Research Article

Prevalence of Metabolic Syndrome Among Iranian Female Teachers Residing in Yazd, Iran

Simin Shahvazi1,2, Ziba Mehri1,2, Azadeh Nadjarzadeh1,2, Amin Salehi-Abargouei1,2

1Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

2Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Corresponding Author: Amin Salehi-Abargouei, PhD in Nutritional Sciences, Department of Nutrition, Faculty of Health, Sahid Sadoughi University of Medical Sciences, Yazd, Iran, Tel: +98-35-38209100; E-Mail:abargouei@hlth.mui.ac.ir

  • Received Date: 12 Mar 2016    Accepted Date: 10 May 2016   Published Date: 25 May 2016
  • Copyright © 2016 Salehi-Abargouei A

Citation: Shahvazi S, Mehri Z, Nadjarzadeh A and Salehi-Abargouei A. (2016). Prevalence of Metabolic Syndrome Among Iranian Female Teachers Residing in Yazd, Iran. M J Nutr. 1(1): 003.

ABSTRACT

Background:Metabolic syndrome (MetS) is a nutrition related diseases, which is predicts several life threatening diseases including diabetes mellitus and cardiovascular diseases.

Objectives:The present study aimed to investigate the prevalence of MetS in female teachers.

Participants and Method:This cross-sectional study was conducted on 450 female teachers who lived in Yazd city, Iran in 2015. Blood pressure, anthropometrics and serum triglyceride, high density lipoprotein cholesterol and fasting blood sugar measurements were conducted following the standardized procedures. General information, socio-economic status, education level and physical activity data were obtained through a self-reported questionnaire.

Results:Findings revealed a high prevalence of MetS based on NCEP ATP III criteria (39.11 %) in female teachers. Low HDL-c (48.67 %) and elevated waist circumference (72.22 %) were the most common components of MetS. Prevalence of high fasting blood glucose and high blood pressure was the same (31.78 %). Age, number of deliveries and menopause were significantly associated with likelihood of MetS.

Conclusions:The study results shows MetS is a serious health problem among female teachers residing in Yazd; community based lifestyle interventions seems to be necessary.

KEYWORDS
Metabolic Syndrome; Prevalence; ATP III; Iran.
INTRODUCTION

Insulin resistance syndrome or syndrome X which are presently known as metabolic syndrome (MetS), refers to a cluster of disorders including insulin resistance, glucose intolerance, obesity, dyslipidemia, and hypertension [1]. The role of MetS in risk of mortality, cardiovascular diseases, stroke, diabetes mellitus, fatty liver and some cancers has been suggested. First MetS diagnosis criteria was announced in 1998 by the world health organization (WHO), after that different definition of MetS appeared [2-6].
Prevalence of MetS varies in different countries. The prevalence of MetS in Saudi females was reported 16.1 and 13.6 % according to international diabetes federation (IDF) and national cholesterol education program (NCEP) ATP III criteria, respectively [7]. Gundogan et al reported the prevalence of MetS in Turkish females to be 41.8 % (based on ATPIII) and 44.0 % (based on IDF) [8]. In Nepal 21.9 % of women had MetS according NCEP and its prevalence in Canadian woman (ATPIII) was 19.5 % [9, 10].
It has been reported that MS has a high prevalence in Iran compared with the other countries and this high prevalence presents a public health problem [11, 12]. In 2009, it was estimated that more than 11 million Iranians affect by MetS and prevalence of MetS ranges between 9.7 % to 62.2 % [11, 13, 14]. Prevalence of MetS in women lived in west of Iran was reported 24.4 % and 20.62 % for women in north east of Iran [15, 16]. Sarrafzadegan et al [17] in Isfahan Healthy Heart Program found 35.1 % of women had MetS. In Tehran lipid and glucose study 42 % of women had MetS [18]. The only related population based study in Yazd city date back to about a decade ago and reported the prevalence of MetS among women to be about 62.2 % [14]. Therefore, we are not able to discuss about the trend of MetS in recent years for Yazd city. Different prevalence rates reported from the understudied region of Middle East makes it necessary to investigate about prevalence of MetS and its associated factors. The aim of the present study was to determine the prevalence of the metabolic syndrome and some of its life-style related determinants in female teachers residing in Yazd city, Iran.

