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| ORIGINAL ARTICLE |
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| Year : 2017 | Volume
: 19
| Issue : 1 | Page : 43-47 |
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Study of lifestyle diseases among workers of an ammunition factory
Arun Gupta1, Neeti Goyal2, AK Jindal YSM 3, Raj Kumar4
1 PMO, INS Kadamba, Karwar, Karnataka, India
2 Pathologist, INHS Patanjali, Karwar, Karnataka, India
3 DDGST(FI), IHQ of MoD (Army), New Delhi, India
4 Commanding Officer, 4033 Field Hospital, C/O 99 APO, Mumbai, India
| Date of Web Publication | 17-Aug-2017 |
Correspondence Address:
Surg Cdr Arun Gupta
Graded Spl (Community Medicine), INS Kadamba, Karwar - 581 308, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmms.jmms_3_16
Background: Lifestyle diseases which include hypertension, type 2 diabetes mellitus, obesity, and stroke are caused by influences on the human body by the way people live their lives. This study is an effort to describe the prevalence of various lifestyle diseases; factors associated with their causation and suggest measures for improvement of the health status among the industrial workers. Materials and Methods: A total of 351 workers were included in this study. The prevalence and pattern of lifestyle diseases among industrial workers were studied. The survey had two principal components, namely, the pretested standardized questionnaire and clinical examination. Blood sugar levels were assessed by a glucometer. Results: Hypertension was the most common lifestyle disease, seen among 43.0% of workers. It was significantly related to age, socioeconomic status type 2, body mass index (BMI), and habit of tobacco chewing. Only one-fourth were aware of their blood pressure status. Other diseases brought out were diabetes type 2 mellitus (7.7%) and obesity (4%). In this study, among those with type 2 diabetes mellitus, 29.63% were not aware of their blood sugar status. Diabetes was significantly related to BMI and increased significantly with increase in age. Also, one-third of the study population was overweight. Conclusion: Lifestyle diseases were found to be the major causes of morbidity among the study participants. Hypertension, type 2 diabetes mellitus, and overweight/obesity were the common morbidities. These conditions were associated with factors such as age, socioeconomic status, BMI, and history of tobacco chewing.
Keywords: Diabetes mellitus, factory workers, hypertension, lifestyle, obesity
How to cite this article:
Gupta A, Goyal N, Jindal A K, Kumar R. Study of lifestyle diseases among workers of an ammunition factory. J Mar Med Soc 2017;19:43-7 |
| Introduction | |  |
Lifestyle is defined as the set of habits and customs that is influenced, modified, encouraged, or constrained by the lifelong process of socialization. These habits and customs include dietary habits, exercise, use of substances such as alcohol and tobacco which have important implications for health.[1] Lifestyle diseases include diseases such as hypertension, type 2 diabetes mellitus, obesity, stroke and diseases associated with smoking, alcohol, and drug abuse.
A significant upward trend has been observed in lifestyle diseases with increase in blood pressure and glucose levels as brought out by the latest research in the field.[2],[3] In addition, among the borderline normal individuals, i.e. high-normal blood pressure, impaired fasting glucose, and impaired glucose tolerance, there is evidence suggestive of increased vascular risk.[4],[5] These individuals with borderline parameters have shown high rate of conversion from at risk status, to disease viz. hypertension and type 2 diabetes mellitus. Lifestyle diseases are part of the metabolic syndrome, which expose vulnerable individuals to twice the risk for future cardiovascular morbidity and mortality.[6],[7]
This study was conducted to assess the various correlates of lifestyle diseases among a cohort of factory workers in an urban area.
| Materials and Methods | | |
The present study was a cross-sectional study carried out in an ammunition factory located in western part of India. All employees of the factory (a total of 4033) formed the study population. A sample size of 351 was calculated using appropriate bio-statistical methods, with expected prevalence of disease as 50% and precision of the estimate set at 5%. The study was approved by the Institutional Ethics Committee. Informed written consent was obtained from all the participants after explaining the purpose of the study.
