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METABOLIC SYNDROME IN IKORODU :A COMMUNITY SURVEY

METABOLIC SYNDROME IN IKORODU :A COMMUNITY SURVEY

Ademolu, Adegbenga B.1 MBBS; Ademolu, Abiola O.2 MBBS; Fasanmade, Olufemi3 FWACP,FACE; Ohwovoriole, Augustine3FMCP,FWACP

CORRESPONDING AUTHOR :DR ADEMOLU ADEGBENGA B ademoluab@yahoo.com 08033575940

  1. Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos Nigeria.
  2. Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital,Sagamu.Ogun State.Nigeria
  3. Department of Medicine, Lagos University Teaching Hospital, Lagos.Nigeria.

ABSTRACTS

Objective: The concept of metabolic syndrome is still a subject of controversy among and between academic societies.The aim of this study is to determine the prevalence of metabolic syndrome in a rural area in ikorodu using the World Health Organisation eligibility criteria.

Methods: In collecting data for this study 47 participants were recruited into the study after obtaining consent from them through their opinion leader.The random blood sugar of all the participants were checked using a glucose meter machine.lmpaired glucose tolerance value was taken as 140mg/dl or above.The waist circumference and the hip circumference of the participants were checked using a non stretch tape.The waist hip ratio(WHR) was then calculated for each participants,central obesity was defined as waist hip ratio >0.9 for male or WHR >0.85 for female.Also a body mass index (BMI)of >30kg/m2 was taken as central obesity.The blood pressure was measured using a mercurial sphygmomanometer at heart level.

Results or Case Presentation: A total of 47 participants were recruited into the study .The age range was between 25-72years.Of these 24(51.06%)participants were male while 23(48.94%)participants were female.Three participants fulfilled the eligibility criteria for metabolic syndrome as outlined by World Health Organisation representing 6.4% of the study population.The male to female ratio is 2:1 in this study population .The female with metabolic syndrome was in her sixth decade of life.Of the two males one was in his sixth decades of life while the other was in his eighth decades of life.

Discussion: The determining factor in metabolic syndrome include insulin resistance amongst others .The aging process that results in atherosclerosis,loss of beta cells in the pancreas,amongst others are key factors in the pathogenesis of metabolic syndrome in the elderly but is not exclusively the cause as metabolic syndrome also occurs in the young patients and children.

Conclusion: The prevalence of metabolic syndrome in ikorodu is 6.4%(WHO CRITERIA).In our country Nigeria,more geriatric centers needs to be opened to cater for the elderly as they form a significant population of metabolic syndrome patients and because metabolic syndrome increases with age and who knows it may become a leading cause of morbidity and mortality in the elderly in the near future if not envisaged now and controlled ahead of old age.

KEY WORDS:Metabolic syndrome,insulin resistance,diabetes mellitus.

INTRODUCTION:

The concept of metabolic syndrome is still a subject of controversy among and between academic societies.Though the association between hypertension and type 2 diabetes mellitus has been long observed,the definition,understanding and criteria of diagnosis of metabolic syndrome differs from one society or study group to the other. According to the World Health Organization 1999 criteria[1] require the presence of any one of diabetes mellitus, impaired glucose tolerance, impaired fasting glucose or insulin resistance, AND two of the following: Blood pressure: ≥ 140/90 mmHg, Dyslipidemia: triglycerides (TG): ≥ 1.695 mmol/L and high-density lipoprotein cholesterol (HDL-C) ≤ 0.9 mmol/L (male), ≤ 1.0 mmol/L (female) ,Central obesity: waist:hip ratio > 0.90 (male); > 0.85 (female), or body mass index > 30 kg/m2 ,Microalbuminuria: urinary albumin excretion ratio ≥ 20 µg/min or albumin:creatinine ratio ≥ 30 mg/g.

