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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 20-25

Lifestyle practice and associated risk factors of noncommunicable diseases among the students of Delhi University


1 Department of Clinical Medicine, National JALMA Institute for Leprosy and Other Mycobacterial Diseases (Indian Council of Medical Research), Agra, Uttar Pradesh, India
2 Department of Epidemiology, National Institute of Health and Family Welfare, New Delhi, India

Date of Web Publication15-Feb-2017

Correspondence Address:
Joy Kumar Chakma
Division of Non Communicable Diseases, Indian Council of Medical Research, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_34_16

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  Abstract 

BACKGROUND: Lifestyle has long been associated with the development of many chronic diseases and noncommunicable diseases (NCDs). NCDs are largely preventable through effective interventions by tackling the shared modifiable risk factors, and onset and progress can also be delayed. Therefore, the objectives of this study were to determine the practice of lifestyle and assess the burden of associated risk factors of NCDs among the students of selected colleges of Delhi University.
MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among 450 students from two coeducational colleges of Delhi University. Data were collected in accordance with the World Health Organization STEPwise approach to Surveillance (WHO STEPS) questionnaires. Standardized questionnaires of WHO STEPS methodology for surveillance of chronic diseases for Step 1 and clinical measurement on height, weight and blood pressure (BP) for Step 2 were used. Data were collected in September 2013 to November 2013.
RESULTS: Of the 450 students, 56.88% were male, all in the age group of 18–26 years. Only 28.66% of the subjects perform the moderate physical activity during a usual week. During the past 7 days, 59.33% consumed carbonated soft drinks at least 1–2 times/day and 49.11% eaten >2 servings of fast foods per day. Tobacco use (smoking only) was prevalent in around 15.77% of the subjects and alcohol in 20.88%. Majorities use tobacco and alcohol in relation to socialization, peer pressure and for enjoyment. 31.55% of the subjects were overweight and obese and 8.22% underweight, while 1.55% high normal BP.
CONCLUSIONS: The present study showed a poor practice of healthy lifestyle with a high burden of lifestyle-related risk factors of NCDs among students of Delhi University. Therefore, the University should emphasize on curriculum for a healthy lifestyle in all faculties as a required subject. Frequent campaigns and educational seminars are to be encouraged for the adoption of healthy lifestyle and health promotions.

Keywords: College students, Delhi University, lifestyle practice, noncommunicable diseases, risk factors


How to cite this article:
Chakma JK, Gupta S. Lifestyle practice and associated risk factors of noncommunicable diseases among the students of Delhi University. Int J Health Allied Sci 2017;6:20-5

How to cite this URL:
Chakma JK, Gupta S. Lifestyle practice and associated risk factors of noncommunicable diseases among the students of Delhi University. Int J Health Allied Sci [serial online] 2017 [cited 2020 Apr 4];6:20-5. Available from: http://www.ijhas.in/text.asp?2017/6/1/20/200199

Lifestyle is the way humans chose to live their day to day lives which may be related to social, occupational or environmental factors. A healthy lifestyle is about striving to obtain a reasonable balance between enhancing one's personal health, the health and well-being of others, and the health of the community and according to the World Health Organization (WHO), health is a state of complete physical, mental, and social well-being not merely absence of disease or infirmity. Promoting healthy lifestyles is a challenge for many primary care practices. Although most individual understand the importance of physical activity and healthy eating, many seem unable to change their unhealthy behaviors to reduce weight and improve chronic conditions, and lifestyle changes have been shown to significantly reduce morbidity and mortality rates for most chronic diseases.[1] An unhealthy lifestyle can contribute to the development of risk factors of noncommunicable diseases (NCDs) such overweight and obesity can lead NCDs such as diabetes, hyperlipidemia, cardiovascular diseases (CVDs), and hypertension.[2],[3] Thus, obesity is an important risk factor of NCDs. Many studies have implicated weight gain in the pathophysiology of hypertension, diabetes, CVD, and cancers.[4],[5],[6],[7] Moreover, obesity can lead to increased mortality and disability and rising costs of treatment in most communities.[8] Annually, 300,000–587,000 deaths worldwide are attributed to obesity. Obesity is considered as the second important preventable cause of death worldwide.[9] Adequate dietary habits and regular practice of physical activities and exercises are important components of a healthy lifestyle that are associated with decreased risk of chronic nontransmissible diseases such as Type 2 diabetes, hypertension, obesity, some cancers, and the metabolic syndrome. Notwithstanding, sedentary behavior (physical inactivity) allied to a lower intake of fruits, vegetables, cereals, and fibers, as well as higher intake of fatty, fried, salted, caloric foods, snacks, and soft drinks have been associated with increased chronic disease risk in children and adults. WHO estimates 2 million deaths/year caused by physical inactivity and unhealthy eating habits.[10]

