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High prevalence of obesity among nursing personnel working in tertiary care hospital
G Model DSX 897 No. of Pages 4
Diabetes & Metabolic Syndrome: Clinical Research & Reviews xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsx
Original Article
High prevalence of obesity among nursing personnel working in tertiary care hospital M. Aslam, A.A Siddiqui, G. Sandeep, S.V. Madhu* Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
A R T I C L E I N F O
A B S T R A C T
Article history: Available online xxx
Aim: To find out the prevalence of obesity and glucose intolerance among nurses working in tertiary care hospital. Methods: Study was conducted in 496 apparently healthy females comprising two groups. Group B had 290 nurses and control group A had 206 age matched female subjects of general population. Detailed performa was filled which included anthropometry, systemic examination and other details. Fasting plasma glucose was done followed by oral glucose tolerance test (OGTT). Subjects with body mass index 23 kg/m2 were categorized as ‘overweight’ and 25 kg/m2 as ‘obese’ as per criteria for Asian Indians. Women with waist circumference of 80 cm were categorized as ‘centrally obese’. Results: Mean age of subjects in groups A and B was 40.45 8.64 years and 40.50 6.96 years respectively. Significantly higher number of nurses (80%) were overweight or obese compared to controls (59.71%,P = < .001). Similarly, central obesity was significantly higher in nurses (82.07%) compared to controls (67.96%,P = <.001). The prevalence of glucose intolerance (prediabetes and newly detected diabetes) was significantly higher in controls compared to nurses (45.63% vs 29.66%, P < .001). Conclusion: Every four out of five nurses working in tertiary care hospital have overweight/obesity and central obesity. Despite this they have lower rates of glucose intolerance. © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Keywords: Central obesity Nurse Obesity Prevalence
1. Introduction Obesity is one of the most common, yet among the most neglected, public health problem across the world. The incidence of overweight and obesity has increased globally over the past three decades [1] and around 700 million people in the world are obese [1]. According to world health organization data, nearly 2.8 million individuals die each year due to overweight or obesity [2]. Further, it has also been reported that mortality rate increases by twelve fold in obese persons when compared to persons of normal weight [3]. Studies have also shown that individuals with higher body mass index, a measure of obesity, are at increased risk of developing morbidities associated with obesity [4–7]. The etiology of obesity is
Abbreviations: BMI, body mass index; FH, family history; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; NGT, normal glucose tolerance; NDDM, newly detected diabetes mellitus; OGTT, oral glucose tolerance test. * Corresponding author at: Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Dilshad Garden, Delhi-110095, India. E-mail address: [email protected] (S.V. Madhu).
multi-factorial. Obesity can be an outcome of genetic defects, unhealthy diet pattern, sedentary life style, medication, hormonal imbalance, infection, odd and prolonged working hours and stress. Higher prevalence of obesity has been particularly reported from urban areas where several of these factors i.e., unhealthy diet pattern, sedentary life style, odd and prolonged working hours and stress are common and therefore urban population is at increased risk of developing obesity and obesity associated diseases like diabetes [7], hypertension [5], dyslipidemia [6,8] cardiovascular disease [6,8] and even some cancers [4,9]. Healthcare professionals particularly nurses are also at increased risk of developing obesity and associated diseases as they are exposed to odd and prolonged working hours, work stress, infection, unhealthy diet pattern. Despite the increased risk of obesity and associated disorders in nurses, very few studies have been carried out in this area. However, most of these studies have reported higher prevalence of obesity and metabolic syndrome in nurses [10–16]. The prevalence of obesity in these studies varied from 40% to 81% whereas no such study has been carried out from India. The present study was therefore carried out to find out the prevalence of overweight, obesity, central obesity and glucose
https://doi.org/10.1016/j.dsx.2017.12.014 1871-4021/© 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: M. Aslam, et al., High prevalence of obesity among nursing personnel working in tertiary care hospital, Diab Met Syndr: Clin Res Rev (2017), https://doi.org/10.1016/j.dsx.2017.12.014
G Model DSX 897 No. of Pages 4
2
M. Aslam et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews xxx (2017) xxx–xxx
intolerance among nursing personnel working in a tertiary care hospital and to compare them with women of control group.
done on SPSS 20.0. Data was considered significantly different if P value was <.05.
