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
Acknowledgement
Abstract
Introduction
Materials and Method
Results
Discussion
Conclusion
Recommendations
References
ACKNOWLEDGEMENT
Special thanks to my facilitator, Dr. Akwasi Anyanful, for his guidance, advise, immense contribution and also for providing materials to conduct 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 anticipated outcome of this study is identification of factors that promote or retard health. 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. 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. 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. (Conway et al, 1990). 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. 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. 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. 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 after its discoverer Adolphe Quetelet, is defined as the body mass divided by the square of the body height, and is universally expressed as kg/m2. 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. 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.
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. 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= 33Number of females= 30
Table 1.0TABLE 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 2.0TABLE 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 3.0TABLE 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. 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.
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.

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. 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. 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. 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.

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. 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. 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 which is seven (7) to nine (9) hours a day.

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
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.

Members should engage in regular exercise, at least three times weekly. This routine will improve blood pressure and burn exercise fat.

Participants should have more rest to rejuvenate them, reduce stress levels and enhance learning abilities.
REFERENCES