|Year : 2016 | Volume
| Issue : 2 | Page : 106-110
Prevalence of non-communicable diseases risk factors among college students of Anjarakandy Integrated Campus, Kannur, Kerala, India
Imaad Mohammed Ismail, PP Venugopalan, AK Sarada, Kanniyan Binub
Department of Community Medicine, Kannur Medical College, Kannur, Kerala, India
|Date of Web Publication||24-May-2016|
Imaad Mohammed Ismail
Department of Community Medicine, Kannur Medical College, Anjarakandy, Kannur - 670 612, Kerala
Source of Support: None, Conflict of Interest: None
Background: India is presently facing a growing burden of noncommunicable diseases (NCDs) due to industrialization, socioeconomic development, urbanization, changing age structure, and changing lifestyles. There is scarcity of data regarding the prevalence of established risk factors of NCDs among college students and hence, this study was undertaken. Aim: To estimate the prevalence of risk factors of NCDs among college students of Anjarakandy Integrated Campus, Kannur, Kerala, India. Settings and Design: It was a cross-sectional study conducted in Anjarakandy Integrated Campus, Kannur, Kerala, India from March 2014 to June 2015. Materials and Methods: The integrated campus has a total of 1,933 students from the medical, dental, engineering, Medical Laboratory Technology (MLT), nursing, and pharmacy colleges who formed the sampling frame. After taking oral consent, a pretested, structured questionnaire was used to collect data on the sociodemographic variables, diet, smoking, alcohol consumption, physical activity, and family history of NCDs. Statistical Analysis: Data entry and analysis were done on Statistical Package for the Social Sciences (SPSS) version 17. Percentages and proportions were used to describe the results. Results: A total of 634 students participated in the study. The prevalence of risk factors of NCDs was as follows: lack of exercise -44.6%, junk food intake of more than 3 times/week -65.9%, extra salt intake -78.5%, daily smoker -2.4%, and alcoholic consumption in the past 30 days -2.5%. On an average, students spend 3 h using their mobile phones and 1 h watching television daily. It was found that 29.8% of the students were undernourished and 9.8% were preobese/obese. A total of 10 students were diagnosed as hypertensive. Conclusion: Lack of exercise, consumption of junk food, and high salt intake were found to be highly prevalent in the study participants. To address the issues, sports should be promoted, especially among women and nutrition education classes should be included in the curriculum.
Keywords: Adolescents, junk food, mobile phone, noncommunicable diseases (NCDs)
|How to cite this article:|
Ismail IM, Venugopalan P P, Sarada A K, Binub K. Prevalence of non-communicable diseases risk factors among college students of Anjarakandy Integrated Campus, Kannur, Kerala, India. J Med Soc 2016;30:106-10
|How to cite this URL:|
Ismail IM, Venugopalan P P, Sarada A K, Binub K. Prevalence of non-communicable diseases risk factors among college students of Anjarakandy Integrated Campus, Kannur, Kerala, India. J Med Soc [serial online] 2016 [cited 2021 Jul 29];30:106-10. Available from: https://www.jmedsoc.org/text.asp?2016/30/2/106/182911
| Introduction|| |
The changing lifestyles of mankind have led to the rise and fall of many diseases. Currently, noncommunicable diseases (NCDs) are in the limelight replacing communicable diseases, which were the leading cause of death in most countries.  NCDs have a prolonged course that does not resolve spontaneously and for which a complete cure is rarely achieved.
Out of the 57 million deaths reported globally, 36 million (63%) deaths and 44% of disability-adjusted life-years (DALYs) are attributed to NCDs, principally cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases.  India is facing a double burden of both communicable disease and NCD. Globally speaking, India experienced the highest loss in potentially productive years; when compared to communicable diseases, NCDs approximately contribute 235 million DALYs, whereas the former leads to 222 million DALYs. ,
The present scenario indicates that NCD-related diseases are on the rise among young people. Once the behavioural patterns of an individual are established, it often persists throughout life and is hard to change. Recognizing the importance of this problem, a resolution was endorsed by the World Health Assembly calling upon member states to address the needs of the youth in the context of NCDs. 
