European Journal of Cardiovascular Medicine

Obesity   is   emerging   as   an   important   health   issue.  The prevalence of obesity is rising to epidemic proportions at an alarming rate in both developed and developing countries. Obesity refers to the excessive accumulation of fat in the body, and the pattern of fat distribution plays a crucial role in determining metabolic risk. [1]

Overweight/obesity has become one of the major noncommunicable diseases (NCDs) risk factors, and this burden as a global pandemic continues to unacceptably rise. The risk of overweight/obesity was higher in developing and developed countries compared to lower-income countries. According to the World Health Organization (WHO) in 2022, worldwide 2.5 billion (43 %) adults aged 18 years or older were overweight, and 890 million (16 %) of these adults were living with obesity. [2]

In India, more than 135 million individuals were affected by obesity. The prevalence of obesity in India varies due to age, gender, geographical environment, socio-economic status, etc. According to ICMR-INDIAB study 2015, prevalence rate of obesity and central obesity are varies from 11.8% to 31.3% and 16.9%-36.3% respectively. In India, abdominal obesity is one of the major risk factors for cardiovascular disease (CVDs). [3] The rising prevalence of obesity in India has a direct correlation with the increasing    prevalence    of    obesity-related    co-morbidities; hypertension, the metabolic syndrome, dyslipidemia, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD). [4]

BMI screens for potential weight and health related issues. There is direct link between rising BMI and lower HDLC and higher TG levels [5]. With this background, a few studies were conducted. A study done by Tejashwini VB et al., in 2021, conducted a cross-sectional study to correlate the relationship between BMI and lipid profile among 100 (45 males and 55 females) young healthy medical students, aged between 18 to 25 years. They reported that the total cholesterol, LDLC, triglycerides levels are significantly higher in overweight group compared to normal weight subjects. HDLC was slightly lower in overweight group and VLDLC was slightly higher in overweight individuals. [6]

Another study by Prasad DKV et al., conducted a retrospective study to assess the serum lipid profile levels in obese subjects with BMI≥30kg/m² and to compare them with that in non- obese subjects with BMI 18.5-24.9 kg/m². They reported that significantly higher level of total cholesterol, LDLC and triglycerides and low levels of HDLC was observed in obese individuals as compared to non-obese subjects. [7]

In a study by M. Swathi et al., to determine BMI (Body Mass Index) in medical students and its association with lipid profile parameters. They reported that higher proportion of overweight among medical students and lipid profile was significantly associated with BMI. [8]

A study by Md. Sakhawat Hossain et al., conducted a cross-sectional study among 100 undergraduate medical students to observe the relationship between Body Mass Index (BMI) and lipid profile. They reported that overweight and obesity is common among the study subjects and those with higher BMI particularly the older ones tend to have abnormal lipid profile. Therefore, adequate dietary control, food habit & life-style modification is needed for prevention of dyslipidemia at early life. [9]

Obesity results in adverse effects on health of the individual. Good health is important for all and especially to medical students and healthcare professionals. [10]

Aim:

This study aimed to assess the correlation between BMI and serum lipid profile parameters among the young medical students of NRI Institute of Medical Sciences (NRIIMS), Sangivalasa, Visakhapatnam, Andhra Pradesh, India.

This cross-sectional study was conducted in Department of Biochemistry, NRI Institute of Medical Sciences (NRIIMS), Sangivalasa, Visakhapatnam, Andhra Pradesh, India. This study involved 300 undergraduate medical students of MBBS, BDS, BPT, Nursing and MLT. Out of 300 subjects, males were 146 and females were 154. Number of MBBS students were 85, MLT were 80, Nursing were 84, BPT were 36 and BDS were 15. Age of study subjects was 17 to 25 years and both genders were included. This study has been approved by the Institutional Ethics Committee (IEC) and informed consent was obtained from all the study subjects.

Inclusion criteria

Medical students willing to participate in the study, age group between 17-25 years, both male and female students were included.

Exclusion criteria

Medical students not willing to participate in the study, students who are taking lipid- lowering drugs, medical students with diabetes mellitus, hypertension, cardiovascular diseases, liver and renal diseases were excluded from the study.