2. Subjects
4. Results
The present cross sectional study was conducted in 496 apparently healthy female subjects in the age group of 20–60 years comprising two groups. Group B consisted of 290 female nursing professionals working in a tertiary care hospital of Delhi and control group A had 206 age matched female subjects of general population from the same geographical area. The study was approved by Institutional Ethics Committee-Human Research, University College of Medical Sciences and GTB Hospital, Delhi, India. The study was carried out as per the guidelines of the institutional ethics committee.
The mean age of subjects in groups A and B was 40.45 8.64 and 40.50 6.96 years respectively. Body mass index (BMI) was found to be significantly higher in group B subjects (nurses) compared to subjects of control group A (Table 1). Significantly higher percentage of nurses were found to be overweight or obese (BMI 23 kg/m2) in group B compared to control group A (Fig. 1). Obesity (BMI 25 kg/m2) alone was also found to be significantly higher in nurses compared to controls (Fig. 1). Also, central obesity (waist circumference 80 cm) was found to be significantly higher in nurses compared to controls (Fig. 1). Data was sub-analyzed further by excluding subjects with ‘positive’ family history of diabetes from both study groups, the prevalence of overweight plus obesity and central obesity was also found to be significantly higher in nurses compared to controls (Fig. 1). Mean systolic and diastolic blood pressure and pulse rate were found to be comparable between both the groups (Table 1). Significantly higher percentage of nurses had positive family history of diabetes and family income compared to controls (Table 1). Eighty seven percent of the women from general population were housewives. Prevalence of glucose intolerance (impaired fasting glucose, impaired glucose tolerance and newly detected diabetes mellitus) was found to be significantly higher in controls compared to nurses (45.63% vs 29.66%, P < 0.001). Percentage of subjects with prediabetes (IGT IFG) and newly detected diabetes mellitus was also found to be significantly higher in controls compared to nurses (34.47% vs 24.14%, P = 0.01 and 11.17% vs 5.52%, P = 0.03 respectively). There was no significant difference in fasting insulin, total cholesterol, triglyceride, HDLc, LDLc or VLDLc between the two groups (Table 2).
3. Materials and methods Pregnant or lactating women, alcoholics, smokers, known case of diabetes, those with history of any chronic illness and those taking any type of medications which could affect glucose or lipid metabolism were excluded from the study. A written informed consent was obtained from all the study subjects. Detailed instructions were given to all the subjects who were asked to come on a prefixed day at 9 am after a minimum of 8 h fasting for oral glucose tolerance tests (OGTTs). On the scheduled day, body weight was recorded in fasting state using digital electronic weighing machine. A detailed performa was filled which included anthropometry, systemic examination and other details and fasting blood sample was drawn for fasting plasma glucose. After fasting blood sampling, 75 gm anhydrous glucose was given and blood sample was drawn again for 2 h postprandial plasma glucose. Also, lipid profile and fasting serum insulin were done in some