A Prospective Comparative Study on M etabolic Syndrome Among Urban and Rural Women Population- A Cross Sectional Study


Associate Professor, Department of General Medicine, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India

Abstract

Background: Metabolic syndrome is a combination of individual risk factors that are associated with several serious health conditions such as diabetes, cardiovascular disease or stroke. The present study was conducted to assess metabolic syndrome among urban and rural women population. Subjects and Methods: 128 females diagnosed with metabolic syndrome were included. Smoking, drug history, past history, family history etc. was taken. Weight, height, BMI, waist circumference, hip circumference, waist to hip ratio, systolic and diastolic blood pressure was also recorded. Results: Age group 20-35 years comprised of 24, 35-50 years had 36 and >50 years had 68 patients. The socio- economic status was middle in 70 and upper in 58, education was primary in 45 and high in 73, occupation was unemployed in 80 and employed in 48. Smoking was seen in 52 (40.6%), hypertension in 78 (60.9%), Hypertriglyceride in 84 (65.6%), alcoholics in 40 (31.2%), increased FBS in 102 (79.6%) and low HDL in 80 (62.5%). Conclusion: Maximum women with MS was seen in age group >50 years. Smoking, hypertension, hypertriglyceride, alcoholism, increased FBS and low HDL was seen in all patients.

Keywords

Metabolic syndrome, Smoking, Hypertension

Introduction

Metabolic syndrome is a combination of individual risk factors that are associated with several serious health conditions such as diabetes, cardiovascular disease or stroke. It is diagnosed by the presence of three or more of five risk factors: abdominal obesity, raised blood pressure (BP), raised fasting blood glucose, raised triglycerides and reduced high-density lipoprotein (HDL) cholesterol.[1]

Metabolic syndrome (MS) is described as a cluster of abnormalities that confers an increased risk of developing atherosclerotic cardiovascular diseases (CVD) and also type 2 diabetes mellitus (T2DM).[2] In fact, MS is now considered as a global epidemic, with current estimates about 20-30% of the adult population worldwide is affected. Of interest to the current study is the fact that the prevalence of these disorders (MS and CVD) among South Asians, a community that represents one-fifth of the global population, is on the rise. This development imposes a significant health burden to the subcontinent that has limited resources. The exact cause of this health trend is currently not clear.[3]

The prevalence of MetS varies depending on the definition applied, the ethnicity, and the age of the study population. The age-adjusted prevalence among adults population was estimated to be 24%–25% in the United States, was approximately 23% in European countries and estimated to be 20%–25% among South Asians.[4] The prevalence in Asia has increased rapidly in the recent years due to rapid socioeconomic transitions to increasing affluence, urbanization, mechanization, auto-mobilization, and urban migration. However, the ethnic, cultural, environmental or economic differences contribute to varied prevalence across Asian countries.[5] The present study was conducted to assess metabolic syndrome among urban and rural women population.

Subjects and Methods

The present study comprised of 128 females diagnosed with metabolic syndrome. All were informed regarding the study and their consent was obtained.

General information such as name, age, race, socioeconomic status, occupation, smoking, drug history, past history, family history etc. was taken. Weight, height, BMI, waist circumference, hip circumference, waist to hip ratio, systolic and diastolic blood pressure was also recorded. Results thus obtained were subjected to statistical analysis using Mann Whitney U test. P value less than 0.05 was considered significant.

Results

Table 1: istribution of patients

Age group (Years)

Number

P value

20-35 years

24

0.01

35-50 years

36

>50 years

68

[Table 1] shows that age group 20-35 years comprised of 24, 35-50 years had 36 and >50 years had 68 patients. The difference was significant (P< 0.05).

Table 2: 2: Demographic profile

Parameters

Variables

Number

P value

Socio- economic status

Middle

70

0.05

Upper

58

Education

Primary

45

0.04

High

73

Occupation

Unemployed

80

0.01

Employed

48

[Table 2 & Figure1] shows that socio- economic status was middle in 70 and upper in 58, education was primary in 45 and high in 73, occupation was unemployed in 80 and employed in 48. The difference was significant (P< 0.05).

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/e0cae3ed-b89f-457e-988b-80d2d0b46d65image1.png
Figure 1: Demographic profile
Table 3: Determinants of metabolic syndrome

Parameters

Number

Percentage

Smoking

52

40.6

Hypertension

78

60.9

Hypertriglyceride

84

65.6

Alcoholics

40

31.2

Increased FBS

102

79.6

Low HDL

80

62.5

[Table 3] shows that smoking   was seen in 52   (40.6%), hypertension in 78 (60.9%), Hypertriglyceride in 84 (65.6%), alcoholics in 40 (31.2%), increased FBS in 102 (79.6%) and low HDL in 80 (62.5%).

