Abstract
Background:
Dyslipidemia, insulin resistance, hypertension, and abdominal obesity are important determinants of metabolic syndrome (MetS). Ample studies provide statistical data on the prevalence of MetS among the general public. Conversely, there is a paucity of data on the risk of MetS among different sedentary occupational groups.
Objective:
To assess the risk of MetS among female school teachers and to identify factors contributing to MetS.
Methodology:
The study was conducted among 256 female school teachers residing in Chennai city. A questionnaire was used to elicit information on the socio-demographic profile, diet pattern, physical fitness, and genetic history of lifestyle diseases. Anthropometric, biochemical, and clinical parameters were measured using standard methods. MetS was diagnosed using the harmonizing definition. Data analysis was done using Statistical Package for Social Sciences software.
Results:
Results evince that 39.45% of female school teachers were diagnosed with MetS, of which 26.56% had three components, 9.77% had four components, and 3.12% had all components of MetS. Abdominal obesity (99%) and low levels of high-density lipoprotein cholesterol (HDL-C) (96.04%) were the most predominant components. The least common component was diastolic hypertension (32.67%). MetS components were high among school teachers aged 36–45 years and 46–55 years. Age, fasting hyperglycemia, paternal history of hypertension, physical inactivity, eating out, and consumption of refined cereals significantly contributed to MetS (P < 0.05).
Conclusion:
Results highlight the need to identify high-risk individuals and promote a healthy lifestyle through various intervention programs.
Keywords: Healthy lifestyle, metabolic syndrome, school teachers, sedentary occupation
INTRODUCTION
Developing countries are experiencing rising epidemics of non-communicable diseases (NCDs). Nearly 63% of deaths occurred due to NCDs, of which 27% of deaths occurred due to cardiovascular diseases (CVD) in India.[1] One contributing factor for modern-day epidemics of CVD and type 2 diabetes mellitus (T2DM) is MetS. MetS is characterized by the presence of central obesity, hyperglycemia, hypertriglyceridemia, low high-density (HDL-C), and hypertension (HTN).[2] Workers spend most of their time in their respective workplaces. Women are employed in different working sectors and the teaching sector is one among them. School teachers represent one of the most important and productive sectors. NCDs represent one of the biggest threats to women's health, mainly affecting women in developing countries. Due to work stress, physical inactivity, changes in dietary habits, and sedentarism, school teachers are vulnerable to develop CVD, HTN, and T2DM.[3,4] The risk of CVD and T2DM is high among women due to the high prevalence of cardiometabolic abnormalities specifically obesity and low HDL-C.[5]
Several studies have been conducted on the risk of MetS among the general public of different ethnicities and age groups but very few studies are available on the risk of MetS among different occupational groups. Since MetS leads to CVD and the prognosis of CVD is worse in women, approaches to prevent CVD before its onset is more effective instead of treating the disease condition. This study focuses on assessing the risk of MetS among female school teachers and identifying various factors contributing to the same.
METHODOLOGY
This cross-sectional study was conducted among female school teachers in Chennai city. The sample size was calculated based on previous research done by Narayanappa et al., (2016).[6] By fixing the precision at 5% and the conventional Z-value as 1.96, the sample size was 330. A multi-stage sampling technique was adopted. According to the Corporation of Greater Chennai, Chennai was categorized into north, south, and central Chennai. Initially, central Chennai was selected randomly. Secondly, one zone was selected randomly from central Chennai. The selected zone covered 15 wards. Three wards were grouped to form a stratum that constituted five strata. Schools were chosen from each stratum using the proportionate allocation technique. Teachers from the selected schools were chosen randomly. Ethical clearance and permission from all school higher authorities were acquired before conducting the study.
A structured validated questionnaire was used to elicit information on the socio-demographic profile, diet pattern, physical fitness, and genetic history of NCDs. Anthropometric measurements (height, body weight, and waist circumference) were measured with minimal clothing. For estimation of biochemical parameters (fasting plasma glucose and serum lipid profile), 5 mL of venous blood was drawn from the mid-cubital vein using a sterile disposable syringe after 8–10 h of overnight fasting by trained phlebotomists from Lister Metropolis Laboratory, Chennai. Blood pressure was measured using an electronic BP device. MetS was diagnosed using the harmonizing definition.[7]
Statistical analysis: Statistical Package for Social Sciences software was used for data analysis. The association between two categorical variables was checked using the Chi-square test. Differences in mean anthropometry, biochemical parameters, and blood pressure levels between the two groups were checked using the independent “t”-test. Factors contributing to MetS were determined using logistic regression analysis. A P value <0.05 was considered to be significant.
