OBJECTIVES: The aim of the study was to determine the prevalence of metabolic syndrome (MetS) and its association with the use of tobacco smoking and caffeine consumption among Palestinian university students. METHODS: A cross-sectional study was conducted in 2020 among university students at An-Najah National University in the West Bank. MetS was diagnosed according to the National Cholesterol Education Programme. We employed adjusted multiple logistic regression models to address the association between MetS and tobacco smoking and caffeine consumption. RESULTS: The number of participants was 392. The findings revealed that 9.2% of the students met the diagnostic criteria for MetS, with a significantly higher prevalence in males (14.1%) than females (4.8%) (p = 0.001). The study highlighted various substance use rates among participants: 20.2% smoked cigarettes, 28.6% smoked waterpipes, 5.6% smoked e-cigarettes, and 39% consumed energy drinks. Coffee (83.9%) and black tea (84.7%) were also widely consumed. Mean values of triglyceride level (p = 0.006), systolic blood pressure (p < 0.001), and diastolic blood pressure (p = 0.016) were higher in cigarette smokers than nonsmokers. Energy drink consumers had higher levels of triglycerides than non-consumers (p = 0.015). Tea consumers had decreased mean values of fast blood sugar (p = 0.020) than non-users. The adjusted binary regression revealed that cigarette smokers were at greater risk of MetS (OR = 3.48, p = 0.009), and black tea consumers were less likely to have MetS (OR = 0.37, p = 0.032). Furthermore, increased BMI was associated with an increased risk of MetS (OR = 1.09, p = 0.008). Moreover, waterpipe smokers were at a higher risk of having high triglyceride levels (OR = 5.18, p = 0.027). CONCLUSION: The study illustrates the health implications of tobacco and energy drink consumption on MetS among Palestinian university students, underlining waterpipe smoking as a pressing health concern linked to elevated triglycerides. These results clarify the MetS burden in Palestine and explore new risks and protective factors.

Biomedical Department Medicine and Health Science Faculty An Najah National University Nablus Palestine

Department of Medicine Medicine and Health Science Faculty An Najah National University Nablus Palestine

Drug and Toxicology Division Medicine and Health Science Faculty An Najah National University Nablus Palestine

Family and Community Medicine Department Medicine and Health Science Faculty An Najah National University Nablus Palestine

See more in PubMed

Mahoney CR, Giles GE, Marriott BP, Judelson DA, Glickman EL, Geiselman PJ, et al. Intake of caffeine from all sources and reasons for use by college students. Clin Nutr. 2019 Apr;38(2):668-75.

Tucktuck M, Ghandour R, Abu-Rmeileh NME. Waterpipe and cigarette tobacco smoking among Palestinian university students: a cross-sectional study. BMC Public Health. 2017 Jul 10;18(1):1. doi: 10.1186/s12889-017-4524-0. PubMed DOI

Nazzal Z, Al-Halaweh MA, Musmar S. Social norms and perception of waterpipe smoking among Palestinian university students. Palestinian Med Pharm J. 2020;5(1):25-34.

Damiri BR. The use of psychoactive substances in a conflict area in the West Bank: drug use risk factors and practices in Palestinian refugee camps. Int J Ment Health Addict. 2020;18(6):1507-20.

Damiri BR, Salahat IA, Aghbar MH. Pattern of substance use among schoolchildren in Palestine: a cross-sectional study. Egypt J Forensic Sci. 2018;8:59. doi:10.1186/s41935-018-0090-6. DOI

Dimsdale JE. Psychological stress and cardiovascular disease. J Am Coll Cardiol. 2008;51(13):1237-46.

Zieve FJ. The metabolic syndrome: diagnosis and treatment. Clin Cornerstone. 2004;6 Suppl 3:S5-13.

Damiri B, Badran L, Safadi D, Sawalha A, Yasin Y, Sawalha M, et al. Metabolic syndrome and related risk factors among adults in the northern West Bank, a cross-sectional study. Int Health. 2022 Jul 1;14(4):339-45.

