Association between Metabolic Syndrome and Psychological Characteristics in Korean Postmenopausal Women

Article information

Korean J Health Promot. 2016;16(2):119-126

Publication date (electronic) : 2016 January 20

doi : https://doi.org/10.15384/kjhp.2016.16.2.119

Eunjoo Kwon ¹, Eun-Hee Nah ¹^,, Hyekyeong Kim ², Sook-Haeng Joe ³, Han-Ik Cho ⁴^,⁵

¹Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea

²Department of Health Convergence, Ewha Womans University College of Science and Industry Convergence, Seoul, Korea

³Department of Psychiatry, Korea University College of Medicine, Seoul, Korea

⁴Korea Association of Health Promotion, Seoul, Korea

⁵Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea

Corresponding author: Eun-Hee Nah, MD, PhD Health Promotion Research Institute, Korea Association of Health Promotion, 350 Hwagok ro, Gangseo-gu, Seoul 07653, Korea Tel: +82-2-2600-0107, Fax: +82-2-2690-4915 E-mail: cellonah@hanmail.net

Received 2015 September 25; Accepted 2016 June 02.

Abstract

Background

Metabolic syndrome is a major health problem in postmenopausal women, along with psychological issues. Hence, this study was conducted to investigate the relationship between metabolic syndrome and mental health properties targeting middle-aged menopausal women, and analyzed the psychological factors affecting the prevalence of metabolic syndrome.

Methods

The study subjects were 479 postmenopausal women aged 45–64 years, who had taken their routine health screenings from August to October in 2012. The presence of 3 or more of 5 risk factors constitutes diagnosis of metabolic syndrome. Depression, trait anxiety, and stress level were measured by Beck Depression Inventory, State-Trait Inventory, and Brief Encounter Psychological Instrument, respectively. Multiple logistic regression analysis was performed to confirm the relationship between the metabolic syndrome and psychological characteristics.

Results

The prevalence of metabolic syndrome in postmenopausal women was 16.5%. Metabolic syndrome was significantly related with trait anxiety (odds ratio [OR]=16.53, P=0.007) and depression (OR=0.16, P=0.012), after adjusting for age, marital status, educational level, monthly income, body mass index, eating habits and exercise.

Conclusions

Trait anxiety and depression were found to be related with the prevalence of metabolic syndrome in postmenopausal women.

Keywords: Metabolic syndrome X; Mental health; Anxiety; Depression; Postmenopause

Table 1.

Characteristics of the study population according to the presence of metabolic syndrome

Table 2.

Correlation between mental health score and risk factors of metabolic syndrome

Table 3.

Factors associated with metabolic syndrome in middle-aged menopausal women^a

References

1. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005;28(7):1769–78.

2. Marroquin OD, Kip KE, Kelly DE, Johnson BD, Shaw LJ, Bairey Merz CN, et al. Metabolic syndrome modifies the cardiovascular risk associated with angiographic coronary artery disease in women: a report from the Women's ischemia syndrome evaluation. Circulation 2004;109(6):714–21.

3. Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003–2012. JAMA 2015;313(19):1973–4.

4. Lim S, Shin H, Song JH, Kwak SH, Kang SM, Won Yoon J, et al. Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998–2007. Diabetes Care 2011;34(6):1323–8.

5. Polotsky HN, Polotsky AJ. Metabolic implications of menopause. Semin Reprod Med 2010;28(5):426–34.

6. Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 2003;88(6):2404–11.

7. Hunter M, Rendall M. Bio-psychosocial perspectives on menopause. Best Pract Res Clin Obstet Gynaecol 2007;21(2):261–74.

8. Sandilyan MB, Dening T. Mental health around and after the menopause. Menopause Int 2011;17(4):142–7.

9. Soules MR, Sherman S, Parrott E, Rebar R, Santoro N, Utian W, et al. Stages of Reproductive Aging Workshop (STRAW). J Womens Health Gend Based Med 2001;10(9):843–8.

10. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120(16):1640–5.

11. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 2007;75(1):72–80.

12. Yim JH, Bae JM, Choi SS, Kim SW, Hwang HS, Huh BY. The validity of modified Korean-translated BEPSI (Brief Psychosocial Instrument) as instrument of stress measurement in outpatient clinic. J Korean Acad Fam Med 1996;17(1):42–53.

