MED 299

TITLE:

HEALTH STATUS OF LEVEL 200 UNIVERSITY OF CAPE

COAST SCHOOL OF MEDICAL SCIENCES(UCCSMS)
STUDENTS: A PRELIMINARY ANTHROPOMETRIC
STUDY

AUTHOR: NANA KWAME OBENG BEMPONG

SM/SMS/ 16/0038

FACILITATOR: DR. AKWASI ANYANFUL

Date: 1st May, 2018.

 TABLE OF CONTENT

1. Acknowledgement

2. Abstract

3. Introduction

4. Materials and Method

5. Results

6. Discussion

7. Conclusion

8. Recommendations

9. References
 ACKNOWLEDGEMENT

Special thanks to my facilitator, Dr. Akwasi Anyanful, for his guidance, advise, and immense
contribution for this study. Eliza Akosua Asaa Gyebi, a Level 200 UCCSMS student is
worthy of honourable mention, for her tremendous help. I am also grateful to all members of
the Class of 2022 for their efforts toward making this study a success. I also feel deep
gratitude to all technicians in the UCCSMS biochemistry laboratory for their assistance in
carrying out the study.
 ABSTRACT

The purpose of this study is to determine the health status of a sample of medical students.
The variables used as determinants of health in this study include anthropometric
measurements such as weight and height, and measurements of blood pressure, visceral fat,
skeletal muscle, body fat and resting metabolic rate. The participants of this study are
students from the level 200 class of UCCSMS. The above-mentioned measurements were
taken from the medical students. The results were analysed. The results of the analysis were
used to determine the health status of the students. The results of the findings may be helpful
in managing lifestyles to promote health.
 INTRODUCTION

The World Health Organization(WHO) in 1994 defined health as “state of complete

physical, mental and social well-being and not merely the absence of disease or infirmity.
(12). In 2013, a research by the United States National Research Council showed that despite
developed countries spending trillions on healthcare costs, their citizens died at a younger age
and experience more illness and injury than people in relatively less developed countries.
This has generated the idea that perhaps, our concept of good-living may not necessarily
reflect health status. Living in a glass house, eating at a golden table and driving the latest
Mercedes does not mean one is healthy.

Current researches now focus on how to increase one’s health span, which is the
period of time lived in a healthy state, rather than the life span, which simply is the length of
time a person stays alive, whether struck with diseases or not. (9). A combination of a few
non-invasive measurements can be used as determinants of health.

These measurements include resting metabolic rate, visceral fat index, skeletal
muscle, blood pressure, body mass index, and body fat, just to mention a few.

The resting metabolic rate, also called the basal metabolic rate(BMR) is the energy
required by an awake individual during physical, digestive and emotional rest. (8). In simpler
terms, it is the energy used by an awake person who is not involved in any conscious activity
at all. It should be noted that this is not the minimum metabolism necessary for maintaining
life, since the metabolic rate during sleep may be less than the BMR. The BMR is influenced
by many factors. It is changed in some hormone diseases; for example, hyperthyroidism. It
changes during growth, reaching a maximum at about 5 years; in the adult, it varies with
body size. Exposure to cold or regular exercise increase it, while starvation produces a
lowering- some small attempt at natural compensation for a reduced calorie intake. With
fever, an approximate 12% increase occurs for each degree centigrade rise in temperature.
Many measurements have been made on humans, but the variations noted have made it
difficult to predict a value for any individual. (6). For the purposes of this study, the energy
demand for basal metabolism will be taken as 24kcal/day.

Visceral fat, the fat that is stored within the abdominal cavity, is another determinant
of health. This type of fat lies deep to the skin and hence is wrapped around important
abdominal viscera such as the liver, pancreas and intestines, ensuring some distance between
them. (2). When measuring the body fat around a person’s waist, it is the visceral fat that is
actually being measured. Having some visceral fat is normal, but the amount is critical.

Body fat percentage, simply put, is the percentage of a person’s weight that is fat.
This percentage is subject to change as the individual’s body composition changes. (4). Body
fat is important, in that it is required to keep the body warm and also to protect the organs and
joints. This term is usually confused with body mass index.