The data was collected using a pretested standardized questionnaire which was prepared with the help of National Institute of Occupational Health, Ahmedabad. Height, weight, and blood pressure were measured using standard methods, and a thorough clinical examination was then carried out. Estimation of random blood sugar level was carried out using OneTouch ® Blood Glucometer under full aseptic precautions. Socioeconomic levels were measured and categorized with Kuppuswamy's socioeconomic status scale.[8],[9]
Definition of variables and outcomes
A positive history of exercise constituted at least 150 minutes of moderate intensity aerobic physical activity per week.[10] The criterion for the diagnosis of diabetes mellitus used in the study was history/symptoms of diabetes plus random blood glucose concentration ≥11.1 mmol/l (200 mg/dl). The term random was defined as regardless to time since the last meal.[11] Body mass index (BMI) between ≥25.0 and 29.9 kg/m2 was considered overweight.[12] Hypertension was defined on the basis of seventh report of the Joint National Committee of hypertension.[13] Statistical analyses were carried out using SPSS Inc., UNICOM Global, Mission Hills, California, USA.
| Results | | |
Majority of the study participants were in the age group of 21–30 years (30.4%). Male-to-female ratio among the study participants was found to be nearly 10:1. Majority of the study participants belonged to upper-middle class (63.8%) of socioeconomic status and 59.3% of the study participants had a history of undertaking physical exercise to remain physically fit. Of the total participants, only 132 (37.6%) gave a history of substance use. Among substance users, most commonly used substances included tobacco chewing (52.7%) followed by alcohol consumption (36.4%) [Table 1]. | Table 1: Descriptive analysis of the study participants from the standardized questionnaire
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Most (61.8%) of the study participants had BMI between 18.5 and 24.9 kg/m2 [Table 2]. Distribution of BMI according to physical activity of the study participants showed that 132 (63.4%) participants who were normal/below normal weight, 69 (33.1%) overweight participants, and 7 (3.4%) obese participants were undertaking physical exercise. The correlation between physical exercise and BMI was not found to be statistically significant (p = 0.361) [Table 3]. | Table 2: Descriptive analysis of the study participants from the clinical examination
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 | Table 3: Association of physical activity with body mass index among the study participants
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A high number of study participants 167 (47.6%) were falling in prehypertensive category (95% CI = 42.38%–52.81%) [Table 2]. From history, however, only 36 (10.3%) study participants were aware of their abnormal blood pressure. About 115 (32.8%) study participants were newly diagnosed with hypertension in the course of the present study.
The correlation between age and hypertension among the study participants was found to be statistically significant (p = 0.041). Sixty-five (51.2%) participants having hypertension belonged to lower-middle socioeconomic status while 86 (38.4%) having hypertension belonged to upper-lower socioeconomic strata. The correlation between socioeconomic status and hypertension was found to be statistically significant (p = 0.02) [Table 4]. | Table 4: Correlation of hypertension and diabetes mellitus with different variables among the study participants
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Hypertension was found to be maximum (85.7%) among the obese study participants. The correlation between BMI and hypertension was found to be statistically significant (p = 0.001) [Table 4]. The association of hypertension with tobacco chewers was found to be statistically significant (P< 0.05) among participants of the study [Table 5]. | Table 5: Association of hypertension and substance use among the study participants
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It is important to mention here that, while taking personal history, it was elicited that a total of 19 (5.4%) study participants were aware of their diabetic status while 8 (2.3%) new cases were diagnosed through the blood investigation in the current study. A total of 27 (7.7%) study participants were found to be diabetic as per the American Diabetes Association 2011 criteria. Maximum diabetic patients (14.3%) were in the age group of 51–60 years. The correlation between the age and diabetes mellitus was found statistically insignificant (p = 0.57); however, the linear trend with age has been found to be statistically significant (P = 0.000673) [Figure 1]. There were 35.7% diabetic patients who were found to be associated with obesity while only 7.8% and 3.7% of diabetic patients were found to have normal or below normal weight and overweight, respectively. The correlation between BMI and diabetes mellitus was found to be statistically significant with p = 0.0001 [Table 4]. | Figure 1: Linear trend between diabetes mellitus and age among the study participants. Chi-square test for linear trend = 7.344, P = 0.000673.
