|Year : 2013 | Volume
| Issue : 2 | Page : 69-75
Prevalence of lifestyle associated cardiovascular risk factors among adolescent students of Rural Bengal
Avisek Gupta1, Gautam Sarker2, Palash Das3, Kashif Shahnawaz4, Ranabir Pal5
1 Assistant Professor, Department of Community Medicine, MGM Medical College & LSK Hospital, Kishanganj-855 107, Bihar, India
2 Assistant Professor, Department of Community Medicine, MGM Medical College & LSK Hospital, Kishanganj- 855 107, Bihar, India
3 Associate Professor, Department of Community Medicine, College of Medicine and Sugore Dutta Hospital, Kolkata-700 058 West Bengal, India
4 Assistant Professor, Department of Community Medicine, College of Medicine and Sugore Dutta Hospital, Kolkata-700 058 West Bengal, India
5 Additional Professor, Community Medicine and Family Medicine, All India Institute of Medical Science, Jodhpur, Rajasthan-342005, India
|Date of Web Publication||21-Aug-2018|
Assistant Professor, Department of Community Medicine, MGM Medical College & LSK Hospital, Kishanganj-855 107, Bihar
Source of Support: None, Conflict of Interest: None
Introduction: Adolescent population at the crossroad of childhood and adulthood start to pick lifestyle related risk factors for cardiovascular diseases.
Methods: To find out the prevalence of lifestyle associated cardiovascular risk factors and risk correlates a study was conducted among 452 adolescent students of class IX-XII of four higher secondary schools; males 247(54.64%), females 205(45.36%) using a predesigned, pretested, semi-structured questionnaire to find out cardiovascular risk factors viz. smoking, physical activity, dietary practices; blood pressure, weight, height was measured; BMI was calculated.
Result: Hypertension was in 12.61 percent adolescents (male 16.59%, female 7.80%; private schools 19.27% Government aided schools 7.69%). Overweight was in 7.74 percent (male 8.90%, female 6.34%; private schools 15.62%, Government aided schools 1.92%). Obesity was in 3.98 percent (male 4.04%, female 3.90%; private schools 8.85%, Government aided schools 0.38%). Insufficient physical activity was in 15.70 percent (female (23.41%), male (9.31%); double in private (21.87%) than Government aided schools (11.15%). Of the 1.32 percent smokers, all were male (2.42%) and from private schools (3.12 %). Mean systolic blood pressure was 112.08±13.51 mm Hg; mean diastolic blood pressure was 72.49±8.51 mm Hg. Consumption of obesogenic foods more than three servings per week and at least three days in a week were fast food (55.53%), sweets(44.46%), ghee and butter(22.56%), red meat(6.41%), cold drinks(3.09%), ice cream(4.86%); protective foods were fruits (57.74 %) and vegetables ( 84.29%).Significant difference existed in risk factors between gender and schools.
Conclusion: Our study findings indicated that prevalence of lifestyle related risk factors for cardiovascular diseases were hypertension, physical inactivity, overweight or obesity in rural Bengal that calls for optimum intervention strategies to be expanded.
Keywords: Lifestyle, Obesity, Hypertension
|How to cite this article:|
Gupta A, Sarker G, Das P, Shahnawaz K, Pal R. Prevalence of lifestyle associated cardiovascular risk factors among adolescent students of Rural Bengal. J Integr Health Sci 2013;1:69-75
|How to cite this URL:|
Gupta A, Sarker G, Das P, Shahnawaz K, Pal R. Prevalence of lifestyle associated cardiovascular risk factors among adolescent students of Rural Bengal. J Integr Health Sci [serial online] 2013 [cited 2022 Aug 12];1:69-75. Available from: https://www.jihs.in/text.asp?2013/1/2/69/239497
| Introduction|| |
Cardiovascular diseases (CVD) are global health problem posing huge morbidity and mortality. With the advances in public health, chemotherapy, antibiotics and vector control communicable diseases has been replaced by non-communicable diseases. CVD has modifiable risk factors like smoking, obesity, physical inactivity, hypertension, hyperlipidaemia and dietary habit; nine common modifiable risk factors are responsible for majority of CVD. Lifestyle changes, medical therapy or interventional procedures can result in substantial reduction of CVD.,,,,, The Organization for Cooperation and Development, and World Health Organization jointly developed a microsimulation/ chronic disease prevention model that implemented a so called causal web of lifestyle risk factors for chronic diseases . Childhood overweight and obesity are evolving as major nutritional problem in the developing countries, affecting a substantial number of adults and resulting in an increased burden of chronic disease.,Outcomes related to childhood obesity include hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy and other problems. Hypertension during childhood is an established predictor of adult blood pressure increasing mortality from CVD that need primordial prevention. Studies on urban Indian schoolchildren reported high prevalence of obese and overweight children. Pediatric weight problems are increasing in frequency and they are usually undiagnosed due to faulty mindset. However, till date we have no nationally representative data. During childhood and adolescent individual choice of lifestyles develops leading to risk factors like atherosclerosis, hypertension, high body mass index related with CVD. The objective of this study was to find out the prevalence of lifestyle associated cardiovascular risk factors among the adolescent students of Bankura district, West Bengal with the risk correlates across gender and schools.