The NCDs are driven by many risk behaviors, which are modifiable such as increased intake of junk food, smoking and alcohol consumption, lack of exercise, and long hours of television and mobile use.  Nearly three out of four obese adolescents remain obese as adults, which increases their risk for diseases such as coronary heart disease, type 2 diabetes, stroke, and cancers. ,,,, Behavioral changes such as addictions also play a significant role in producing NCDs, which mainly evolve during early adolescence.  Smoking is an important risk factor for NCDs and it is estimated that around one lakh young people start smoking every day and 90% among them begin smoking before the age of 18 years. ,
Despite these alarming statistics, children, adolescents, and the role of youth more generally have not received adequate attention. There is limited data available regarding the prevalence of established risk factors of NCDs among college students. The available studies conducted on college students have mostly been conducted on students belonging to only one academic discipline such as medical science or engineering, which is not representative of the student community as a whole; hence, this comprehensive study was undertaken to understand the problem among students from multiple academic disciplines. The objective of the study is to estimate the prevalence of risk factors of NCDs among college students of Anjarakandy Integrated Campus, Kannur, Kerala, India.
| Materials and methods|| |
It was a cross-sectional study conducted in Anjarakandy Integrated Campus, Kannur, Kerala, India from March 2014 to August 2015. The integrated campus has a total of 1,933 students from the medical, dental, engineering, Medical Laboratory Technology (MLT), nursing and pharmacy colleges who formed the sampling frame. Prevalence of overweight/obesity among students of 20% was considered for calculating the sample size at 20% relative precision and 95% confidence level.  The minimum sample size required for the study was calculated as 400.
All the students from the sampling frame who were willing to participate were included in the study after taking consent. Those students who were not willing to participate in the study or students who were not available even after two visits were excluded from the study. The students were approached during lunch break or after college hours for data collection. A pretested, structured questionnaire was used to collect data on sociodemographic variables, diet, tobacco smoking, alcohol consumption, and physical activity. Junk food was defined as those food items containing high levels of calories from sugar or fat with little protein, vitamins, or minerals such as packed chips and cola. Extra salt intake was defined as the consumption of two or more pinches of salt per meal excluding the previously added salt during preparation or use of salted pickle with most meals. A daily smoker was defined as a person who smoked tobacco products in any form on all the days. History of alcohol consumption of all types in the past 30 days was recorded. Regular physical exercise was defined as aerobic physical activity such as brisk walking for at least 30 min per day. No exercise was defined as no aerobic physical activity and some exercise was defined as aerobic physical exercise on some days of the week.
Weight was registered using an electronic weighing machine (Venus, China) and was rounded off to the nearest 0.5 kg. For measuring height, the subject was made to stand erect looking straight on a level surface and height was read to the nearest 0.5 cm. Body mass index (BMI) was classified according to the standard WHO criteria.  BMI of 25.0-29.9 kg/m 2 was considered as overweight and BMI ≥ 30 kg/m 2 was considered as obesity. As WHO recommends BMI ≥ 23 kg/m 2 as a public health action point for Asian populations, this level has also been considered during analysis.  Blood pressure was recorded in the right arm with the subject in a seated position using a mercury sphygmomanometer (Diamond, India). Two readings were taken and the average of these readings was considered for analysis. The first reading was taken after at least 15 min of rest and the second reading was taken 15 min after the first reading. The Eighth Joint National Committee (JNC 8) criteria were used for the diagnosis of hypertension.  Data entry and analysis were done on Statistical Package for the Social Sciences (SPSS) version 17 (SPSS Inc., Chicago). Quantitative data were expressed in mean and standard deviation (SD), whereas qualitative data were expressed as percentage and proportions. Ethical clearance for the study was taken from the Institutional Ethics Committee of Kannur Medical College.
| Results|| |
A total of 634 students of Anjarakandy Integrated Campus studying in various academic disciplines volunteered and participated in the study [Table 1]. A large proportion of students were from the medical college (28.2%) followed by the nursing college (26.3%). Most of the students were in the age group of 16-25 years [Table 2]. The mean age (±SD) of students was 20.3 (±2.1) years and 69.2% were females.
