Gender Difference in Association with Socioeconomic Status and Incidence of Metabolic Syndrome in Korean Adults

Role of sex and gender-related variables in development of metabolic syndrome: A prospective cohort study

INTRODUCTION

The burden of metabolic syndrome (MetS) and its components has been increasing mainly amongst male individuals. Nevertheless, clinical outcomes related to MetS (i.e., cardiovascular diseases), are worse among female individuals. Whether these sex differences in the components and sequalae of MetS are influenced by gender (i.e., psycho-socio-cultural factors)) is a matter of debate.  Therefore, the purpose of this study was to determine the association between gender-related factors and the development of MetS, and to assess if the magnitude of the associations vary by sex.

METHOD

Data from the Colaus/PsyColaus study, a prospective population-based cohort of 6,734 middle-aged participants in Lausanne (Switzerland) (2003-2006) were used. The primary endpoint was the development of MetS as defined by the Adult Treatment Panel III of the National Cholesterol Education Program. Multivariable models were estimated using logistic regression to assess the association between gender-related factors and the development of MetS. Two-way interactions between sex,  age and gender-related factors were also tested.

RESULTS

Among 5,195 participants without MetS (mean age=51.3 ± 10.6, 56.1 % females), 27.9 % developed MetS during a mean follow-up of 10.9 years. Female sex (OR:0.48, 95 %CI:0.41-0.55) was associated with decreased risk of developing MetS. Conversely, older age, educational attainment less than university, and low income were associated with an increased risk of developing MetS. Statistically significant interaction between sex and strata of age, education, income, smoking, and employment were identified showing that the reduced risk of MetS in female individuals was attenuated in the lowest education, income, and advanced age strata. However, females who smoke and reported being employed demonstrated a decreased risk of MetS compared to males. Conversely smoking and unemployment were significant risk factors for MetS development among male adults.

CONCLUSIONS

Gender-related factors such as income level and educational attainment play a greater role in the development of MetS in female than individuals. These factors represent novel modifiable targets for implementation of sex- and gender-specific strategies to achieve health equity for all people.

Comparison of metabolic syndrome and related factors in married pre-menopausal white- and blue-collar woman

This study aimed to identify the prevalence and associated factors of metabolic syndrome in pre-menopausal married women with white-collar and blue-collar jobs. This study analyzed 4,447 women with jobs in the Korean National Health and Nutrition Examination Survey (2010-2018). The prevalence of metabolic syndrome was higher among blue-collar women (15.3%) than among white-collar women (10.5%). Age, family type, alcohol consumption, frequency of high-risk drinking, perceived health status, and body mass index (BMI) were significantly associated with metabolic syndrome in the white-collar (p < .05). Age, family type, frequency of eating out, and BMI were associated in the blue-collar (p < .05). Blue-collar women were more vulnerable to metabolic syndrome than white-collar ones. To prevent metabolic syndrome in pre-menopausal married women with jobs, lifestyle modifications such as mitigating obesity and reducing alcohol consumption with aging are necessary.

Mental Health Status of Adults with Cardiovascular or Metabolic Diseases by Gender

This study aimed to compare mental health in people with cardiovascular or metabolic diseases and the general adult population in each gender. Cardiovascular and metabolic diseases affect mental health, and the prognosis and incidence rates of these diseases differ by age. To date, studies comparing mental health in adults with cardiovascular or metabolic diseases by gender and with the general population have been insufficient. This work is a cross-sectional study. Data from 9828 men and 13,389 women aged 19 years or older from the Korea National Health and Nutrition Examination Survey V and VI (2010–2013) were used. Men and women with cardiovascular diseases showed high risks of stress, depression, and suicidal ideation. Men with metabolic diseases had worse mental health in relation to depression and suicidal ideation, and women with metabolic diseases in relation to stress and depression, indicating a need for intervention and management of mental health by gender for these individuals. There is a need to develop a clear perception and understanding, both among practitioners and the general population, of mental health issues associated with having cardiovascular or metabolic diseases. Active, specific health improvement and training programmes considering gender differences are necessary.

