Assessment of overweight , obesity and metabolic variables among students of a private medical college in Dhaka city

Introduction Overweight and obesity are considered major epidemic health problems in both developed and underdeveloped countries as many studies showed a remarkable rise1. Several recent studies in the united states, showed that overweight and obesity prevalence is increasing dramatically and suggesting that 86.3% of adults will be overweight or obese as well as 51.1% will be obese by 20302. Overweight and obesity are recognized as an ‘escalating epidemic’ affecting both developed and developing countries. Obesity and its associated morbidities are leading causes of cardiovascular disease (CVD), type-2 diabetes and several other health problems 3. Physical activities promote controlling blood lipid abnormalities, diabetes, and obesity. On the other hand, sedentary lifestyle is associated with high risk


Introduction
Overweight and obesity are considered major epidemic health problems in both developed and underdeveloped countries as many studies showed a remarkable rise 1 .Several recent studies in the united states, showed that overweight and obesity prevalence is increasing dramatically and suggesting that 86.3% of adults will be overweight or obese as well as 51.1% will be obese by 2030 2 .
Overweight and obesity are recognized as an 'escalating epidemic' affecting both developed and developing countries.Obesity and its associated morbidities are leading causes of cardiovascular disease (CVD), type-2 diabetes and several other health problems 3 .Physical activities promote controlling blood lipid abnormalities, diabetes, and obesity.On the other hand, sedentary lifestyle is associated with high risk of coronary, cerebral, and peripheral vascular diseases and all-cause morbidity and mortality among both genders at all ages 4 .It is estimated that more than 2 two million deaths annually in the world are attributed to physical inactivity 5 .Cardiovascular diseases are the leading cause of mortality and morbidity in the world even in the developing countries 6 .Evidence indicates that the pathophysiological process of cardiovascular disease begins at early age, though the manifestations of the disease do not appear until middle age adulthood.Risk factors for cardiovascular disease, particularly lipoprotein profiles, are affected by physiological abnormalities, and lifestyle related issues 7 .The childhood roots of adult obesity and also dyslipidaemia, glycaemic status are widely recognized and associated which calls for health promotion targeted at youth.Recent studies have indicated the presence of increasing trends in overweight and obesity among children and adolescents in Greece 3 , but there is no study among adult groups.Moreover, although there are many studies on the health status of medical students, a target group of particular interest as they are future physicians, these have mostly tracked the use of alcohol and tobacco 8 .Although obesity has important genetic and familial components, environmental factors are probably the predominant factors in the current epidemic.In addition to the approach provided by Guo et al at 2004 the status of the parents can be used.Children from families in which one or both parents are overweight have a substantially higher risk of becoming obese than do children whose parents are not overweight 5 .Obesity relates to other risk factor in children as well as adults, but there is little information on the effects of persistent obesity in early Iife.Because obesity begins in childhood, it is important to determine the level at which obesity begins to influence cardiovascular risk.Consequently, individuals who have been obese since childhood are of particular interest for studying the early natural history of obesity and its relationship to the development of dyslipidaemia and glycaemic status.Childhood obesity is associated with high level blood pressure, LDL Cholesterol, insulin resistance and lower level of HDL-C, increased heart rate and increased cardiac output 4 .Anthropometric indices include body mass index (BMI), waist circumference and waist to hip ratio (WHR) and waist height ratio (WHtR).These data are not always easy to interpret but they are important to obtain because, overweight adults are at increased risk for adverse health outcomes, including mortality in later life.Prospective and retrospective studies have shown that obesity, Lipid Profiles, unhealthy diets and sedentary life style have their roots in childhood and tend to track into adulthood 5 .

