NASUI Bogdana Adriana1, RAJAB Mahmoud2, POP Anca Lucia3*, CIUCIUC Nina4
1Lecturer, Department of Community Health, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Louis Pasteur Street, No.6
2Graduated Student, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Louis Pasteur Street, No.6
3Lecturer, Clinical Laboratory –Food Safety, Carol Davila University of Medicine and Pharmacy, Bucharest,
4Assistant Professor, Community Health, University of Medicine and Pharmacy, Cluj-Napoca, Louis Pasteur Street, No.6
Corresponding author: ancapop@hotmail.com
Abstract
The metabolic syndrome is correlated with genetic, environmental, nutritional and physical activity factors. In order to analyze the physical activity, nutritional and anthropometric parameters of the patients already admitted in the cardio-vascular clinic for various cardiological diseases, we conducted a cross-sectional study on a group of 100 hospitalized patients in “Niculae Stancioiu” Heart Institute during July – October 2019, 50% of them were males and 50% were females, aged between 21-91years, mostly from urban area. To investigate the risk factors among the studied sample we used a valid lifestyle questionnaire estimated the physical activity performed by the patient, the weight and height , the waist circumference (WC), the lipid profile were performed in order to correlate the metabolic syndrome aspects and the levels of physical activity. A large subgroup (41%) of patients were obese (BMI > 30 kg/m2) (58,5% men and 41,4% woman) of respectively 34% of obese women from the total women subgroup and 48% obese males. 22,7% of patients had uncontrolled high blood pressure (stage I) and 11,4% normal high blood pressure – under hospitalization conditions. 18% had high cholesterol levels and 19% high LDL levels – of which 6% respectively 9% very high levels (considering cutoffs of >240 mg/dl in cholesterol and >160 mg/dl for LDL) with decreased HDL levels in 11,25% of patients. From the studied sample, more than 85% of patients didn’t fulfilled the minimal physical activity requirements for 5 days with 30 minutes highlighting again the need for a nutritional and physical training backup as mandatory for the cardio-metabolic patients in order to complementary support the medical cardio-metabolic therapy.
Introduction
As all over the developed countries during last 10 years, according to WHO statistic, in Europe and Romania most deaths are caused by cardiovascular diseases, second most by oncological diseases and third most by digestive diseases. Last developments suggest a genetic involvement in the chronic cardio-metabolic diseases, nevertheless we should target the modifiable risk factors. Non communicable diseases (NCDs) threaten is enlisted on WHO 2030 Agenda for Sustainable Development WHO targets the decrease of premature deaths generated by NCDs by one-third by 2030. The metabolic risk factors contribute generate four high mortality diseases: (1) raised blood pressure generating cardio-vascular mortality (cerebral, coronary pulmonary, renal and peripheral arterial accidents) (2) overweight/obesity generating insulin resistance and hepatic consequences (among the most known) (3) hyperlipidemia generating atheromathosis and (4) hyperglycemia with insulin resistance and diabetes [1]. Detecting, screening and treating these diseases is critical to accomplish the WHO objectives by a integrate approach: including health, education, agriculture, finance – targeted to the modifiable factors that are on the core of the NCD’s: tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol [2, 3].). In Romania 46,4% of the adult population is overweight, while the rate of obese people is 19,4% [4]. More than that, the obesity is a increased risk factor in viral exposure as the COVID-19 [5, 6, 7]
The overweight and obesity, and the related no communicable diseases are largely preventable but despite the public health measures and enormous actual level of knowledge no palpable results has arisen. So, continuous surveillance and nutrition intervention should be targeted to focus on premorbid characteristics, namely obesity [8] of certain populations to tackle the most influent and preventable risk factor of NCD [9, 10, 11]. Waist circumference (WC) is used to define central obesity. Central obesity is associated with clustering of cardiovascular risk factors. People with central obesity are known to be at higher risk of developing hypertension, diabetes, dyslipidaemia, stroke, cancer and metabolic syndrome (MS). To investigate the risk factors among the studied sample we used a valid lifestyle questionnaire estimated the physical activity performed by the patient Weight and height Waist circumference (WC), the lipid profile were performed in order to correlate the metabolic syndrome aspects and the levels of physical activity.
Materials and Methods
We conducted a cross-sectional study during July – October 2019 on a group of 100 hospitalized patients in “Niculae Stancioiu” Heart Institute, 50% of them were males and 50% were females, aged between 21-91years. We obtained the permission from the Institute management to perform this study. We selected 100 patients. The patients were informed that the participation was voluntary and confidential. The duration to complete a questionnaire was 15-20 minutes. The informed consent was given by the participants in the study. To investigate the risk factors among the studied sample we used a valid lifestyle questionnaire administered by interview. The questionnaire estimated the physical activity performed by the patient asking ” how frequent do you perform a moderate physical activity at least 30 minutes as a duration” using the items: 5-7 times per week, 4 times per week, 2-3 times per week and less than once per week. Definition of moderate physical activity was given in the questionnaire.
