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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 15-18

Metabolic syndrome and its component factors in adult obese individuals attending an obesity clinic in a tertiary care teaching hospital in Kerala


1 Department of Biochemistry, Government Medical College, Thrissur, Kerala, India
2 Department of Biochemistry, Government Medical College, Trivandrum, Kerala, India, India

Date of Web Publication2-Feb-2017

Correspondence Address:
Shajee Sivasankaran Nair
Department of Biochemistry, Government Medical College, Thrissur - 680 596, Kerala
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.199366

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  Abstract 

Introduction: Obesity is fundamental to the development of metabolic syndrome (MetS) as it appears to precede the emergence of the other MetS risk factors. Aim: The objective of this study was to calculate the frequency of MetS among obese individuals attending the obesity clinic in a tertiary care center in Kerala and also to review the association of various anthropometric and biochemical factors of MetS among obese individuals in this region of the country. Materials and Methods: A cross-sectional study was designed among ninety obese individuals who have attended obesity clinic in a tertiary care center in Kerala. Anthropometric measurements such as height, weight, body mass index (BMI), and waist to hip ratio were recorded. Lipid profile and fasting plasma glucose level were estimated. MetS was diagnosed using the International Diabetic Federation criteria, and the study population was grouped as those with and without MetS. Results: The frequency of MetS among the study population was 61.1%. The mean age of the study population was 32 years. Parameters such as BMI, blood pressure, fasting blood glucose level, and triglycerides showed statistically significant association with MetS in obese individuals. Conclusion: Since all the components of MetS are modifiable, public should be made aware of this condition, and they should be advised regarding preventive measures.

Keywords: Kerala, metabolic syndrome, obesity


How to cite this article:
Nair SS, Nair RS, Ponnappan KC. Metabolic syndrome and its component factors in adult obese individuals attending an obesity clinic in a tertiary care teaching hospital in Kerala. Muller J Med Sci Res 2017;8:15-8

How to cite this URL:
Nair SS, Nair RS, Ponnappan KC. Metabolic syndrome and its component factors in adult obese individuals attending an obesity clinic in a tertiary care teaching hospital in Kerala. Muller J Med Sci Res [serial online] 2017 [cited 2017 Feb 26];8:15-8. Available from: http://www.mjmsr.net/text.asp?2017/8/1/15/199366


  Introduction Top


The prevalence of obesity worldwide has now reached an epidemic level. It is considered as a risk factor for a number of serious disorders which include metabolic syndrome (MetS). MetS consists of a group of metabolic abnormalities that include central obesity, dyslipidemia, hyperglycemia, and hypertension.[1] It has been reported that the prevalence of MetS is more in obese individuals. Obesity is now considered as an independent predictor for MetS development.[2] Recently, the potential consequences of obesity and MetS have gained greater attention in both the developed and developing nations.

Prevalence of MetS varies according to the region, extent of urbanization, lifestyle patterns, socioeconomic, and cultural factors. The reported prevalence of MetS ranges from 10 to 30% in different regions of India.[3],[4],[5] A cross-sectional survey in five metro cities in India showed a higher prevalence of obesity and sedentary behavior among the population of Trivandrum city, the capital of Kerala, compared to other regions of the country.[6] This study was aimed at calculating the frequency of MetS among obese individuals attending the obesity clinic attached to Government Medical College Hospital, Trivandrum, and also it reviewed the association of various anthropometric and biochemical factors of MetS among obese individuals in this region.


  Materials and Methods Top


We conducted a cross-sectional study among ninety obese individuals who had attended the obesity clinic attached to the Physical Medicine and Rehabilitation, Government Medical College Hospital, Trivandrum, from July 2010 to December 2010 over a period of 6 months. The study was approved by the Institutional Ethics Committee.

