Metabolic Syndrome among Nurses in Manipur

Thiyam, Ranabir, Devi, Prasad, Devi and Singh: Metabolic Syndrome among Nurses in Manipur Introduction Metabolic syndrome (MetS) affects around 20-25% of the world’s adult population 1 . In North India, MetS affects 31.6% to 49.2% of the urban population 2 - 7 . In South India it is reported in 18.3 to 46.4% 8 - 12 . In Mumbai, West India, the prevalence ranges from 19.5-35.2% 13 , 14 In the rural population of Central India it is seen in around 9% 15 . In Sub-Himalayan region of Eastern India, MetS ranges from 4% to 50% in different communities 16 . Individuals with MetS have a 30%-40% probability of developing diabetes and/or CVD within 20 years 17 . This study was carried out to determine the prevalence of MetS among nurses in Manipur as there is no data on MetS among the mongoloid population of North-Eastern India. Material and Methods This cross-sectional study was carried out after obtaining approval from the Institutional Ethical Committee in the Department of Medicine, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur. A total of 239 nurses were selected randomly from the nursing staff of RIMS Hospital. Sample size was calculated based on the prevalence of MetS of 33.2% among health care workers 18 with 95% precision, coming to a sample size of 237. Nurses suffering from acute MI, renal failure, liver disease, critical illness, cancer, any acute infection or with a history of endocrine disorder and/or previous treatment with hormones or steroids were excluded. Detailed history of clinical information including the age, smoking, alcohol consumption, inter current illness was taken. Detailed general and physical examination was performed. Anthropometric measurements including body weight, height, body mass index and waist circumference (WC) was recorded. Waist circumference w as measured at the plane between the anterior superior iliac spine and lower costal margin at the narrowest part with the patient standing and during slight expiration. Fasting blood glucose and lipid profile was measured for each patient. Diagnosis of MetS was made using International Diabetes Federation (IDF) Criteria 2005 which defines MetS as central obesity plus two or more of the following factors: i) raised concentration of serum triglycerides e”150%, ii) reduced concentration of serum (High Density Lipoprotein Cholesterol) HDL: <40mg% in males and <50 mg% in females, iii) raised blood pressure: systolic blood pressure e”130mmHg or diastolic blood pressure e”85mmHg, and iv) raised fasting blood glucose e”100mg%. Central adiposity is defined as waist circumference (WC) e”90cm in males and e”80 cm in females among South East Asian population 1 . Statistical Analysis Statistical analysis was done using Statistical Package for the Social Sciences (SPSS 16.0. version) software. Results were expressed as mean ± standard deviation (SD). Student ‘t’ was used to compare the mean values among nurses with and without metabolic syndrome. Pearson’s chi-square test was used to compare categorical variables between the two groups. A p-value of <0.05 was taken as statistically significant. Results In the present study a total of 239 female nurses were randomly selected from the nursing staff of our hospital. The mean age was 39.67±7.87 (range, 27 to 62) years. The mean age of nurses with MetS was 44.69±8.18 years compared to 38.37±7.27 years ( p = 0.000) in those without MetS. Forty nine (20.5%) out of 239 nurses had MetS and the prevalence of MetS increased with age ( p = 0.000), from 6% among 21-30 years to 67% among 61-70 years. ( Table 1 ) There was no difference in mean height of nurses between nurses with and without MetS; 152.03±2.55cm vs 152.33±2.13 ( p = 0.449). However, the nurses with MetS were significantly heavier than those without MetS; 61.37±7.77 Kg vs 56.34±6.21 Kg ( p = 0.000). Ninety-one (38.08%) nurses were overweight, 88 (36.82%) nurses were obese and 60 (25.1%) nurses were of normal weight. The mean BMI among nurses with MetS was 26.45±3.36 Kg/m2 compared to 24.36±2.45 Kg/m 2 in those without MetS ( p = 0.000). Distribution of BMI among nurses with and without MetS is shown in Table 2 . Table 1 | Showing Prevalence of Metabolic Syndrome (Mets)in Relation to Age Age group (years) Number of nurses with MetS Number of nurses without MetS Total number of nurses Prevalence of MetS (%) 21-30 2 29 31 6 31-40 16 105 121 13 41-50 18 40 58 31 51-60 11 15 26 42 61-70 2 1 3 67 Table 2 | Showing The Distribution of Body Mass Index (BMI)of the Nurses with and without Metabolic Syndrome (Mets) BMI (Kg/M 2 ) With Mets N(%) Without Mets N(%) Total N(%) <23 6(10.00) 54(90.00) 60(25.10) 23-24.99 10(11.00) 81(89.00) 91(38.08) 25-32.49 32(37.65) 53(62.35) 85(35.56) ≥ 32.50 1(33.33) 2(66.67) 3(1.26) Total 49(20.50) 190(79.50) 239 The mean waist circumference (WC) of the nurses was 88.12±12.93 cm. Central adiposity was common among the nurses studied, 194 (81.17%) subjects out of 239 had waist circumference (WC) e”80 cm. However nurses with MetS were more obese with a mean waist circumference (WC) of 95.18±9.58 compared to those without MetS 86.3±13.07 cm ( p =0.000). Out of the total 239 nurses,54(22.6%) nurses were found to be hypertensive of which 4 nurses had prior history of hypertension. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) was 120.60±13.10 mmHg and 78.46±9.14 mmHg respectively. 46(19.25%) nurses had high SBP (e” 130 mmHg) and 36 (15.06%) had high DBP (e” 85 mmHg). Both the mean SBP and DBP was significantly higher among the nurses with MetS than those without MetS (SBP, 131.71±20.22 vs 117.74±8.50 mmHg; p=0.000) and (DBP, 86.94±11.03 vs 76.28±7.13 mmHg; p =0.000). The mean FBG was 86.28±21.17 mg/dl. Impaired fasting glucose was found in 46 (19.25%) nurses, and 10 (4.18%) nurses were found to be diabetic of which 2 nurses were already diagnosed diabetic in the study. Twenty-six (53.06%) out of 49 nurses with MetS had high FBG. Mean FBG among nurses with MetS and without MetS nurses were 100.29±29.58 and 82.67±16.68 mg/dl respectively ( p =0.000). The mean TG level among the nurses studied was 141.72 ± 53.44 mg/dl. Mean TG level in nurses with MetS and nurses without MetS were 177.03 ± 48.36 and 132.61 ± 50.95 mg/dl respectively ( p =0.000). High TG (e” 150mg/dl) was found in 101 (42.26%) out of the 239 nurses in the study and 36(73.5%) out of 49 nurses with MetS. The mean HDL-c level of all the 239 nurses was 51.76±11.57 mg/dl. 63nurses (26.36%) had low HDL-c (<50mg/dl). Among nurses with MetS, 21(42.86%) out of 49 nurses had low HDL-c. The mean HDL-c was 48.52±13.84 mg/dl and 52.6±11.03 mg/dl respectively in those with and without MetS ( p =0.015). Comparison of various parameters among nurses with and without metabolic syndrome is shown in Table 3 . Table 3 | Comparison of Various Parameters among Nurses with and without Metabolic Syndrome Parameter Nurses with MetS Nurses without MetS p- value Age (years) 44.7±8.2 38.4±7.3 0.00 Height (cm) 152.3±2.1 152.0±2.6 0.45 Weight (Kg) 61.4±7.8 56.3±6.2 0.00 BMI (Kg/m2) 26.5±3.4 24.4±2.5 0.00 WC (cm) 95.2±9.6 86.3±13.1 0.00 Systolic BP (mmHg) 131.7±20.2 117.7±8.5 0.00 Diastolic BP(mmHg) 86.9±11.0 76.3±7.1 0.00 Fasting blood glucose(mg/dl) 100.3±29.6 82.7±16.7 0.00 Serum triglyceride (mg/dl) 177.0±48.4 132.6±51.0 0.00 Serum HDL (mg/dl) 48.5±13.8 52.6±11.0 0.00 Discussion To our knowledge this was the first study to evaluate MetS among the nurses population in the North Eastern India. Out of 239 nurses, MetS was seen in 49 nurses with a prevalence of 21% and this result is similar with the finding of Gustavo et al. 19 , in which the overall prevalence of MetS was also 21.6%. But in the study by Chuang et al 20 the prevalence of MetS is 12.9% (15.5% in men and 10.5% in women). These figures are lower than those reported from the study population of Kinmen, an island of the coast of South China 21 . These large variations in the prevalence of the MetS could be partly accounted for by differences in study populations, lifestyles and socioeconomic status. The prevalence of MetS increased with age from 6% in those aged 21 to 30 years to 67% in the age group 61 to 70 years ( p = 0.000). Since aging is associated with increased risk of insulin resistance, the hormonal alteration and increase in visceral adipose tissue 22 , the prevalence of th e MetS in this study was expected to increase steeply with age. This result was similar with the study of Hildrum et al 23 , in which the prevalence increased from 11% among participants aged 20 through 29 years