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ORIGINAL ARTICLE
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Metabolic Syndrome among urban slum population of Pune City: A pilot study


1 Department of Community Medicine, Symbiosis Medical College for Women, Symbiosis International (Deemed University); Department of Community Medicine, Bharati Vidyapeeth (dtu) Medical College, Pune, Maharashtra, India
2 Department of Community Medicine, Bharati Vidyapeeth (dtu) Medical College, Pune, Maharashtra, India

Date of Submission06-Jan-2022
Date of Decision28-Mar-2022
Date of Acceptance16-Apr-2022

Correspondence Address:
Reshma S Patil,
A-106, Kanchanban Phase II, Shivtirthnagar, Kothrud, Pune, Maharashtra - 411 038
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_16_22

  Abstract 


Background: The metabolic syndrome (MetS) is a multiplex risk factor for atherosclerotic cardiovascular diseases. It is proven that genetic and certain modifiable factors are responsible for the syndrome. Objectives: To assess the prevalence of MetS in the high-risk urban slum population of Pune city and its association with various risk factors. Materials and Methods: A cross-sectional study was conducted among high-risk people for type 2 diabetes mellitus in the field practice area of the Urban Health Training Centre of a private medical college, Pune, India. Variables like age, waist circumference, and blood pressure (BP) and fasting parameters like triglyceride (TG), high-density lipoprotein (HDL) cholesterol, and blood glucose after 12 h overnight fast were tested. Results: Prevalence of MetS was 26.6%. It was maximum in the higher age group (53%), housewives (36.7%), subjects with secondary education (36.7%), and in the socioeconomic lower class (36%). Abdominal obesity, high TGs, low HDL, high BP, and raised blood glucose significantly contributed to an increased risk of MetS. Conclusion: The study shows that identification of even a single component of MetS should be considered and accordingly subject should be counseled to prevent further progression of the disease.

Keywords: High risk, metabolic syndrome, urban



How to cite this URL:
Patil RS, Gothankar JS. Metabolic Syndrome among urban slum population of Pune City: A pilot study. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 7]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=346445




  Introduction Top


Metabolic syndrome (MetS) is a concept of interconnected physiological, clinical, and metabolic abnormalities. Owing to rapid urbanization, sedentary lifestyle, and surplus energy intake, it is becoming a major public health challenge globally.[1] Currently, about 12–37% of the Asian population is suffering from MetS.[2] In India, a varied picture of the prevalence of MetS among adults was reported by different studies as 11–56%.[3]

Depending on the presence of the number of components, there is a 30–40% risk of developing diabetes, chronic kidney disease, and/or cardiovascular disease (CVD) within the next 20 years among individuals with MetS.[1],[4],[5]

Characterizing MetS, especially among patients with diabetes or who are at risk of developing diabetes in the future, is beneficial for preventing CVDs through multiple risk reductions among them.[6],[7] Hence if early detection of MetS is done by a family physician who is the primary-level caregiver and if proper lifestyle modifications and drugs are initiated, the risk of CVD can be reduced among elderly people.[8]

Most of the studies are done to know the occurrence of MetS in the general population, either urban or rural. In the current study, we have targeted the high-risk people for developing type 2 diabetes mellitus identified from our previous study done in the urban slum population by using the Indian Diabetes Risk Score (IDRS).[9]


  Objectives Top


  • To estimate the prevalence of MetS among high-risk people from the urban slum population of Pune city.
  • To determine the association between various risk factors and MetS.



  Materials and Methods Top


This was a community-based observational type of cross-sectional study carried out in Joshiwada, Kumbhar Wada, Poolachiwadi, that is, the field practice area of the Urban Health Training Centre of a Private Medical College, Pune, India.

Sample size: From our previous study which was done in the same area on “Assessment of risk of type 2 diabetes using the Indian Diabetes Risk Score in an urban slum,” it was found that 169 people were at high risk for type 2 diabetes mellitus. In the current study, these people were followed to confirm the development of MetS.[8]

Inclusion criteria

All 169 male and female subjects residing in the study area for more than 6 months were included in the study. Approval from the Institutional Ethical Committee was obtained before initiating the study. Written informed consent from all subjects was taken. A predesigned questionnaire was filled with the help of an interview technique.

Information on the following variables was obtained:

  • Sociodemographic – Age, gender, education, occupation, socioeconomic status
  • Anthropometric measurements – waist circumference (WC), blood pressure (BP)
  • Biochemical tests – Fasting blood glucose, high-density lipoprotein (HDL), and triglyceride (TG) levels were observed after 12 h overnight fast.


