Obesity, Metabolic Syndrome And Related Risk Behaviors .

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Open AccessJ Nutri HealthApril 2017 Vol.:3, Issue:1 All rights are reserved by Thaweekul, et al.Journal ofObesity, Metabolic Syndromeand Related Risk Behaviorsamong Thai Medical Students ofThammasat UniversityIntroductionObesity and metabolic syndrome are the major health problemsamong children, adolescents and adults all over the world. Accordingto the World Health Organization (WHO) report in 2008, more thanone third of adults (35%) were overweight (BMI 25 kg/m2). Theworldwide prevalence of obesity has nearly doubled between 1980and 2008 [1]. In Thailand, the prevalence of obesity in adulthoodis increasing from 13.0% in men and 23.2% in women in 1991 to22.4% and 34.3% in 2004 respectively [2]. The increasing prevalenceof obesity is related to the increase of metabolic syndrome, a clusterof central obesity, insulin resistance, hypertension and dyslipidemia.Metabolic syndrome is a known risk factor for the cardiovasculardisease and diabetes in the adolescents and adults.Adolescent obesity is a strong precursor of obesity and relatedmorbidity in adulthood [3,4]. The previous study during transitionalperiod from the adolescence to young adulthood revealed that youngadults gain weight faster than other period of adulthoods [5]. Thetransition to college of adolescents is an important period of risk forbeing overweight [6]. Various lifestyles of the college students areimportant risk factors of developing obesity and related metabolicdiseases [7,8]. Instead of being the future healthcare professional,the medical students have many risk behaviors of developingobesity during the long period of the 6-year medical curriculum.The inappropriate food consumption, abnormal eating habits, lackof sleep and exercise were identified to be the vulnerable factors todevelop obesity among them [9,10].To the best of our knowledge, no studies demonstrated thealteration of nutritional status during the training in medical program.The present study was conducted to determine the prevalence andrisk behaviors of obesity and related metabolic disorders among thefinal-year medical students of Thammasat University. The change innutritional status during the studying program was also focused.Materials and MethodsThis institution-based, cross-sectional study was conductedamong the sixth-year medical students of Thammasat Universityduring the academic year 2014. The Ethic Committee of ThammasatUniversity approved the protocol. Written informed consent wasobtained from all participants.The voluntary medical students were asked to complete theself-report questionnaires. The questionnaires contained thedemographic data (such as the student ID, sex and birth date) andvarious metabolic risk behaviors including fast food and beveragesResearch ArticleNutrition andHealthPatcharapa Thaweekul* and Paskorn SritipsukhoDepartment of Pediatrics, Faculty of Medicine, ThammasatUniversity, Pathumthani, Thailand*Address for CorrespondencePatcharapa Thaweekul, Department of Pediatrics, Faculty of Medicine,Thammasat University, 95 Paholyothin Road, Klong-luang, PathumThani12120, Thailand, Tel: ( 6681) 583-6848, ( 662) 926-9514; Fax: ( 662) 9269513; E-mail: maybemay@yahoo.com,thaweekul@gmail.comSubmission: 14 March, 2017Accepted: 15 April, 2017Published: 25 April, 2017Copyright: 2017 Thaweekul P et al. This is an open access articledistributed under the Creative Commons Attribution License, whichpermits unrestricted use, distribution, and reproduction in any medium,provided the original work is properly cited.consumption, fruit and vegetable intake, breakfast skipping, nighteating, snacks, exercise, screen time and sleep duration. The weight,height and waist circumference were obtained. Three systolic anddiastolic blood pressures were measured after 5-minutes rest. Bloodsamples were taken after an overnight, 12-hour fast to measure lipidprofile (total cholesterol, high-density lipoprotein [HDL-C], lowdensity lipoprotein cholesterol [LDL-C] and triglycerides [TG]) bythe enzymatic methods. Fasting plasma glucose (FPG) was measuredby hexokinase method. The body weight and height of the medicalstudents in the first year were collected from the medical report atthe entry.The body mass index (BMI) is defined as the weight in kilogramsdivided by the square of the height in meters (kg/m2). Accordingto WHO cut-off points for Asian, the medical students withoverweight and obesity were divided into 3 groups based on theirBMI: overweight, 23-24.9 kg/m2; obesity grade I, 25-29.9 kg/m2;obesity grade II 30 kg/m2 [11]. Normal weight students defined asBMI 17-22.9 kg/m2. The participants with the BMI less than 17 kg/m2 were defined as underweight. Abdominal obesity was diagnosedin the participants who had the waist circumference more than 80 cmin females or 90 cm in males [12]. Abnormal metabolic parameterswere defined according to the International Diabetes Federation(IDF) consensus definition of the metabolic syndrome as follows:triglycerides 150 mg/dL; HDL-C 50 mg/dL in females or 40 inmales and FPG 100 mg/dL [12]. According to the Expert Panel onDetection, Evaluation, and Treatment of High Blood Cholesterol inAdults (Adult Treatment Panel III), the abnormal blood cholesterolwas determined as borderline high or high when the total cholesterolwas 200-239 mg/dL and 240 mg/dL, respectively. The LDL-C wasdetermined as borderline high or high when the LDL-C was 130-159mg/dL and 160 mg/dL, respectively [13]. Hypertension was definedas the systolic and diastolic blood pressure 130 and 85 mmHg,respectively [12].According to IDF consensus, the students were defined to havethe metabolic syndrome when central obesity presented plus any twoof the four additional factors. These four factors are: 1) raised TGCitation: Thaweekul P, Sritipsukho P. Obesity, Metabolic Syndrome and Related Risk Behaviors among Thai Medical Students of Thammasat University.J Nutri Health. 2017;3(1): 5.

Citation: Thaweekul P, Sritipsukho P. Obesity, Metabolic Syndrome and Related Risk Behaviors among Thai Medical Students of Thammasat University.J Nutri Health. 2017;3(1): 5.ISSN: 2469-4185Table 1: Demographic data among the underweight, normal weight and overweight/obese students.Profile(mean SD)Total(123)Underweight(n 14)Age23.0 1.222.9 0.5Gender (Male, %)51 (41.5)3 (21.4)BMI at 1 year (kg/m )20.9 3.516.9 0.9Current BMI (kg/m2)21.9 3.517.7 0.7st2Normal weight(n 72)Overweight/obese(n 37)p-value22.8 0.723.3 20.18828 (38.9)20 (54.1)0.08519.9 1.924.4 3.6 0.00120.7 1.425.7 3.6 0.001Waist circumference (cm)76.5 9.167.9 4.474.0 6.884.5 8.5 0.001SBP (mmHg)110.8 9.4108.7 9.9109.5 8.8114.0 9.60.040DBP (mmHg)72.1 7.469.9 6.571.9 7.173.2 8.20.373FPG (mg/dL)88.0 9.189.1 6.487.9 7.787.8 12.00.633195.3 35.2187.4 26.1193.8 32.6201.2 42.10.395Total cholesterol mg/dL)HDL-cholesterol mg/dL)62.9 13.970.1 9.264.2 14.154.6 13.30.006LDL-cholesterol (mg/dL)114.2 30.4101.1 25.4111.8 27.4123.8 35.20.032Triglyceride (mg/dL)72.6 33.067.7 23.271.7 32.576.4 37.20.662SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure; FPG: Fasting Plasma Glucose; HDL: High-Density Lipoprotein; LDL: Low-Density LipoproteinTable 2: Nutritional status of the medical students according to the nutritional status during the first year.Nutritional statusCurrent(n 123)Underweight1st year (n 121)UnderweightNormalOverweightObese grade IObese grade IITotal1 (9.1)0 (0)0 (0)0 (0)0 (0)1 (0.8)10 (90.9)71 (83.5)5 (41.7)0 (0)0 (0)86 (69.9)Overweight0 (0)11 (12.9)5 (41.7)5 (38.5)0 (0)21 (17.1)Obese grade I0 (0)3 (3.5)2 (16.7)6 (46.2)0 (0)11 (8.9)Obese grade II0 (0)0 (0)0 (0)2 (15.4)2 (100)4 (3.3)118512132123NormalTotalTable 3: The prevalence of abnormal metabolic profiles between the low to normal weight and the overweight/obese students.ProfileN (%)Total(n 122)Low to normal weight (n 85)Overweight/obese(n 37)p-valueAbdominal obesity13 (10.7)0 (0)13 (35.1) 0.001Hypertriglyceridemia5 (4.1)2 (2.4)3 (8.1)0.163Hypercholesterolemia200-239 mg/dL 240 mg/dL39 (32.0)11 (9)25 (29.4)8 (9.4)14 (37.8)3 (8.1)0.295Low HDL-cholesterol8 (6.6)3 (3.5)5 (13.5)0.054High LDL-cholesterol130-159 mg/dL0.02421 (17.2)12 (14.1)9 (24.3)9 (7.4)4 (4.7)5 (13.5)Impair FPG11 (9)6(7.1)5 (13.5)Diabetes1 (0.8)0 (0)1 (2.7)2 (1.7)0 (0)2 (5.5) 160 mg/dLFPGMetabolic syndrome0.111level: 150 mg/ dL; 2) reduced HDL-C: 40 mg/dL in males and 50 mg/dL in females; 3) raised blood pressure (systolic BP 130 or diastolicBP 85 mmHg or treatment of previously diagnosed hypertension; 4)raised FPG 100 mg/dL or previously diagnosed type 2 diabetes [12].Statistical analysisJ Nutri Health 3(1): 5 (2017)0.092Demographic and biochemical data were report as means SD,unless indicated otherwise. The prevalence of the abnormal metabolicprofiles and the presence of the risk behaviors were reported as number(percent). The student t-test or Analysis of Variance (ANOVA) wasused to test for the differences in the physical characteristics andPage - 02

Citation: Thaweekul P, Sritipsukho P. Obesity, Metabolic Syndrome and Related Risk Behaviors among Thai Medical Students of Thammasat University.J Nutri Health. 2017;3(1): 5.ISSN: 2469-4185Table 4: Comparison of the risk behaviors between the low to normal weight and the overweight/obese students.Risk behaviorsLow to normal weightN (%)Overweight/obese N (%)p-valueRegular fast food consumption3 (3.61)3 (9.1)0.223Regular beverage consumption51 (60)14 (42.4)0.067Low vegetable intake75 (87.2)31 (96.9)0.099Low fruit intake62 (72.1)21 (63.6)0.247Regular breakfast skipping61 (70.9)18 (54.5)0.071Regular night eating25 (29.4)6 (18.2)0.156Frequent snacks8 (9.3)5 (15.2)0.271Irregular exercise habits76 (91.9)30 (90.6)0.543 4 hours of screen times per day18 (20.9)8 (24.2)0.435 6 hours of sleep per day38 (44.2)22 (66.7)0.023Table 5: The comparative data of prevalence rate of overweight/obesity among the Asian medical students.Sample sizeYearOverweightObesityUnderweightThai [10]Countries5441200610.16.7Not presentedChina [9]54712010-2011Malaysia [16]290201214.821.114.8India [15]212201321.2615.529.79This study123201417.112.20.8biochemical parameters among the medical students with overweight/obesity; normal weight and/or underweight. The presence of variousrisk behaviors among both groups were compared using Chi-squaretest. P-value 0.05 is considered to be significant.ResultsOne hundred and twenty-three participants completed thequestionnaires and were enrolled in the study. The demographic dataof the students with underweight, normal weight and overweight/obesity are shown in Table1. The mean BMI of the medical studentsin the first and the final year were 20.9 3.5 and 21.9 3.5 kg/m2,respectively. There are statistically significant differences in waistcircumference, systolic blood pressure, HDL-C and LDL-C levelsamong the three groups. The prevalence of overweight and obesityat the entry to medical school was 22.0% and increased to 29.3% inthe final year. Contrary, the prevalence of underweight among themedical students decreased from 8.9% in the first year to 0.8% in thefinal year. The nutritional statuses among the medical students inthe first and final year are shown in Table 2. The current BMI wassignificantly correlated with the BMI at the entry as shown in Figure1 (R2 0.72, p 0. 001). The prevalence of abnormal metabolic factorsin the students with overweight/obesity tended to be higher than thenormal weight and underweight group, with statistically significancein only the serum LDL-C, as shown in Table 3. There were twostudents diagnosed as metabolic syndrome, according to IDFcriteria. Sleep deprivation was significantly frequent in the medicalstudents with overweight/obesity as compared to the normal weightstudents. The risk behaviors of the students with normal weight andoverweight/obesity are shown in Table 4.7.6%6.28prevention and intervention of obesity and related metabolicdisorder. The medical students, despite being health educated, havemany metabolic-risk lifestyles predisposing to adolescent obesity. Theprevalence of overweight and obesity in this present study were 17.1%and 12.2%, respectively, which was slightly lower than overall rateof overweight/obesity of the general Thai population. As comparedto the Fifth Thai