Keywords: Stress, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, lady health visitors, housewives.

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1 Original Article Effect of stress on serum lipid levels in lady health visitors and housewives Feroza Hamid Wattoo 1, Muhammad Saleh Memon 1, Allah Nawaz Memon 1, Muhammad Hamid Sarwar Wattoo 2, Syed Ahmed Tirmizi 2, Javed Iqbal 3 From 1 Institute of Biochemistry, University of Sindh, Jamshoro, 2 Department of Chemistry, Quaid-i-Azam University, Islamabad and 3 Institute of Chemistry, University of the Punjab, Lahore, Pakistan Correspondence: Mrs. Feroza Hamid Wattoo, Institute of Biochemistry, University of Sindh, Jamshoro-76080, Pakistan. Received: October 20, 2006 Accepted: December 15, 2006 Abstract Objective: To study the effects of stress among lady health visitors and housewives in regard to their serum total cholesterol, HDL cholesterol, and LDL cholesterol and triglyceride levels. Methods: The study was performed at the Institute of Biochemistry, University of Sindh, Jamshoro, Pakistan during the years 2003 to Seventy lady health visitor and housewives aged between years participated in this study and were selected from Hyderabad and its adjoining areas. Environmental, psychological and physiological stress levels were measured with likert scale. Total cholesterol, LDL cholesterol and HDL cholesterol and triglyceride levels were measured. Results: Environmental, psychological and physiological stresses were significantly higher in housewives as compared to lady health visitors. A low level of HDL cholesterol was observed in housewives as compared to lady health visitors. The levels of total cholesterol, LDL cholesterol and triglyceride were found higher in housewives than lady health visitors. Conclusions: Housewives are under more stress than lady health visitors. The levels of total cholesterol, LDL cholesterol and triglyceride increases but HDL cholesterol decrease with stress. (Rawal Med J 2007;32:41-44) Keywords: Stress, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, lady health visitors, housewives. INTRODUCTION Cholesterol in our body is necessary for cell function. High-density lipoprotein cholesterol (HDL-C) is commonly referred to as good cholesterol and Low-density lipoprotein cholesterol (LDL-C) is as the bad cholesterol. Triglycerides are fat molecules that the body uses for energy. Some individuals may be genetically predisposed to produce more cholesterol. 1 Excess cholesterol heightens risk of heart disease. Elevated blood cholesterol leads to formation of plaque which causes 1

2 blockages and interferes with the flow of blood through the arteries, depriving cells of oxygen. 2 Women with total cholesterol levels of 265 mg/dl or more have been found to have coronary artery disease two or three times as often as women with levels of about 200 mg/dl. And even mildly elevated levels, of about 235 mg/dl, had about 70% higher rates, than normal person levels. 3 Mental stress has been reported to induce silent myocardial ischemia in patients with coronary artery diseases. 4 Few studies have examined the relationship of cholesterol and serum lipids to psychiatric disorders. 3 In the present study, we have investigated the effect of stress on total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride levels in lady health visitors and housewives of Hyderabad district. MATERIAL AND METHODS The study was performed at the Institute of Biochemistry, University of Sindh, Jamshoro, Pakistan during the years 2003 to The Ethical Committee of Institute of Biochemistry, University of Sindh, Jamshoro approved the study and informed consent was taken from all the participants included in this study. A questionnaire was designed to measure the environmental, psychological and physiological stresses. 5,6 The method of scoring was based on eight-point likert scale. The authors filled in these questionnaires for 35 lady health visitors and 35 housewives of the same area. In order to see the effect of different nutrients on stress, a separate questionnaire 7 was used in. No subject was found to have diabetics. This questionnaire was filled in for each individual in both the groups, in which age, height, weight, marital status, socioeconomic status and diet patterns were recorded. 7 Anthropometric measurements were conducted using the standard methods. 8 Weight with minimum clothing was recorded to the nearest 0.1 kg, using a portable digital scale (Tanita model 1597; Tanita, Tokyo, Japan) and height, to the nearest 1 mm. The body mass index (BMI) was calculated by standard method. 9 Five ml blood samples were collected in the morning for total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride and analyzed using Merck-Micro lab 200 instrument, Germany. by using the prescribed standard procedures/methods given in the instrument operational manual of the company. Statistical analysis Data were expressed as mean standard deviation (SD). Means of two groups were compared by using student s t-test or analysis of variance. The results were considered statistically significant if the p value was less than Data was analyzed by SPSS version 12. RESULTS Demographic and professional characteristics of responding lady health visitors (LHVs) and housewives are given in Table % LHVs were of age less than 30, 51.4% were between years and there was no lady health visitor with age greater than 40 years. The mean of body mass index (BMI) of lady health visitors is 22.7±1.1 2

