Assessment of Students' Knowledge about Metabolic Syndrome and Its Components

Background and Objectives Despite the increasing prevalence of metabolic syndrome among the youth, little is known about the knowledge of university students about this disease. This study aimed to evaluate the knowledge of students at Ahvaz Jundishapur University of Medical Sciences (AJUMS) about metabolic syndrome. Subjects and Methods A valid questionnaire was completed by 245 university students. The questions were divided into 4 sections: diabetes, obesity, high blood pressure, and high cholesterol. Correct answers received 1 score while incorrect ones received 0 score. The answers were presented as a percentage. All data were analyzed with SPSS27 software, and p < 0.05 was considered statistically significant. Results The students’ mean scores were obtained as follows: diabetes: 83.26±10.23, obesity: 89.72±10.45, blood pressure: 92.51±12.47, cholesterol: 86.66±20.33, and total score: 88.04±8.27. There was no significant difference between the two genders in terms of the mean total score and the sections of the questionnaire. A significant difference was observed between different educational levels in terms of mean total score (P<0.01), with the graduate students having the highest knowledge level. However, there was no significant difference between the educational levels regarding the knowledge score of obesity and cholesterol. There was a significant difference between the mean knowledge score in relation to the sections of the questionnaire and the total scores by faculty. The highest and the lowest total knowledge scores were related to the Faculty of Health and the School of Pharmacy, respectively. Conclusion Considering that a score of 81-100% is considered good knowledge, the results showed that AJUMS students had generally good knowledge about metabolic syndrome.


Extended Abstract
Introduction etabolic syndrome (MetS) is a set of metabolic abnormalities that include hypertension, abdominal obesity, insulin resistance, and atherogenic dyslipidemia.The prevalence of this syndrome varies greatly in societies and depends on the definition used, age, gender, socioeconomic status, and ethnic background of the study groups.MetS is an important risk factor for coronary heart disease and type 2 diabetes and increases overall and cardiovascular mortality.Early detection of risk factors and intervention to prevent or reduce the incidence are necessary.Since the probability of occurrence of factors causing metabolic syndrome is higher at young ages, university students could be regarded as an important population.Evaluation of students' knowledge about this syndrome, in case they have inadequate or no knowledge, will lead to early diagnosis, control, and prevention of its complications after the students' awareness and knowledge are raised with necessary training.Moreover, because medical students have an effective role in informing other members of society, they can have a significant contribution to the control of this syndrome in the general population.Therefore, this study evaluated medical students' level of awareness and knowledge about conditions related to metabolic syndrome.

Methods
This descriptive-analytical study involved 245 students at Ahvaz Jundishapur University of Medical Sciences (AJUMS) who completed a valid questionnaire for the assessment of their knowledge about metabolic syndrome.The questions were divided into 4 sections: diabetes, obesity, high blood pressure, and high cholesterol.A correct answer received 1 point while an incorrect one received 0 point.The questionnaire was developed in accordance with Najat Yahia et al.'s questionnaire.The content and face validity of the questionnaire were verified.Kuder-Richardson was used to determine the reliability of the questionnaire.To check the content validity, the questionnaire was checked by 8 experts in the relevant field, and the questions were checked in terms of simplicity, clarity, and relevance.Furthermore, face validity was quantitatively measured, and if the validity was greater than 1.5, the question was kept.Age, faculty, level of education, and gender were recorded by the participants before filling out the questionnaires.Quantitative variables were reported as minimum, maximum, mean, and standard deviation, while qualitative variables were expressed as number (percentage).The normality of quantitative variables was checked using the Shapiro-Wilk test.Mann-Whitney test was used to investigate the relationship between quantitative and qualitative variables with two levels.Analysis of variance was used to investigate the relationship between quantitative and qualitative variables with more than two levels.The significance level of the above tests was considered smaller than 0.05.All analyses were performed in SPSS software version 27.

