Demographic and clinical characteristics of study subjects: Table 1
Table 1
Demographic and clinical characteristics of study subjects relative to age, gender, stage of adolescence and Body-Mass-Index-for- age.
|
All
|
Gender
|
Stage of adolescence
|
Body Mass Index for age (Mean ± sd: -0.48 (1.32)
|
|
Male
|
Female
|
Early
|
Mid
|
Late
|
Under
Weight
BMI < 5th pctl
|
Healthy
BMI ≥ 5th < 85th pctl
|
Over
Weight BMI ≥ 85th < 95th pctl
|
Obese BMI ≥ 95th pctl
|
Total
|
Freq.
|
624
|
241
|
383
|
300
|
207
|
117
|
108*
|
466**
|
30!
|
20!!
|
%
|
100.0
|
38.6
|
61.4
|
48.1
|
33.2
|
18.7
|
17.5
|
74.7
|
4.8
|
3.2
|
Age
|
Mean (± sd)
|
14.7 (2.1)
|
14.8 (2.2)
|
14.7 (2.1)
|
12.9 (1.3)
|
15.6 (0.5)
|
17.8 (0.7)
|
15.3 (2.0)
|
14.7 (2.1)
|
13.6 (2.3)
|
13.4 (2.1)
|
WC < 94 cm (male)
|
Freq (%)
|
-
|
240 (99.6)
|
-
|
109 (99.1)
|
84 (100.0)
|
47 (100.0)
|
56 (51.4)
|
170 (36.5)
|
9 (30.0)
|
5 (26.3)
|
Mean (± sd)
|
-
|
64.9 (6.5)
|
-
|
63.6 (6.6)
|
65.3 (5.8)
|
67.2 (7.1)
|
59.7 (4.9)
|
65.8 (5.3)
|
68.9 (8.3)
|
79.9 (9.1)
|
WC ≥ 94 cm (male)
|
Freq (%)
|
-
|
1 (0.4)
|
-
|
1 (0.9)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
1 (5.3)
|
Mean (± sd)
|
-
|
98.0 (0.0)
|
-
|
98.0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
98.0 (0.0)
|
WC < 80 cm (female)
|
Freq (%)
|
-
|
-
|
366 (95.6)
|
178 (93.7)
|
120 (97.6)
|
66 (94.3)
|
52 (47.7)
|
292 (62.7)
|
18 (60.0)
|
3 (15.8)
|
Mean (± sd)
|
-
|
-
|
64.8 (5.3)
|
64.1 (5.3)
|
65.4 (5.5)
|
66.0 (4.7)
|
59.0 (4.1)
|
64.5 (4.6)
|
71.7 (5.8)
|
69.0 (7.5)
|
WC ≥ 80 cm (female
|
Freq (%)
|
-
|
-
|
17 (4.4)
|
12 (4.0)
|
3 (2.4)
|
4 (5.7)
|
1 (0.9)
|
4 (0.9)
|
3 (10.0)
|
10 (52.6)
|
Mean (± sd)
|
-
|
-
|
84.8 (4.2)
|
85.9 (4.5)
|
84.7 (6.4)
|
82.3 (2.1)
|
85 (0.0)
|
82.5 (1.9)
|
83.0 (3.5)
|
85.8 (5.1)
|
FBS
|
Mean (± sd)
|
87.7 (41.5)
|
88.9 (38.9)
|
87.0 (43.0)
|
89.3 (44.2)
|
87.0 (40.2)
|
84.8 (36.3)
|
92.9 (36.4)
|
86.5 (42.8)
|
93.3 (41.4)
|
78.4 (32.1)
|
Low
|
Freq (%)
|
198 (31.7)
|
68 (28.2)
|
130 (33.9)
|
96 (32.0)
|
67 (32.4)
|
35 (29.9)
|
29 (26.6)
|
151 (32.4)
|
8 (26.7)
|
10 (52.6)
|
Mean (± sd)
|
47.1 (18.2)
|
48.3 (18.1)
|
46.5 (18.3)
|
47.5 (17.8)
|
47.8 (18.3)
|
45.0 (19.3)
|
50.2 (17.5)
|
46.2 (18.3)
|
44.8 (21.1)
|
54.7 (15.8)
|
Normal
|
Freq (%)
|
234 (37.5)
|
101 (41.9)
|
133 (34.7)
|
108 (36.0)
|
79 (38.2)
|
47 (40.2)
|
34 (31.2)
|
185 (39.7)
|
10 (33.3)
|
5 (26.3)
|
Mean (± sd)
|
85.5 (9.7)
|
87.2 (9.4)
|
86.1 (10.0)
|
86.2 (10.4)
|
87.1 (9.2)
|
86.5 (9.2)
|
85.5 (8.4)
|
86.7 (10.1)
|
86.5 (8.2)
|
88.9 (6.5)
|
Impaired
|
Freq (%)
|
119 (19.1)
|
48 (19.9)
|
71 (18.5)
|
53 (17.7)
|
39 (18.8)
|
27 (23.1)
|
31 (28.4)
|
79 (17.0)
|
7 (23.3)
|
2 (10.5)
|
Mean (± sd)
|
110.5 (9.2)
|
109.5 (11.6)
|
111.1 (7.2)
|
110.5 (11.8)
|
110.6 (6.3)
|
110.1 (6.8)
|
111.7 (7.6)
|
109.8 (9.8)
|
113.6 (9.4)
|
107.0 (5.4)
|
Diabetic
|
Freq (%)
|
73 (11.7)
|
24 (10.0)
|
49 (12.8)
|
43 (14.3)
|
22 (10.6)
|
8 (6.8)
|
15 (13.8)
|
51 (10.9)
|
5 (16.7)
|
2 (10.5)
|
Mean (± sd)
|
164.6
(46.3)
|
170.0
(38.8)
|
161.8
(49.7)
|
164.7
(48.2)
|
164.6 (46.4)
|
164.0 (40.6)
|
153.4
(26.5)
|
169.6 (52.1)
|
155.8
(30.8)
|
141.5 (18.8)
|
Systolic
BP
|
Mean (± sd)
|
108.3 (12.4)
|
108.6
(13.9)
|
108.2
(11.4)
|
106.9
(12.5)
|
109.5 (12.7)
|
109.8 (11.4)
|
101.4
(12.4)
|
109.4 (11.9)
|
113.8
(12.8)
|
113.4 (11.0)
|
Low
|
Freq (%)
|
41 (6.6)
|
22 (9.1)
|
18 (4.7)
|
22 (7.3)
|
14 (5.2)
|
5 (4.3)
|
22 (20.2)
|
17 (3.6)
|
2 (6.7)
|
0 (0.0)
|
Mean (± sd)
|
83.9 (5.1)
|
84.9 (4.4)
|
82.6 (5.7)
|
84.0 (5.3)
|
83.9 (4.8)
|
82.8 (5.7)
|
84.2 (4.5)
|
83.0 (6.0)
|
87.0 (2.8)
|
0 (0.0)
|
Normal
|
Freq (%)
