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ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 8-14

Metabolic syndrome among obese adults in Baghdad, Iraq


1 Ministry of Health, Yarmouk Hospital, Mustansiriya University, Baghdad, Iraq
2 Ministry of Health, Nutrition Clinic, Yarmouk Hospital, Mustansiriya University, Baghdad, Iraq
3 Diabetes Research Center, Mustansiriya University, Baghdad, Iraq
4 College of Medicine, Mustansiriya University, Baghdad, Iraq; Global Health, University of Washington, Seattle, Washington, USA

Date of Web Publication13-Jul-2017

Correspondence Address:
Ali H Hayawi
Ministry of Health, Nutrition Clinic, Yarmouk Hospital, Mustansiriya University, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjo.sjo_3_17

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  Abstract 

Background: Metabolic syndrome is a cluster of interconnected factors that directly increase the risk of coronary heart disease, other forms of cardiovascular atherosclerotic diseases, and diabetes mellitus type 2. Obesity and physical inactivity are the driving forces.
Objective: To explore the magnitude of metabolic syndrome (and some associated factors) in a sample of obese adults attending the main Nutrition Clinic in Baghdad, Iraq.
Materials and methods: This cross-sectional study that included 440 obese attended the Nutrition Clinic at Al-Yarmouk Teaching Hospital was conducted during a period of six months (March to September 2016). All the patients were interviewed on voluntary base. Height, weight, and waist circumference were measured to diagnose obesity. Blood pressure, fasting blood sugar, and lipid profile were also measured.
Results: The prevalence of metabolic syndrome among obese was 40.6% more in females (42.8%) than males (36.5%). The main associated factor was central obesity, followed by diabetes mellitus, dyslipidemia, and hypertension. The old individuals and women who had 9 to 12 children showed the highest frequencies (55 and 61.5%), respectively.
Conclusion: Metabolic syndrome among Iraqi obese is relatively common. Female gender, old age, and multiparity can be regarded as risk factors.

Keywords: Baghdad, Iraq, metabolic syndrome, obesity


How to cite this article:
Saleh AA, Hayawi AH, Al-Samarrai AY, Lafta RK. Metabolic syndrome among obese adults in Baghdad, Iraq. Saudi J Obesity 2017;5:8-14

How to cite this URL:
Saleh AA, Hayawi AH, Al-Samarrai AY, Lafta RK. Metabolic syndrome among obese adults in Baghdad, Iraq. Saudi J Obesity [serial online] 2017 [cited 2017 Sep 23];5:8-14. Available from: http://www.saudijobesity.com/text.asp?2017/5/1/8/210588


  Introduction Top


Metabolic syndrome is a cluster of interconnected factors that directly increase the risk of cardiovascular atherosclerotic diseases, especially coronary heart disease, and diabetes mellitus type 2. Its main components are dyslipidemia, elevation of arterial blood pressure, and deregulated glucose homeostasis. Obesity and physical inactivity are the driving forces.[1],[2]

A fundamental component in metabolic syndrome is central obesity, an excess of body fat in the abdomen, measured by waist circumference, and is more indicative of the metabolic syndrome profile than body mass index (BMI).[3],[4]

Excess central adiposity can lead to insulin resistance, which together with hyperinsulinemia can lead to metabolic syndrome.[5],[6],[7],[8]

It is estimated that around 20 to 25% of the world’s adult population have metabolic syndrome and they are twice as likely to have a heart attack or stroke compared with people without the syndrome.[9] Approximately one-fourth of the adult European population is estimated to have metabolic syndrome.[2] In the United States, the prevalence is 23.7%, which is similar to Europe, and appears to be higher in population with advanced age.[10] It can reach up to 47.2% in the 80 to 89-year age group in men and 64.4% for women in the corresponding age group.[11]

In Asia, the prevalence of metabolic syndrome reported in different countries varies, ranging from 21.9% in Thailand to 49.4% in Malaysia. The prevalence of metabolic syndrome in Korea has been shown to be notably increased from 24.9% in 1998 to 31.3% in 2007.[12] The prevalence has been reported to be 29.3% in middle-aged Chinese men and 26.8% in Hong Kong professional drivers[10]; in Turkey, it is 33.9%, differs significantly in men (28%) and women (39.6%).[10] In Northern Jordan, the prevalence is 36.3%, significantly higher in women.[5]

