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Diabetes & Metabolic Syndrome: Clinical Research & Reviews xxx (2018) xxx–xxx

Contents lists available at ScienceDirect

Diabetes & Metabolic Syndrome: Clinical Research &

Reviews
journal homepage: www.elsevier.com/locate/dsx

Obesity and cardio-metabolic risk factors in Ecuadorian university

students. First report, 2014–2015
Cesar Ruanoa,* , Erika Lucumia , José Albána , Sofía Arteagaa , Martha Forsb
a
Faculty of Medicine, Universidad Central del Ecuador, Quito, Ecuador
b
Escuela de Medicina, Universidad de Las Américas, Quito, Ecuador

A R T I C L E I N F O A B S T R A C T

Article history: Objective: Overweight and obesity are risk factors for developing cardiovascular disease. The objective of
Available online xxx this study was to determine the prevalence of obesity and risk factors associated with metabolic
syndrome and cardiovascular disease in university students.
Methods: 883 students from the Faculty of Medical Sciences of the Central University of Ecuador were
Keywords: included, who were surveyed with demographic data, smoking habits and physical activity. Body mass
Obesity
index, abdominal circumference and blood pressure were determined. Blood chemistry and lipid profile
Cardio-metabolic risk factors
were performed. Central tendency and dispersion measures, average comparisons (Student's T) and
Cross-sectional study
Ecuador
Pearson's correlation were calculated to study quantitative variables and x2 distributed statistic for the
Body mass index comparison of qualitative variables.
Metabolic syndrome Results: The prevalence of overweight and obesity was 25.5%. The body mass index was similar in both sexes
(23.15 women / 23.57 men), waist circumference was higher inwomen. Men had higher than normal levels in
blood pressure and elevated triglycerides while women had high cholesterol.
Conclusions: One of four students presents some degree of overweight or obesity and an important
percentage of altered levels of plasma lipids and blood pressure. Blood glucose levels were found in
normal ranges.
© 2018 Diabetes India. Published by Elsevier Ltd. All rights reserved.

1. Introduction commitment in the capacity of metabolization of fats and glucose

Overweight and obesity occurring at an early age are a serious
public health problem because of their association with the risks of
developing various chronic non communicable diseases that have
been the leading causes of death in developed and developing
countries [1,2]. Obesity is considered a major risk factor for
cardiovascular disease (CVD) and diabetes mellitus type 2 (DM2)
and is associated with hyperinsulinemia, insulin resistance,
glucose intolerance, arterial hypertension and metabolic syn-
drome (MS) [3,4]. Individuals with obesity (especially abdominal)
have a lipid profile known as atherogenic dyslipidemia, which is
characterized by increased triglyceride, low-density lipoprotein
(LDL), decreased levels of high-density lipoprotein (HDL) [5], and is
associated with MS, DM2 and CVD. They also present a decrease of
the physical activity that is a risk factor that is reflected by the
* Corresponding author at: Iquique N14-121 y Sodiro, Itchimbía, El Dorado, Quito,
Ecuador.
E-mail addresses: ciruano@uce.edu.ec (C. Ruano), martha.fors@udla.edu.ec
(M. Fors).
by the muscle deriving in the development of chronic metabolic
and cardiovascular pathologies.
Several studies have analyzed these risk factors especially in
adulthood [6], to a lesser extent in the infant and adolescent
population [7,8], but very few have done so in young people in
early adulthood (17–25 years) [9,10], which is characterized by a
series of changes that may affect life habits, especially hygienic-
diet and physical activity, previously acquired in childhood [11].
Data collected in the United States show that in this age range
there is an increase of the risks of having unhealthy diets,
decreased physical activity and development of obesity [12,13],
which can be aggravated in university students who carry a style
of life characterized by stress and time loads that lead to the
consumption of fast foods that are not very nutritious, irregular
feeding schedules and lack of time for physical exercise,
which makes them susceptible to develop obesity and its
complications [14,15].
Sedentary behaviors and eating habits are associated with
overweight and obesity among the young [16], leading to a higher
morbidity and mortality [17]. In Ecuador, according to data
published in the National Health and Nutrition Survey Ecuador

