|
|
||||
|
Published by : PROFESSIONAL MEDICAL PUBLICATIONS |
||||
|
ISSN 1681-715X |
||||
|
||||
|
- |
||||
|
ORIGINAL ARTICLE |
||||
|
- |
||||
|
Volume 25 |
April - June 2009 (Part-I) |
Number 2 |
||
|
|
||||
|
|
||||
|
|
||||
|
Published by : PROFESSIONAL MEDICAL PUBLICATIONS |
||||
|
ISSN 1681-715X |
||||
|
||||
|
- |
||||
|
ORIGINAL ARTICLE |
||||
|
- |
||||
|
Volume 25 |
April - June 2009 (Part-I) |
Number 2 |
||
|
|
||||
|
|
||||
Prevalence of obesity and metabolic syndrome in
adolescent girls in South East of Iran
Zinat Salem1, Reza Vazirinejad2
ABSTRACT
Objectives: Obesity is the most common cause of insulin resistance and metabolic syndrome (MetS). These are the most important risk factors for Coronary Heart Disease (CHD). The objective of the present study was to evaluate the prevalence of obesity and metabolic syndrome (MetS) in adolescent girls in Rafsanjan, Iran.
Methodology: In this cross sectional study 1221 respondents were randomly selected using a multiphase sampling method. The individual questionnaire was completed after receiving a written informed consent. The weight, height, Waist Circumference (WC) and blood pressure were measured using standard equipments. Five milliliters blood were taken for measuring TG, HDL CHO and FBS of the obese volunteers after detecting obesity (n=76). We determined metabolic syndrome according to the earlier Adult Treatment Panel III (ATPIII) criteria.
Results: Mean age of respondents was 14.3 ± 1.7 years and 11.2% (95% CI = 9.4% -12.9%) and 2.4% (95% CI = 1.5% - 3.3%) of subjects were overweight and obese respectively. Based on our finding about 1.2% (95% CI= 0.6% - 1.8%) respondents had abdominal obesity. According to ATPIII criteria 3.9% (CI95% = 2.8% - 5%) of respondents had metabolic syndrome.
Conclusion: This study showed high prevalence of obesity and metabolic syndrome among girls studying in secondary and high schools of Rafsanjan. We suggest screening programme for children aged 6-11 years as the result will help in planning to control obesity & metabolic syndrome.
KEY WORDS: Metabolic Syndrome, Obesity, Adolescent girls.
Pak J Med Sci April - June 2009 Vol. 25 No. 2 196-200
How to cite this article:
Salem Z, Vazirinejad R. Prevalence of obesity and metabolic syndrome in adolescent girls in South East of Iran. Pak J Med Sci 2009;25(2):196-200.
1. Zinat Salem, MSc,
2. Reza Vazirinejad, Ph.D
1-2: Social Medicine Department,
Medical School,
Rafsanjan, Iran.
Correspondence
Zinat Salem
Social Medicine Department,
Medical School,
Rafsanjan, Iran.
E-mail: zinatsalem@yahoo.com
* Received for Publication: July 3, 2008
* Revision Received: February 18, 2009
* Revision Accepted: March 20, 2009
INTRODUCTION
Obesity is the most common public health problem in developed and developing counties.
1 The problem has important endocrine and metabolic consequences.2 Obesity is a risk factor for metabolic syndrome. The metabolic syndrome is defined by the constellation of abdominal obesity. hypertension type 2 diabetes and dyslipidemia. Abdominal obesity is associated with resistance to the effects of insulin on peripheral glucose utilization.2The prevalence of obesity among children is 10.5% -27% in developed countries. The trend of obesity in developed and developing countries is similar between children and adolescents. The prevalence of metabolic syndrome among children aged 8- 19 years with risk of overweight and with risk of obesity are 6.8% and 28.7% respectively.
