Prevalence of Metabolic Syndrome Among Rural

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Prevalence of Metabolic Syndrome Among Rural Women in a Primary Health Centre Area in Tamil Nadu *I. Selvaraj1, S. Gopalakrishnan2, M. Logaraj2 1

Assistant Professor, 2Professor, Department of Community Medicine, SRM medical College Hospital & Research Centre, Kattankulathur, Tamil Nadu, India

Summary A study was conducted to estimate prevalence of metabolic syndrome among 150 rural women in the age group of 30-50 years in a primary health centre area in Tamil Nadu. Prevalence of metabolic syndrome was estimated using National Cholesterol Education program (NCEP), Third report Adult Treatment Panel ATP III criteria, and Modified NCEP ATP III criteria for Asian Indians. Prevalence of metabolic syndrome was found to be 30.7% based on NCEP, ATP-III Criteria. Based on the Modified NCEP, ATP-III Criteria, the prevalence was found to be 36%.The most commonly observed components of metabolic syndrome in this study was increased waist circumference (56.0%) followed by low HDL (45.3%), high triglyceride (37.3%), high blood pressure 29.3%, and fasting blood sugar 12.7%. Identifying the risk factors and treating patients with the metabolic syndrome is a public health challenge especially in the rural population.

Key words: Metabolic syndrome, National cholesterol education program, Rural women, Tamil Nadu

Prevalence of metabolic syndrome may vary greatly in different regions and also in different ethnicities in the same region. 1,2 Estimation of prevalence of metabolic syndrome is essential for the prediction of the future burden of Type-2 Diabetes and cardiovascular disease. The Expert Panel of National Cholesterol Education program (NCEP) Adult Treatment Panel (ATP) III highlighted importance of identifying and treating patients with metabolic syndrome, as there is increased risk of morbidity and mortality.3 Prevalence of metabolic syndrome in India is varying between 10 to 50% depending on age and sex. Prevalence of *Corresponding Author: Dr. I. Selvaraj, Assistant Professor, Department of Community Medicine, SRM medical College Hospital & Research Centre, Kattankulathur, Tamil Nadu – 603203, India. E-mail: [email protected]

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Website: www.ijph.in DOI: 10.4103/0019-557X.106423 PMID: ****

diabetes, obesity, dyslipidemia, and central adiposity has significantly increased among these populations, especially in female subjects.4 Developing countries such as India are expected to confront an enormous health care burden due to large number of populations suffering from this chronic disorder and its sequelae. As Prevalence of metabolic syndrome is found to increase steeply after 30 years of age,1 it was planned to estimate the prevalence of metabolic syndrome among rural women in the age group of 30-50 years in Tamil Nadu. A cross-sectional study was conducted using a pre-tested structured questionnaire in a rural population served by a Primary Health Center (PHC) in Thiruvallur District in Tamil Nadu. Based on technical feasibility one villages in the PHC area was selected randomly. There were 711 women in the age group of 30-50 years based on the voters list. Using this as the sampling frame, 150 women were selected by simple random sampling method. Overall prevalence of metabolic syndrome in India ranges from 10 to 50 %.4 Hence, assuming a prevalence of 35% with limit of accuracy of 8%, the sample size was worked out to be 137.The anticipated non-response in providing blood samples was assumed to be about 10% and accordingly the final sample size arrived at was 150.

Indian Journal of Public Health, Volume 56, Issue 4, October-December, 2012

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Selvaraj I et al.: Metabolic Syndrome Among Rural Women

Considering the high cost of investigations and financial constraints, the sample size was restricted to 150 fixing the limit of accuracy at 8%. The participant’s informed consent was obtained. Prevalence of metabolic syndrome was estimated using NCEP ATP III criteria. Diagnosis of metabolic syndrome was made when three or more of the following risk determinants were present: Waist circumference for women ≥ 88 cm, triglyceride for women ≥ 150 mg/dl, HDL cholesterol for women 0.05

Standard of living Low Medium and High

104 (69.3) 46 (30.7)

30 (28.8) 16 (35.6)

20.4 to 38.6 21.9 to 51.2

χ2 = 0.529 df = 1 P = 0.233

1.3 0.6 to 2.8 > 0.05

Physical activity Inactive Minimally Active

66 (44) 84 (56)

23 (34.8) 23 (27.4)

23.5 to 47.6 18.2 to 38.2

χ2 = 0.969 df = 1 P = 0.162

1.4 0.7 to2.9 > 0.05

Figures in parenthesis indicate percentages, *The number of women among the Muslim community with metabolic syndrome and without metabolic syndrome is one each, So for χ2 calculation purpose we merged the Muslim and Christian community as non-Hindu component.

This study showed that prevalence of metabolic syndrome was 30.7%. Similar findings were reported in two SubHimalayan populations in rural areas with 52.2% among Toto and Bhutia women.10 In contrast to our findings, a study done in a rural population in Andhra Pradesh showed prevalence of only 18.4%, which could be due to inclusion of women less than 30 years in the study.11 Ozsahin et al.,12 found 39.1% among Turkish rural women, Fakhrzadeh et al.,13 found 35.9% among Tehran women. Ramachandran et al.,5 reported prevalence of 46.5% while using a modified waist circumference for Indian women ≥ 85 cm (modified NCEP ATP-III criteria for Asian Indian). In our study, it was 36%. Prevalence of metabolic syndrome among women in the age group of 41-50 years was 44.2% compared to 25.2% in the age group of 30-40 years. The comparison made here was based on the chance finding during the analysis. As the age increases, the risk of developing metabolic syndrome is 2.3 times more. Ramachandran et al.,5 observed similar findings that the prevalence substantially increased by age. The prevalence of metabolic syndrome was 35.6% among women with