|
472 (75.6)
|
162 (67.2)
|
310 (80.9)
|
235 (78.3)
|
146 (70.5)
|
91 (77.8)
|
80 (73.4)
|
359 (77.0)
|
18 (60.0)
|
15 (78.9)
|
Mean (± sd)
|
106.2 (7.7)
|
105.4 (7.8)
|
106.5 (7.6)
|
105.4 (7.9)
|
106.6 (7.4)
|
107.6 (7.4)
|
104.0 (7.9)
|
106.4 (7.6)
|
109.3 (7.0)
|
109.0 (7.0)
|
Pre-HT
|
Freq (%)
|
84 (13.5)
|
39 (16.2)
|
45 (11.7)
|
32 (10.7)
|
36 (17.4)
|
16 (13.7)
|
5 (4.6)
|
72 (15.5)
|
5 (16.7)
|
2 (10.5)
|
Mean (± sd)
|
123.9 (2.9)
|
124.3 (2.8)
|
123.6 (3.0)
|
123.7 (2.9)
|
124.1 (3.1)
|
124.0 (2.9)
|
122.4 (2.2)
|
124.1 (3.0)
|
122.3 (2.6)
|
126.5 (3.5)
|
Stage 1 HT
|
Freq (%)
|
24 (3.8)
|
15 (6.2)
|
9 (2.3)
|
9 (3.0)
|
10 (4.8)
|
5 (4.3)
|
2 (1.8)
|
15 (3.2)
|
5 (16.7)
|
2 (10.5)
|
Mean (± sd)
|
132.9 (2.0)
|
133.1 (1.8)
|
132.7 (2.4)
|
133.0 (2.3)
|
132.9 (1.9)
|
132.8 (2.2)
|
133.5 (2.1)
|
133.1 (1.9)
|
132.0 (1.4)
|
133.5 (4.9)
|
Stage 2 HT
|
Freq (%)
|
3 (0.5)
|
2 (0.8)
|
1 (0.3)
|
2 (0.7)
|
1 (0.5)
|
0 (0.0)
|
0 (0.0)
|
3 (0.6)
|
0 (0.0)
|
0 (0.0)
|
Mean (± sd)
|
147.3 (9.3)
|
142.0 (1.4)
|
158.0 (0.0)
|
150.5 (10.6)
|
141.0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
147.3 (9.3)
|
0 (0.0)
|
0 (0.0)
|
Diastolic BP
|
Mean (± sd)
|
66.2 (9.5)
|
65.1 (10.3)
|
67.0 (9.0)
|
65.6 (9.4)
|
67.0 (10.2)
|
66.6 (8.8)
|
62.5 (10.1)
|
66.6 (9.1)
|
70.7 (11.1)
|
71.1 (7.6)
|
Low
|
Freq (%)
|
299 (47.9)
|
129 (53.5)
|
170 (44.4)
|
152 (30.7)
|
96 (46.4)
|
51 (43.6)
|
71 (65.1)
|
214 (45.9)
|
10 (33.3)
|
4 (21.1)
|
Mean (± sd)
|
58.4 (5.6)
|
57.6 (5.9)
|
59.1 (5.4)
|
58.3 (5.4)
|
58.2 (5.6)
|
59.1 (6.3)
|
56.7 (6.4)
|
58.9 (5.3)
|
59.0 (5.8)
|
62.3 (2.5)
|
Normal
|
Freq (%)
|
278 (44.6)
|
92 (38.2)
|
186 (48.6)
|
128 (42.7)
|
88 (42.5)
|
62 (53.0)
|
33 (30.3)
|
220 (47.2)
|
14 (46.7)
|
11 (57.9)
|
Mean (± sd)
|
71.4 (3.7)
|
71.1 (3.7)
|
71.6 (3.7)
|
71.1 (3.9)
|
71.9 (3.5)
|
71.5 (3.6)
|
71.2 (3.3)
|
71.5 (3.8)
|
72.4 (4.1)
|
70.2 (3.4)
|
Pre-HT
|
Freq (%)
|
39 (6.3)
|
16 (6.6)
|
23 (6.0)
|
18 (6.0)
|
18 (8.7)
|
3 (2.6)
|
3 (2.8)
|
27 (5.8)
|
5 (16.7)
|
4 (21.1)
|
Mean (± sd)
|
83.3 (2.9)
|
83.9 (3.2)
|
82.9 (2.6)
|
83.6 (3.3)
|
83.0 (2.3)
|
83.7 (4.0)
|
83.0 (3.6)
|
83.3 (2.5)
|
84.4 (4.2)
|
82.5 (4.4)
|
Stage 1 HT
|
Freq (%)
|
8 (1.3)
|
4 (1.7)
|
4 (1.1)
|
2 (0.7)
|
5 (2.4)
|
1 (0.9)
|
2 (1.8)
|
5 (1.1)
|
1 (0.3)
|
0 (0.0)
|
Mean (± sd)
|
93.6 (3.4)
|
92.8 (2.4)
|
94.5 (4.4)
|
98.0 (2.8)
|
92.0 (2.3)
|
93 (0.0)
|
91.5 (0.7)
|
94.0 (4.1)
|
96.0 (0.0)
|
0 (0.0)
|
Dyslipidemia
|
Yes
|
Freq (%)
|
53 (8.5)
|
26 (10.8)
|
27 (7.1)
|
25 (8.3)
|
20 (9.7)
|
8 (6.8)
|
9 (8.3)
|
38 (8.2)
|
2 (6.7)
|
4 (21.1)
|
No
|
571 (91.5)
|
215 (89.2)
|
356 (72.9)
|
275 (91.7)
|
187 (90.3)
|
109 (93.2)
|
100 (91.7)
|
428 (91.8)
|
28 (93.3)
|
15 (78.9)
|
* of the 108 underweight subjects, 56 (51.9) were males and 52 (48.2%) were females; **of the 466 healthy weight subjects, 170 (36.5%) were males and 296 (63.5%) were females; !of the 30 overweight subjects, 9 (30.0%) were males and 21 (70.0%) were females; !!of the 20 obese subjects 6 (30.0%) were males and 14 (70.0%) were females |
A total of 650 adolescents were initially recruited for the study but the data of only 624 (96.0%), 241 (38.6%) males and 383 (61.4%) females, were finally analyzed. Data from 26 (4.0%) were excluded because of missing or incomplete information. The mean (± sd) age of the study participants was 14.7 (2.1) ranging from 10 to 19 years. Overall, 48.1%, 33.2% and 18.7% of the study participants were categorized as early, mid, and late adolescents and 17.5%, 74.7%, 4.8% and 3.2% were classified as underweight, healthy weight, overweight, and obese