of the subjects in each group. Subjects who had body mass index (BMI) 23 kg/m2 were categorized as ‘overweight’ and 25 kg/m2 as ‘obese’ as per obesity criteria for Asian Indians. Women with waist circumference of 80 cm were categorized as ‘centrally obese’. On the basis of OGTT, subjects were classified as normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and newly detected diabetes mellitus (NDDM) based on American Diabetes Association criteria. Plasma glucose was estimated by glucose oxidase-peroxidase methods (Accures kit, Accurex Biomedicals, India). Serum total cholesterol and triglyceride were estimated by commercially available kits (Merck-Labkit, Spain). The HDL was estimated by direct method (Accurex Biomedicals, India). Very low density lipoprotein (VLDL) and LDL were calculated as follows; VLDL = [TG/ 5] and LDL = [CHL (HDL + VLDL)]. Statistical Analysis: Unpaired t-test was used to compare continuous variables between the two groups. Binomial variables were compared by chi-square test. All the statistical analysis was
5. Discussion The present study found obesity and central obesity in four out of every five nurses working in a tertiary care hospital. This was significantly higher than in age matched women in the control group in which obesity was seen in three out of every five and central obesity in two thirds of them. However, glucose intolerance was observed in a significantly lower percentage of nurses compared to controls. Our study confirms the findings of several earlier studies from different parts of the world outside India which have reported a higher prevalence of obesity in nurses ranging from forty percent to eighty one percent [10–16]. However, most of these studies have reported lower prevalence of obesity compared to present study. These studies have reported prevalence of overweight/obesity varying from forty percent from Iran [12], forty three percent from
Table 1 Anthropometry, hemodynamic and demographic data of study subjects. Variable
Group A
Group B
P-value
Age (years) BMI (kg/m2) SBP (mmHg) DBP (mmHg) Pulse (BPM) Positive Family history of diabetes (%) Family income (INR/year)
40.45 8.64 24.77 5.37 127.30 12.00 79.57 6.24 80.40 7.45 24.01 64155 62205
40.50 6.96 26.40 3.82 126.10 12.50 80.64 6.88 79.88 7.32 36.93 302185 114140
P = .93 P < .001 P = .28 P = .07 P = .43 P < .001 P < .001
n = 206 for group A and n = 290 for group B.
Please cite this article in press as: M. Aslam, et al., High prevalence of obesity among nursing personnel working in tertiary care hospital, Diab Met Syndr: Clin Res Rev (2017), https://doi.org/10.1016/j.dsx.2017.12.014
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3
Fig. 1. Overweight, Obesity and Central Obesity status in study subjects with and without family history of diabetes.
Table 2 Biochemical parameters of study subjects. Variable
Group A
Group B
P-value
FPG (mg/dl) PPPG (mg/dl) Serum insulin (mIU/ml) Cholesterol (mg/dl) Triglyceride (mg/dl) HDLc (mg/dl) LDLc (mg/dl) VLDLc (mg/dl)
100.12 35.82 141.78 73.82 6.08 4.45 192.40 37.95 178.20 84.83 41.19 7.26 115.52 34.23 35.67 17.03
94.92 18.39 114.36 39.80 8.21 6.43 192.20 44.37 157.30 75.66 41.02 9.07 119.80 37.99 31.40 15.07
P = .057 P < .001 P = .09 P = .98 P = .30 P = .93 P = .66 P = .30
Group A; n = 35 for fasting insulin and n = 21 for lipids. Group B; n = 50 for fasting insulin and lipids.
