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, 12:762 | Cite as

Magnitude of overweight and associated factors among type 2 diabetes mellitus patients at Mekelle public hospitals, Tigray, Ethiopia: a cross-sectional study

  • Kbrom Gemechu KirosEmail author
  • Gebre Yitayih Abyu
  • Desta Siyoum Belay
  • Mekonnen Haftom Goyteom
  • Tensay Kahsay Welegebriel
Open Access
Research note
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Abstract

Objective

To assess magnitude of overweight and associated factors among type 2 diabetes mellitus patients at Mekelle public hospitals, Tigray, Ethiopia.

Results

A total of 365 participants were enrolled in this study. One hundred ninety-eight (54.2%) of the participants were males and 288 (78.9%) of the study participants were from an urban residence. In this study 161 (44.1%) and 12 (3.3%) of the study subjects were alcohol consumers and smokers respectively. Besides, 166 (45%) of the study participants had poor dietary intake and around 302 (82.7%) had low level of vigorous physical activity. The proportion of individuals who were overweight using body mass index as a measure was 149 (40.8%) and the proportion of individuals who had central obesity using waist circumference as a measure was 194 (53.2%). The magnitude of overweight among study participants from urban residence and alcohol consumers was 138 (92.6%) and 93 (62.4%) respectively. Residence area, alcohol consumption, physical activities, central obesity and dietary intake were the determinant factors for overweight among type 2 diabetes mellitus patients.

Keywords

Overweight Determinant factors Type 2 diabetes mellitus 

Abbreviations

AOR

Adjusted Odds Ratio

BMI

body mass index

CI

confidence interval

COR

Crude Odds Ratio

DM

diabetes mellitus

SPSS

Statistical Package for Social Sciences

SSA

Sub-Saharan Africa

WC

waist circumference

Introduction

Globally, more than 1.9 billion adults aged 18 years and above were overweight in 2016. Of these, over 650 million adults were obese [1]. In Sub-Saharan African (SSA) countries the magnitude of overweight is increasing at an alarming rate [2]. This is due to rapid urbanization, dramatic lifestyle changes and high prevalence of child hood stunting [3]. Overweight has been an issue in developed countries for the past years. However, currently, it has gained attention in developing countries as an issue that needs to be addressed [4]. Overweight in people with diabetes could induce increased thrombogenic factors, cardiovascular disease and raised blood pressure. It also interferes with the treatment of hyperglycemia and diabetes-related complications [5, 6].

In Ethiopia, magnitude of overweight is increasing among type 2 DM patients. However, data on overweight of type 2 DM patients is limited because priority has always been given to under nutrition and communicable diseases [7, 8]. Besides, previous studies predominantly relied on body mass index (BMI) as measure of overweight. However, our study used both BMI and waist circumference to measure overweight. Therefore, the aim of this study was to assess magnitude of overweight and associated factors among type 2 DM patients.

Main text

Study area, design, period and participants

The study was conducted from February to April, 2018 by using cross-sectional study design in Mekelle public hospitals, Tigray, Ethiopia. All type 2 DM patients who were available at the time of data collection period were included and patients who had severe illness or physical disability, pregnant mothers and patients with edema were excluded from this study.

Sample size determination and sampling technique

A single population proportion formula was used. The estimated proportion of overweight among type 2 DM patients was 31.5% [8]. Accordingly, the required sample size (n) was estimated with a confidence level of 95%, 5% margin of error and by adding 10% non-response rate the final sample size was 365.

Systematic random sampling method was used to select the study participants from a total of 2442 type 2 DM patients who were on treatment follow up in Mekelle public hospitals. To select the required sample size the total sample size was proportionally allocated to the three public hospitals. Accordingly, the list of the patients was taken from the follow up unit of the three public hospitals and sampling frame was developed. Then the first study subject was randomly selected from the sampling frame by using lottery method and based on the sampling interval (k = 6) every six interval was selected from the sampling frame. Finally, 365 of patients with type 2 DM were included in our study.