Iraq is undergoing an epidemiological transition with an increasing burden of chronic noncommunicable diseases[13]; particularly diabetes and hypertension that are major risk factors for cardiovascular diseases, a leading cause of death in humans. Insulin resistance and hyperglycemia combine to make hypertension more prevalent in type 2 diabetics. Approximately 15% of the hypertensives are diabetic, and approximately 75% of type 2 diabetics are hypertensive.[14] In 2010, the International Diabetes Federation reported a diabetes prevalence of 7.8% in Iraq.[15]

We set this study to explore the magnitude of metabolic syndrome (and some associated factors) in a sample of obese adults attending the main Nutrition Clinic (Al-Yarmouk Teaching Hospital) in Baghdad, Iraq.


  Materials and methods Top


This cross-sectional study was conducted during the period from March to September 2016 in the Nutrition Clinic at Al-Yarmouk Teaching Hospital, Baghdad, Iraq. This clinic was chosen for data collection as it introduces medical advices for weight management for large geographical areas in Baghdad with different socioeconomic population.

Sampling Technique

A consecutive sample of adult obese of both sexes aged 20 to 79 years (with inclusion/exclusion criteria) was collected on daily basis throughout the study period. Every adult who meets the eligibility criterion of obesity (BMI equals to 30 kg/m2 or more) was included in the study. Pregnant and lactating women were excluded because of the rapid increase in weight that is not in correlation with true BMI, also patients with secondary obesity like Cushing syndrome and hypothyroidism were excluded.

Questionnaire

A questionnaire form has been developed by the researchers; it enquires about general information (age, sex, marital status, and parity), medical history (personal and family), smoking history, and physical activity (type of activity and time spent in exercise). A verbal consent was taken from each participant. Physical examination was done for every respondent, including measuring blood pressure, weight, height, and waist circumference. Biochemical investigations: fasting plasma glucose and fasting lipid profile [total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein, and triglycerides] were also done.

Measurements

Height was measured (using the UNICEF sliding caliber-flexible metallic) to the nearest 0.5 cm, each individual was asked to stand straight next to the wall and barefooted. Weight was recorded to the nearest 0.1 kg with the patient wearing light clothes using a mechanical beam balance scale. Overweight and obesity were classified as follows: overweight, when BMI is 25 to 29.9 kg/m2, moderately obese, BMI is greater than or equal to 30 kg/m2, and morbidly obese when BMI is greater than or equal to 40 kg/m2.[16]

Waist circumference was measured using a non-stretchable measuring tape, at the point halfway between the lower border of the ribs and the iliac crest in a horizontal plane. Two measurements were done and recorded to the nearest 0.5 cm, if the difference between them shown to be greater than two cm, a third measurement was taken, and the mean of the two closest measurements was adopted. So, a patient was considered obese if his/her calculated body mass index was ≥ 30 kg/m2. Abdominal obesity was diagnosed if the waist circumference exceeded 102 cm for males and 88 cm for females.[17]

Biochemical Estimation

Ten milliliters of venous blood (after an overnight fasting) was drawn from the antecubital vein of each participant. Separation was done using a centrifuge at 3000 round/min for about 15 min, the HDL cholesterol (HDL-C) fraction was measured after the precipitation of low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C) with dextran sulfate magnesium technique. Triglyceride estimation was measured by the enzymatic method. The diagnosis of metabolic syndrome was confirmed by obtaining the measurements of fasting plasma glucose, waist circumference, triglyceride, HDL-C, and blood pressure. According to ATP III criteria, patients who have three or more of the following criteria were defined as having metabolic syndrome: abdominal obesity (waist circumference >102 for men and >88 cm for women),[18],[19] hypertriglyceridemia (>1.7 mmol/l), low HDL-C (<1 mmol for men and <1.2 mmol/l for women,[7] blood pressure of (>130/85 mmHg),[19] and fasting plasma glucose ≥100 mg/dl (5.6 mmol/l) or drug treatment for high blood glucose.[20]

Ethical Consideration

The data forms were anonymous. Every subject was given the complete unconditioned choice to participate in the study. Confidentiality of data throughout the study was guaranteed, and the patients were assured that all data will only be used for research purposes.

