plane.
Weight and height was measured to calculate Body Mass Index (BMI) by Formula- Weight in KG/(Height in Meter)2 using the BMI criteria of WHO[1,2] the body types were categorized as underweight (BMI <18.5), normal (18.5-24.9), overweight (25.0-29.9) and obese (>30).
Blood pressure was measured by Standard mercury Sphygmomanometer and classified as per the Seventh Report of the Joint National Committee[3] where Pre-hypertension is systolic BP (SBP) of 120-139 mmHg or diastolic BP (DBP) of 80-89 mmHg and Hypertension stage 1 as SBP of 140-159 or DBP of 90-99 mmHg. Subjects were informed about the study and their voluntary written consent was taken. Since the Stage 1 hypertension had only 6 subjects, the subjects of pre-hypertension and stage 1 hypertension were clubbed into a single group for appropriate statistical analysis. Data was collected, tabulated and analysed statistically.
Statistical methods- Calculations were done by methods described by J.E. Park [4]
95% Confidence interval (CI): It is the range of 95% confidence in any data. To calculate CI, SEP (Standard Error of proportion) is calculated as followed
SEP=√(pq/n)
Where
p=Proportion of the parameter for which 95% CI is to be calculated
q=Proportion of the rest of the parameters
n=Sample size
95% CI =SEP×1.96±p
i.e. (SEP×1.96CI) + (SEP×1.96CI)-p
95% CI is calculated for every parameter
Results
• Out of 411 obese subjects maximum 56% were hypertensive and 44% were normotensive
• 57% had positive family history of Cardiovascular disease.
• 55% were leading sedentary lifestyle; and only 45% were exercising
• Maximum 76% were having vegetarian diet while only 24% were non-vegetarian.
Table-1: Risk factors: hypertension
Out of 411 Obese subjects 56% (CI- 0.51-0.60) were hypertensive and 44% (CI-0.39-0.48 ) were normotensive.
Table-2: Risk factors: positive family history (f/h) for CVD
CVD-Cardiovascular disease
Out of 411 Obese subjects 57% (CI-0.52-0.61) were having positive F/H for CVD
Table-3: Risk factors: lifestyle
Out of 411 Obese subjects 55% (CI-0.50-0.59) were leading a sedentary life while only 45% (CI-0.40-0.49) were found to be exercising.
Table- 4: Risk factors: diet
Out of 411 Obese subjects only24% (CI-0.19-0.28) were on Non-veg diet and maximum 76% (CI-0.71-0.80 ) were vegetarian
Discussion
Our study was conducted with 411 male Medical students of Index Medical College Hospital & Research Center, Indore (M.P.).
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 Non-vegetarian 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.
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.
Permission from IRB: Yes
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How to cite this article?
Singh M. P, Singh D.. Risk factors for cardiovascular disease in obese adolescent male medical students. J PediatrRes.2016;3(12):914-918.doi:10.17511/ijpr.2016.12.12.