Metabolic Syndrome Among College Students

Article Outline

• Abstract
• Prevalence and Risk of Metabolic Syndrome
• The Pilot Study
  • Methodology
  • Findings
• Discussion
  • Limitations
  • Implications for Practice
• Summary
• References
• Copyright

Abstract 

An estimated 30% to 35% of U.S. college students are affected by overweight and obesity, placing them at a substantial risk for metabolic dysfunction. However, little monitoring for metabolic dysfunction seems to be occurring in college health facilities. This study reviewed data obtained in a university student health center to determine whether blood pressure, triglyceride and high-density lipoprotein (HDL) levels, blood glucose, and waist circumference measurements indicate a prevalence of metabolic syndrome in this population. The overall prevalence of metabolic syndrome in the current sample was only 10%; however, the rate of having any metabolic abnormality was 43%, with the students having at least 1 component of metabolic syndrome. In addition, 14.3% of the students had 2 components of metabolic syndrome.

Keywords:  college students , metabolic syndrome , obesity , overweight

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Metabolic syndrome, a group of risk factors linked with overweight and obesity, contributes heavily to chronic illnesses such as cardiovascular disease and type 2 diabetes. The risk factors for metabolic syndrome include abdominal fat, increased triglycerides, decreased high-density lipoprotein (HDL) levels, increased blood pressure, and impaired glucose metabolism. An individual with 3 of any of these 5 risk factors is considered to have metabolic syndrome. That individual's risk for cardiovascular disease subsequently doubles and the risk for developing type 2 diabetes becomes 5 times higher.¹ Although research has shown the fastest increase in rates of obesity occurring within the 18- to 29-year-old age group, including those with some college education, little research has been done on components of metabolic syndrome among U.S. college students.²

One of every three young adults attends college. The majority of these students enter college at the crucial transition period from adolescence to young adulthood.³ Present research has demonstrated that these college students make unhealthy diet choices and have limited physical activity.⁴ In addition, increases in stress, and changes in the college student's surroundings and social groups, affect the choices students make regarding exercise, alcohol consumption, and diet. Any of these factors can contribute to weight gain and decreased overall health, with long-term consequences.⁵ This paper will present research findings from a pilot study that attempts to address these issues.

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Prevalence and Risk of Metabolic Syndrome 

An estimated 47 million U.S. adults aged 20 years and older have metabolic syndrome, and 1 in every 10 U.S. adolescents aged 12 to 19 years are affected by the disorder. Even more discouraging is that two thirds of all adolescents have at least one component of metabolic syndrome.⁶ Two components, body mass index (BMI), and weight gain, have consistently been shown to predict the development of metabolic syndrome. The CARDIA study examined risk factors for the development of metabolic syndrome among young adults aged 18 to 30 years (n = 4192). Baseline measurements for BMI; smoking; carbohydrate, fat, and fiber intake; alcohol consumption; metabolic syndrome components; and physical activity were obtained and then repeated 6 times over a 15-year period. During this time, 575 participants developed metabolic syndrome. The risk for developing metabolic syndrome increased with advancing age, was more prevalent among black participants (11%), and higher in the least educated participants. Black women had the highest rate of development (12.2%). Weight gain, regardless of gender or race, correlated with an increased risk for the development of metabolic syndrome. In addition, participants with a higher BMI were found to have a significantly increased risk for developing metabolic syndrome. In contrast, regular physical activity throughout the study period was found to be protective regardless of weight gain or other risk factors.⁷

Data from the CARDIA⁷ study were examined further to determine how a change in BMI over a 15-year period would affect the development of metabolic syndrome. Among the participants (n = 2679; 1358 men and 1321 women), 16.3% maintained a stable/decreased BMI, 73.9% had an increased BMI, and 9.8% had a fluctuating BMI over the study period. The results found that participants who maintained or decreased their BMI (regardless of baseline BMI) had no components of metabolic syndrome or only minimally worsened components. On the other hand, participants whose BMI increased (regardless of baseline BMI) had a progressively worsened metabolic profile. It appears that there is a natural progression of metabolic components with advancing age, and that it is unavoidable. Men with a baseline BMI of 20.0 to 24.9 kg/m² that decreased or remained stable had a mean increase of only 15 mg/dL in fasting triglycerides over 15 years. In contrast, men whose BMI increased had a significant mean increase of 65 mg/dL (P < 0.001). Waist circumference was shown to be highly associated with BMI (P < 0.0001). This study found a distinctly low overall prevalence of metabolic syndrome within both gender groups that maintained a stable BMI, whereas, the percentage was much higher (P < 0.001) among men and women with an increased BMI. This study demonstrated that maintaining a stable BMI can help avoid metabolic syndrome, which has been linked significantly with increased risk for a cardiovascular event.⁸