|Table 1: Distribution of students according to their academic discipline|
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The prevalence of risk factors of NCDs were as follows: Lack of exercise - 44.6%, junk food intake more than 3 times per week - 65.9%, extra salt intake - 78.5%, daily smokers - 2.4%, and alcohol consumption in the past 30 days - 2.5% [Table 3]. Around 30% of the students were found to be undernourished, whereas 9.8% were preobese/obese. It was also observed that 20% of the students had BMI equal to or more than 23 kg/m 2 , which is an important public health action point for the Asian population. On an average, students spent 3 h using their mobile phones and 1 h watching television daily [Table 4]. A total of 10 out of the 634 students were found to be hypertensive.
|Table 3: Distribution of the risk factors of NCDs among the study population|
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|Table 4: Table showing average time spent on television, computer, mobile, and books by the students|
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| Discussion|| |
In India, 20% of the population constitutes adolescents.  These adolescents are the future strength and productive group of the country. This study was undertaken to estimate the prevalence of risk factors of NCDs in college students. Among the Indian states, Kerala has the highest sex ratio and female literacy rate. A similar picture was seen in the present study where 67.2% of the study participants were females.
Awareness of proper diet and nutrition helps people to have a longer life span. Due to lack of awareness among the youth, use of junk food has become common in our day-to-day life, which adds extra calories. The consumption of bottled soft drinks, canned food, and packed items are on a rise. The changing dietary lifestyle has been reflected in this study, which showed that 65.9% of the students ate junk food more than three times a week. In contrast, a study conducted in Guwahati, Assam, India reported that 9% of the students had consumed junk food once in a week. 
Adequate exercise can reduce the burden of many diseases. It is estimated that 2 million deaths are caused due to inadequate physical activity.  In the present study, 39.3% of the students exercised regularly. Similar findings were also reported among college students of Uttar Pradesh, India where 30% of them were found to exercise regularly.  Another study conducted at Ahmedabad, Gujarat, India showed that 15.2% of the students exercised daily and 56.3% exercised weekly, which was much lower compared to the present study.  This could be attributed to the proper functioning of the sports department in the campus. In order to further increase the number of people doing regular exercise, the sports wing of the universities must play a significant role in the promotion and facilitation of sports in colleges. This in the long run will reduce diseases associated with a sedentary lifestyle.
Childhood obesity and adolescent obesity are on the rise in India. Overweight and obesity can lead to adverse metabolic effects on cholesterol, triglycerides, insulin resistance, and blood pressure. In the present study, 9.8% of the students were found to be preobese/obese. A study conducted in Belgaum, Karnataka, India showed 9.1% of the students to be obese.  A trend shift in the eating pattern and physical inactivity among a section of the students has led to overweight and obesity in them. The current study also found around 29% of students to be undernourished. This may be attributed to the fact that a majority of the students depend on the college canteen for their meals, which are monotonous in nature (similar food items are frequently repeated) and also the high intake of junk food by the student population.
Tobacco is the second major cause of death in the world. Tobacco kills 5.4 million people every year in the world, mostly in poor countries.  In India, more than 0.8 million people die due to tobacco each year. In Kerala, India, 28% of the population use tobacco.  The present study found that 2.4% of the study population were daily tobacco smokers. Similar studies conducted in Uttar Pradesh, India and Saudi Arabia found a prevalence of 4.5% and 3.1%, respectively. , The lower level of tobacco smoking in the current study could be due to the high level of discipline maintained by the management of the campus. Globally, 2.3 million people die from alcohol-related causes and it constitutes 3.7% of all deaths.  In the present study, 2.5% of the students consumed alcohol at least once in a month. It is comparatively less when compared to students of Uttar Pradesh, India, which was 5.6%.  This can be attributed to the reduced availability of alcohol and the fear of students to stand in the queue to procure it as alcohol is mainly available in the government-owned outlets, which usually have long waiting queues.
Hypertension is also known as a silent killer as it does not produce many symptoms. In today's scenario, it plays a vital role as a risk factor for stroke, ischemic heart disease, and renal failure. In the present study, the prevalence of hypertension was found to be 1.6%, which is less when compared to the study conducted in Saudi Arabia (11.9%).  Excessive intake of salt can lead to an increase in blood pressure. In the current study, 78.5% of the students consumed extra salt in their diet. As part of the local culture, the students consumed lot of pappad and pickle in their regular diet, which is rich in salt and it is the main source of the extra salt. Though the salt intake was high among the students, we found that the prevalence of blood pressure was not in excess.
