NUTRITIONAL ASSESSMENT OF AN OBESE GROUP IN RELATION TO HEALTH IMPLICATION

INTRODUCTION

Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer disorders of liver and kidneys functions and osteoarthritis (Haslam and James, 2009 ). Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility (Adams and Murphy, 2000 ).

Dieting and physical exercise are the mainstays of treatment for obesity. It is important to improve diet quality by reducing the consumption of energy – dense foods such as those high in fat and sugars, and by increasing the intake of dietary fiber. To supplement this, or in case of failure, anti – obesity drugs may be taken to reduce appetite or inhibit fat absorption. In severe cases, surgery is performed or an intragastric balloon is placed to reduce stomach volume and / or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food (Sweeting, 2007).

This work was carried out to assess the nutritional and health status of males and females, 45 – 65 years old, visiting the Internist Department, Kasr El – AinyHospital, Cairo.

SUBJECTS AND METHODS

Sample:

A total sample of 40 members enrolled in this study, being 10 females & 10 males at the age of 45 - < 55 years, and 10 females & 10 males at the age of 55 – 65 years. Study sample included only overweight or obese subjects based on body mass index (BMI ). Participants were the visitors of Internist Department, Kasr El – AinyHospital, Cairo.

Instrumentation:

The instrumentation of this study consisted of a structure interviewing questionnaire of different forms. Assessment of nutrient intake from food consumption data carried out at Faculty of Home Economics, Minufiya University (Shebin El – Kom) using the Counter Program for Nutrients of Ready to Eat Egyptian Food Version 1, in the Unit of Statistics and Food Analysis.

To evaluate results of total Kcal, DRI (2007). Equation for estimated energy requirements (EER) used. To evaluate results of other macronutrients, minerals and vitamins tables of Dietary Reference Intake (DRI, 2007) were used.

Anthropometric measurements were carried out as described by Jelliffee (1966), while biochemical analysis carried out using methods as follows: Serum glucose (Tietz, 1976), serum glutamate pyruvate transaminase (GPT, ALT) (Srivastava et al., 2002), creatinine (Chary and Sharma (2004), urea (Henery et al., 1974), uric acid (Fossati et al., 1980), TC (White et al., 1970 ), TG (Fossati and Pricipe (1982), VLDL " TG/5 " (Srivastava et al., 2002), LDL " TC – [TG + HDL] " was calculated according to (Castelli, 1977), HDL (Richmond, 1973), Hemoglubin (Jacobs et al., 2001 ), thyroid stimulating hormone (Waada et al., 1983), hemoglobin parameters " HCT, WBC, MCV, RBC, MCH, MCHC, RDW, PLT, PCT, MPV, PDW, Lym, Mon and GRA " respectively complete blood picture determined in the Laboratory of the Specific Misr & El – Sudan Hospital, Ain Shams University, Cairo. Statistical analysis carried out using SPSS (1998), PC Statistical Software (Version 10, SPSS INC, Chicago, USA) in the Unit of Statistical and Food Analysis, Faculty of Home Economics, Minufiya University (Shebin El – Kom).

RESULTS AND DISCUSSION

1. Percent distribution of study sample according to ailments:

From results of tables (1 & 2) it is evident that prevalence of diabetes mellitus (DM) was much greater for females than males and raised with age; for the higher age nearly all participants (90 %) were diabetic. High blood pressure also increased with age; at 55 – 65 years old 50 – 70 % were affected by this disease. From deficiency anemia and kidney disorders were pronounced at the higher age (20 – 30 %) and (30 – 60 %) respectively. Low efficiency of thyroid gland was marked at the higher age, specially for males (50 % ). It is known that low efficiency of thyroid gland (thyroidism) reduce the secretion of leptin; leptin is responsible for suppression of appetite and enhancement of energy expenditure (possibly reducing obesity) (Barness et al., 2007 ).

Table (1): Percent distribution of obese females & males (45 - < 55 years) according to morbidity

* Significant P < 0.05                               ** High significant P < 0.01

*** Very high significant P < 0.001          NS: Nonsignificant

Table (2): Percent distribution of obese females & males (55 – 65 years) according to morbidity

* Significant P < 0.05                               ** High significant P < 0.01

*** Very high significant P < 0.001          NS: Nonsignificant

2. Frequency distribution of sample among weight classification groups :

Results of tables (3 & 4) revealed that with increasing of age overweight, morbid obesity and super obesity increased on account of class II obesity. The total sample showed that overweight was at 40 % level while obesity 60 % being class I obesity 35 %, class II obesity 35 % & morbid obesity 15 %.