Damiri B, Alhala AA, Najjar L, Alqadome S. Metabolic syndrome and its risk factors among overweight and obese Palestinian schoolchildren using IDF and NCEP-ATP/III Definitions. Ann Clin Lab Res. 2018;6(3):242. doi: 10.21767/2386-5180.100242. DOI

Abdelaal M, le Roux CW, Docherty NG. Morbidity and mortality associated with obesity. Ann Transl Med. 2017 Apr;5(7):161. doi: 10.21037/atm.2017.03.107. PubMed DOI

Campbell B, Wilborn C, La Bounty P, Taylor L, Nelson MT, Greenwood M, et al. International Society of Sports Nutrition position stand: energy drinks. J Int Soc Sports Nutr. 2013 Jan 3;10(1):1. doi: 10.1186/1550-2783-10-1. PubMed DOI

Damiri B, Aghbar A, Alkhdour S, Arafat Y. Characterization and prevalence of metabolic syndrome among overweight and obese young Palestinian students at An-Najah National University. Diabetes Metab Syndr. 2018 May;12(3):343-8.

Damiri B, Sandouka HN, Janini EH, Yaish ON. Prevalence and associated factors of psychoactive substance use among university students in the West Bank, Palestine. Drugs Educ Prev Policy. 2020;27(2):173-82.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001 May 16;285(19):2486-97.

Haidar SA, Karavetian M, Radwan H, de Vries N. University Lebanese students are not immune to the metabolic syndrome. Mediterr J Nutr Metab. 2019;12(1):23-32.

Mbugua SM, Kimani ST, Munyoki G. Metabolic syndrome and its components among university students in Kenya. BMC Public Health. 2017 Nov 28;17(1):909. doi: 10.1186/s12889-017-4936-x. PubMed DOI

Damiri B, Khatib O, Nazzal Z, Sanduka D, Igbaria S, Thabaleh A, et al. Metabolic syndrome associated with tobacco and caffeine products use among refugee adolescents: risk of dyslipidemia. Diabetes Metab Syndr Obes. 2021 Sep 29;14:4121-33.

Damiri B, Abualsoud MS, Samara AM, Salameh SK. Metabolic syndrome among overweight and obese adults in Palestinian refugee camps. Diabetol Metab Syndr. 2018 Apr 19;10:34. doi: 10.1186/s13098-018-0337-2. PubMed DOI

Berro J, Akel M, Hallit S, Obeid S. Relationships between inappropriate eating habits and problematic alcohol use, cigarette and waterpipe dependence among male adolescents in Lebanon. BMC Public Health. 2021 Jan 15;21(1):140. doi: 10.1186/s12889-021-10184-2. PubMed DOI

Al-Sawalha NA, Almahmmod Y, Awawdeh MS, Alzoubi KH, Khabour OF. Effect of waterpipe tobacco smoke exposure on the development of metabolic syndrome in adult male rats. PLoS One. 2020 Jun 19;15(6):e0234516. doi: 10.1371/journal.pone.0234516. PubMed DOI

Waziry R, Jawad M, Ballout RA, Al Akel M, Akl EA. The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis. Int J Epidemiol. 2017 Feb 1;46(1):32-43.

Kopin L, Lowenstein C. Dyslipidemia. Ann Intern Med. 2017 Dec 5;167(11):ITC81-ITC96.

Bajaj M. Nicotine and insulin resistance: when the smoke clears. Diabetes. 2012 Dec;61(12):3078-80.

Trapp G, Hurworth M, Jacoby P, Christian H, Ambrosini G, Oddy W, et al. Energy drink intake and metabolic syndrome: a prospective investigation in young adults. Nutr Metab Cardiovasc Dis. 2020 Sep 24;30(10):1679-84.

Nehlig A, Daval JL, Debry G. Caffeine and the central nervous system: mechanisms of action, biochemical, metabolic and psychostimulant effects. Brain Res Brain Res Rev. 1992 May-Aug;17(2):139-70.

Nawrot P, Jordan S, Eastwood J, Rotstein J, Hugenholtz A, Feeley M. Effects of caffeine on human health. Food Addit Contam. 2003 Jan;20(1):1-30.

Liu W, Wan C, Huang Y, Li M. Effects of tea consumption on metabolic syndrome: a systematic review and meta-analysis of randomized clinical trials. Phytother Res. 2020 Nov;34(11):2857-66.

Chiva-Blanch G, Badimon L. Effects of polyphenol intake on metabolic syndrome: current evidences from human trials. Oxid Med Cell Longev. 2017;2017:5812401. doi: 10.1155/2017/5812401. PubMed DOI

Ludovici V, Barthelmes J, Nägele MP, Enseleit F, Ferri C, Flammer AJ, et al. Cocoa, blood pressure, and vascular function. Front Nutr. 2017 Aug 2;4:36. doi: 10.3389/fnut.2017.00036. PubMed DOI