Prevalence and factors associated with metabolic syndrome in university students and academic staff in Bangladesh

Non-communicable diseases (NCDs) are a major concern for public health in developing countries and are responsible for the highest number of deaths and disease burden worldwide. It has been estimated that 74% of all global deaths per year are caused by NCDs, with 77% of these occurring in low- and middle-income countries¹. NCDs have placed a significant burden on health systems and economies globally. Metabolic Syndrome (MetS) is a condition that raises the likelihood of developing chronic NCDs, particularly cardiovascular disease². MetS is a group of at least three of five metabolic abnormalities occurring together³. These include high blood sugar, high blood pressure, elevated levels of triglycerides, low levels of high-density lipoprotein cholesterol, and an increase in waist circumference³. MetS is primarily caused by a combination of overeating and a lack of physical activity⁴. This leads to the accumulation of excess body fat, eventually resulting in other metabolic issues⁴. MetS is a contributing factor in the development of various health issues such as diabetes, stroke, advanced colorectal polyps, and cardiovascular diseases^3,5.

The global prevalence of MetS varied from 12.5 to 31.4% based on its definition⁶. A review conducted in South Asia reported that the prevalence of MetS was 14.0% (WHO), 26.1% (ATP III), 29.8% (IDF), and 32.5% (modified ATP III)⁷. Bangladesh, a developing country in South Asia, is particularly at risk for NCDs⁸. Non-communicable chronic diseases and associated mortality have significantly increased in Bangladesh due to rapid urbanization and changes in food habits, such as increased access to processed food, irregular meal times, and less physical activity^9,10. A systematic review and meta-analysis reported the prevalence of metabolic syndrome as 37.0% in the Bangladeshi population¹¹. The high prevalence of MetS is a pressing public health issue that requires exploration of potential risk factors.

Over the past few years, there has been a noticeable increase in obesity among university students^12,13. Studies have shown that regardless of age or education, certain lifestyle factors can contribute to the development of MetS, which can lead to chronic health complications¹⁴. Teaching is an important profession that does not require strenuous physical activity but involves stress. High levels of sedentary behaviour and low physical activity can increase the risk of MetS among teaching staff. It was observed in many studies that metabolic syndrome and cardiovascular diseases are rising in the sedentary population^15,16. Although few studies have reported the prevalence of MetS in general adults in Bangladesh^11,17, there is a lack of or limited data on the prevalence of MetS in the university context in Bangladesh. Moreover, it is important to know the prevalence of MetS and associated risk factors among university students and academic staff in Bangladesh to develop effective measures and strategies for identification and management from a public health perspective. This study was conducted to estimate the prevalence of MetS and identify associated risk factors among university students and academic staff in Bangladesh.

This study aimed to determine the prevalence of MetS among university students and academic staff in Bangladesh and identify potential risk factors. So far, this is the first study that estimated the prevalence of MetS in student and staff populations within the university context of the country. Our study found that 27.7% of students and 47.7% of staff had MetS. A significant difference in MetS prevalence was observed between male and female students. In both student and staff groups, an increasing trend in MetS and its components was observed with age. The most common component of MetS was low levels of HDL-C, impacting 78% of students and 81.4% of staff. Risk factors associated with MetS in students included age, BMI, hypertension, dyslipidemia, low physical activity, and smoking. For academic staff, the significant factors were age, BMI, hypertension, and dyslipidemia.

In this study, it was found that the prevalence of MetS is lower among students but higher among staff members compared to the estimates reported by Chowdhury et al., where MetS was prevalent in 37% of the Bangladeshi population¹¹. On the other hand, in a separate study by Gupta et al., MetS was found in only 15.2% of Bangladeshi adults¹⁷. The difference in results could be attributed to the fact that our study focused on a specific population within a university context, while Chowdhury et al. and Gupta et al. conducted studies at the local/community level and included participants from both rural and urban areas^11,17.

Our findings from the student group can be compared to other studies conducted in different countries. For example, Malik et al. conducted a study in Pakistan and reported a lower prevalence of MetS among medical college students, with 6.48% in males and 1.13% in females³¹. In another study of US college students, the estimated prevalence of MetS was 12% in males and 6% in females³². A study conducted at West Virginia University in the USA found the prevalence of MetS to be 15% (18.8% in males and 11.1% in females) among their students³³. A systematic review by Ampo-Arias et al. estimated the prevalence of MetS among university students in America, Asia, and Europe, which included 16 studies conducted between 2000 and 2016, using NCEP-ATP III criteria³⁴. The review showed that the prevalence of MetS among students was up to 19.2%³⁴. However, a recent study conducted in Iraq reported a higher prevalence of MetS (41.3%) among university students, with a higher frequency among female students (66.9%)³⁵. Our finding is consistent with other studies that show a higher prevalence of MetS in male students than in female students^31,33.

The prevalence of MetS in our staff group is higher than in a study conducted in India. The study reported a prevalence of 20.5% among teaching staff of an Engineering college, with a higher prevalence in females (25.32%) than in males (19.31%)³⁶. On the other hand, a low prevalence of MetS was found among University staff in Iran, where MetS was prevalent in 13.1% of the participants, with a higher prevalence in females than males using NCEP-ATP III guidelines³⁷. Similar to our study, the prevalence of MetS was higher in females than in males in both studies. However, another study at a Malaysian University reported the prevalence of MetS at 20.6%, with a higher prevalence in males (24.9%) than in females (18.3%)³⁸.