Data collection tools and procedures

The tools for data collection include a portable Stadiometer, stretch-resistant tape meter and structured questionnaire. The questionnaire was composed of questions on socio-demographic data, behavioral and health-related factors, dietary factors and anthropometric measurement (weight, height and waist circumference).

The data was collected using a structured questionnaire through face to face interview and physical measurements of weight, height, waist circumferences using standardized techniques and calibrated equipment. Weight and height were measured with participants standing without shoes and wearing light clothing. Participants were standing upright with the head, shoulder, buttock, lower limb and heal of the foot touches the height board for height measurement. Waist circumference was measured midway between the lower rib margin and the iliac crest in the horizontal plane using a tape meter by following the standard procedure.

Data quality control

The questionnaire was initially prepared in English and translated to Tigrigna language then back to the English language. One day training was given on the objective of the study, instrument and data collection procedures by the principal investigator for the data collectors and supervisors. The weight measurement scale was checked if it is at zero before each measurement. Five percent of the questionnaire was tested before the actual data collection period outside of the study area. Data collectors were instructed to check the completeness of the instrument just after its completion. The principal investigator checked out the questionnaire for completeness each night. Moreover, the collected data were coded, cleaned and explored before analysis to check missing items and completeness of the collected data.

Operational definitions

Overweight BMI greater than or equals to 25 kg/m2.

Central obesity waist circumference greater than 88 cm for females and greater than 102 cm for males was considered as having abdominal obesity.

Low level of physical exercise individual activity less than 150 min per week was considered as low level of physical activities.

Adequate level of physical exercise individual activity above 150 min per week was considered as adequate level of physical activities.

Dietary intake level of dietary intake was determined based on dietary factors questionnaire. Six items were asked and based on the mean value of those questions individuals who score below the mean value were classified as poor and those who score above the mean value were classified as good dietary practices.

Data processing and analysis

The collected data were entered and cleaned using Epi-data manager. Two items of dietary questions were reversely coded to explain total score to be interpreted as higher scores meaning better outcomes. Then it was exported to SPSS version 21 for statistical analysis. Descriptive statistics were computed using the frequency table and numerical summary measures. Binary logistic regression was done to determine the magnitude, direction and strength of association between a set of independent variables and the outcome variable at p < 0.25 significance level. Then those variables that were significant at p < 0.25 with the outcome variable were selected for multivariable analysis. Odds ratio with 95% confidence level was computed and significant association was declared at p-value < 0.05. Finally, the result was presented using text and tables.

Results

Socio-demographic characteristics

A total of 365 participants were enrolled in this study. One hundred ninety-eight (54.2%) of the participants were males. Two hundred seventy (74%) of the study subjects were Orthodox followers. Besides, 288 (78.9%) of the study participants were from an urban setting and 291 (79.7%) were married (Table 1).
Table 1

Socio-demographic characteristics of type 2 diabetes mellitus patients at Mekelle public hospitals, Tigray, Ethiopia, 2018

Variables

Number

Percent

Sex

 Male

198

54.2

 Female

167

45.8

Age

 25–34

30

8.2

 35–44

71

19.5

 45–54

133

36.4

 Above 55 years

131

35.9

Marital status

 Single

12

3.3

 Married

291

79.7

 Divorced

25

6.8

 Widowed

37

10.2

Religion

 Orthodox

270

74

 Muslim

78

21.4

 Others

17

4.6

Ethnicity

 Tigray

354

97

 Amhara

11

3

Educational status

 Can’t read and write

74

20.3

 Primary

94

25.8

 Secondary

72

19.7

 Diploma and above

125

34.2

Occupational status

 Housewife

87

23.8

 Government employee

127

34.8

 Merchant

83

22.7

 Farmer

40

11

 Retired

18

4.9

 Other

10

2.7

Residential area

 Rural

77

21.1

 Urban

288

78.9

Behavioral factors and dietary intake of type 2 DM patients

Out of 365 respondents, 161 (44.1%) and 12 (3.3%) of the study subjects were alcohol consumers and smokers respectively. About 247 (67.7%) of the study subjects had a habit of walking on their daily living and 302 (82.7%) had low level of vigorous physical activity. In our study 199 (55%) of the study participants had good dietary intake and 166 (45%) had poor dietary intake. Of these, 333 (91.2%) had got nutritional education from different sources and 32 (8.8%) individuals didn’t have nutritional education from any sources.