National Nutrition Survey in the year 2003, theprevalence of overweight and obesity in the young adults were 13.9%and 21.7%, respectively [14]. A National survey of 5441 Thai Medicalstudents in the year 2006 reported the prevalence rate of 10.1 and 6.7%which were much lower than the general Thai population and thispresent study [10]. The prevalence of overweight and obesity amongthe Asian medical students as compared to their general populationsare inconsistent. There are some studies reports the higher prevalenceof overweight and obesity among the medical students in India andDiscussionThe college students are in the important period for the detection,J Nutri Health 3(1): 5 (2017)Figure 1: Correlation of the current BMI and BMI at the entry.Page - 03

Citation: Thaweekul P, Sritipsukho P. Obesity, Metabolic Syndrome and Related Risk Behaviors among Thai Medical Students of Thammasat University.J Nutri Health. 2017;3(1): 5.ISSN: 2469-4185Malaysia [15,16]. The lower prevalence is reported from the medicalstudents in China and Thailand including from this present study.The comparative data of the prevalence rate of overweight/obesityamong the Asian medical students are shown in Table 5.As tracking the bodyweight from the entry of the medical schoolto the final year, the prevalence of overweight increased from 9.8%to 17.1%. The prevalence of obesity in the final year students wasnearly the same as in the first year. The BMI in the final year wascorrelated with the BMI at the entry. More than half of the studentswith overweight and all of the students with obesity since the first yearwere still overweight or obese at the final year. The BMI increasedmore significant in male medical students as compared to femalestudents (1.76 1.74 and 0.43 1.82 kg/m2, respectively; p 0.001). Theprevalence of overweight and obesity was also reported to be higherin male than female students in many previous studies [9,17-19]. Themore increasing BMI among the male students may be due to thefact that the female students are more likely to perceive themselves asoverweight and more often try to control or lose their weights [20].The prevalence of malnutrition in medical students was also decreasedfrom 8.9% in first year to 0.8% in the final year. This correspondedwith the increasing prevalence of overweight in the students in thefinal year.Metabolic syndrome was diagnosed in two female students andnone of the males. The prevalence of metabolic syndrome among thestudents with overweight/obesity from this present study was 14.29%.Many abnormal metabolic parameters, which are atherosclerotic andcardiovascular risks, were identified among all student groups, evenin the students with underweight. The prevalence of high LDL-C inthe students with overweight/obesity was significantly higher than thestudents who had low/normal weight. Metabolic parameters shouldbe done especially in the medicals students with overweight/obesityto early identify the cardiovascular risk in this population.Of all the life-style factors, sleep deprivation was more frequentbehavior in the students with overweight/obesity when compared tothe normal weight students. Previous studies reported that studentswho have fewer hours of sleep were significantly more likely to beoverweight or obese [9,21]. This strong association may be due tothe increase in ghrelin and decrease in leptin levels [22]. This presentstudy could not demonstrate the difference of other risk behaviorsamong the low to normal weight and the overweight/obese students.This may due to small sample size in this study. However, more thanhalf of the medical students have various metabolic-risk behaviorssuch as unhealthy eating habits: breakfast skipping, low fruits andvegetable consumption; limit exercise and sleep deprivation.ConclusionAs the trend toward of becoming overweight during the final yearof the medical students, they should be annually assessed for theirnutritional status and evaluated their metabolic parameters, especiallythe students with overweight/obesity. Lifestyle modification shouldbe advised to the