3 and for housewives it is 24.2±1.2. Comparison of environmental, psychological and physiological stresses in lady health visitors and housewives is presented in Table 2. Statistical difference was calculated by using t-test, which is 6.8 for environmental stress, 6.7 for psychological stress, 5.5 for physiological stress and for all probability was p Table-1: Demographic and professional characteristics of responding lady health visitors and housewives. Variables Lady health visitors Housewives Number n = 35 n = 35 Socioeconomic Condition (SEC) Middle socioeconomic % 10% Age (years) % 76.9% 45 0% 13.1% Weight (kg) 51.2 ± ± 4.5 Height (cm) ± ± 1.4 BMI (kg/m 2 ) 22.7 ± ± 1.2 BMI > 25 (kg/m 2 ) % BMI < 25 (kg/m 2 ) 100% 62.5% Data was shown as mean ± SD, Percentage of subjects with BMI > 25 (kg/m 2 ) and BMI < 25 (kg/m 2 ) respectively. Total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides of lady health visitors and housewives are shown in Table 3. The mean value for total cholesterol in LHVs is 123.9±13.3 mg/dl and in housewives the mean value is 155.1±18 mg/dl. Mean level of LDL-cholesterol in LHVs is 106.9±15.3 mg/dl where as in housewives the mean level is 121.8±13.3 mg/dl. In housewives the mean value of triglyceride level is 131.8±24.6 mg/dl and in LHVs the mean value of the same parameter is 116±28.5 mg/dl. The little difference found is in LDL- cholesterol of both the groups. The mean HDLcholesterol in LHVs is 36.5±4.3 mg/dl but in housewives it is 35.6±4.0 mg/dl. Table 2. Comparison of stress in lady health visitors and housewives. Stress Lady Health Visitors Housewives n = 35 n = 35 t - test Probability Mean ± SD Mean ± SD Environmental 21.6 ± ± Psychological 22.3 ± ± Physiological 22.7 ± ± Discussion The data indicates that there is a significant difference between lady health visitors and housewives and that the housewives are under more stress as compared to lady health 3

4 visitors. The working women although having a lot of work pressure both at home and at job place, the feeling of being a super woman seemed to have good impact on her mental health. The housewives have shown more impairment in physical and mental functioning than lady health visitor. 9 Table 3. Comparison of Serum lipid concentrations of lady health visitors and housewives. Variables Statistical Results LHVs (n = 35) Housewives (n = 35) t-test Probability TC Mean ± SD ± ± (mg/dl) Range HDL Mean ± SD 36.5 ± ± (mg/dl) Range LDL (mg/dl) Mean ± SD ± ± Range TG (mg/dl) Mean ± SD 116 ± ± Range TC/HDL ratio Mean ± SD 3.4 ± ± TC > 220 mg/dl % 0% TC < 140 mg/dl % TC=Total Cholesterol, HDL=High Density Lipoprotein Cholesterol, LDL=Low Density Lipoprotein Cholesterol, TG=Triglyceride Data was shown as mean ± SD, Range, Percentage of subjects with total cholesterol > 220 mg/dl and < 140 mg/dl respectively. Comparison of serum lipid levels show that high levels of total cholesterol, LDLcholesterol and triglycerides are found in housewives as compared to lady health visitors but low levels of HDL cholesterol in housewives as compared to lady health visitors. Catecholamines stimulate lipolysis in adipose tissue, through activation of hormonesensitive lipase, leading to the breakdown of triacylglycerols into fatty acids and glycerol. 10 This effect is sensitized by cortisol. 11 Increased levels of fatty acids and cortisol lead to insulin insensitivity in tissues and promote increased triacylglycerol synthesis and apolipoprotein B secretion by the liver. 12 These combined effects result in increased hepatic production and secretion of very low-density lipoprotein, which is ultimately converted to LDL, the principal carrier of cholesterol in the blood. Lipoprotein lipase activity is diminished during acute psychological stress. 13 LDL is normally cleared from the blood through binding to hepatic LDL receptor. LDL receptor expression is stimulated by insulin and inhibited by cortisol. 14 In conclusion, housewives were found to be under more stress compared to lady health visitors. They had elevated levels of total cholesterol, LDL-cholesterol, triglycerides and low levels of HDL cholesterol which may be related ti their stress. ACKNOWLEDGEMENT This study is the part of project titled Effect of stress and nutrition on biochemical constituents of working and non-working females in different ethnic groups of Hyderabad district. Authors are thankful to Director, Institute of Biochemistry, 4