RESULTS
Due to lack of interest, absenteeism, expression of fear, and failure to come on a fasting state for the blood test, only 256 school teachers participated thereby leaving a response rate of 77.6%. Results indicate that 101 (39.45%) of school teachers had MetS of which 26.56% had three components, 9.77% had four components, and 3.12% had all components of MetS. Abdominal obesity (99%) and low HDL-C (96.04%) were the most common components of MetS followed by systolic HTN (53.47%) [Figures 1 and 2].
Figure 1:
Percent distribution of school teachers based on MetS
Figure 2:
Percent distribution of individual components of MetS
Visceral adiposity acts as a key factor for the occurrence of lifestyle disorders among individuals having lower levels of BMI. Figure 3 illustrates that school teachers whose BMI <25 kg/m2 were also diagnosed with MetS.
Figure 3:
Percent distribution of MetS based on BMI
The age of the participants who took part in the study ranged from 23 to 60 years. The income level was measured as the total annual income of all family members and categorized as aspirers, middle class, and rich.[8] Since school teachers were chosen as the target group, all the study participants were graduates. The incidence of maternal history of HTN and paternal history of T2DM was high. The physical activity index scoring method developed by Sharkey and Gaskill (2013)[9] was used to evaluate the participant's physical fitness. On analyzing the scores obtained, it was found that the majority of school teachers led a sedentary type of life as their physical activity scores were below 20 [Table 1].
Table 1:
General profile of school teachers screened for MetS
| Particulars |
N=256 |
P value | |
|---|---|---|---|
| With MetS (n=101) | Without MetS (n=155) | ||
| Age | |||
| 23-25 | 8 (7.92) | 6 (3.87) | 0.017 * |
| 26-35 | 18 (17.83) | 35 (22.58) | |
| 36-45 | 42 (41.58) | 61 (39.35) | |
| 46-55 | 31 (30.69) | 40 (25.81) | |
| 56-60 | 2 (1.98) | 13 (8.39) | |
| Annual income | |||
| Aspirers <Rs 2,00,000 | 30 (29.70) | 48 (30.97) | 0.526 |
| Middle class Rs 2,00,000-10,00,000 | 63 (62.38) | 100 (64.52) | |
| Rich >Rs 10,00,000 | 8 (7.92) | 7 (4.51) | |
| Class handled | |||
| Primary school | 43 (42.57) | 59 (38.06) | 0.251 |
| Middle school | 16 (15.85) | 38 (24.52) | |
| High and secondary school | 42 (41.58) | 58 (37.42) | |
| Paternal history of T2DM | |||
| Yes | 27 (26.73) | 52 (33.55) | 0.270 |
| No | 74 (73.27) | 103 (66.45) | |
| Paternal history of HTN | |||
| Yes | 28 (27.72) | 27 (17.42) | 0.005** |
| No | 73 (72.28) | 128 (82.58) | |
| Maternal history of HTN | |||
| Yes | 8 (7.92) | 33 (21.29) | 0.063 |
| No | 93 (92.08) | 122 (78.71) | |
| Maternal history of T2DM | |||
| Yes | 28 (27.72) | 37 (23.87) | 0.005** |
| No | 73 (72.28) | 118 (76.13) | |
| Habit of eating out | |||
| Yes | 78 (77.2) | 139 (89.7) | 0.008** |
| No | 23 (22.8) | 16 (10.3) | |
| Frequency of eating out | |||
| Alternate days | 30 (38.46) | 45 (32.37) | 0.048* |
| Weekly twice | 18 (23.08) | 30 (21.58) | |
| Weekly once | 20 (25.64) | 26 (18.71) | |
| Monthly once | 10 (12.82) | 38 (27.34) | |
| Habit of eating junk foods | |||
| Yes | 44 (43.6) | 77 (49.7) | 0.371 |
| No | 57 (56.4) | 78 (50.3) | |
| Frequency of eating junk foods | |||
| Alternate days | 12 (27.27) | 25 (32.47) | 0.942 |
| Weekly twice | 7 (15.91) | 10 (12.99) | |
| Weekly once | 10 (22.73) | 12 (15.58) | |
| Monthly once | 15 (34.09) | 30 (38.96) | |
| Habit of consuming refined cereals | |||
| Yes | 76 (75.2) | 139 (89.7) | 0.003** |
| No | 25 (24.8) | 16 (10.3) | |
| Frequency of consuming refined foods | |||
| Alternate days | 35 (46.05) | 50 (35.97) | 0.020* |
| Weekly twice | 16 (21.05) | 30 (21.58) | |
| Weekly once | 15 (19.74) | 25 (17.99) | |
| Monthly once | 10 (13.16) | 34 (24.46) | |
| Habit of consuming salty foods | |||
| Yes | 55 (54.5) | 84 (54.2) | 1.000 |
| No | 46 (45.5) | 71 (45.8) | |
| Frequency of consuming salty foods | |||
| Alternate days | 10 (18.18) | 25 (29.76) | 0.952 |
| Weekly twice | 13 (23.64) | 17 (20.24) | |
| Weekly once | 20 (36.36) | 12 (14.29) | |
| Monthly once | 12 (21.82) | 30 (35.71) | |
| Habit of exercising | |||
| Yes | 70 (69.31) | 126 (81.29) | 0.259 |
| No | 31 (30.69) | 29 (18.71) | |
| Physical activity scores | |||
| <20 | 56 (80.00) | 98 (77.80) | 0.217 |
| 20-40 | 11 (15.70) | 24 (19.00) | |
| 40-60 | 1 (1.40) | 4 (3.20) | |
| 60-80 | 2 (2.90) | - | |
| Duration of physical activity (minutes) | |||
| >30 | 15 (21.42) | 20 (15.87) | 0.826 |
| 20-30 | 10 (14.29) | 21 (16.67) | |
| 10-20 | 10 (14.29) | 20 (15.87) | |
| <10 | 35 (50) | 65 (51.59) | |
*Significant at P<0.05; **Significant at P<0.01
School teachers were categorized into different two groups, namely, with MetS (n = 101) and without MetS (n = 155). A significant difference was observed in the mean biochemical parameters between both groups (P < 0.01). No significant differences were observed in mean anthropometry values and blood pressure levels between the groups [Table 2].
