This study highlights the high level of perceived stress among Saudi students entering pre-college education. The prevalence of high perceived stress, which was noted among 44% of students, is similar to the ones examined in Egypt and Malaysia [15, 16], although these studies utilized medical students as subjects as opposed to the pre-college students in the present study. Comparatively, only total cholesterol was significantly elevated among female students with perceived stress than those without, with no apparent differences observed in male students.
The presence of perceived stress was significantly and inversely associated with several anthropometric parameters in the present study, including fat, mineral and protein values, suggesting modest metabolic alterations at this stage of life. These significant associations have clinical implications, despite the fact that the tool used to assess stress is highly subjective and dependent on the individual’s personal judgment of how stressed he or she is. It has been well established that stress, both acute and chronic induces a powerful cascade of metabolic and inflammatory processes . How the students in question respond to stress may affect their development and largely predispose to various endocrine, metabolic, autoimmune and psychiatric disorders .
The start of college life coincides with emerging adulthood, when young people begin to take control of their own eating and exercise behaviors [19, 20]. Both the level and duration of stress encountered during this vulnerable period may, thus, further contribute to dysregulation of the stress system, subjecting adolescents to a vicious cycle between distress and distorted self-image, maintaining and worsening distress and associated physiologic and somatic changes [21–23].
We have previously observed that abnormal metabolic patterns among Arabs are highly heritable and can manifest as early as preadolescence . Furthermore, we demonstrated that abnormal sleeping patterns and micronutrient deficiencies such as calcium and vitamin D can increase the likelihood of weight gain in Arab adolescents, a finding also observed in the present study [25, 26]. These past observations, and the findings of the present study, highlight the importance of chronic disease prevention by targeting the younger population. It is worthy to note that while the Preparatory Year of King Saud University is replete with several physical education classes, its food court is not as health-conscious as it should be. Implementing school-based health promotion that has been proven efficacious in the prevention of childhood obesity , therefore, should be taken into consideration.
The strengths of this observational study are that it contributes to the literature in significant ways. First, it takes into account findings from an understudied population from an equally understudied ethnic group. Second, the gender difference elicited in terms of cardiometabolic risk factor prevalence showcase the need for a tailored approach in the prevention of cardiometabolic manifestations in this vulnerable age group. Nevertheless the authors also acknowledge several limitations. The cross-sectional and single center approach despite the big sample size limits the causality and generalizability of the study findings.