Fatimah AL Awadh, FatimahALRamadhan, Manal Balise, Badriyah ALHnowah.Collage ofMedicine, King Faisal University, Al Ahsa – Kingdome of Saudi Arabia Abstract—The simple term “blood glucose” is surprisingly complex. Minor raises in bloodglucose considerably increase the risk of diabetes mellitus development.Obesity and overweight is a recognized risk factor for developing type 2diabetes.
One unresolved question is, if there is a relation between body massindex (BMI) and blood glucose level (BGL) in female students of King FaisalUniversity (KFU). This study examined thecorrelation between BMI and BGL amongst 125 randomly selected, consenting KFUfemale students who are apparently healthy. Thereis no significant correlation between BMI and BGL in subjects.
College ofmedicine student subjects had significantly lower BGL compared with college ofsciences and others. Number of sugar spoons in subjects’ hot drink with bodymass index is approaching significance with p = 0.09. Highblood glucose levels in young females don’t results from high BMI.
Instead,they are associated with high sugar consumption. Awareness should be increaseamong the university students in order to reduce the prevalence ofhyperglycemia and consequent pre-diabetes. Index Terms— Blood glucose level,Body mass index, Diabetes, Hyperglycemia, Obesity, Overweight, Prediabetes. —————————— u ——————————1 Introduction Diabetes is a chronic illness that needs endless health care and constant self-management, public health education and reliable psychosocial support to avoid acute complications and to shrink the risk of chronic complications (1). The highest prevalence of diabetes overall is anticipated to occur in the Middle East and North Africa due to rapid economic development, urbanization and changes in lifestyle patterns in the region. (2) The simple phrase “bloodglucose” is remarkably complex. Blood glucose can be highly variable, growingbriskly after a carbohydrate meal then falling to the relatively steady fastingstate (3). Minor raises in blood glucose considerably increase the risk ofdiabetes mellitus development (4).
A study in England founded a significant associationbetween an elevated BMI and diagnosis of type-2 diabetes mellitus from a studyof about 7000 British men (12 years mean follow-up) (5). Moreover, a report bythe Saudi Arabian Ministry of Health, published that nearly 0.9?million peoplewere diagnosed DM in the year 1992, However this rate reached 2.
5?millionpeople in 2010, signifying a 2.7 times rise in the incidence in less than twodecades. (20) A cross-sectional study in 2009 carried out in KSA revealed that30% of subjects were diagnosed with diabetes mellitus and correlating with theprevalence of body mass index of ?25 amongst diabetics which was was 85.
7%(P<.0001). (19) Obesity and overweight isa recognized risk factor for developing type 2 diabetes, nevertheless, mostobese individuals do not develop type 2 diabetes. Latest studies haverecognized correlation between Body mass index and type 2 diabetes includingpro-inflammatory cytokines (tumor necrosis factor and interleukin-6), insulinresistance, deranged fatty acid metabolism, and cellular processes such asmitochondrial dysfunction and endoplasmic reticulum stress (1).It is impotent toelaborate the relationship between BMI and BGL in order to estimate theincidence of hyperglycemia level that is a risk factor for developing type 2diabetes mellitus.
Identifying risk factors is an essential step for preventionand health education as well as lowering the DM health burden. To date, noarticle has reviewed the relationship between BMI and BGL in female students ofKFU. 2 Materials And Methods This cross-sectional studywas conducted at King Faisal University during April 2013. The study wasapproved by the ethical board of College of Medicine in King Faisal University.The target group was female students from all colleges of KFU in apparent goodhealth. The sample included 125 girlswith confidence level 95% and confidence interval of 8.74.
Measured usingonline sample size calculator. The age group of the sample ranged from 18 to26. A questionnaire was designed by the research team and tested using pilottest to be modified accordingly. A group of external undeclared respondentswere chosen from different colleges of KFU and interviewed individually. Theinterview consisted of brief introduction about the aim of this study, handlingthe questionnaire and finally asking respondents to read it and answer out loudwhile a member of the team is recording notes. Finally, the research teamreviewed all respondent’s questionnaires and made minor adjustments.
