Metabolic Syndrome in Kurnool District in adults(20-60 Years)- A Cross Sectional study using Modified NCEP ATP III Criteria.

Abstract

Background Rapid unplanned urbanization, globalization of unhealthy lifestyle and lack of physical activity are vulnerable risk factors contributing to Non Communicable Diseases (NCDs) like type 2 diabetes mellitus and cardiovascular diseases. Over 15 million of all deaths attributed to NCDs occur between 3060 years of age, of them 80% are estimated to occur in low and middle income countries like India. Unhealthy life style and lack of physical activity lead to increased blood pressure, elevated blood glucose, altered lipid parameters and obesity. These are called metabolic risk factors and the condition is referred as metabolic syndrome (MetS). Identification of regional prevalence of MetS and trends will enable the prioritization and implementation of interventions through existing regional collaborations. Objective The main objective of this study is to assess the prevalence of metabolic syndrome in urban, rural and tribal population of Kurnool district using modified NCEP ATP III criteria. Methods A cross sectional study has been conducted to assess the prevalence of metabolic syndrome. Total 1032 subjects were recruited in this study having 344 subjects in each group aged between 20-60 years. The subjects have been screened for metabolic syndrome using modified NCEP ATP III criteria. Fasting insulin levels are estimated and insulin resistance (defined by HOMA-IR) has been calculated in 20 subjects from each group. Correlation of HOMA-IR with each component of metabolic syndrome was done. CVD risk profile of the subjects was studied using WHO/ISH- CVD risk prediction algorithm chart-D. Results We found a high prevalence of metabolic syndrome (31.97%) in Kurnool district and results indicate that prevalence is highest in urban population (42.15%) as compared to rural (31.97%) and tribal (21.80%) population. While comparing the MetS between male and female it was observed that male is having higher (41.82%) as compared to female (30.82%). The prevalence of MetS was found to be near similar in case of urban male (41.82%) and female (42.64%) as compared to rural male (33.65%) and female (29.93%), tribal male (20.93%) and female 22.67%). Decreased HDL-C (78.87%) increase of WC (57.84%) and elevation of TG (31.78%) were found to be potent risk factors for MetS in all the groups of males and females. Age dependent rise in prevalence of MetS were observed in urban and rural population, highest prevalence is noted after 50 years of age while in case of tribal population prevalence is decreased after 50 years. In urban area post-menopausal aged females have shown higher prevalence of MetS as compared to males (58.62% vs. 44.11%); equal prevalence is noted in rural area (38.70% vs. 38.77%); while in case of tribal area males have shown higher prevalence compared to females (35.00% vs. 30.30%). Mean fasting insulin level (µIU/ml) is 18.77(±10.61) [urban population 18.32(±9.56), rural population 23.32(±9.56) and tribal population 18.10(±5.72)]. The prevalence of hyper insulinemia in urban population is 60%, rural population 40% and tribal population 25%. Mean HOMA-IR is 4.17(±2.99) [urban: 4.14(±3.06), rural: 5.62(±3.38) and tribal population: 3.69(±1.21)]. Prevalence of Insulin resistance in urban population is 65%, rural population: 75% and tribal population: 55%. Rural population has not shown significant correlation between Insulin resistance and MetS components [WC (p=0.6642), TG (p=0.9901) and SBP (p=0.1941)] whereas, urban and tribal population are showing correlation. HDL-C is not correlated with insulin resistance in overall (p=0.2483); urban (p=0.5209); rural (p=0.8839); tribal (p=0.4040). Moderate CVD risk is present in 11.82% subjects [urban: 15.69%, rural: 11.33% and tribal: 11.33%] and high CVD risk is present in 4.84% subjects [urban: 6.9%, rural: 6% and tribal: 2.9%]. Only 25.38% of participants were without any habitual or physiological CVD risk factors. An alarming is 43.45% population were with combination of two or more cardiovascular risk factors. Conclusion The study findings reveal that prevalence of metabolic syndrome is very high in Kurnool district. The cardiovascular risk is also correspondingly high. Elevated fasting insulin and insulin resistance without correlation with metabolic syndrome components suggest the need for further improvement of awareness and promotion of lifestyle changes to reduce risk of CVD.