https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/21 Tue, 02 Aug 2016 08:24:56 +0000 Bangladeshis are prone to develop type 2 diabetes mellitus (T2DM), hypertension (sHTN and dHTN) and atherosclerotic heart diseases, observed more predominantly in the urban population. Though metabolic syndrome (MetS) is a related disorder, there are few studies in this regard. The prevalence of obesity, T2DM and MetS in three urban communities of Bangladesh were addressed in this study. Nine hundred non-slum urban households in three Dhaka City Wards were randomly selected. One member (age ³ 25y) from each household was invited for investigation with an overnight fast. Socio-demographic information as well as height, weight, waist-girth, hip-girth and blood pressure were measured. Fasting plasma glucose (FPG), total cholesterol (chol), triglycerides (TG) and high-density lipoproteins-c (HDL) were estimated. A total of 705 (m / f = 239 / 466) subjects volunteered for the study. The mean value with 95% confidence interval (CI) of age was 42.4 (40.9 – 43.1) years for men and 37.8 (36.8 – 38.7) for women. The mean (CI) body mass index (BMI) was 21.0 (20.6 – 21.5) and 22.6 (22.2 – 22.9) and waist hip ratio (WHR) was 0.84 (0.83 – 0.84) and 0.82 (0.81 – 0.83), respectively for men and women. The mean (CI) FPG (fasting plasma glucose) was 5.5 (5.2 – 5.7) for men and 5.2 (5.0 – 5.4) for women. The prevalence of obesity (BMI ³ 25.0) was 21%, T2DM (FPG ³ 6.1 mmol/l) was 22.2%, triglyceridemia (TG ³ 150mg/dl) was 45.1% and low HDL-c (HDL<40mg/dl) was 43.8%. The crude prevalence of MetS varied based on different cluster combinations, being the lowest (0.3%) recommended by WHO cluster (FPG + BMI + SBP/DBP) and the highest (8.7%) by International Diabetes Federation (IDF) cluster (waist + FPG + HDL). The MetS was found higher in male than female by NCEP criteria and higher in female than male by IDF criteria. The study revealed an increased prevalence of obesity, T2DM and MetS in the urban communities. It also revealed that T2DM and MetS are moderately common and of growing healthcare burden in the rapidly growing urban population. Additionally, the study observed the wide ranging prevalence rates of MetS in the same study population indicating the need to establish a consistent and useful MetS-cluster depending on population characteristics. Introduction   The study was conducted from October 2004 to February 2005. Three City Corporation Wards (CCW) of Dhaka City were purposively selected. Each CCW has its own household (HH) number. Three hundred HHs were randomly selected from each CCW. Thus, in 3 CCWs 900 HHs were selected for this study. One member who attained the age of 25 years was enlisted from each HH as an eligible participant. The enlisted member was then informed about the objectives and procedural details of the study. Informed consent was taken and invited to volunteer for the study. The willing participant was advised to attend a nearby site in the next morning with an overnight (~12h) fast for investigation. The investigation included interviewing (education, occupation, income and clinical history), anthropometry (height, weight, waist- and hip-circumference), systolic and diastolic blood pressure (SBP & DBP) and biochemical tests like fasting plasma glucose (FPG), total cholesterol (Chol), triglycerides (TG) and high-density lipoprotein-cholesterol       (HDL-c).   The prevalence rates of diabetes, hypertension, obesity and metabolic syndrome were given in percentages. The characteristics were shown in mean with 95% confidence interval (CI) separately for men and women. Simultaneously, unpaired t-test was used to show comparison of characteristics between male and female subjects. The associations between MetS and risk variables like social class, sex, physical activities were determined by Chi-sq test. SPSS 11.5 was used for all statistical analysis. The level of significance was accepted at 0.05 level. Results The characteristics of both male and female participants are shown in table 1. The mean value of each characteristic with 95% confidence interval (CI) is given separately for either sex. The comparisons between sexes are also shown. The mean values (95% CI) for age, height, weight, WHR and TG were significantly higher in male than female; whereas BMI, HDL-c and LDL-c were significantly higher in female than male subjects. Fasting plasma glucose and blood pressure did not differ. Table-1: Comparison of characteristics between male and female participants       Diabetes – The prevalence of IFG was 9.1% and T2DM was 21.1%. Compared with the female, the male subjects had significantly higher prevalence of T2DM (p=0.02) and triglyceridemia (p=0.01).     