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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 19  |  Issue : 1  |  Page : 36-41

Metabolic syndrome and its associated factors among the adult population residing in Kannavam tribal area of Kannur District, Kerala


Department of Community Medicine, Kannur Medical College, Kannur, Kerala, India

Date of Web Publication17-Dec-2015

Correspondence Address:
Imaad Mohammed Ismail
Department of Community Medicine, Kannur Medical College, Anjarakandy, Kannur - 670 612, Kerala
India
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DOI: 10.4103/1119-0388.172060

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  Abstract 

Background: Metabolic syndrome is an important predictor for the development of cardiovascular diseases and diabetes mellitus. The prevalence of metabolic syndrome is increasing rapidly due to sedentary lifestyle, changing dietary patterns, and increased tobacco smoking and alcohol consumption. As the syndrome is relatively unexplored among the tribal population of India, this study was undertaken to address the issue. Objectives: To estimate the prevalence of metabolic syndrome and to identify its associated factors among the adult population of Kannavam tribal area, Kannur district, Kerala. Materials and Methods: It was a cross-sectional study carried out in Kannavam tribal area, Kannur district, Kerala. The study period was from March 2014 to December 2014. There are around 6,000 tribal people living in the said area. Using convenient sampling, 120 individuals aged 18 years and above were selected for the study. Data were collected using a pretested and semi-structured questionnaire. Blood samples were collected and transferred to central lab of the institute for analysis. National Cholesterol Education Program (NCEP) - Adult Treatment Panel (ATP) III criteria were used for the diagnosis of metabolic syndrome. Data entry and analysis were done on SPSS Inc. version 17 (Statistical Package for Social Sciences, Chicago). Results: The prevalence of metabolic syndrome according to the NCEP-ATP III criteria was 28.3%. The prevalence was higher in females (32.5%) as compared to males (21%), but this difference was not statistically significant. Body mass index (BMI) ≥25 kg/m2, high waist-hip ratio (WHR), and very-low-density lipoprotein (VLDL) cholesterol ≥30 mg/dL were found to be significantly associated with metabolic syndrome, whereas no association was found with tobacco intake, alcohol consumption, and physical inactivity. Conclusion and Recommendation: For a naive population like tribal people, 28.3% prevalence of metabolic syndrome is a cause of concern. As one-third of the study population had two out of the five risk factors, health education focused on lifestyle modification, such as regular physical activity, intake of a balanced diet, and annual checkup, should be conducted.

Keywords: Adult Treatment Panel III criteria, metabolic syndrome, prevalence, tribal population


How to cite this article:
Ismail IM, Azeez K, Antomy A, Kunnummal SV. Metabolic syndrome and its associated factors among the adult population residing in Kannavam tribal area of Kannur District, Kerala. Trop J Med Res 2016;19:36-41

How to cite this URL:
Ismail IM, Azeez K, Antomy A, Kunnummal SV. Metabolic syndrome and its associated factors among the adult population residing in Kannavam tribal area of Kannur District, Kerala. Trop J Med Res [serial online] 2016 [cited 2019 Oct 17];19:36-41. Available from: http://www.tjmrjournal.org/text.asp?2016/19/1/36/172060


  Introduction Top


Metabolic syndrome, also known as syndrome X, is a combination of risk factors that increase risks for heart disease, diabetes, and stroke.[1],[2] It is characterized by the presence of dyslipidemia, glucose intolerance, hypertension, abdominal obesity, and other abnormalities.[3] Metabolic syndrome has emerged as a major public health challenge in both developed and developing countries. It is estimated that a quarter of the world's adults have metabolic syndrome. South Asians, especially Indians, have a high predisposition to it.[4] The prevalence of metabolic syndrome in India ranges 28-36% in the urban population and 18-30% in the rural population.[5],[6],[7],[8]

Metabolic syndrome is an important predictor for the development of cardiovascular diseases and diabetes mellitus. People with metabolic syndrome are twice as likely to die from heart attack and three times more likely to have a heart attack or stroke as compared with people without the syndrome.[9] People with metabolic syndrome have five times higher risk of developing type 2 diabetes.[10]

The prevalence of metabolic syndrome is increasing rapidly due to sedentary lifestyle, changing dietary patterns, and increased tobacco smoking and alcohol consumption. With improved connectivity and technology, the lifestyle of tribal populations is also gradually changing. As the syndrome is relatively unexplored among the tribal population of India, this study was undertaken to address the issue. The objective of the study is to estimate the prevalence of metabolic syndrome and identify its associated factors among the tribal population of Kannavam of Kannur district, Kerala.


  Materials and Methods Top


It was a cross-sectional study carried out in Kannavam tribal area of Kannur district, Kerala. The study period was from March 2014 to December 2014. Kannur is a major port city in the western coast of India along the Arabian Sea. There are around 6,000 tribal people residing in Kannavam forest area of Kannur, and it is spread across four gram panchayats (Chittariparamba, Kolayad, Pattiom, and Thrippangottur). Sample size required for the study was 100 and it was calculated using the formula 4 pq/l 2 (prevalence of 50% and relative precision of 20% was considered for sample size calculation at 95% confidence level). Permission to conduct the study was taken from the tribal officer and written informed consent was taken from the study participants. Ethical clearance was taken from the Ethics Committee of the institute. Local volunteers were recruited for assistance in this study.