3 There was no consistent and consensus diagnostic criteria for metabolic syndrome in adolescents until 2005. Recent definitions by ATP III present three or more criteria.4 Latest consensus Diagnosis method for metabolic syndrome is presented by International Diabetes Federation (IDF). These criteria use the 90th percentile as a cut off point for waist circumference as abdominal obesity and the presence of two or more other clinical features like elevated triglyceride, low HDL cholesterol, high blood pressure, increased fasting glucose.5 The most effective programme for prevention of metabolic syndrome is to avoid the development of child hood obesity. In case of established disease, the effective treatment should address the different components of the syndrome. There is a need for elaboration of pediatric diagnostic criteria, national prevalence data, protocols for prevention early recognition and effective treatment.6 The aim of this study was to determine the prevalence of obesity and metabolic syndrome among girls aged 11-18 years in Rafsanjan, Iran.METHODOLOGY
This surrey was a cross sectional study carried out among girls aged 11-18 years. The sample size was estimated based on ( = 0.05%, d = 2.5%, P=25%).
5 Respondents 1221 girls were randomly selected using a multiphase sampling method. The project was approved by Ethical Review Board of Research Council of Rafsanjan University of Medical Sciences. This study lasted from September 2006 to September 2007. The questionnaire was completed after receiving a written informed consent from respondents. The blood pressure, weight, height and waist circumference (WC) were measured using standard equipment (mercury sphanghometer made in Japan), Seca scale (made in Germany.Obesity was determined based on Body Mass Index (BMI), and classification scheme introduced by the Centres for disease control and prevention (CDC). Charts was also used for defining respondents who were at risk of overweight (BMI >85) and obesity (BMI >95) respectively),
1,3 Abdominal obesity was defined using waist circumference percentiles by sex and age. Percentiles equal or over 90 were defined as abdominal obesity.4 Hypertension was detected using seventh joint national committee on evaluation, diagnosis, treatment, prevention of blood pressure (JNC7) classification criteria. If blood pressure (systolic and diastolic) readings was at >90th percentile based on sex and height it was defined as pre hypertension and reading >95 and >99 as type I and II hypertension respectively.7,8 After detecting obese girls informed consent was obtained for second time and then a blood sample was taken. For detecting HDL Cholesterol, fasting blood glucose and triglyceride Pars Azemon Kit and Auto Analyzer BT 3000 were used. In this study we defined metabolic syndrome besed on ATP III criteria.2 This is based on elevated triglyceride (>=110 mg/dl), low HDL cholesterol (<=45mg/dl), increased fasting glucose (>110, <=126 mg/dl), abdominal obesity, obesity and hypertension. Data were analyzed using SPSS version 12 software applying Chi square test.RESULTS
Demographic characteristic of respondents are presented in Table-I. About 11.2% of participants were overweight and 2.4% of them were obese. Table-II shows distribution of girls based on percentile of BMI and age.
Overweight in participants living in the city was more prevalent as compared to respondents living in villages (13.9% versus 12.4%, P=0.5). Again 1.2% of adolescent girls had abdominal obesity. About 5.2% of participants had systolic high blood pressure (as pre hypertension) 4.9% of them hypertension. Moreover 7.7% had high diastolic blood pressure as pre hypertension and 1.5% of them had hypertension. In this study 7.9% of girls had impaired fasting sugar. Also 44.7% and 15.8% of them had hyper teriglyceridemia and decreased HDL cholesterol respectively. Mean and standard deviation of biochemical factors are presented in Table-III. Prevalence of metabolic syndrome was 3.9% among adolescent girls or 3.9% of participants had at least three risk factors for CHD.
DISCUSSION
This study showed that obesity and metabolic syndrome (MetS) are common problems in adolescent girls in Rafsanjan. Prevalence of obesity was similar to other studies that have been done worldwide and in different parts of Iran.