respectively according to their Body-Mass-Index-for -Age (BMI-for-Age). Only 1 (0.4%) male, early adolescent and obese, had waist circumference ≥ 94cm while 17 (4.40%) females had waist circumference ≥ 80 cm. Overall mean (± sd) FBS (mg/dl) was 87.7 (41.5), highest among males at 88.9 (38.9), early adolescents at 89.3 (44.2) and overweight at 93.3 (41.4) values. Impaired and diabetic FBS were observed in 19.1% and 11.7% of the subjects. The overall mean (± sd) systolic BP (mmHg) was 108.3 (12.4). In all, 13.5%, 3.8% and 0.5% subjects presented with systolic pre-hypertension, stage 1 hypertension, and stage 2 hypertension respectively. The mean diastolic BP (mmHg) was 66.2 (9.5) with 6.3% and 1.3% presenting with diastolic pre-hypertension and stage 1 hypertension. The overall prevalence of dyslipidemia was 8.5%, higher in males (10.8%), in mid adolescents (9.7%) and in obese (21.1%) subjects.
Biochemical parameters and triglyceride/HDL ratio relative to gender, stage of adolescence and BMI-for age among the study subjects. Table 2. Figures 1 and 2.
Table 2
Biochemical parameters and triglyceride/HDL ratio relative to gender, stage of adolescence and BMI-for-Age.
|
|
Gender
|
Stage of adolescence
|
BMI-for-Age
|
|
All
|
Male
|
Female
|
t-test
(P-value)
|
Early
|
Mid
|
Late
|
F-ratio
|
Under-weight
|
Healthy weight
|
Over-weight
|
Obese
|
F-ratio
|
|
624
|
241
|
383
|
300
|
207
|
117
|
108 **
|
466 !!
|
30 ##
|
20@
|
Triglyceride
|
All
|
Mean ± sd
|
199.4 (113.1)
|
206.7 (122.2)
|
194.8 (106.9)
|
0.90 (0.37)
|
184.8 (99.1)
|
215.4 (123.6)
|
208.5 (123.1)
|
5.07 (0.007)
|
188.7 (100.7)
|
201.2 (115.7)
|
216.3 (116.2)
|
190.1 (114.4)
|
0.67 (0.57)
|
Median
|
180.8
|
187.1
|
179.5
|
171.6
|
195.0
|
187.8
|
180.8
|
179.9)
|
205.9
|
180.2
|
≥ 130 mg/dl
|
Freq. (%)
|
440 (70.5)
|
172 (71.4)
|
268 (70.0)
|
1.61 (0.11)
|
204
(68.0)
|
151
(72.9)
|
85
(72.6)
|
4.33 (0.01)
|
77
(71.3)
|
327
(70.2)
|
22
(73.3)
|
14 (70.0)
|
1.71 (0.63)
|
Mean (± sd)
|
246.6 (100.6)
|
256.5 (108.6)
|
240.2 (94.8)
|
231.8 (83.7)
|
260.8
(114.0)
|
256.8
(108.6)
|
232.3 (83.3)
|
249.4 (104.1)
|
260.9 (103.1)
|
238.0 (103.3)
|
Median
|
218.1
|
224.1
|
214.8
|
213.5
|
227.2
|
220.5
|
204.5
|
219.1
|
228.2
|
205.7
|
χ² (P-value) /
OR (95% CI)
|
M vs F: 0.14 (0.71) / 1.07 (0.75, 1.51)
F vs M: 0.14 (0.71) / 0.93 (0.66, 1.33)
|
Mid vs Early: 1.76 (0.42) / 1.27 (0.79, 2.00)
Late vs Early: 1.76 (0.42) / 1.25 (0.71, 2.15)
|
Obese vs Underweight: 0.23 (0.97) / 1.16 (0.29, 3.80)
Obese vs Healthy: 0.23 (0.97) / 1.19 (0.32, 3.54)
Obese vs overweight: 0.23 (0.97) / 1.02 (0.21, 4.48)
|
Total Cholesterol
|
All
|
Mean ± sd
|
205.8 (87.1)
|
206.3 (83.5)
|
205.5 (89.5)
|
0.11 (0.91)
|
214.7
(97.2)
|
199.0 (74.0)
|
195.2 (79.5)
|
2.99 (0.05)
|
207.4
(78.1)
|
204.2
(89.0)
|
210.4
(80.9)
|
227.5 (100.4)
|
0.40 (0.75)
|
Median
|
199.4
|
204.7
|
198.0
|
207.3
|
198.1
|
192.5
|
204.1
|
198.0
|
213.9
|
228.9
|
≥ 200 mg/dl
|
Freq. (%)
|
310 (49.7)
|
123 (51.0)
|
187 (48.8)
|
0.18 (0.86)
|
157
(52.3)
|
98
(47.3)
|
55
(47.0)
|
3.54 (0.03)
|
55 (50.9)
|
226 (48.5)
|
16 (53.3)
|
13 (65.0)
|
0.13
(0.94)
|
Mean (± sd)
|
272.0 (67.6)
|
271.6 (53.6)
|
272.3 (75.5)
|
281.6 (82.0)
|
261.4 (48.2)
|
263.8
(44.4)
|
268.4 (54.6)
|
272.5 (71.0)
|
271.2 (54.1)
|
280.9 (76.8)
|
Median
|
253.6
|
260.9
|
249.5
|
255.9
|
247.8
|
252.4
|
256.4
|
252.6
|
250.4
|
277.1
|
χ² (P-value) /
OR (95% CI)
|
M vs F: 0.29 (0.59) / 1.09 (0.79, 1.50)
F vs M: 0.29 (0.59) / 0.92 (0.66, 1.26)
|
Early vs Mid: 1.63 (0.44) / 1.22 (0.80, 1.86)
Early vs Late: 1.76 (0.42) / 1.24 (0.74, 2.05)
|