| Methods|| |
A cross sectional descriptive study was conducted among adolescent students of higher secondary schools in Bankura-I block from April 2011 to January 2012. In absence of study in eastern India on prevalence of cardiovascular risk factors among adolescents, 17.64 percent prevalence of overweight/obesity in Singh et al study in Delhi was taken for calculation of sample size, considering 95 percent confidence level and 20 percent relative precision, the final sample size becomes 450.29 Among eight higher secondary schools in Bankura-I block, 50 percent of schools i.e. four schools were selected through stratified random sampling, two were government aided schools and two were private schools.
Census populations of class IX-XII present on the day of data collection in the selected schools were included in the study; total sample size was 452 with a response rate of 90 percent. The main outcome measures were prevalence of cardiovascular diseases and their risk correlates viz. dietary practices, physical inactivity, overweight, obesity, hypertension and smoking.
The data collection tool used for the study was an interview schedule that was developed at the Institute with the assistance from the faculty members and statistician. A predesigned, pretested, semi-structured questionnaire was used to collect the data relating to the dietary practices, physical activities, record of height, weight and BP. By initial translation, back-translation, retranslation followed by pilot study the module was custom-made for the study. The pilot study was carried out at the out patients department among comparable subjects following which some of the questions from the interview schedule were modified.
Ethical clearance was obtained from Institutional Ethics Committee and requisite permission was obtained from the schools. All concerned principals, teachers, and members of parents associations were explained about the objectives of the study and were assured of confidentiality of data that will be used only for research purposes. All the participants were explained about the purpose of the study along with the scope of future intervention, if necessary and informed assent was obtained from each of the participants or informed consent from their caregivers.
Dietary practices was assessed by using semiquantitative food frequency questionnaire and the average amount and frequency of consumption of obesogenic (like fast food, cold drinks, ice cream, sweets, ghee, butter, red meat) and protective foods for cardiovascular diseases (fruits and vegetables) in last week. Whether consumption was three servings or more per week or not was calculated by using this questionnaire.
Physical activity-Those students were engaged in running, fast walking, cycling, biking, and dancing, playing football for at least 60 minutes/day on 5 or more days per week are defined as physically active. Those who failed to fulfill the following criteria are considered as insufficiently physically active. 
Smoking- Smoker is defined by any history of single puff of smoking by the participant in the last 30days. 
Data regarding weight and height measurement and BP check-up were recorded by investigators during visit to schools. Study subjects were called for screening according to their classes and were given rest for 5 min. The procedures were explained briefly and demonstrated to them. Anthropometric measurements were done in standing posture. A calibrated and standardized mechanical weighing scale was used to measure weight with a precision of 0.1 kg. Height was measured by a WHO approved wall-mounted height measuring scale with a precision of 0.1 cm,
According to these two measurements, BMI was calculated. Overweight and obesity were defined by body mass index (BMI) for gender and age. Z scores were determined for Body mass index (BMI) Using WHO anthrop plus software. Overweight and obesity were defined when the adolescents have the z scores for BMI more than or equal to 1 and 2 respectively.
Blood pressure was measured by mercury sphygmomanometer. Participant took at least 5 minutes rest before measurement. Reading was taken in sitting posture and on the right hand of the participants. Three readings of the BP of each child were taken, maintaining an interval of 2 min between each reading. The mean of three readings was reported.
Gender, age and height were considered for determining hypertension. BP was measured using standard methodology as recommended by The Fourth Report on the diagnosis, evaluation, and treatment of high BP in children and adolescents. 
Hypertension in children and adolescents:
Hypertension is defined as average systolic and/or diastolic BP that is 95 th percentile for gender, age, and height on three or more occasion ,and / or history of hypertension or taking any antihypertensive drugs,
In case of students aged 18 years or above, Hypertension will be defined when the systolic blood pressure will be more than 140 mm of Hg and/ or diastolic blood pressure will be more than 90 mm of Hg and/ or those individual currently taking antihypertensive drugs.
The principal investigator disseminated information on importance on BMI, hypertension in health education sessions among the students to complement the findings of the study.
