1. INTRODUCTION:

The metabolic syndrome has been identified as a constellation of metabolic and non-metabolic disorders related to defects in insulin sensitivity that lead to a high risk for the development of type-2 diabetes and cardiovascular disease. The National Cholesterol Education Program’s Third Adult Treatment Panel Report and World Health Organization had reported that the metabolic syndrome is associated with an approximate twofold increase in Cardiovascular Disease[1]. The metabolic syndrome especially visceral obesity, dyslipidaemia, hyperglycaemia, and hypertension have become one of the major public-health challenges worldwide. However, the cause of the syndrome remains obscure although some of the risk factors have been known for more than 80 years. By the year 1988, Reaven proposed that insulin resistance played an important role, but it remains uncertain for most of the metabolic syndrome [2].

Després et al suggested visceral obesity and hypertriglyceridemia as the central components of the disease but this too has been contested throughout the years [3]. Metabolic syndrome like Diabetes Mellitus type-2 directly affects about 7.8% of the population of the United States and roughly 23.6 million people out of the total population. Around 17 million people diagnosed with diabetes with another 5 million who are categorized under the high-risk group. With an increasing rate of 1.6 million new cases reported every year, the incidence of the disease is insane [4]. The incidences of Metabolic Syndrome are escalating rapidly around the globe due to the increasing rates of urbanization and changing lifestyles. According to the World Health Organisation, these diseases will account for approximately three quarters of all deaths in the developing world in 2020[5].

Therefore, the fight against the diseases can only be won back if the population especially the young generation knows the risk factors of Metabolic Syndrome well enough. Good knowledge of the risks of Metabolic Syndrome as well as taking precautions against it is of vital importance to raise healthy generations. University students are supposed to know more about Metabolic Syndrome so that they can play a vital role in educating the communities. For this reason, it is very important to assess the knowledge of undergraduate students regarding Metabolic Syndrome to correct their myths and misconceptions on these diseases.

Health status is a concept that is determined by more than the presence or absence of any disease and is often summarized by life expectancy or self-assessed health status. Metabolic syndrome is increasing in prevalence, paralleling the rise in the epidemic of obesity. Metabolic syndrome is a multiplex risk factor that arises from insulin resistance following adipose deposition and function. It is a risk factor for coronary heart disease, diabetes, fatty liver, and malignancies. Metabolic disease is any of the diseases or disorders that disrupt normal metabolism, the process of breaking down food on a cellular level. Enzymes participating in numerous interdependent metabolic pathways carry out this process.[6] The complications of metabolic syndrome are various. Several associated cardiovascular complications exist, particularly coronary heart disease, atrial fibrillation, heart failure, aortic stenosis, ischemic stroke, and venothromboembolic disease. In addition, metabolic syndrome has been implicated in the pathophysiology of several other diseases, including obstructive sleep apnoea. Breast cancer has also been linked to metabolic syndrome, possibly through dysregulation of the plasminogen activator inhibitor-1 (PAI-1) cycle.[7] Additional studies have linked metabolic syndrome with cancers of the colon, gallbladder, kidney, and, possibly, prostate gland. Additional research has raised the possibility that metabolic syndrome adversely affects neurocognitive performance. Metabolic syndrome has been found to be responsible for accelerated cognitive aging. Patients with mental illnesses also face increased cardio metabolic risk due at least in part to socioeconomic factors such as greater poverty and poorer access to medical care. In this study, the conceptual framework identifies the different risk factors that affect the prevalence of metabolic syndrome is a cluster of conditions which include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels that occur together, increasing your risk of heart disease, stroke and diabetes[8].

Hypertension or high blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problem, such as heart disease. Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.[9].

Diabetes mellitus or more commonly referred to as "diabetes" is a chronic disease associated with abnormally high levels of the sugar glucose in the blood. Diabetes is due to one of two mechanisms, inadequate production of insulin, or inadequate sensitivity of cells to the action of insulin. In type 1 diabetes there is no insulin or not enough of it. In type 2 diabetes, there is generally enough insulin but the cells upon which it should act are not normally sensitive to its action [10].