MATERIALS AND METHODS
Participants

The present cross-sectional study was conducted in 2015 among female teachers in Yazd. Four hundred and fifty female teachers aged 20-60 years, were selected using multistage cluster random-sampling method. Informed consent was taken from the female teachers who agreed to participate in the study. Our study was approved by the Nutrition and Food Security Research Center of Shahid Sadoughi University of Medical Sciences (Registry Number: P.17.1.11523).

Anthropometric Measurements

Weight was measured to the nearest 100 g using SECA portable digital scale (model no: 813), when the participants were minimally clothed and without shoes. Height was measured to the nearest 0.5 centimeter in the standing position while the participants shoulders were in a normal state, using a plastic non-stretchable tape measure fixed on a straight wall [19]. Participants with BMI < 24.9 Kg/m2 were categorized as normal and those with BMI = 25 Kg/m2 and < 30 Kg/m2 were defined as overweight. Other study attendants with BMI = 30 Kg/m2 were regarded as obese. Waist circumference (WC) was recorded by using a non-stretchable plastic tape placed midway between iliac crest and lowest rib while participants were in standing position and were removed belts and tight garments that could change the shape of the body [20]. WC was measured to the nearest 0.5 centimeter while the participants were asked to express the tension of the tape on their body to make sure about proper tension. All measurements were done by a trained nutritionist.

Laboratory Assessments

For laboratory assessment each participant were referred to laboratory after overnight fast (10-12 hours) and venous blood samples were drawn. Serum was separated immediately by centrifugation. Serum levels of fasting Blood Glucose (FBG), HDL-cholesterol, and triglycerides were measured using an auto-analyzer (Technicon, model no: RA1000) and Pars Azma kits.

Assessment of Blood pressure

Blood pressure (BP) was measured when participants were seated at least for 15 minutes using a standard mercury sphygmomanometer (ALP k2-Japan). The systolic blood pressure was defined as the appearance of the first sound (Korotkoff phase 1) and the diastolic blood pressure was defined as the disappearance of the sound (Korotkoff phase 5) during deflating the cuff. All measurements were taken by the same person.

Assessment of other variables

A questionnaire about the demographic characteristics, physical activity, history of chronic diseases, and medication use was filled by each participants and send it back to researchers. Data on physical activity were asked using the short-form of Iranian version of international physical activity questionnaire (IPAQ); then we categorized the participantsí physical activity to sedentary or active (those with at least 60 minutes of severe activities per week were categorized as physically active) [21].

Definition of metabolic syndrome

Having 3 or more of the following was considered as MetS according to the ATP III Criteria [22]:

  1. Abdominal Obesity: Waist Circumference > 88 cm;
  2. Hypertriglyceridaemia: Serum triglycerides level > 150mg/ dl;
  3. HDL-Cholesterol < 50 mg/dl;
  4. High Blood Pressure: systolic blood pressure (SBP) > 130 mmHg and/or diastolic blood pressure (DBP) > 85 mmHg or on treatment for hypertension;
  5. High Fasting Glucose: Serum glucose level > 100 mg/dl or medication use to control serum glucose levels.

Statistical Analysis

Prevalence rates of metabolic syndrome and its components for all study members and also based on participantsí age (< 50/ = 50), marital status (single/married), economic status (low income/ middle income/high income), education (high school/bachelorís degree/masterís degree), number of parities (none, one, two, three or more), physical activity (sedentary/ active), husbandís education (high school/bachelorís degree/ masterís degree), menstruation (yes/no), family history of Diabetes mellitus (DB) (yes/no) and history of cardiovascular diseases (CVD) (yes/no) were calculated and reported.
Comparison of continuous and categorical variables was done by the use of independent samples studentís t-test and chisquare test, respectively. All statistical analyses was done by SPSS version 20 (IBM SPSS, Tokyo, Japan). P-values = 0.05 were considered as Statistical signi?cant level.

