RESEARCH PROPOSAL

RELATIONSHIP OF METABOLIC SYNDROME TO PHYSICAL ACTIVITY IN SELECTED POPULATION OF MANGALORE

MASTER OF PHYSIOTHERAPY

(CARDIO RESPIRATORY DISORDERS)

MS. D`SOUZA MARILYN MAXIM

DEPARTMENT OF PHYSIOTHERAPY

FR. MULLER MEDICAL COLLEGE, MANGALORE-575002

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / MS. D`SOUZA MARILYN MAXIM
DEPARTMENT OF PHYSIOTHERAPY
FATHER MULLER MEDICAL COLLEGE
MANGALORE-575002
2. / NAME OF THE INSTITUTION / FATHER MULLER MEDICAL COLLEGE
MANGALORE.
3. / COURSE OF THE STUDY / MASTER OF PHYSIOTHERAPY IN CARDIO RESPIRATORY DISORDERS
4. / DATE OF ADMISSION TO THE COURSE / 9TH AUGUST, 2012
5. / TITLE OF THE TOPIC / RELATIONSHIP OF METABOLIC SYNDROME TO PHYSICAL ACTIVITY IN SELECTED POPULATION OF MANGALORE
/ BRIEF RESUME OF THE INTENDED WORK.
6.1 NEED FOR THE STUDY:
Metabolic syndrome (also known as cardio-metabolic syndrome, syndrome X, insulin resistance syndrome) is a threat to global public health due to its escalating incidence in both developed and developing countries1,2. South Asians contribute significantly to the global public threat of metabolic syndrome (MetS) since it represents one-fifth of global population. In addition the most recent surveys done on hospital based samples revealed that the prevalence of MetS is 25.3% in India1.
The term Metabolic Syndrome represents a group of cardiovascular risk factors like hypertension, overweight or obesity, hypertriglyceridaemia, low high density lipo-protein cholesterol and glucose intolerance3. Metabolic syndrome is escalating due to the marked shift of lifestyle in India caused by economic growth, affluence, urbanization and dietary habit changes. It is well recognized that the syndrome has a genetic basis along with certain modifiable environmental factors. It has been reported that technology, automation and a more comfortable lifestyle encourage sedentary behavior especially in urban population4 The diagnosis of Metabolic Syndrome in adults and recently in children and adolescents is established when 3 or more of 5 individual elements exist together in the same subject3. Experts from International Diabetes Federation (IDF), National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and World Health Organization (WHO) have proposed different diagnostic criteria for MetS5. The Modified National Cholestrol Educational Programme Adult Treatment Panel III (MS ATPM) criteria predict highest occurrence of metabolic syndrome in Asian Indian population than the WHO, NCEP-ATP III and IDF criteria6.
Lack of moderate to vigorous physical activity and sedentary behavior defines physical inactivity7.Lifestyle changes are important in treating metabolic syndrome8. An increase in physical activity leads to an increase in aerobic capacity, which is inversely related to different health indicators such as lipid profile and MS indicators9. The previous findings suggest that there could be ethnicity specific physiological difference in response to physical activity. However most studies on the relation of physical activity with MetS and single MetS components have been conducted on persons of American or European descent showed positive corelation10. There is insufficient evidence linking anthropometric measures, presence of MetS using MS ATPM diagnostic criteria and adherence to physical activity in the sample of local population.This study aims to identify the relationship between the physical activity and MetS in people from Mangalore below the age of 40.
RESEARCH QUESTION-
What is the relation between physical activity and the risk factors of metabolic syndrome in selected population of Mangalore?
HYPOTHESIS-
Physical activity has a correlation with the Metabolic Syndrome.
OPERATIONAL DEFINITIONS
  • PHYSICAL ACTIVITY
Physical activity is defined as any bodily movement produced by skeletal muscles that require energy expenditure. (WHO)
  • METABOLIC SYNDROME
Metabolic Syndrome is defined using the criteria recommended in the Modified National Cholesterol Education Programme Adult Treatment Panel III (MS- ATPM/ Modified NCEP-ATP III) Guidelines.
Presence of more than or 3 criteria of the following will define metabolic syndrome in our participants:-
  1. Waist circumference ( >90cm in men , > 80cm in women).
  1. Systolic Blood Pressure ( > or equal to 130mHg ) and / or Diastolic Blood Pressure( > or equal to 85mmHg ) or medical treatment of previously diagnosed hypertension.
  2. Triglycerides( > or equal to 150mg/dl )
  3. High density Lipoprotein Cholesterol (HDL-C)- <40mg/dl in men and, <50mg/dl in women.
  4. Fasting Glucose> 110mg/dl.
6.2 REVIEW OF LITERATURE:
Metabolic Syndrome is extremely common. The problem is that it often comes without alarming symptoms. Researchers have focused on this global threat and explored its relation in many studies.
Gupta, et al studied a sample of 1800 adults of more than 20 years of age. The sample was analyzed for MetS based on the risk factors. The study revealed that high prevalence of Metabolic syndrome was more evident in 40-60yers of age group and that overweight, obesity are the major driving forces in the development of MetS11. Prasad determined the prevalence of MetS by evaluating the urban city dwellers in Orissa for the indicators. The MetS criteria used in this study was based on 5major scientific organizations. The study concluded reinforcing the need for prevention and control programme due to its high prevalence12.
Mohabbi, et al assessed the prevalence of MetS among Iranian professional drivers using International Diabetes Federation. The study suggest that MetS has become a noteworthy health problem in this population due to lack of physical activity13. In a cross sectional study Ana Patricia, et al determined the association between demographic lifestyles and reproductive characteristics in a sample of women in San Juan Metropolitan area. The MetS criteria was based on the Revised NCEP ATP III criteria. The study concluded as many other studies that increase in age , BMI and physical inactivity are associated with metabolic syndrome14.
Prasad et al, evaluated the Sri Lankan adult population for the prevalence of MetS and it association with age, urban living, higher socio-economic status and physical inactivity. He concluded a positive relation between them1. Similarly a study was done in high school students from Vietnam by Trang et al and Brazilian adolescents by Antonia et al which concluded that increase physical activity at a young age is important for metabolic health in children and adults2,10.