Using convenient sampling, 120 individuals aged 18 years or more were selected from Chittariparamba and Kolayad gram panchayats for the study. After obtaining written informed consent from the study participants, data were collected using a pretested and semi-structured questionnaire. Data on sociodemographic variables, tobacco consumption, alcohol intake, and physical activity were collected. Weight was recorded using an electronic weighing machine and was rounded off to the nearest 0.5 kg. For measuring height, the subjects were made to stand erect, looking straight on a level surface and height was read to the nearest 0.5 cm. Waist circumference was measured to the nearest 1 mm, using a nonelastic plastic tape with the subject in standing position midway between the lower rib margin and the iliac crest. Hip circumference was measured around the widest portion of the buttocks, with the tape parallel to the floor. Blood pressure was recorded in the right arm, with the subject in a seating position, using a mercury sphygmomanometer. Two readings were taken 20 min apart, and the average of these readings was considered for analysis.

All the participants were instructed 1 day prior to data collection to observe overnight fasting for blood test. Blood samples were collected by venipunture and transferred to the central lab of the institute in cold boxes for analysis. In the laboratory, glucose was analyzed by glucose oxidase method, total serum cholesterol by cholesterol oxidase (CHOD) method, triglycerides by triglycerides by glycerol-phosphate oxidase (GPOD) method, and high-density lipoprotein (HDL) cholesterol by detergent solubilization method. Very-low-density lipoprotein (VLDL) cholesterol was calculated as one-fifth of the triglyceride level. Low-density lipoprotein (LDL) cholesterol was calculated by subtracting HDL and VLDL from total serum cholesterol. National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III criteria modified for the Asian population were used for diagnosis of metabolic syndrome.[11] According to these criteria, any person having three or more of the following five diagnostic risk factors (waist circumference ≥90 cm in males, ≥80 cm in females; serum triglycerides ≥150 mg/dL; HDL cholesterol <50 mg/dL in males, <40 mg/dL in females; fasting blood sugar ≥110 mg/dL; and systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg) were diagnosed as having metabolic syndrome. Data entry and analysis were done on SPSS Inc. version 17 (Statistical Package for Social Sciences, Chicago). Odds ratio and Chi-square test at 5% significant level were applied, and the data are presented as mean [± standard deviation (SD)] and percentage.


  Results Top


A total of 120 tribal people from Kannavam were interviewed and samples were collected. The mean age (±SD) of the study population was 42.6 (±15.9) years and 35.8% among them were males. The age distribution of the population is presented in [Figure 1]. Out of the total 120 individuals, 86 were married. In the study population, 26.7% had no formal schooling and 21.3% had only studied up to primary school. Most of them were self-employed (40.8%) and were working as daily wage coolie workers, construction workers, auto drivers, maids, etc., while 21% of the population comprised home makers. Of the total population, 12.5% were able to work but were unemployed. As per the modified BG Prasad's socioeconomic classification, a large proportion of the population belonged to Class V, i.e. the lower class (35%), and Class IV, i.e. the lower middle class (26.7%).
Figure 1: Bar chart showing age distribution of the study population

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The prevalence of metabolic syndrome according to NCEP-ATP III criteria was 28.3% [Figure 2]. The prevalence was higher in females (32.5%) as compared to males (21%) but this difference was not statistically significant (P = 0.179). The diagnostic variables of metabolic syndrome were found to be similar in both males and females except for the waist circumference, which was higher in males [Table 1]. Analysis with reference to prevalence of diagnostic risk factors of metabolic syndrome revealed that a vast majority (69.2%) had abnormally low HDL cholesterol levels [Table 2]. Around one-third of the study population had two out of the five diagnostic risk factors, and they are potential candidates for developing metabolic syndrome in the near future [Table 3].
Figure 2: Pie chart showing prevalence of metabolic syndrome among the study population

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Table 1: Comparison of diagnostic variables of metabolic syndrome among males and females in the tribal population

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Table 2: Prevalence of diagnostic risk factors of metabolic syndrome in the study population

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Table 3: Distribution of study population based on number of diagnostic risk factors of metabolic syndrome

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Of the total 120 individuals, 12 smoked tobacco products on a daily basis out of whom which 7 were predominantly cigarette smokers and the remaining 5 were predominantly beedi smokers. Also, 24.2% of the study population was consuming smokeless tobacco products and a majority of them were consuming it daily. With regard to alcohol intake, 30% reported having consumed alcohol in the past 1 month and most of them used to have it either daily or on alternate days. A person was considered physically active if he/she walked for at least 30 min/day or was regularly involved in sports/fitness activity or if his/her work involved physical activity. In the current study, 24.2% of the study participants were found to be physically inactive. Body mass index (BMI) ≥25 kg/m 2, high waist-hip ratio (WHR), and VLDL cholesterol ≥30 mg/dL were found to be significantly associated with metabolic syndrome, whereas no association was found between tobacco intake, alcohol consumption, physical inactivity, and metabolic syndrome [Table 4].
Table 4: The association of various study variables with metabolic syndrome