Obese vs Underweight: 3.12 (0.37) / 2.13 (0.57, 6.69)
Obese vs Healthy: 3.12 (0.37) / 2.30 (0.67, 6.72)
Obese vs Overweight: 3.12 (0.37) / 1.90 (0.41, 7.48)
|
LDL-C
|
All
|
Mean ± sd
|
312.3 (256.9)
|
280.7 (227.7)
|
332.3(272.1)
|
2.55 (0.01)
|
337.1 (296.7)
|
294.1 (199.0)
|
281.2 (232.6)
|
2.67 (0.07)
|
331.6 (340.2)
|
306.7 (231.8)
|
340.4 (339.9)
|
298.4 (131.1)
|
0.30 (0.83)
|
Median
|
289.6
|
271.5
|
295.4
|
295.2
|
284.6
|
273.1
|
265.7
|
290.1
|
298.6
|
322.4
|
≥130 mg/dl
|
Freq. (%)
|
536 (85.9)
|
204
(84.6)
|
332
(86.7)
|
2.33 (0.02)
|
260 (86.7)
|
176 (85.0)
|
100 (85.5)
|
2.80 (0.06)
|
99
(91.7)
|
393
(84.3)
|
27
(90.0)
|
17 (85.0)
|
0.11
(0.95)
|
Mean (± sd)
|
351.0 (256.9)
|
318.2 (227.7)
|
371.3 (271.6)
|
377.4 (298.6)
|
332.0 (191.7)
|
316.0 (233.8)
|
357.67 (344.5)
|
349.6 (227.2)
|
364.6 (350.7)
|
324.2 (114.3)
|
Median
|
305.4
|
293.9
|
315.0
|
315.2
|
303.9
|
282.9
|
291.1
|
310.3
|
306.0
|
335.8
|
χ² (P-value) /
OR (95% CI)
|
M vs F: 0.30 (0.58) / 0.88 (0.56, 1.37)
F vs M: 0.30 (0.58) / 1.14 (0.73, 1.79)
|
Early vs Mid: 0.29 (0.86) / 1.14 (0.64, 2.08)
Early vs Mid: 0.29 (0.86) / 1.11 (0.56, 2.30)
|
Overweight vs Healthy: 4.03 (0.26) / 1.67 (0.35, 4.91)
Obese vs Healthy: 4.03 (0.26) / 1.58 (0.25, 5.02)
Underweight vs Healthy: 4.03 (0.26) / 1.84 (0.72, 4.01)
|
HDL-C
|
All
|
Mean ± sd
|
65.7 (41.7)
|
65.7 (42.1)
|
65.7 (41.5)
|
0.00 (1.00)
|
67.0
(41.3)
|
65.0 (43.1)
|
63.6 (40.5)
|
0.32 (0.72)
|
69.0
(42.5)
|
65.0
(41.6)
|
68.0
(47.8)
|
62.0 (30.8)
|
0.37 (0.77)
|
Median
|
55.9
|
54.2
|
56.5
|
56.6
|
55.2
|
57.0
|
55.0
|
56.0
|
58.4
|
54.9
|
< 40 mg/dl
|
Freq. (%)
|
154 (24.7)
|
67 (27.8)
|
87 (22.7)
|
0.07 (0.95)
|
70
(23.3)
|
54 (26.1)
|
30
(25.6)
|
2.55 (0.08)
|
19
(17.6)
|
123
(26.4)
|
8
(26.7)
|
4 (20)
|
0.11
(0.96)
|
Mean (± sd)
|
26.1 (9.3)
|
26.1 (8.3)
|
26.0 (10.0)
|
27.5
(8.3)
|
25.9 (10.3)
|
23.0
(9.1)
|
26.2
(9.6)
|
26.0
(9.5)
|
26.6
(7.7)
|
28.6 (6.5)
|
Median
|
26.8
|
26.7
|
27.1
|
27.3
|
28.2
|
23.9
|
28.9
|
26.7
|
23.1
|
28.3
|
χ² (P-value) /
OR (95% CI)
|
M vs F: 2.06 (0.15 / 1.31 (0.91, 1.89)
F vs M: 2.06 (0.15 / 0.76 (0.53, 1.10)
|
Mid vs Early: 0.50 (0.78) / 1.16 (0.72, 1.89)
Late vs Early: 0.50 (0.78) / 1.06 (0.60, 1.93)
|
Obese vs Underweight: 4.02 (0.26) / 1.26 (0.36, 5.76)
Overweight vs Underweight: 4.02 (0.26) / 1.72 (0.56, 5.70)
Healthy vs Overweight: 4.02 (0.26) / 1.70 (0.83, 3.23)
|
Pre-HT/
HT
|
Freq. (%)
|
35 (5.6)
|
18 (7.5)
|
17 (4.4)
|
-
|
14
(4.7)
|
17
(8.2)
|
4
(3.7)
|
-
|
3
(2.8)
|
24
(5.2)
|
6
(20.0)
|
2 (10.0)
|
-
|
Ratio of Triglyceride: HDL ≥ 3:1
|
Yes
|
Freq. (%)
|
291 (46.6)
|
126 (52.3)
|
207 (54.1)
|
0.34 (0.74)
|
150
(50.0)
|
117 (56.5)
|
66
(56.4)
|
5.20 (0.006)
|
53
(48.6)
|
253
(54.3)
|
18
(60.0)
|
9 (45.0)
|
1.39 (0.25)
|
No
|
333 (53.4)
|
115 (47.7)
|
176 (45.9)
|
150
(50.0)
|
90 (43.5)
|
51
(43.6)
|
55
(50.9)
|
213
(45.7)
|
12
(40.0)
|
11 (55.0)
|
Mean (± sd)
|
5.30 10.4)
|
5.11 (4.5)
|
5.42 (11.9)
|
3.96
(4.40)
|
6.33 (12.44)
|
6.91 (15.78)
|
4.21
(6.78)
|
5.65
(11.52)
|
4.67
(4.35)
|
4.04 (3.63)
|
Median
|
3.17
|
3.12
|
3.17
|
3.00
|
3.72
|
3.25
|
2.98
|
3.19
|
3.56
|
2.84
|
χ² (P-value) /
OR (95% CI)
|
M vs F: 0.19 (0.67) / 0.93 (0.68, 1.28)
F vs M: 0.19 (0.67) / 1.07 (0.78, 1.48)
|
Mid vs Early: 2.63 (0.27) / 1.30 (0.85, 1.98)
Late vs Early: 2.63 (0.27) / 1.29 (0.78, 2.14)
|
Overweight vs Obese: 1.95 (0.58) / 1.67 (0.39, 6.66)
Overweight vs Underweight: 1.95 (0.58) / 1.58 (0.55, 4.28)
Healthy vs Obese: 1.95 (0.58) / 1.32 (0.44, 3.91)
|
BMI pctl
|
< 85
|
Freq. (%)
|
574 (92.0)
|
226 (93.8)
|
348 (90.9)
|
-
|
266
(88.7)
|
198 (95.7)
|
110
(94.0)
|
-
|
108
(100.0)