Magnitude of overweight

The magnitude of overweight among type 2 DM patients using BMI as a measure was 149 (40.8%) [95% CI (35.7, 46)] and by using waist circumference as a measure 194 (53.2%) of the study subjects had central obesity (Table 2).
Table 2

Magnitude of overweight by socio-demographic characteristics among type 2 diabetes mellitus patients at Mekelle public hospitals, Tigray, Ethiopia, 2018

Variable

Category

Overweight

No

Yes

Number (%)

Number (%)

Sex

Male

122 (56.5)

76 (51)

Female

94 (43.5)

73 (49)

Age category

25–34

21 (9.7)

9 (6)

35–44

61 (28.2)

10 (6.7)

45–54

83 (38.4)

50 (33.6)

Above 55

51 (23.6)

80 (53.7)

Marital status

Single

8 (3.7)

4 (2.7)

Married

171 (79.2)

120 (80.5)

Divorced

17 (7.9)

8 (5.4)

Widowed

20 (9.3)

17 (11.4)

Religion

Orthodox

186 (86.1)

84 (56.4)

Muslim

25 (11.6)

53 (35.6)

Others

5 (2.3)

12 (8)

Ethnicity

Tigray

208 (96.3)

146 (98%)

Amhara

8 (3.7)

3 (2)

Educational status

Can’t read and write

52 (24.1)

22 (14.8)

Non formal education

1 (0.5)

0 (0.0)

Primary school

56 (26)

38 (25.5)

Secondary school

42 (19.4)

30 (20.1)

Diploma and above

66 (30.6)

59 (39.6)

Occupational status

Housewife

48 (22.2)

39 (26.2)

Government employee

86 (39.8)

41 (27.5)

Merchant

34 (15.7)

49 (32.9)

Farmer

35 (16.2)

5 (3.4)

retried

5 (2.3)

13 (8.7)

Other

8 (3.7)

2 (1.3)

Residential area

Rural

66 (30.6)

11 (7.4)

Urban

150 (69.4)

138 (92.6)

Factors associated with overweight

Being from urban residence had 3.4 times the odds of being overweight compared to their counterparts [AOR = 3.4, 95% CI (1.26–9.4)]. The odds of overweight among participants who stayed with type 2 DM for 3–6 years was 2.8 times higher compared to those who stayed less than 3 years [AOR = 2.8, 95% CI (1–7.85)]. Study participants who were alcohol consumers were 2.9 times more likely to develop overweight compared to non-consumers [AOR = 2.9, 95% CI (1.5–5.5)]. Overweight was 4 times higher among peoples with type 2 diabetes mellitus who had low level of vigorous physical activity as compared with study subjects who had adequate level of vigorous physical activity [AOR = 4, 95% CI (1.19–13.8)]. Besides, study subjects who did not walk regularly were 2.3 times more likely to have overweight as compared to their counterpart [AOR = 2.3, 95% CI (1–5.17)]. Concerning dietary intake, the odds of being overweight increased by nearly 8 times in type 2 DM patients with poor dietary intake [AOR = 7.9, 95% CI (4.02–15.5)] (Table 3).
Table 3

Factors associated with overweight among type 2 diabetes mellitus patients at Mekelle public hospitals, Tigray, Ethiopia, 2018

Variable

Category

Overweight

COR (95% CI)

AOR (95% CI)

p value

No

Yes

Age

25–34

21 (9.7)

9 (6)

1

1

 

35–44

61 (28.2)

10 (6.7)

0.4 (0.14, 1.07)

