Increasing urbanization, mechanization, and rural-to-urban migration has led to deranged sleeping patterns, surplus energy intake, and sedentary lifestyles in South Asian young people. This shift poses an insidious health risk for the development of metabolic syndrome (MetS). Early detection is needed because in the South Asian population, this syndrome carries an increased risk of comorbidities compared to people without the syndrome. This study was designed to elucidate the prevalence of MetS and its risk factors in young people in urban areas of Pakistan.
Methods:
A cross-sectional study was conducted in four undergraduate institutions in Lahore, Pakistan. Five hundred and nine young people participated, and each provided their informed consent for the collection of data on their demographic, physical, and biochemical characteristics along with information on their dietary, sleep, and physical activity habits.
Results:
Most participants reported consuming greater-than-recommended amounts of protein and smaller-than-recommended amounts of vegetables and fruits. The International Diabetes Federation criteria for MetS were fulfilled by 6.1% of the students. Hypertension (67.7%) and hypo-HDL-emia (64.5%) were the most common risk factors. More than 50% of the respondents slept fewer hours per day than recommended, and 33% had a sedentary lifestyle. Men, participants with a family history of metabolic illness and those with low physical activity levels had higher odds of a positive result on screening for MetS.
Conclusions:
The early detection of MetS and early identification of probable risk factors may make beneficial contributions to both public health and clinical interventions directed at high-risk individuals. Establishing and using cutoff values for modified waist circumference and specific body mass index in Asian populations may aid in early detection.
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References
1.
EbbelingCB, PawlakDB, LudwigDS. Childhood obesity: Public-health crisis, common sense cure. Lancet, 2002; 360:473–482.
2.
CollisonKS, ZaidiMZ, SubhaniSN, et al.Sugar-sweetened carbonated beverage consumption correlates with BMI, waist circumference, and poor dietary choices in school children. BMC Public Health, 2010; 10:234.
3.
GungorNK. Overweight and obesity in children and adolescents. J Clin Res Pediatr Endocrinol, 2014; 6:129–143.
4.
NisarN. Childhood obesity: A major public health challenge of 21st century. J Coll Physicians Surg Pak, 2018; 28:815–816.
5.
PappasG, AkhtarT, GergenPJ, et al.Health status of the Pakistani population: A health profile and comparison with the United States. Am J Public Health, 2001; 91:93–98.
6.
SpagnoloA, GiussaniM, AmbruzziAM, et al.Focus on prevention, diagnosis and treatment of hypertension in children and adolescents. Ital J Pediatr, 2013; 39:20.
7.
ViazziF, AntoliniL, GiussaniM, et al.Serum uric acid and blood pressure in children at cardiovascular risk. Pediatrics, 2013; 132:e93–e99.
8.
GenovesiS, AntoliniL, GiussaniM, et al.Hypertension, prehypertension, and transient elevated blood pressure in children: Association with weight excess and waist circumference. Am J Hypertens, 2010; 23:756–761.
9.
LurbeE, CifkovaR, CruickshankJK, et al.Management of high blood pressure in children and adolescents: Recommendations of the European Society of Hypertension. J Hypertens, 2009; 27:1719–1742.
10.
LurbeE, Agabiti-RoseiE, CruickshankJK, et al.2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens, 2016; 34:1887–1920.
11.
PaniaguaJA. Nutrition, insulin resistance and dysfunctional adipose tissue determine the different components of metabolic syndrome. World J Diabetes, 2016; 7:483–514.
12.
LentferinkYE, ElstMAJ, KnibbeCAJ, et al.Predictors of insulin resistance in children versus adolescents with obesity. J Obes, 2017; 2017:3793868.
13.
PulgaronER, DelamaterAM. Obesity and type 2 diabetes in children: Epidemiology and treatment. Curr Diab Rep, 2014; 14:508.
14.
WangY, LobsteinT. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes, 2006; 1:11–25.
15.
HydrieMZ, SheraAS, FawwadA, et al.Prevalence of metabolic syndrome in urban Pakistan (Karachi): Comparison of newly proposed International Diabetes Federation and modified Adult Treatment Panel III criteria. Metab Syndr Relat Disord, 2009; 7:119–124.
16.
ChenF, WangY, ShanX, et al.Association between childhood obesity and metabolic syndrome: Evidence from a large sample of Chinese children and adolescents. PLoS One, 2012; 7:e47380.
17.
PopkinBM, AdairLS, NgSW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev, 2012; 70:3–21.
18.
ReavenGM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes, 1988; 37:1595–1607.
19.
DeFronzoRA, FerranniniE. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care, 1991; 14:173–194.
20.
KaplanNM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med, 1989; 149:1514–1520.
21.
MisraA, KhuranaL. Obesity-related non-communicable diseases: South Asians vs White Caucasians. Int J Obes (Lond), 2011; 35:167–187.
22.
NarayananP, MengOL, MahanimO. Do the prevalence and components of metabolic syndrome differ among different ethnic groups? A cross-sectional study among obese Malaysian adolescents. Metab Syndr Relat Disord, 2011; 9:389–395.
23.