Ghana [17], fifty four percent from Nevada [16] to sixty nine percent Scotland [10] compared to eighty percent observed in our study. A study by Goon et al. [13] from South Africa has reported a prevalence of eighty one percent among nurses similar to our study. The prevalence of central obesity in nurses has also been reported by an earlier study from Iran [12]. However, our study found more than twice the number of nurses with central obesity as compared to this study (eighty two percent vs thirty eight percent). To the best of our knowledge there is no other study in literature that has reported on central obesity. We believe that higher prevalence of overweight/obesity and central obesity in nurses compared to controls could be due to the factors related to their profession. Nurses are known to practice shift work in order to provide round the clock healthcare services. Shift work is associated with adverse health effects including obesity [18], metabolic syndrome [19] and diabetes [20]. Unhealthy diet pattern, exposure to hospital infection, prolonged working hours and work stress further contribute to obesity in them. However, which of these factors have contributed in this study cannot be said with certainty as we did not record the details of the work environment of the nurses. When the data was further analyzed after excluding the subjects from both groups who had a positive family history of diabetes, the prevalence of overweight/obesity and central obesity in nurses remained the same and significantly higher than women of control group. These findings suggest that overall, higher prevalence of overweight/obesity and central obesity among
nurses may be related more to environmental factors than an inherent genetic predisposition. Nearly one third of nurses showed evidence of newly detected glucose intolerance. Prediabetes was detected in one fourth of nurses and in one third of women of control group. Also, the number of cases of newly detected diabetes mellitus in nurses was only half of those found in women of control group. The finding of lower prevalence of newly detected diabetes mellitus and prediabetes among nurses can be due to several reasons. A higher awareness of diabetes and more frequent screening for the same could have led to prior detection of diabetes and prediabetes. More active life style among nurses compared to women of control group consisting predominantly of house wives could also have led to better insulin sensitivity and glucose tolerance. It has been shown earlier that an active lifestyle reduces the risk of glucose intolerance even in the presence of central obesity [21]. It is also likely that those nurses detected with prediabetes earlier adopted healthier lifestyle due to better access to medical advice and care which contributed to restoration of glucose tolerance in them. In conclusion, a large majority of nurses working in a tertiary care hospital have overweight/obesity and central obesity. Despite this they have lower rates of newly detected diabetes and prediabetes. Source of funding None. Declaration It is hereby declared that no conflict of interest is associated with manuscript entitled ‘High prevalence of obesity among nursing personnel working in tertiary care hospital’. Acknowledgement Authors are thankful to nursing personals for participation in the study. References [1] Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and
Please cite this article in press as: M. Aslam, et al., High prevalence of obesity among nursing personnel working in tertiary care hospital, Diab Met Syndr: Clin Res Rev (2017), https://doi.org/10.1016/j.dsx.2017.12.014
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adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2013;384(9945):766–81. World Health Organization (WHO). World Health Statistics. Geneva: WHO; 2012. . Available from: accessed on 28 November 2012 http://www.who.int/ gho/publications/world_health_statistics/EN_WHS2012_Full.pdf. Drenick EJ, Bale GS, Seltzer F, Johnson DG. Excessive mortality and causes of death in morbidly obese men. JAMA 1980;243(5):443–5. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008;371(9612):569–78. Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N. Impact of obesity on 24-h ambulatory blood pressure and hypertension. Hypertension 2005;45(4):602–7. Stabouli S, Kotsis V, Papamichael C, Constantopoulos A, Zakopoulos N. Adolescent obesity is associated with high ambulatory blood pressure and increased carotid intimal medial thickness. J Pediatr 2005;147(5):651–6. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17(9):961–9. Zalesin KC, Franklin BA, Miller WM, Peterson ED, McCullough PA. Impact of obesity on cardiovascular disease. Med Clin North Am 2011;95(5):919–37. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348(17):1625–38. Kyle RG, Neall RA, Atherton IM. Prevalence of overweight and obesity among nurses in Scotland: A cross-sectional study using the Scottish Health Survey. Int J Nurs Stud 2016;53:126–33. Ribeiro RP, Marziale MH, Martins JT, Ribeiro PH, Robazzi ML, Dalmas JC. Prevalence of Metabolic Syndrome among nursing personnel and its association with occupational stress, anxiety and depression. Rev Latino-Am Enfermagem 2015;23(3):435–40.