Sex Differences in Risk Factors for Metabolic Syndrome in the Korean Population

With an increase in the obese population, the prevalence of metabolic syndrome is increasing in Korea. This study aimed to identify sex- and age-specific risk factors for metabolic syndrome. A secondary data analysis was performed using the Korean National Health and Nutritional Examination Survey. Participants comprised 6144 adults aged 20-79 years. The prevalence of metabolic syndrome was high in the middle- and old-aged men (31.9% and 34.5%, respectively) and in old-aged women (39.1%). Risk factors for metabolic syndrome showed different patterns for men and women. In men, alcohol drinking was identified as the main risk factor for hypertension (odds ratio (OR); young = 3.3 vs. middle age = 2.0), high triglycerides (young = 2.4 vs. middle age = 2.2), and high fasting blood sugar (middle age = 1.6). In women, the main risk factors were household income and education level, showing different patterns in different age groups. In conclusion, the vulnerable groups at high risk of metabolic syndrome are those of middle-aged men and women. The pattern of risk factors is sex-specific.

Sociodemographic and Health Characteristics Associated with Metabolic Syndrome in Men and Women Aged ≥50 Years

Background: There are limited studies on the prevalence of and risk factors for metabolic syndrome (MetS) in people aged ≥50 years. This study investigated the sociodemographic and health characteristics related to MetS prevalence in men and women aged ≥50 years to assess clustering of risk factors. Methods: This study used the 2016 survey data of 2927 people aged 50-79 years who were administered questionnaires and underwent examinations. Participants were divided into adults aged 50-64 and 65-79 years and further into four subgroups, according to sex. Differences in sociodemographic and health characteristics by sex were verified using the chi-squared test. Complex sample logistic regression analysis was performed to verify factors related to MetS. Results: The sociodemographic characteristics associated with MetS in men and women aged 50-64 years, included living without a spouse, having a middle school education or less, and reporting a low economic status. The health characteristics associated with MetS in men aged 50-64 years were current smoking status and strength training <2 times/week. The sociodemographic characteristic associated with MetS in women aged 65-79 years was living without a spouse. Hypertriglyceridemia was the risk factor most associated with MetS prevalence. Conclusions: Among men and women aged 50-64 years, living without a spouse, having a low education level, and reporting a low economic status were associated with MetS prevalence. Current smoking status and strength training <2 times/week for men and living without a spouse for women aged 65-79 years were associated with MetS.

Association of low urine pH as a metabolic feature with abdominal obesity

Objective

Low urine pH (LUP) is not only affected by environmental factors, but is also a feature of metabolic syndrome (MS), which is characterized by insulin resistance, abdominal obesity, dyslipidaemia and hypertension. However, it is unclear which factors contribute most to urine acidity. This study investigated factors influencing LUP and the link between LUP and metabolic traits in South Korea.

Methods

Participants were middle-aged subjects (age, 52.2 ± 8.9 years; average body mass index, 24.6 ± 3.2 kg/m²), of whom 4,626 had urine pH of 5.0 and were assigned to the LUP group and 4,185 had urine pH > 5.0 and were assigned to the control group. The association between LUP and various phenotypes, including environmental and metabolic traits, was analysed.

Results

LUP was significantly associated with MS diagnostic components and with environmental exposures such as smoking, alcohol intake and low-fibre diet. Multivariate analysis showed that the waist-to-hip ratio was the best predictor for LUP compared with other MS components (OR: 2.439).

Conclusions

LUP is an indicator of MS and is mainly related to the MS diagnostic criterion of abdominal obesity, even after adjusting for environmental influences on urine acidity.