Hyperlipidemia is abnormally elevated levels of any or all lipids or lipoproteins in the blood. It is the most common form of dyslipidemia. Hyperlipidemias are divided into primary and secondary subtypes. Primary hyperlipidemia is usually due to genetic causes, while secondary hyperlipidemia arises due to other underlying causes such as diabetes. Lipid and lipoprotein abnormalities are common in the general population and are regarded as modifiable risk factors for cardiovascular disease due to their influence on atherosclerosis [11].Stroke is the sudden death of brain cells due to lack of oxygen, caused by blockage of blood flow or rupture of an artery to the brain. Sudden loss of speech, weakness, or paralysis of one side of the body can be symptoms. The death rate and level of disability resulting from strokes can be dramatically reduced by immediate and appropriate medical care. Prevention involves minimizing risk factors, such as controlling high blood pressure and diabetes. People at risk for stroke include those who have high blood pressure, high cholesterol, diabetes, and those who smoke. People with heart rhythm disturbances, especially atrial fibrillation are also at risk [12]

2. MATERIALS AND METHODS:

The aim of the study was to assess university undergraduate students’ level of knowledge about metabolic syndrome and conditions related to it. Cross-sectional study was used as the study design for this research. Our target population were undergraduate students of university. We included first year, second year and third year students from nursing, pharmacy, biomedical science and physiotherapy department. For medicine and dentistry departments, we only included first year students in order to avoid bias. Sample size for this research was 251 which was calculated using single proportion formula. Stratified random sampling method was implemented. This probability sampling method divides the population into subgroups. The variables of the study were total knowledge score, gender, ethnicity, course of study, total knowledge scores of metabolic syndromes, diabetes mellitus, adiposity, hypertension and stroke. The type of variables used in this study were categorical. Frequency and percentage tabulation were used to describe the categorical variables data. Moreover, pie charts were used to organize and display the data.

3. RESULTS:

Figure 1

Figure 2

Figure 3

Table 1: Descriptive statistics for Categorical Variables

		n	%
Gender	Male	126	50.2%
	Female	125	49.8%
Ethnicity	Malay	60	23.9%
	Chinese	130	51.8%
	Indian	29	11.6%
	Others	32	12.7%
Course of study	Medicine	42	16.7%
	Dentistry	42	16.7%
	Pharmacy	42	16.7%
	Biomedical sciences	42	16.7%
	Nursing	42	16.7%
	Physiotherapy	41	16.3%

Table 2: Total knowledge score on metabolic syndrome

Total knowledge score
	Frequency (f)	Percent (%)
Poor knowledge	107	42.6
Good knowledge	144	57.4
Total	251	100.0

Table 3: Total Knowledge score from different courses from different courses on metabolic syndrome and conditions related to metabolic syndrome

Knowledge score
	Poor knowledge (%)	Good knowledge (%)
Medicine	9.5 %	90.5%
Dentistry Pharmacy Nursing Physiotherapy Biomedical Science	21.4% 35.7% 78.6% 58.5% 52.4%	78.6% 64.3% 21.4% 41.5% 47.6%
Total Chi Square value P value		100.0 55.421 0.000

Table 2 shows that of the 251 undergraduates, 144 (57.4%) students had good knowledge on metabolic syndrome while 107 (42.6%) students had poor knowledge. Thus, it was found that majority of the participants had good knowledge on metabolic syndrome.

Table 3 presents that the total knowledge score on metabolic syndrome was highest among students from faculty of medicine (90.5%), followed by dentistry (78.6%), pharmacy (64.3%), biomedical science, physiotherapy and nursing. A statistically significant association was found between total knowledge score and course of study because the p-value = 0.001 which is less than 0.05. H_A is accepted.

Table 4.1: Total knowledge score from different courses on diabetes mellitus topic

Diabetes Mellitus
	Poor knowledge (%)	Good knowledge (%)
Medicine	21.4	78.6
Dentistry Pharmacy Nursing Physiotherapy Biomedical Science	14.3 33.3 57.1 39.0 45.2	85.7 66.7 42.9 61.0 54.8
Total		100.0

Table 4.2: Total knowledge score from different courses on adiposity topic

Adiposity
	Poor knowledge (%)	Good knowledge (%)
Medicine	9.5	90.5
Dentistry Pharmacy Nursing Physiotherapy Biomedical Science	9.5 19.0 66.7 53.7 45.2	90.5 81.0 33.3 46.3 54.8
Total		100.0