Lifestyle has long been associated with the development of many chronic diseases and NCDs. WHO has identified four major NCDs, i.e., diabetes, CVDs, cancer and chronic lung disease/chronic obstructive pulmonary disease (COPD) which share common lifestyle-related behavioral risk factors. These risk factors are tobacco use (smoking/chewing), physical inactivity, unhealthy diet, and alcohol use leads to key metabolic and or physiological changes like raised blood pressure (BP), overweight/obesity, raised blood glucose, and raised cholesterol levels. Many studies have shown that the prevalence of risk factors of NCDs in the early phase of life, i.e., childhood and adolescence bears significant tendency toward development of disease in adulthood.[11],[12],[13]

In a developing country like India, the present scenario of these diseases is in quite alarming situation as the profile of these diseases is changing very rapidly. The WHO has identified India as one of the nations that is going to have most of the lifestyle-related disorders in the near future. However, the important fact is that not only are the lifestyle disorders becoming more common, but they are showing a drastic shift toward the younger population. According to the WHO, 53 percent of the deaths in 2008 were due to NCDs in India and CVDs alone account for 24 percent of all deaths.[14] As of 2005, India experienced the “highest loss in potentially productive years of life” worldwide, and the leading cause of death was CVD; mostly affecting people aged 35–64 years.[15]

Lifestyle behaviors, in particular, the impact on individuals' weight and public health concerns such as obesity have substantial health, social, and economical impacts. Increases in obesity have been seen in many population groups, but in particular in young adults aged 19–26, where young adults have a greater propensity to become obese as they age. The incidence of obesity in young adults is somewhat unsurprising given that research indicates that young adults engage in low levels of physical activity, consume binge quantities of alcohol and have nutritionally poor diets. A need to tackle these “poor” lifestyle behaviors is increasingly recognized in government policy, yet there is limited research in this area with young adults.[16] NCDs are largely preventable through effective interventions by tackling these shared modifiable risk factors, and even their onset and progress can also be delayed. Therefore, the objectives of this study were to determine the practice of lifestyle and assess the burden of associated risk factors of NCDs among the selected college students of Delhi University.


  Materials and Methods Top


A descriptive cross-sectional study was conducted among the 450 students, both male and female from two coeducational colleges of Delhi University. Two colleges, one from North campus and one from South campus were randomly selected from the six colleges from whom prior permission was obtained for the study. The sampling was done in two stages by simple random sampling from three major streams of arts, commerce, and science of undergraduate and postgraduate courses who has consented to participate in the study.

Data were collected by suing WHO STEPwise approach to Surveillance (STEPS) methodology for surveillance of chronic diseases.[17] For Step 1, a structured questionnaire developed in English language as per WHO STEPS guidelines was used to collect information on sociodemographic variables, practice of healthy lifestyle and related behavioral risk factors of NCDs like physical activity, dietary habits, fruits and vegetable eating, consumption of fast foods and carbonated soft drinks, tobacco, and alcohol use. The subjects were explained in detailed how to answer the questionnaire and were counseled before inclusion in the study.

The practice of healthy lifestyle was assessed in context to physical activity, dietary habits, fruits, and vegetables eating and behavioral risk factors like tobacco and alcohol use. The level of physical activity was determined as per WHO recommendation on physical activity for adults aged 18–64 years should do at least 150 min of moderate-intensity physical activity throughout the week and should be performed in bouts of at least 10 min duration. The concept of accumulation refers to meeting the goal of 150 min/week by performing activities in multiple shorter bouts, of at least 10 min each, spread throughout the week then adding together the time spent during each of these bouts, for example, 30 min of moderate-intensity activity per day, 5 times/week are considered to be physically active, and the rest who do not fulfill the above criteria on physical activity are considered as physically inactive.

Information on dietary habits, fruits and vegetables eating was collected as per the number of serving eaten per day from different food groups. Servings are the amount of a food from one of the food groups taken into consideration as per the definition of USDA. Thus, servings for each of the food groups like fruits and vegetables, etc., taken into account.

For Step 2, information on clinical measurement of height and weight for calculation of body mass index (BMI) and BP was collected. Measurement of height in centimeter was recorded in standing position by using a standardized stature meter, and weight in kilograms (in barefooted) was recorded with standardized electronic weighing equipment. Waist circumference and waist to hip ratio was not included. BMI is a person's weight in kilograms (kg) divided by his or her height in meters squared and is universally expressed in units of kg/m 2. WHO BMI classification for Asian adults (Indians) was used to categorize overweight and obesity. BP in mmHg (in sitting posture) was recorded with standardized electronic BP monitoring equipment. The average of two readings taken in 5 min intervals was taken into account for final reading.[18] Step 3 was not included, as collecting and analyzing blood samples is a relatively complex process and can be done only in the context of a comprehensive survey and in settings where appropriate. Hence, the study was conducted based on the recommendations of WHO Step 1 and Step 2.