3,6,9-12 These results also showed that nutritional transition has also taken place although there was under nutrition along with over nutrition simultaneously.1 In developing countries, there is under nutrition including malnutrition and over nutrition. As in our study 11.3% of participants were underweight. This result is similar to the research that was done by Kelishadi.13 His finding showed that not only adolescents suffer from obesity and over weight but also they are faced with malnutrition.3 Emerging non communicable diseases relating to diet and lifestyle have been increasing over the last two decades and evidence of the MetS is emerging in adolescents.14 Another study reported that MetS may be on the rise in adolescents with increasing rates of obesity.15
In this study prevalence of abdominal obesity was 1.2% that is lower than reported by Shahbazpour and Halley Castillo E.12,16 However this finding will be alarming for this group because abdominal adiposity is considered high-risk fat, and it is associated with insulin resistance,17 it can predict the risk of Type II diabetes and CHD in future.8,19 Waist Circumference (WC) may have significant clinical usefulness in identifying adolescents and teenagers at risk for later onset of CHD.20 In the present study prevalence of metabolic syndrome was 3.9%. This finding was similar to Ekelund study.21 However it was lower than what was reported by Moayeri,22 Esmailzadeh,23 and Kelishadi.24,25 Moayeri,s study was done on adolescents but prevalence of metabolic syndrome was 26.6% without gender difference in the distribution of metabolic syndrome.22 Findings of other studies showed prevalence of metabolic syndrome as 10.1% and 14.1% respectively.23-25 Lower prevalence of MetS in the present study might be due to the low prevalence of abdominal obesity that was 1.2% among our participants. Other factors can be nutritional status including dietary behavior and intake of total energy. However we did not assess this factor.
Another cause could be urbanization. The prevalence of obesity in cities such as Rafsanjan is high and low in rural areas as compared to big cities such as Tehran. It seems in small cities nutritional status is changing and both under nutrition and over nutrition exist simultaneously "Few studies conducted in developing countries have showed a considerably high prevalence of the metabolic syndrome among youth. These findings provide alarming data for health professionals about the extent of these problems in developing countries, many of which are still grappling with malnutrition and micronutrient deficiencies".13 However in our study over nutrition was higher than under nutrition. Other problematic factor is Diagnostic Criteria ATPIII which was used. It seems IDF criteria showed the prevalence of Metabolic Syndrome higher than ATP111 Criteria.26 Other surveys on different age groups in Iran showed higher prevalence of metabolic syndrome.27-30 It isn’t unexpected because age, gender and urbanization can affect Metabolic Syndrome risk factor. The results of this study will help in planning to control these problems in future and also screening children aged 6-11 years to assess both over and under nutrition risk factors for non communicable disease.
ACKNOWLEDGMENT
We thank research council of Rafsanjan University of Medical Sciences for sponsoring this study and Dr. Mehdi Mahmoodi coordinator in laboratory, Fariba Khatami and Fatemeh Amini who all helped with the collection of data.
REFERENCES
1. Mosavi Jazayeri SM. Overweight and obesity among school – aged children of metropolitan Tehran, Iran. P J Nutr 2005;4(5):342-4.
2. Jessup A, Joanne S, Harrel L. The Metabolic syndrome: look for it in children and adolescents, too. Clin Diabetes. 2005. www.Find Articles.com
3. Malekzadeh R, Merat SH, Pourshams A, Etemadi A. Obesity pandemic: an Iranian perspective. Arch Iranian Med 2006;8(1):1-7.
4. Barkail, Paragh G. Metabolic syndrome in childhood and adolescence. Orv Hetil 2006;1217(6):943-50
5. The IDF Consensus definition of the metabolic syndrome in children and adolescents. International Diabetes Federation. http://www.idf.org/webdata/docs/mets-definition - children. pdf
6. Moayeri H, Bidad K, Aghamohammadi A, Rabbani A, Anari S, Nazemi L, et al. Overweight, obesity and associated factors in adolescents in Tehran, Iran, 2004-2005. Eur J Pediatr 2006;165(7):489-93.
7. National Heart, Lung and Blood Institute (NHLBI). New practice guidelines Average blood pressure levels on rise among American children teenagers. http://www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.htm.
8. National Heart lung and blood Institute. Blood pressure tables for children and adolescents from the fourth report on the diagnosis, evaluation and treatment of High blood pressure in children and adolescents. http://www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.htm.
9. Jana P, Andrew H. Childhood obesity Preventive and treatment. 1st edition. LONDON. CRC Press. 2001;30.
10. Mozaffari H, Nabaei B. Obesity and related risk factors. Indian J Pediatr 2007;741(3):265-7.
11. Janghorban M, Parvin F. Prevalence of overweight and thinness in high school girls in Kerman, Iran. Int J Obes Relat Metab Disord 1998;22(7):629-33.
12. Shahbazpour N. Prevalence of overweight and obesity relation to hypertension in adult male university students in Kerman. Iran Int J Endocrinol Metab 2003;2:55-60.
