How to cite this article: Cruz-Domínguez MP, González-Márquez F, Ayala-López EA, Vera-Lastra OL, Vargas-Rendón GH, Zárate-Amador A, Jara-Quezada LJ. Overweigth, obesity, metabolic syndrome and waist/height index in health staff. Rev Med Inst Mex Seguro Soc. 2015;53 Supl 1:S36-41.
Received: October 22nd 2014
Accepted: March 6th 2015
Maria del Pilar Cruz-Dominguez,a,h Fabiola González-Márquez,b Ernesto A. Ayala-López,c Olga Lidia Vera-Lastra,d,h Gerardo H. Vargas-Rendón,e Alfonso Zárate-Amador,f Luis Javier Jara-Quezada,g,h
aDivisión en Investigación en Salud
bServicio de Medicina Interna
dServicio de Medicina Interna
eDivisión de Servicios de Apoyo Diagnostico
gDirección de Educación e InvestigaciónhFacultad de Medicina. División de Estudio de Posgrado,Universidad Nacional Autónoma de México
a-gHospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social
Distrito Federal, México
Communication with: María del Pilar Cruz-Domínguez
Telephone: (55) 5724 5900, extensión 23015
Background: Health staff self-applied strategies are insufficiently to reduce cardiovascular risk factors. The aim of this article is to investigate the prevalence of overweight, obesity and metabolic syndrome and waist/height index on health staff.
Methods: This is a cross-sectional study from January to April 2014 in 735 workers of the UMAE Specialties La Raza. A diagnosis of overweight and obesity was established according to WHO criteria and metabolic syndrome NCEP ATP-III. In 250 participants lipid profile and blood chemistry were obtained. Descriptive statistics was applied, chi square, Student t test or Kruskal-Wallis to compare groups.
Results: We included 496 women and 239 men (physicians, nurses and other workers). 38 % were overweight; 22 % had obesity. We found fasting hyperglycemia > 126 mg/dl in 5.1 %, between 100-126 mg/dl in 17.4 %, hypertriglyceridemia in 40.4 %; HDL cholesterol < 40 mg/dl 66 % in men and HDL cholesterol < 50 mg/dl 51.4 % in women. Waist measurement was 93 ± 11 cm in men vs. 88 ± 13 m in women. The waist/height index in the ideal weight group was 0.048 ± 0.04, for overweight 0.55 ± 0.04 and for obesity 0.65 ± 0.064 (p < 0.01). Metabolic syndrome prevalence was 30.6 %, smoking 21.6 % and alcohol consumption 35 %.
Conclusions: The prevalence of obesity-overweight was 60 % and metabolic syndrome 30 %, making it necessary to take immediate actions to modify the lifestyle of health staff.
Keywords: Prevalence, Overweight, Obesity, Metabolic syndrome.
Obesity, the "epidemic of the century" according to the World Health Organization, is one of the largest and most-neglected public health problems of our times.1 Obesity and excess visceral fat predispose hypertension, hyperglycemia, and lipid disorders, identified as metabolic syndrome (MS).2 MS is associated with at least twice the risk of cardiovascular disease3-5 and type 2 diabetes mellitus.6
In health workers, the prevalence of obesity is usually lower than in the general population, but at least 10% of these workers will develop metabolic syndrome7-9 or cardiovascular disease within the next 10 years.10,11
In a Colombian study of health care workers, 21% were obese, 46.4% overweight, and 13.2% had metabolic syndrome according to the NCEP-ATP III criteria.12 In Mexico, according to the ENSANUT 2012, combined overweight-obesity prevalence is higher in women (73%) than men (69.4%) as well as obesity (37.5% of men compared to 26.8% of women). Mexico is undergoing a process of unprecedented increase in the prevalence of obesity and is among the countries that have most rapidly developed this disease, where 7 out of 10 adults are overweight and, of these, half are obese. From 1988 to 2012 overweight women aged 20 to 49 years of age increased from 25 to 35.3% and obesity increased from 9.5 to 35.2%.13
Previous studies of Mexican hospital personnel documented prevalence of overweight at 15-40% and obesity at 20-31%.14-17
Transversal, descriptive, epidemiological design was executed from January 2014 to April 2014 by open verbal and written call to 2600 hospital workers at Hospital de Especialidades Centro Médico Nacional La Raza, Hospital “Dr. Antonio Fraga Mouret”. They were given a self-administered survey that asked for demographics, cardiovascular risk factors, physical activity habits, tobacco use, and junk food and alcohol consumption. Anonymity and free participation were ensured by signing the informed consent.