This study was approved by the Institutional Academic and Ethical Committee. The students were being explained the objective and invited to participate voluntarily. Informed consent was taken from all the participants before inclusion in the study. Data were collected in the month of September to November 2013.


  Results Top


A total of 450 students were included in this study, of them, 56.88% were male. All the study subjects were in the age group of between 18 and 26 years. 85.1% of the study subjects were in the age group of 18–23 years (mean, 21.7, standard deviation, ±2.9) and 71.33% was Hindu by religion. About the dietary habit, 56.88% of the study subjects were nonvegetarian. The economic status was categorized based on information given by the study subjects on the monthly family income of their parents. 72.21% of the subjects were from upper middle and middle-class socioeconomic background as per revised and modified BG Prasad socioeconomic classification scale (2014).[19] Regarding living status, 70.22% of the study subjects were staying in their own house with their parents [Table 1].
Table 1: Distribution of subjects according to sociodemographic variables

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Physical activity performed during a usual week and during the past 7 days did not reveal much difference. Only 28.66 of the subjects perform moderate physical activities during a usual week as per WHO recommendation which indicates that majority of them either performed an inadequate physical activity or remained sedentary. Regarding the reasons for not performing physical activity, 70% of the subjects responded as “No time” and 63.77% as “Problem of space.” However, in response to the question on time spent in sitting activities like watching TV, playing games on computer/mobile, etc., during a usual day, 63.77% of the subjects spent 4–6 h or more.

The majority of the subjects have a poor dietary habit and low fruits and vegetable intake [Table 2]. There were only 5.77% of the study subjects do not eat fast food during the past 7 days while 49.11% had >2 servings/day during the past 7 days and 59.33% consumed carbonated soft drinks at least 1–2 times in a usual day. When enquired for reasons for eating at fast food restaurant, the most common response was food taste better, friends company and eat for fun.
Table 2: Lifestyle practice among the students of selected colleges of Delhi University

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There were 8.66% of the subjects do not eat fruits in a typical week and 64% eaten only 1–2 servings/day which is inadequate as per WHO recommendation of 2–3 servings/day. Regarding vegetable eating, only 26.44% takes >2 serving of vegetable/day in a typical week [Table 2] which indicates poor dietary habits. A healthy dietary habit start with taking breakfast that is high in complex carbohydrates such as oatmeal, root crops, whole grain cereals, and bread with increased consumption of vegetables particularly the leafy and yellow vegetables like fresh salads and at least 2–3 servings of fruits rich in Vitamin C, beta-carotene, and potassium and to limit consumption of fatty foods especially those from animal sources, sugar, and salt.

Regarding behavioral risk factors, Tobacco use (smoking only) was prevalent among 15.77% of the subjects with 12% male and the most common reasons for using tobacco (smoking) among tobacco users revealed that 45% use tobacco (smoking of cigarette) for enjoyment and 39.43% to share smoking with their friends. In response to drinking of alcohol, 20.88 of the subjects drink alcohol at least once or twice in a usual week, of them 12.66% were male and 8.22% female. The most common reasons for drinking alcohol were to drink with friends (60.63%) and followed by for enjoyment. Thus, social drinking and peer pressure could be an important factor for exposure to tobacco and alcohol.

As per the WHO classification of BMI for adults Asian (Indian), 31.55% of the subjects were in the category of overweight and obese and 8.22% underweight [Table 3].
Table 3: Distribution of subjects as per the World Health Organization body mass index classification for Asian Indians

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Regarding screening for hypertension, none of the subjects recorded to have hypertension as per The Association of Physicians of India (API) classification on BP.[20] 58.89% of the study subjects were recorded with optimal BP and 39.55% with normal BP. There were 1.55% of the subjects recorded to have high normal BP and were counseled and advised to be on regular follow-up with the physician.


  Discussion Top


NCDs constitute a large group of diseases that are of long duration, and generally slow to progress; therefore, these diseases are also called chronic diseases, and they are the major cause of adult mortality and morbidity worldwide.[21] The four main NCDs are generally considered to be dominant in NCD mortality, and morbidity are CVDs (heart disease and stroke), cancers, chronic respiratory diseases (COPD and asthma) and diabetes. Although diverse in symptoms, these four NCDs share common lifestyle-related or behavioral risk factors. A recent report of WHO identified that most NCDs are the result of four particular lifestyle-related behavioral risk factors such as tobacco use, physical inactivity, unhealthy diet, and harmful use of alcohol that lead to four key metabolic/physiological changes, for example, raised BP (hypertension), overweight/obesity, raised blood glucose, and raised cholesterol levels.[22]

In this study, it is evident that there is a high prevalence of physical inactivity and sedentary lifestyle among the study subjects and unfavorable attitude toward physical activity and could be a major challenge for improving the level of physical activity and healthy lifestyle. In a study among the Malaysian University students by Al-Naggar et al.[23] also reported a high prevalence of physical inactivity and many studies [24],[25] have shown lower physical activity and physical inactivity is pandemic especially among younger adults and a leading cause of death in the world. Thus, targeted strategies need to be formulated to increase the level of physical activity as well as for improving the practice of healthy lifestyle.

