the prevalence of metabolic syndrome among active sportsmen ...

Journal of Science and Technology, Vol. 31, No. 1 (2011), pp

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© 2011 Kwame Nkrumah University of Science and Technology (KNUST)

THE PREVALENCE OF METABOLIC SYNDROME AMONG ACTIVE SPORTSMEN/SPORTSWOMEN AND SEDENTARY WORKERS IN THE KUMASI METROPOLIS 1

W. K. B. A. Owiredu, 2N. Amidu, 2 E. Gockah-Adapoe, 1R. K. D. Ephraim Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana 2 Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana 1

ABSTRACT This study sought to establish the prevalence of the metabolic syndrome (MetS) among active sportsmen/sportswomen and sedentary workers in the Kumasi Metropolis using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), World Health Organization (WHO), and International Diabetes Federation (IDF) criteria. The study was conducted between March and April, 2010. One hundred and eighty six (186) participants were involved with eighty five (85) being active sportsmen/sportswomen as study control and one hundred and one (101) sedentary workers from the Kumasi metropolis as study subjects. The study participants were recruited from a population of young and adult individuals between the ages of 19-82 years. The percentage prevalence of MetS was 1.6%, 7.4% and 14.4% when the WHO, NCEP-ATP III and IDF criteria respectively were applied on the total population. Generally, the prevalence of MetS was significantly higher among the sedentary group i.e. 3.5%, 14.0% and 26.7% for WHO, NCEP-ATP III and IDF criteria respectively as compared to the active population i.e. 0.0%, 2.0% and 3.9% for WHO, NCEP-ATP III and IDF criteria respectively. The prevalence of the MetS varied greatly between the active and sedentary subjects depending on the criteria used. Central obesity appears to be the key determinant of the prevalence of the MetS in Ghana. Preventive actions such as exercise, active lifestyles and healthy eating habits have to be implemented to reduce the tendency to obesity and MetS in the Ghanaian populace. Keywords: Metabolic Syndrome; Obesity; Sedentary; Sportsmen/Sportswomen; Ghanaian. INTRODUCTION The metabolic syndrome (MetS) is a group of cardiovascular risk factors characterized by abdominal obesity, central obesity, insulin resistance, atherogenic dyslipidemia, and hypertension (Deedwania and Gupta, 2006). Even though differences exist in the various definitions of the metabolic syndrome; the regular pathophysiology of this syndrome is insulin

resistance (Ford, 2004). Abdominal or central obesity remains the major clinical feature of this syndrome. According to Alberti et al. (2006), the criteria for the MetS include five variables namely; abdominal obesity, raised triglycerides, low high density cholesterol (HDL), elevated blood pressure and a history of diabetes mellitus or impaired fasting glucose state. The risk of developing diabetes and car-

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Owiredu et al.

diovascular disease is increased in people with the metabolic syndrome. Because of the high prevalence and the morbidity and mortality associated with this syndrome, a detailed understanding of its risk factors is central to developing appropriate primary and secondary preventive programmes. Obesity is an increasingly important public health problem and is considered a major risk factor for diet-related chronic diseases including MetS, type II diabetes, hypertension, stroke and certain forms of cancer (Grundy et al., 2004). The risk of developing the MetS is directly affected by both genetics and life style factors such as diet and exercise patterns. The causes and prevalence will, therefore, vary from population to population based on the individual’s life style (Park et al., 2003). The prevalence of the MetS among the US adult population is approximately 24% (Ford et al., 2002). In developing countries such as Ghana there is paucity of data on the prevalence of the MetS among the population. However, with the increasing westernization of Ghanaian lifestyle and eating habits the prevalence of obesity and the metabolic syndrome has been reported to be on the increase. Recent studies conducted in Kumasi by Val–Titty et al. (2008) and Turpin et al. (2008) among diabetic and pregnancy induced hypertensive (PIH) patients put the prevalence of the metabolic syndrome at 55.9% (NCEP ATP III) for the diabetics; and at 10% (WHO) and 62% (NCEP ATP III) for the PIH patients respectively. Lifestyle changes have been shown to alter the prevalence and severity of MetS, as well as to reduce insulin resistance in adults (Helge, 2002). Among modifications in lifestyle, increase in physical activity plays a significant role (Balkau et al., 2006). Studies by Ford et al. (2002) and Kartzmarzyk et al. (2004) have reported an inverse relationship between physical activity and increased risk of coronary heart disease in a healthy adult population. Physical activity can decrease several risk factors, which