The degree of obesity was defined by calculating the body mass index (BMI), weight (kg)/height (m2).2 We adjusted the concept of obesity for the Mexican population to BMI ≥ 27 and for low height ≥ 25; overweight BMI > 25 to < 27 and adjusted for low height > 23 to < 25, as stated in the Norma Oficial Mexicana NOM-008-SSA3-2010. Waist/height index was also calculated.
Following the WHO criteria (1995) and adapted to 1995, 2000, and 2004,3 we classified the different degrees of obesity as Normal, BMI 18.50-24.99; Obese class I, BMI 30.00-34.99; Obese class II, BMI 35.00-39.99; Obese class III, BMI ≥ 40.00.
We define metabolic syndrome (MS) by the presence of three or more of the following components of the Adult Treatment Panel III (ATP III):4 abdominal obesity (waist circumference > 102 cm in men and > 88 cm in women); triglycerides ≥ 150 mg/dl; low HDL cholesterol (≤ 40 mg/dL in men, ≤ 50 mg/dL in women); blood pressure ≥ 130/85 mmHg; fasting hyperglycemia ≥ 110 mg/dl.
We included 311 physicians (42.3%), 216 nurses (29.4%), and 208 other workers including administrative staff, general services, nutrition, and laboratory staff (28.3%). 24 subjects were excluded because they had a chronic pathology that could explain altered lipid and carbohydrate metabolism (hypothyroidism, myasthenia gravis, known diabetes).
Of those surveyed, 270 were visited at their workplace and 465 were given appointments at the office of health services for trained clinical personnel to perform the examination.
Blood pressure was measured with Citizen-brand CH 452 automatic sphygmomanometer, recommended by dabl-Educational trust, to avoid errors by alteration in hearing, and according to the guidelines established by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC).
Body weight was taken using a BAME-brand scale up to 150 kg with an accuracy of 100 g. Participants were weighed with normal work clothing, without shoes or coat. Height was taken with the scale stadiometer (precision: 0.1 cm). Waist circumference was measured at the midpoint between the costal margin and the iliac crest.
Of all the participants, we took a random sample of 250 individuals to determine their lipid profile and blood chemistry. 5 ml of venous blood was taken after fasting for 8-10 hours, which evaluated total cholesterol, cholesterol bound to low density lipoprotein (LDL C), and high density (HDL C), triglycerides, and fasting glucose. Blood glucose and lipid profile were determined by ARCHITECT c800 machines from the company Falcon. Glucose was determined with glucose oxidase technique, cholesterol was determined with esterase oxidase procedure, and triglycerides with peroxidase oxidase.
Descriptive statistics of the variables of interest were applied, the data were recorded in the program Microsoft Excel 2010 and analyzed using SPSS version 20; to analyze group results Pearson’s chi-squared test was used, significant value of p < 0.05.
A total of 735 people were surveyed: 311 physicians (237 residents, 71 staff specialists, and 3 medical service directors), 216 nurses, 78 nutritionists and dietitians, 12 laboratory workers, 59 administrative staff, and 59 general service. The average age of medical staff was 30.6 years, nurses 34.7 and other staff 38.9; 67.5% were female and 32.5% male.