Afterobtaining the informed consent from subjects, the questionnaire wasdistributed. The age, the height, the weight, Random BGL and the college of thesubjects were recorded. Random bloodsugar was taken using glucometer and the weight and height was measured using ascale. Our exclusion criteria included invalid blood glucose test, absentweight and height information, and pregnancy. The BMI for each subject wascalculated using the standard formula i.e. weight in kilograms divided byheight in square meters (6). All the variables including age, college, height,weight, BMI, BGL, diet, exercise and family history of diabetes from studygroup were organized and analyzed statistically using SPSS computer program.
Person correlation coefficient was used to find the correlation between BGL andBMI. One-way ANOVA test was used to check the statistical significance of thechanges in BMI and BG with respect to college and other factors. Chi-squaretest was used to find relation between body mass index categories anddiet. 3 ResultAnalysis of one hundredand ten (110) consented female KFU students’ data was carried on and theachived results are presented in Tables 1, 2, 3 and Graphs 1, 2.
First, BMI and BGL didn’tshow significate correlation in our subjects p= 0.61. However, graph 1showed positive association. As college changes, thereis a corresponding change just in BGL but BMI changes diversely. College ofmedicine is statistically significantly different compared with college ofSciences and Others (Business administration, Computer and informationtechnology, Art, Community Service and Pharmacy). The p value was (p=0.04and p=0.
003) respectively. Between the college of medicine and college ofeducation there is a relationship approaching significance with p = 0.09.The college of medicine is not statistically significantly different in bodymass index compared with others, p>0.
05. In all, main relationship issignificant between college and blood glucose in subjects. As the intake of potato chipsincreases in subjects, the body mass index increases. This relationship issignificant (p=1.17). Conversely, subjects with normal BMI favoritechocolates for snacks.
The most fruit favorite snack are low BMI subjects. Number of sugar spoons insubjects’ hot drink with body mass index is approaching significance with p=0.09.Overall, for the 110 subjects, BMI and BGL showed no significant relationship. College N BMI (Kg/Mˆ2) BGL (mmol/L) Sciences 24 24.89 ± 6.27 123.75 ± 29.
75 Education 22 27.33 ± 6.70 120.36 ± 28.97 Agriculture 16 26.
40 ± 5.06 115.13 ± 18.84 Medicine 18 23.69 ± 5.46 107.06 ± 20.
30 Others 26 27.67 ± 5.84 130.65 ± 24.
92 Table 1: Body Mass Index (BMI) andBlood Glucose Level (BGL) for female subjects in different colleges. Values areexpressed as Mean ±SD for N subjects. BMI Category N BGL (Moll/L) Normal 51 120.
28 ± 25.71 Overweight 23 120.87 ± 27.
45 Obese 32 119.34 ± 26.57 Table2: Blood Glucose Levels (BGL) in different body mass index categories. Valuesare expressed as Mean ±SD for N subjects. BMI classification: 18.5-25.
0: normal, 25-30.0: overweight,>30.0: obese.
BGL 1 ³ 2 ³3 Normal 18 28 35 Hyperglycemic 1 10 15 Table 3: Number of sugar spoons in hot beverages among differentBGL categories. Graph 1: The correlation between BMI and BGL. Graph 2: The correlation between BGL and college.
Graph 3: The correlationbetween BMI and favorite snack. Graph 4: The correlation between BGL and number of sugar spoons. 4 Discussion Present study was conducted to evaluate therisk of diabetes and prevalence of hyperglycemia in overweight and obese femalestudents of KFU, based on assessment of family history of risk factors, diet,physical exercising and blood sugar levels in comparison with BMI. Etiology of developingtype 2 diabetes mulites has many risk fators.
However, the key modifiable andacquired risk factor in probably is obesity as found in multiple studies(7,8,9). A study by E. Skarfors, et al.investigated a sample of men in Sweden with a normal BGL for development oftype-2 diabetes mellitus revealed that the incidence of diabetes mellitus grewtwenty-two times in subjects with elevated BMI compared to lower BMI subjects(8).
Similarly, a prospective study exploring about 7000 men living in England(12.8 years’ follow-up) recognized a solid significant association between highBMI and risk of developing type 2 diabetes. These interpretations are acceptedbecause obesity is scientifically proven to induce insulin resistance (10,11). Consequently, it isexpected that BMI should correlate with blood glucose levels. This is, however,not always the case. A Scottish study has previously shown no significantcorrelation between random blood sugar levels and BMI (12). As well as our studywhich has shown that the correlation between BGL and BMI among female studentsof KFU was not statistically significant.
