Income, Education Affect Metabolic Risk During Menopause

Tara Haelle

December 21, 2015

Several social and lifestyle factors appear to play a role in women's risk for metabolic syndrome as they experience menopause, according to a Korean cohort study published online December 3 in Menopause.

In the study, a lower education or income level and a sedentary lifestyle conferred the greatest increased risk for metabolic syndrome.

"Implications include the need for stronger emphasis on weight control before midlife and experiencing menopause, promoting exercise across the menopausal transition, and supportive policy measures for economically disadvantaged women," write Sue Kim, PhD, RN, from the College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea, and colleagues.

These data would likely mirror data from US women, according to JoAnne Pinkerton, MD, the executive director of the North American Menopause Society (NAMS).

"Studies have shown that differences in diet, environment, ethnicity, cultural beliefs, and genetics all play a role in how women transition through menopause," Dr Pinkerton told Medscape Medical News. "Despite that, there are many common issues between cultures, and I believe this study would have the same findings in the United States. We have the same issues: obesity, lack of physical exercise, weight gain, and risk for metabolic syndrome, which is greater in those with less education and income."

The researchers tracked 1228 women, aged 45 to 55 years, for 4 years, gathering data at baseline, 2 years, and 4 years on the women's menopausal status, alcohol consumption, exercise, smoking history, secondhand smoke exposure, and breakfast habits. None of the women were taking hormonal therapy. At the third assessment, 44.87% of the women were premenopausal, 25.65% were perimenopausal, and 29.48% were postmenopausal.

Prevalence of metabolic syndrome was 13.03% at baseline, 11.54% at the first follow-up, and 14.37% at the second follow-up, a pattern also seen in high-density lipid cholesterol and triglyceride levels. Blood pressure remained stable across the period, but waist circumference steadily increased.

"For women who experienced menopause during the observed time frame, education level, monthly income, [body mass index (BMI)], and exercise were significant factors in [metabolic syndrome] risk differences," the authors report.

The proportion of women who did not exercise remained fairly steady, from 64.3% to 70.7%, across the 4 years, and these women had 1.6 times greater odds of metabolic syndrome than those with high levels of exercise (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.14 - 2.13).

"[O]ur data indicate that midlife women do seek to change exercise patterns," write Dr Kim and colleagues. "However, more than two thirds of the women analyzed were sedentary, which suggests that although the menopausal transition can be a potential motivator for physical activity...long-term sedentary habits are difficult to change."

Women with less than 10 years of education had 1.4 greater odds of metabolic syndrome than those with more than 10 years (OR, 1.38; 95% CI, 1.03 - 1.86), and women in the middle and lower income categories had 1.7 and 1.6 greater odds of metabolic syndrome compared with women in the highest category (OR, 1.74 [95% CI, 1.17 - 2.60]; and OR, 1.61 [95% CI, 1.06 - 2.45]).

Women who were overweight according to their BMI had four times greater odds (OR, 4.16; 95% CI, 2.60 - 6.67) and women with obesity had 12 times greater odds (OR, 11.92; 95% CI, 7.48 - 18.99) of metabolic syndrome compared with those with a normal BMI. These numbers jumped to 10 times and 31 times greater odds, respectively, when other factors were controlled for in menstruating women. The odds were three times greater and nine times greater, respectively, when controlling for other factors in perimenopausal women. And in postmenopausal women, being overweight increased odds of metabolic syndrome three times and obesity increased it 8.5 times.

"In this study, in women who continued to menstruate as well as those who became postmenopausal, [metabolic syndrome] risk increased with socioeconomic disadvantage," the authors write. "This underscores the importance of policy measures that are sensitive to the health needs of economically disadvantaged women."

Menopause itself did not appear associated with metabolic risk after controlling for the confounders. "This appears to be contrary to the literature that metabolic risk increases during the menopausal transition but may be related to differences in the heavier role of BMI and overall lack of exercise among women during the observed time frame," the authors report.

"Considering that lack of time is often cited as the most common barrier of exercising, such as, 47.4% among Koreans, creating changes in the perception of physical activity is needed, especially in early adulthood."

Lack of time is a challenge facing US women as well, Dr Pinkerton told Medscape Medical News.

 
Losing weight is not easy, while regaining it happens very easily. Dr JoAnne Pinkerton
 

"Physicians need to stress weight management and physical activity in women before perimenopausal changes occur, and it's particularly important for women who are already overweight and have less education and economic advantage," Dr Pinkerton said. Women tend to gain an average of 12 to 15 pounds between ages 45 and 55 years, and most of that gathers around the abdomen, putting them at risk for elevated blood pressure, metabolic syndrome, or diabetes, she said.

"If women were aware that this was coming, maybe they could start finding some physical activity they enjoy and they could begin decreasing portion size and their fats and carbs," she said. "Weight issues are complex in any culture, and losing weight is not easy, while regaining it happens very easily."

The study did not offer recommendations for how to avoid weight gain in women, Dr Pinkerton said, but one culprit that makes weight gain harder to avoid is stress.

"What happens, is women get stressed, they get busy, and they fall off. They forget to eat smaller portion sizes," Dr Pinkerton said. "For all women, watch how you handle stress and recognize the stresses that come from raising children, making a home, taking care of aging parents, work, relationships, church, and community. Instead of eating, add more physical activity and then take care of yourself."

The research was funded by Hallym University Research Fund and a grant from the Korea Center for Disease Control and Prevention. The authors have disclosed no relevant financial relationships.

Menopause. Published online December 3, 2015. Abstract

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