Table 2:
Mean anthropometry, biochemical parameters, and blood pressure levels of school teachers based on the presence and absence of MetS
| Parameters |
N=256 |
P value | |
|---|---|---|---|
| With MetS (n=101) | Without MetS (n=155) | ||
| Anthropometry | |||
| Body weight (kg) | 68.98±12.63 | 67.32±11.45 | 0.276 |
| Waist circumference (cm) | 87.05±10.24 | 88.68±11.73 | 0.256 |
| BMI (kg/m2) | 27.77±4.51 | 28.59±4.79 | 0.176 |
| Biochemical parameters (mg/dL) | |||
| Fasting plasma glucose | 111.93±46.43 | 91.09±21.90 | 0.001* |
| Total cholesterol | 195.27±32.11 | 179.90±37.34 | 0.001* |
| Triglyceride | 137.71±55.64 | 89.43±30.17 | 0.001* |
| HDL-C | 39.71±6.99 | 44.80±8.24 | 0.001* |
| Non-HDL-C | 155.55±30.63 | 135.15±36.10 | 0.001* |
| LDL-C | 128.19±28.02 | 117.27±33.42 | 0.007* |
| VLDL-C | 27.54±11.13 | 19.18±7.42 | 0.001* |
| TC:HDL-C ratio | 3.33±0.93 | 2.70±0.92 | 0.001* |
| LDL-C:HDL-C ratio | 5.06±1.16 | 4.11±1.16 | 0.001* |
| Blood pressure (mmHg) | |||
| Systolic | 117.37±17.29 | 115.77±14.40 | 0.426 |
| Diastolic | 75.36±10.23 | 73.23±10.01 | 0.101 |
*Significant at P<0.01
School teachers aged 23 to 60 years participated in the screening phase. The mean age was 41.11 ± 9.02 years. Table 3 indicates that MetS and components of MetS were high among school teachers aged 36–45 years and 46–55 years.
Table 3:
Distribution of individual components of MetS based on age
| Components of MetS | Age (years) |
||||||||
|---|---|---|---|---|---|---|---|---|---|
| 23-25 | 26-35 | 36-45 | 46-55 | 55-60 | |||||
| Waist circumference (≥80 cm) | 2 | 16 | 37 | 40 | 5 | ||||
| Fasting plasma glucose (≥100 mg/dL) | 1 | 6 | 14 | 25 | 3 | ||||
| Triglyceride (≥150 mg/dL) | 2 | 9 | 11 | 16 | 1 | ||||
| HDL-C (<50 mg/dL) | 2 | 17 | 37 | 37 | 5 | ||||
| Blood pressure | |||||||||
| Systolic (≥130 mmHg) | 1 | 5 | 16 | 27 | 4 | ||||
| Diastolic (≥85 mmHg) | 1 | 5 | 10 | 17 | - | ||||
Results of regression analysis indicate that age, paternal history of HTN, fasting hyperglycemia, eating out, physical inactivity, and consumption of refined cereals contributed to MetS among school teachers (P < 0.05) [Table 4].
