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Indian Journal of Community Medicine

Nutritional Status and Blood Pressure of Medical Students in Delhi

Author(s): P. Chhabra, V. L. Grover, K. Aggarwal, A.T. Kannan

Vol. 31, No. 4 (2006-10 - 2006-12)

P. Chhabra, V. L. Grover, K. Aggarwal, A.T. Kannan


Adolescence is a significant period of growth and maturation, unique changes occur and many adult patterns are established during this period. Proximity to biological maturity may provide final opportunities for preventing health problems1,2. It has often failed to receive the attention given to earlier periods in childhood with regards to health related issues and interpretation of anthroponetry3. Most nutrition research in the developing world focused on under-nutrition in under-five children. Studies4,5 have shown that many of the developing countries including India are facing the dual burden of under-nutrition and over-nutrition. Data from National Family Health Survey 2 (NFHS 2)6 has identifi ed that significant proportion of over-weight coexists with high rates of malnutrition, pointing that the nutrition transition is underway in India. The emergence of obesity and its sequel as public health problems has renewed interest in the adolescent anthropometry. Overweight and obesity during this period are associated with risk factors for obesity related diseases7,8. The age group from 18-21 years is important physically, mentally and emotionally. This is the period of transition when individuals are entering adulthood. Medical students joining Medical Colleges represent this group. There are no studies on the health and nutritional status for this group in our country. The WHO Expert Committee9 has recommended that measures of height and weight provide useful source of data for assessment of growth status of adolescents. The present study is an endeavor to study the health and nutritional status of medical students joining the Medical College.

Material and Methods

The study was conducted in a Medical College under the University of Delhi, where students qualifying the Entrance Examination are admitted. Every year a medical examination is done for the students joining the College. Each student filled up a questionnaire recording his/her age, residential address, gender, history of illness, family history of illness etc. A thorough general physical and systemic examination was done by specialists. The weight, height and blood pressure were also recorded. Weight was taken on a weighing scale with standard minimum clothing to the nearest 0.5 kg. Height was measured on a vertical scale with heels, buttocks, occiput against the wall and head in Frankfurt plane, to the nearest 0.5 cm. Blood pressure was measured and classifi ed as per the Sixth Report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC VI)10.

The same team of workers took all the measurements. The instruments were calibrated on the day of the examination. Body Mass Index (BMI) was computed as weight (in kg)/ height2 (in m). For underweight the BMI 5th percentile developed by Must et al on the basis of the US National Health and Nutrition Examination Survey I data, was the cutoff while for overweight a BMI of 85th percentile of the same data set was used11,12. Data for four years 1998-2001 was compiled and analyzed on a computer using SPSS version 9 software. Mean, median and percentiles were computed for weight, height, BMI and blood pressure. These were compared with the existing standards. Chi square test was used to study association between BMI and blood pressure.


A total of 335 fi rst year students were examined from year 1998-2001. Of these 298 (88.95%) were males and 37 (11.05%) females. The students were in the age group 17-21 years. Majority (39.93%) were 18 years of age. The mean height was 171.5 cm, weight 61.5 kg and BMI 20.0 for the boys while it was 159.0 cm, 49.6 kg and 19.6 for girls respectively. Percentiles were computed only for boys, as the girls were very few in each year. The 50th percentile was 171.0 cm, 61.0 kg and 20.8; the 85th percentile was 178.0cm, 75 kg and 25.32; the 5th percentile was 162.0 cm, 46.0 kg and 16.5 for height, weight and BMI respectively. The mean systolic blood pressure was 116 mmHg for boys and 107mmHg for girls. The age wise percentiles of weight, height systolic and diastolic blood pressure are shown in Table I.

Table I Weight, Height, Blood pressure and BMI Percentiles in the Students

Percentile Weight (kg) Height (cm) Systolic BP
(mm Hg)
Age=17 years
5 43.2 161.0 100.4 60.2 15.8
50 60.0 172.0 117.0 77.0 20.3
85 73.4 176.5 126.0 84.0 24.8
95 82.2 179.1 131.8 90.0 27.2
Age=18 years
5 46.2 162.0 100.8 60.5 16.7
50 62.5 171.0 120.0 80.0 21.4
85 79.9 178.0 126.0 84.0 26.2
95 89.8 180.7 140.0 90.0 29.1
Age=19 years
5 45.8 161.7 98.8 60.1 17.0
50 61.0 172.0 120.0 80.0 20.4
85 76.8 179.9 126.0 84.0 24.0
95 87.8 185.5 132.5 90.0 28.2
Age≥ 20 years
5 45.0 160.0 100.4 60.1 16.1
50 62.0 175.0 120.0 80.0 20.9
85 73.1 180.2 125.2 84.0 24.57
95 82.7 184.0 134.8 90.0 28.7

The age-wise percentiles of BMI for boys are depicted in Table II.

Table II Prevalence of underweight, overweight and obesity in the students

Age n Underweight Overweight Obese
17 72 13.8(10) 8.7(6) 1.39(l)
18 119 10.9(15) 16.8(20) 2.52(3)
19 55 16.4(7) 9.1(5) 1.81(1)
≥20 52 15.4(7) 7.7(4) 1.92(1)
Total 298 13.7(1) 11.7(35) 2.01(1)

The prevalence of underweight was 13.4 taking 5th percentile and overweight was 11.7 taking 85th percentile and 2.1 taking 95th percentile values of NHANES I data11,12. According to JNC-VI criteria10, 7.16 % of the students had mild hypertension. None of the girls had hypertension. The hypertensive students had a mean height of 175.8cm (range 170cm-180cm), weight 72.6kg (range 17.8kg-115kg) and BMI 23.39 (17.8-35.5). We studied the relation of blood pressure with weight and BMI. Students with BMI more than 25 were more likely to have systolic blood pressure more than 130 mmHg and diastolic blood pressure more than 85 mm Hg. (Table III).