high and medium standard of living and 28.8% with low standard of living. Women with high standard of living had 1.3 times higher risk than women from low standard of living. Mohan et al.,14 had observed similar findings from two residential colonies in Chennai representing middle and lower income groups. Wamalla et al.,15 had observed in their study that low education was associated with increased risk. It was reverse in this study as literate women were 2.2 times at higher risk than illiterate women. Physically active women had lower prevalence of metabolic syndrome (27.4%) when compared with inactive women (34.8%). Physically inactive women were 1.4 times at higher risk than physically active women. Mohan et al., observed similar findings of physically inactivity with the risk of having metabolic syndrome.16 This study highlights the high prevalence of metabolic syndrome among rural women which could increase the burden of non-communicable diseases in the near future. Seventy percent of Indian population is living

Indian Journal of Public Health, Volume 56, Issue 4, October-December, 2012

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Selvaraj I et al.: Metabolic Syndrome Among Rural Women

in rural areas and the demographic transition is towards population aging; if the current trend continues, there will be increase in the number of patients with metabolic syndrome leading to increased morbidity and mortality. Identifying the risk factors and treating patients with metabolic syndrome is a public health challenge especially among the rural population. Hence, while planning for new or expansion of existing health services, prevention and control strategies for non-communicable disease should be addressed specifically.

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References 1. Ford SE, Giles HW, Dietz HW. Prevalence of the metabolic syndrome among US adults. JAMA 2002;287:356-9. 2. Choi SH, Ahn CW, Cha BS, Chung YS, Lee KW, Lee HC, et al. The prevalence of the metabolic syndrome in Korean adults: Comparison of WHO and NCEP criteria. Yonsei Med J 2005;46:198-205. 3. Deen D. Metabolic Syndrome: Time for Action. Am Fam Physician 2004;69:2875-82. 4. National Cardiovascular Disease. Available from: http:// whoindia.org/LinkFiles/NMH_Resources_National_CVD_ database-Final_Report.pdf. [Last accessed on 2012 Feb 05]. 5. Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Metabolic syndrome in urban Asian Indian adultspopulations study using modified ATP III criteria. Diabetes Res Clin Pract 2003;60:199-204. 6. Minimum Wages Act 1948. Ministry of Labour, G.O (20) N.o.7 Labour and Employment Department. Govt. of Tamil Nadu Dated 27-2-200. Available from: http://www.tn.gov.in/ gorders/labour/labemp-e-48-2D-2004.htm. [Last accessed on 2012 Feb 05]. 7. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ) version 2.0. April 2004. Available from: http://www.institutferran.org/ documentos/Scoring_short_ipaq_april04.pdf. [Last accessed on 2012 Feb 05]. 8. Deepa M, Pradeepa R, Rema M, Mohan A, Deepa R,

12.

13.

14.

15.

16.

317

Shanthirani S, et al. The Chennai Urban Rural Epidemiology Study (CURES) – study design and methodology (urban component) (CURES-1). J Assoc Physicians India 2003;51:863-70. Dallongeville J, Grupposo MC, Cottel D, Ferriéres J, Arveiler D, Bingham A, et al. Association between the metabolic syndrome and parental history of premature cardiovascular disease. Eur Heart J 2006;27:722-8. Gupta R, Sarna M, Thanvi J, Rastogi P, Kaul V, Gupta VP. High prevalence of multiple coronary risk factors in Punjabi Bhatia community: Jaipur Heart Watch-3. Indian Heart J 2004;56:646-52. Chow CK, Naidu S, Raju K, Raju R, Joshi R, Sullivan D, et al. Significant lipid, adiposity and metabolic abnormalities amongst 4535 Indians from a developing region of rural Andhra Pradesh. Atherosclerosis 2008;196:943-52. Ozsahin AK, Gokcel A, Sezgin N, Akbaba M, Guvener N, Ozisik L, et al. Prevalence of the metabolic syndrome in a Turkish adult population. Diabetes Nutr Metab 2004;17: 230-4. Fakhrzadeh H, Ebrahimpour P, Pourebrahim R, Heshmat R, Larijani B. Metabolic syndrome and its associated risk factors in healthy adults: A population-based study in Iran. Metab Syndr Relat Disord 2006;4:28-34. Mohan V, Shanthirani S, Deepa R, Premalatha G, Sastry NG, Saroja R. Intra-urban differences in the prevalence of the metabolic syndrome in southern India – the Chennai Urban Population Study (CUPS No. 4). Diabet Med 2001;18:280-7. Wamala SP, Lynch J, Horsten M, Mittleman MA, SchenckGustafsson K, Orth-Gomér K. Education and the metabolic syndrome in women. Diabetes Care 1999;22:1999-2003. Mohan V, Gokulakrishnan K, Deepa R, Shanthirani CS, Datta M. Association of physical inactivity with components of metabolic syndrome and coronary artery disease: The Chennai Urban Population Study (CUPS no.15). Diabet Med 2005;22:1206-11.

Cite this article as: Selvaraj I, Gopalakrishnan S, Logaraj M. Prevalence of metabolic syndrome among rural women in a primary health centre area in Tamil Nadu. Indian J Public Health 2012;56:314-7. Source of Support: Nil. Conflict of Interest: None declared.

Indian Journal of Public Health, Volume 56, Issue 4, October-December, 2012