http://dx.doi.org/10.1016/j.dsx.2018.05.015
1871-4021/© 2018 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: C. Ruano, et al., Obesity and cardio-metabolic risk factors in Ecuadorian university students. First report,
2014–2015, Diab Met Syndr: Clin Res Rev (2018), https://doi.org/10.1016/j.dsx.2018.05.015
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DSX 1003 No. of Pages 5
2 C. Ruano et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews xxx (2018) xxx–xxx
(ENSANUT-ECU 2011-2013), the prevalence of overweight and
obesity at a national level in adolescents aged 12–19 years is 26%,
while in those older than 19 is 62.8% being greater in women
(65.5%) than in men (60%) [18].
Other researchers found a prevalence of overweight and obesity
of 13.7% and 7.5%, respectively [19]. Some authors attribute these
percentages of overweight and obesity to the lack of physical
activity, which is becoming more frequent at an early age. Physical
activity is inversely associated with different metabolic indicators
such as lipid profile, insulin resistance and arterial hypertension.
However, physical activity must meet certain conditions at the
time of its performance (type, intensity, frequency and duration) to
become effective [20].
The present study investigates the prevalence of obesity and its
association with lipid abnormalities and other risk factors
associated with MS and CVD (hypertension, DM2, smoking and
physical inactivity) among university students between 17 and 25
years of age at the Faculty of Medical Sciences of the Universidad
Central del Ecuador (UCE).
2. Material and methods
This is an epidemiological, descriptive, cross-sectional study in
which risk factors correlated with the prevalence of obesity were
determined. Students of first, second and third semester of UCE
were included prior informed consent. The study was approved by
the Ethics Committee of the Faculty of Medical Sciences. Students
answered a survey on demographic data, smoking habits and
exercise practice and it was run from October 2014 to March 2015.
Weight and height were determined using a calibrated height
scale (SECA brand), the students attended with light clothing and
without shoes. Nutritional status was determined by calculating
Body Mass Index (BMI), weight (kilograms) / square of height
(meters) [21].
Waist circumference (WC) was measured with a non-elastic
measuring tape at the midpoint between the upper border of the
anterior iliac crest and the last costal ridge, with the patient
standing naked, with arms placed along the body and in the
expiratory phase of breathing. The World Health Organization
(WHO) states that it will be considered abdominal obesity if the
WC is in men> 90 cm and in women> 80 cm [1].
Blood pressure (BP) was measured with the patient in a seated
position and after a resting period of at least 5 min using a mercury
sphygmomanometer and Riester sphygmomanometer (calibrated)
by a single investigator previously trained to avoid inter- takes. The
air cuff was placed on the left forearm. Arterial AT was taken twice
at intervals of 5 min; the value used was the average blood pressure
in both shots. The diagnosis of hypertension (HBP) was performed
using the criteria recommended by ATP-III and IDF for age, cut
point BP > 130/85 mmHg [22] and the values established by JNC 7,
hypertension >140/90, pre hypertension 120–139/80–89 [23].
Table 1
Average of anthropometric and biochemical variables by gender. Ecuador 2014–2015.
Source: Prepared by the authors from the study results.Variable
BMI
Waist Diameter (cm)
TAS (mm/hg)
TAD (mm/hg)
Total Cholesterol (mg/dl)