Methods and Materials
This Cross sectional study was carried out in Ibrahim medical college from June 2012-June 2013.Study populations were the Medical student of Ibrahim Medical College from 1 st year to 5th year.313 students were selected on the basis of their availability for examine in due time.Students were selected purposively.Data was taken on a questionnaire and check list Participants after obtaining informed consent will be examined on the following parameter: Anthropometric measurements such as, BMI, WC, WHR and WHtR (to define normal overweight and obesity) Blood pressure.Lipid profile Glycemic status Methods for Anthropometry and Blood Pressure: Anthropometric measurements was done by a digital scale to measure body weight (BW).Body height (BH) was measured by using a commercial stadiometer.Body Mass Index (BMI) was calculated as BW in kg divided by the square of the BH in meters (m 2 ).Waist circumference (WC) was measured in the highest point of iliac crest at the level of umbilicus and hip circumference (HC) at the fullest point around the buttocks.Hip and waist ratio and waist to height ratio will be measured also 9 .

Based on the INTERNATIONAL OBESITY TASK FORCE, convened by the world Health
Organization, a subject with BMI of 25-29.9kg/m 2 was defined as overweight; BMI>30 kg/m 2 was defined as obese.The waist circumference (WC), waist to hip ratio (WHR) and waist height ratio (WHtR) measurements was used to determine the extent of central adiposity.For waist circumference, cut off points of>90 cm in men and>80 cm in women was used 11 .A waist to hip ratio>0.9 in men and>0.8 in women was considered to represent central obesity 12 and waist to height ratio values of> Assessment of Overweight, Obesity and Metabolic Variables 50 in either sex was adopted as cut offs 10 .The individual blood pressure was measured by sphygmomanometer at sitting position.Optimal systolic blood pressure(SBP) is <120mm of Hg, normal SBP is <130 mm of Hg and high normal SBP is 130-139mm of Hg 16 .Optimal diastolic blood pressure(DBP) is <80mm of Hg, normal DBP is 85 mm of Hg and high normal DBP is 85-89 mm of Hg 16 .

Collection of blood samples:
Early morning, venous blood samples were drawn for biochemical screening tests, following a 12-hour overnight fasting.Blood samples were collected from the study subjects with all aseptic precautions in clean and dry test tube.Under all aseptic precautions 5cc of blood was collected from the study subjects by using disposable syringe from the medial cubital vein.The needle was detached from the nozzle and blood was transferred immediately into a dry clean plastic test tube with a gentle push to avoid haemolysis.Collected blood was allowed to clot and centrifuged.Separated serum then collected into plastic micro centrifuged tubes and appropriately labeled and stored at -20 0 C. Laboratory method: Serum glucose was measured by glucose -oxidaseperoxidase method fasting blood sugar(FBS) 3.5-5.6mmol/land 2ABF(2hours after breakfast) is 7.8-11.1mmol/l13 .Lipid profile (serum Total Cholesterol, serum tri-glyceride, LDL-C and HDL-C) was measured.Serum total cholesterol was measured by cholesterol oxidase-peroxidase method 14 .Serum tri-glyceride(TG) and serum HDL-C was measured by kit method.Serum LDL-C was calculated by a using formula 6 .LDL-chol = Total Cholesterol-(HDL-chol + TG/5) 6. Dyslipidaemia is defined as total cholesterol>5.2mmol/L (200 mg/dl), TG>1.5 mmol/L (150 mg/dl), LDL-C>3.4 mmol/L (130 mg/dl) and HDL-C>0.9 mmol/L (40 mg/dl).These cut offs correspond to the adult panel treatment-III criteria for borderline high total cholesterol, TG, LDL-C and low HDL-C levels 6 .A total cholesterol : HDL-C ?4 was also considered as adverse serum lipid profile 5 .Statistical analysis: All collected data were corrected and entered into the computer based SPSS program for analysis.Qualitative data was analyzed by Chi-Square test and quantitative data by students Ttest.

Table 3 : Distribution of the according to the anthropometric measurements.
showed the vast increase in weight in overweight American adults was faster than in children and in women than in men.There is no significant relationship between metabolic variables and overweight and obesity p value <.347.Conclusions:The epidemic of overweight and obesity is having a huge impact on the physical and social well-being of adult in future.Computer use, watching TV, less physical activity and family factors are important risk factors for obesity.Obesity promotes insulin resistance, hypertension as well as dyslipidimia.Reducing obesity through life style changes is an important step for adult to prevent the development of non communicable disease 16 .Overweight and obesity remain a challenging problem in future, and more effective interventions are desperately needed.