Statistical analysis: The collected data were thoroughly screened and entered into Excel spreadsheets and analysis was carried out. The procedures involved were transcription, preliminary data inspection, content analysis, and interpretation. SPSS 11.0 was used to calculate proportions, and significance test was used in this study. Proportion of different risk factors between male and female, Govt. aided and private schools was compared by Z test.
| Results|| |
Of the 452 participants, 247 (54.64 %) were male and 205 (45.36%) were female.[Table 1]
Hypertension was present in 12.61percent students (male 16.59%, female 7.80%); difference among gender was significant (p= 0.0008); in private schools it was significantly higher (19.27%) compared to Government aided schools (7.69%) (p=0.00025). Overweight was present in 7.74 percent students (male 8.90%, female 6.34% with no significant difference among genders); in private schools it was significantly higher (15.62%) than Government aided schools (1.92%) (p=0.00000189). Obesity was in 3.98 percent with insignificant gender disparity (p= 1.00); in private schools significantly higher (p=0.00000162). Insufficient physically activity was among 15.70 percent [female 23.41% and male 9.31%; gender difference was significant (p - 0.0000071)]; in private schools significantly higher (p= 0.0003). Among participants 1.32 percent were smokers; only males (2.42%) and from private schools (3.12 %). [Table 2]
|Table 2: Distribution of risk factors among male and female school children|
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Mean systolic blood pressure was 112.08 ±13.51 mm Hg (male 115.17 ±12.09, female 108.35 ± 14.23); gender difference was significant (t=6.20); in private schools significantly higher (118.72 ±10.80) than Government aided schools (107.17 ± 13.24) (t=4.98). Mean diastolic blood pressure was 72.49 ± 8.51 mm Hg (male 73.81 ± 8.21, female 70.90 ±8.50) with significant difference (t=0.0002); in private schools insignificantly higher.[Table 3]
|Table 3: Distribution of mean systolic and diastolic blood pressure among school children|
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Obesogenic foods consumed three servings or more per week and at least three days per week were fast foods (55.53%), sweets (44.46%), ghee and butter (22.56 %). Similar amount of protective foods consumed were fruits (57.74%) and vegetables (84.29%). In both sexes, predominant obesogenic foods were fast foods, sweets, ghee and butter while comparative figures on protective foods were fruits and vegetables with no significant gender difference.[Table 4]
| Discussion|| |
We conducted a cross sectional descriptive study to find out the prevalence of lifestyle associated cardiovascular risk factors among the adolescent students of Bankura district, West Bengal and the risk correlates.
In the present study, 12.61 percent students were hypertensive, male (16.59%) were more than female (7.80%) among private students it was present 19.27 percent and Government aided school student (7.69%). Study conducted by Singh et al in a New Delhi of 510 students overall 10.00 percent was hypertensive, (male 279, female 231) aged 12to 18 years showed that prevalence of hypertension 15.41 percent in male and 3.46 percent in female, followed the male dominance of hypertension in adolescent age groups·  A study conducted by Chakraborty P et al, in four urban Schools of Kolkata with 979 students of 5-18 years age groups showed childhood hypertension prevalence of 1.53 percent. 
In the present study Overweight was present in 7.74 percent students among them more in male students (8.90 %); among private school students 15.62 percent. Obesity was present 3.98 percent; among private school students 8.85 percent. Overall overweight or obesity was 11.72 percent in the present study. Prevalence of overweight or obesity in Singh et al  study was 18.6 percent male and 16.5 percent female corroborated with present study findings. Childhood obesity showed a prevalence of 2.25 per 100 children. On the whole, prevalence of overweight and obesity was 20.74%. 
The study done in Ernakulum district, Kerala observed that the proportion of overweight children increased from 4.94 percent of the total students in 2003 to 6.57 percent in 2005. The increase was significant in both boys and girls. The proportion of overweight children was significantly higher in urban regions and in private schools with rising trend limited to private schools’ 
The prevalence values of childhood obesity in this study were lower than those of other studies from similar settings. ,,,, Benson et al undertook a study to assess trends in diagnosis rates of overweight and obesity in children aged 2 through 18 years between June 1999 and October 2007 in a large academic medical system in northeast Ohio. On retrospective review of BMI measurements recorded for patients during the study period, 19 percent of the children were overweight, 23 percent were obese, and 8 percent (33% of the obese patients) were severely obese; among these, 10 percent of overweight patients, 54 percent of obese patients, and 76 percent of severely obese patients had their conditions diagnosed.
Benson et al  also found that 90 percent of overweight children, 46 percent of obese children and 24 percent of severely obese children remained undiagnosed. These data highlight the need to improve the diagnosis of weight problems in children and adolescents, especially overweight children, who could benefit most from potential interventions. 
Morales-roan et al created a logistic regression model to estimate the relationship of overweight and obesity to various factors including screen time, physical activity etc. among Mexican adolescents. 
