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THE PREVALENCE OF OVERWEIGHT AND OBESITY AND THEIR RELATIONSHIP WITH TYPE 2 DIABETES MELLITUS IN ADULT PATIENTS SEEN AT THE FEDERAL MEDICAL CENTRE, BIDA
SUMMARY
INTRODUCTION: Undoubtedly, obesity and diabetes mellitus have established negative impact on the health and well-being of the human race all over the world. Obesity has been shown to have a hand in nearly every pile of major non-communicable chronic diseases of the human race in the twenty first century. This disorder is now one of the most important factors contributing to the overall disease burden globally, among which diabetes mellitus is prominent. Diabetes mellitus remains one of the most important non-communicable diseases in Nigeria today. Overweight and obesity are significant risk factors for type 2 diabetes mellitus. Literatures are replete with reports to support this assertion. Unfortunately there is a dearth of such materials in this part of the country. This study is partly an effort to fill this vacuum.
OBJECTIVE: The study was undertaken to determine the prevalence of overweight, obesity and type 2 diabetes mellitus and the relationship between overweight/obesity and type 2 diabetes mellitus in adult patients seen at the Federal Medical Centre, Bida in Niger state. It was also aimed at exploring the patterns of the relationship between type 2 diabetes mellitus and its known risk factors on the one hand, and that between overweight/obesity and their known risk factors on the other hand, in the adult patient population in our centre.
METHOD: The study was descriptive cross–sectional in design. A systematic sampling technique was used to select the subjects after a simple random selection of the first subject. A total of 480 respondents were selected for the study over 3 months. Data collection was done through the use of structured questionnaires to obtain information on the sociodemographic characteristics such as age, gender, educational and marital status; lifestyle information such as occupation, food habit, leisure time physical activity, alcohol, kolanuts and tobacco usage; anthropometric measurements for weight and height measurements used in body mass index calculation; as well as the use of fasting plasma glucose. Two fasting plasma samples obtained at one week interval, from each of the respondents who had not been diagnosed diabetic and were not already on drugs for diabetes mellitus were analysed for plasma glucose. The subjects were classified as diabetic or non-diabetic based on their fasting plasma glucose level and on whether or not they were known diabetics and were already on drugs for diabetes. They were also classified as either obese, overweight, normal weight or underweight based on their body mass indices which were calculated from their weight and height measurements using the formula: weight (in kilogrammes) divided by height (in metre squared). The prevalences of overweight and obesity were calculated in the total sample and separately for diabetic and non-diabetic males and females. Data analysis was done using the 19th version of Statistical Package for Social Scientists software package. Tables, bar charts, frequencies, percentages and means were used to describe the data. Chi-square (X2) test was used to test the level of statistical significance of the differences between categorical variables.
RESULTS: The overall prevalences of obesity and overweight were 19.4% and 25.4% respectively and combined prevalence as 44.8%. The prevalences of obesity and overweight in males were 8.0% and 23.3% respectively, while in females the prevalences were 26.0% and 26.7% respectively. The overall prevalence of diabetes mellitus was 10.2% while the male and female sex prevalences were 10.8% and 9.9% respectively. About 77.6% of the diabetic population were either obese or overweight. The prevalence of obesity was significantly higher in diabetic (44.9%) than in non-diabetic population (16.5%). Same for overweight: 32.7% (among diabetics) and 24.6% (in non-diabetic population).
Also the prevalence of diabetes mellitus was significantly higher among the older subjects, those with family histories of obesity and diabetes mellitus as well as those with diabetic first degree relatives. Similarly, the prevalence of overweight and obesity was significantly higher among the older subjects, the females, the Yorubas, those with family histories of obesity and hypertension, those with obese first degree relatives and those who ate nonbalanced diet. It was also higher among those who were physically inactive. Out of the 49 identified diabetics, 20 (40.8%) were newly diagnosed.