Table (3) : Frequency distribution of females among weight classification groups*

*Classification based on BMI (kg/m2) level: < 18.5

Underweight; 12.5 – 24 g                      Normal; 25 – 29 g

Overweight; 30 – 34 g                           Class I obesity; 35 – 39 g

Class II obesity; 40 – 44 g                    

Morbid obesity; 45 – 50 g Supper obesity (Mokdad et al., 2004 and Imaz et al., 2008 ).

Table (4): Frequency distribution of males among weight classification groups*

*Classification based on BMI (kg/m2) level: < 18.5

Underweight; 12.5 – 24 g                      Normal; 25 – 29 g

Overweight; 30 – 34 g                           Class I obesity; 35 – 39 g

Class II obesity; 40 – 44 g

Morbid obesity; 45 – 50 g Supper obesity (Mokdad et al., 2004 and Imaz et al., 2008 ).

Data of table (5) revealed with increasing of age TSF increased nonsignificantly for females and males. AC and AMC also increased which was significantly for females and nonsignificantly for males. This also confirmed the more development of overweight and obesity with age.

Table (5) : Some anthropometric measurement of females and male 45 - < 55 & 55 – 65 years of age

 TSF

AMC = AC – (3.14 ).

* Significant at P < 0.05.                       NS: Nonsignificant at P < 0.05.

3. Macronutrients of food as estimated for participants:

Data of tables (6 & 7) revealed that intakes calories, protein, fat and carbohydrates by 45 - < 55 and 55 – 65 years were higher than DRI recommendation, except fat of younger males (98.67 % of DRI ). For both age groups nonsignificant difference found between intakes of females and males. Meanwhile numerically total calories and carbohydrates were higher for females than males at both age groups. The higher total calories, protein, fat and carbohydrates (energy sources) that DRI may be the reason for overweight and obesity of study sample.

Table (6) : Macronutrients of food as estimated for 45 - < 55 years old participants

Table (7) : Macronutrients of food as estimated for 55 – 65 years old participants

 4. Minerals of food as estimated for participants:

The results of table (8) showed that intakes of Ca was lower while Fe and Na higher by both age groups compared to DRI. The low Ca intake is no proper for bones health, pronounced Fe increase may affect the function of liver, while high Na intake cause high blood pressure and other diseases (Whitney, Eleanor et al., 1991 ).

Table (8) : Minerals of food as estimated for 45 - < 55 and 55 - 65 years old participants

5. Vitamins of food as estimated for participants:

Data of table (9) revealed that no deficiency was found for vitamins intakes by study sample. This was in line with the results of Abo – Tabl (2005 ). Nevertheless as reported by Whitney, Eleanor and Rolfes, Sharon (1993) except of B vitamins, C and other vitamins mat be undesirable for health.

Table (9) : Vitamins of food as estimated for 45 - < 55 and 55 - 65 years old participants

6. Serum analysis:

Results of table (10) indicated that except for uric acid and possibly HDL all other values for serum parameters showed health disorders which revealed by deviation from the range for normal, affected mean or Max and even sometimes the Min, confirming the deteriorated health of study sample which were overweight to obese including morbid and sample obesity. T.S.H. (1.9 + 6.11) which was described by medical report for study as " Low " (giving no range for normal ). According to Barness et al., (2007) hypothyrodism (low T.S.H.) reduces the leptin hormone secretion (from that tissues ), which results in increase of food intake and decreased of energy expenditure leading accordingly to overweight and obesity. This was also reported by Rosen et al., (1993) and Flier (2004 ).

Table (10) : Biochemical analyses data of study sample (N = 40 )

7. Haematological analysis:

Data of table (11) revealed the possible deteriorated of overweight and obese subjects of present study. This was indicated by low Min hemoglobin and hematocrit leading to possible risk of anemia which inflicted 20 % of females and 30 % of males at 55 – 65 age years old (Table 2 ). Disorders were found also for Min, Mix values, or sometime for both (as for MCV, MPV and Mon ). Moreover immunity cells a LYMM (low than Min) and monocytes (low Min and higher Max) were not indicative for good health.

Table (20) : Haematological analyses data of study sample (N = 40 )