Table 4:
Logistic regression analysis determining the risk of MetS among school teachers
| Risk factors | OR | 95% CI |
P value | |
|---|---|---|---|---|
| Lower | Upper | |||
| Age (years) | ||||
| 23-25 | 2.41 | 0.23 | 2.58 | 0.297 |
| 26-35 | 9.42 | 1.30 | 68.25 | 0.026* |
| 36-45 | 3.58 | 0.67 | 19.25 | 0.137 |
| 46-55 | 5.53 | 1.09 | 27.94 | 0.039* |
| 56-60 | 6.13 | 1.198 | 31.35 | 0.030* |
| Paternal history of HTN | 0.46 | 0.21 | 0.99 | 0.046* |
| Fasting plasma glucose (>100 mg/dL) | 1.02 | 1.01 | 1.04 | 0.001** |
| Eating out | 0.32 | 0.13 | 0.74 | 0.008** |
| Waist circumference (>80 cm) | 1.06 | 0.53 | 2.12 | 0.866 |
| Physical inactivity | 0.51 | 0.27 | 0.98 | 0.042* |
| Intake of salty foods | 0.911 | 0.56 | 1.58 | 0.739 |
| Intake of refined cereals | 0.28 | 0.13 | 0.61 | 0.001** |
*Significant at P<0.05; ** Significant at P<0.01; OR - Odds ratio; CI - Class interval
DISCUSSION
This study reports that 39.45% of female school teachers had MetS. Narayanappa et al., (2016)[6] using the IDF consensus statement as diagnostic criteria for MetS, reported that 38.3% of secondary school teachers in Mysore city had MetS. MetS was high among female teachers (39.9%) than male teachers (35.7%). Among female teachers, common components of MetS were obesity (68.0%) and low HDL-C (47.8%), while in male teachers; it was hypertriglyceridemia (56.3%) and systolic HTN (50.9%). Results are on par with the findings of this study. The present study reports abdominal obesity and low HDL-C to be the most common components of MetS among female school teachers [Figure 2]. Kant et al. (2019)[10] reported that one-third of individuals with HTN have MetS. Results are in agreement with the above statement, wherein 53.47% of school teachers with systolic HTN and 32.67% of them with diastolic HTN had MetS. Manaf et al. (2021)[11] reported the prevalence of MetS to be 20.6% among teaching staff in a Malaysian public university. However, MetS was high among male teachers than female teachers (24.9% vs 18.3%). Cheserek et al. (2014)[12] reported a higher incidence of MetS among male teaching staff. The prevalence rate of individual components of MetS was HTN (37.9%) hypertriglyceridemia (20.8%), low HDL-C (13.8%), fasting hyperglycemia (13.3%), and abdominal obesity (4%). Low HDL-C and HTN were common among female teaching staff.
Lone et al. (2014)[13] showed an age-specific prevalence of T2DM among school teachers in Nagpur, central India. Cases of T2DM were high among teachers aged 41–50 years. Likewise, Vyas et al. (2017)[14] mentioned that out of 220 teachers screened for T2DM, 12.7% had T2DM, and 5.5% had pre-diabetes. Furthermore, the prevalence was high were among teachers aged 36-45 and 46-55 years. Similar results were observed in the present study. MetS and MetS components increased with age and were high among the 36–45 and 46–55 age groups.
Individuals with BMI <25 kg/m2 having MetS are known as metabolically obese non-obese individuals (MONO). Results of the study report presence of MetS among non-obese school teachers [Figure 3]. Lee et al. (2017)[15] reported the prevalence of MONO to be 17.7% among non-obese teachers. The relative risk (RR) of developing MetS increased by 1.9 times for individuals with a BMI of 23–24.9 kg/m2.
Regression analysis indicates that paternal history of HTN increased the odds of MetS by 0.46 times. Lan et al. (2018)[16] concluded that the possibility of developing MetS due to familial history of HTN increases the risk by 1.58 times (95%, CI: 1.374–1.838). Sitting for a longer time at the workplace, personal history of systolic HTN, and familial history of T2DM contributed to T2DM among bank employees and school teachers.[17] Eating out and intake of refined cereals increased the RR of MetS by 0.32 times and 0.28 times. As time changes, an individual's eating habit also changes. One such change commonly noticed is the practice of eating out. The increased number of eating outlets along with sale of unhealthy foods in school canteens and cafeterias might have contributed to the consumption of energy-dense calorie foods among school teachers. The chances of getting MetS are less if sedentary occupation workers are physically active.[18] In the present study, it is observed that teachers led a sedentary lifestyle. Reasons given for not exercising were time constraints, avolition, and lack of interest. The concept of fitness centers in workplace sectors along with peer support may help school teachers to exercise during their leisure time.
CONCLUSION
This study indicates the presence of MetS among sedentary occupational workers in this metropolitan populace. This necessitates the need to conduct interventional follow-up studies for preventing the onset of CVD and T2DM besides conducting screening programs. Schools can be utilized for conducting awareness programs on disease prevention and interventional studies since providing comprehensive quality health care to high-risk individuals and monitoring them can be done simultaneously.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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