The explanation for these findingscould be that our sample was young in age. And age has a major role indevelopment of diabetes, prediabetes, and hyperglycemia. Also, it might be thatour sample size was not large enough to illustrate the correlation. Anotherfactor that needs to be further explored is the racial factor as was suggestedin a study involving Caucasian and African-American women (13). Also, we found thathyperglycemia was more prevalent among students of sciences and other collegesas shown in graph 2. We think that is because of sedentary life style.
Theuniversity have no gym for females at that time. Their students do have a longbreak in comparison to medical students. This time is usually spent in thecafeterias which mainly offer unhealthy junk food, rich in carbohydrates andfat. However, the lowest blood glucose levels were among medical students.
Wethink that is because of their busy lifestyle between long lectures, labs,assignments, studying and researching. Also, in the university they have nofree time or long breaks between lectures so they don’t depend on the cafeteriafood. Annother possible explanation for the significant drop in BGL in medicalstudents compared to sicence and others is psychological stress and evendepression. According to H.
Abdulghani in a recent cross sectional studyconducted in Saudi Arabia, the stress in medical students was significantlymore in females and in preclinical years (21). Also, a study by E. Eva inBangladesh found that 54% of medical students are suffering from psychologicalstress especially due to academic load (22). Furthermore, the risk ofdeveloping depression in medical students, with CES-D ³ 16, was 28.4 % and 39.0% in first and thrird yearsrespectively with a significant increase in perceived stress (23). According tocurrent literature, stress can induce hypophagia as well as hyperphagia atequal rate of 40% while 20% experience no change in eating behavior (24, 25).
However,this controversial relationship is suggested to be dependant on severity ofstresso. Where minor stress results in hyperphagia and major stress results inhypophagia (26). This finging explains the elevated BGL in students of scienceand other colleges in relation tomedical students regarding the stress level of their academic requirements.
Furthermore, dietaryhabits have long been associated with the management and/or prevention ofvarious metabolic disorders, such as insulin resistance, obesity, type 2diabetes (14,15). However, our study showed no significant relation between thedaily diet and snacks between meals with blood glucose levels. However, therewas a significant relation between the number of sugar spoons consumed in hotbeverages and the BGL as shown in table 3 and graph 4. High consumption ofsugar-sweetened beverages has also been associated with a greater weight gainand with higher risk of type 2 diabetes (16). As an explanation of theinsignificant relation between the diet and BGL, we can say that it can’t beaccurate to use a questionnaire to measure dietary habits. Subjects may notanswer accurately or not understood properly. However, the statistics revealedthat there is a relation between the snack and BMI as shown in graph 3.
Although it isscientifically proven that physical activity reduces the risk of type 2diabetes (17), Our study has supported this information base by revealing inverselyrelated association between physical activity and underlying asymptomaticdiabetes or prediabetes. Furthermore, our finding suggests that the familyhistory of diabetes had no relation to the random blood glucose level. Opposeto our findings, a cross-sectional study by R.D. Morris et al. of female members of a weight-control club,obesity showed a positive correlation with diagnosis of type 2 diabetesmellitus that is greater in individuals who had a family history of diabetesrather than in those who did not (18). This can be due to our relatively smalland young sample. A number of limitationswere recognized by the research team.
First, some data was collected using aquestionnaire. Also, the time used for data collection was short. And it wasdifficult to access some collages due to distance. Finally, the lack ofexperience of researcher team. 5 ConclusionBased on this researchfindings, there is no significant relation between BMI and BGL in young femalestudents of KFU. Also, there is no significant relation between BGL or BMI anddiet, snack, exercise, or family history in our target group. This study foundthe relation between number of sugar spoons in hot beverages and BGL to besignificant. People with high blood sugar but not diabetic are considered aspre-diabetic.
Pre-diabetics are likely to develop Type 2 diabetes within 10years. The study recommends pre-diabetics to modify their lifestyle by reducingjunk food intake and sugar spoons consumption to one and a half or less percup. Also, we recommend that all universities provide the facilities for ahealthier lifestyle.
These facilities include a gym or a playground forstudents, healthier meals and snack options and health education.6 Acknowledgment Theauthors wish to thank King Faisal University for the opportunity to conductthis study. Also, we wish to thank collage of medicine for providing thenecessary tools for the study.
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