RESULTS

Four hundred and fifty participants aged 40.60Ī8.25 years had complete data to be included in the current analysis. Metabolicsyndrome was prevalent among 39.11 % of participants. Table 1 shows the prevalence of the metabolic syndrome components according to participants general and lifestyle characteristics of included participants. Prevalence of high fasting blood glucose (FBG) increased with age (P = 0.005) and number of deliveries (P = 0.002). High FBG levels was more prevalent in participants who experienced menopause (P < 0.001). The overall prevalence of high FBG in the study population was 31.74 %. Prevalence of high blood pressure (BP) was statistically higher in older subjects (P < 0.001) and increased by number of deliveries (P = 0.002). Participants with family history of cardiovascular diseases (CVDs) showed higher prevalence of hypertension (P = 0.022). Low HDL-c was more common compared to other components of MetS (48.67 %); low HDL-c was more prevalent in subject with cardiovascular diseases (CVDs) history (P = 0.022). Similar to the other components prevalence of high triglyceride (TG) (P < 0.001) and abdominal obesity (P < 0.001) was increased with age and number of deliveries.

Table 1: Prevalence of metabolic syndrome components in all participants (n = 450).

  High FBG (%) Hypertension (%) High TG (%) Low HDL (%) Abdominal obesity (%)
Age group 20-50 y 29.21 27.11 30.0 50.53 69.21
Over50 y 46.38 56.52 62.32 37.68 88.41
P value 0.005 < 0.001 < 0.001 0.05 0.001
Marital Status Single 30.23 30.23 37.21 37.21 60.47
Married 31.85 32.10 34.81 49.63 73.58
P value 0.828 0.803 0.754 0.121 0.068
Economic Status Low 27.66 24.82 31.21 51.06 70.92
Middle 31.79 35.76 33.77 49.01 70.86
High 35.67 34.39 39.49 45.86 75.16
P value 0.334 0.093 0.304 0.662 0.628
Physical Activity Sedentary 33.83 33.83 35.61 47.18 73.59
Active 24.53 26.42 30.19 52.83 68.87
P value 0.072 0.154 0.305 0.310 0.342
Education college 39.77 37.50 48.86 48.86 79.55
Bachelorís degree 30.74 30.42 32.36 49.84 72.49
Masterís degree or higher 23.53 29.41 27.45 41.18 58.82
P value 0.114 0.422 0.008 0.518 0.031
Husbandís Education High school 37.93 44.83 39.66 48.28 81.03
College or Bachelorís degree 28.65 27.85 34.18 50.63 72.15
Masterís degree or higher 31.25 26.56 29.69 50.0 71.88
P value 0.215 0.003 0.374 0.917 0.171
Number of Deliveries None 17.31 15.38 17.31 44.23 36.54
1 child 26.44 25.29 26.44 44.83 68.97
2 children 30.16 28.57 34.92 50.26 70.90
3 or more children 43.80 47.93 47.93 51.24 91.74
P value 0.002 < 0.001 < 0.001 0.697 = 0.001
Menopause no 28.04 26.72 29.89 50.0 68.52
Yes 51.39 58.33 61.11 41.67 91.67
P value < 0.001 < 0.001 < 0.001 0.195 < 0.001
Family history of cardiovascular diseases Yes 40.0 40.71 35.71 40.0 80.71
No 27.36 27.70 33.78 51.01 67.57
P value 0.022 0.025 0.238 0.022 0.014
Family history of diabetes mellitus Yes 36.07 31.15 37.70 46.99 Ī 0.50 75.96
No 28.40 32.40 34.40 48.40 Ī 0.50 69.20
P value 0.168 0.139 0.178 0.704 0.426
Total 31.78 31.78 34.89 48.67 Ī 0.50 72.22

For more analysis and detailed description of prevalence of MetS, women without any previous or current chronic disease (cardiovascular diseases, stroke, diabetes, polycystic ovary syndrome, multiple sclerosis and cancers) were analyzed, separately (Table 2). Older age was linked to high BP (P = 0.001) and high TG (P = 0.02) also increasing the number of deliveries was associated with high BP (P = 0.002) and high WC (P < 0.001). Postmenopausal women also had higher rates of hypertension (P = 0.001), hypertriglyceridemia (P = 0.022) and abdominal obesity (P = 0.014).

Table 2: Prevalence of metabolic syndrome components among participants without history of chronic diseases (n = 255).