c HDL (mg/dl)
c LDL (mg/dl)
Triglycerides (mg/dl)
Glucose (mg/dl)
T test.Source: Prepared by the authors from the study results.
Please cite this article in press as: C. Ruano, et al., Obesity and cardio-metabolic risk factors in Ecuadorian university students. First report,
2014–2015, Diab Met Syndr: Clin Res Rev (2018), https://doi.org/10.1016/j.dsx.2018.05.015
Students with a 12-hour fast had a sample of venous blood
drawn from the elbow fold. Blood chemistry (urea, glucose,
creatinine, uric acid, lipid profile: total cholesterol (TC), trigly-
cerides, HDL) were determined.* The cut-off points for each
variable were those established by WHO and IDF.
Physical inactivity of the students was defined if physical
activity was not performed at least 3 times (days) a week, and as
smokers those who consumed at least one cigarette a week.
The examinations were carried out in an office specially
prepared for the purpose in the Faculty of Medical Sciences of the
Universidad Central del Ecuador and the biochemical determi-
nations in an internationally accredited laboratory.
A database was prepared in Microsoft Excel 2007 and statistical
analysis was performed using SPSS 21. The results are presented in
tables and graphs. Central tendency measures and dispersion
measures were calculated for the quantitative variables, the means
were compared using Student's T-Test. We also performed an
Analysis of Variance (ANOVA) for the comparison of averages of the
measurements performed according to the categories of BMI
(normal, overweight and obesity). Associations of these variables
were studied with BMI and WC using Pearson's correlation.
For qualitative variables, relative frequencies (prevalence),
were calculated, and to establish associations between these
variables, the x2 test. It was considered as statistically significant
differences p values less than 0.05.
3. Results
883 university students, aged 17–25 years and an average of
19.3  1.4 years old, were included in the study, 67% of which
were female.
Table 1 shows the average of the anthropometric and
biochemical variables according to gender. A comparative analysis
showed that both men and women have similar BMI, the average of
the WC is increased in women, and the men have higher systolic
(TAS) and diastolic (TAD) blood pressure, in women the total
cholesterol and in men the triglyceride values were higher. The
average difference between men and women was statistically
significant (Student's t-test p < 0.05) in WC, TAS, TAD, total
cholesterol, HDL cholesterol, Triglycerides and Glucose.
25.5% of the students evaluated showed some degree of
overweight or obesity. It was found that 22% were overweight
and 3% were obese, as shown in Fig. 1.
In women, 20.9% were overweight and 2.3% were obese, while
men presented 24.7% and 4.6% of overweight and obesity,
respectively. CW was altered (women> 80 / men> 90) in 52.3%
of women and 26.2% of men (p0.001). HDLc was altered in 39.7% of
women compared to 18.2% of men (p0.001).
The prevalence of abnormal BP was higher in men than in
women (24.4% vs 9.8%, p0.001). The values of total cholesterol, LDL,
triglycerides and glucose did not present statistically significant
Women Men P valuea
23.15  3.06 23.57  3.38 0.06
80.5  7.6 84.3  9.1 0.0001
114  10.0 119  11.8 0.0001
71.9  8.0 75.5  8.8 0.0001
160.2  27.7 155  29.4 0.01
53.7  11.9 48.0  10.0 0.0001
87.6  23.6 86.6  26.8 0.55
94.9  45.6 103.0  51.1 0.01
80.8  6.5 81.9  6.7 0.01
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C. Ruano et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews xxx (2018) xxx–xxx 3