Factors Affecting Onset and Persistence of Metabolic Syndrome in Korean Breast Cancer Survivors: A Prospective Study

This study aimed to investigate the onset and persistence of metabolic syndrome in breast cancer survivors in a community setting. The study included 329 female breast cancer survivors from 39 community health examination centers located in 14 urban areas in Korea. After an average of 4.6 years of follow-up, based on the presence of metabolic syndrome at baseline and follow-up, the subjects were assigned to three groups: Non-metabolic syndrome (n = 249), onset (n = 32), and persistent (n = 48). Factors associated with the metabolic syndrome were analyzed and presented as odds ratios (ORs). Older age, postmenopausal status, lower education, and lower-income level were associated with an increased prevalence of metabolic syndrome in the onset Mets and persistent Mets group. In particular, when the breast cancer survivor was obese (≥25 kg/m²), the probability of developing metabolic syndrome was 3.33 times higher than normal-weight subjects (<23 kg/m²) and the probability of metabolic syndrome persisting was 16.34 times. When breast cancer survivors were in their 60s or older, the probability of metabolic syndrome persisting was 4.27 times higher than those in their 40s. To prevent the onset and persistence of metabolic syndrome in breast cancer survivors, health-care providers should identify risk factors. Obesity, in particular, should be controlled.

Comparison of health-related habits and metabolic syndrome risk factors according to obesity type in Korean postmenopausal women

OBJECTIVE

This study aimed to investigate the differences in health-related habits, metabolic syndrome risk factors, and related diseases prevalence according to obesity type in postmenopausal women.

METHODS

This cross-sectional study used a data set of 1,443 postmenopausal women who were 40 years or older (range = 45-80, mean = 64.10) from the 2016 Korean National Health and Nutrition Examination Survey VII-1. The participants were classified into normal group (body mass index [BMI] <25 kg/m, waist circumference (WC) <85 cm), BMI obesity group (BMI ≥25 kg/m, WC <85 cm), abdominal obesity group (BMI <25 kg/m, WC ≥85 cm), and BMI and abdominal obesity group (BMI ≥25 kg/m, WC ≥85 cm). To compare health-related habits and metabolic syndrome risk factors according to obesity type, a chi-square test and t test were performed. The relationship between obesity and metabolic syndrome was assessed using a logistic regression analysis of adjusted demographic and women's health covariates.

RESULTS

The abdominal obesity group had a significantly longer sedentary time per day (524.31 min), a higher activity restriction rate (25.0%), and a lower nutrition labeling recognition rate (3.6%) than the other groups (P < 0.001). The occurrence of metabolic syndrome was the highest in the BMI and abdominal obesity group (66.1%), followed by the abdominal obesity group (59.3%). Compared with the normal group, the prevalence of metabolic syndrome was significantly higher in the BMI obesity group (adjusted odds ratio [OR] = 2.23, 95% CI = 1.15-4.31), abdominal obesity group (adjusted OR = 7.33, 95% CI = 4.38-12.25), and the BMI and abdominal obesity group (adjusted OR = 12.44, 95% CI = 8.78-17.62).

CONCLUSIONS

In postmenopausal women, the abdominal obesity group was associated with a high prevalence of metabolic syndrome and related diseases. Therefore, to reduce abdominal obesity in postmenopausal women, it is necessary to correct long sedentary time, high activity restriction rate, and low nutritional labeling recognition rate identified as health-related habits of the abdominal obesity group.

Factors Associated with Metabolic Syndrome among Middle-Aged Women in their 50s: Based on National Health Screening Data

This study aimed to identify the risk factors associated with metabolic syndrome among middle-aged women in their 50s to provide a strategy for managing the metabolic syndrome of those whose prevalence is rapidly increasing. Secondary data from the 2012 Korean National Health Insurance Service Medical check-up cohort database were analyzed. Participants included 36,582 middle-aged women in their 50s from the cohort who received a general medical check-up. The risk factors were estimated using logistic regression analysis. Metabolic syndrome was identified in 14.6% of the surveyed persons among middle-aged women in their 50s. Working women, low household income levels, country residents, high body mass index (BMI), total cholesterol of over 240 mg/dL, non-drinker, non-exerciser, history of diabetes or hypertension, and family history of diabetes were associated with increased risk of metabolic syndrome. It is necessary to prepare a strategy to increase access to health care services so that socioeconomic vulnerability does not lead to negative health behavior such as obesity and lack of physical activity. In particular, we recommend active interventions at workplaces for the working women who have a higher risk of metabolic syndrome.

Difference in health status of Korean farmers according to gender

Background

The objective of this study was to compare differences in lifestyle diseases, musculoskeletal pain, psychosocial stress, and self-health awareness according to gender in Korean farmers.