There are few studies that focus on the prevalence of metabolic syndrome in the college-aged student. One such study examining metabolic abnormalities in this population aged 18 to 24 years (n = 800) was conducted at the University of New Hampshire. One third of the participants were overweight and 60% of the men had hypertension. At least one risk factor for metabolic syndrome was present in 60% of men and 50% of women, and 8% of males had metabolic syndrome.⁹

Researchers at the University of Kansas examined relationships between weight status and metabolic components within a college sample. Of the study sample (n = 163), 27% were overweight. Twenty-five percent had 1 component of the metabolic syndrome, 1.2% had 2 components, and 0.6% had 3 components. The overweight students were 2.9 times more likely to have at least 1 metabolic abnormality compared with students of normal weight. More than 10% of the students had elevated total cholesterol or low HDL-C or both, and more than 6% had pre-diabetes. This demonstrates that early screening for obesity and metabolic abnormalities can assist in prevention of cardiovascular disease risk among the apparently healthy asymptomatic college-aged population.¹⁰

Once students enter college, they experience many changes and added stress. Across college campuses, students are surrounded by new environments and social influences that have been linked with unhealthy behaviors. Most specifically, the unhealthy behaviors have involved poor dietary habits and decreased physical activity. Researchers at Rutgers looked at a sample of 67 freshmen to determine if significant body weight changes occurred during the first year of college. The researchers were specifically interested in seeing if freshman did in fact gain 15 pounds during the first year of college. Measurements were taken at the beginning of the school year and repeated closer to the end of the school year. The majority of the sample was white non-Hispanic, 30% were Hispanic and Asian, and 3% were African American. The sample included an equal number of men and women. Although 27% of the sample lost weight, all characteristics of body composition increased (fat-free mass, weight, and fat mass). BMI also increased among those who gained weight. The average weight gain among college freshmen was actually around 7 pounds (3.1 kg). The researchers speculated that should the college freshman continue on this path, the potential weight gain of the student's 4-year period could equal 27 pounds (12.4 kg). From previous research, probable reasons for the increase in weight could be attributed to a decrease in physical activity, increased alcohol intake, poor dietary choices, and eating at buffet-style cafeterias on campus.⁵ This research demonstrates the need for counseling college freshman regarding lifestyle issues that may impact the development of metabolic syndrome and methods the student can use to avoid this.

The data have shown that the most rapid increases in weight have occurred among 18- to 29-year-olds and those with some college education.² This demonstrates how the college period is a prime opportunity for intervention by designing programs to prevent weight gain, and educating students regarding exercise and healthy dietary choices.⁵ Research has also suggested this transition is a time when many future lifestyle behaviors are developed.¹¹ With the evidence that increased weight at an early age leads to overweight and obesity in later life, screening for overweight, obesity, and metabolic abnormalities becomes important.¹²

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The Pilot Study 

Understanding that college students are at risk for overweight and obesity and, subsequently, metabolic syndrome, researchers at a 4-year college in the southeast United States examined data obtained in a university student health center. The variables of blood pressure, triglyceride and HDL levels, blood glucose, and waist circumference measurements were obtained in an effort to determine the prevalence of metabolic syndrome in this population.

Methodology 

The participants in this study consisted of randomly sampled students who were fasting and presented to a southeastern university student health center from February 1, through April 28, 2008 (n = 21). After reviewing the purpose of the study and getting written consent from the students, waist circumference was obtained with a standard cloth tape measure. A standard clinic scale was used to measure weight in pounds and height in feet to the nearest one-quarter inch. Blood pressure readings were obtained with an electric sphygmomanometer. Fasting lipid profiles and fasting glucose were obtained with the Cholestech LDX. The same clinician performed the testing for all 21 students.