[12] Kazemi1 T, Sharifzadeh G, Javadinia SA, Salehiniya H. Prevalence of cardiovascular risk factors among the nurse population in the east of Iran. Int J Travel Med Glob Health 2015;3(4):133–6. [13] Goon DT, Maputle MS, Olukoga A, Lebese R, Khoza LB, Anyanwu FC. Overweight, obesity and underweight in nurses in Vhembe and Capricorn districts, Limpopo. S Afr J Clin Nutr 2013;26(3):147–9. [14] Shafei MN, Awang AF. Wan Mohamad WMZ: prevalence of metabolic syndrome and its associated factors among female nurses in a teaching hospital in North-Eastern state of Malaysia. J Public Health Epidemiol 2011;3 (9):394–400. [15] Ogunjimi1 LO, Ikorok MM, Olayinka YO. Prevalence of obesity among Nigeria nurses: the AkwaIbom state experience. Int NGO J 2010;5(2):45–9. [16] Miller SK, Alpert PT, Cross CL. Overweight and obesity in nurses, advanced practice nurses and nurse educators. J Am Acad Nurse Pract 2008;20(5):259– 65. [17] Aryee PA, Helegbe GK, Baah B, Sarfo-Asante RA, Quist-Therson R. Prevalence and risk factors for overweight and obesity among nurses in the tamale metropolis of Ghana. J Med Biomed Sci 2013;2(4):13–23. [18] Antunes LC, Levandovski R, Dantas G, Caumo W, Hidalgo MP. Obesity and shift work: chronobiological aspects. Nutr Res Rev 2010;23(1):155–68. [19] De Bacquer D, Van Risseghem M, Clays E, Kittel F, De Backer G, Braeckman L. Rotating shift work and the metabolic syndrome: a prospective study. Int J Epidemiol 2009;38(3):848–54. [20] Pan A, Schernhammer ES, Sun Q, Hu FB. Rotating night shift work and risk of type 2 diabetes: two prospective cohort studies in women. PLoS Med 2011;8 (12):e1001141. [21] Racette SB, Weiss EP, Obert KA, Kohrt WM, Holloszy JO. Modest lifestyle intervention and glucose tolerance in obese African Americans. Obes Res 2001;9(6):348–55.
Please cite this article in press as: M. Aslam, et al., High prevalence of obesity among nursing personnel working in tertiary care hospital, Diab Met Syndr: Clin Res Rev (2017), https://doi.org/10.1016/j.dsx.2017.12.014
Diabetes & Metabolic Syndrome: Clinical Research & Reviews xxx (2017) xxx–xxx
Contents lists available at ScienceDirect
Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsx
Original Article
High prevalence of obesity among nursing personnel working in tertiary care hospital M. Aslam, A.A Siddiqui, G. Sandeep, S.V. Madhu* Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
A R T I C L E I N F O
A B S T R A C T
Article history: Available online xxx
Aim: To find out the prevalence of obesity and glucose intolerance among nurses working in tertiary care hospital. Methods: Study was conducted in 496 apparently healthy females comprising two groups. Group B had 290 nurses and control group A had 206 age matched female subjects of general population. Detailed performa was filled which included anthropometry, systemic examination and other details. Fasting plasma glucose was done followed by oral glucose tolerance test (OGTT). Subjects with body mass index 23 kg/m2 were categorized as ‘overweight’ and 25 kg/m2 as ‘obese’ as per criteria for Asian Indians. Women with waist circumference of 80 cm were categorized as ‘centrally obese’. Results: Mean age of subjects in groups A and B was 40.45 8.64 years and 40.50 6.96 years respectively. Significantly higher number of nurses (80%) were overweight or obese compared to controls (59.71%,P = < .001). Similarly, central obesity was significantly higher in nurses (82.07%) compared to controls (67.96%,P = <.001). The prevalence of glucose intolerance (prediabetes and newly detected diabetes) was significantly higher in controls compared to nurses (45.63% vs 29.66%, P < .001). Conclusion: Every four out of five nurses working in tertiary care hospital have overweight/obesity and central obesity. Despite this they have lower rates of glucose intolerance. © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Keywords: Central obesity Nurse Obesity Prevalence
1. Introduction Obesity is one of the most common, yet among the most neglected, public health problem across the world. The incidence of overweight and obesity has increased globally over the past three decades [1] and around 700 million people in the world are obese [1]. According to world health organization data, nearly 2.8 million individuals die each year due to overweight or obesity [2]. Further, it has also been reported that mortality rate increases by twelve fold in obese persons when compared to persons of normal weight [3]. Studies have also shown that individuals with higher body mass index, a measure of obesity, are at increased risk of developing morbidities associated with obesity [4–7]. The etiology of obesity is
Abbreviations: BMI, body mass index; FH, family history; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; NGT, normal glucose tolerance; NDDM, newly detected diabetes mellitus; OGTT, oral glucose tolerance test. * Corresponding author at: Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Dilshad Garden, Delhi-110095, India. E-mail address: [email protected] (S.V. Madhu).