The prevalence of MetS (WHO criteria) was significantly higher among the higher social class than among the lower and middle social class (8.0 v. 1.8%, p<0.001). It was also higher among those with sedentary habits than among those with regular physical activity (4.3 v. 1.1%, p<0.02). There was no significant difference of prevalence between male and female participants. As regards physical activity there was no difference between those with and without brisk walking of less than 15 min; and also between those with and without leisurely walking of less than 30 min. Discussion The study revealed that the prevalence of obesity (BMI>25) almost equals the prevalence of thinness (20.9 v. 17.7%). This indicates that both extremes of nutritional problems coexist in the heterogeneous urban dwellers. Interestingly, obesity was more prevalent among women and thinness among men. It is not clear why the females are more obese than males. This may be due to an occupational hazard as more than 80% of the female participants were housewives. Culturally and traditionally housewives are confined to the house and have less opportunity for outdoor walking or exercise. Their lifestyle may contribute to obesity. On the other hand, the thinness (BMI<18.5) was more prevalent among the male participants of the low and middle social class. Obviously, this may be attributed to their nutritional deficiency with respect to their energy requirement. As already mentioned, the prevalence of MetS varied (0.3 to 8.7%) depending on the different diagnostic criteria. The variation of prevalence rates were also reported by several studies.10-12 Considering the prevalence of MetS found in Greece13 and in African Americans14 Bangladeshis had a lower prevalence. Hoang et al.12 rightly pointed out that the East Asians have a lower prevalence than that of Caucasians. Though general obesity and central obesity was not very marked (table-1), the level of TG was very high and HDL-c was very low in the study population. This was also observed by Zaman et al.9 This indicates that dyslipidemia is one of the important components that should be addressed while measuring the risk factors. Conclusions   We are grateful to BIRDEM authority for providing the logistics and the laboratory facilities. We are thankful to the social leaders of Azimpur, New Market and Mughda for their active cooperation. We are indebted to the local volunteers and participants who helped us in every step of the investigation. References 2.  James WP. The epidemiology of obesity: the size of the problem. J Intern Med 2008; 263(4): 336-52. 4.  Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3(11): e 442. 6.  Amuna P, Zotor FB. Epidemiological and nutrition transition in developing countries: impact on human health and development. Proc Nutr Soc 2008; 67(1): 82-90. 8.  Erem C, Hacýhasanoglu A, Deger O, Topbaº M, Hosver I, Ersoz HO, Can G. Prevalence of metabolic syndrome and associated risk factors among Turkish adults: Trabzon MetS study. Endocrine 2008 Mar 13 [Epub ahead of print]. 10.Bhopal R, Fischbacher C, Vartiainen E, Unwin N, White M, Alberti G. Predicted and observed cardiovascular disease in South Asians: application of FINRISK, Framingham and SCORE models to Newcastle Heart Project data. J Public Health (Oxf). 2005; 27(1): 93-100 12.Hoang KC, Le TV, Wong ND. The metabolic syndrome in East Asians. J Cardiometab Syndr. 2007; 2(4): 276-82. 14.Taylor H, Liu J, Wilson G, Golden SH, Crook E, Brunson CD, Steffes M, Johnson WD, Sung JH. Distinct Component Profiles and High Risk among African Americans with the Metabolic Syndrome: The Jackson Heart Study. Diabetes Care 2008; Mar 10. 2026 Ibrahim Medical College. All rights reserved.