Findings 

The diagnosis of metabolic syndrome is made when any 3 of the following 5 components are present in an individual (Table 1). The definitions for the components of metabolic syndrome, utilized for this research, are the criteria developed by the Third Report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III).¹³ The ATP III guidelines were recently updated to include the lowering of fasting blood glucose, as suggested by both the American Heart Association and the National Heart, Lung, and Blood Institute, and was used in this study.¹ The statistical analysis was performed utilizing the SPSS software version 17.0. The sample included 21 students (13 females, 8 males). Significant correlations were found between body mass index (BMI) and triglycerides, as well as BMI and waist circumference (P < 0.01). In addition, a significant correlation between BMI and high-density lipoproteins (HDL) was found (P < 0.05). No significant correlations were found between BMI and systolic blood pressure (SBP), BMI and diastolic blood pressure (DBP), BMI and fasting glucose, BMI and total cholesterol, or BMI and gender (Table 2).

Table 1. NCEP Criteria for Metabolic Sydrome¹, ¹³

Table 2. Correlations for the Variables

FG indicates fasting glucose; SBP, systolic blood pressure; DBP, diastolic blood pressure.

For this study, 52% of the study sample had a BMI above the normal 24.9 kg/m² (7 female and 4 male). Seven were considered overweight and 4 fell within the obesity range. No student fell below the normal BMI range. Thirty-eight percent of the students had an HDL level above normal (n = 8; 6 female, 2 male), as well as an SBP above normal (n = 8; 3 female, 5 male). Twenty-nine percent of the participants had a DBP above normal (n = 6; 4 female, 2 male), while 24% had a waist circumference measurement above normal (n = 5; 4 female, 1 male). The percentage was much lower for triglycerides with only 10% of the sample above normal (n = 2; 1 female, 1 male), and only 1 male student had blood glucose above normal. Triglycerides were not calculated on 9 of the 21 students, which is a limitation of this study and will be discussed.

Individual student data regarding the components of metabolic syndrome produced interesting data. Of the total sample, 43% had at least 1 component of metabolic syndrome (n = 9; 5 female, 4 male). Three female students (14.3%) had at least 2 metabolic abnormalities, and 2 students (10%) had metabolic syndrome (1 female, 1 male; Table 3). No student had more than 3 components of metabolic syndrome based on the NCEP ATP III guidelines.¹, ¹³ Of the students who were overweight and obese, 81.8% had at least 1 component of metabolic syndrome. Surprisingly, 50% of those with a normal BMI also had at least 1 component of metabolic syndrome.

Table 3. Metabolic Syndrome Prevalence

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Discussion 

The typical college student is of the age where the transition from adolescence to young adulthood occurs, a period that is known for significant changes in lifestyle and behavior choices. Recent literature has suggested that the rate of overweight and obesity has escalated most rapidly among individuals aged 18 to 29 and those with some college education.² That significant upward trend sparked more research examining multiple variables contributing to the vast weight increased within this age group, including food choices, physical activity, time spent watching television or playing video games, alcohol intake, and level of stress.³, ¹⁴ Although the research pertaining to overweight and obesity is prevalent, little has focused specifically on the college-age student and even less on the prevalence of metabolic syndrome within this population.²

An estimated 30% to 35% of U.S. college students are affected by overweight and obesity, placing them at substantial risk for metabolic dysfunction and cardiovascular disease.², ¹⁵ The present study revealed results alarmingly higher than the national estimates, with 52% of the sample being overweight (BMI = 25.0–29.9 kg/m²), including 36% with a BMI over 30 (obese). These results were also markedly higher than a previous study, which examined the prevalence of metabolic dysfunction among college students (n = 300). In that study, 23% of the sample were overweight and 6% were obese.² The study at the University of Kansas found 27% were overweight, also lower than the present study's results.¹⁰ Currently in progress, the University of New Hampshire study⁹ results suggest that one third of the total participants (n = 800) are overweight.