Statistical Analysis

Data were analyzed by using IBM Statistical Package for the Social Sciences (SPSS), version 20 (USENET group, IBM Corporation, United States) for categorization, tabulation, and analysis. Mean and standard deviation were computed. Chi-square test was used to find out the significance of association. In respect with the level of significance, P value of 0.05 was considered as a cutoff point.


  Results Top


A total of 440 obese (out of 512 that attended the facility during the period of the study), 148 (33.6%) males and 292 (66.4%) females were included in this study. The sample was classified according to the three classes of obesity: class I composed of 22.3%, class II, 40.2%, and class III composed of 37.5% of the sample. In respect with other demographic characteristics, 45.0% of the respondents had five children or more, 4.8% were practicing exercises regularly, and 8.6% of the total sample were smokers, as shown in [Table 1].
Table 1: Demographic characteristics and grades of obesity among participants

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[Figure 1] demonstrates the frequency of individual criteria of metabolic syndrome; waist circumference was on the top of the list with 99.3% of the total, diabetes mellitus came next forming 75.7%, hypertriglyceridemia was present in 53.0%, hypertension in 50%, and low HDL in 47.5% of the total sample.
Figure 1: Frequency of individual criteria of metabolic syndrome

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In respect with the distribution of metabolic syndrome criteria, increased waist circumference was seen in 99.2% of the age groups 40 to 59 and 60 to 79 years, and hypertension was more evident in the age group 60 to 79 years (65.1%). Diabetes mellitus type 2 was present in 75.7% of the sample, more in males (83.7%) than in females (71.5%). Regarding hypertriglyceridemia (53%), it was found that 64.1% of the males showed hypertriglyceridemia versus 47.2% of the females. The results also revealed that low HDL was present in 58.7% of the males and in 41.7% of the females [Table 2].
Table 2: The distribution of five criteria of metabolic syndrome in relation to some demographic and lifestyle variables

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[Table 3] shows that metabolic syndrome was found in 40.6% of the sample (36.5% of the males and 42.8% of the females). A highly significant association was found between the prevalence of metabolic syndrome and age; among the age group 60 to 79 years, 55% were shown to have metabolic syndrome versus 41.3% of the age group 40 to 59 years. Metabolic syndrome was more prevalent in females who had 9 to 12 children (61.5%) with a significant association. It was less in smokers than nonsmokers (47.3 versus 79.7%), and more in obese who did not report practicing exercises (41.3 versus 48%).
Table 3: Association of metabolic syndrome with some demographic and lifestyle variables

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  Discussion Top


Out of the 440 obese participants, 66.4% were females and 33.6% were males; this might be due to that obesity tends to be more prevalent in women as its prevalence in Iraq is 8% in males and 19% in females. Changes in food consumption, socioeconomic and demographic factors, limited physical activity, and multiple pregnancies are important factors that might contribute to the increased prevalence of obesity in most of the Arab countries.[21] Most of the respondents (95.2%) did not report practicing exercises, which means that exercise is not a usual part of the life style among Iraqis, could be due to many factors like social norms, hot climate, and security instability.

Several studies have shown that sedentary lifestyle (prolonged television viewing, physical inactivity, and unhealthy eating habits during childhood) is associated with an elevated risk of obesity.[22] Data from the National Health and Nutrition Examination Surveys 2011 to 2014 in the United States showed that the prevalence of obesity among adult women (38.3%) was a bit higher than among men (34.3%).[23] In Kuwait, 55% of females and 30% of males over the age of 15 years are obese,[21] whereas a study done in Lebanon (American University) showed that obesity was more common among male students (13.6%) compared to females (3.2%).[24] According to a health survey in England in 2002, BMI > 30 kg/m2 was reported in 22.8% of women and 22.1% of men.[25]

The results revealed that the prevalence of metabolic syndrome was high among the obese (40.6%), noticeably higher than the estimated global prevalence, which is between 20 and 25%.[26] Also higher than the results of a study in Erbil, Iraq, which showed a prevalence of 30.6%,[27] and much higher than that in the Omani population (21%),[28] whereas it was comparable to a study conducted in the United Arab Emirates (UAE) where metabolic syndrome was estimated to be around 40%.[29]

