After the first big part of our project, namely the examination days, we had to face the next big step: analysing the data from the questionnaires.
Since we already knew we could not do this all on our own, we tried to find helpful hands. Luckily, many of the younger students in our school were willing to help. In the end we actually ran out of workspace to employ all of the volunteers. It was great to see how many students wanted to get involved. Thus motivated, we got down to work.
After we had instructed all of our helpers, the data was entered into a prepared Excel spreadsheet. Every row was filled with the data of one student. 350 questionnaires with 170 items each added up to an incredible 55250 single entries.
On top of entering the data from the questionnaire, we also had to cope with all the physiological data, such as the measurements of weight, height, waist and hip measurements, blood pressure and lab results. In spite of the amount of data we had to deal with, we managed to digitalize it within a short period of time. In order to reward our helpers and keep them happy while helping out, we organised drinks and snacks.
Eventually, two students had to revise the data to root out typing errors or double entries./p>
As the Excel spreadsheet later proved to be impractical and faulty, we decided to let our computer expert Flo transfer the data to an Access database. We learned from this mistake: for future statistical analyses , we would MS Access from the outset.
MDr. Elmar Aigner from the hospital in Oberndorf analysed this dataset with a statistical programme. At this point we would like to thank him for introducing us to the software "SigmaStat" and for helping us with the analysis. He offered lots of advice and explanations which helped us to understand and interpret the data we had gathered. Most of all, we would like to thank him for the tremendous amount of time he has dedicated to this project.
The correlation between lifestyle, cardiometabolic risk factors and the trace elements zinc and copper in healthy youths.
General characteristics of the HLFS Ursprung test population.
In total, the data of 325 students (234 male, 91 female) was gathered and analysed at our school (ultrasound, blood pressure, blood samples, height, weight, belly and hip size). This is a turnout of 95%.
You will find the most important characteristics in table 1 below.
Evidence for pathological values?
The ultrasound examination showed that 17 students (5,2%) already have fatty livers, though most of them in an early stage. The body mass index (BMI; weight/height2 [kg/m2]) - an indicator for being overweight - exceeded the normal range (BMI of up to 25) in 30 boys (12,8%) and 13 girls (14,8%). This frequency of overweight is significantly below the European average (27,6% and 21%, respectively) and even below the Austrian average (28,5% and 16,4%). These average values were taken from the recently published European HELENA report (Healthy Lifestyle in Europe by Nutrition in Adolescence).(1) In the course of our analysis we discovered elevated liver values in 10 students (3,1%) who were advised to see their GPs in order to clarify the test results.
The kidney values (serum creatinine, carbamide) of one student were elevated due to disease. The values of 10 other students, however, were clearly elevated so that another check within the next 3-6 months was recommended.
The blood lipids of 17 students indicated elevated levels of total cholesterol. 18 samples were very low on HDL cholesterol (protective or "good" cholesterol) and 11 samples showed elevated triglyceride levels.
The levels of fasting blood glucose and insulin were measured in order to establish parameters for the metabolism of sugar.
Only one sample showed an elevated fasting blood glucose level. In 8 of the students the levels of insulin were higher than expected.
Our examination also showed a severe and rare dysfunction of haematosis, an aplastic anaemia, which had to be treated immediately in a specialist clinic.
We also found three cases of minimal anaemia, resulting from iron deficiency.
One can only speculate about the causes for this gender-specific difference. It is interesting to note that we did not find any scientific documentation on similar findings. 22 female students (6,8%) had very low levels of copper while all of the 13 students whose levels exceeded the norm range of recommended copper levels were girls. Lastly, we could find elevated levels of zink in 8 samples, and zink deficiency in 2 samples.
How are the tested factors related to the indications of the Metabolic Syndrome?
Nowadays, it is a well-known fact that overweight people face problems with diabetes and high blood pressure, as well as elevated triglyceride levels and deficient levels of HDL cholesterol. This complex of symptoms is generally called the Metabolic Syndrome. If these values are not within a certain range the risk of suffering strokes or heart attacks increases. (2) Overweight as such is determined via the BMI (body mass index) and the waist-hip-ratio.
The development of the Metabolic Syndrome is influenced by genetic factors as well as lifestyle factors, such as malnutrition and supernutrition, or lack of physical activity. (3) It is usually observed more frequently as people grow older, but in the course of the last decade, several publications show that Metabolic Syndrome increasingly affects youths and children. (4, 5)
One aim of our project was to highlight these correlations with the test population at our school. However, the majority of the students is healthy, relatively slim and did not, at first sight, meet the established definitions of Metabolic Syndrome.
But even with this healthy, relatively slim group of students (BMI average kg/m2)we were able to establish a highly significant correlation between BMI, waist-hip-ratio, low HDL cholesterol, high levels of triglycerides, blood pressure and fasting insulin.
Those students who have a slightly increased waist-hip-ratio and BMI also show low levels of HDL cholesterol and higher levels of triglycerides and fasting insulin. As a result we could prove the serious correlation of all risk factors for later diseases even at a very early stage. These early stages refer to the age group of 15-19 year olds as well
as the levels as such, which are still within the range of valid norms and would not necessarily be the cause of any concern for a GP or health officials. However, diseases and after effects which are related to those correlations discussed in our report have a high impact on our country's health budget and have become the leading causes of death in the Western civilization.
Most of the medical measures to treat Metabolic Syndrome are not taken until a person is at the end of the road, i.e. when someone has already had a heart attack or suffers from diabetes.
If you have already crossed this threshold, it is already too late to effectively change your lifestyle
or easily improve your health status. Our results show that students need more information on how their lifestyles affect their health and that they need to be motivated to turn their backs on unhealthy habits. With our results we were able to show how great a part of the test population was already affected by unhealthy lifestyles - a ticking
Table 1: Characteristics of the test population
In this table you find the characteristics of the girls (left column) and boys (right column) as mean values ± standard deviation. Abbreviations: RR - blood pressure; GOT and GPT - liver levels, i.e. transanimase; HOMA-IR - homeostasis model assessment and insulin resistance; insulin resistance plays a major role in the development of diabetes and arteriosclerosis; CRP - C-reactive protein, inflammation protein; MCV - mean corpuscular volume; a measure of the size of the blood cells is also indicates indirectly whether there is enough iron in the bone marrow.
As indicated by the analysis of trace elements, 4 girls and 3 boys suffered from relatively low levels of iron. The boys were asked to have these low levels checked out. In the girls' samples the low iron levels are likely to have resulted from recent blood loss. No sample showed elevated iron values.
The levels of copper (serum copper, caeruloplasmin) in the test samples were spread across a fairly broad range. However, the norm levels of copper have notyet been clearly defined. Girls generally had higher copper levels than boys (cp. table 1).
time bomb which can only be defused by taking the right action in time.
One organ which is particularly affected by this ”lifestyle" disease" or "prosperity disease" is the liver. It stores increasing amounts of fat.
This phenomenon is known as non-alcoholic fatty liver, because it resembles the kind of fatty livers found in heavy drinkers. (6) Our results establish that the liver values (transaminases, GPT) are closely related to the body fat (BMI, WHR) and blood pressure of the students. This indicates an early involvement of the liver in the development of the Metabolic Syndrome. This furthermore raises the question
of whether the norms used for our analyses can actually be considered ”normal”found in heavy drinkers.
Table 2: Correlation between Metabolic Syndrome and slight overweight