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  Discussion Top


The prevalence of metabolic syndrome in the Kannavam tribal population was 28.3%, which is similar to the rates seen in the rural population of India (18-30%).[7],[8] The observation of such high rates of metabolic syndrome in tribal areas is alarming. This could be accounted for by the fact that with improved connectivity and technology, there is a lifestyle and nutrition transition taking place among these tribals even, without their migration to an urban area. A study conducted by Sarkar et al. in 2006 in the sub-Himalayan tribal population found a prevalence of 4-9% in the Toto tribal population and 30-50% in the Bhutia tribal population.[12] The Bhutia population had a modern lifestyle compared to the traditional lifestyle of the Toto population.

Abnormal lipid profile was found to be highly prevalent among the Kannavam tribal population, 69% of whom had low HDL cholesterol and 39% high triglycerides. Among the five diagnostic variables of metabolic syndrome, HDL cholesterol was found to be the single most important variable present in the tribals. Around one-third of the tribal population had two out of the five diagnostic risk factors, making them a high-risk group for the development of metabolic syndrome in the near future. This necessitates corrective measures such as health education and lifestyle modification to prevent metabolic syndrome among them.

Among the study variables, BMI, WHR, and VLDL cholesterol were found to be significantly associated with metabolic syndrome. BMI ≥25 kg/m 2 was found to be an important factor associated with the development of metabolic syndrome. Obesity contributes to hypertension, cardiovascular diseases, high serum cholesterol, low HDL levels, and hyperglycemia.[13],[14] Obese people have an excess of adipose tissue, which secretes cytokines that alter the insulin signaling cascade and thus, insulin secretion.[15] Obesity increases blood pressure by activation of the sympathetic nervous system, activation of the rennin angiotensin system, and sodium retention.[16] Similar findings were also reported by Prasad et al. in Odisha where BMI ≥25 kg/m 2 was found to be significantly associated with metabolic syndrome.

In the present study, a WHR of >0.95 in males and >0.85 in females was found to be associated with metabolic syndrome. Many tribal people who had a normal BMI were found to have a high WHR. Similar to waist circumference, WHR is indicative of abdominal obesity or central obesity. At any given BMI, Indians have a higher abdominal fat compared to Caucasians.[17] Abdominal obesity leads to insulin resistance and also elevated blood pressure.[18] There is deregulation of certain endocrine, inflammatory, neuronal, and cell intrinsic pathways that lead to insulin resistance. The obesity-associated increase in fatty acids alters intracellular metabolites that activate protein kinase C, leading to activation of serine/threonine kinases that inhibit insulin signaling.[19] A population-based study conducted by Katulanda et al. in Sri Lanka also found high WHR to be associated with metabolic syndrome (P > 0.001).[20]

VLDL >30 mg/dL was also found to be significantly associated with metabolic syndrome. VLDL promotes atherosclerosis and is the most important lipid profile parameter related to coronary heart diseases.[21] The “lipid triad” or “atherogenic lipoprotein phenotype” characterized by elevated serum triglycerides, VLDL cholesterol, and low HDL cholesterol leads to cardiovascular diseases and diabetes mellitus. Recent evidence suggests that a fundamental defect in metabolic syndrome is the hepatic overproduction of VLDL particles, which initiates a sequence of lipoprotein changes, resulting in higher levels of remnant particles, smaller LDL, and low levels of HDL cholesterol.[22],[23] Similar findings were also reported in a study by Salaroli et al. in which they found VLDL to be associated with metabolic syndrome (P > 0.001).[24]

Smoking was found to be an important factor associated with metabolic syndrome in some studies, but this was not observed in the current study. This could be due to the low prevalence of tobacco smoking (10%) in the tribal population. Alcohol is also implicated as an associated factor of metabolic syndrome in a few previous studies. The state of Kerala has the highest per capita alcohol consumption in India. The prevalence of alcohol intake was also high in the study population (25%), but this was not found to be associated with metabolic syndrome in the present study.


  Conclusion and Recommendations Top


The prevalence of metabolic syndrome of 28.3% in a naive population like tribal people is quite high and a cause of concern. One-third of the study population already had two out of the five risk factors and they have a high potential to develop metabolic syndrome in the near future. Hence, health education focused on lifestyle modification, such as regular physical activity, intake of a balanced diet, quitting of alcohol and tobacco products, annual blood pressure checkup, and annual blood examination for sugar and lipid levels must be done. In the population, 70% had abnormally low HDL cholesterol level; further studies must be carried out to explore whether HDL cholesterol can be used as a marker for detecting metabolic syndrome in tribal populations.


  Acknowledgments Top


We sincerely acknowledge the tribal volunteers for their wholehearted support rendered during data collection. We thank the study participants for their cooperation during the study. We thank the management of Kannur Medical College for providing a vehicle to carry out the study.

 
  References Top

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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