Table 4.3: Total knowledge score from different courses on hypertension topic

Hypertension
	Poor knowledge (%)	Good knowledge (%)
Medicine	26.2	73.8
Dentistry Pharmacy Nursing Physiotherapy Biomedical Science	45.2 35.7 73.8 51.2 45.2	54.8 64.3 26.2 48.8 54.8
Total		100.0

Table 4.4: Total knowledge score from different courses on stroke topic

Stroke
	Poor knowledge (%)	Good knowledge (%)
Medicine	14.3	85.7
Dentistry Pharmacy Nursing Physiotherapy Biomedical Science	28.6 42.9 57.1 61.0 42.9	71.4 57.1 42.9 39.0 57.1
Total		100.0

Table 4.1 shows the knowledge score of undergraduate students across various faculties, on diabetes mellitus. With regards, the highest knowledge score was found among students from faculty of dentistry (85.7%), followed by medicine (78.6%), pharmacy (66.7%), physiotherapy (61%), biomedical science (54.8%) and nursing (42.9%).

Table 4.2 shows knowledge score of students on adiposity. The highest score was found among students from faculty of medicine (90.5%) and dentistry (90.5%) followed by pharmacy (81%). With a percentage difference of 8.5%, biomedical students scored more than physiotherapy students. The least percentage of knowledge score on adiposity was noted among nursing students (33.3%).

Table 4.3 displays knowledge score on hypertension obtained by undergraduate students across faculties. The students with highest percentage of knowledge score on hypertension were from faculty of medicine (73.8%), followed by pharmacy (64.3%), biomedical science, dentistry, physiotherapy and nursing. 51.2% of physiotherapy students scored poor knowledge and 48.8 of them scored good knowledge on hypertension.

Table 4.4 depicts the knowledge score on stroke across various faculties. Students from medical faculty had the highest knowledge score of 85.7%. In contrast to that, physiotherapy students scored lowest with the percentage of 39%. The second highest good knowledge score on stroke was gained by dentistry students with the percentage of 71.4%. Pharmacy and biomedical students shared same percentage of scoring good knowledge with the percentage of 57.1%

Table 5.1: Total knowledge score VS gender

Gender
	Poor knowledge (%)	Good knowledge (%)
Male	38.1	61.9
Female	47.2	52.8
Total Chi Square value P value Fisher's Exact Test		100.0 2.127 0.145 0.161, 0.092

Table 5.2: Total knowledge score VS ethnicity

Ethnicity
	Poor knowledge (%)	Good Knowledge (%)
Malay	58.3	41.7
Chinese Indian Others	31.5 48.3 53.1	68.5 51.7 46.9
Total Chi Square value P value		100.0 14.408 0.002

The results obtained from 251 undergraduate students among different faculties, it was seen that males had a higher percentage of good knowledge compared to females. Of the 126 males, 78 (61.9%), of them and of the 125 females, 66 (52.8%) scored good knowledge.

Table 5.1 displays, on determining the association between knowledge across gender, chi-square analysis was performed. Chi square value was 2.127 and the p-value = 0.145 which was more than 0.05 showing that there was no statistically significant association between gender and total knowledge score. Fisher’s Exact test was used as the assumptions for Chi square test was not met.

Table 5.2 shows, while determining the total knowledge score across different ethnic groups, Chinese ethnicity has the highest percentage of good knowledge. Of the 251 respondents, 60 were Malays, 130 Chinese, 29 Indians and 32 from other ethnic groups. Of the 60 Malay respondents, 25(41.7%), of them, among the Chinese 89(68.5%) of them had good knowledge on metabolic syndrome. Chi-square analysis was performed to determine the association between ethnicity and knowledge score on metabolic syndrome. Chi square value was 14.408 and the p-value = 0.002 which is less than 0.05. On interpretation a statistically significant association was found between ethnicity and total knowledge score. H_A is accepted.

4. DISCUSSION:

Gender:

The observed relationship is not statistically significant because the p-value, 0.145, is greater than 0.05. We decide in favour of the null hypothesis - Knowledge and gender are not related in the population of the students.