The greatest prevalence of ideal weight was found between ages 20 and 29, overweight between 40 and 49 years, and obesity from 50 to 59 years of the working female population. For men the prevalence was reversed, with more overweight between 50-59 years and more obesity from 40 to 49 years. The overall prevalence of overweight was 37.8% and adjusted for low height 37.2%; men had a higher percentage of overweight, with 51.5% versus 31.9% in women. The overall prevalence of obesity was 22%; 26% in females versus 15.1% in males; after adjusting the overall prevalence of obesity for low height, it rose from 22 to 23.9% (Table I). By body mass index (BMI) we found obesity class I in 17.3%, obesity class II in 4.5%, and obesity class III in 1.36% (Table II). Waist circumference was greater in staff who were not doctors or nurses in both females and males, with the female medical staff having the lowest waist circumference (Table IV). The waist/height index in the group of ideal weight was 0.48 ± 0.04, in the overweight group 0.55 ± 0.04, and the obesity group in 0.65 ± 0.064. The prevalence of waist/height ratio above 0.5 was 36.2% in the ideal BMI group, 89.2% in the overweight group, and 100% in the group with obesity, which together corresponds to 68% of the representative sample of the personnel working in this hospital. We found blood pressure > 135/85 mmHg in 2% of the study population. (Table III).
|Table I Prevalence of ideal weight, overweight, and obesity by gender and age group|
|WHO, World Health Organization.|
|Table II Prevalence of ideal weight, overweight, and different degrees of obesity by age group|
|n= 316||n= 224||n= 144||n= 48||n= 735|
|Metabolic s. %||13.80%||20.50%||47.40%||46.70%||30.60%|
|Fasting glucose % 100 - 125 mg/dL||10.80%||15.10%||31.60%||36.70%||22.50%|
|Triglycerides > 150||28.80%||37.50%||46.10%||56.70%||40.60%|
|Table III Prevalence of ideal weight, overweight, and different degrees of obesity by occupational category and the population requiring adjustment for low height|
n = 208
N = 735
|Body mass index||Ideal||155(49.8)||70(32.4)||58(27.9)||283(38.5)|
|Adjusted for low height
n = 56
|High blood pressure||> 135/85||6(5.6)||3(4.1)||7(21.2)||16(2.2)|
|Table IV Waist circumference|
|Mean ± SD||Mean ± SD|
|*p< 0.05student's t;SD standard deviation|
Of the 244 included with lipid profile results, 39/186 women (20.9%) and 14/58 men (24.1%) were detected with impaired fasting glucose; 2.2% of workers with hypertension; 77 women (41.2%) and 22 men (37.9%) with hypertriglyceridemia; and 55 women (28.8%) and 17 men (29.3%) with hypercholesterolemia. The prevalence of metabolic syndrome was 29.4% among females and 34.5% among males, and proportion according to age group. Hypertriglyceridemia was the most common component of metabolic syndrome in the study population (Table II).
Smoking was presented in 21.6%, alcohol consumption in 35.1%, junk food in 89%, and physical inactivity in 65.4%. Doctors smoke less, nurses consume less alcohol, and other staff exercise less (Table V).
|Table V Habits and addictions|
|% (units/day)||% (units/day)||% (units/day)||%|
|Alcohol (days/month)||43.2(1-15)||13.7(1-5) *||39.4(1-10)||35.1|
|Exercise (days a week)||43.8(1-7)||50.7(1-7)||36.4(1-7) *||44.6|
|*p< 0.05 chi-squared|
The overall prevalence of overweight or obesity in hospital health workers was 61%, which is slightly lower than the 71.3% reported by the ENSANUT 2012 for the Mexican general population. Males had 8.5% higher prevalence of overweight and lower obesity prevalence than for the general male population according to the same survey. In women the prevalence of overweight was 4% lower and obesity 11% lower than in the general population as reported in ENSANUT 2012.13
Regarding category, a higher percentage of overweight was found among physicians (39.9%) and a higher percentage of obesity among nursing staff (24.5%), which is different compared to that found by Palacios-Rodriguez et al. in a family medicine unit in the metropolitan area of the Valley of Mexico where family physicians-dentists have higher prevalence of overweight and obesity (20 and 38% respectively).14 For age, the trend was different because only the economically active population was included, with a greater representation of the of 20-29 age group.