The body mass index(BMI), also known as the Quetelet index is defined as the body
mass divided by the square of the body height, and is universally expressed as kg/m2. (1). It is
calculated by taking anthropometric measurements, specifically the height and the weight,
and inserting the two values into the formula;
BMI= Weight(kg)/ Height(m2).
A high BMI assumes a higher percentage of body fat, which places a person at greater risk
for developing chronic diseases such as diabetes mellitus, hypertension, heart disease, and
even cancer.

Just like the body fat percentage, skeletal muscle percentage is the percentage of the
body weight that is muscle. Muscle is the bundle of actin and myosin fibres, attached to
bones, that contracts and relaxes to induce movement in the individual. Having a low muscle
mass percentage can bring lots of drawbacks, such as obviously not being able to lift
moderately heavy objects, having difficulty performing routine daily tasks, and fatigue. On
the contrary, a higher than normal skeletal muscle percentage requires higher metabolic rate,
which means the individual has to eat frequently, and have extreme workout regimes just to
maintain the high muscle mass. (3).

The blood pressure of an individual is the pressure exerted by the blood on the walls
of the arteries as the heart contracts and relaxes to pump blood through them. Blood pressure
is usually presented as two figures; a first, higher one called the systolic pressure, and a
second, lower one called the diastolic pressure. (13). Systolic pressure is the pressure in the
arteries following ventricular contraction whereas diastolic pressure is that for ventricular
relaxation.

For the purpose of this study, medical students were chosen because they will become
medical doctors, and advise people on how to live healthy lives for long. They will also
professionally propagate the findings of this study better as they have detailed understanding
of these parameters and the complications that can arise if their values hit extremes.
 MATERIALS AND METHOD

Vertical, calibrated stadiometers were used to check the heights of the students. The
heights were taken from the dorsal part of the students, making sure the stadiometer touched
the calves, buttocks, scapulae and occiput. With heels together, legs straight, arms at the
sides, shoulders relaxed, and head positioned in the Frankfurt plane (upright and straight), the
correct reading of each student was taken.

The body fat percentage, skeletal muscle percentage, BMI, BMR, visceral fat and
weight of the students were measured electronically with Omron BF511 body composition
monitors. These devices are more accurate and precise than the traditional way of taking
these measurements. They have sensors which take the readings. These sensors work by
sending a tiny electrical signal through the body, ensuring that the measurements are taken
throughout the body, unlike the traditional methods.

The blood pressure of each student was measured using manual mercury
sphygmomanometers and stethoscopes. Students were also required to give their ages,
genders, religions and places of residence, which were essential for correct readings on the
body composition monitors.
 RESULTS

Number of students involved in study= 63

Number of males= 33 Number of females= 30

Table 1.0 TABLE OF RESULTS FOR FEMALE DATA

Parameter Normal range Mean Median Mode Highest Lowest

Age(years) 20.3 20 20 25 18
Height(cm) 163.5833 163.75 161 177.5 153
Weight(kg) 65.6833 59.2 58.3 112.5 48.2
Systolic BP(mmHg) 90-120 116.0689 116 124 138 99
Diastolic BP(mmHg) 60-80 74.3448 73 76 103 60
Body fat(%) 21-32.9 36.0933 34.7 33.8 54.8 24.2
Visceral fat 1-8 4.0667 4 4 7 2
Skeletal muscle(%) 24.3-30.3 26.1933 27.05 25.2 30.9 20
BMI(kg/m2) 20.0-27.0 24.43 22.85 23.5 38.6 17.9
BMR(kcal/day) 1359.9 1287.5 1877 1160
Average hours(sleep) 5.6033 6 6 8 4

Table 2.0 TABLE OF RESULTS FOR MALE DATA

Parameter Normal range Mean Median Mode Highest Lowest

Age(years) 20.6667 20 20 25 19
Height(cm) 174.5303 174.5 175 187 166
Weight(kg) 68.7364 66.6 68.5 101.6 51.9
Systolic BP(mmHg) 90-120 126.1852 125 120 142 102
Diastolic BP(mmHg) 60-80 76.6296 78 70 89 64
Body fat(%) 8-19.9 17.2424 16 11.9 38.5 6.5
Visceral fat 1-8 4.6364 4 1 16 1
Skeletal muscle(%) 33.3-39.1 40.9909 42.8 46.2 48.7 21.4
BMI(kg/m2) 20.0-27.0 22.5849 22.2 23.5 35.2 17.9
BMR(kcal/day) 1635.121 1604 1479 2081 1400
Average hours(sleep) 5.8688 6 6 8 4
 Table 3.0 TABLE OF RESULTS FOR ENTIRE CLASS

