Prevalence of Obesity and Chronic Disease Risks among Ethnic Groups of College Students in Southeast Texas

Research Article

Austin J Nutr Metab. 2014;1(1): 6.

Prevalence of Obesity and Chronic Disease Risks among Ethnic Groups of College Students in Southeast Texas

Chen JJ1*, Pegram LI2, Adcock KR1 and Johnson MR1

1Department of Family and Consumer Sciences, Lamar University, USA

2Independent nutrition consultant, USA

*Corresponding author: Chen JJ, Department of Family and Consumer Sciences, P.O. Box 10035, Lamar University, Beaumont, TX 77710, USA

Received: July 15, 2014; Accepted: August 11, 2014; Published: August 13, 2014

Abstract

Obesity at a young age poses a greater risk of developing chronic diseases such as heart disease, hypertension, type-II diabetes, and certain types of cancers, yet many young adults at risk for these diseases are unaware of their body weights, family histories, and health risks. The present study used anthropometrics and behavioral risk factors to assess the prevalence of obesity and chronic disease risks among ethnic groups of college students in Southeast Texas. The participants completed a self-reported health and dietary behavior survey containing 29 questions followed by the measurements of anthropometrics, blood pressure, and blood glucose. Chronic disease risk factors were summed and scored from 0-8. The mean age of the 96 participants was 22±5.3 years; 52% were overweight or obese (BMI ≥ 25 kg/ m2). The black participants showed a trend of higher average body weight, BMI, waist circumference, and hip circumference than other ethnic groups; specifically, 39% of the black participants had abdominal obesity. Over one third of the participants (37%) had four to seven chronic disease risk factors which included family history of diabetes or heart disease. Those who reported eating vegetables or fruits two or more times daily totaled only 39% and 37%, respectively. In summary, overweight or obesity was prevalent on the Southeast Texas college campus, especially among black participants. About two third of the participants had multiple chronic disease risk factors. Activities to raise awareness of risk factors for chronic diseases and actions to promote a healthy lifestyle are needed on the college campus.

Keywords: Chronic disease; Risk factors; Ethnic groups; Anthropometry; Obesity

Introduction

According to a report from the Centers for Disease Control and Prevention (CDC) in October 2013, the prevalence of obesity among adults in the U.S. remains very high (34.9%) and has remained statistically unchanged between 2009–2010 and 2011–2012 [1]. Although obesity remains most prevalent among the middle aged, the rate of obesity among U.S. adolescents aged 12-19 more than quadrupled from 1980 to 2012, from 5% to nearly 21% [2]. Similarly, the greatest magnitude of increase in obesity between the years 1991 to 2001 was among 18-29 year olds, rising from 7.1% to 14%, based upon results of the Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional telephone survey of women and men, ages 18 and older, living within the U.S. [3,4]. This age group represents the majority of U.S. college students. Researchers have also discovered that becoming overweight or obese during adolescence and early adulthood increases one’s likelihood of remaining overweight or becoming obese throughout adulthood [5].

Obesity at a young age poses a greater risk of developing chronic diseases such as heart disease, high blood pressure, type-2 diabetes (DM), and certain types of cancers in young adults [6]. Poor diet, inactivity, and family history are major risk factors for these diseases, which are also commonly linked to obesity. Research suggests that younger generations may have shorter life expectancies than their parents if the obesity epidemic is not controlled [7,8]. The development of the chronic diseases could largely be reduced or even prevented if actions promoting increased awareness, early intervention, and lifestyle changes are implemented early. Yet many young adults at risk for these diseases are unaware of their body weights and health risks due to a lack of medical care and misinformation. Routine recommendations for young adults are blood pressure and weight checks about every 2 years after their initial checkups and a cholesterol check every 5 years after age 35. Women who are sexually active should receive a well-woman check-up every year. Many college students do not receive annual checkups and fail to request testing for blood glucose, blood pressure or cholesterol [9].

Besides obesity, family histories of diabetes and heart disease were the most prevalent risk factors for chronic diseases. Family history of heart attack has been shown to nearly double the risk of heart attack in men and increase the risk to nearly 70% in women [10,11]. In Texas the African American population had the highest age-adjusted mortality rate for cardiovascular disease (CVD) than other racial/ethnic populations [12]. The Vital Signs publication from CDC has also shown that African Americans are nearly twice as likely as whites to die early from preventable heart disease and stroke [13].

The purpose of this study was to assess the prevalence of obesity and risk factors for chronic diseases among racial/ethnic groups of college students in Southeast Texas. Early detection of risk factors in target groups along with lifestyle changes, such as increased physical activities and improved quality of diet, may effectively lower the risks of the chronic diseases and even prevent or delay their occurrences in the future. Few studies of this nature have been conducted in this region.

Materials and Methods

Study population and recruitment

College students from a midsize four year public university located in Southeast Texas of the United States (student enrollment, approximately 14,000 as of spring 2014) were recruited for a free health assessment. An advertisement was sent in an email to each student through the University email system. Flyers were also strategically placed on bulletin boards throughout the campus. On the day of the health fair students who passed by the event booths were solicited for a free health assessment.

The study was approved by the University’s Institutional Review Board (IRB). We certify that all processes and procedures regarding the ethical use of human subjects in this study were in accordance with all applicable regulations. A signed written informed consent was obtained from each participant prior to taking the survey or initiation of any measurements.