In our study, BMI was strongly correlated with MetS among the students, consistent with other studies that showed a significant relationship between BMI and MetS^31,33. It has been demonstrated that BMI is associated with an increased risk of developing MetS in adulthood³⁹. In our staff group, increased BMI was significantly associated with MetS. Similar findings were reported in other studies, where BMI caused an increased risk of developing MetS among academic staff^36,38. In obese individuals, breakdown of adipose cells releases free fatty acids and cytokines, such as tumor necrosis factor-alpha (TNF-α). These substances hinder the signal transduction pathways that rely on phosphatidylinositide-3-kinase, which, in turn, reduces glucose uptake in the liver and skeletal muscles^3,40. Consequently, the pancreas is overburdened to secrete more insulin, leading to hyperglycemia or diabetes⁴¹.

In the present study, hypertension and dyslipidemia were significantly associated with MetS in student and staff groups. Of the MetS components, low HDL-C was the most prevalent form in students and staff. Similar findings were reported in other studies where hypertension and dyslipidemia were the independent risk factors of MetS^31,38, suggesting these groups are at increased risk of developing cardiovascular disease. We also observed that age was significantly associated with MetS in students and staff groups, which is supported by other study findings, where increased age has been shown as an independent risk factor of MetS^11,17,38. It is assumed that over time, the blood vessels tend to lose their elasticity and become more resistant, which can hinder the flow of blood. This, in turn, can result in poor circulation, leading to the accumulation of lipids in the abdomen and the release of free fatty acids into the bloodstream. These changes can cause an increase in levels of insulin resistance and serum triglycerides⁴².

Furthermore, inadequate physical activity and smoking significantly contributed to MetS, especially in students. Sedentary work and sitting tasks are more common in teaching than in general workers. Although physical activity did not significantly affect MetS among staff, sedentary behaviours may increase the risk of developing MetS^43,44. In the student group, smoking showed a significant association with MetS. These findings were similar to previous studies^45–48. However, no association was found in other studies⁴⁹.

Regarding gender difference, the prevalence of MetS was about two times higher among male students than female students. This could be a reason hypertension prevalence was significantly higher among male students (16.9%) than female students (3.3%), which may influence the MetS rate in male students. In addition, male students might be less aware of food and body weight maintenance than female students. On the other hand, MetS prevalence was higher in female staff than in the male staff; even the prevalence of hypertension was higher in male staff. This might be related to some factors; for example, the physiological and metabolic changes that occur during menopause are a result of a decrease in estrogen levels, which impact lipid metabolism, energy consumption, insulin resistance, and body fat composition^50,51. This hormonal shift causes a transition from a gynecoid body shape to an android one with an increase in abdominal and visceral fat accumulation, leading to a higher risk of cardiovascular disease and metabolic issues^50,51. Furthermore, pregnant women are more likely to be obese, and multiple pregnancies can further increase the risk of developing MetS⁵². Overall, our findings indicate a widespread prevalence of MetS among students and academic staff in the University context in Bangladesh. These data identify the importance of implementing health programs to screen for MetS components and prevent the onset of chronic diseases among the university population. It is imperative for University administrators across the country to take action and prioritize the health of their students and staff. Although sex and age are non-modifiable risk factors for MetS, modifiable lifestyle behaviors such as sleep patterns, dietary habits, physical activity levels, and stress management practices may offer more significant interpretations.

One of the key strengths of the study was its use of a precise case definition that relied on blood tests to confirm diagnoses of dyslipidemia and diabetes. Additionally, the study's analysis took into account numerous factors that could potentially increase the risk of MetS. Our study also had some limitations. Due to the study’s cross-sectional nature, it was impossible to establish a causal relationship between MetS and certain risk factors. Additionally, it is important to note that the sample size for this study was relatively small; therefore, more extensive studies are needed to better understand the prevalence of MetS among university students and staff across the country. Lastly, it is worth mentioning that the prevalence of MetS was determined based on a single measurement of blood parameters, which may have resulted in minor inaccuracies.

A considerably higher prevalence of MetS was observed among students and academic staff. Older individuals showed a higher likelihood of having MetS. For students, significant factors associated with MetS were age, BMI, hypertension, dyslipidemia, low-intensity physical activity, and smoking. Academic staff showed significant associations with age, BMI, hypertension, and dyslipidemia. Interventions aimed at improving lifestyle behaviours and identifying high-risk individuals may help reduce the burden of MetS. These findings emphasize the importance of implementing health screening and interventions for students and staff in various university settings in Bangladesh. The data from such screenings can inform researchers, public health officials, and university administrators to implement effective interventions to prevent chronic disease progression in academic settings. Health promotion activities, such as healthy diet and exercise programs, should be implemented more rigorously. Conducting future research with more representative samples can provide precise insights into the prevalence of MetS among different subgroups of the university population, which can help design and implement interventions for high-risk groups.

The authors express their gratitude to all the participants for actively taking part in and cooperating with the study. The authors also express gratitude to their colleagues who assisted in sample and data collection process.

N.A. conceptualized the study, designed the research, interpreted the results, drafted and revised the manuscript. M.S. and J.H.S. conducted experiments and analyzed data. A.T. assisted with sampling and experiments. F.I., contributed to review of the manuscript. All authors have read and approved the final version of the manuscript.

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

The authors declare no competing interests.