Parameter Normal range Mean Median Mode Highest Lowest

Age(years) 20.4921 20 20 25 18
Height(cm) 169.3175 170 175 187 153
Weight(kg) 67.2825 62.9 54.6 112.5 48.2
Systolic BP(mmHg) 90-120 120.9464 121.5 120 142 99
Diastolic BP(mmHg) 60-80 75.4464 76 70 103 60
Body fat(%) 26.2191 26.6 11.9 54.8 6.5
Visceral fat 1-8 4.3651 4 4 16 1
Skeletal muscle(%) 33.9444 30.3 25.2 48.7 20
BMI(kg/m2) 20.0-27.0 23.4635 22.4 23.5 38.6 17.9
BMR(kcal/day) 1504.063 1491 1478 2081 1160
Average hours(sleep) 5.7424 6 6 8 4
 DISCUSSION

Female Data

The average age for female participants was 20.3 years. The average height was
163.5cm. This value is higher than the average height of Ghanaian women between 20-25
years, which was given as 158.3cm by The New York Times online site. (11). The average
weight was 59.2kg.

The average of the systolic blood pressure of females was found to be 116mmHg,
which falls in the normal range. However, 33% of the participants had their systolic blood
pressure above the normal range but none was below the normal range. For the diastolic
blood pressure, the average was 74mmHg, which is also normal. The fraction above the
normal range was 23% while none of the values for this parameter fell below the normal. The
average blood pressure was 116/74mmHg which is normal. Out of 30 female participants,
only three had their blood pressure above normal, while none was below normal.

On the body fat percentage, the mean obtained was 36.1%. However, due to the
presence of outliers, the median, 34.7%, was used for analysis. Both measures are higher than
the normal though. About 54% of the participants had body fat percentages higher than
normal, with the highest being 54.8%. None fell below the normal.

The average visceral fat index was 4. About one-fourth of the female participants had
a visceral index above 4. Out of this number, 75% had their visceral fat levels at potentially
harmful levels (6-8). Twenty-two (22) participants had a visceral fat index below 5. Of this
number, only twelve (12) were with a visceral fat level below 3. Though the average falls in
the normal range, it will be better to have a visceral fat index below 4 in the youthful ages, as
visceral fat is highly likely to increase as the individual grows older.

Females are noted to have more body fat, and less skeletal muscle. From the results of
the study, the average muscle mass percentage was 26.2%. This value is normal for females
of the average age. Eight (8) participants had values lower than normal while the percentage
for one participant was above normal.

Most female participants (64%) fell in the normal range of BMI, with an average of
22.9kg/m2. Four (4) participants were underweight, and the same number were obese, and
three (3) were overweight.
Male data

The average age and height of the male participants were 20.6 years and 174.5cm
respectively. According to The New York Times online site, this average is higher than the
average height, 169.2cm, for males between ages 20-25 in Ghana. (11).

The average systolic blood pressure for males was found to be 126mmHg, which is
higher than normal. From the results, 70% of the values for systolic blood pressure was
higher, while the remaining 30% were within the normal range. None was below. For the
diastolic blood pressure, the average found was 76mmHg, a normal value. The percentage
that was higher than normal was 18%. None of the participants had a value below normal.
The average blood pressure for males is thus 126/76mmHg. Five entries for blood pressure
were higher than normal.

The average body fat percentage for male participants, 16%, fell within the normal
range. The median was used instead of the mean for analysis because of the effect of outliers
on the latter. Participants with a body fat percentage higher than the normal constituted 27%.
Only two participants had critically low percentages of body fat.

The average visceral fat index for males was 4. This value is normal. Three
participants had values which were high (9-14) while one participant had a very high visceral
fat index (16). Fourteen (14) participants had ideal values of 2 and 3 while 39% had indices
from 4 to 8.