5 University of Sindh, Jamshoro, Pakistan, for providing funding and essential laboratory facilities for this project. REFERENCES 1. Friedman M., Rosenman R.H. Association of specific overt behavior pattern with blood and cardiovascular findings. J Am Med Assoc 1959; 169: Tao S, Li Y, Xiao Z, Cen R, Zhang H, Zhuo B, Chen P, Li Y, and Liao Y, Serum lipids and their correlates in Chinese urban and rural population of Beijing and Guangzhou. J Epidemiol 1992; 21: Hayward C, Taylor CB, Roth WT, King R, Agras WS. Plasma lipid levels in patients with panic disorder or agoraphobia. Am J Psychiatry 1989; 146: Shimamoto T, Iso H, Tanigawa T, Sankia T, Imano H, Ohira T, Miyaka S. Trend for cardiovascular risk factors and diseases in Japan. J. Epidemiol 1996; 6: SI83-SI88 5. Feroza ZM, Comparison of emotional status of health and Nutrition of working and non-working females in Sindh, Pakistan, M. Phil. Thesis, University of Sindh, Jamshoro, Pakistan, Memon MS, Kazi FA, Soomro NH and Arain AA. A Comparative study of job oriented occupational stress of peak workload on physician and clerks. Proc: ISBBP. Biochem, Biophy 1997; 2: Feroza ZM, Effect of stress and nutrition on biochemical constituents of working and non-working females in different ethnic groups of Hyderabad district. Ph.D. Thesis, University of Sindh, Jamshoro, Pakistan, Hill, A. Roberts, J. Body mass index: a comparison between self-reported and measured height and weight. J Public Health 1998; 20: Khan MA. Stress in working and nonworking women in Pakistan, Pak J Psychol 1994;25: Brindley, D. N., McCann, B. S., Niaura, R., Stoney, C. M., & Suarez, E. C. Stress and lipoprotein metabolism: Modulators and mechanisms. Metabolism: Clin & Exp 1993; 42: Brindley, D. N., & Salter, A. M. Hormonal regulation of the hepatic low density lipoprotein receptor and the catabolism of low density lipoproteins: Relationship with the secretion of very low density lipoproteins. Progress Lipid Research 1991; 30: Stoney, C. M., Hughes, J. W., Kuntz, K. K., West, S. G., & Thornton, L. M. Cardiovascular stress responses among Asian Indian and European American women and men. Annals Behav Med 2002; 24: Yukht, A., Davis, R. C., Ong, J. M., Ranganathan, G., & Kern, P. A. Regulation of lipoprotein lipase translation by epinephrine in 3T3 L1 cells. Importance of the 3 untranslated region. J Clin Invest 1995; 96: Brindley, D. N., & Salter, A. M. Hormonal regulation of the hepatic low density lipoprotein receptor and the catabolism of low density lipoproteins: Relationship with the secretion of very low density lipoproteins. Progress Lipid Research, 1991; 30:

Figure S1. Comparison of fasting plasma lipoprotein levels between males (n=108) and females (n=130). Box plots represent the quartiles distribution

Figure S1. Comparison of fasting plasma lipoprotein levels between males (n=108) and females (n=130). Box plots represent the quartiles distribution of A: total cholesterol (TC); B: low-density lipoprotein