The International Diabetes Federation[2] consensus worldwide definition of the metabolic syndrome (2006) is: Central obesity (defined as waist circumference# with ethnicity-specific values) AND any two of the following:Raised triglycerides: > 150 mg/dL (1.7 mmol/L), or specific treatment for this lipid abnormality .Reduced HDL cholesterol: < 40 mg/dL (1.03 mmol/L) in males, < 50 mg/dL (1.29 mmol/L) in females, or specific treatment for this lipid abnormality ,Raised blood pressure (BP): systolic BP > 130 or diastolic BP >85 mm Hg, or treatment of previously diagnosed hypertension ,Raised fasting plasma glucose (FPG): >100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes,If FPG is >5.6 mmol/L or 100 mg/dL, an oral glucose tolerance test is strongly recommended, but is not necessary to define presence of the syndrome., If BMI is >30 kg/m², central obesity can be assumed and waist circumference does not need to be measured.

The European Group for the Study of Insulin Resistance (1999) requires insulin resistance defined as the top 25% of the fasting insulin values among nondiabetic individuals AND two or more of the following:Central obesity: waist circumference ≥ 94 cm (male), ≥ 80 cm (female) Dyslipidemia: TG ≥ 2.0 mmol/L and/or HDL-C < 1.0 mmol/L or treated for dyslipidemia ,Hypertension: blood pressure ≥ 140/90 mmHg or antihypertensive medication ,Fasting plasma glucose ≥ 6.1 mmol/L.

The US National Cholesterol Education Program Adult Treatment Panel III (2001) requires at least three of the following:[3],Central obesity: waist circumference ≥ 102 cm or 40 inches (male), ≥ 88 cm or 36 inches(female) ,Dyslipidemia: TG ≥ 1.7 mmol/L (150 mg/dl), Dyslipidemia: HDL-C < 40 mg/dL (male), < 50 mg/dL (female) ,Blood pressure ≥ 130/85 mmHg ,Fasting plasma glucose ≥ 6.1 mmol/L (110 mg/dl).

In The American Heart Association/Updated NCEP,there is confusion as to whether, in 2004, the AHA/NHLBI intended to create another set of guidelines or simply update the NCEP ATP III definition. According to Scott Grundy, University of Texas Southwestern Medical School, Dallas, Texas, the intent was just to update the NCEP ATP III definition and not create a new definition.[4][5],Elevated waist circumference: Men — greater than 40 inches (102 cm) ,Women — greater than 35 inches (88 cm),Elevated triglycerides: Equal to or greater than 150 mg/dL (1.7 mmol/L) ,Reduced HDL (“good”) cholesterol: Men — Less than 40 mg/dL (1.03 mmol/L) Women — Less than 50 mg/dL (1.29 mmol/L),Elevated blood pressure: Equal to or greater than 130/85 mm Hg or use of medication for hypertension ,Elevated fasting glucose: Equal to or greater than 100 mg/dL (5.6 mmol/L) or use of medication for hyperglycemia.

Metabolic syndrome is a diagnosis that transverse the different stracta of the society from high to middle and low income earners .lt also cut across communities whether rural, semi urban or urban.While insulin resistance is a major factor in metabolic syndrome gold standard measurement of it cannot be routinely done especially in a rural setting ,hence the use of clinical and laboratory parameters as an indexes of insulin resistance make metabolic syndrome a disease that can easily be studied even in a rural community hence difficulty in insulin resistance measurement in day to day clinical practice is not a limitation in rural setting.The prevalence of metabolic syndrome in different parts of Africa varies.In Nigeria there is no national data though there are pockets of studies on metabolic syndrome,in katsina (northwest Nigeria)prevalence of metabolic syndrome was 22%(ATP III Guidelines)with M:F ratio 1:3,Zaria,kaduna state(northwest Nigeria)metabolic syndrome prevalence was found in 40% with female preponderance.Sokoto (northwest Nigeria)metabolic syndrome in 59.1%(WHO guideline)Jos (north central)prevalence of metabolic syndrome is 63.6%.In rural community in ife 12.7%-males,11.8%-female(?criteria used). The aim of this pioneer study in ikorodu is to determine the prevalence of metabolic syndrome in a rural area in ikorodu using the world health organisation eligibility criteria.