The average skeletal muscle mass percentage was 41%. This value is higher than
normal. Actually, twenty-four (24) out of the thirty-three (33) male participants had a skeletal
muscle percentage higher than normal. This number corresponds to 73% of the male
participants. Some of the participants (12%) however had values lower than the normal
range. Only 15% were within the normal range.

For BMI, the average value recorded for males was 22.2kg/m2 which is normal.
Eleven (11) participants, corresponding to 30% were underweight. One participant was
obese, and three others were overweight.
Total data

The average blood pressure for the class was 121/75mmHg. This value is normal.
Twelve (12) participants had their blood pressure being higher than normal. None of the
participants had a lower blood pressure than the normal. Blood pressure should not be too
high or too low. Chronic elevation of the blood pressure, or hypertension, presents with
serious cardiovascular complications while a blood pressure that is too low results in equally
serious conditions such as shock. (13).

The class managed an average body fat percentage of 26.2%. As expected, females
had more body fat percentage than males. It is not healthy to have too much or too little fat. If
the body fat percentage is too low, resistance to diseases, and energy levels are reduced and
the body is at risk of health issues. On the other hand, if the percentage is too high, there is a
higher risk of diabetes and other health problems. It is therefore important to stay in the
healthy range all the time. (4). The high range of body fat among some participants, mostly
females, could be attributed to an increase in consumption of processed foods and foods high
in calories. Chocolates, carbonated drinks, sweets, and fried foods have become the order of
the day at any gathering involving students; official seminars and student ‘drink-ups’ alike.
The growing attitude of physical inactivity of students, and the Ghanaian youth at large
cannot be ignored.

On the issue of visceral fat, the average for the class was 4. Surprisingly, female
participants happened to have more visceral fat than their male counterparts. High levels of
visceral fat can lead to inflammation and high blood pressure, which increases the risk of
serious health problems. (2). Another problem with high visceral fat is its impact on the ‘fat
hormone’ or adiponectin. This hormone regulates body fat. Visceral fat inhibits adiponectin,
and as a result, the body produces more fat than is actually needed. (5). High visceral fat also
influences insulin sensitivity. This means it can lead to glucose intolerance, and diabetes type
II later in life.

Due to the fact a greater fraction of the participants were males, and they had high
skeletal muscle percentage, the average for the class was shifted up to 30.3%. Males had
more skeletal muscle mass than females because the former are involved in more physical
activity. Unlike fat, muscle is metabolically active and affects metabolism. Having a low
muscle mass percentage can bring lots of drawbacks, such as obviously not being able to lift
moderately heavy objects, having difficulty performing routine daily tasks, and fatigue. On
the contrary, a higher than normal skeletal muscle percentage requires higher metabolic rate,
which means the individual has to eat frequently, and have extreme workout regimes just to
maintain the high muscle mass. (3).

Most participants had a normal body-mass-index. The class average was 22.4kg/m2.
for some people the BMI is not a reliable indication of health. A highly muscled individual
who is very fit and healthy may have a somewhat heavy body weight because muscles pack
on a lot of pounds. (1). This person may have a high BMI that improperly puts him or her in
the overweight or obese categories. Likewise, thin individuals who have a low body weight
with very little muscle and a higher percentage of fat may have a normal BMI, which would
be an incorrect indication of health status.

On the BMR, the class average was 1504kcal/day. The BRM in males was found to
be greater than in females. This is because the male participants have a higher percentage of
skeletal muscle, which is metabolically active and tends to consume more calories. (7).
Unlike females who have more metabolically inactive body fat than muscle.

Average hours of sleep was six (6) hours a day. This is lower as compared to the
recommended hours of sleep by the Centre for Disease Control and Prevention(CDC), which
is seven (7) to nine (9) hours a day. (10).
 CONCLUSION

Only one-third (33%) of all participants had normal values for all the variables.
Mechanisms should be devised to increase this percentage to more than half (>50%).

RECOMMENDATION

1. All members of the class should be encouraged to eat less fatty foods, processed foods
and sugary foods as these contribute to more body fat and visceral fat.
2. Members should engage in regular exercise, at least three times weekly. This routine
will improve blood pressure and burn exercise fat.
3. Participants should have more rest to rejuvenate them, reduce stress levels and
enhance learning abilities.
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