|
466
(100.0)
|
0
(0.0)
|
0 (0.0)
|
-
|
≥ 85
|
50 (8.0)
|
15 (6.2)
|
35 (9.1)
|
34
(11.3)
|
9
(4.3)
|
7
(6.0)
|
0
(0.0)
|
0
(0.0)
|
30
(60.0)
|
20 (40.0)
|
χ² (P-value) /
OR (95% CI)
|
M vs F: 1.70 (0.19) / 1.52 (0.80, 2.68)
F vs M: 1.70 (0.19) / 0.66 (0.37, 1.25)
|
Mid vs Early: 8.91 (0.01) / 2.81 (1.12, 6.07)
Late vs Early: 8.91 (0.01) / 2.01 (0.72, 4.59)
|
Overweight vs Obese: 624.00 (0.0001) / 1.00 (0.08, 5.50)
Overweight vs Underweight: 624.00 (0.0001) / -
Healthy vs Obese: 624.00 (0.0001) / 1014.00 (1.2x103, 8x105)
|
WC cm (m)
|
< 94
|
Freq. (%)
|
-
|
240 (99.6)
|
-
|
-
|
299 (99.1)
|
207 (100.0)
|
117 (100.0)
|
-
|
108 (100.0)
|
466 (100.0)
|
30 (100.0)
|
5 (83.3)
|
-
|
≥ 94
|
-
|
1 (0.4)
|
-
|
1
(0.9)
|
0
(0.0)
|
0
(0.0)
|
0
(0.0)
|
0
(0.0)
|
0
(0.0)
|
1 (16.7)
|
WC cm (f)
|
< 80
|
Freq. (%)
|
-
|
-
|
366 (95.6)
|
-
|
179 (94.2)
|
121 (98.4)
|
66 (94.3)
|
-
|
52 (100.0)
|
293 (99.4)
|
18 (85.7)
|
3 (21.4)
|
-
|
≥ 80
|
-
|
-
|
17 (4.4)
|
11 (5.8)
|
2 (1.6)
|
4 (5.7)
|
0 (0.0)
|
3 (0.6)
|
3 (14.3)
|
11 (78.6)
|
MetS
|
All
|
37 (5.9)
|
18 (7.5)
|
19 (5.0)
|
-
|
17 (5.7)
|
17 (8.2)
|
3 (2.6)
|
-
|
6 (5.6)
|
22 (4.7)
|
6 (20.0)
|
3 (15.0)
|
-
|
3 risk factors
|
32 (5.1)
|
15 (6.2)
|
17 (4.4)
|
|
12 (4.0)
|
17 (8.2)
|
3 (2.6)
|
|
6 (5.6)
|
22 (4.7)
|
3 (10.0)
|
1 (5.0)
|
-
|
4 risk factors
|
4 (0.6)
|
2 (0.8)
|
2 (0.5)
|
|
4 (1.3)
|
0 (0.0)
|
0 (0.0)
|
|
0 (0.0)
|
0 (0.0)
|
3 (10.0)
|
1 (5.0)
|
-
|
5 risk factors
|
1 (0.2)
|
1 (0.4)
|
0 (0.0)
|
|
1 (0.3)
|
0 (0.0)
|
0 (0.0)
|
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
1 (5.0)
|
-
|
** males (m) = 56 (51.9%), females (f) = 52 (48.1%); !! males = 170 (36.5%), females = 296 (63.5%); ## males = 9 (30.0%), females = 21 (70.0%); @ males = 6 (30.0%), females = 14 (70.0%), MetS = Metabolic syndrome |
A total of 536 (85.9%) subjects had plasma low-density lipoprotein of 130 mg/dl or higher, while 440 (70.5%) and 310 (49.7%) had plasma triglyceride level of 130 mg/dl or higher and plasma total cholesterol of 200 mg/dl or more. Low level of high-density lipoprotein below 40 mg/dl was observed in 154 (24.7%) subjects. Overall, 70.5%, 49.7%, 85.9% and 24.7% study subjects presented with high plasma levels of TG, TC, LDL-C and HDL-C respectively. Compared to females, males were 1.07, 1.09, and 1.31 more likely to present with hyper-triglyceridemia, hyper-cholesterolemia (total) and low level of high-density lipoprotein whereas females were 1.14 times more likely to have high levels of low-density lipoprotein. Mid-adolescents were approximately 1.27 times more likely to develop hypertriglyceridemia compared to early adolescents (χ² =1.76, P-value = 0.42, OR = 1.27, 95% CI = 0.79, 2.00) and obese subjects were 1.19 times more like to develop hypertriglyceridemia compared to underweight subjects (χ² =0.23, P-value = 0.97, OR = 1.19, 95% CI = 0.32, 3.54). Overall, 46.6% study subjects presented with triglyceride:HDL ratio ≥ 3:1, more prominent among females (χ² =0.19, P-value = 0.67, OR = 1.07, 95% CI = 0.78, 1.48) than males among mid (χ² =2.63, P-value = 0.27, OR = 1.30, 95% CI = 0.85, 1.98) compared to early or late adolescents and among overweight (χ² =1.13, P-value = 0.77, OR = 1.41, 95% CI = 0.52, 3.70) compared to obese study subjects. There was no significant difference in the proportion of females (207, 54.1%) and males (126, 52.3%) with triglyceride:HDL ratio ≥ 3:1. However, overweight subjects were over 1½ times as likely to present with triglyceride:HDL ratio ≥ 3:1 (χ²=1.94, P-value = 0.58, OR = 1.67, 95% CI: 0.39, 6.66) compared with obese subjects.