  High FBG (%) Hypertension (%) High TG (%) Low HDL (%) Abdominal obesity (%)
Age group 20-50 y 24.66 18.83 21.97 50.67 63.68
Over50 y 29.03 45.16 48.39 38.71 80.65
P value 0.60 0.001 0.02 0.212 0.062
Marital Status Single 25.93 29.63 33.33 37.04 51.85
Married 25.11 21.59 24.23 50.66 67.87
P value 0.926 0.344 0.303 0.181 0.097
Economic Status Low 23.53 20.00 25.88 56.47 64.71
Middle 25.61 20.73 18.29 50.00 67.07
High 26.44 26.44 31.03 41.38 66.67
P value 0.903 0.542 0.160 0.139 0.941
Physical Activity Sedentary 27.42 23.12 24.19 47.58 66.13
Active 18.75 20.31 25.00 53.12 67.19
P value 0.168 0.642 0.897 0.467 0.877
Education college 25.00 18.18 18.18 50.00 70.54
Bachelorís degree 24.72 23.03 24.16 50.56 68.54
Masterís degree or higher 25.81 22.58 16.13 41.94 45.16
P value 0.992 0.784 0.113 0.673 0.032
Husbandís Education High school 23.73 27.12 18.64 45.76 74.58
College or Bachelorís degree 22.79 21.32 27.21 52.94 65.44
Masterís degree or higher 32.43 16.22 18.92 54.05 70.27
P value 0.475 0.436 0.329 0.612 0.437
Number of Deliveries None 18.42 15.79 18.42 42.11 34.21
1 child 25.93 16.67 22.22 50.00 64.81
2 children 23.42 18.02 26.13 48.65 66.67
3 or more children 32.69 42.31 30.77 55.77 88.46
P value 0.443 0.002 0.554 0.640 < 0.001
Menopause Yes 32.00 48.00 44.00 40.00 88.00
No 24.35 19.57 23.04 50.43 63.48
P value 0.402 0.001 0.022 0.322 0.014
Family history of cardiovascular diseases Yes 32.88 24.66 26.03 42.47 76.71
No 21.26 21.26 23.56 50.57 60.92
P value 0.094 0.760 0.221 0.103 0.058
Family history of diabetes mellitus Yes 26.60 17.02 26.60 48.94 68.09
No 23.49 25.50 26.17 49.99 64.43
P value 0.836 0.146 0.411 0.924 0.812
Total 25.10 22.35 25.10 49.41 65.88

Prevalence of metabolic syndrome among all included participant was 39.11 % and this rate among women without history of chronic diseases was 28.24 %. Prevalence of MetS is reported in Table 3.

Table 3: Prevalence of metabolic syndrome in all women (n = 450) and women without history of chronic diseases (n = 255).

  Total participants (n = 450) (%) Participants without history of chronic diseases (n = 255) (%)
Age group 20-50 y 34.74 25.11
Over50 y 62.33 48.39
Pvalue < 0.001 0.007
Marital Status Single 39.53 33.33
Married 39.01 27.75
P value 0.947 0.543
Economic Status Low 34.75 29.41
Middle 39.74 25.61
High 42.68 29.89
P value 0.371 0.798
Physical Activity Sedentary 41.54 29.03
Active 30.19 25.0
P value 0.058 0.744
Education college 47.73 27.27
Bachelorís degree 38.51 29.21
Masterís degree or higher 27.45 22.58
P value 0.032 0.965
Husbandís Education High school 49.14 27.12
College or Bachelorís degree 37.13 28.68
Masterís degree or higher 31.25 27.03
P value 0.036 0.535
Number of Deliveries None 13.46 13.16
1 child 34.48 29.63
2 children 35.45 23.42
3 or more children 58.68 48.08
P value < 0.001 0.001
Menopause No 34.66 26.52
Yes 62.50 44.0
P value < 0.001 0.065
Family history of cardiovascular diseases Yes 42.86 32.88
No 34.49 25.29
P value 0.166 0.165
Family history of diabetes mellitus Yes 43.72 28.72
No 36.40 28.86
P value 0.124 0.211
Total 39.11 28.24

Prevalence of MetS according to NCEP ATP III in both groups increased with more age (P < 0.001 and P = 0.007). Number of deliveries was positively associated with prevalence of MetS (P < 0.05). Higher level of teacherís education (P = 0.032) and their husbands education (P = 0.036) was linked with less MetS in all participants, but this relationship was not found in participants without history of chronic diseases. Marriage status, economic status, physical activity, and family history of CVDs and DM associated with MetS neither in all population nor in those without history of chronic diseases.
Table 4 describes the prevalence rates for MetS and its components according to BMI categories. Low HDL-c levels was not significantly associated with overweight or obesity (P = 0.267). However, prevalence of all other MetS components significantly increased with overweight and obesity (P < 0.001). The Prevalence of MetS based on NCEP ATPIII definition was also significantly related to overweight and obesity (P < 0.001).