multi-factorial. Obesity can be an outcome of genetic defects, unhealthy diet pattern, sedentary life style, medication, hormonal imbalance, infection, odd and prolonged working hours and stress. Higher prevalence of obesity has been particularly reported from urban areas where several of these factors i.e., unhealthy diet pattern, sedentary life style, odd and prolonged working hours and stress are common and therefore urban population is at increased risk of developing obesity and obesity associated diseases like diabetes [7], hypertension [5], dyslipidemia [6,8] cardiovascular disease [6,8] and even some cancers [4,9]. Healthcare professionals particularly nurses are also at increased risk of developing obesity and associated diseases as they are exposed to odd and prolonged working hours, work stress, infection, unhealthy diet pattern. Despite the increased risk of obesity and associated disorders in nurses, very few studies have been carried out in this area. However, most of these studies have reported higher prevalence of obesity and metabolic syndrome in nurses [10–16]. The prevalence of obesity in these studies varied from 40% to 81% whereas no such study has been carried out from India. The present study was therefore carried out to find out the prevalence of overweight, obesity, central obesity and glucose
https://doi.org/10.1016/j.dsx.2017.12.014 1871-4021/© 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: M. Aslam, et al., High prevalence of obesity among nursing personnel working in tertiary care hospital, Diab Met Syndr: Clin Res Rev (2017), https://doi.org/10.1016/j.dsx.2017.12.014
G Model DSX 897 No. of Pages 4
2
M. Aslam et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews xxx (2017) xxx–xxx
intolerance among nursing personnel working in a tertiary care hospital and to compare them with women of control group.
done on SPSS 20.0. Data was considered significantly different if P value was <.05.
2. Subjects
4. Results
The present cross sectional study was conducted in 496 apparently healthy female subjects in the age group of 20–60 years comprising two groups. Group B consisted of 290 female nursing professionals working in a tertiary care hospital of Delhi and control group A had 206 age matched female subjects of general population from the same geographical area. The study was approved by Institutional Ethics Committee-Human Research, University College of Medical Sciences and GTB Hospital, Delhi, India. The study was carried out as per the guidelines of the institutional ethics committee.
The mean age of subjects in groups A and B was 40.45 8.64 and 40.50 6.96 years respectively. Body mass index (BMI) was found to be significantly higher in group B subjects (nurses) compared to subjects of control group A (Table 1). Significantly higher percentage of nurses were found to be overweight or obese (BMI 23 kg/m2) in group B compared to control group A (Fig. 1). Obesity (BMI 25 kg/m2) alone was also found to be significantly higher in nurses compared to controls (Fig. 1). Also, central obesity (waist circumference 80 cm) was found to be significantly higher in nurses compared to controls (Fig. 1). Data was sub-analyzed further by excluding subjects with ‘positive’ family history of diabetes from both study groups, the prevalence of overweight plus obesity and central obesity was also found to be significantly higher in nurses compared to controls (Fig. 1). Mean systolic and diastolic blood pressure and pulse rate were found to be comparable between both the groups (Table 1). Significantly higher percentage of nurses had positive family history of diabetes and family income compared to controls (Table 1). Eighty seven percent of the women from general population were housewives. Prevalence of glucose intolerance (impaired fasting glucose, impaired glucose tolerance and newly detected diabetes mellitus) was found to be significantly higher in controls compared to nurses (45.63% vs 29.66%, P < 0.001). Percentage of subjects with prediabetes (IGT IFG) and newly detected diabetes mellitus was also found to be significantly higher in controls compared to nurses (34.47% vs 24.14%, P = 0.01 and 11.17% vs 5.52%, P = 0.03 respectively). There was no significant difference in fasting insulin, total cholesterol, triglyceride, HDLc, LDLc or VLDLc between the two groups (Table 2).