Table III Blood Pressure in Relation to Weight and BMI of Boys

Weight in
Systolic BP
Systolic BP
BP <85
BP >85
<60 94.4(117) (5.6) 7* 97.6 (121) (2.4) 3 ** 124
60-79 85.7 (78) 14.3 (13)* 91.2 (83) 8.8 (8)** 91
>70 74.5 (49) 25.5 (14)* 85.5 (55) 14.5 (8)** 63
BMI in kg/m2
<25 91.2 (226) 8.8 (22)* 94:8 (235) 5.2(13)* 248
>25 60.0(18) 40.0(12)* 80.0 (24) 20.0 (6)** 30

Figures in parenthesis indicate number of boys

* – p<0.01 ** – p<0.05


Data obtained from health examination of fi rst year medical students was utilized to assess their health and nutritional status. The WHO Expert Committee has also recommended that routine measures of height and weight provide useful assessment of growth status9. The median height and weight was compared with the reference suggested by Agrawal et al13, while the height is comparable to the data set the weight is more in our students. This may be as the reference was obtained from various cities in India while our subjects were from Delhi. The NFHS 2 has also shown the mean BMI of women in Delhi to be higher than the national average. Studies from the rural areas have observed a lower weight and height than that in the present study14,15.

BMI – for – age is recommended as the best indicator for use in adolescence: it incorporates the required information on age, it has been validated as an indicator of total body fat at upper percentiles and it provides continuity with recommended adult indicators. The Expert Committee’s final recommendation was that BMI data developed from the NHAENS I should be used for international reference11,12. There is paucity of data on nutritional status of adolescents in our country. The only data available is that by Agarwal et al13 among urban adolescents of affluent families. We compared the values in our observations with the NHAENS I data, the 5th, 50th, 85th and 95th percentiles of BMI – for – age was lower than that reported by Must et al11,12. The 5th, 50th, 85th and 95th percentiles of BMl-for-age were also compared with that suggested by Agarwal et al13. The values were higher than the data set that was obtained from affluent school children from cities all over India. There were few children in the age group we studied so may not he comparable.

As per the NHAENS I reference 13.4% of students were observed to be under-weight. In a study among rural children of Haryana as many as 43.8% of the boys were underweight while the National Nutrition Monitoring Bureau has reported a fi gure of 53.1% 14,15. Our subjects were from urban Delhi, thus prevalence of underweight was much lower than in the rural adolescents. No information on underweight in Indian urban adolescents was available however a similar prevalence for Chinese and Russian adolescents has been reported16,17.

A cut-off of BMI-for-age > or = 85th and 95th percentile has been recommended for risk of overweight and obesity respectively. A prevalence of 11.7% for overweight and 2.0% for obesity was observed using these cutoffs. A study among affluent adolescent school children in Delhi reported a prevalence of 7.4%18. Gupta et al recorded a prevalence of 10.1% using 90th percentile as the cut off19. This shows that overweight is emerging as a major problem in our young population. An increasing prevalence of overweight was observed in developed and developing countries namely United States, Brazil and China in a study using International references18. A prevalence of 6.2% of overweight was reported in Chinese adolescents, which is less than that reported in our students. The National Health and Nutrition Examination surveys, 1963-1991 in the USA have reported an increasing overweight prevalence among all sex and age groups. In the last survey the prevalence of overweight was 10.9% based on the 95th percentile and 22% based on the 85th percentile20. Our figures are much lower than these.

Prevalence of hypertension according to the JNC VI criteria was observed to be 7.16%. None of the students were aware of their hypertension status. There are not many studies on blood pressure of adolescents in our country. A study from Jaipur has reported a similar prevalence of defi nite hypertension in 7.2 % of the adolescents aged 13-17 years, though the mean systolic and diastolic BP was higher than in our study19. Gopinath et al observed an overall prevalence of 3.1%, 4.1% in males and 2.17% in females among young persons of urban Delhi in the 15 to 24 year age group21. Higher prevalence of hypertension in our sample could be due to the majority of students belonging to a upper middle or middle socio-economic status. Also, changing diets and lifestyles are contributing to rise in BP and obesity. Data is available from physical examination done in university students in the United Kingdom in the 50’s22,23. The mean blood pressure reported is similar to that in our students, though the weight is lower in our students. A significant relation between blood pressure and body mass index was observed. Both systolic and diastolic blood pressure have been shown to be related to measures of body mass and ponderosity24-26. The Muscatine study followed up children through adolescence and observed that change in blood pressure is related to amount of ponderosity gain or loss, thus suggesting weight loss may be an effective method of reducing blood pressure26.

Thus the problem of underweight, overweight and hypertension was observed amongst students joining a medical college of Delhi. These need to be addressed to prevent its sequelae.


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Department of Community Medicine, University College of Medical Sciences, Delhi-110095,
Email: [email protected]
Received: 14.3.05

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