Cardio-Pulmonary Symptoms Associated With Metabolic Syndrome Among Sub-Sahara Black African Adolescents – Nigerians: A Follow-Up Study.
Bamgboye M. Afolabi
Department of Biochemistry and Nutrition, Nigerian institute of Medical Research, Yaba, Lagos.
Susan J. Holdbrooke
Health, Environment and Development Foundation, Surulere, Lagos, Nigeria
Mercy T. Sanni
AfriHealth Optonet Association, Abuja, Nigeria
Keywords: Cardio-pulmonary symptoms, Metabolic syndrome, Diabetes, Adolescents, Sub-Sahara Africa
Abstract
Background: Cardiopulmonary symptoms (CPS) may possibly reinforce the effect of metabolic syndrome (MetS) or vice versa. However, there is scanty data on the possible association between MetS and symptoms such as easy fatigability, chest pain, shortness of breath and heart disease among Black adolescents in sub-Sahara Africa
Objective: Metabolic syndrome is recognized as a cluster of three of five risk factors including obesity, hypertension, abnormally high levels of triglyceride (TG), dyslipidemia (abnormally high concentrations of total cholesterol (TC), low-density lipoprotein (LDL) and an abnormally low level of high-density lipoprotein (HDL) and hyperglycemia. Its association with cardio-pulmonary symptoms is not well documented. There is dearth of scientific data focusing on MetS and its association with cardio-pulmonary symptoms among adolescents in sub-Saharan populations. This study, therefore, aimed at determining the prevalence and possible association of MetS and CPS among Black adolescents living in Lagos, Nigeria
Research design and methods: Six hundred and thirteen Secondary school students (age range: 10–19 years, both sexes) were recruited into this cross-sectional study, epidemiological. In addition to questionnaires which included cardio-pulmonary symptoms that were administered, anthropometric measurements (weight in kilograms, height, and waist circumferences in centimeters) were measured for each student. Fasting venous blood was aseptically collected and preserved for lipid profile and blood glucose assessments. Systolic and diastolic blood pressures were taken. MetS was assessed using appropriate diagnostic criteria for adolescents. NCSS 22 software was used for data analysis. Results: A total of 613 Secondary School students aged between 10 and 19 years (mean (±sd) age:14.7 (2.1) yrs. were included. The BMI (Kg/m2) of girls was significantly higher (t-test=-2.22, P-value=0.03) than that of boys. Though overweigh/obese students were significantly younger (t-test=4.02, P-value=0.0002), their systolic blood pressure was significantly higher (t-test=-3.32, P-value=0.002) than that of lean subjects. Girl’s waist circumference status (χ²=7.13, P-value=0.008) and high systolic blood pressure (χ²=8.00, P-value=0.005) were significantly higher among girls than among boys. Height (cm) (t-test = -2.03, P-value =0.047), weight (kg) t-test = -3.78, P-value = 0.0004), BMI (kg/m2) (t-test = -3.51, P-value = 0.0008), BMI-for-age percentile (t-test=-4.37, P-value = 0.00005) and waist circumference (t-test = -3.45, P-value = 0.001) were significantly higher in those with, than those without MetS. Pearson’s correlation coefficient only shows strong association with MetS among study subjects with shortness of breath (r = 0.12, t = 3.01, P-value = 0.003, 95% CI: -0.04, 0.20). Girls who were easily fatigued were 1.27 times more likely to have MetS, whereas girls with chest pain (OR= 0.83, 95% CI=0.31, 2.19), shortness of breath (OR= 0.33, 95% CI=0.09, 1.15). The mean SBP of study participants with MetS who were easy fatigued was significantly higher (t-test=-2.51, P-value=0.02) than that of participants without MetS.
Conclusion: The study agrees that preventing the escalating burden of blood lipid and glucose abnormalities among Nigerian secondary school students is essential. Shortness of breath, which may be a precursor of hypertension, diabetes, and coronary heart disease, was significantly associated with MetS. Therefore, governments at Federal and State levels should consider appropriate interventions to curtail these early onset morbidities among adolescents. Clinicians should also be aware of them.
References
Al-Zahrani J, Shubair MM, Al-Ghamdi S, Alrasheed AA, Alduraywish AA, Alreshidi FS, et al. The prevalence of hypercholesterolemia and associated risk factors in Al-Kharj population, Saudi Arabia: a cross-sectional survey. BMC Cardiovasc Disord. 2021;21(1):1–8.
Daka IR, Amaewhule MN, Wekhe C. The Prevalence of Dyslipidemia in the Niger Delta Region of Southern Nigeria. Greener Journal of Medical Sciences, 2021;11(2):159-171.
Akintunde AA, Ayodele OE, Akinwusi PO, Opadijo GO. Metabolic syndrome: Comparison of occurrence using three definitions in hypertensive patients. Clin Med Res 2011;9:26-31.
Bruno G, Merletti F, Biggeri A, Bargero G, Ferrero S, Runzo C. Metabolic syndrome as a predictor of all-cause and cardiovascular mortality in type 2 diabetes: The Casale Monferrato study. Diabetes Care 2004;27:2689-94.
Ogbera A. Prevalence and gender distribution of the metabolic syndrome. Diabetol Metab Syndrome 2010;2:1.
Isezuo SA, Ezunu E. Demographic and clinical correlates of metabolic syndrome in native African type 2 diabetic patients. J Natl Med Assoc 2005;97:557-63.
Fezeu L, Balkau B Kengne A, Sobngwi E, Mbanya JC. Metabolic syndrome in a Sub-Saharan African setting: Central obesity may be the key determinant. Atherosclerosis 2007;193:70-6.
Vorster HH. The emergence of cardiovascular disease during urbanization of Africans. Public Health Nutr 2002;5:239-43.