0.7 (0.18, 2.97)

0.658

45–55

83 (38.4)

50 (33.6)

1.4 (0.6, 3.31)

1.4 (0.41, 5.05)

0.573

> 55 years

51 (23.6)

80 (53.7)

3.66 (1.55–8.61)

3.5 (0.9, 12.3)

0.051

Residence area

Rural

66 (30.6)

11 (7.4)

1

1

 

Urban**

150 (69.4)

138 (92.6)

5.52 (2.8, 10.9)

3.4 (1.26, 9.4)

0.016

Alcohol drink

Yes**

68 (31.5)

93 (62.4)

3.61 (2.33–5.6)

2.9 (1.5, 5.5)

0.001

No

148 (68.5)

56 (37.6)

1

1

 

Alcohol drink frequency

7 days/week

6 (2.8%)

11 (7.4)

4.7 (1.67, 13.38)

1.2 (0.02, 15)

0.932

5–6 days/week

10 (4.6%)

16 (10.7)

4.1 (1.76, 9.62)

0.2 (0.006, 8.03)

0.414

1–4 days/week

17 (7.9)

23 (15.4)

3.4 (1.73, 7.00)

0.3 (0.01, 10.12)

0.518

1 day/week

35 (16.2)

42 (28.2)

3 (1.79, 5.32)

0.2 (0.007, 5.9)

0.359

Not drink

148 (69.5)

57 (38.3)

1

1

 

Vigorous activity

Yes

85 (39.4)

24 (16.1)

1

1

 

No

131 (60.6)

125 (83.9)

3.37 (2, 5.65)

1.2 (0.48, 3.18)

0.656

Moderate activity

Yes

94 (43.5)

40 (26.8)

1

1

 

No

122 (56.5)

109 (73.2)

2.1 (1.33, 3.29)

0.7 (0.27, 1.66)

0.390

Walk

Yes

182 (84.3)

65 (43.6)

1

1

 

No**

34 (15.7)

84 (56.4)

6.9 (4.24, 11.27)

2.3 (1.01, 5.17)

0.045

Central obesity

Yes**

73 (33.80

121 (81.2)

8.46 (5.14, 13.9)

3.4 (1.64, 6.91)

0.001

No

143 (66.2)

28 (18.8)

1

1

 

Duration of DM

0–3 years

69 (31.9)

22 (14.8)

1

1

 

3–6 years**

46 (21.3)

32 (21.5)

2.1 (1.12, 4.21)

2.8 (1, 7.85)

0.039

> 6 years

101 (46.8)

95 (63.8)

3 (1.69, 5.14)

2.5 (1.08, 5.74)

0.031

Dietary intake

Good

160 (74.1)

39 (26.2)

1

1

 

Poor**

56 (25.9)

110 (73.8)

8 (5.00, 12.96)

8 (4.02, 15.5)

0.000

Vigorous activity

Adequate

58 (26.9)

5 (3.4)

1

1

 

Low**

158 (73.1)

144 (96.6)

10.5 (4.12, 27)

4 (1.19, 13.8)

0.025

Moderate activity

Adequate

70 (32.4)

16 (10.7)

1

1

 

Low

146 (67.6)

133 (89.3)

3.98 (2.2, 7.20)

2.1 (0.89, 4.97)

0.089

Walk level

Adequate**

131 (60.6)

24 (16.1)

1

1

 

Low

85 (39.4)

125 (83.9)

8 (4.76, 13.43)

3.3 (1.45, 7.61)

0.005

COR Crude Odd Ratio, AOR Adjusted Odd Ratio, CI confidence interval

** p value < 0.05 significant

Discussion

In this study, the overall magnitude of overweight was 40.8% [95% CI (35.7, 46)]. This is almost similar to the study done in Addis Ababa, and Hosanna [7, 8]. However, it is lower than the study done in India, Nepal and Bahrain [9, 10, 11]. This difference might be due to variation in socio-demographic factors, lifestyle, and economic status. In this study, using waist circumference as an indicator yielded the highest magnitude of obesity compared to using BMI. By using waist circumference as a measure 53.2% of the study subjects had central obesity that is higher as compare to the general obesity (40.8%). In general, this finding indicates that using BMI alone underestimate the magnitude of overweight or obesity.