students who are overweight/obese at the entryto decrease their body weights. Male students have higher risk ofincrease their BMI and should be closely monitored. Medical schoolsshould promote healthy behavior to increase the healthy eating andexercise habits and reduce the risk behaviors among them.J Nutri Health 3(1): 5 (2017)References1. WHO (2008) Global health observatory (GHO) data: Obesity. World HealthOrganization.2. Aekplakorn W, Mo-Suwan L (2009) Prevalence of obesity in Thailand. ObesRev 10: 589-592.3. Magarey AM, Daniels LA, Boulton TJ, Cockington RA (2003) Predictingobesity in early adulthood from childhood and parental obesity. Int J ObesRelat Metab Disord 27: 505-513.4. Toschke AM, Rückinger S, Reinehr T, von Kries R (2008) Growth aroundpuberty as predictor of adult obesity. Eur J Clin Nutr 62: 1405-1411.5. Gordon-Larsen P, Adair LS, Nelson MC, Popkin BM (2004) Five-year obesityincidence in the transition period between adolescence and adulthood: theNational Longitudinal Study of Adolescent Health. Am J Clin Nutr 80: 569575.6. Vella-Zarb RA, Elgar FJ (2009) The ‘freshman 5’: a meta-analysis of weightgain in the freshman year of college. J Am Coll Health 58: 161-166.7. Spencer L (2002) Results of a heart disease risk-factor screening amongtraditional college students. J Am Coll Health 50: 291-296.8. Desai MN, Miller WC, Staples B, Bravender T (2008) Risk factors associatedwith overweight and obesity in college students. J Am Coll Health 57: 109114.9. Chen J, Yi H, Liu Z, Fan Y, Bian J, et al. (2013) Factors associated with beingoverweight among Inner Mongolia medical students in China. BMJ Open 3:e003900.10. Ekpanyaskul C, Sithisarankul P, Wattanasirichaigoon S (2013) Overweight/Obesity and related factors among thai medical students. Asia Pac J PublicHealth 25: 170-180.11. World Health Organization Regional Office for the Western Pacific,International Diabetes Institute, International Association for the Studyof Obesity, International Obesity Task Force (2000) The Asia-Pacificperspective: redefining obesity and its treatment. Health CommunicationAustralia, Sydney.12. Alberti KG, Zimmet P, Shaw J (2006) Metabolic syndrome--a new worldwide definition. A Consensus Statement from the International DiabetesFederation. Diabet Med 23: 469-480.13. Expert Panel on Detection, Evaluation, and Treatment of High BloodCholesterol in Adults (2001) Executive Summary of The Third Report of TheNational Cholesterol Education Program (NCEP) expert panel on detection,evaluation, and treatment of high blood cholesterol in adults (Adult TreatmentPanel III). JAMA 285: 2486-2497.14. Department of Health, Ministry of Public Health (2003) Report on the 5th Thainational Nutrition Survey. Ministry of Public Health, Nonthaburi, Thailand.15. Sharma S, Raina SK, Bhardwaj AK, Chander V, Kumar D, et al. (2013)Utility of consensus statement in assessment of obesity: a study amongundergraduate medical students from rural Northwest India. J Fam Med PrimCare 2: 274-276.16. Gopalakrishnan S, Ganeshkumar P, Prakash MV, Christopher, AmalrajV (2012) Prevalence of overweight/obesity among the medical students,Malaysia. Med J Malaysia 67: 442-444.17. Kamien M, Power R (1996) Lifestyle and health habits of fourth year medicalstudents at the University of Western Australia. Aust Fam Physician Suppl1: S26-S29.18. Nisar N, Qadri MH, Fatima K, Perveen S (2008) Dietary habits and life styleamong the students of a private medical university Karachi. J Pak Med Assoc59: 98-101.19. Carter AO, Elzubeir M, Abdulrazzaq YM, Revel AD, Townsend A (2003)Health and lifestyle needs assessment of medical students in the United ArabEmirates. Med Teach 25: 492-496.Page - 04

of obesity is related to the increase of metabolic syndrome, a cluster of central obesity, insulin resistance, hypertension and dyslipidemia. Metabolic syndrome is a known risk factor for the cardiovascular disease and diabetes in the adolescents and adults. Adolescent obesity is a strong precursor of obesity and related morbidity in adulthood .

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