MisraA, AthikoD, SharmaR, et al.Non-obese hyperlipidemic Asian northern Indian males have adverse anthropometric profile. Nutr Metab Cardiovasc Dis, 2002; 12:178–183.
24.
PatelSA, ShivashankarR, AliMK, et al.Is the “South Asian Phenotype” unique to South Asians?: Comparing cardiometabolic risk factors in the CARRS and NHANES Studies. Glob Heart, 2016; 11:89–96.e83.
25.
MohanV, DeepaM, FarooqS, et al.Anthropometric cut points for identification of cardiometabolic risk factors in an urban Asian Indian population. Metabolism, 2007; 56:961–968.
26.
RazakF, AnandSS, ShannonH, et al.Defining obesity cut points in a multiethnic population. Circulation, 2007; 115:2111–2118.
27.
MisraA, KhuranaL. The metabolic syndrome in South Asians: Epidemiology, determinants, and prevention. Metab Syndr Relat Disord, 2009; 7:497–514.
28.
AryalN, WastiS. The prevalence of metabolic syndrome in South Asia: A systematic review. Int J Diabetes Dev Count, 2015; 36:255–262.
29.
RanasingheP, MathangasingheY, JayawardenaR, et al.Prevalence and trends of metabolic syndrome among adults in the asia-pacific region: A systematic review. BMC Public Health, 2017; 17:101.
30.
MorrisonJA, FriedmanLA, Gray-McGuireC. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: The Princeton Lipid Research Clinics Follow-up Study. Pediatrics, 2007; 120:340–345.
31.
MisraA, SinghalN, KhuranaL. Obesity, the metabolic syndrome, and type 2 diabetes in developing countries: Role of dietary fats and oils. J Am Coll Nutr, 2010; 29(3 Suppl):289s–301s.
32.
SaklayenMG. The global epidemic of the metabolic syndrome. Curr Hypertens Rep, 2018; 20:12.
33.
MorrisonJA, FriedmanLA, WangP, et al.Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later. J Pediatr, 2008; 152:201–206.
34.
MisraA, KhuranaL, VikramNK, et al.Metabolic syndrome in children: Current issues and South Asian perspective. Nutrition, 2007; 23:895–910.
35.
MagnussenCG, KoskinenJ, ChenW, et al.Pediatric metabolic syndrome predicts adulthood metabolic syndrome, subclinical atherosclerosis, and type 2 diabetes mellitus but is no better than body mass index alone: The Bogalusa Heart Study and the Cardiovascular Risk in Young Finns Study. Circulation, 2010; 122:1604–1611.
36.
BerensonGS. Bogalusa Heart Study: A long-term community study of a rural biracial (Black/White) population. Am J Med Sci, 2001; 322:293–300.
37.
RaitakariOT, JuonalaM, KähönenM, et al.Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood the cardiovascular risk in young Finns study. JAMA, 2003; 290:2277–2283.
38.
(UNDESA) Definition of Youth. (www.un.org/esa/socdev/documents/youth/fact-sheets/youth-definition.pdf)
39.
AlbertiKG, ZimmetP, ShawJ. Metabolic syndrome—A new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med, 2006; 23:469–480.
40.
BeilbyJ. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Clin Biochem Rev, 2004; 25:195–198.
41.
AhmadW, TaggartF, ShafiqueMS, et al.Diet, exercise and mental-wellbeing of healthcare professionals (doctors, dentists and nurses) in Pakistan. PeerJ, 2015; 3:e1250.
42.
BiddleSJ, GorelyT, PearsonN, et al.An assessment of self-reported physical activity instruments in young people for population surveillance: Project ALPHA. Int J Behav Nutr Phys Act, 2011; 8:1.
43.
GionetNJ, GodinG. Self-reported exercise behavior of employees: A validity study. J Occup Med, 1989; 31:969–973.
44.
GodinG, ShephardRJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci, 1985; 10:141–146.
45.
HirshkowitzM, WhitonK, AlbertSM, et al.National Sleep Foundation's updated sleep duration recommendations: Final report. Sleep Health, 2015; 1:233–243.
46.
BuysseDJ, ReynoldsCF3rd, MonkTH, et al.The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res, 1989; 28:193–213.
47.
ClarkeA, FriedeT, PutzR, et al.Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Validated for teenage school students in England and Scotland. A mixed methods assessment. BMC Public Health, 2011; 11:487.
48.
TaggartF, FriedeT, WeichS, et al.Cross cultural evaluation of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS)—A mixed methods study. Health Qual Life Outcomes, 2013; 11:27.
49.
DodaniS, QureshiR, AliBS. Syndrome X and family practitioners. J Pak Med Assoc, 1999; 49:177–180.
50.
CookS, WeitzmanM, AuingerP, et al.Prevalence of a metabolic syndrome phenotype in adolescents: Findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med, 2003; 157:821–827.
51.
MorrellJS, Byrd-BredbennerC, QuickV, et al.Metabolic syndrome: Comparison of prevalence in young adults at 3 land-grant universities. J Am Coll Health, 2014; 62:1–9.
52.
NamwongpromS, RerkasemK, WongthaneeA, et al.Relationship between body composition parameters and metabolic syndrome in young Thai adults. J Clin Res Pediatr Endocrinol, 2014; 6:227–232.