13. Kelishadi R. Childhood overweight, obesity, and the metabolic syndrome in developing countries: Epidemiol Rev 2007;29:62-76.
14. Amuna P, Zotor Fb. Epidemiological and nutrition transition in developing countries : Impact on human health and development. Proc Nutr Soc 2008;67(1)82-90.
15. Huang TT, Ball GD, Franks PW. Metabolic syndrome in youth: current issues and challenges. Appl Physiol Nutr Metab 2007;32(1):13-22.
16. Halley Castillo E, Borges G, Talavera JO, Orozco R, Vargas-Alemán C, Huitrón-Bravo G, et al. Body mass index and the prevalence of metabolic syndrome among children and adolescents in two Mexican populations. J Adolesc Health 2007;40(6):521-6.
17. Spinler SA. Challenges associated with metabolic syndrome. Pharmacotherapy 2006;26(12 Pt 2):209S-217S.
18. Pyörälä M, Miettinen H, Laakso M, Pyörälä K. Hyper insulinemia predicates coronary heart disease risk in healthy middle aged men. The 22 year follows –up results of the Helsinki policemen study. Circulation 1998;98:398-404.
19. Weiss R-Dziura J, Burgert T. Obesity and metabolic syndrome in children and adolescents. New Eng J Med 2004;350(23):2362-74.
20. Messiah SE. Body Mass Index, waist circumference and cardiovascular risk factors in adolescents. J Pediatr 2008;153(6):845-50.
21. Ekelund U, Anderssen S, Andersen LB, Riddoch CJ Sardinha LB, Luan J, et al. Prevalence and correlates of the metabolic syndrome in a population-based sample of European youth. Am J Clin Nutr 2009;89:(1)90.
22. Moayeri H, Rabbani A, Keihanidoust ZT, Bidad K, Anari S. Overweight adolescents: A group at risk for metabolic syndrome Tehran adolescent obesity study. Arch Iran Med 2008;11(1):10-5.
23. Esmaillzadeh A, Mirmiran P, Azadbakht L, Etemadi A, Azizi F. High prevalence of the metabolic syndrome in Iranian adolescents. Obesity (Silver Spring) 2006;14(3):377-82.
24. Kelishadi R, Razaghi EM, Gouya MM, Ardalan G, Gheiratmand R, Delavari A, et al. CASPIAN Study Group. Association of physical activity and the metabolic syndrome in children and adolescents: CASPIAN Study. Horm Res 2007;67(1):46-52. Epub 2006 Oct 11.
25. Kelishadi R, Ardalan G, Adeli K, Motaghian M, Majdzadeh R, Mahmood-Arabi MS, et al. CASPIAN Study Group. Factor analysis of cardiovascular risk clustering in pediatric metabolic syndrome: CASPIAN study. Ann Nutr Metab 2007;51(3):208-15.
26. Messiah SE, Arheart KL, Steven E, Lipshultztracie, Miller L. Body mass index, waist circumference and cardiovascular disease risk factors in adolescents. J Paeds 2008;6(13):845-50
27. Sadeghian S, Darvish S, Salimi S, Esfehani FA, Fallah N, Mahmoodian M, et al. Metabolic syndrome: stronger association with coronary artery disease in young men in comparison with higher prevalence in young women. Coron Artery Dis 2007;18(3):163-8.
28. Hadaegh F, Zabetian A, Harati H, Azizi F. Metabolic syndrome in normal-weight Iranian adults. Ann Saudi Med 2007;27(1):18-24.
29. Zabetian A, Hadaegh F, Azizi F. Prevalence of metabolic syndrome in Iranian adult population, concordance between the IDF with the ATPIII and the WHO definitions. Diabetes Res Clin Pract 2007;77(2):251-7.
30. Janghorbani M, Amini M. Metabolic syndrome in type 2 diabetes mellitus in Isfahan, Iran: Prevalence and risk facto. Metab Syndr Relat Disord 2007;5(3):243-5.
HOME | SEARCH | CURRENT ISSUE | PAST ISSUES
Professional
Medical Publications
Room No. 522, 5th Floor, Panorama Centre
Building No. 2, P.O. Box 8766, Saddar, Karachi - Pakistan.
Phones : 5688791, 5689285 Fax : 5689860
pjms@pjms.com.pk