3. Materials and methods Pregnant or lactating women, alcoholics, smokers, known case of diabetes, those with history of any chronic illness and those taking any type of medications which could affect glucose or lipid metabolism were excluded from the study. A written informed consent was obtained from all the study subjects. Detailed instructions were given to all the subjects who were asked to come on a prefixed day at 9 am after a minimum of 8 h fasting for oral glucose tolerance tests (OGTTs). On the scheduled day, body weight was recorded in fasting state using digital electronic weighing machine. A detailed performa was filled which included anthropometry, systemic examination and other details and fasting blood sample was drawn for fasting plasma glucose. After fasting blood sampling, 75 gm anhydrous glucose was given and blood sample was drawn again for 2 h postprandial plasma glucose. Also, lipid profile and fasting serum insulin were done in some of the subjects in each group. Subjects who had body mass index (BMI) 23 kg/m2 were categorized as ‘overweight’ and 25 kg/m2 as ‘obese’ as per obesity criteria for Asian Indians. Women with waist circumference of 80 cm were categorized as ‘centrally obese’. On the basis of OGTT, subjects were classified as normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and newly detected diabetes mellitus (NDDM) based on American Diabetes Association criteria. Plasma glucose was estimated by glucose oxidase-peroxidase methods (Accures kit, Accurex Biomedicals, India). Serum total cholesterol and triglyceride were estimated by commercially available kits (Merck-Labkit, Spain). The HDL was estimated by direct method (Accurex Biomedicals, India). Very low density lipoprotein (VLDL) and LDL were calculated as follows; VLDL = [TG/ 5] and LDL = [CHL (HDL + VLDL)]. Statistical Analysis: Unpaired t-test was used to compare continuous variables between the two groups. Binomial variables were compared by chi-square test. All the statistical analysis was
5. Discussion The present study found obesity and central obesity in four out of every five nurses working in a tertiary care hospital. This was significantly higher than in age matched women in the control group in which obesity was seen in three out of every five and central obesity in two thirds of them. However, glucose intolerance was observed in a significantly lower percentage of nurses compared to controls. Our study confirms the findings of several earlier studies from different parts of the world outside India which have reported a higher prevalence of obesity in nurses ranging from forty percent to eighty one percent [10–16]. However, most of these studies have reported lower prevalence of obesity compared to present study. These studies have reported prevalence of overweight/obesity varying from forty percent from Iran [12], forty three percent from
Table 1 Anthropometry, hemodynamic and demographic data of study subjects. Variable
Group A
Group B
P-value
Age (years) BMI (kg/m2) SBP (mmHg) DBP (mmHg) Pulse (BPM) Positive Family history of diabetes (%) Family income (INR/year)
40.45 8.64 24.77 5.37 127.30 12.00 79.57 6.24 80.40 7.45 24.01 64155 62205
40.50 6.96 26.40 3.82 126.10 12.50 80.64 6.88 79.88 7.32 36.93 302185 114140
P = .93 P < .001 P = .28 P = .07 P = .43 P < .001 P < .001
n = 206 for group A and n = 290 for group B.
Please cite this article in press as: M. Aslam, et al., High prevalence of obesity among nursing personnel working in tertiary care hospital, Diab Met Syndr: Clin Res Rev (2017), https://doi.org/10.1016/j.dsx.2017.12.014
G Model DSX 897 No. of Pages 4
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3
Fig. 1. Overweight, Obesity and Central Obesity status in study subjects with and without family history of diabetes.