Anthropometric measurements such as height, weight, body mass index (BMI), and waist to hip ratio (WHR) were recorded. Weight was measured using a beam balance to the nearest 0.1 kg and height was measured to the nearest centimeter using a tape stuck to the wall. Waist circumference was measured in minimal light clothing during mid-respiration between the 10th rib and the iliac crest to the nearest 0.1 cm. Hip girth was measured at the widest point of the hips at the level of the greater trochanter with the patient standing with both feet together. WHR was calculated from these measurements. Blood pressure (BP) was recorded twice (5 min apart) in the sitting position in the right arm to the nearest 2 mmHg with a mercury sphygmomanometer and the mean was taken as the final reading. MetS was diagnosed using the International Diabetic Federation (IDF) criteria [Table 1].
Table 1: International diabetes federation criteria for metabolic syndrome

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Venous blood samples were collected after 12 h of fasting from all the individuals. Serum was separated by centrifugation and kept at −20°C until analysis was carried out. Estimation of fasting plasma glucose (FPG) was done by glucose oxidase-peroxidase based method. Lipid profile which includes total cholesterol, high-density lipoprotein cholesterol (HDL-C) and serum triglycerides (TGs) was analyzed by enzymatic methods using ERBACHEM5 analyzer. Low-density lipoprotein cholesterol (LDL-C) was estimated using the Friedewald equation.[7]

Statistical analysis of the data was performed using Epi info version 7 (Centre for Disease Control (CDC), Atlanta, Georgia, USA). Student's t-test was used to find out the difference between components of MetS in MetS positive and negative population. Results were expressed as a mean ± standard deviation. Chi-square test was used to find out the association between components of MetS in MS positive and MS negative population. The value of P < 0.05 was considered statistically significant.


  Results Top


All the subjects (n = 90) were divided into two groups, i.e., with MetS (n = 55; 61.1%) or without MetS (n = 35, 38.9%). Diagnosis of MetS was done as per IDF criteria. The mean age of the study population was 32 years. Of these, 56.7% (51) were males and 43.3% (39) were females. The general characteristics of the study population are mentioned in [Table 2] and [Table 3]. Regarding age distribution, most of the participants with MetS were between 30 and 34 years. The frequency of MetS in males and females were 58.82 and 64.1%, respectively.
Table 2: General and biochemical characteristics of the study population (n=90)

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Table 3: Comparison of mean for various parameters in subjects with (n=55) and without metabolic syndrome (n=35)

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[Table 2] also shows the association of various risk factors for MetS. Among the biochemical parameters, FPG (P < 0.001), LDL-cholesterol (P = 0.028), and TG level (P < 0.001), showed statistically significant association with MetS. Comparison of the mean value for different parameters for both the groups is shown in [Table 3]. Both the BP and BMI (P = 0.013) showed statistically significant association with MetS in obese individuals. The mean TG level in individuals with MetS was significantly higher compared to those without MetS [Table 3]. MetS subjects had reduced HDL-C levels than those without MetS, although the difference was not statistically significant (P = 0.052).


  Discussion Top


Obesity is fundamental to MetS as it appears to precede the emergence of the other MetS risk factors.[1] The prevalence of obesity has been reported as between 10 and 30% in different regions of India.[8],[9],[10] Hyperinsulinism and alteration in other cardiometabolic factors such as low HDL, increased TGs and LDL-C and increased BP result in an increased risk for type 2 diabetes and other cardiovascular disorders. Like in any other developing countries the prevalence of MetS is increasing in India too.

In this study, 61.1% of the subjects have MetS. This higher frequency is attributed to the hospital-based study design and the selection criteria of the participants (obese individuals). The prevalence of MetS in Indian population varies between 20 and 40% in different regions of the country.[3],[4],[5],[10] The dissimilarity in the prevalence within the country is mainly due to the difference in diagnostic criteria used by different authors.

A higher trend of MetS seen in females (64.1%) in this study was similar to that observed by both Mangat et al. and Ramachandran et al.[5],[11] Our result is different from the study by Sawant et al., which reported a higher proportion of MetS among males.[12] The National Family Health Survey-3 found that 9% of males and 13% of females in India were obese or overweight.[13] A cross-sectional study from Trivandrum showed a greater prevalence of obesity among females compared to that among males, which is in favor of our observation.[6]

The maximum proportion of individuals with MetS was observed between 25 and 34 years (53.33%). The increased frequency among this young age group might be due to varied factors such as increased preference for junk food, high-calorie beverage, sedentary behavior, and unhealthy lifestyle, which are all part of adopting the western life culture.

A statistically significant association between MetS and increasing BMI in this study was consistent with the literature.[11],[12] Significant association with BP, fasting blood sugar level, and various lipid components, especially TGs are in concordance with many studies.[4],[11],[12],[14] In addition to obesity and insulin resistance, dyslipidemia is considered as a hallmark of MetS. The link between dyslipidemia and MetS has been extensively studied. In MetS, as a result of insulin resistance, there will be overproduction of very LDL and apolipoprotein-B (apo-B), decreased breakdown of apo-B and increased catabolism of HDL cholesterol. The significant difference in TGs levels in individuals with or without MetS was similar to that reported in previous studies.[12],[15]

There are few limitations associated with the study. The sample size of the study was relatively small and since it is a hospital-based cross-sectional study generalization of the finding to the population may not be adequate.


