Our study assessed the cardio-metabolic risk among medical students in a selected Faculty of Medicine in Colombo. We found a significantly high prevalence of hypercholesterolemia, low HDL levels, prehypertension, physical inactivity with sedentary life style and inadequate fruit and vegetable consumption.
While no one was having hypertension in our study sample, 4% had pre-hypertension, which marks a risk of developing hypertension in future and this could be a result of unhealthy diet and stressful lifestyle as well as familial tendency. When compared to results from other studies done in the region and the world (8, 19, 20, 21, 22, 23), this prevalence is not high. According to these studies, the prevalence of hypertension among medical students and other undergraduates with ages ranging from 18 to 36 years, varied between 1.3% and 17% while the prevalence of pre-hypertension was much higher. Relatively low prevalence in the current study could be due to the subjects being very young and of a narrow age range (mean age 23 years SD ± 1.7 years) and belonging a different ethnicity. This could be considered as a warning that hypertension and other associated CVD risk factors are health problems beginning from a young age group and with time it could adversely affect the health of future generations. This would not only increase morbidity and decrease productivity of the work force, but also adversely affect the longevity of the population by way of reducing the high level of life expectancy at birth that had been achieved.
Dyslipidemia was the most prevalent modifiable risk factor for CVD among the respondents (46.6%, n = 88). This would be an unexpected result as it is not the practice to screen for dyslipidemia in a healthy group of young adults like our study population. The studies that have assessed the CVD risk among medical students and other university students report prevalence of 8–9% of hypertriglyceridaemia, 14–24% of low HDL and 9.1–26% of hypercholesterolaemia (8, 9, 19, 20). The prevalence of hypercholesterolaemia and low HDL reported in the current study are higher than the previous studies. The significantly high prevalence (28%) of hypercholesterolemia associated with other dyslipidemias in this young age group shows the need to begin screening from a younger age. An important observation made in these students with dyslipidemia, is that 86% were having normal BMI while only 14% were overweight or obese. Other anthropometric indices like WC, WHR and WHtR were also normal in a large majority. However, most of them had a family history of dyslipidemia. Therefore, it highlights the importance of initiation of early screening in those with a family history of dyslipidemia, rather than waiting for later age or development of abnormal anthropometric indices. This highlights the importance of adopting healthy lifestyle (diet and physical activity) in all ages and in all nutritional status as people who would be considered otherwise ‘normal’ could go undetected and present with a life-threatening event such as myocardial infarction later in life. Screening can help early detection of any adverse health state and help to take remedial measures in advance thus enabling to prevent the occurrence of such adverse health events.
Dysglycaemia (diabetic and prediabetic states) was seen in 14.4% of the study population and this is somewhat high compared to previous findings of 9% (20) and 1% (9) among college students and medical students, however, the latter study using a cut off of 110 mg/dl. A majority with dysglycaemia were either normal or underweight and had normal WC, WHR and WHtR. These were young healthy persons without features of type I diabetes mellitus. This means these young persons are at risk of type II diabetes mellitus despite having normal BMI and central obesity related parameters. This highlights the importance of actively screening young adults for diabetes and other metabolic diseases (24).
Prevalence of any metabolic abnormality in this population was very high, with only 38% (n = 71) being free of metabolic abnormalities. Forty percent (n = 74) had one metabolic abnormality while 22% (n = 41) had two or more metabolic abnormalities with majority having normal anthropometric markers. This denotes its limitation under the present cutoff values. There were three students (two males and one female) having metabolic syndrome. All of them had family history of CVD showing that individuals with high risk shows that onset of illness is from a younger age. This study shows that even the so called ‘knowledgeable’ sectors of the community are at risk of developing NCDs from a very younger age thus contributing to this ever increasing disease burden.
The prevalence of alcohol consumption was 9%, which is less in comparison to other studies (11, 22). We expected it to be so, since medical students have knowledge about the adverse health outcomes associated with alcohol. Zero rate of smoking in our study is a factor that could be hailed with the control measures operating in the country. However, the alcohol consumption and prevalence of smoking could have been underestimated due to selection bias, non divulgence or due to majority of sample being females.
Prevalence of other risk factors of NCD was high in this population. A majority did not consume adequate amounts of fruits while about half of the population did not consume the recommended amount of vegetables. The poor diversity in their dietary behavior highlight the importance of introducing nutritious food at affordable cost in the faculty canteens and hostels. About 40% of the total sample and nearly half of the females did not engage in adequate physical activities. About one third of the sample had a sedentary lifestyle. Unavailability of facilities for physical activity within the faculty premises could have intensified this situation. Although we didn’t identify significant associations between sedentary life style and metabolic markers, the curricular and lack of space within the premises may promote sedentary behavior. Special awareness campaigns would be advantageous to improve physical activities among medical students in order to maintain a healthy life.
Our study had some limitations. Some variables like diet, physical activity and substance use were assessed using self-report information which could be subjected to reporting bias, especially given the high level of knowledge on the expected healthy behaviours. Recruitment of participants into the study was purely voluntary, which could have created a selection bias. It would be interesting to carry out such screening program in other medical schools of the country and among university students of other streams.