METHODOLOGY

In collecting data for this study 47 participants were recruited into the study after obtaining consent from them through their opinion leader.The random blood sugar of all the participants were checked using a glucose meter machine.lmpaired glucose tolerance value was taken as 140mg/dl or above. The waist circumference and the hip circumference of the participants were checked using a non stretch tape.The waist hip ratio was then calculated for each participants,central obesity was defined as waist hip ratio >0.9 for male or WHR >0.85 for female.Also a BMI of >30kg/m2 was taken as central obesity. The weight of each participants was taken using standard weighing scale and the height for each individual was taken,then the body mass index was computed using the formula BMI is equal to weight in kilogram divided by height in metres squared.The blood pressure was measured using a mercurial sphygmomanometer at heart level.The limitation of this study is that lipid profile level to determine dyslipidemia was not done,and urine was not tested for presence or absence of microalbuminuria which required use of specialised urine sticks.

RESULTS

A total of 47 participants were recruited into the study .The age range was between 25-72years.Of these 24(51.06%)participants were male while 23(48.94%)participants were female.Three participants fulfilled the eligibility criteria for metabolic syndrome as outlined by world health organisation representing 6.4% of the study population.Of these three with metabolic syndrome one(33.3%)was not diabetic,he only had impaired glucose tolerance,while two(66.6%)were known diabetics.These latter two were also the two known diabetics in the study population making the prevalence of metabolic syndrome in diabetics in this study population to be hundred percent(100%).The prevalence of metabolic syndrome among hypertensives in this study population is 10%.The prevalence of metabolic syndrome in hypertensive and diabetics is 100%.

Further analysis also showed that two (66.6%)participants of the three with metabolic syndrome were male while only one(33.3%)was a female putting the male to female ratio to 2:1 in this study population .The female with metabolic syndrome was in her sixth decade of life with waist circumference of 110cm and a waist to hip ratio of 1.18.The high waist circumference in her can be explained by the fact that with ageing there is fat redistribution in the body with tendency towards high abdominal adiposity.Of the two males one was in his sixth decades of life while the other was in his eighth decades of life.

DISCUSSION

The determining factor in metabolic syndrome include insulin resistance which may present as glucose intolerance,impaired fasting glucose or frank diabetes;high blood pressure ,dyslipidaemia,which may be in form of low levels of high density lipoprotein(defined as HDL<50mg/dl in women or <40mg/dl in men)high triglycerides(>150mg/dl).Other determinants include high abdominal adiposity,microalbuminuria and pro inflammatory factors .

The other risk factors for the metabolic syndrome include increasing body weight ,increasing age,certain races,post menopausal status,smoking,low household income,physical inactivity,high carbohydrate diet,soft drink consumption,anti psychotic medication especially clozapine,poor cardiorespiratory fitness,parental history of metabolic syndrome,genetic factors.

The prevalence of metabolic syndrome among a group of hypertensive Nigerians was found to be 34.3%(ATP iii),35%(WHO)and 42.9%(IDF).(6).These values generally were similar to that which emerged from non diabetic Turkish adults where the prevalence rates were as follows:38%(NCEP,ATP III),42%(ACE and IDF),20%(EGIR),and 19%(WHO),(7).These rates favourably compared to those observed in Canada(8).ln developed nations increased physical inactivity and consumption of energy laden foods has caused high rates of obesity making the prevalence of metabolic syndrome to be high in these population.In African population,the prevalence of metabolic syndrome ranges from as low as 0% to as high as about 50% or even higher depending on the population setting.(9,10).The current trend of increase in the prevalence of metabolic syndrome is largely and generally attributed to adoption of western lifestyle which is characterised by reduced physical activity,substitution of the traditional African diet rich in fruits,and vegetables for the more energy-laden foods(18).Comparatively, metabolic syndrome appears to be more common in the presence of diabetes mellitus than hypertension(10,19,20).Among diabetics subjects ,the prevalence was as high as 80% whereas it was 21.2% among hypertensives subjects but varying with places of domicile (rural or semiurban)(11,12,15,21).In this study ,the prevalence of metabolic syndrome among diabetics was 100%.This supports the findings in many other papers that the prevalence of metabolic syndrome is higher in diabetic patients,also the inclusion of diabetes mellitus in the definition of metabolic syndrome is also contributory to this high prevalence compared to that obtainable in the general population.It therefore follows that insulin resistance whose spectrum covers impaired glucose tolerance,impaired fasting glucose and diabetes mellitus is the major metabolic predictive factor in the determination of prevalence of metabolic sundrome.Hence population settings who are not necessarily diabetic but have high prevalence of impaired glucose tolerance or impaired fasting glucose are also at risk of high prevalence of metabolic syndrome compared to the general population.