Instrumentation

The Behavioral Risk Factor Surveillance System (BRFSS) survey [14], which was created by the CDC to screen for health related behavioral risks such as smoking, alcohol use, diet practices, physical activity, and family medical history, was adapted to fit the needs of this study. Additional questions to obtain demographic information were added to form the 29 questions used in the health assessment survey. Participants’ ethnicity and racial background were self-reported using the following categories: White, Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian, Hawaiian or Pacific Islander, and Multiracial. Examples of other questions included family history of diabetes, heart disease, and hypertension.

Participants’ height and weight were measured with a calibrated medical scale with a height rod in inches and centimeters (Detecto, Cardinal Scale Manufacturing Co, Webb City, MO 64870). Body mass index (BMI) was calculated according to CDC and NIH published guidelines and categorized as underweight (BMI < 18.49 kg/2), normal (BMI =18.5 to 24.9 kg/2), overweight (BMI= 25 to 29.9 kg/ 2), and obese (BMI ≥ 30 kg/2) [15,16].

Waist and hip circumferences were measured to the nearest 0.1 cm with a non-extensible tape. For waist circumference the tape was placed at the uppermost lateral border of the hip crest (ilium) [17]. A waist circumference that was greater than 88 cm (35 inches) for women or greater than 102 cm (40 inches) for men substantially increased the risks for heart disease and type 2 diabetes and was classified as abdominal obesity [18]. Hip circumference was measured at the largest circumference of the buttocks. Waist-to-hip ratio (WHR) was defined as the waist circumference divided by the hip circumference. Participants who are WHR were above 0.90 in men and above 0.85 in women were classified as high risk for chronic diseases [18].

Percentage of body fat was determined through the use of a bioelectrical impedance analysis (BIA) instrument (Model Quantum IV, RJL systems, Clinton Township, Michigan 48035, USA). The electrodes were placed on the right hand and right foot of the participant according to the manufacturer’s instructions. The resistance and reactance were recorded and entered into the system program to obtain percentage of body fat.

A blood pressure sphygmomanometer (Model BP710, Omron Healthcare, Inc., Bannockburn, IL 60015) was used to screen participants for hypertension. According to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guidelines systolic blood pressure > 130 mm Hg or diastolic blood pressure > 85 mm Hg is considered one of the risk factors for metabolic syndrome [19]. Casual blood glucose was measured with a blood glucose meter (Accu-Chek Aviva, Roche Diagnostics, Indianapolis, Indiana 46250), and a level exceeding 200 mg/dl was considered elevated [20].

Protocol

On the day of the health fair, students who passed by the event location were solicited to participate in the study. Students were informed about the study’s protocol, the confidentiality of the data collected, and their right to withdraw or refuse to answer any questions, or to be measured at any time during the study. A signed informed consent was obtained from each student who agreed to participate. Pregnant or lactating women and students who wore a pace maker were identified before signing the consent form and were excluded from the study. Anthropometric measurements began after the participants completed the health survey.

Trained research staff screened the participants, administered the survey, followed the protocol, and conducted anthropometric measurements. Participants were instructed to remove shoes, heavy clothing, and objects from the pockets for height and weight measurements. Waist and hip circumferences were measured with a medical measuring tape. Subjects then reclined in a slanted chair with both feet up and socks removed for bioelectrical impedance analysis. Blood sugar and blood pressure were measured last after the participant had been sitting calmly for at least five minutes.

Eight risk factors were selected on the basis of previously identified factors in the literature and comprised of both measurement-derived items and self-reported items. Three measurement-derived items included BMI ≥ 25 kg/2, high risk waist circumference (> 102 cm for men or > 88 cm for women) [18], and high risk blood pressure (BP) that included systolic BP (SBP) > 130 mm Hg or diastolic BP (DBP) > 85 mm Hg (NCEP-ATP III) [19]. Five self-reported items obtained from the survey included being a current smoker, over-drinking (alcohol), physical inactivity, family history of diabetes (FHxDM), and family history of CVD (FHxCVD). A current smoker was defined as consistently smoking a tobacco product within the past year. Over-drinking was defined following Dietary Guidelines for Americans as consuming more than the recommended two drinks for men or one drink for women in one day [21]. Physical inactivity was defined as physical activity performed less than 3 times a week.

Statistical analysis

Continuous variables are presented as means and standard deviations (SDs), and categorical data are summarized as frequency and percentages. Differences between races/ethnicities on continuous variables were analyzed using analysis of variance (ANOVA). Categorical data and demographic variables were analyzed using cross-tabulations and were compared using Pearson’s chi-square tests. Chronic disease risk factors were dichotomized into presence or absence of risk. A multiple risk factor score ranging from 0 to 8 (0 = no risk factor, 8 = all 8 risk factors) was obtained by summing individual risk factors. A p value < 0.05 was considered statistically significant for all analyses. All data analyses were performed with Statistical Package for the Social Sciences (SPSS) software, version 19.0 (Chicago, IL, USA).

Results

Anthropometric characteristics of the participants

A total of 96 students participated in the study. Table 1 shows the characteristics of the participants and anthropometric results based on race/ethnicity. The average age was 22.3 years old (plusmn;5.3 years). Asian and White students were three to four years older than Black and Hispanic students in average age. Average height, weight, BMI and the remaining anthropometric measurements showed no significant differences among participants of different races/ethnicities. The overall mean weight was 76.6 kg and ranged from 67.4 kg in Asians to 81.5 kg in Black or African Americans. Similar trends appeared in BMI which spanned from 23.9 in Asian to 28.9 in Black or African American students with an overall average of 26.8 plusmn; 6.4. Although the average of body fat percentages was the highest in Hispanic students, due to a low number of participants, the differences were not statistically significant. For waist and hip circumferences, Black or African American students showed the highest circumferences compared to other ethnic groups. No participant’s casual blood glucose level was over 200 mg/dl.