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| Discussion | | |
The maximum study participants in the present study belonged to upper-middle socioeconomic status,[8] followed by lower-middle socioeconomic status. The high number of workers in upper-middle socioeconomic status could be explained by the fact that their place of work was a public sector undertaking. In addition, majority of the workers benefitted from the overtime allowance given to workers, for working extra in the factory over and above the normal duty routine.
In the current study, 37.6% of the study participants gave a history of substance use. Among these, maximum were tobacco chewers (52.7%), followed by alcohol consumers (36.4%) and tobacco smokers (29.5%). According to human health risk assessment studies in asbestos-based industries in India, published by the Central Pollution Control Board, 21.25% were smokers, 3.75% chew tobacco, and 0.20% were ex-smokers, while 20.41% were alcohol consumers.[14] The reason for more number of tobacco chewers than tobacco smokers in the current study is because of strict prohibition of smoking in any form within the factory premises due to handling of explosives by the workers. So when unable to smoke, workers tend to get attracted toward the other cheap alternatives such as tobacco chewing, which has a similar physiological and psychological effect on the body. Prevalence rates of alcohol consumption in the present study are nearly similar to various other studies done in the field.[15],[16],[17]
Mean BMI of the workers in the current study was found to be similar, as observed by Prabhakaran et al.[18] Mehan among 220 workers in a chemical factory found that individuals, with BMI >25 kg/m2 and BMI >30 kg/m2 were 37.7% and 4.1%, respectively.[19] Recent WHO recommendations have attributed moderate-to-high health risks with BMI ≥23 kg/m2 in Asians.[20] A mean BMI of 24.1 kg/m2 among workers in this study reflected a significant finding of antecedent moderate-to-high health risks. The high percentage of overweight workers can be attributed to high intake of saturated fats in snacks during tea time, as brought out by the questionnaire. Health education is imperative in such a setting, where industrial workers need to be informed of potential hazards of overweight and obesity. They need to be sensitized with low-cost and less time-consuming methods of weight loss and lifestyle changes such as incorporation of physical exercise in the daily routine, avoidance of diet rich in saturated fats, and decrease/cessation of alcohol consumption.
The prevalence of prehypertension and hypertension in the current study participants was found to be 41.6% and 43%, respectively. The significant finding brought out in the study is that only 23.8% of the total hypertensive study participants were aware of their blood pressure status. The proportion of individuals with hypertension also increased with age. Similar results were also found by various other studies.[18],[19] This high prevalence of hypertension with only a fourth of workers being aware of their disease status can be explained by the lack of structured periodic medical examination program in the industrial unit. Periodic medical examination based on the hazard levels in the industrial unit needs to be incorporated to break the “Rule of Halves” of blood pressure.
The prevalence of type 2 diabetes mellitus in the industrial workers was found to be 7.7%. Similar results were observed by other studies.[19],[21] Linear trend between diabetes mellitus and age among the study participants was highly significant with P = 0.000673 [Figure 1]. Nearly 29.63% of new cases of diabetes were detected during the course of the study, who were unaware of their deranged blood sugar levels, as also brought out in a study by Prabhakaran et al.[18] As the proportion of individuals affected with diabetes increased with age, it requires gradual increase in the frequency of medical contact and employment of more intensive investigations (like Hb1Ac) for early detection of the disease and monitoring to ensure maintaining normal levels of blood glucose parameters. It is also important to incorporate physical exercise and fitness schedule in the daily routine. Information, education, and communication (IEC) activities should be directed toward health hazards of changing lifestyle and its prevention. There is a need for advertising campaigns to highlight the consequences of the common addictions along with diligent conduct of annual medical examination.
| Conclusion | | |
Lifestyle diseases were found to be the major causes of morbidity among the study participants. Hypertension, diabetes mellitus, and overweight/obesity were the common comorbid conditions brought out by the study. These conditions were associated with factors such as age, socioeconomic status, BMI, and history of tobacco chewing. The study brings out the overarching need for IEC activities to sensitize the industrial workers regarding health hazards of changing lifestyle and its prevention. Health education should be backed by structured periodic medical examination and there should be an emphasis on incorporation of physical exercise in the daily routine, intake of healthy diet, and decrease/cessation of alcohol and tobacco consumption.
Acknowledgments
The authors would like to thank the Department of Community Medicine, AFMC, Pune.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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