Al-Zahrani J, Shubair MM, Al-Ghamdi S, Alrasheed AA, Alduraywish AA, Alreshidi FS, et al. The prevalence of hypercholesterolemia and associated risk factors in Al-Kharj population, Saudi Arabia: a cross-sectional survey. BMC Cardiovasc Disord. 2021 Dec 1;21(1).
Basulaiman M, El Bcheraoui C, Tufaha M, Robinson M, Daoud F, Jaber S, et al. Hypercholesterolemia and its associated risk factors-Kingdom of Saudi Arabia, 2013. Ann Epidemiol. 2014;24(11):801–8.
Taher Al-Hassan Y, Fabella EL. Lipid profile analysis of patients in a Saudi University clinic. http://www.sciencepublishinggroup.com [Internet]. 2017 [cited 2023 December 23];2(3):89. Available from: http://www.sciencepub lishinggroup.com/j/wjph
Xi B, Zong X, Kelishadi R, Litwin M, Hong YM, Poh BK, et al. International waist circumference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years. J Clin Endocrinol Metab. 2020;105(4):e1569.
Okafor CI. The metabolic syndrome in Africa: Current trends. Indian Journal of Endocrinology and Metabolism, 2012;16(1):56-66.
Mottillo S, Filion KB, Genest J, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113–1132.
Esser N, Legrand-Poels S, Piette J, Scheen AJ, Paquot N. Inflammation as a link between obesity, metabolic syndrome, and type 2 diabetes. Diabetes Res Clin Pract. 2014;105(2):141–150.
Gurka MJ, Lilly CL, Oliver MN, DeBoer MD. An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: a confirmatory factor analysis and a resulting continuous severity score. Metabolism. 2014;63(2):218–225.
Bonomini F, Rodella LF, Rezzani R. Metabolic syndrome, aging and involvement of oxidative stress. Aging Dis. 2015;6(2):109–120.
Weiss R, Bremer AA, Lustig RH. What is metabolic syndrome, and why are children getting it? Ann. N. Y. Acad. Sci. 2013, 1281: 123–140.
Nelson RA, Bremer AA. Insulin Resistance and Metabolic Syndrome in the Pediatric Population. Metab. Syndr. Relat. Disord. 2010; 8: 1–14.
Halpern A, Mancini MC, Magalhães MEC, Fisberg M, Radominski R et al. Metabolic syndrome, dyslipidemia, hypertension, and type 2 diabetes in youth: From diagnosis to treatment. Diabetol. Metab. Syndr. 2010, 2, 55–75.
Fleischman A, Rhodes ET. Management of obesity, insulin resistance and type 2 diabetes in children: Consensus and controversy. Diabetes Metab. Syndr. Obes. 2009, 2, 185–202.
Marott JL, Ingebrigtsen TS, Çolak Y, Kankaanranta H, Bakke PS, et al. Impact of the metabolic syndrome on cardiopulmonary morbidity and mortality in individuals with lung function impairment: a prospective cohort study of the Danish general population. Lancet Reg Health Eur. 2023, 6;35:100759.
Agustí A., Edwards L.D., Rennard S.I., et al. Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype. PLoS One. 2012;7
Jackson P., Siddharthan T. The global significance of PRISm: how data from low- and middle-income countries link physiology to inflammation. Eur Respir J. 2020;55.
Adcock CJ. Sample size determination: A Review Journal of the Royal Statistical Society, Series D. The Statistician 1997, 46 (2):261-283.
World Health Organization. AnthroPlus V1.04. WHO 2014
Gurka MJ, DeBoer MD, Filipp SL, Khan JZ, Rapczak TJ, Braun ND, Hanson K S, Barnes CP. MetS Calc: Metabolic Syndrome Severity Calculator. 2019., doi: 10.5281/zenodo.2542213.
NHLBI. Obesity Education Initiative. The practical guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Institute for Health, Bethseda MD, USA. (NIH Publication Number 004084), 2021. nhlbi.nih.gov.
Lande MB, Batisky DL. New American Academy of Pediatrics Hypertension Guideline, Hypertension 2019;73(1):31-32.
CDC. Healthy weight, Nutrition, and Physical activity. cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_children_bmi.html. Accessed on 10th November 2022.
WHO. Mean fasting blood glucose. www.who.int/data/gho/indicator-metadata-registry/imr-details/2380 (accessed on September 12, 2023).
Nordestgaard BG, Varbo A. Triglycerides and cardiovascular disease. Lancet 2014, 384: 626-635
Kesteloot H, Oviasu VO, Obasohan AO, Olomu A, Cobbaert C, Lissens W. Serum lipid and apoprotein levels in a Nigerian population sample. Atherosclerosis 1989;78:33-8
Onyemelukwe GC, Stafford WL. Serum lipids in Nigerians: The effect of diabetes mellitus. Trop Geogr Med 1981;33:323-8
Mangili L. High prevalence of dyslipidemia in children and adolescents: opportunity for prevention. Arq Bras Cardiol. 2020;114(1):57–8.
Dai S, Fulton JE, Harrist RB, Grunbaum JA, Stefen LM, Labarthe DR. Blood Lipids in Children: Age-Related Patterns and Association with Body-Fat Indices. Project HeartBeat! Am J Prev Med. 2009;37(1):56–64.
Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346(11):802–10.
Bulut T, Demirel F, Metin A. The prevalence of dyslipidemia and associated factors in children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab. 2017;30(2):181–7.
Grabia M, Markiewicz-Żukowska R. Nutritional status of pediatric patients with Type 1 diabetes mellitus from northeast Poland: a case-control study. Diabetes Ther. 2021;12(1):329–43