Details of the variables studied:

  • Socioeconomic status – Modified Prasad's classification was used to identify the status.
  • WC was measured by a non-stretchable tape at the umbilicus in the front and at the midpoint between the tip of the iliac crest and the last costal margin in the back. The subject was allowed to stand in a relaxed position and at the end of normal expiration WC was noted.[9]
  • BP was measured in a sitting position on the right arm of the subject using a standard mercury sphygmomanometer. Two consecutive measures of systolic and diastolic BP were noted and the mean value of the two readings was taken into consideration.


Risk factors for MetS: Patients were diagnosed as having MetS according to National Cholesterol Education Program (NCEP) Adult Treatment Plan-III (ATP III) criteria. According to the NCEP ATP III criteria, the diagnosis of MetS was made when three or more of the following were present[6]:



Field workers (FWs) were identified and trained for data collection. A list of high-risk subjects for type 2 diabetes mellitus was given to them. FWs numbered the houses of high-risk subjects to be included in the project and had communication with them to develop a repo for a good response. They were also informed about the details of the project and to remain fasting for 12 h after 8 pm to investigate fasting blood sugar, TGs, and HDL. The next morning FWs visited the identified houses, collected information and blood, and took anthropometric measurements from study subjects. The data were summarized as frequencies and percentages.

Statistical analysis

The Chi-square test was applied to test the significance of the difference between the two groups, and P value < 0.05 was considered significant. Statistical analysis was conducted by using Statistical Package for Social Sciences (SPSS) 20.0 software and descriptive statistics were calculated as frequency and percentage.


  Results Top


Out of 169 subjects, 96 (56.8%) were females and 73 (43.2%) were males. The prevalence of MetS was 26.6%. It was statistically more prevalent among females compared to males and in the higher age group (53.3%), that is, 60–80 years of age [Table 1]. No significant association was found between education, occupation, socioeconomic class, and MetS [Table 2].
Table 1: Age and gender-specific prevalence of MetS

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Table 2: Sociodemographic characteristics of study subjects

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A maximum of 53 (31.4%) subjects were having at least two or three components and two females had all five components of MetS present in them [Table 3]. On analyzing the individual components among subjects with MetS, low HDL was the most common component (86.7%) followed by high blood glucose and high TGs in 68.9% of cases [Table 4].
Table 3: Prevalence of number of components of MetS

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Table 4: Prevalence of individual components of metabolic syndrome

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  Discussion Top


The present study was planned to assess the prevalence of MetS in the already screened population based on the prevalence of high-risk people for type 2 diabetes mellitus (32.88%) using IDRS found in our previous study.[8]

In this observational study conducted in an urban slum of Pune city, the prevalence of MetS was 26.6% [Table 1]. Almost similar findings were noted in a Kerala study by Harikrishnan et al.,[10] of 24%, in Salem by Thiruvagounder et al.[11] it was 28.1%, Sigit et al.[2] in the Dutch population it was 29.2%, and Sinha et al.[12] in South Delhi showed 29.6%. Other studies done by Khan et al.,[1] Madan et al.,[3] Prasad et al.,[9] Banerjee et al.,[13] Yadav et al.,[14] and Ravikiran et al.[15] in various Indian populations noted little higher prevalence of about 40.9, 40, 43.2, 44.6, 45.8, and 35.8%, respectively. Few studies from outside countries like Indonesia[2] and Ghana[5] also noted a little higher prevalence, that is, 39 and 43.83% while a very high prevalence rate was reported in Kochi at 76% by Vatakencherry et al.,[7] in Mexico by Ortiz-Rodríguez et al.[16] 72.9%, in Kathmandu 71.2% by Tamrakar et al.,[17] and in Pakistan 63.7% by Ali et al.[18] Studies done in different parts of Iran showed a varied picture of MetS, that is, lesser, similar, and more prevalent compared to our study. Ostovaneh et al.[19] in Zahedan, Shahbazian et al.[20] in southwest Iran, and Kaykhaei et al.[21] in southeast Iran showed the prevalence of MetS at about 12.0, 22.8, and 21.0%, respectively, which is lesser than our study. Ostovaneh et al.[19] observed 27.8% prevalence in Amol, which is similar to the current study, while Nikbakht et al.[22] showed more prevalence of 33.82% in south Iran. Such varied picture in prevalence could be due to geographical area, lifestyle patterns, eating habits, and socioeconomic/cultural factors.