In this study population the prevalence of metabolic syndrome among hypertensives is 10% which is far less than the prevalence among diabetics,see table 1,

TABLE 1

metabolic stndrome table

this also has been found in many population studies and further agrees with the fact that the prevalence of metabolic syndrome is lower in hypertensives compared to diabetics, lt will be very interesting to know what the prevalence will be like in a population setting of patients that are both hypertensive and diabetic in the world,Africa and in Nigeria,in this study the prevalence of metabolis syndrome in hypertensives and diabetic subjects is 100%.More studies are needed in this area as the population studied here is small and may not reflect the true picture among hypertensive and diabetic subjects though this finding suggest that the prevalence will be equally high as in diabetic population alone.The prevalence of metabolic syndrome in this study was 6.4%(WHO).It is worth nothing that this figure is within the range of 0 to 50% found in previous studies in african population(18).The low prevalence here may be because of the rural setting where the study location was, and it suggests that living in rural area is protective to development of metabolic syndrome,though more studies needs to be done on this.In Africa ,metabolic syndrome was found to be more common in females and to increase with age,and urban dwelling (13-15).In this study more males were affected compared to females,similar male preponderance was found in Jos plateau Nigeria (22),however the low number of the population studied may be the reason here.The three participants that meets the eligibility criteria are in their sixth (two participants)and eighth(one participants)decade of life agreeing with the fact that metabolic syndrome increases with age (1,12,15,16,17,23).Hence the aging process that results in atherosclerosis,loss of beta cells in the pancreas,amongst others are key factors in the pathogenesis of metabolic syndrome in the elderly(24-35)but is not exclusively the cause as metabolic syndrome also occurs in the young patients and children.Age adjusted prevalence of central obesity (using NCEP-ATP III and definition,based on waist cicumference)was found to be higher in women compared to men and were lower in the rural areas(15).

CONCLUSION

The prevalence of metabolic syndrome in ikorodu is 6.4%(WHO CRITERIA).There is a deer need for a unified definition to allow for easy comparison of data among nations and study populations.Activities aimed at primary prevention of hypertension,glucose intolerance,diabetes mellitus etc should be intensified to avoid an epidermic of metabolic syndrome in the near future.In our country Nigeria,more geriatric centers needs to be opened to cater for the elderly as they form a significant population of metabolic syndrome patients and because metabolic syndrome increases with age and who knows it may become a leading cause of morbidity and mortality in the elderly in the near future if not envisaged now and controlled ahead of old age.Due to the fact that metabolic syndrome is a constellation of symptoms and signs that cut across discipline,multidisciplinary approach to management is essential in disease control.Furthermore the low prevalence of metabolic syndrome in rural areas in our country can be used as an health tip to encourage people to stay in rural areas so as to reduce rural-urban migration causing overpopulation of the cities in our country.

Similarly factors that determines which symptoms signs criteria will be present in each patients with metabolic syndrome should be well studied in order to enhance our understanding of the disease condition.Most rural areas are near to the natural habitats of mankind so probably the more man moves away from his natural habitat,the more likely he is to develop metabolic syndrome.

ACKNOWLEDGEMENT:I thank the participants in this study for their consent given without which this research work would have been impossible.

DISCLOSURE:No disclosure.

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