Results
The questionnaire was handed to 35 students to determine its validity and reliability.After importing data into SPSS, Cronbach's alpha was obtained at 0.71 and standardized Cronbach's alpha at 0.74.A sample of 245 students including 133 women (54.3%) and 112 men (45.7%) with an average age of 22.30 years (SD=2.60)participated in this research.Considering their field of study, 13.5% of the students were students of medicine, 16.7% were health students, 20.4% were nursing, midwifery, and operating room technology students, 10.2% were rehabilitation students, 5.3% were pharmacy students, 31% were students of allied medical sciences, and 2.9% were dental students.With respect to the study program, 70.2% of the students participating in the research were undergraduate students, 10.2% were graduate students, and 19.6% were general doctoral students.Regarding their year of university arrival, 41.6% of the students had entered university between 2015 and 2019, 39.2% in the year 2021, and 19.2% in 2022.The following mean knowledge scores were obtained: diabetes: 83.26±10.23 (range 50-100), obesity: 89.72±10.45(range 50-100), blood pressure: 92.51±12.47(range 50-100), cholesterol: 86.66±20.33(range 0-100), and the total score: 88.04±8.27(range 55-100).Therefore, overall knowledge about metabolic syndrome and knowledge about its components was good (scores between 80-100).No significant difference was observed between the two genders in terms of the mean score of knowledge about diabetes, obesity, blood pressure, cholesterol, and the total score of knowledge (P<0.05).The results of the Kruskal-Wallis test showed that the mean score of knowledge about diabetes in the age group of 18-21 years was the lowest, while it was the highest in the age group of 26-34 years, and this difference was statistically significant (P<0.001).The results of the post hoc test showed that this significance was related to the difference between the age group of 18 to 21 years and 22 to 25 years (P<0.001) and 26 to 34 years (P=0.006).The mean score of knowledge about obesity was highest in the age group of 18 to 21 years and lowest in the age group of 26 to 34 years, and this difference was statistically significant (P=0.03).The mean score of knowledge about blood pressure was highest in the age group of 18 to 21 years and lowest in the age group of 26 to 34 years, and this difference was statistically significant (P<0.001).The mean score of diabetes knowledge was highest at the graduate level and lowest at the undergraduate level, and the difference between different educational levels in terms of the mean score of diabetes knowledge was statistically significant (P<0.001).A statistically significant difference was also observed between educational levels in terms of the mean score of knowledge about blood pressure (P=0.010) and the total M score of the questionnaire (P<0.001).There was no statistically significant difference between the three educational levels in terms of knowledge about obesity and cholesterol (P<0.05).The mean score of knowledge about diabetes, obesity, blood pressure, and cholesterol, and the total score of the questionnaire in terms of the faculties of AJUMS had a statistically significant difference (P<0.05).The highest level of knowledge was related to the Faculty of Health, while the lowest was related to the Faculty of Pharmacy.The mean score of knowledge about diabetes was highest in students entering AJUMS from 2015 to 2019, whereas the lowest was related to the students of the year 2021.The difference in the mean scores of diabetes knowledge in different year entries was statistically significant (P=0.006).The mean score of knowledge about other conditions showed no statistically significant difference (P<0.05).

Conclusion
The present study provides insight into AJUMS students' knowledge about conditions related to metabolic syndrome.Overall, our results showed that these students had good knowledge about metabolic syndrome.The highest knowledge score was related to high blood pressure, while the lowest was related to diabetes.Considering the increasing prevalence of metabolic syndrome among college-aged adults, increasing awareness about metabolic syndrome in this age group is important to reduce the prevalence of this disease.Universities are ideal settings for educating students about health issues.However, students must go beyond simple knowledge acquisition and educators must focus on the ability to connect this "personal" knowledge to the student's individual understanding of risk.After that, appropriate skills should be taught to help them turn knowledge into positive lifestyle behaviors.Future research should examine whether college students' knowledge of metabolic syndrome-related conditions translates into their lifestyles to reduce metabolic syndrome risk.This question can be investigated by assessing the actual prevalence of metabolic syndrome among college students.Future research should also explore strategies that can stimulate students' personal risk perception to make positive changes in their lifestyle behaviors.

Ethical Considerations Compliance with ethical guidelines
The main goal of any research should be to promote human health along with respecting their dignity and rights.The researchers made sure that the consent of the participants was freely obtained to participate in the research.Behaviors that involve threats, seduction, deception, or coercion in any way and cause the subject's consent to be revoked were avoided.The way of reporting the results of the research should guarantee the material and moral rights of all the people related to the research, including the researcher himself or the researchers and the subjects.Also, at the end of the research, every person who entered the study as a subject has the right to be informed about the results of the study and the results will be sent to the participants by email.

Funding
We are grateful to the Research Vice-Chancellor of Jundishapur University of Medical Sciences, Ahvaz, for funding the project.

Authors contributions
R. Chaharlang: designing the idea and design, reviewing the texts, collecting and processing the data, assessing the validity and reliability of the questionnaire, analyzing the results, writing the article, editing the article.
M. Karandish: project design, critical review control and supervision, article editing, final approval for publication Z. Asadi: collecting and processing data, analyzing the results, evaluating the validity and reliability of the questionnaire, writing the article, editing the article S. Moradi: analysis of results, interpretation of data, writing of the article, editing of the article

Conflicts of interest
All authors declare that they have no conflict of interest.Conducting this research is not influenced by external factors such as financial resources, personal or professional relationships or political affiliations.Also, the principles of academic integrity and ethical behavior have been strictly adhered to throughout this project.