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SHORT COMMUNICATION
Year : 2012  |  Volume : 56  |  Issue : 4  |  Page : 314-317  

Prevalence of metabolic syndrome among rural women in a primary health centre area in Tamil Nadu


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

Date of Web Publication24-Jan-2013

Correspondence Address:
I Selvaraj
Assistant Professor, Department of Community Medicine, SRM medical College Hospital & Research Centre, Kattankulathur, Tamil Nadu - 603203
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.106423

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   Abstract 

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.

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


How to cite this article:
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

How to cite this URL:
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 [serial online] 2012 [cited 2019 Sep 17];56:314-7. Available from: http://www.ijph.in/text.asp?2012/56/4/314/106423

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 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. 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 <50 mg/dl, blood pressure (systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 85 mmHg), and fasting glucose ≥ 110 mg/dl. [3] Prevalence was also estimated using the criteria for metabolic syndrome for Asian Indians. [5] It includes all the components of metabolic syndrome (NCEP ATP-III) with modified waist circumference appropriate for Indian women ≥ 85 cm.

Socio economic status was assessed by Standard of Living Index which includes 11 items on housing details, basic amenities, ownership of land livestock and durable goods. The scoring ranges 0-67 classified as low, medium, and high. Criterion for identifying the skilled and semi-skilled and unskilled women is based on the 'Minimum Wages Act 1948. [6] Physical activity of woman was computed based on the International Physical Activity Questionnaire. [7] Waist circumference was measured as the smallest horizontal girth between the costal margins and the iliac crests at minimal respiration. [8]

Blood pressure was measured on the right arm, with the subject in a sitting position and after a minimum 5 min rest, using a standard mercury sphygmomanometer. Two consecutive measures of systolic and diastolic blood pressure were recorded and mean value of the two readings was taken into account. [9] Fasting venous blood samples were drawn from antecubital vein after an overnight fast for fasting blood sugar, triglyceride and HDL cholesterol. [2]

Data entry and analysis was done using the SPSS 15 version. The descriptive data were analyzed for frequency and percentages. Simple bivariate analysis using 2×2 contingency table with chi-square test and odds ratio for statistical significance with 95% CI was calculated for the association between certain variables.

Out of 150 women in the age group 30 to 50 years, 71.3% of women were in the age group of 30 to 40 and 28.7% were in the age group of 41 to 50 years, 78% of women from nuclear families, 11.3% from joint families, and 10.7% from other types of families. Among them, 84 % were Hindus, 14.7% Christians, and 1.3% Muslims. There were 4% unmarried women, 85.3% married women, and 10.7% widow/divorced/separated. Illiterate women in the sample were 36.0% and 64% literate. Women of unskilled category were 70.7% and skilled and semiskilled were 29.3%. About 69.3% of women were from low standard of living, and 30.7% was from medium and high standard of living.96.7% of the women were having mixed diet and 3.3% were purely vegetarians, 44.0% women were physically inactive and 56.0% were minimally active. 30% of women had family history of diabetes/hypertension, 10% with known history of hypertension and 10% with known history of diabetes .

The overall prevalence of metabolic syndrome in this study was 30.7%. The prevalence 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, even though the age distribution of the population is not similar. Christian women had highest prevalence (54.5%), followed by Muslim women (50%), and Hindus had lowest prevalence (26.2%). Illiterate woman had lowest prevalence (20.4%), followed by women who had secondary education (32.7%), and highest among women up to primary level of education (42.1%). The prevalence among women having mixed diet was 31.7%. Among women with family history of Diabetes/Hypertension the prevalence was 35.6% and for women without family history of Diabetes/Hypertension, the prevalence was 28.6% [Table 1].
Table1: Prevalence of metabolic syndrome and its association between certain risk factors among rural women

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Based on NCEP ATP III Criteria, 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%. Women in the age group of 40-50 years were 2.4 times at higher risk for developing metabolic syndrome compared to women in the age group of 30-40 years. Women of medium and high standard of living (combined) had 1.3 times higher risk than women from low standard of living. Christian and Muslim women (combined) were found to be 3.3 times at higher risk than Hindu women. Literate women were 2.2 times at higher risk than illiterate women and physically inactive women were 1.4 times at higher risk than active women [Table 1].

This study showed that prevalence of metabolic syndrome was 30.7%. Similar findings were reported in two Sub-Himalayan 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 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.

 
   References Top

1.Ford SE, Giles HW, Dietz HW. Prevalence of the metabolic syndrome among US adults. JAMA 2002;287:356-9.  Back to cited text no. 1
    
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.  Back to cited text no. 2
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3.Deen D. Metabolic Syndrome: Time for Action. Am Fam Physician 2004;69:2875-82.  Back to cited text no. 3
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4.National Cardiovascular Disease. Available from: http://whoindia.org/LinkFiles/NMH_Resources_National_CVD_database-Final_Report.pdf. [Last accessed on 2012 Feb 05].  Back to cited text no. 4
    
5.Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Metabolic syndrome in urban Asian Indian adults-populations study using modified ATP III criteria. Diabetes Res Clin Pract 2003;60:199-204.  Back to cited text no. 5
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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].  Back to cited text no. 6
    
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].  Back to cited text no. 7
    
8.Deepa M, Pradeepa R, Rema M, Mohan A, Deepa R, 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.  Back to cited text no. 8
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10.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.  Back to cited text no. 10
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11.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.   Back to cited text no. 11
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16.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.  Back to cited text no. 16
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