General performance:

The participants are all from health and science departments where they must have a knowledge or experience regarding the answers to the questions asked, and that’s why the Result of the survey shows that more than half of the participants 144 students (57.4%) have a good knowledge on metabolic syndrome.

Course of study:

Students from Medicine Department even though only year 1 participated for the survey have the highest overall score of good knowledge (69.0%) followed by dentistry (78.6%), pharmacy (64.3%), biomedical science (47.6%), physiotherapy (41.5%) and nursing (21.4%) students. Students from MBBS year 1 have the highest overall score of good knowledge because of the general knowledge that they are taught from basic medical sciences, genetics to system blocks like Cardiovascular, Haematology and Respiratory block.

Knowledge on Metabolic Syndrome:

The result for the questions on metabolic syndrome topic shows that students from faculty of Medicine have the highest score of good knowledge (69.0%), followed by physiotherapy, dentistry, pharmacy, biomedical science and nursing. The questions that have been asked in this section were done to access students’ knowledge of signs and symptoms on metabolic syndrome and complications related to it[13].

Knowledge on Diabetes Mellitus:

Survey shows that participants from dentistry have the highest score of good knowledge 85.7%, ahead of medicine (78.6%), pharmacy (66.7%), physiotherapy (61.0), biomedical science (54.8%) and nursing (42.9%). Medicine student score is lower than dentistry which is because they have not studied their Endocrinology block.

Knowledge on Adiposity:

Here, the students with highest score of good knowledge are medicine and dentistry with equal percentage of 90.5% followed by pharmacy, biomedical science, physiotherapy and nursing. The overall result shows that participants have more knowledge on adiposity topic with score of good knowledge 66.1%, probably because the questions are mostly based on signs of adiposity and not on disease pathogenesis, also may be because of its prevalence among people. Also, in contrast with the research done by Najat Yahia, Carrie Brown, Melyssa Rapley and Mei Chung show that students were most knowledgeable about arteriosclerosis and stroke conditions.[14]

Knowledge on Hypertension and Arteriosclerosis:

The participants with the highest score of good knowledge are the medicine students (73.8%) followed by pharmacy (64.3%), dentistry and biomedical science with equal percentage (54.8%), physiotherapy (48.8%) and nursing (26.2%). Students scored the lowest percentage of good knowledge 53.8% with respect to other subtopics.[15]

Knowledge on Stroke and Myocardial Infarction:

Under this subtopic, participants from medicine got the highest score of good knowledge (85.7%), followed by dentistry (71.4%), pharmacy and biomedical science both with 57.1%, nursing 42.9% and the least good knowledge score was from physiotherapy with 39.0%. Students from medicine got high scores of good knowledge in adiposity and serum cholesterol level, hypertension and arteriosclerosis, stroke and myocardial Infarction because of experience and mostly due to knowledge acquired in class especially for the Cardiovascular system.[16]

5. CONCLUSION:

Metabolic syndrome such as diabetes mellitus, hyperlipidemia and high blood pressure possess a great treat to human health as it kills thousands of lives each year. Risk factors were carefully considered to measure their association with metabolic syndrome. Prevention is important and vital in order to reduce the population at risk. Therefore, an adequate and proper knowledge regarding metabolic syndrome is very important to increase the awareness of prevention among the community. To conclude, based on the result it shows that 57.4% of university students are found to have good knowledge on metabolic syndrome while the remaining 42.6% are found to have poor knowledge on the topic. The findings of this study seem to indicate that the students’ understanding on metabolic syndrome differed among courses of study. From this study, participants will have a general knowledge and awareness on metabolic syndrome as there were leaflets distributed to participants upon completion of the questionnaire. This will prevent conditions of metabolic syndrome from being undiagnosed as metabolic syndrome and will be helpful for students in their clinical years.

6. ETHICAL CONSIDERATIONS:

· Ethical approval was obtained from MAHSA University Research Ethics Committee.

· All information and data collected will be kept confidential and will not be made publicly available unless disclosure is required by law.

7. CONFLICT OF INTERESTS:

We declare no conflict of interest.

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Received on 28.04.2020 Modified on 05.06.2020

Research J. Pharm. and Tech 2021; 14(4):1893-1898.

DOI: 10.52711/0974-360X.2021.00334