Estimation of individual risk factors for metabolic syndrome relative to gender, stage of adolescence and BMI-for-Age. Table 3, Figs. 3a-3c.
Table 3
Estimation of individual risk factors for metabolic syndrome relative to gender, stage of adolescence and BMI-for-age as defined by the presence of three of five known risk factors
Individual risk factors
for Metabolic
syndromes
|
All
|
Gender
|
Stage of adolescence
|
BMI-for-age
|
Male
|
Female
|
Early
|
Mid
|
Late
|
Under
weight
|
Healthy weight
|
Over
weight
|
Obese
|
N
|
624
|
241
|
383
|
300*
|
207!
|
117#
|
108 **
|
466 !!
|
30 ##
|
20@
|
Number of risk factors for metabolic syndrome
|
0
|
92 (14.7)
|
31 (12.9)
|
61 (15.9)
|
43 (14.3)
|
32 (15.5)
|
17 (14.5)
|
12 (11.0)
|
79 (17.0)
|
1 (3.3)
|
0 (0.0)
|
1
|
272 (43.6)
|
111 (46.1)
|
161 (42.0)
|
133 (44.3)
|
92 (44.4)
|
47 (40.2)
|
58 (53.2)
|
205 (44.0)
|
5 (16.7)
|
4 (21.1)
|
2
|
202 (32.4)
|
77 (32.0)
|
125 (32.6)
|
93 (31.0)
|
63 (30.4)
|
46 (39.3)
|
32 (29.4)
|
155 (33.3)
|
9 (30.0)
|
6 (31.6)
|
3
|
47 (7.5)
|
19 (7.9)
|
28 (7.3)
|
23 (7.7)
|
17 (8.2)
|
7 (6.0)
|
7 (6.4)
|
25 (5.4)
|
12 (40.0)
|
3 (15.8)
|
4
|
10 (1.6)
|
3 (1.2)
|
8 (2.1)
|
8 (2.7)
|
3 (1.5)
|
0 (0.0)
|
0 (0.0)
|
2 (0.4)
|
3 (10.0)
|
6 (31.6)
|
5
|
1 (0.2)
|
1 (0.4)
|
0 (0.0)
|
1 (0.3)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
1 (5.0)
|
Fisher’s χ²
|
4.12
|
10.00
|
95.66
|
P-value
|
0.58
|
0.44
|
< 0.00001
|
Cumulative risk factor
|
862
|
335
|
527
|
421
|
281
|
160
|
143
|
598
|
71
|
50
|
Ratio of risk factor:person
|
1.38:1
|
1.39:1
|
1.38:1
|
1.40:1
|
1.36:1
|
1.37:1
|
1.32:1
|
1.28:1
|
2.37:1
|
2.50:1
|
* males = 110 (36.7%), females = 190 (63.3%); ! males = 84 (40.6%), females = 123 (59.4%); # males = 47 (40.2%), females = 70 (59.8%); ** males = 56 (51.9%), females = 52 (48.1%); !! males = 170 (36.5%), females = 296 (63.5%); ## males = 9 (30.0%), females = 21 (70.0%); @ males = 6 (30.0%), females = 14 (70.0%). |
Only 14.7% of all the study subjects had no risk factor for MetS which included 12.9% and 15.9% among males and females. While only 3.3% of overweight subject had no risk factor, there was no obese subject with no risk factor. In fact, 31.6% of obese subjects had 4 risk factors for MetS. Pooled analysis also shows a significant variation (Fisher’s χ²=65.66, P-value < 0.00001) in the distribution of risk factors relative to BMI-for-age. In addition, the ratio of risk factor per person was highest at 2.50:1 in obese subjects and lowest among healthy weight individuals at 1.28:1. Interestingly, though no underweight adolescents presented with 4 or 5 risk factors for metabolic syndrome, 53.2%, 29.4% and 6.4% presented with 1, 2 and 3 risk factors, indicating that MetS is prevalent among this cohort of adolescents.
Distribution of type of individual risk factors, number of risk factors and associated risk factors for metabolic syndrome. Table 4.
Table 4
Estimation of risk factors for metabolic syndrome relative to gender, stage of adolescence and BMI-for-age.