Dietary intake was also the other variable that had significant association with overweight among type 2 DM patients. This is in line with the study done in Addis Ababa, Ethiopia [7]. It is also supported by study done in South Africa [12]. The reason might be due to rapid nutrition transition in developing countries and lack of nutritional education. There was also a statistically significant association between overweight and physical activities. This finding is in line with a study done in South Africa, Yemen, and Ghana where physical activity was significantly associated with overweight [12, 13, 14]. This might be due to high in sedentary behavior and poor motivation to physical exercise.

Residence area was the other variable that had a significant association with overweight in this study. Being from urban residence had 3.4 times odds of being overweight. The possible reason might be due exposure of urban population to unhealthy lifestyle, high proportion of urban study subjects in the current study and participants from rural area were more physically active. It is also showed that duration of diabetes after diagnosis was significantly associated with overweight. However, it contradicts with the finding reported from Yemen and Kenya which reports, the occurrence of overweight decreases with the duration of DM after diagnosis [13, 15]. So, this contradicting issue needs further investigation. Previous studies reported that being female associated with overweight however in this study sex had no significant association with overweight [9, 10]. This might be due to variation in socio-demographic factors.

Conclusion and recommendations

The magnitude of overweight was high among type 2 DM patients. The determinant factors were residence area, alcohol consumption, low level physical activities, duration of DM, central obesity and dietary intake. Using waist circumference in conjunction with BMI would be useful for better diagnosis and early detection of overweight among type 2 DM patients. Researcher should have to investigate perceived barriers to regular physical activity among type 2 DM patients.

Limitations of the study

  • There might be recall bias among respondents answering questions related to dietary intake of the week, time spent for doing physical activity and sitting/reclining on a typical day.

  • Nutritional knowledge and genetic susceptibility of the respondent to overweight was not considered.

Notes

Acknowledgements

First and for most, we thank Mekelle University, school of nursing for its financial support. Our recognition also goes to data collectors, supervisors, workers at diabetic clinic and authorities of Mekelle public hospitals who were facilitating the data collection. Finally, we would like to thank the study participants who were willing to take part in this study.

Author’s contributions

KGK conceived the idea of the study, prepared the study proposal, supervised the data collection in the field, performed the data analysis, and drafted the manuscript. GYA, DSB, MHG, and TKW assisted with the preparation of the proposal and the interpretation of data, participated in data analysis. They also participated in the interpretation of data and critically reviewed the manuscript. All authors participated in the revision of the manuscript. All authors read and approved the final manuscript.

Funding

Mekelle University. The funder has no role in the design, analysis, preparation of the manuscript and decision to publish.

Ethics approval and consent to participate

Ethical clearance and approval was obtained from Mekelle University ethical review committee. Official letter was written from Tigray regional health bureau to each hospital and letter of permission was obtained from the medical director office to communicate with relevant bodies at the hospitals. All participants recruited to this study were informed about the purpose of the study, the right to participate or to terminate at any time if they want and they were ensured about the confidentiality of information. Finally, written consent was obtained from all the study participants.

Consent to publish

Not applicable for this section.

Computing interests

All authors declare that they have no competing interests.

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Kbrom Gemechu Kiros
    • 1
    Email author
  • Gebre Yitayih Abyu
    • 2
  • Desta Siyoum Belay
    • 3
  • Mekonnen Haftom Goyteom
    • 1
  • Tensay Kahsay Welegebriel
    • 3
  1. 1.Department of NursingAdigrat UniversityAdigratEthiopia
  2. 2.Department of NursingBahirdar UniversityBahir DarEthiopia
  3. 3.Department of NursingMekelle UniversityMekelleEthiopia

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