On gender-wise prevalence, MetS was found more in females. Consistent with the findings of this study, Khan et al.,[1] Sigit et al.,[2] Prasad et al.,[9] Harikrishnan et al.,[10] Banerjee et al.,[13] Shahbazian et al.,[20] Kaykhaei et al.,[21] Nikbakht et al.,[22] Yadav et al.,[14] Tamrakar et al.,[17] and Ravikiran et al.[15] noted significantly higher prevalence in female patients, However, Sigit et al.[2] in Dutch population, Sawant et al.,[4] Vatakencherry et al.,[7] Ortiz-Rodríguez et al.,[16] Ali et al.,[18] and Thiruvagounder et al.[11] found that it was significantly more in males. More involvement in household work and because of disinterest or least priority to physical exercise make females more prevalent for developing MetS. In contrast to this study, James et al.[5] in Ghana have reported equal prevalence in both the genders. In the present study, as shown in [Table 1], MetS was significantly prevalent in the higher age group (60–80 yrs). A probable reason we can state is that increasing life expectancy makes them get exposed to atherosclerotic risk factors associated with MetS for a prolonged period leading to a rising burden of noncommunicable diseases at the higher ages. Similarly, Vatakencherry et al.,[7] Prasad et al.,[9] Harikrishnan et al.,[10] Shahbazian et al.,[20] Kaykhaei et al.,[21] Nikbakht et al.,[22] Sinha et al.,[12] Thiruvagounder et al.,[11] Ortiz-Rodríguez et al.,[16] and Ravikiran et al.[15] reported increasing age as a significant predictor of MetS. Khan et al.[1] and Banerjee et al.[13] showed maximum numbers of cases in the age range of 40–49 and 50–59 years, respectively. In contrast to our study, Sawant et al.[4] found a marginal decrease in prevalence in the >60 age group.

While assessing the number of components [Table 3] present among study subjects, we found that two components (31.4%) were present in the maximum study population and 1.2% of female subjects had all five components. Tamrakar et al.[17] had a clustering of 3 or more individual components of MetS. Shahbazian et al.[20] noted maximum subjects 29.9% with one component and 1.4% have five components. Kaykhaei et al.[21] found 35.3% of subjects had one and 1.4% had five risk factors. Nikbakht et al.[22] showed that at least one component of MetS was present in 90% of the subjects and all five components were seen in 3.3% of patients.

When the prevalence of individual components of MetS was studied, low HDL levels were present in maximum study subjects including subjects with MetS followed by abdominal obesity in all subjects, while among subjects with MetS the second most common component (86.7%) was high blood glucose and high TGs in 68.9%. Similar findings were noted by Kaykhaei et al.[21] and Tamrakar et al.[17] Khan et al.[1] reported the prevalence of components of MetS in the study population in the decreasing order: hyperglycemia (29.2%), high TG (19.7%), obesity (19.5%), high blood pressure (18.3%), and low HDL in 18.3% of cases. The most prominent component noted by Sigit et al.[2] was hypertension in Indonesian (61.0%) and in Dutch populations (62.0%) like Prasad et al.,[9] Ortiz-Rodríguez et al.[16] followed by abdominal obesity (in the Dutch) and hyperglycemia (in the Indonesian) as the second most common contributing component. Madan et al.,[3] Sawant et al.,[4] James et al.,[5] Banerjee et al.[13] and Nikbakht et al.[22] showed high percentage prevalence of obesity was one of the major driving forces in the development of MetS which was followed by prehypertensive. Shahbazian et al.[20] noted high TG level and low HDL as the most prevalent component which was followed by abnormal FBS. Ali et al.[18] showed 63.4% had raised plasma fasting glucose which was followed by reduced HDL cholesterol (58.7%).

This was a community-based study conducted in an urban slum population of a metropolitan city in India on a high-risk population for type 2 diabetes mellitus. Such studies have not yet been reported to our knowledge. As this was a pilot study, the findings cannot be generalized to the whole population. Hence study on a large population with similar characteristics should be done to delay the occurrence of complications related to metabolic diseases.


  Conclusion Top


The findings of the study emphasize that on detection of one component of the MetS should lead to the search for the other components and their management as early as possible through continuous screening. In addition, awareness of risk factors in the high-risk population should be conducted simultaneously.

Acknowledgments

The author would like to acknowledge the management of Bharati Vidyapeeth (dtu) Medical College, Pune and Bharati University for providing financial support and granting permission to conduct and collect data with all due consent from the field practice area of their Urban Health Center.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Ethical approval

Ethical approval and/or Institutional Review Board (IRB) approval are to be submitted within this file document: Ethical approval received from IEC of Bharati Vidyapeeth deemed University Medical College, Pune, India and the approval number is BVDU/MC/30 dated 02/05/2019.

Financial support and sponsorship

The current project was funded by Bharati Vidyapeeth University, Pune, Maharashtra, India.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

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



 

 
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