13. Kim JT, Shin DK. A study based on the standardization of the STAI for Korea. New Med J 1978;21(11):69–75.

14. Lee YJ, Bhang SY, Choi S, Lee HK, Kim BW, Kim W, et al. Korean state-trait anxiety inventory application study in middle and high school students. J Korean Neuropsychiatr Assoc 2008;47(5):471–80.

15. Lee YH, Song JY. A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean J Clin Psychol 1991;10(1):98–113.

16. Lee YH, Kwon SS, Shin MH, Choi JS, Rhee JA, Ryu SY, et al. Association between metabolic syndrome and depression in community-dwelling adults. Korean J Health Promot Dis Prev 2009;9(4):296–305.

17. Ministry of Health & Welfare. Korea health statistics 2013: Korea national health and nutrition examination survey Sejong: Ministry of Health & Welfare; 2014. p. 28–9.

18. Ministry of Health & Welfare. The epidemiological survey of mental disorder in Korea Seoul: Ministry of Health & Welfare; 2011. p. 75–6.

19. Carroll D, Phillips AC, Thomas GN, Gale CR, Deary I, Batty GD. Generalized anxiety disorder is associated with metabolic syndrome in the Vietnam experience study. Biol Psychiatry 2009;1(66):91–3.

20. Räikkönen K, Matthews KA, Kuller LH. The relationship between psychological risk attributes and the metabolic syndrome in Healthy Women: antecedent or consequence? Metabolism 2002;51(12):1573–7.

21. Therrien F, Drapeau V, Lupien SJ, Beaulieu S, Doré J, Tremblay A, et al. Awakening cortisol response in relation to psychosocial profiles and eating behaviors. Physiol Behav 2008;93(1–2):282–8.

22. Weigensberg MJ, Toledo-Corral CM, Goran MI. Association between the metabolic syndrome and serum cortisol in overweight Latio youth. J Clin Endocrinol Metab 2008;93(4):1372–8.

23. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic disease, and decrements in health: results from the World Health Surveys. Lancet 2007;370(9590):851–8.

24. Khuwaja AK, Lalani S, Dhanani R, Azam IS, Rafique G, White F. Anxiety and depression among outpatients with type 2 diabetes: a multi-centre study of prevalence and associated factors. Diabetol Metab Syndr 2010;2:72.

25. Collins MM, Corcorant P, Perry IJ. Anxiety and depression symptoms in patients with diabetes. Diabet Med 2009;26(2):153–61.

26. Yoon SH, Han KY, Kim SJ, Sohn TY, Jeon B, Kim W, et al. Combined effect of body mass index and body size perception on metabolic syndrome in South Korea: results of the fifth Korea National Health and Nutrition Examination Surveys (2010–2012). BMC Public Health 2015;15:554.

27. Jung JW, Shin HC, Park YW, Kim CH, Cheong SY, Sung EJ. The relationship between betabolic syndrome, stress and depression: among the 35–64 years old clients of comprehensive medical examination center in one university hospital. Korean J Health Promot Dis Prev 2004;4(1):10–7.

28. Sekita A, Arima H, Ninomiya T, Ohara T, Doi Y, Hirakawa Y, et al. Elevated depressive symptoms in metabolic syndrome in a general population of Japanese men: a cross-sectional study. BMC Public Health 2013;13(1));862.

29. de Wit LM, van Straten A, van Herten M, Penninx BW, Cuijpers P. Depression and body mass index, a u-shaped association. BMC Public Health 2009;9:14.

30. Yu NW, Chen CY, Liu CY, Chan YL, Chang CM. Association of body mass index and depressive symptoms in a Chinese community population: results from the Health Promotion Knowledge, Attitudes, and Performance Survey in Taiwan. Chang Gung Med J 2011;34(6):620–7.

Article information Continued

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Table 1.

Characteristics of the study population according to the presence of metabolic syndrome