CONCLUSION: The prevalences of overweight, obesity and type 2 diabetes mellitus in the study population were relatively high. These disorders were significantly associated with both modifiable and non–modifiable risk factors. There was a positive relationship between overweight/obesity and type 2 diabetes mellitus with the obese and overweight subjects more likely diabetic than their normal weight counterparts. A significant number of the diabetics in Bida were undiagnosed.
Health education on overweight and obesity including education on lifestyle modification are recommended in the management of these disorders.
TABLE OF CONTENTS
CONTENT PAGE
Title i
Declaration ii
Certification iii
Dedication iv
Acknowledgements v
Summary viii
Table of Contents xi
List of abbreviations xiii
List of tables xiv
List of figures xiv
CHAPTER ONE: INTRODUCTION
1.1 Background 1
1.2 The problem statement 2
1.3 Justification for the study 2
1.4 Relevance to Family Medicine 3
1.5 Aim and objectives of study 4
CHAPTER TWO: LITERATURE REVIEW 5
CHAPTER THREE: METHODOLOGY
3.1 The study centre 25
3.2 The study area 26
3.3 The study design 26
3.4 The study population 26
3.5 The inclusion criteria 27
3.6 The exclusion criteria 27
3.7 Ethical consideration 27
3.8 Sample size calculation 27
3.9 Sampling technique 28
3.10 Data collection and instruments 29
3.11 Data analysis 32
CHAPTER FOUR: RESULTS 33
CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS 53
LIMITATION 69
REFERENCES 70
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND
Obesity and overweight could be defined as abnormal or excessive body fat accumulation that may lead to impairment in health.1 They constitute a serious medical condition in which excess fat has accumulated in the body to the extent that it may have adverse health consequences, leading to reduced life expectancy and/or increased health problems.2,3 All who are obese are overweight, but the reverse is not always true since the excess weight in overweight individuals may come from muscle, bone, and/or body water, and not necessarily due to abnormal or excessive fat accumulation in the body.4
Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia, and presents classically with polyuria, polydypsia and polyphagia.5 While some patients may also present with sepsis or diabetic coma (hyperosmolar non-ketotic states), a minority of people with diabetes mellitus remain asymptomatic and are therefore usually identified at
screening.5,6
The two most common clinical types of diabetes mellitus are type 1 and type 2, of which the latter accounts for over 90% of the diabetic patient population.7
Two processes underlie the development of type 2 diabetes mellitus. These processes include (1) increased insulin resistance and (2) failure in insulin secretion. Age has a powerful effect on these two processes. There is a rise in incidence rate of type 2 diabetes mellitus with age.
There is lessening insulin secretory capacity with age, but the mechanism is not quite known. Resistance to insulin action also increases with age. Resistance to insulin action can be due to either diminished physical activity or to increased body fat that accompanies ageing.