Body Mass Index (BMI)

Body mass index (BMI) is calculated by dividing height in meters squared (m²) by body weight in kilograms (kg). BMI can be classified into four groups [11]. Under weight <18.5, normal weight 18.5-24.9, overweight 25.0-29.9, and obese- BMI with 30.0 and above [>30.0]

Based on BMI values, the subjects were divided into the following groups:

1. Under weight: less than <18.5 kg/m²
2. Normal weight: 18.5 to 24.9kg/m²
3. Over weight: 25.0 to 29.9 kg/m²
4. Obese: 30 kg/m²or higher

Sample collection

Under aseptic conditions, 5 ml of fasting venous blood samples were collected from all the study subjects, allowed to stand for 30 minutes and centrifuged at 3000 rpm to obtain clear serum. The serum sample was used for the estimation of serum total cholesterol (cholesterol oxidase/peroxidase method), triglycerides (glycerol phosphate peroxidase), and high density lipoprotein cholesterol (HDLC) (oxidase/peroxidase). Low density lipoprotein cholesterol (LDLC) and very low-density lipoprotein cholesterol (VLDLC) were calculated by using Frieldwald’s formula. Biochemical analysis of lipid profile parameters was done by using Biosystem BA200 fully autoanalyzer.

Statistical analysis

The results were expressed as mean ± SD and standard error. Significance of mean was analysed by using one-way analysis of variance (ANOVA) for BMI groups. The differences between 5 groups were compared using one-way ANOVA. Statistical analysis was done by using the statistical package for social sciences (SPSS) version 24. P value < 0.05 was considered as statistically significant.

This study aimed to assess the association between serum lipid profile parameters and BMI among the young medical students, Andhra Pradesh, India. In this study, a total of 300 medical students of male and females were included. Age of the study subjects was 17 to 25 years. Out of 300 subjects, males were 146 (48.7%) and females were 154 (51.3%). Number of MBBS students were 85 (28.3%), MLT were 80 (26.6%), Nursing were 84 (28%), BPT were 36 (12%) and BDS were 15 (5%).

Based on BMI value, study subjects were categorized as underweight, normal weight, overweight and obese. In this study, underweight subjects were 58 (19.3%), normal weight subjects were 173 (57.6%), overweight subjects were 51 (17%) and obese subjects were 18 (6%) as shown in table 1.

Table1: Distribution of participants based on their BMI and Gender

Lipid profile parameters were compared among the study subjects. Significant increase in serum cholesterol (156.3±38.4 mg/dl), triglycerides (108.2±62.1 mg/dl) and VLDLC (21.6±12.4 mg/dl) was observed in overweight subjects compared to other groups. LDLC (82.7±36.6 mg/dl) was increased and HDLC (50.3±11.4 mg/dl) was decreased in obese subjects compared to other groups as shown in table 2.

Table 2: Comparison of lipid profile parameters among study subjects

p<0.05, considered as significant.

In this study, lipid profile parameters were correlated with BMI. Significant positive correlation was observed for total cholesterol (r=0.171), triglycerides (r=0.252), LDLC (r=0.195), VLDLC (r=0.252) and HDLC (r= -0.252) showed significant negative correlation as shown in table 3. 

Table 3: Pearson correlation of lipid profile parameters with BMI

*Correlation is significant at 0.01 level (2 tailed test)

In this study, lipid profile parameters were compared in MBBS students (n=85). Increase in serum cholesterol (158.3±29.6 mg/dl), triglycerides (109.2±67.6 mg/dl), LDLC (79.2±22.3 mg/dl) and VLDLC (21.8±13.5 mg/dl) were observed in overweight, but not reached statistical significance. Significant decrease was observed in HDLC (55.9±7.6 mg/dl) in obese subjects compared with other groups as shown in table 4.

Table 4: Comparison of lipid profile parameters with BMI in MBBS students (n=85)

In this study, in MLT students, total Cholesterol (199.2± 55.2 mg/dl), LDLC (135.6±45.2 mg/dl) were increased and HDLC (39.8±1.3 mg/dl) was decreased in obese subjects. Triglycerides (122.6±45.5 mg/dl) and VLDLC (24.5±9.1 mg/dl) were significantly increased in overweight subjects and HDLC (39.8±1.3 mg/dl) was decreased compared to other groups as shown in table 5.

Table 5: Comparison of lipid profile parameters among MLT students (n=80)

In nursing, HDLC (44.2±15.6 mg/dl) is decreased remaining all parameters not shown any differences as shown in table 6.