  Conclusion Top


MetS has been highlighted as a major socioeconomic problem throughout the world, and India is no exception. About 61.1% of the obese individuals in this study have MetS as per IDF criteria. Biochemical parameters such as fasting blood glucose level and TGs showed statistically significant association with MetS in obese individuals. Since all the components of MetS are modifiable, the public should be made aware of this condition, and they should be advised regarding preventive measures.

Acknowledgment

This study was conducted as part of postgraduate thesis for MD Biochemistry by Dr. Shajee S. Nair, from Kerala University, Kerala. Authors are extremely grateful to Dr. M. Saboora Beegum MD, Professor and Head of the Department of Biochemistry for her help and support. Dr. V. K. Sreekala MS, Professor and Head of the Department of Physical Medicine and Rehabilitation gave all the facilities and guidance to do this work in PMR Department. Authors are grateful to Dr. Ajith V. L., for his help in drafting the manuscript.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
O'Neill S, O'Driscoll L. Metabolic syndrome: A closer look at the growing epidemic and its associated pathologies. Obes Rev 2015;16:1-12.  Back to cited text no. 1
    
2.
Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents – An IDF consensus report. Pediatr Diabetes 2007;8:299-306.  Back to cited text no. 2
    
3.
Deepa M, Farooq S, Datta M, Deepa R, Mohan V. Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: The Chennai urban rural epidemiology study (CURES-34). Diabetes Metab Res Rev 2007;23:127-34.  Back to cited text no. 3
    
4.
Gupta R, Sarna M, Thanvi J, Sharma V, Gupta VP. Fasting glucose and cardiovascular risk factors in an urban population. J Assoc Physicians India 2007;55:705-9.  Back to cited text no. 4
    
5.
Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Metabolic syndrome in urban Asian Indian adults – A population study using modified ATP III criteria. Diabetes Res Clin Pract 2003;60:199-204.  Back to cited text no. 5
    
6.
Singh RB, Pella D, Mechirova V, Kartikey K, Demeester F, Tomar RS, et al. Prevalence of obesity, physical inactivity and undernutrition, a triple burden of diseases during transition in a developing economy. The Five City Study Group. Acta Cardiol 2007;62:119-27.  Back to cited text no. 6
    
7.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.  Back to cited text no. 7
    
8.
Unnikrishnan AG, Kalra S, Garg MK. Preventing obesity in India: Weighing the options. Indian J Endocrinol Metab 2012;16:4-6.  Back to cited text no. 8
    
9.
Zargar AH, Masoodi SR, Laway BA, Khan AK, Wani AI, Bashir MI, et al. Prevalence of obesity in adults – An epidemiological study from Kashmir Valley of Indian Subcontinent. J Assoc Physicians India 2000;48:1170-4.  Back to cited text no. 9
    
10.
Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 2008;93 11 Suppl 1:S9-30.  Back to cited text no. 10
    
11.
Mangat C, Goel NK, Walia DK, Agarwal N, Sharma MK, Kaur J, et al. Metabolic syndrome: A challenging health issue in highly urbanized union territory of North India. Diabetol Metab Syndr 2010;2:19.  Back to cited text no. 11
    
12.
Sawant A, Mankeshwar R, Shah S, Raghavan R, Dhongde G, Raje H, et al. Prevalence of metabolic syndrome in urban India. Cholesterol 2011;2011:920983.  Back to cited text no. 12
    
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Available from: http://www.nfhsindia.org/nfhs3.html. [Last accessed on 2012 Mar 06].  Back to cited text no. 13
    
14.
Rodríguez A, Delgado-Cohen H, Reviriego J, Serrano-Ríos M. Risk factors associated with metabolic syndrome in type 2 diabetes mellitus patients according to World Health Organization, Third Report National Cholesterol Education Program, and International Diabetes Federation definitions. Diabetes Metab Syndr Obes 2010;4:1-4.  Back to cited text no. 14
    
15.
Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. adults. Diabetes Care 2004;27:2444-9.  Back to cited text no. 15
    



 
 
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