include reducing LDL cholesterol and triglyceride levels, raising HDL cholesterol, improving insulin sensitivity, and lowering of blood pressure (Helmrich et al., 1991). The aim of this study, therefore was to establish the prevalence of the metabolic syndrome among active sportsmen/sportswomen and sedentary workers (bank and business executives whose vocations involves sitting for long hours) in the Kumasi Metropolis. MATERIALS AND METHODS Subjects This study was conducted between March and April, 2010. One hundred and eighty six (186) participants were involved with eighty five (85) being active sportsmen/sportswomen as control and one hundred and one (101) sedentary workers from the Kumasi metropolis as participants. The study participants were recruited from a population of young and adult individuals between the ages of 19-82 years. Active sportsmen/sportswomen were individuals who were engaged in any physical activity causing light perspiration or a slight to moderate increase in breathing or heart rate for at least 30 minutes. The participation of the respondents who are all indigenes of Ghana was voluntary and informed consent was obtained from each of them after thorough explanation of what the study entailed. This study was approved by the School of Medical Sciences and KATH Committee on Human Research Publications and Ethics (CHRPE/02/10). Sample Processing Venous blood samples were collected after an overnight fast (12-16 hours) between 7 am and 10 am. About 5 ml of venous blood was collected. Four (4) ml was dispensed into vacutainer® plain tubes and one (1) ml into fluoride oxalate tubes. After centrifugation at 500 g for 15 minutes, the serum and plasma were stored at - 80°C until assayed. Parameters that were determined include: fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-C). Serum low density lipoprotein cho-


Prevalence of Metabolic Syndrome…

lesterol (LDL-C) was calculated using the Frederickson-Friedwald’s formula according to which LDL-C = TC- TG/2-HDL-C. The methods adopted for the determination of the above parameters were predetermined by the reagent manufacturer – (Fortress Diagnostics Limited, Unit 2C Antrim Technology Park, Antrim BT41 1QS, United Kingdom). Total cholesterol determination was according to the method described by Trinder (1969). Triglycerides determination employed a modified Trinder method. Anthropometric variables Anthropometric measurements included height to the nearest centimetre without shoes and weight to the nearest 0.1 kg in light clothing. Subjects were weighed on a bathroom scale (Zhongshan Camry Electronic Co. Ltd, Guangdong, China) and their height measured with a wall-mounted ruler. Body mass index (BMI) was calculated by dividing weight (kg) by height squared (m2). Waist circumference (to the nearest centimeter) was measured with a Gulick II spring-loaded measuring tape (Gay Mills, WI) midway between the inferior angle of the ribs and the suprailiac crest. The hip circumference was measured as the maximal circumference over the buttocks in metres and the waist to hip ratio (WHR) calculated by dividing the waist circumference (m) by the hip circumference (m). Metabolic Syndrome Definitions National Cholesterol Education Program, Adult Treatment Panel III (NCEP ATP III). Metabolic syndrome was defined according to the criteria of the National Cholesterol Education Programme, Adult Treatment Panel III (NCEP ATP III) to include individuals with any three or more of the following five components: (1) abdominal obesity-ATP III (waist circumference > 102 cm for men, or > 88 cm for women); (2) high TG ≥ 1.7 mmol/L (150 mg/dl); (3) low HDL-C : men < 0.9 mmol/ L (< 40 mg/dl) or women < 1.0 mmol/L (< 50 mg/dl); and (4) High BP (systolic BP ≥ 130 mm Hg or diastolic BP ≥ 85 mm Hg or