Table 3
Average of anthropometric and biochemical variables according to BMI. Ecuador
2014–2015.

Variable Normal Overweight Obesity pa

BMI 21.85  1.04 26.82  1.24 32.68  2.27 0.0001
Waist diameter (cm) 78.8  6.3 89.5  5.5 99.7  9.8 0.0001
TAS (mm/hg) 114.7  10.8 119.4  10.4 126.1  11.9 0.0001
TAD (mm/hg) 72.3  8.4 75.2  8.0 80.8  9.5 0.0001
Total Cholesterol (mg/dl) 156.7  27.2 163.3  31.8 162.7  26.5 0.001
c HDL (mg/dl) 52.8  11.7 49.1  10.2 41.2  9.4 0.0001
c LDL (mg/dl) 85.2  23.2 92.8  28.6 94.8  25.3 0.0001
Triglycerides (mg/dl) 92.6  43.1 109.3  51.2 141.3  83.1 0.0001
Glucose (mg/dl) 80.8  6.6 82.3  6.5 83.4  7.6 0.004
a
ANOVA Test.Source: Prepared by the authors from the study results.
Fig. 1. Prevalence of overweight and obesity in medical students Normal 75%,
Overweight 22%, Obesity 3%.

Table 4
differences by gender. Smoking in men is higher than in women
Pearson linear correlation coefficients between the parameters evaluated.
(19.8% vs 7.3%, p0.001). In relation to physical inactivity, the Ecuador.2014–2015.
number of women is higher than that of men (92.5% vs 75%,
BMI (kg/m2) WC (cm)
p0.001). (Table 2).
Statistically significant differences were found in the averages DC(cm) 0.787*
Total Cholesterol (mg/dl) 0.146* 0.114**
of all variables studied classified, according to BMI. (Table 3).
HDL (m/dl) 0.242* 0.245*
The association of laboratory variables with WC and BMI were LDL (mg/dl) 0.199* 0.151*
studied. A good correlation was found 0.787 (p0.0001) between Trigliceridos (mg/dl) 0.241* 0.263*
BMI and WC. Statistical differences were also significant for the TAS (mm/hg) 0.275* 0.317*
rest of the variables. (Table 4). TAD (mm/hg) 0.22* 0.264*
Glucemia 0.107** 0.141*
PCRus 0.172* 0.164*
4. Discussion IL 6 0.035 0.003
*
p 0.0001.
Pre-obesity and obesity in young adults is associated with a high **
p 0.001.Source: Prepared by the authors from the study results.
prevalence of abnormal levels of cardiometabolic variables [24].
It is known that weight gain is the result of the interaction
between genetic factors and an environment that leads to found in the population aged 19–60 years (62.8%) [18], which
sedentary lifestyle and high calorie consumption. Overweight means that in the Ecuadorian population, pre-obesity and obesity
adolescents are 70% more likely to become overweight or obese increase significantly with age and there is no significant difference
adults, which increases to 80% if one or both parents are obese or by gender. Similar data were found in a Chilean study (23.4%, 5.2%)
overweight [25]. In recent decades, the increase in overweight and [26]. Two Cuban studies reported 13.9% of overweight and 9.3% of
obesity in the population of young adolescents has been adolescents with obesity [27], and the other, in 12–19 year olds,
significant, suggesting an increase in cardiovascular risk. The obesity was 16.9% [28]. Other authors reported that 17.5% and
present study found that 22.3% of the population were overweight 16.4% of the young evaluated were overweight and obese [29], all
and 3.2% obese, which corresponds with the data found in the three studies presented values lower than those found in the
ENSANUT ECU carried out by the Ministry of Public Health of present study. However, other studies revealed that 40% of the
Ecuador, where the prevalence of pre obesity and obesity in adolescents studied were overweight, of which 28% were
adolescents aged 12–19 years is 26%, but it is much lower than that overweight and 12% were obese [30]. Another study conducted

Table 2
Prevalence of risk factors assessed in relation to gender. Ecuador 2014–2015.

Characterisitics % Female (n = 559) % Male (n = 324) pa

Overweight/Obesity (IMC) 23.3 29.3 0.46
Overweight (25 - 29.9 kg/m2) 20.9 24.7
Obesity (>30 kg/m2) 2.3 4.6
Waist Circunsference (WC) (men >90/women >80) 52.3 26.2 0.001
Total Cholesterol (>200 mg/dl) 7.9 5.2 0.12
High Limit (200 – 239 mg/dl) 7.2 4
Elevated (>240 mg/dl) 0.7 1.2
c HDL < 40 mg/dl men, <50 mg/dl women 39.7 18.2 0.001
c LDL > 100 mg/dl 24.9 26.9 0.71
Superior (100 - 129 mg/dl) 19.9 22
High limit (130 – 159 mg/dl) 4.3 3.7
Elevated (>160 mg/dl) 0.7 1.2
Triglycerides>150 mg/dl 10.6 12.3 0.63
High limit (150 - 199 mg/dl) 6.6 8.3
Elevated (200 - 400 mg/dl) 3.9 4
Arterial Pressure(>130/85 mg/dl) 9.8 24.4 0.001
Glucose (>90 mg/dl) 6.4 11.1 0.01
Smoking 7.3 19.8 0.001
Sedentary lifestyle 92.5 75 0.001
a
Chi square Test.Source: Prepared by the authors from the study results.