The prevalence of metabolic syndrome using the ATP-III criteria was higher in males, which is different from other research where females are more affected; further, increased rate compared with age is noted. The prevalence of metabolic syndrome is higher than that found in the general population in our country.
However, the overall prevalence of metabolic syndrome in this study is underestimated because the age range of participants was greater in the 20-29 age group and because the target population was healthy workers, excluding those already known to be diabetic or hypertensive. It is significantly higher than the prevalence reported in Argentina or Chile, for which we have no clear explanation; racial, nutritional, or both factors could be involved. While there are no studies on the prevalence of metabolic syndrome among indigenous populations in our country, the majority are of mixed race, as is the study group. Indigenous peoples who have adopted western lifestyles have higher prevalence of metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease.17
The influence of the female gender in this study is overrepresented because of greater participation of women in it. Moreover, in this study population there is a high prevalence of poor eating habits, sedentary lifestyle, and substance addiction. General population studies highlight the importance of treating patients with overweight, obesity, and metabolic syndrome in order to prevent or delay the development of diabetes and cardiovascular disease. We found a fifth of participants with impaired fasting glucose and 5% in diabetes ranges. The glucose threshold that implies increased cardiovascular risk has been debated throughout the world, but the risk of developing coronary heart disease in patients with serum glucose between 110 and 125 mg/dl is very similar to that conferred by diabetes. However, men have a higher absolute risk of cardiovascular events and a progressive incidence starting from 100 mg/dl, up to 20% within the next four years in the presence of diabetes.18
Waist circumference relative to height or waist/height ratio is better than circumference or BMI alone to predict cardiovascular disease, and has shown strong correlation with > 130 cm2 of visceral fat and high sensitivity (81.6%) and specificity (78%) in the 20-59 age range. It is recommended to consider that the waist should not be greater than half the height for an individual to be considered healthy, which corresponds to a maximum waist/height index of 0.5.19 The health personnel included in our study presented a waist/height index greater than 0.5 in 36% of individuals with ideal BMI, in almost all of those who were overweight, and in all who were obese, meaning that 68% of all staff have an elevated risk of cardiovascular disease.
Modifying lifestyle tends to normalize all risk factors, delaying the appearance of irreversible complications that lead to increased morbidity and overall mortality, making it necessary to intervene in the behavior and awareness of staff in the health area.
Numerous epidemiological studies have shown that insufficient sleep is associated with the risk of overweight and obesity, while stress is involved in the creation of hypertension; both conditions, sleep deprivation and stress, are present in health personnel, but were not analyzed in this study.20 However, this study can serve as a basis for implementing primary prevention measures, primarily diet, exercise, smoking cessation, and decreased consumption of junk food, as they are the main modifiable risk factors. It is essential that workers experience the beneficial effects of the change in lifestyle, since otherwise it will be difficult to convince the general population to adopt healthy lifestyles.
Obesity and metabolic syndrome are complex and heterogeneous clinical entities with a strong genetic component, whose expression is influenced by environmental, social, cultural, and economic factors. Health workers in a Mexican hospital have a high prevalence of obesity-overweight corresponding to 61%, associated with predominant visceral fat distribution reflected by an elevated waist/height index in more than two thirds of them. Furthermore, a fifth of this risk group had fasting glucose higher than 100 mg/dl, which is a factor that multiplies the coronary and cardiovascular risk in the short and medium terms. In the set of criteria involved in metabolic syndrome by ATP III, we found that one of every 3 individuals has three or more of them.
Conflict of interest statement: The authors have completed and submitted the form translated into Spanish for the declaration of potential conflicts of interest of the International Committee of Medical Journal Editors, and none were reported in relation to this article.