Table 4: Prevalence of metabolic syndrome and its components in all study participants according to their body mass index (BMI) status 1 (n = 450).

  Normal Number (%) Overweight Number (%) Obese Number (%) P value
High FBS 18 (13.6 %) 66 (33.8 %) 59 (48 %) < 0.001
High TG 24 (18.2 %) 70 (35.9 %) 63 (51.2 %) < 0.001
Hypertension 23 (17.4 %) 64 (32.8 %) 56 (45.5 %) < 0.001
Low HDL 58 (43.9 %) 103 (52.8 %) 58 (47.2 %) 0.267
Abdominal obesity 35 (26.5 %) 167 (85.6 %) 123 (100 %) < 0.001
Metabolic Syndrome 18 (13.6 %) 80 (41 %) 78 (63.4 %) < 0.001

1Normal weight: BMI < 24.9 Kg/m2, Overweight: BMI = 25 Kg/m2 and < 30 Kg/m2, Obese: BMI = 30 Kg/m2.
DISCUSSION

The present study showed that the prevalence of MetS among female teachers was 39.11%. This finding was close to a study done by Sadrbafoghi et al [14]; they reported that about one third of Yazd population had MetS according to NCEP criteria. Several studies have reported the prevalence of MetS in different cities of Iran. Most of these studies reported high prevalence of MetS among females [15, 16, 18]. It is estimated that 11 million of Iranian population are affected by MetS [11]. Similar to Iran in other countries like Turkey, Pakistan and Saudi Arabia the prevalence of MetS is high. In Turkey the rate of having MetS among women was reported 45 % and 49 % for women in Pakistan [23, 24]. In the present study, low HDLc and increased WC were the most common components of MetS. These findings are consistent with other studies that previously carried out in Iran [18, 25, 26].
Changes in lifestyle, unhealthy diet, sedentary lifestyle, increased prevalence of hypertriglyceridemia, overweight and obesity, genetic polymorphism that have been suggested by family and twin studies are associated with low HDL-c. With removing women with previous disease or current disease, these finding still remained the same. In Iran most of women do not have enough physical activity and overweight and obesity are common, so this finding are not unexpected [18, 27-30].
In our study participantsí age was related to MetS and its components. Other studies have also reported the association between age and the prevalence of MetS [31]. This increasing trend can be observed to a similar age-related trend in each of the components of metabolic syndrome.
Our study had several limitations. Causal relationships cannot be inferred from our study because of its cross-sectional nature. Including female teachers in the present study makes it hard to attribute the prevalence rates and the associations found to general population. It should be considered that the last study about prevalence of MetS in Yazd city was conducted in 10 years ago and after that no study is published about the prevalence of MetS and its associated factors in Yazd city. Although we tried to examine the association between several demographic and lifestyle related variables, as the main objective of the present study was reporting the prevalence of MetS among female teachers we did not investigate the association between dietary intake and its association with MetS.
In conclusion, the findings of our study revealed a high prevalence of the metabolic syndrome in a highly educated part of females residing in Yazd city; Furthermore, about one third of the participants who reported no history of chronic diseases had MetS. Designing community based intervention programs to reduce the prevalence of MetS in Yazd city is highly recommended.

ACKNOWLEDGEMENTS

This study was financially supported by research council of Shahid Sadoughi University of Medical Sciences (SSU). We thank all teachers who participated in our study.

COMPETING INTERESTS

The authors have no conflicts of interest.

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Citation:
Shahvazi S, Mehri Z, Nadjarzadeh A and Salehi-Abargouei A. (2016). Prevalence of Metabolic Syndrome Among Iranian Female Teachers Residing in Yazd, Iran. M J Nutr. 1(1): 003.