In the present study, 15.70 percent students are insufficiently physically active. More than one-fifth of females (23.41%) and 9.31 percent male were insufficiently physically active. It is present among 21.87 percent private school students. Singh et al 18.3 percent boys and 22.2 percent girls were not physically active. Global School Health Survey, 2007 showed that in Trinidad overall 19.5 percent students were physically active of them male were 25.3 percent and female 13.8 percent, the above two studies corroborated with the present study findings.,
Reilly et al examined risk factors for obesity at 7 years of age in a subsample of 909 UK children from the Avon longitudinal study of parents and children. A junk-food dietary pattern at 3 years of age was associated with obesity at 7 years of age in an unadjusted model. A junk food dietary pattern was characterized by increased levels of fizzy drinks, sweets, chocolates, chips, fried foods and other junk foods. There was no significant relationship with obesity for a healthy, traditional, or fussy dietary pattern. Height and weight were measured by the research team’ 
In the present study only 1.32 percent were smokers, present in male student, 3.12 percent private students were smoker. In Singh et al study 3.6 percent boys and 1.3 percent girls were smoker.
Yusuf S et alshowed that Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity account for most of the risk of myocardial infarction worldwide in both sexes and at all ages in all regions. Muller- Rimenscheinder et al. showed that prevalence of cardio vascular risk factors is increasing rapidly across age group from 11 to 17 years. In late adolescence, the majority of boys and girls were exposed to one or more cardiovascular risk factors
In the present study, in male students mean systolic blood pressure is 115.17 ±12.09 mm Hg. Among female students mean systolic blood pressure is 108.35 ± 14.23 mm Hg. Among male students, mean diastolic blood pressure is 73.81 ± 8.21 mm Hg. Among female students, mean diastolic blood pressure is 70.90 ±8.50 mm Hg. Among private school students, mean systolic blood pressure is 118.72 ±10.80 mm Hg. Among govt. aided school students, mean systolic blood pressure is 107.17 ± 13.24 mm Hg. Among private school students, mean diastolic blood pressure is 73.38 ± 9.28 mm Hg. Among govt. aided school students, mean diastolic blood pressure is 71.84 ± 7.86 mm Hg. Blood pressure was more in male student and private school student. Study by Singh et al  that systolic Blood pressure of male student were 121.9 ± 13.81 and female 111.84±12.95 and diastolic blood pressure were 70.42±9.43 and in case of female 68.17 ±8.58, systolic blood pressure slightly higher than the present study and diastolic Blood pressure slightly lower than the present study. Lauer et al  that childhood blood pressure was having a positive correlation with adult blood pressure.
In the present study, consumption of obesogenic foods three servings or more per week and at least three days per week were fast food (55.53%), ghee and butter (22.56%), red meat (6.41%) , cold drinks (3.09%), ice cream (4.86%). Among male , consumption of obesogenic foods three servings or more per week and at least three days per week were fast food (54.3 %), red meat (6.5%), cold drinks (3.6 %), ice cream (5.3 %). Among female, consumption of obesogenic foods three servings or more per week and at least three days per week were fast food (57.1 %), red meat (6.3%), cold drinks (2.4 %), ice cream (4.4 %). Consumption of protective foods three servings or more per week and at least three days per week were fruits (57.74%) and vegetables (84.29%). Among males prevalence of consumption of protective foods = 3 servings / week and at least 3 days in a week were fruits (56.7 %) and vegetables (87.4%). Among female, prevalence of consumption of protective foods three servings or more per week and at least three days per week were fruits (59%) and vegetables (80.5 %). Singh et al.  noted that 34.40 percent male and 29.40 percent female student were consuming fast foods more than 3 times in week less than present study. Overall consumption of fruits was 39.40 percent which was less than the present study.
Strengths of the study: We attempted to find out the cardiovascular risk factors among adolescent school students. To the horizon of our knowledge, no related publication on adolescent lifestyle has been reported so far from Bankura district of West Bengal, India.
Limitations of the study: We have pursued the study in the resource poor infrastructure of a state Government run medical college in eastern part of India with limited sample population.
Future directions of the study:
In next phase of study we wish to work with robust sample and hope to include children and adolescents school drop outs also.
| Conclusion|| |
Data from representative sample of adolescent students indicated that prevalence of cardiovascular risk factors were present in significant proportion. Prevalence of hypertension, physical inactivity, combined overweight or obesity was present with significant difference in proportion of risk factors between male and female, private and government aided schools that need to be addressed.
Financial Support - Fund for study supported by IAPSM, West Bangal Chapter Conflict of interest - Nil
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[Table 1], [Table 2], [Table 3], [Table 4]