The majority of the subjects have poor dietary habit and low fruit and vegetable intake in their daily diet with frequent consumption of fast foods and carbonated soft drinks. Many of them eat at fast food restaurant as food taste better and for friends company and eat for fun which indicates a multi-factorial relationship could be associated with the unhealthy dietary habit. Similar observations were reported in a study conducted by Sarathy and Kumar [26] among students of two professional colleges in Krishna district of Andhra Pradesh, India with majority students of both the colleges were having the habit of eat outs (junk food) every week. In another study by Larson et al. also showed that young adults and eating away from home and associations with dietary intake patterns and weight status differ by choice of restaurant indicating that young adults frequently patronize restaurants, and most away-from-home eating occurs at fast-food restaurants.[27]

There is low and inadequate intake of fruits and vegetables in the majority of the study subjects. In a typical week, some even do not eat fruits and vegetables at all. As per the WHO recommendation on daily fruits and vegetable intake, we must take at least 3 servings/day as part of our healthy dietary requirement. The above findings are comparable with observations in a study conducted by Videon and Manning [28] reported that a large percentage of adolescents reported eating less than the recommended amount of vegetables, fruits, and dairy foods. Many similar studies have reported findings on fruits and vegetables eating pattern which are comparable with the present findings.[10],[23]

Regarding behavioral risk factors, Tobacco use (smoking only) was prevalent in 15.77% of the subjects and the most common reasons for using tobacco (smoking) was for enjoyment and friend's company (peer pressure). Many studies [29],[30] have reported similar observations although the prevalence of tobacco use in the present study is slightly lower to the Global Adult Tobacco Survey prevalence of tobacco usage in India, more targeted interventions and anti-tobacco campaign will be needed among the adolescents. With regard to drinking of alcohol, 20.88% of the subjects drink alcohol at least once or twice in a usual week, and the most common reasons for drinking alcohol was “to drink with friends” followed by for enjoyment. Thus, social drinking and peer group pressure could be an important factor for exposure to alcohol use. Similar observations were reported by Vidyulata et al.[29] that 17.4% of adolescents admitted to drinking alcohol and friends contributed 77.1% and family 23% as a source of initiation of substance abuse while admiration by peer (35.4%) was most common reason for the continuation of substance abuse.

In the present study, overweight and obesity was found in 31.55% of the subjects while 8.22% were underweight as per WHO classification of BMI for adults Asian (Indian).[30] Both these conditions could be related to the poor dietary habits; minimal or inadequate physical activity and sedentary lifestyle. The above findings are comparable with the study conducted by Peltzer et al.[31] on the prevalence of overweight/obesity and its associated factors among university students from 22 countries including India. Similar observations were reported in various studies [32],[33],[34],[35] conducted among the different professional students from India and aboard. The prevalence of overweight and obesity is in rising trend among the adolescents and young adults which is a major risk factor of NCDs such as hypertension, diabetes, and CVDs later in life.[36],[37]

In the present study, none of the subjects screened were found to have hypertension as per API classification on BP. Majority screened were with optimal and normal BP. However, there were 1.55% of the subjects recorded to have high normal BP (prehypertension) who are at high risk of developing hypertension later in life and the risk increases by many folds with an unhealthy lifestyle. In a similar study conducted by Al-Majed and Sadek reported a high proportion of prehypertension and hypertension among college students in Kuwait [38] and many studies [39],[40] have shown a high prevalence of prehypertension and hypertension among adolescents. It is remarkable that not only overweight and obesity but also poor lifestyle practices are important risk factors of hypertension and other NCDs.


  Conclusions Top


This study showed a poor practice of healthy lifestyle and a high burden of lifestyle-related risk factors of NCDS among the college students of Delhi University. Therefore, colleges of Delhi University should emphasize a healthy lifestyle in all faculties as a required subject. Sociodemographic characteristics and peer group pressure significantly influence the practice of healthy lifestyle and thus should be considered when planning preventive measures among university students. Frequent campaigns and educational seminars are to be encouraged for the adoption of healthy lifestyle practices and health promotions. It is in view of the fact that present study is being conducted in an urban setting and the study subjects may not be representative of the general population. Thus, more comprehensive studies should be extended to the young adult population from rural and urban settings and investigate the presence of risk factors of NCDs and their trends over time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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