The results also showed that the prevalence is higher in women (42.8 versus 36.5% of the total males). This can be explained by the fact that females (most of whom are housewives in our society) are more prone to obesity after child birth, besides, women transition from the premenopausal to the postmenopausal stage with substantial metabolic changes and estrogen deficiency might lead to an increased predisposition to metabolic syndrome. A study conducted in Baghdad[30] in 2011 showed that the prevalence of metabolic syndrome in females was almost double that in males (34.8 versus 65.2%), this indicates that there might be some changes in the risk factors especially among females. An Indian study revealed that the prevalence of metabolic syndrome was 57.38% in females and 42.63% in males,[31] whereas a study in Tunisia revealed that the prevalence was 45.5%, significantly higher among women.[32]

This alarming figure places a large portion of obese patients at an increasing risk of developing cardiovascular diseases (CVD) as has been shown in several studies.[30],[31],[33]

The current study showed that the prevalence of metabolic syndrome is significantly increasing with age. The age groups 40 to 59 and 60 to 79 years had the highest frequencies of metabolic syndrome that can be explained by the aging process. This agrees with a study done among US adults and showed that the prevalence increases from 18.3% among those 20 to 39 years of age to 46.7% among those 60 years or older,[34] and this is also supported by a study in UAE that showed a positive association between the prevalence of metabolic syndrome and age.[30]

The most common component of metabolic syndrome in our sample was shown to be central obesity and diabetes mellitus followed by hypertriglyceridemia and hypertension; this disagrees with the Indian study, which showed that the main component was hypertension (98.37%), followed by dyslipidemia (77.05%), hyperglycemia (75.41%), and obesity (59.02%).[31] This disagreement might be due to differences in population characteristics or in the research methodology.

There was also a significant association between the prevalence of metabolic syndrome in females and the number of children they have; this agrees with a study that included a sample of nonpregnant (age ≥ 20) in the United States and showed that the increase in the number of children was associated with higher rates of metabolic syndrome.[35]

Most of the obese who showed metabolic syndrome were not exercising, but no significant association was found between metabolic syndrome and practicing exercises. The HERITAGE family study in the United States showed that exercise training resulted in improvement in the metabolic profile of the participants; the prevalence of metabolic syndrome was decreased from 16.9% before training to 11.8% after training.[36]

The current study showed no statistical association between cigarette smoking and metabolic syndrome. This result disagrees with a study on healthcare personnel in Erbil, Iraq, which showed that metabolic syndrome was strongly related to smoking in 51.7% of the patients.[37]In this study, more than three-quarters of the sample (75.6%) were shown to have diabetes mellitus type 2, more than half of them were within the age group 40 to 59 years, with a significant association between glucose concentration and age. Studies in Saudi Arabia found that age-adjusted prevalence of type 2 diabetes mellitus was 30.0 to 31.6%, with the highest prevalence in those aged 46 to 60 years.[38] Iraq is considered as having a medium prevalence (9.3%) of diabetes in the Middle East based on surveys from 2006 to 2007.[39] The global burden of diabetes estimated that more than 171 million individuals (>2.8% of the world’s population) have diabetes. This number is predicted to increase to 366 million (4.4% of the world’s population) by 2030.[40]

Hypertriglyceridemia was present in 53% of the sample; this is similar to a study that was carried out among Iraqi adult population in Mosul, Iraq (2003–2004), which revealed that the prevalence of hypertriglyceridemia was 41.6%.[41] Reports from neighboring Middle Eastern countries vary from 40.3% in Saudi Arabia to 35.3% in Lebanon, 30.4% in Turkey, and 20.7% in Oman.[42]

The results also showed that the mean value of triglyceride in males was higher than in females. This goes with a study in Iran which showed a higher prevalence of hypertriglyceridemia in Iranian males.[42]

In the current study, 47.5% of the sample showed low HDL; this agrees with a study done in Iraq and showed a prevalence of 49.9%[30] and is lower than that in Oman which showed a low HDL in 75.4%.[43]

It can be concluded from this study that the prevalence of metabolic syndrome among Iraqi obese is relatively high. Female gender, old age, and multiparity (for women) can be regarded as related factors.

Educational programs through mass media are required to prevent (and early manage) childhood and adolescent obesity through cooperation of the parents, healthcare professionals, and community leaders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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