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treatment of hypertension); and (5) high fasting glucose ≥ 6.1 mmol/l (NCEP, 2001). International Diabetes Federation (IDF) According to the new definition by the International Diabetes Federation (IDF) (Alberti et al., 2006), metabolic syndrome can be diagnosed if central obesity (waist measurement >90 cm for men or >80 cm for women) is accompanied by any 2 of the following 4 factors: (1) TG levels of 1.7 mmol/ L or greater, (2) an HDL cholesterol lower than 1.03 mmol/L for men or lower than 1.29 mmol/ L for women, (3) a blood pressure (BP) of 130/85 mm Hg or greater or treatment of previously diagnosed hypertension, and (4) a fasting blood glucose (FBG) of 5.6 mmol/L or greater or previously diagnosed type 2 diabetes. World Health Organization (WHO) World Health Organization criteria (Alberti et al., 2005) required presence of diabetes mellitus, impaired glucose tolerance or insulin resistance and any two of the following: (1) Body mass index (BMI) ≥30 kg/m2 and/or waist-to-hip ratio >0.90 (male), >0.85 (female), (2) blood pressure ≥140/≥90 mmHg or on medication, (3) diabetes ≥6.1 mmol/L or on medication for diabetes, impaired glucose tolerance or insulin resistance, (4) triglyceride ≥1.7 mmol/L and/or HDL-C 2 without MetS 5(2.7%) 4(4.7%) 1(1.0%) 0.1805 Data are presented as a proportion with corresponding percentages in parenthesis. The proportions were compared using Fischer’s exact test. Journal of Science and Technology © KNUST April 2011

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Owiredu et al.

Table 3: Prevalence of the various metabolic syndrome risk factors among the study population classified by exercise Total (n = 186)

Sedentary (n = 85)

Active (n = 101)

P value

Abdominal Obesity

23(12.2%)

20 (23.3%)

3(2.9%)

< 0.0001

Raised fasting glucose

15(8.0%)

5(5.8%)

10( 9.8 %)

0. 4205

Raised Triglyceride

21(11. 2 %)

10( 11.6%)

11 (10.8%)

1.0000

Raised blood pressure

47(25.0%)

32(37.2)

15(14.7%)

0.0006

Reduced HDL-C

74(39.4%)

61(70.9%)

13(12.7%)

< 0.0001

WHO Central Obesity

45(23.9%)

29(33.7%)

16(15.7%)

0.0057


15(8.0%)

5(5.8%)

10(9.8%)

0.4205

Hyperlipidaemia

6(3.2%)

5(5.8%)

1(1.0%)

0.0949


31(16.5%)

23(26.7%)

8(7.8%)

0.0007

Abdominal Obesity

23(12.2%)

20(23.3%)

3(2.9%)

< 0.0001


15(8.0%)

5(5.8%)

10(9.8%)

0.4205

Raised Triglyceride

21(11.2%)

10(11.6%)

11(10.8%)

1.0000


47(25.0%)

32(37.2)%

15(14.7%)

0.0006

Reduced HDL-C

74(39.4%)

61(70.9%)

13(12.7%)

< 0.0001

Parameters NCEP-ATP III

IDF

The prevalence of BMI overweight and obesity, WHR overweight and obesity, hypertension and dyslipidaemia were significantly higher among the sedentary population as compared to the active group (Table 4). The prevalence were 27.9%, 17.4%, 29.1%, 27.9%, 26.7%, and 5.8% for BMI overweight and obesity, WHR overweight and obesity,

WHR overweight and obesity, hypertension and dyslipidaemia respectively for the active group (Table 4). Prevalence of MetS stratified by age As shown in Fig. 1, the prevalence of MetS increased with age using chi square test for trend irrespective of the criteria used.


29 Table 4 : Prevalence of obesity, hypertension, diabetics and dyslipidaemia among the population classified by exercise Prevalence of Metabolic Syndrome…

Parameters BMI Underweight Normal Overweight Obese WHR Normal Overweight Obese FBS Hyperglycemia Impaired Glucose Diabetes Hypertension Dyslipideamia

Total (n = 186)

Sedentary (n = 85)

Active (n = 101)

P value

15(8.0%) 118(62.8%) 34(18.1%) 21(11.2%)

6(7.0%) 41(47.7%) 24(27.9%) 115(17.4%)

9(8.8%) 77(75.5%) 10(9.8%) 6(15.9%)

0.7889 0.0001 0.0020 0.0186

124(66.0%) 37(19.7%) 27(14.4%)

37(43.0%) 25(29.1%) 24(27.9%)

87(85.3%) 12(11.8%) 3(2.9%)

< 0.0001 0.0033 < 0.0001

15(8.0%) 15(8.0%) 0(0.0%) 31(16.5%) 5(2.7%)

5(5.8%) 5(5.8%) 0(0.0%) 23(26.7%) 5(5.8%)

10(9.8%) 10(9.8%) 0(0.0%) 8(7.8%) 90(0.0%)

0.4205 0.4205 150 mg/dl and HDL-C < 40 mg/dl

Using NCEP ATP III criteria, the prevalence significantly (χ2 = 17.42; p