to 47.2% in the 80 to 89 years group in men and from 9.2% to 64.4% for women in corresponding age groups. Also in the study by Perez et al. 24 prevalence significantly rose with age, from 12.8% among participants aged 21 to 29 years to 58.2% for participants aged 70 to 79 years (p < 0.001). However, in the study by Sawant et al. 14 the prevalence of MetS did not change with respect to age difference, 20 to 40 and 41 to 60 age groups showed similar prevalence of MetS and a marginal decrease was seen in more than 60 age group. In women, prevalence continuously increased with age, which could in part be an effect of menopause 25 . Although menopausal status was not included in the survey, there was another study that reported visceral fat accumulation and acute increase of insu lin resistance after menopause 26 . Several population studies have reported an increase in the prevalence of the MetS with age regardless of definition, though some have reported a peak in the seventh decade and then a decline in both sexes or only in men 27 . The development of obesity, or more specifically an increase in abdominal fat, is thought to be the primary event in the progression of MetS. A tendency to gain fat in the abdominal area, as opposed to the hip, buttock, and limb areas, is linked to a rise in fatty acids in the blood, which is thought to lead to insulin resistance, high blood pressure, abnormal blood lipids, and eventually diabetes. Asian Indians tend to develop central obesity rather than generalised obesity 22 . About three fourth of the nurses who participated in this study were overweight/obese (BMI e”23 Kg/m 2 ) and is the prime determinant of MetS prevalence. A steep rise in the prevalence of MetS is observed in obese nurses (i.e. BMI e” 25). In the s tudy by Park et al. 28 , a steep rise in the prevalence of MetS was observed in overweight men and women. Overall 4.6%, 22.4% and 59.6% of normal weight, overweight and obese men, respectively, met the MetS diagnostic criteria. Similarly, in women, the corresponding prevalence rates were 6.2%, 28.1% and 50% respectively. Participants with BMI less than 23 meeting the MetS criteria may be the metabolically obese, normal weight individuals as referred to by Ruderman et al. 29 who purportedly have insulin resistance as the central feature of their cluster of metabolic abnormalities. Gupta et al. 30 also showed a strong association between MetS and overweight particularly when the whole population is considered, prevalence of MetS was significantly higher in overweight and obese subjects. The IDF emphasizes central obesity as an essential criterion for the MetS, due to the evidence linking ethnicity-specific waist circumference to CVD and to the other components of the MetS 1 . In addit ion to the role of genetic factors, environmental factors are thought to play a major role in the increasing frequency of abdominal obesity. Excessive or unbalanced intake of food and technological advances limiting physical activity are partly responsible for the obesity epidemic 31 . In this study, presence of abdominal obesity considerably increases the prevalence of MetS. Kozan et al. 32 reported a relatively lower frequency of MetS and abdominal obesity among health worker which may have resulted from a number of factors including younger age, higher level of physical activity due to working conditions and awareness about healthy lifestyle habits. Although BMI serves as a useful marker of obesity and related insulin resistance, stronger correlations are observed between abdominal obesity and metabolic risk factors. The ATP III included waist circumference as a proxy measure of abdominal obesity and waist circumference is well correlated with visceral adipose tissue and is a bet ter anthropometric predictor of metabolic risk factors than BMI 33 . In conclusion this study showed a high prevalence of MetS among nurses in Manipur, a mongoloid population in North Eastern India who are ethnically different from the mainland India. Metabolic syndrome MetS was seen more among nurses with increasing age, who are more obese and associated with higher blood pressure and glucose levels. This display is generated from NISO JATS XML with jats-html.xsl . The XSLT engine is SAXON 9.1.0.2 from Saxonica.