Type of individual risk factors
|
Number of Risk factors
|
Associated Risk factors
|
0
|
1
|
2
|
3
|
4
|
5
|
TG ≥ 130 mg/dl
|
HDL < 40mg/dl
|
FBS ≥ 100mg/dl
|
BMI ≥ 85th percentile
|
Systolic/Diastolic
Pre-hypertension/
Hypertension
|
WC ≥ 94cm (males)
|
WC ≥ 80cm (females)
|
440 (70.5%)
|
154 (24.7%)
|
192 (30.8%)
|
49
(7.9%)
|
35
(5.6%)
|
1
(0.4)
|
17
(4.4)
|
Triglyceride ≥ 130 mg/dl (n = 440, 70.5%)
|
3 (0.7)
|
195 (44.3)
|
186 (42.3)
|
45 (10.2)
|
10
(2.3)
|
1
(0.2)
|
-
|
117
(76.0)
|
138
(71.9)
|
36
(73.5)
|
25
(57.1)
|
1
(100.0)
|
13
(76.5)
|
High-density lipoprotein < 40 mg/dl
(n = 154, 24.7%)
|
0 (0.0)
|
25 (16.2)
|
88 (57.1)
|
34 (22.1)
|
6
(3.9)
|
1
(0.7)
|
117
(26.6)
|
-
|
41
(21.4)
|
19
(38.8)
|
6
(17.1)
|
1
(100.0)
|
6
(35.3)
|
FBS ≥ 100mg/dl
(n = 192, 30.8%)
|
2 (1.0)
|
40 (20.8)
|
110 (57.3)
|
32 (16.7)
|
7
(3.7)
|
1
(0.5)
|
138
(31.4)
|
41
(26.6)
|
-
|
17
(34.7)
|
14
(40.0)
|
1
(100.0)
|
4
(23.5)
|
BMI ≥ 85th percentile
(n = 50, 8.0%)
|
1 (2.0)
|
9 (18.0)
|
15 (30.0)
|
16 (32.0)
|
8
(16.0)
|
1
(2.0)
|
36
(8.2)
|
19
(12.3)
|
17
(8.9)
|
-
|
8
(22.9)
|
1
(100.0)
|
12
(70.6)
|
Pre-hypertension / Hypertension
(n = 35, 5.6%)
|
4 (11.4)
|
14 (40.0)
|
11 (31.4)
|
3 (8.6)
|
3
(8.6)
|
0
(0.0)
|
25
(5.7)
|
6
(3.9)
|
14
(7.3)
|
8
(16.3)
|
-
|
0
(0.0)
|
2
(11.8)
|
WC ≥ 94cm male
(n = 1, 0.4%)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
0
(0.0)
|
1
(100.0)
|
1
(0.2)
|
1
(0.7)
|
1
(0.5)
|
1
(2.0)
|
0
(0.0)
|
1
(100.0)
|
-
|
WC ≥ 80cm female
(n = 17, 4.4%)
|
0 (0.0)
|
1 (5.9)
|
4 (23.5)
|
8 (47.1)
|
4
(23)
|
0
(0.0)
|
13
(3.0)
|
6
(3.9)
|
4
(2.1)
|
12
(24.5)
|
2
(5.7)
|
-
|
17 (4.4)
|
Of the 440 (70.5%) subjects with hypertriglyceridemia alone, 3 (0.7%) had no risk factor while 11 (2.5%) had 4 various risk factors for MetS. The proportions of subjects having risk factors associated with hypertriglyceridemia were 26.6% with HDL-C < 40 mg/dl, 31.4% with FBS ≥ 100 mg/dl, 8.2% with BMI ≥ 85th percentile and 5.7% with pre-hypertension and hypertension respectively. Likewise, of the 154 with HDL-cholesterol < 40 mg/dl, 25 (16.2%) had only 1 risk factor while 7 (4.6%) had 4 risk factors. Similarly, among the 154 (24.7%) subjects with HDL-C < 40 mg/dl, 76.0%, 26.6%, 12.3% and only 3.9% had hypertriglyceridemia, FBS ≥ 100 mg/dl, BMI ≥ 85th percentile and pre-hypertension and hypertension respectively. Only one subject, an obese male in early adolescence had 5 risk factors including hypertriglyceridemia, HDL < 40 mg/dl, FBS ≥ 100 mg/dl, BMI ≥ 95th percentile, WC ≥ 94 cm (central obesity) without prehypertension or hypertension.
Determination of early occurrence of metabolic severity risk score (continuous metabolic syndrome risk score) by gender and stage of adolescence relative to type of BMI-for age. Table 5.
Table 5
Determination of early occurrence of metabolic severity risk score (continuous metabolic syndrome risk score) by gender and stage of adolescence relative to type of BMI-for age.
cMETs
|
Male
|
Female
|
Stage of adolescence
|
All
|
Lean
|
Over
weight
/Obese
|
All
|
Lean
|
Over
weight
/Obese
|
Early
|
Mid
|
Late
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
Lean
|
O/O
|
Lean
|
O/O
|
Lean
|
O/O
|
Lean
|
O/O
|
Lean
|
O/O
|
Lean
|
O/O
|
n (%)
|
241 (38.6)
|
226
(93.8)
|
15
(6.2)
|
383 (61.4)
|
349 (91.1)
|
34
(8.9)
|
99 (90.0)
|
11 (10.0)
|
167 (87.9)
|
23 (12.1)
|
82 (97.6)
|
2
(2.4)
|
116 (94.3)
|
7
(5.7)
|
45 (95.7)
|
2
(4.3)
|
65 (92.9)
|
5 (7.1)
|
BMI
Z-score
|
-0.89 (1.4) *
|
-1.05 (1.3)!
|
1.54 (0.4)
|
-0.38 (1.2) *
|
-0.57 (1.1)!
|
1.60 (0.4)
|
-0.79 (1.2)
|
1.56 (0.4)
|
-0.40 (1.0)
|
1.70 (0.4)
|
-1.11 (1.2)
|
1.34 (0.2)
|
-0.72 (1.2)
|
1.49 (0.3)
|
-1.53 (1.6)
|
1.65 (0.8)
|
-0.78 (1.1)
|
1.37
(0.3)
|
cMets
Z-score
|
-0.30 (1.6)
|
-0.37 (1.6)
|
0.77 (1.3)
|
-0.28 (5.2)
|
-0.35 (5.4)
|
0.46 (1.1)
|
-0.45 (1.7)
|
0.68 (1.5)
|
-0.59 (1.2)
|
0.62 (0.9)
|
-0.15 (1.6)
|
1.24 (0.2)
|
-0.67 (1.4)
|
-0.21 (1.8)
|
-0.60 (1.4)
|
0.79 (0.0)
|
-0.68 (1.2)
|
0.87 (0.5)
|
MetS pctl
|
46.88 (34.6)
|
45.35 (34.1)
|
69.95 (33.4)
|
38.82 (29.6)
|
36.17 (28.6)
|
66.02 (26.6)
|
44.9 (33.6)
|
64.9 (38.1)
|
37.2 (27.6)
|
68.36 (25.8)
|
49.44 (35.2)
|
89.07 (3.6)
|
35.33 (28.8)
|
53.17 (32.0)
|
38.84 (33.0)
|
78.42 (0.5)
|
34.12 (30.3)
|
78.45 (16.9)
|
MetS ≥ 90th pctl
|
34 (14.1)
|
28
(12.4)
|
6
(40.0)
|
18
(4.7)
|
12
(3.4)
|
6
(17.6)
|
12 (12.1)
|
5
(45.5)
|
2
(1.2)
|
5
(21.7)
|
13 (15.9)
|
1
(50.0)
|
6
(5.2)
|
1
(14.3)
|
3
(6.7)
|
0
(0.0)
|
3
(4.6)
|
1 (20.0)
|
*P-value < 0.0001; *indicates P-value for comparisons between sex cohorts; |
!P-value < 0.0001; !indicates P-value for comparisons between lean males and lean females; |
There was a significant variation (t-test = 4.67, P-value < 0.0001) in the BMI z scores of females (-0.38 ± 1.2) compared to their males (-0.89 ± 1.4). As expected, BMI z scores were significantly higher (t-test = 19.23, P-value < 0.0001) in males that were overweight/obese (1.34 ± 0.4) compared to their lean counterparts (-1.05 ± 1.3) and significantly higher (t-test = 24.00, P-value < 0.0001) in obese females (1.60 ± 0.4) compared to lean females (-0.57 ± 1.1). In addition, negative cMetS z scores were recorded for both males (-0.30 ± 1.6) and females (-0.28 ± 5.2), for lean males (-0.37 ± 1.6) and lean females (-0.35 ± 5.4) but strongly positive values were recorded for obese males (0.77 ± 1.3) and obese females (0.46 ± 1.1). Higher values of MetS percentile were also recorded for obese males (69.95 ± 33.4) compared to lean males 45.35 (34.1) and for obese females (66.02 ± 26.6) compared to lean females (36.17 ± 28.6) as well as in the stages of adolescence relative to sex. Going by the MetS definition of cMetS score ≥ 90th percentile, the prevalence of MetS was higher in males (14.1%) than in females (4.7%), In all, 28 (12.4%) lean males as against 12 (3.2%) lean females had a cMetS ≥ 90th percentile.