Methods

The study population comprised 436 farmers residing in rural areas in Korea. A self-administered questionnaire was used to survey demographic characteristics, health-related behaviors, and musculoskeletal pain. The psychosocial well-being index short form (PWI-SF) was used to survey psychosocial stress, and the 12-item short form health survey (SF-12) was used to survey self-health awareness. In addition, a clinical examination was performed for each participant, and lifestyle diseases were identified through a health checkup.

Results

Among lifestyle diseases, females showed a significantly higher proportion than males for metabolic syndrome (OR: 4.57 [95% CI, 1.67-12.51]). For musculoskeletal pain, females again showed significantly higher proportion than males for hand pain (OR: 16.79 [95% CI, 3.09-91.30]), and pain in at least one body part (OR: 2.34 [95% CI, 1.16-4.70]). For psychosocial stress, females showed a significantly higher proportion than males for high-risk stress (OR: 3.10 [95% CI, 1.17-8.24]). Among the items in self-health awareness, females showed significantly higher proportion than males for mental component score (MCS) (OR: 3.10 [95% CI, 1.52-6.31]) and total score (OR: 2.34 [95% CI, 1.11-4.90]).

Conclusions

For all items that showed significant differences, females showed higher proportion than males, which indicates that female farmers tended to have poorer overall health than male farmers. Therefore, specialized programs will have to be developed to improve the health of female farmers.

Educational Disparities in Risk for Metabolic Syndrome

BACKGROUND

The objective of this study was to evaluate the relationship between educational level as a surrogate marker of socioeconomic status and the risk of developing metabolic syndrome (MetS).

METHODS

Study subjects were 1915 Korean adults (1193 women and 722 men) who participated in a cohort study. Educational level was categorized into two groups: (1) high education (more than 12 years of education), and (2) low education (less than 12 years of education). MetS was defined according to diagnostic criteria of the National Cholesterol Education Program (NCEP-III) and the International Diabetes Federation (IDF). Multiple logistic regression analysis and Cox proportional hazard analysis were performed to evaluate cross-sectional and prospective association between MetS or MetS components and educational level after adjusting for covariates.

RESULTS

The overall prevalence of MetS at baseline was 15.0% in women and 20.4% in men. Incidence of MetS over 4.52 years was 16.6 per 1000 person-year in women and 27.6 per 1000 person-year in men. The prevalence and incidence of MetS were higher in the low educational group than those in the high educational group in both sexes. At baseline, the risk of MetS (odds ratio [OR]: 1.63, 95% confidence interval [CI]: 1.05-2.53 for NCEP criteria; OR: 2.30, 95% CI: 1.41-3.76 for IDF criteria) and abdominal obesity (OR: 2.62, 95% CI: 1.75-3.93) were higher in less educated women compared with those in more educated women. In men, there was no association between Mets or MetS components and educational level. Over 4.6 years of follow-up, the risk of developing MetS in women in the low education group (hazard ratio [HR]: 1.95, 95% CI: 1.12-3.50 for NCEP criteria; HR: 2.36, 95% CI: 1.14-4.86 for IDF criteria) was significantly higher than that in the high education group. In men, low education significantly increased the risk of developing impaired fasting glucose (HR: 1.95, 95% CI: 1.12-3.40).

CONCLUSION

An inverse association between educational level and MetS was found in Korean women, suggesting that socioeconomic disparities might increase the risk of MetS development, especially in women.

Discrepancies between subjective perception and waist-to-height ratio measurement of obesity, and their policy implications

In social sciences, researchers rely on subjective perceptions of obesity measures to examine the determinants of obesity and the likely effects of obesity on health outcomes. However, subjective perception tends to produce estimation biases. In this study, we investigated the misreporting behavior of individuals regarding obesity using waist-to-height ratio as an objective measurement of obesity. Using the Korean National Health and Nutrition Examination Survey for 2008-2011, we showed that false-reporting behavior was significantly associated with socio-economic status. Furthermore, we presented that subjective perception of obesity yielded misleading estimates in both the determinants and the consequences of obesity.