1.2 THE PROBLEM STATEMENT
Obesity is a major risk factor for type 2 diabetes mellitus.2 In fact over 80% to 90% of individuals with type 2 diabetes mellitus are either obese or overweight.2,8
Obesity has long been recognized as a medical disorder, and the honour of this early recognition is credited to the Greeks.9 Also the association of obesity with potentially fatal conditions such as diabetes mellitus, systemic arterial hypertension, congestive cardiac failure, stroke, various cancers, among others, has been well recognized since ancient times when Hippocrates first reported that ‘‘sudden death is more common in those who are
naturally fat than in the lean”.10 Similarly in an attempt to relate obesity with various other disease conditions as noted above, Hippocrates stated that ‘corpulence is not only a disease by itself, but a harbinger of others’.3
Although overweight and obese adults are more likely to have been so in their childhood than their normal weight counterparts, there is no optimal age during childhood for the prediction of overweight and obesity in adult life.11 Also studies have shown that excessive weight gain may begin at any time.11 Juvenile-onset obesity has been described as hyperplastic, where the increase in body fat is due to an increase in the number of fat cells, while adult–onset type of obesity is described as hypertrophic, where the increase in body fat is due to enlargement in the size of fat cells.12
1.3 JUSTIFICATION FOR THE STUDY
In the course of working in this centre, the researcher observed that a good number of the adult patients seen, especially the adults, were on the obese side. He had also observed over time that a significant number of the adult diabetics were obese. Armed with the background knowledge that age and obesity are important risk factors in the development of type 2 diabetes mellitus the author therefore decided to undertake this study to see whether his observations are chance findings or they can be scientifically substantiated. Using the WHO criteria (body mass index) the researcher wanted to know how many of the adult patients aged 18 years and above attending the hospital are actually overweight and obese (BMI of ≥25kg/m2), how many of this group of patients attending the hospital are diabetic and then what percentage of those that are diabetic are overweight and obese. In addition, using appropriate statistical instrument, the researcher wanted to determine whether or not there exists a positive relationship between overweight/obesity and diabetes mellitus. There is also the need to identify the risk factors for obesity in this environment. This will ensure a focused health education to reduce its prevalence to the barest minimum and proffer suggestions on preventive activities. Furthermore, the author wanted to find out the relationship between overweight/obesity and the known risk factors, as well as that between type 2 diabetes mellitus and its known risk factors in our patients, and to provide evidence to include routine weight and height measurement and blood glucose estimation. Lastly, there is dearth of information in this locality on obesity and diabetes and their correlates.
1.4 RELEVANCE TO FAMILY MEDICINE
Family Medicine is a unique specialty, which emphasizes responsibility for total health care for the patient and his family irrespective of age, sex or creed, and regardless of the presence of disease or the nature of the presenting complaint. Family physicians accept responsibility for managing an individual’s total health needs while maintaining an intimate, confidential relationship with the patient. Given that the management of obesity and diabetes mellitus is hinged squarely on effective counseling on dietary and lifestyle modifications, the family physician is best positioned to undertake studies that define the true prevalence of these conditions in his facility. This is important in order to have evidence-based, first hand facts needed in the management of his patients. Both obesity and type 2 diabetes mellitus are chronic non-communicable diseases and need continuing care by family physicians. Family issues such as prevention and management of sicknesses and diseases as well as education on healthy eating from the cradle to the grave are also factors of relevance. The family physician mans the “gate” of offering these preventive and health promotion services to his practice population. This present study is therefore also aimed at providing such needed information. It is expected that the findings in this study will contribute to the control of obesity and diabetes mellitus locally and in Nigeria as a whole. Also it is the author’s desire that the outcome of this study will be a stimulus for more in-depth and far–reaching studies on these conditions.
1.5 AIM AND OBJECTIVES OF STUDY
The general objective of this study was:
To determine the prevalence of overweight and obesity and their relationship with type 2 diabetes mellitus among adult patients 18 years and above attended to at the General Out
Patient Department (GOPD) of the Federal Medical Centre, Bida (FMCB).
The specific objectives include:
- To determine the prevalence of overweight and obesity among adult patients 18 years and above attended to in the GOPD of the Federal Medical Centre, Bida (FMCB).
- To determine the prevalence of type 2 diabetes mellitus among adult patients 18 years and above attended to in the GOPD of the Federal Medical Centre, Bida (FMCB).
- To determine the relationship between overweight/obesity and type 2 diabetes mellitus among adult patients 18 years and above attended to in the GOPD of the Federal Medical Centre, Bida.
- To determine the relationship between type 2 diabetes mellitus and the known risk factors in the study population.
- To determine the relationship between overweight/obesity and the known risk factors
in the study population
THE PREVALENCE OF OVERWEIGHT AND OBESITY AND THEIR RELATIONSHIP WITH TYPE 2 DIABETES MELLITUS IN ADULT PATIENTS SEEN AT THE FEDERAL MEDICAL CENTRE, BIDA