Multivariate regression analysis with cMets percentile as independent variable and various other dependent variables. Table 6. Figure 4
Table 6
Multivariate linear regression analysis with cMetS percentile as independent variable and various other dependent variables.
Dependent variable:
Continuous metabolic Syndrome risk score percentile (cMetS)
|
R2 = 0.887
|
F-test = 689.47
|
P-value < 0.00001
|
t-test
|
P-value
|
Independent variables
|
Regression coefficient
|
Standard error
|
95% confidence interval
|
Intercept
|
-3.067
|
0.229
|
-3.52, -2.62
|
-13.42
|
< 0.0001
|
Age
|
-0.073
|
0.009
|
-0.09, -0.06
|
-7.95
|
< 0.0001
|
Body mass Index (kg/m2)
|
0.075
|
0.005
|
0.07, 0.84
|
15.44
|
< 0.0001
|
Systolic BP (mmHg)
|
0.019
|
0.002
|
0.02, 0.02
|
11.76
|
< 0.0001
|
FBS (mg/dl)
|
0.013
|
0.0004
|
0.01, 0.01
|
27.23
|
< 0.0001
|
Total cholesterol (mg/dl)
|
0.00004
|
0.0002
|
-0.00, 0.00
|
0.19
|
0.85
|
Triglyceride (mg/dl)
|
0.003
|
0.0002
|
0.00, 0.00
|
15.73
|
< 0.0001
|
HDL (mg/dl)
|
-0.023
|
0.0005
|
-0.02, -0.02
|
-48.90
|
< 0.0001
|
The seven predictor variables significantly (P-value < 0.0001) explain 88.7% of the variance in the independent outcome variable. One unit change in cMetS risk factor percentile is associated with decrease in age (-0.073) and in high-density lipoprotein, respectively. |
(a) (b) (c) (d) |
Gender 1 = male, 2 = female; BMI stage 1 = Underweight, 2 = Healthy weight, 3 = Overweight, 4 = Obese |
TG = Triglyceride, TChol = Total cholesterol, LDL-C = Low-density lipoprotein C, HDL-C = High-density lipoprotein C. |
(a) (b) |
The seven predictor variables significantly explain 88.7% of the variance in the independent outcome variable (R2 = 0.887, F-test = 689.47, P-value < 0.0001). One unit change in cMetS risk factor percentile is associated with decrease in age (Regression coefficient = -0.073, P-value < 0.0001) and in high-density lipoprotein (Regression coefficient = -0.023, P-value < 0.0001), respectively. Except Total Cholesterol (Regression coefficient 0.00004, P-value = 0.85) which has insignificant association with cMetS, all other independent variables have positive association. The residual plots in Fig. 4 illustrate fairly random patterns of dispersion for all the independent variable against the dependent variable, indicating that the linear regression model is appropriate for the data.
Density plot peaks to visualize display where lipid values are concentrated over the data interval. Figures 1, 2.
For male study subjects, the density plots illustrate unimodal fasting plasma levels of TG, T-Chol and LDL and bi-modal HDL for underweight (red) and healthy weight (blue) but bi-modal TG, T-Chol, and HDL for those overweight (green). For the obese (purple), the density plot was tri-modal for TG, bi-modal for T-Chol and HDL but unimodal for LDL. For underweight and healthy weight female study subjects, the density plot was mainly unimodal for TG, T-Chol, LDL and HDL but mainly bi-modal or trimodal for overweight and obese subjects. Figure 2 illustrates the density plot for study subjects with hyperlipidemia. Underweight males had one distinct peak for LDL, one distinct and one indistinct modes for TG and T-Chol and multiple peaks for HDL. Healthy weight subjects had multiple modes for HDL, bimodal for all the parameters except LDL. TG among obese was bimodal. Female subjects unimodal fasting plasma levels of LDL in all the BMI groups, poly-modal for HDL among underweight and healthy weight but bi-modal for overweight and obese individuals.
Distribution of risk factor for Metabolic Syndrome relative to (a) gender (b) stage of adolescence and (c) Body Mass Index-for-Age. Figures 3a-c.
Figurative illustration of the distribution of total number of risk factor by gender, stage of adolescence and anthropometric BMI-for-age is as shown in Figs. 3a-c. Females had an insignificant higher proportions of individuals without a risk factor for MetS and with 4 risk factors than males. Figure b indicates that while no late adolescents presented with 4 risk factors, a relatively high proportion of those in early and mid-adolescence had 1 risk factor. Figure c illustrates that 9 (29.0%) and another 8 (25.8%) of 31 obese subjects had 3 and 4 risk factors respectively while 11 (33.3%) and another 3 (9.1%) of overweight subjects presented with 3 and 4 risk factors. No individual who was underweight or healthy had 4 risk factors for MetS.