Table 2 Biochemical parameters of study subjects. Variable
Group A
Group B
P-value
FPG (mg/dl) PPPG (mg/dl) Serum insulin (mIU/ml) Cholesterol (mg/dl) Triglyceride (mg/dl) HDLc (mg/dl) LDLc (mg/dl) VLDLc (mg/dl)
100.12 35.82 141.78 73.82 6.08 4.45 192.40 37.95 178.20 84.83 41.19 7.26 115.52 34.23 35.67 17.03
94.92 18.39 114.36 39.80 8.21 6.43 192.20 44.37 157.30 75.66 41.02 9.07 119.80 37.99 31.40 15.07
P = .057 P < .001 P = .09 P = .98 P = .30 P = .93 P = .66 P = .30
Group A; n = 35 for fasting insulin and n = 21 for lipids. Group B; n = 50 for fasting insulin and lipids.
Ghana [17], fifty four percent from Nevada [16] to sixty nine percent Scotland [10] compared to eighty percent observed in our study. A study by Goon et al. [13] from South Africa has reported a prevalence of eighty one percent among nurses similar to our study. The prevalence of central obesity in nurses has also been reported by an earlier study from Iran [12]. However, our study found more than twice the number of nurses with central obesity as compared to this study (eighty two percent vs thirty eight percent). To the best of our knowledge there is no other study in literature that has reported on central obesity. We believe that higher prevalence of overweight/obesity and central obesity in nurses compared to controls could be due to the factors related to their profession. Nurses are known to practice shift work in order to provide round the clock healthcare services. Shift work is associated with adverse health effects including obesity [18], metabolic syndrome [19] and diabetes [20]. Unhealthy diet pattern, exposure to hospital infection, prolonged working hours and work stress further contribute to obesity in them. However, which of these factors have contributed in this study cannot be said with certainty as we did not record the details of the work environment of the nurses. When the data was further analyzed after excluding the subjects from both groups who had a positive family history of diabetes, the prevalence of overweight/obesity and central obesity in nurses remained the same and significantly higher than women of control group. These findings suggest that overall, higher prevalence of overweight/obesity and central obesity among
nurses may be related more to environmental factors than an inherent genetic predisposition. Nearly one third of nurses showed evidence of newly detected glucose intolerance. Prediabetes was detected in one fourth of nurses and in one third of women of control group. Also, the number of cases of newly detected diabetes mellitus in nurses was only half of those found in women of control group. The finding of lower prevalence of newly detected diabetes mellitus and prediabetes among nurses can be due to several reasons. A higher awareness of diabetes and more frequent screening for the same could have led to prior detection of diabetes and prediabetes. More active life style among nurses compared to women of control group consisting predominantly of house wives could also have led to better insulin sensitivity and glucose tolerance. It has been shown earlier that an active lifestyle reduces the risk of glucose intolerance even in the presence of central obesity [21]. It is also likely that those nurses detected with prediabetes earlier adopted healthier lifestyle due to better access to medical advice and care which contributed to restoration of glucose tolerance in them. In conclusion, a large majority of nurses working in a tertiary care hospital have overweight/obesity and central obesity. Despite this they have lower rates of newly detected diabetes and prediabetes. Source of funding None. Declaration It is hereby declared that no conflict of interest is associated with manuscript entitled ‘High prevalence of obesity among nursing personnel working in tertiary care hospital’. Acknowledgement Authors are thankful to nursing personals for participation in the study. References [1] Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and
Please cite this article in press as: M. Aslam, et al., High prevalence of obesity among nursing personnel working in tertiary care hospital, Diab Met Syndr: Clin Res Rev (2017), https://doi.org/10.1016/j.dsx.2017.12.014
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Please cite this article in press as: M. Aslam, et al., High prevalence of obesity among nursing personnel working in tertiary care hospital, Diab Met Syndr: Clin Res Rev (2017), https://doi.org/10.1016/j.dsx.2017.12.014