The present-day youth are in a habit of watching television for long hours and spending a lot of time on mobiles. The current study found that on an average, students spend 3 h using their mobile phones. Most students possessed smartphones with Internet connection, which resulted in them spending more time using social networking apps and also mobile gaming. The study also found that the students spent on an average about 1 h watching television daily. The results were comparable to studies conducted in Punjab in India and Saudi Arabia. The study conducted in Punjab showed that 32.5% of the students spent more than 2 h and in Saudi Arabia, 57.2% students spent ≥1 h in watching television. ,
| Conclusion and recommendation|| |
Lack of exercise, consumption of junk food, and high salt intake were found to be highly prevalent risk factors of NCDs in the study participants. Sports should be promoted, especially among women as many of them were found to be physically inactive. Nutrition education classes should be included in the curriculum to address the issue of malnutrition.
We are grateful to the Management and Principals of the colleges located in Anjarakandy Integrated Campus for their full cooperation during the study. We thank the students of the campus for their wholehearted support during data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Global Status Report on Non-communicable Diseases. Geneva: WHO, 2011. p. 9-10.
Srinath Reddy K, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet 2005;366:1744-9.
Bloom DE, Cafiero-Fonseca ET, Candeias V, Adashi E, Bloom L, Gurfein L, et al
. Economics of Non-Communicable Diseases in India: The Costs and Returns on Investment of Interventions to Promote Healthy Living and Prevent, Treat, and Manage NCDs. Switzerland: World Economic Forum, Harvard School of Public Health; 2014. p. 12-3.
World Health Organization. Youth and Health Risks. Sixty fourth World Health Assembly. Geneva: WHO; 2011. p. 55-8.
World Health Organization. The world health report 2002: Reducing risks, promoting healthy life. Geneva: WHO; 2002. p. 23-5.
Dehghan M, Akhtar-Danesh N, Merchant AT. Childhood obesity, prevalence and prevention. Nutr J 2005;4:24.
Niklas TA, Baranowski T, Cullen KW, Berenson G. Eating patterns, dietary quality and obesity.
J Am Coll Nutn 2001;20:599-608.
Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997;337:869-73.
Parsons TJ, Power C, Logan, S, Summerbell CD. Childhood predictors of adult obesity: A systematic review. Int J Obes Relat Metab Disord 1999;23(Suppl 8):S1-107.
Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:11-25.
Morrison MA. Addiction in adolescents, In Addiction Medicine [Special issue]. West J Med 1990;152:543-6.
Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992;327:1350-5.
Peltzer K, Pengpid S, Samuels TA, Ozcan NK, Mantilla C, Rahamefy OH, et al
. Prevalence of overweight/obesity and its associated factors among university students from 22 countries. Int J Environ Res Public Health 2014;11:7425-41.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al
. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507-20.
Lal S. Textbook of Community Medicine, Preventive and Social Medicne. 4 th
ed. Delhi: CBS Publishers; 2014. p. 155-6.
Dutta S. An assessment of the factors affecting food choices and their corresponding association with overweight and obesity among school going children in urban Guwahati in the age group of 13-18 years. AMCHSS, MPH thesis; 2012. p. 5-11.
Srivastava A, Sharma M, Gupta S, Saxena S. Epidemiological investigation of lifestyle associated modifiable risk factors among medical students. Nat J Med Res 2013;3:210-5.
Shah TA, Bhatt R J, Patel M, Patel PG. Body mass index, dietary habits and physical exercise among school going adolescent: A cross sectional study in Ahmedabad. Natl J Community Med 2013;4:314-6.
Banjade B, Naik VA, Narasannavar A. Prevalenceof obesitry and its risk factors among Pre university college adolescents of Belgaum city, Karnataka. IOSR-JDMS 2014;13:56-60.
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al
. Risk factor profile for chronic non communicable diseases: Results of a community based study in Kerala, India. Indian J Med Res 2010;13:53-63.
Desouky DS, Omar MS, Nemenqani DM, Jabbar J, Khan NM. Risk factors of non-communicable diseases among female university students of the health colleges of Taif University.
Int J Med Med Sci 2014;6:97-107.
Sadana B, Khanna M, Mann SK. Consumption pattern of fast foods among teenagers. Appl Nutr 1997;22:41-5.
[Table 1], [Table 2], [Table 3], [Table 4]