Most of the above studies have concluded a positive relation between physical activity and metabolic syndrome outside India. In this proposed study the level of physical activity can be objectively measured using International Physical Activity Questionnaire (IPAQ).IPAQ is an international measure having acceptable psychometric properties for use in many settings and in different languages. IPAQ comprises a set of 4 questionnaires- 5 activity domains asked independently, can be asked by or self administered methods. The purpose of using this questionnaire is to obtain international comparable data on health related physical activity15.
6.3 OBJECTIVES OF THE STUDY:
  • To detect the risk factors of metabolic syndrome in people below the age of 40 living in Mangalore using the Modified- NCEP ATP III guidelines.
  • To find out the relationship between risk factors of Metabolic Syndrome and physical activity, in the same population.
MATERIALS AND METHODS:
7.1 SOURCE OF DATA :
Subjects undergoing health check up at Father Muller Hospital, Mangalore.
7.2 METHOD OF COLLECTION OF DATA:
STUDY DESIGN
  • Cross Sectional Study
SAMPLE SIZE AND SAMPLING TECHNIQUE:
  • 286 Participants of health check up will be recruited on the basis of purposive sampling techniques. The sample size was calculated based on the previous population based study conducted by Katulanda.1
PROCEDURE
Data for this cross-sectional study will be collected during a health check up. The participants who will be voluntarily visiting Father Muller Medical College Hospital, Karnataka (India) for a 1-day health-check up and those who fulfill the inclusion and exclusion criteria will be a part of the study.
A written informed consent will be taken from all the participants. Information on gender, birth date, occupation and other pertinent medical data will be documented.
INCLUSION CRITERIA
  • Subjects between 25-40yrs of age.
  • No previous coronary event (acute MI, angina pectoris and cerebro- vascular accident.)
EXCLUSION CRITERIA
Diagnosed with diabetes.
  • Subjects under hypoglycemic, anti-hypertensive, hypolipidemic medications
STATISTICAL ANALYSIS
  • Collected data will be analyzed by Mean, Standard deviation, Karl-Pearson correlation coefficient procedure.
  1. BLOOD PRESSURE MEASUREMENTS
Using a standard protocol the blood pressure will be measured with a mercury column sphygmomanometer.
  1. BLOOD SAMPLE
A blood sample will be collected after an overnight fast of at least 8 hours. Plasma glucose level, Serum HDL cholesterol and triglyceride levels will measured in the blood sample. This is the routine procedure carried out during the health check up.
  1. ANTHROPOMETRIC MEASUREMENTS
Physical measurements will be taken after the blood sample is taken.
Bodyheight to the nearest 0.1cm will be measured without shoes with a wall mounted stadiometer. Body weight will be measured in light clothing with a calibrated balance scale. Then BMI will be calculated as body weight/height2. Waist circumference will be measured at the end of gentle expiration, midway between the lower rib margin and iliac crest with a flexible and non-elastic measuring tape, with 0.1cm precision without compressing the tissues. During the measurement the participant should be in the orthostatic position with the weight equally distributed between the 2 feet.
  1. PHYSICAL ACTIVITY-
All subjects will be given the self-administered long form International
Physical Activity Questionnaire (IPAQ) in the Indian regional language they are comfortable.
7.3 Does the study require any investigation or intervention to be conducted on patients or animals?
Yes.(Anthropometric measures, blood sample, physical activity questionnaire, Blood Pressure)
7.4Has ethical clearance been obtained from your institution in case of 7.3?
Yes, copy attached.
LIST OF REFERENCES:
  1. Katulanda et al. Metabolic syndrome among Sri Lankan adults: prevalence, patterns and correlates.Diabetology & Metabolic Syndrome.2012;4:24
  2. Nguyen et al. Association between physical activity and metabolic syndrome: a cross sectional survey in adolescents in Ho Chi Minh City, Vietnam.BMC Public Health.2010;10:141
  3. Antonio Stabelini et al. Physical activity, cardiorespiratory fitness, and metabolic syndrome in adolescents: A crosssectional study.BMC Public Health.2011;11:674
  4. Ethiraj Dhanaraj et al.Predictors of metabolic syndrome in Asian north Indians with newly detected type 2 diabetes.Indian J Med Res 129, May2009, 506-514.
  5. Foong Ming Moy , Awang Bulgiba. The modified NCEP ATP III criteria maybe better than the IDF criteria in diagnosing Metabolic Syndrome among
Malays in Kuala Lumpur.BMC Public Health 2010, 10:678.
  1. Roberta R Dalacorte, César L Reichert and José L Vieira . Metabolic syndrome and physical activity in southern Brazilian community-dwelling elders: a population-based, cross-sectional study.BMC Public Health 2009, 9:25.
  2. Andrea Bankoski et al. Sedentary Activity Associated With Metabolic Syndrome Independent of Physical Activity.Diabetes care. Feb 2011;34.
  3. J. J. Muros , M. J. Oliveras, M. Meyer Reyes, T. Reyes Burgos, H. Lopez. Influence of physical activity and dietary habits on lipid profile, blood pressure BMI in subjects with Metabolic syndrome. Nutr Hospital.2011;26:1105-1109
  4. Tomoko Kobayashi , Etsuji Suzuki , Soshi Takao and Hiroyuki Doi . Long working hours and metabolic syndrome among Japanese men: a cross-sectional study.BMC Public Health 2012, 12:395.
  5. Eivind Andersen, Arne T. Høstmark , Sigmund A. Anderssen. Effect of a Physical Activity Intervention on the Metabolic Syndrome in Pakistani Immigrant Men: A Randomized Controlled Trial.J Immigrant MinorityHealth (2012) 14:738–746.
  6. Apurva Sawant et al. Prevalance of Metabolic Syndrome in Urban India. Cholestrol. 2011.
  7. D. S. Prasad, Z. Kabir, A. K. Dash, B. C. Das. Prevalence and risk factors for metabolic syndrome in Asian Indians: A community study from Urban Eastern India.J Cardiovasc Dis Res. 2012 Jul-Sep; 3(3): 204-211.
  8. Iraj Mohebbi , Soheil Saadat, Mohammadreza Aghassi , Mahsa Shekari , Maghsuod Matinkhah , Shadi Sehat . Prevalence of Metabolic Syndrome in Iranian Professional Drivers: Results from a Population Based Study.PLoS ONE.Feb 2012;7(2).
  9. Ana Patricia ,et al. Prevalence of Metabolic Syndrome in Iranian Professional Drivers: Results from a Population Based Study of 12,138 Men.Metabolic Syndrome and related disorders.2010;8(3).
  10. Ralph Madison et al.International Physical Activity Questionnaire (October 2002) long last 7 days self - administered format. (accessed 25.09.2012)