Please cite this article in press as: C. Ruano, et al., Obesity and cardio-metabolic risk factors in Ecuadorian university students. First report,
2014–2015, Diab Met Syndr: Clin Res Rev (2018), https://doi.org/10.1016/j.dsx.2018.05.015
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in Mexico found 35.26% and 15.80% of overweight and obesity
respectively [31], which shows a higher prevalence of obesity in
relation to the data found in this study.
It has been demonstrated that WC in young adolescents is a
good predictor of metabolic complications and cardiovascular risk
[32]. In the present study, WC in the female gender was altered in
33.67% of the population compared to 9.55% in men, which is in
agreement with data found in the Chilean study in which the
abdominal perimeter was significantly higher in women [26]. Data
on WC are directly related to those obtained in relation to
sedentary, which is also greater in women, data that coincide with
the Mexican study [31] and with ENS Chile, in a similar population
[33]. These results demonstrate that WC is a good indicator of
central obesity with clinical and epidemiological usefulness [32].
In relation to total cholesterol, LDL and glucose, values were not
altered in most of the sample, unlike other studies [34,9]. It is
noteworthy that the alteration of the HDL values found in the
present study are predominantly presented in women 39.7%,
compared to 18.2% in men, data similar to those found in Mexican
studies [35,36], but does not agree with the data found in studies in
countries such as Colombia and Chile, which find that low HDL
levels were significantly higher in men [35,9]. Regarding triglycer-
ide values, it was found that 12.3% in men and 10.6% in women
were greater than 150 mg / dl compared to 5.7% in the Chilean
study [9].
The levels of BP were above normal limits in men (24.4% vs
9.8%), the same predisposition as in the studies cited above [35,9].
One noteworthy finding is the likely association between the risk of
developing hypertension at an early age and some altered risk
factors such as triglycerides, BMI and WC. In general terms, we can
say that subjects with obesity and overweight present risk factors
whose mean values are much higher than those with normal
weight, which is consistent with the literature [37,38].
5. Conclusions
Obesity in young adults is associated with a high prevalence of
abnormal levels of cardio-metabolic risk factors. In the present
study, 1 in 4 students presented some degree of overweight or
obesity and a significant percentage of alterations in plasma lipid
levels and blood pressure. Although most students are still in the
low risk categories, it is advisable to continue doing this type of
studies that will allow us to increase the knowledge about the
presence of risk for chronic non communicable diseases. Given the
large number of people with at least one risk factor it is essential to
promote healthy lifestyles that include non-pharmacological
measures such as diet and exercise. It is recommended to
implement policies for the prevention of obesity in the early ages
of life as a cost-effective measure.
Funding
This work was sponsored and funded by Universidad Central del
Ecuador. Project code No. 91750000.0000374041.
Conflict of interests
The authors of this manuscript have no conflicts of interest to
declare.
Acknowledgements
To students of first, second and third semester of the period
October 2014 - March 2015 of the School of Medicine of the Faculty
of Medical Sciences of the Universidad Central del Ecuador.
Please cite this article in press as: C. Ruano, et al., Obesity and cardio-metabolic risk factors in Ecuadorian university students. First report,
2014–2015, Diab Met Syndr: Clin Res Rev (2018), https://doi.org/10.1016/j.dsx.2018.05.015
*NETLAB S.A., clinical laboratory accredited under international
standard ISO 15,189 and certification of the LIPIDS STANDARIZA-
TION PROGRAM of the CDC of Atlanta.
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Please cite this article in press as: C. Ruano, et al., Obesity and cardio-metabolic risk factors in Ecuadorian university students. First report,
2014–2015, Diab Met Syndr: Clin Res Rev (2018), https://doi.org/10.1016/j.dsx.2018.05.015