Weight and height were self-reported in the questionnaire. Waist circumference (WC) was measured in cm by standard methods using a tape measure. WC was measured in the horizontal plane midway between lowest rib and the iliac crest, to the end of a normal expiration. Before recording the measurement, we would ensure that the tape was snug but did not compress the skin and was parallel to the floor.
The BMI was calculated with the formula BMI=Weight/ Height 2 (kg/m2). We stratified the sample by the category of adult BMI recommended cut points by World Health Organization (WHO): underweight<18.5 kg/m2, normal weight=18.5-24.9 kg/m2, overweight > 25 kg/m2 and obese>30 kg/m2. We stratified the females sample depending on WC, patients with WC>88cm and those with WC<88cm. Also we divided the males sample according to the waist circumference patients with WC>102cm and those with WC<102 cm. Blood cholesterol, LDL, HDL values were taken from the medical records for each patient.
The statistical analysis was performed with the IBM Statistical Package for Social Sciences (SPSS) version 20 and with application Excel (from the package Microsoft Office 2010) using descriptive analyses. The χ2 test was used to assess differences in data. We considered statistically significant the results with p<0.05.
Results
The mean age of the selected sample was sample 61.19 ±13.61 years. Females – mean age 63.12 ±13.68 years , males mean age 59.26±13.39 years (p=0.157). 56% urban si 44 % rural
Figure no. 4 Distribution of the sample depending of the BMI Categories.
The abdominal (waist) circumference (WC) in the studied group was over the cutoff level in 34% men and 37% women.
Table II Mean waist circumference depending on BMI categories by gender
| BMI Categories | Mean of WC (cm) –Males | No. Males | Mean of AC (cm) Females | No Females |
| Underweight | – | 0 | 77.00 | 2 |
| Normal weight | 96.50 | 6 | 84.76 | 13 |
| Overweight | 101.11 | 20 | 98.83 | 18 |
| Obese | 116.29 | 24 | 113.71 | 17 |
| Total | 107.98 | 50 | 99.36 | 50 |
Table III Distribution of the males patients depending on BMI and WC
| BMI Categories | Males (n) | WC>102 cm | WC<102 cm | p |
| Underweight | 0 | 0 | 0 | .000 |
| Normal weight | 6 | 2 | 4 | .000 |
| Overweight | 20 | 9 | 11 | .000 |
| Obese | 24 | 23 | 1 | .000 |
Table IV Distribution of the females patients depending on BMI and WC
| BMI Categories | Females (n) | WC>88 cm | WC<88 cm | p |
| Underweight | 2 | 0 | 2 | .000 |
| Normal weight | 13 | 4 | 9 | .000 |
| Overweight | 18 | 17 | 1 | .000 |
| Obese | 17 | 16 | 1 | .000 |
Figure no. 5 Cholesterol and LDL levels in the studied group
Considering the correlation of the comorbid factors in the metabolic syndrome we evaluated the blood pressure levels in the studied group (Table VI). 22,7% of the patients had high blood pressures during the study period.
Conclusions
In the present study we conducted a cross-sectional study on a group of 100 admitted in the “Niculae Stancioiu” Heart Institute during a four month period in 2019, 50% of them were males and 50% were females aged between 21-91years old mostly from urban area, mostly highschool graduates. We used a validated lifestyle questionnaire estimating the physical activity performed by the patient during the usual way of life; anthropometric values and paraclinical parameters – the lipid profile. A large subgroup (41%) of patients were obese (BMI > 30 kg/m2) (58,5% men and 41,4% woman) of respectively 34% of obese women from the total women subgroup and 48% obese males. 22,7% of patients had uncontrolled high blood pressure (stage I) and 11,4% normal high blood pressure – under hospitalization conditions. 18% had high cholesterol levels and 19% high LDL levels – of which 6% respectively 9% very high levels (considering cutoffs of >240 mg/dl in cholesterol and >160 mg/dl for LDL) with decreased HDL levels in 11,25% of patients. From the studied sample, more than 85% of patients didn’t fulfilled the minimal physical activity requirements for 5 days with 30 minutes highlighting again the need for a nutritional and physical training backup as mandatory for the cardio-metabolic patients in order to complementary support the medical cardio-metabolic therapy.
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