	Group without MetS	Group with MetS	Total	P^a
N	400 (83.5)	79 (16.5)	479 (100.0)
Age, y	57.0 (54.0–60.5)	57.0 (53.0–61.0)	57.0 (54.0–61.0)	0.591
Stress^b				0.197
Mild	224 (56.7)	51 (64.6)	275 (58.0)
Moderate to severe	171 (43.3)	28 (35.4)	199 (42.0)
Trait anxiety^c				0.039
Normal	373 (98.2)	74 (93.7)	447 (97.4)
Mild to moderate	7 (1.8)	5 (6.3)	12 (2.6)
Depression				0.008
Normal	260 (65.0)	62 (78.5)	322 (67.2)
Mild	73 (18.3)	3 (3.8)	76 (15.9)
Moderate	48 (12.0)	12 (15.2)	60 (12.5)
Severe	19 (4.8)	2 (2.5)	21 (4.4)
BMI, kg/m²	23.1 (21.8–24.8)	26.2 (23.5–28.1)	23.4 (21.9–25.5)	<0.001
Waist circumference, cm	77.0 (73.0–82.0)	86.0 (79.0–90.0)	78.0 (73.0–83.0)	<0.001
Systolic BP, mmHg	118.0 (110.0–127.0)	131.0 (124.0–137.0)	118.0 (110.0–130.0)	<0.001
Diastolic BP, mmHg	74.0 (70.0–80.0)	83.0 (78.0–88.0)	76.0 (70.0–81.0)	<0.001
Total cholesterol, mg/dL	209.0 (185.0–235.0)	219.0 (186.0–238.0)	211.0 (186.0–235.0)	0.373
HDL-cholesterol, mg/dL	57.0 (51.0–64.0)	46.0 (39.0–50.0)	56.0 (50.0–63.0)	<0.001
LDL-cholesterol, mg/dL	129.0 (106.0–153.5)	131.2 (103.4–154.8)	129.0 (105.6–154.0)	0.728
Triglycerides, mg/dL	90.0 (66.0–126.0)	174.0 (122.0–210.0)	98.0 (69.0–145.0)	<0.001
Fasting glucose, mg/dL	93.0 (88.0–99.0)	105.0 (94.0–116.0)	94.0 (89.0–101.0)	<0.001
Marital status^d				0.607
Married living with partner	347 (87.0)	67 (84.8)	414 (86.6)
Widow/divorced/single	52 (13.0)	12 (15.2)	64 (13.4)
Educational level^e				0.037
≤Middle school	158 (39.5)	43 (55.1)	201 (42.1)
High school	164 (41.0)	23 (29.5)	187 (39.1)
College/Universe	78 (19.5)	12 (15.4)	90 (18.8)
Monthly income^f				0.940
≤2 million won	146 (38.0)	27 (35.5)	173 (37.6)
2–3 million won	76 (19.8)	14 (18.4)	90 (19.6)
3–5 million won	99 (25.8)	21 (27.6)	120 (26.1)
≥5 million won	63 (16.4)	14 (18.4)	77 (16.7)

Abbreviations: MetS, metabolic syndrome; BMI, body mass index; BP, blood pressure; HDL, high density lipoprotein; LDL, low density lipoprotein. Values are presented prevalence (%) or median (range).

Calculated by chi-square test, Fisher's exact test or Mann-Whitney U test.

5 missing.

20 missing.

1 missing.

19 missing.

Table 2.

Correlation between mental health score and risk factors of metabolic syndrome

	Stress		Trait anxiety		Depression
	r	P^a	r	P^a	r	P^a
Waist circumference, cm	–0.058	0.209	–0.035	0.454	-0.118	0.010
Systolic blood pressure, mmHg	–0.114	0.013	–0.060	0.203	–0.101	0.026
Diastolic blood pressure, mmHg	–0.114	0.013	–0.071	0.127	–0.107	0.019
HDL-cholesterol, mg/dL	0.031	0.497	0.007	0.885	0.054	0.240
Triglycerides, mg/dL	0.021	0.652	0.042	0.368	0.004	0.928
Fasting glucose, mg/dL	0.016	0.723	0.015	0.746	–0.054	0.237
No. of metabolic components	–0.055	0.234	–0.016	0.737	-0.103	0.025

Abbreviations: HDL, high density lipoprotein.

Calculated by Spearman rank correlation.

Table 3.

Factors associated with metabolic syndrome in middle-aged menopausal women^a

MetS	OR	95% CI	P^b
Stress
Mild (Reference)	1.00
Moderate to severe	0.64	0.288–1.400	0.260
Triat anxiety
Normal (Reference)	1.00
Mild to moderate	16.53	2.161–126.506	0.007
Depression
Normal (Reference)	1.00
Mild	0.16	0.039–0.667	0.012
Moderate	0.87	0.271–2.781	0.867
Severe	0.15	0.014–1.548	0.147
BMI	1.46	1.305–1.639	<0.001

Abbreviations: Mets, metabolic syndrome; OR, odds ratio; CI, confidence interval; BMI, body mass index

This model was adjusted for age, educational level, monthly income, BMI, eating habit and exercise.

Calculated by multiple logistic regression.