Table 6: Correlation of lipid profile parameters among Nursing students (n=84).

In this study, total number of BPT students (n=36) and BDS students (n=15) were less, so the comparison of lipid profile parameters with BMI was not done.

Obesity is now estimated to be the second leading cause of mortality and morbidity,  causing  an  estimated  2.6  million  deaths  worldwide and 2.3%  of  the  global  burden  of  disease.  There is an overall consensus that obesity poses a significant risk for the development of cardiovascular disease, alterations in glucose metabolism and reduces life expectancy. [11]

The present study aimed to correlate BMI with lipid profile parameters in northern Andhra Pradesh. In this study, significant elevation of total cholesterol, triglycerides, LDLC, and VLDLC was observed in obese subjects compared to other groups. Significant reduction of HDLC was noted in obese subjects than other groups.

Lipids and lipoproteins are well known risk factors for ischemic heart disease. Elevated levels of triglyceride, cholesterol and LDLC are documented as risk factors for atherogenesis. LDLC in its oxidized or acetylated form has been identified as a major atherogenic particle, as it not only load macrophages with cholesterol for the formation of foam cells but also because it is chemotactic for circulating monocytes, is cytotoxic and can adversely alter coagulation pathways. The blood level of HDLC in contrast bears an inverse  relationship  of  the  risk  of  atherosclerosis  and  coronary  heart disease  that  is  higher  the  level,  smaller  the  risk. [13]

In support of our study findings, a study conducted by Dholakia J et al., studied the correlation of anthropometric and biochemical parameters in first year medical students. They recruited 150 first year MBBS students in the study. Anthropometric measurements such as body weight (BW), body height (BH), Waist circumference (WC) and hip circumference (HC) and Body mass index (BMI) was calculated. They reported that the Overweight and obesity among the students were 17.3% and 4% respectively. When the abnormal serum cholesterol (≥200 mg/dl) was compared between male and female students it was statistically significant. [14]

 Another study by Ramkumar Singhal et al., conducted a prospective study to evaluate the correlation of serum lipid profile and BMI in young first year MBBS students. They reported that Lipid profile was significantly raised among overweight subjects. [12]

In a study conducted by Jitendra Kumar Jain et al., conducted a cross-sectional study by recruiting 300 MBBS students of JMC Jhalawar, Rajasthan in age group 17-30 years. They reported, that obesity was positively associated with triglycerides and males are more prone to be obese and change in the lipid profile is also seen. [15].

Yet another study by Soobia Rashid et al., conducted a cross-sectional study by recruiting 180 medical students, to explore the connection between anthropometric and lipid profile markers to assess obesity risk in medical students. They reported that prevalence of cardiovascular risk factors such as obesity, hypertension, and elevated triglycerides were high among medical students. [16]

Similarly, another study by Sagarika Sarkar et al., conducted a cross-sectional study by recruiting 200 medical students to assess the relationship between serum lipids to different obesity parameters in medical students. They reported that a substantial proportion of young medical students were found to be overweight. Increased levels of triglycerides, LDLC and low levels of HDLC were observed. BMI was found as an useful index for dyslipidemia in males. [17].

The present study results may conclude that significantly elevated cholesterol, triglycerides, LDLC, VLDLC and significantly low HDLC levels in obese young medical students compared to other groups. Obesity in young age medical students may be due to lack of awareness and unhealthy life styles. Therefore, educating the students about the effects of obesity and dyslipidaemia on the quality of health can help in bringing lifestyle modifications that can help them in the long run.

Acknowledgement

We would like to thank the DR YSR University Health Sciences and authorities of NRI Institute of Medical Sciences (NRIIMS), Sangivalasa, Visakhapatnam, Andhra Pradesh, India.

Sources of funding:

This study was supported by DR YSR University of Health Sciences, Vijayawada, Andhra Pradesh, India under the Dr YSR Undergraduate Student Research Scholarship Scheme.