53.
van Tienhoven-WindLJ, DullaartRP. Low-normal thyroid function and the pathogenesis of common cardio-metabolic disorders. Eur J Clin Invest, 2015; 45:494–503.
54.
KrishnadathISK, ToelsieJR, HofmanA, et al.Ethnic disparities in the prevalence of metabolic syndrome and its risk factors in the Suriname Health Study: A cross-sectional population study. BMJ Open, 2016; 6:e013183.
55.
MbuguaSM, KimaniST, MunyokiG. Metabolic syndrome and its components among university students in Kenya. BMC Public Health, 2017; 17:909.
56.
YahiaN, BrownCA, SnyderE, et al.Prevalence of metabolic syndrome and its individual components among Midwestern University students. J Community Health, 2017; 42:674–687.
57.
KaradagMK, AkbulutM, LowHDL. Levels as the most common metabolic syndrome risk factor in heart failure. Int Heart J, 2009; 50:571–580.
58.
WangH, PengDQ. New insights into the mechanism of low high-density lipoprotein cholesterol in obesity. Lipids Health Dis, 2011; 10:176.
59.
RutterMK, MeigsJB, SullivanLM, et al.C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study. Circulation, 2004; 110:380–385.
60.
YusufS, HawkenS, OunpuuS, et al.Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: A case-control study. Lancet, 2005; 366:1640–1649.
61.
VillegasR, XiangYB, ElasyT, et al.Purine-rich foods, protein intake, and the prevalence of hyperuricemia: The Shanghai Men's Health Study. Nutr Metab Cardiovasc Dis, 2012; 22:409–416.
62.
KrishnanE, KwohCK, SchumacherHR, et al.Hyperuricemia and incidence of hypertension among men without metabolic syndrome. Hypertension, 2007; 49:298–303.
63.
HallMH, MuldoonMF, JenningsJR, et al.Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep, 2008; 31:635–643.
64.
Borges PrettoAD, Correa KaufmannC, Ferreira DutraG, et al.Prevalence of factors associated to metabolic syndrome in a cohort of children in South Brazil. Nutr Hosp, 2015; 32:118–123.
65.
ChengX, WangH, YuanB, et al.Prevalence of metabolic syndrome and its family factors for children and adolescents in Chongqing City in 2014 [in Chinese]. Wei Sheng Yan Jiu, 2017; 46:557–562.
66.
BuxtonOM, MarcelliE. Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Soc Sci Med, 2010; 71:1027–1036.
67.
ChaputJP, BouchardC, TremblayA. Change in sleep duration and visceral fat accumulation over 6 years in adults. Obesity (Silver Spring), 2014; 22:E9–E12.
68.
SalonenMK, WaseniusN, KajantieE, et al.Physical activity, body composition and metabolic syndrome in young adults. PLoS One, 2015; 10:e0126737.
69.
ShiZ, McEvoyM, LuuJ, et al.Dietary fat and sleep duration in Chinese men and women. Int J Obes (Lond), 2008; 32:1835–1840.
70.
SperrySD, ScullyID, GramzowRH, et al.Sleep duration and waist circumference in adults: A meta-analysis. Sleep, 2015; 38:1269–1276.
71.
PeltzerK, PengpidS. Sleep duration, sleep quality, body mass index, and waist circumference among young adults from 24 low- and middle-income and two high-income countries. Int J Environ Res Public Health, 2017; 14.
72.
BerentzenNE, SmitHA, BekkersMB, et al.Time in bed, sleep quality and associations with cardiometabolic markers in children: The Prevention and Incidence of Asthma and Mite Allergy birth cohort study. J Sleep Res, 2014; 23:3–12.
73.
LeeJA, ParkHS. Relation between sleep duration, overweight, and metabolic syndrome in Korean adolescents. Nutr Metab Cardiovasc Dis, 2014; 24:65–71.
74.
Rey-LopezJP, de CarvalhoHB, de MoraesAC, et al.Sleep time and cardiovascular risk factors in adolescents: The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Sleep Med, 2014; 15:104–110.
75.
LaMonteMJ, BarlowCE, JurcaR, et al.Cardiorespiratory fitness is inversely associated with the incidence of metabolic syndrome: A prospective study of men and women. Circulation, 2005; 112:505–512.
76.
Lloyd-JonesDM, LiuK, ColangeloLA, et al.Consistently stable or decreased body mass index in young adulthood and longitudinal changes in metabolic syndrome components: The Coronary Artery Risk Development in Young Adults Study. Circulation, 2007; 115:1004–1011.
77.
WuS, Fisher-HochSP, ReiningerB, et al.Recommended levels of physical activity are associated with reduced risk of the metabolic syndrome in Mexican-Americans. PLoS One, 2016; 11:e0152896.
78.
ThompsonPD, BuchnerD, PinaIL, et al.Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: A statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation, 2003; 107:3109–3116.
79.
CappuccioFP, TaggartFM, KandalaNB, et al.Meta-analysis of short sleep duration and obesity in children and adults. Sleep, 2008; 31:619–626.
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