The overall prevalence of metabolic syndrome in the current sample was only 10%; however, the rate of having any metabolic abnormality was 43%, with students having at least 1 component of metabolic syndrome. In addition, 14.3% of the students had 2 components of metabolic syndrome. Although the evidence for comparison is minimal, Huang et al² found that the rate of metabolic abnormality ranged from 26% to 40%. Huang et al² also differed in that all 3 definitions for metabolic syndrome (WHO, ATP III, and IDF) were utilized. Examining the results using only the ATP III definitions, 33% (n = 99) had at least 1 component of metabolic syndrome, 5.7% (n = 17) had 2 components, and 1.3% (n = 4) were classified as having metabolic syndrome. The University of Kansas¹⁰ study also elicited results lower than the present study. Twenty-five percent had 1 component of the metabolic syndrome, 1.2% had 2 components, and 0.6% had 3 components (Table 4). The results of the University of New Hampshire research, still in progress, are similar to the present study. At least one risk factor for metabolic syndrome was present in 60% of men and 50% of women, and 8% of males had metabolic syndrome.⁹

Table 4. Comparison of Results to Other Studies², ¹⁰

The University of Kansas¹⁰ study found that the overweight students were 2.9 times more likely compared with students of normal weight. The results of the present study were lower, with overweight students only 1.6 times more likely to have at least one metabolic abnormality than those of normal BMI. The current study elicited 81.8% of overweight students to have at least one metabolic abnormality. In addition, 50% of the students with normal BMI also had at least one component of metabolic syndrome. Looking at specific components of metabolic syndrome, the present study found higher rates of low HDL, increased waist circumference, and increased systolic and diastolic blood pressures. Huang et al² found higher rates of low HDL, pre-diabetes, and hypertriglyceridemia, compared to the study at the University of Kansas¹⁰ where more than 10% of the students had elevated total cholesterol or low HDL-C or both, and more than 6% had pre-diabetes.

Limitations 

Limitations to this study were that the sample population was small (n = 21), and the majority of the population were female (62%). In addition, 9 of the 21 (43%) triglyceride scores were not calculated due to machine error. This was almost half of the sample, which could have affected the results significantly. Age and race/ethnicity were not recorded, and this might affect generalizability. In addition, the present study used only 1 set of definitions for metabolic syndrome. Huang et al² cites 3 different categorizations for defining metabolic syndrome rather than using only the ATP III guidelines. They found twice as many students had metabolic syndrome utilizing the WHO definitions compared with the only the ATP III definitions. The study remarked that insulin levels are a significant marker for metabolic dysfunction, an indicator that the ATPIII does not recognize. Utilizing more than one reference in screening for metabolic abnormalities may produce more students at risk for metabolic syndrome and cardiovascular disease.² However, when researching metabolic syndrome, it is important to define which definition will be utilized for the study prior to data collection.

Implications for Practice 

The results of this study strengthen the growing evidence that overweight, obesity, and metabolic abnormalities are prevalent among the college-age population. It is estimated that 30% to 35% of the U.S. college population is overweight and obese.², ¹⁵ With the findings that 52% of the sample in this study had a BMI of 25 or higher, the national estimates may actually be too low.

Increased BMI contributes to increased risk of metabolic abnormalities.², ⁸, ¹⁰ This study found that 81.8% of overweight students had at least 1 component of metabolic syndrome. Of the total sample, 43% of the students had at least 1 component of metabolic syndrome, 14.3% had 2, and 10% had metabolic syndrome. This suggests that the rate of undiagnosed metabolic abnormalities may be high within the college population.²

An additional finding that 50% of the students who actually had a normal BMI also had at least one component of metabolic syndrome was unexpected. This is an example of how early screening for obesity and metabolic abnormalities can assist in prevention of cardiovascular disease risk among the apparently healthy asymptomatic college-age population.¹⁰

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Summary 

Monitoring for metabolic syndrome at the college level would allow for timely recognition and intervention in early risk factors for chronic disease. However, little monitoring for metabolic dysfunction seems to be occurring in college health facilities.² As evidenced by our study, there is a need for screening for metabolic syndrome within the college population. In addition, these results support to the need for implementation of preventive measures aimed at overweight and obesity across college campuses nationwide. Without increased screening and prevention efforts and continuing research, the college-age population may unnecessarily suffer from chronic disease related to metabolic syndrome.

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References 

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