Discussion

Several factors are believed to be potential etiological factors in the development of MS, including increased urbanization, economic growth, irregular meal times, and lifestyle change and adoption of western diet. Unfortunately, millions of people in South Asia are facing a double health burden i.e., the impact of poverty-related diseases (associated with infections and nutrition) is being exacerbated by the increasing load of chronic non-communicable diseases.[6]

MetS is a chronic low grade inflammatory state starting from adipose tissue and further recruits immune cells which consequently releases inflammatory cytokines (TNF-α, IL-6, adiponectin, etc.) and results in an insulin-resistant state.[7] When the secretary capacity of the pancreas is overwhelmed by battling an insulin resistance state, diabetes develops. Furthermore, an increased secretion of prothrombin activator inhibitor-1 contributes to a pro-coagulant state; and along with endothelial dysfunction leads to increased risk of atherothrombosis, hypertension and CVD.[8] Estrogen production by an enlarged stromal mass predisposes the subject to the development of breast cancer. Moreover, several drugs, e.g., corticosteroids, antidepressants, antipsychotics, antihistamines can produce weight gain and predispose to MetS features: obesity and glucose intolerance. Hence, the constellation of these multiple underlying mechanisms results in MetS.[9] The present study was conducted to assess metabolic syndrome among urban and rural women population.

In present study, age group 20-35 years comprised of 24, 35-50 years had 36 and >50 years had 68 patients. Gupta et al,[10] found that there were 180 males and 300 females. 260 subjects were obese, 140 were overweight and 80 were normal. The difference was significant (P< 0.05). Low HDL was seen in 340, hypertension in 420, increased fasting blood glucose in 385 and hypertriglyceride in 365. There were 265 smokers and 270 were alcoholics.

We found that socio- economic status was middle in 70 and upper in 58, education was primary in 45 and high in 73, occupation was unemployed in 80 and employed in 48. Kaur et al,[11] assessed age, gender, social status, employment, education, family history, physical activity, dietary habits, alcohol, sleep, body mass index and stress as determinants of MetS. The results were analyzed by Chi Square test with statistical significance of p value 50 years (86.90%; p < 0.05), middle socioeconomic status (70.50%), illiteracy (39.35%), and unemployment (81.97%; p < 0.05) were found contributing though to different extents. Subjects with a sedentary lifestyle (72.14%), positive family history (42.63%), omnivore diet (47.55%), stress (78.69%; p < 0.05), insomnia (29.51%) and increased BMI (83.62%; p < 0.001) had shown predisposition to MetS. However, the protective role of alcohol (38.28%), an active lifestyle (36.21%), vegetarian diet (62.07%) and adequate sleep (73.11%) was observed. A significant hypertension (98.37%; p < 0.001), dyslipidemia (77.05%; p < 0.001), dysglycemia (75.41%; p < 0.001) and obesity (59.02%; p < 0.001) was reported in MetS. Common concerns of female gender, increasing age and BMI, sedentary lifestyle, stress and positive family history should be considered for early identification and appropriate intervention to fight the growing MetS epidemic.

We observed that smoking was seen in 52 (40.6%), hypertension in 78 (60.9%), hypertriglyceride in 84 (65.6%), alcoholics in 40 (31.2%), increased FBS in 102 (79.6%) and low HDL in 80 (62.5%). Jesmin et al,[12] included a total of 1535 rural women aged ≥ 15 years. The prevalence of MS was estimated using NCEP ATP III, modified NCEP ATP III and IDF criteria. The prevalence rates of MS were 25.60% (NCEP ATP III), 36.68% (modified NCEP ATP III), and 19.80% (IDF), as revealed by the present study. Furthermore, based on the NCEP ATP III criteria, 11.60% of the subjects were found to have excess waist circumference; 29.12% had elevated blood pressure, 30.42% had elevated fasting plasma glucose level, 85.47% had low HDL values and 26.91% had increased triglyceride values. Low plasma HDL level was found to be the most common abnormality in the target population and elevated waist circumference was the least frequent component.

Conclusion

Authors found that maximum women with MS was seen in age group >50 years. Smoking, hypertension, hypertriglyceride, alcoholism, increased FBS and low HDL was seen in all patients.