9 / SIGNATURE OF CANDIDATE
10 / REMARKS OF THE GUIDE
11 / 11.1 NAME AND DESIGNATION OF GUIDE / MR. NARASIMANN. S PROFESSOR DEPARTMENT OF PHYSIOTHERAPY(FMMC)
11.2 SIGNATURE
11.3 HEAD OF THE DEPARTMNT / MR. NARASIMANN. S PROFESSOR DEPARTMENT OF PHYSIOTHERAPY(FMMC)
11.4 SIGNATURE
12 / 12.1 REMARKS OF THE CANDIDATE & PRINCIPAL
12.2 SIGNATURE

APPENDIX-I

INFORMED CONSENT

I______hereby agree to provide my fullest consent and cooperation as a subject for the dissertation work of Ms. D`souza Marilyn Maximtitled “Relationship of Metabolic Syndrome to physical activity in selected population of Mangalore” as a part of her post graduation in physiotherapy.

The possible benefits as well as the procedure of the study have been explained to me. The question and queries I have posed have been answered to my satisfaction and I am aware that my identity will be kept confidential. I am also aware that I can discontinue the study at any time I wish to do.

I also agree to undergo the various investigatory procedures, including the blood sampling, required for the study.

Date: Signature

Place:

APPENDIX-II

DATA OF THE PATIENT

NAME:

AGE:

GENDER:

OCCUPATION:

PAST MEDICAL HISTORY:

PRESENT MEDICATIONS:

BLOOD PRESSURE MESUREMENTS:

BLOOD SAMPLE:

i)Plasma Glucose Level-

ii)Serum HDL Cholesterol-

iii)Serum Triglyceride level-

ANTHROPOMETRIC MEASURES-

i)Body Height-

ii)Body Weight-

iii)BMI-

iv)Waist Circumference-

PHYSICAL ACTIVITY LEVEL-

International physical activity questionnaire (Long Form) in Indian regional languages.

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