Conflicts of interest: Nil

1. Alzoubib, Omar F. Khaboura, Lubna Tinawia, Rawan Hamada, Esraa    Keewanc,  Sulaiman   K.Matarnehb,   Mahmoud   A. Alomarid.Assessment  of  Cardiovascular  Risk  Factors  Among University  Students:The  Gender  Factor,  Cardiology Research. 2012; 3(4):172-179.
2. Shamsul Islam, Hafiza Sultana, Md. Nazmul Hassan Refat, Zaki Farhana, Anton Abdulbasah Kamil, Mohammad Meshbahur Rahman. The global burden of overweight-obesity and its association with economic status, benefiting from STEPs survey of WHO member states: A meta-analysis. Preventive Medicine Reports. 2024; 46: 102882:1-8.
3. Ahirwar R, Mondal PR. Prevalence of obesity in India: A systematic review. Diabetes & Metabolic Syndrome. 2019;13(1):318-321.
4. Ross A Hammond, Ruth Levine. The economic impact of obesity in the United States. Journal of Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2010;3:285-295.
5. Arshad Hussain, Iftikhar Ali, Waqar Ahmad Kaleem, Fatima Yasmeen et al., Correlation between body mass index and lipid profile patients with type 2 diabetes attending a tertiary care hospital Peshawar. Pakistan Journal of Medical Sciences. 2019;35(3):591-597.
6. Tejaswini V B, Ganashree C P. Correlation between serum lipid profile and body mass index in young healthy medical students. Indian Journal of Clinical Anatomy and Physiology. 2021;8(2):106-109.
7. Prasad DKV, Preethi B. A study on BMI and lipid profile in obese and non-obese individuals: A retrospective study in a tertiary care centre. European Journal Pharmaceutical and Medical Research. 2022;9(4):379-382.
8. Swathi, G. Rachel Raveena Paul, K. Dharahasa, T. Dinesh Kumar, P. Priyanka. Study of body mass index (BMI) and its association with lipid profile among medical students in Nizamabad. International Journal of Academic Medicine and Pharmacy. 2023; 5 (5); 152-155.
9. Sakhawat Hossain, Md. Daharul Islam, Asadullahil Galib, Roksana Malek, Khaleda Akter, Maksuda Khanam. Lipid Profile in Relation to Body Mass Index among Medical College Students in Dhaka, Bangladesh. Medicine Today, 33(2), 114-119.
10. Jafar TH, Chaturvedi N,Papps   Prevalence of Overweight and Obesity and their Association with Hypertension and Diabetes Mellitus in an Indo Asian Population.  Canadian Medical Association Journal (CMAJ). 2006; 175(9):1071-1077.
11. Obesity: Preventing and managing the global epidemic. Report of a WHO Consultation on Obesity, Geneva, 3-5 June, 1997, WHO/NUT/NCD/98.1. WHO: Geneva, 1998.
12. Ramkumar Singhal, Vishva Deepak Yadav, Sunil Kumar Saini. An Institutional Based Prospective Study to Evaluate the Correlation of Serum Lipid Profile and BMI in Young First Year MBBS Students. International Journal of Health and Clinical Research, 2021; 4(22):133-135.
13. Ranjana Tiwari,  Vikas Jain,  Ajit  Singh  Rajput,  K.  Bhagwat, Manish Goyal, Sakshi  Tiwari.  A study to assess prevalence of obesity among medical students of GR Medical College, Gwalior, MP, India.  International Journal of Research in Medical Sciences. 2014; 2(4):1412.
14. Dholakia J, Sharma H, Vasava SN, Kayal S. Correlation of anthropometric parameters with lipid profile in first year medical students. International Journal of Clinical Biochemistry and Research. 2018;5(1):54-60.
15. Jitendra Kumar Jain, Shashikant Agarwal, Shrikant Shete, Kusum Bala Jain. Correlation of overweight and lipid profile among medical college students at Jhalawar: A cross sectional study. International Journal of Medical and Pharmaceutical Research. 2023;4(2);521-525.
16. Soobia Rashid, Gurmeet Kaur, Gazala Abbas, Retash Shan, Fiza Shahid, Sheetal Kotwal, Mamta Sharma. Correlation of Anthropometric and Lipid Markers in GMC Jammu Medical Students. Indian Journal of Public Health Research and Development 2023;14(3). 327-330.
17. Sagarika Sarkar, Debjani Chakraborti and Mehboob Alam. Overweight and obesity in relation to lipid profile among medical students in Kolkata, India. International Journal of Recent Scientific Research. 2015; 6(7): 5103-5106.