Original article
Metabolic syndrome and impaired health-related quality of life and in non-Hispanic White, non-Hispanic Blacks and Mexican-American Adults

https://doi.org/10.1016/j.dsx.2013.06.007Get rights and content

Abstract

Objective

We examined the relationship between metabolic syndrome (MetS) and impaired health-related quality of life (HRQoL) in non-Hispanic Whites (NHW), non-Hispanic Black (NHB), and Mexican-Americans (MA).

Methods

Data (n = 5170) from 2009–2010 NHANES were used. Subjects perceived poor overall health (POH), poor physical health (PPH), and poor mental health (PMH) status in the past 30 days were used as indices of impaired HRQoL. Race/ethnic-specific associations between MetS and indices of HRQoL were determined using prevalence odds ratios (POR) from logistic regression models. Statistical adjustments were made for age, sex, education, marital status, income and smoking.

Results

Rates of POH, PPH and PMH in the past 30 days increased linearly with increased number of components of MetS in NHW, NHB and MA. MetS was associated with increased odds of PPH in NHW (POR = 2.34; 95% CI = 1.73–3.17) and MA (POR = 1.65; 95% CI = 1.09–2.50); increased odds of PPH in NHW (POR = 1.65; 95% CI = 1.18–2.31), NHB (POR = 1.83; 95% CI = 1.01–3.35), and MA (POR = 1.67; 95% CI = 1.09–2.83); and increased odds of PMH in NHW (POR = 1.50; 95% CI = 1.08–2.08), NHB (POR = 2.28; 95% CI = 1.29–4.01), and MA (POR = 1.44; 95% CI = 0.80–2.59). Upon adjustment for other independent variables, smoking and lack of education were found associated with increased odds of impaired HRQoL.

Conclusions

MetS is associated with POH, PPH, and PMH in American adults. From clinical standpoint, this study further suggests that HRQoL should be considered in the management of subjects with MetS. Robust public health programs designed to reduce the prevalence of MetS may help in reducing impaired HRQoL, including POH, PPH, and PMH in American adults who have MetS.

Introduction

Metabolic syndrome (MetS) is a complex disorder defined by a cluster of interrelated factors that increase the risk of cardiovascular atherosclerotic diseases and type 2 diabetes. Described originally by Hanefeld and Leonhardt [1] and popularized by Reaven [2], MetS remains a subject of considerable curiosity because of the complexity of the pathophysiology. The main components of MetS are abdominal obesity, elevated arterial blood pressure, dysregulated glucose homeostasis, and dyslipidemia (hyperinsulinemia, hypercholesterolemia, hypertriglyceridemia, and low levels of high-density lipoprotein cholesterol) [3], [4]. An emergent aspect of MetS is its increasing prevalence in childhood [5], adolescent [6] and young adulthood [7], and the future implications to the global health burden it could confer. MetS has a high socioeconomic cost and is considered a worldwide epidemic [8]. Many organizations and expert groups variably define MetS. However, the two most widely used definitions are those of the National Cholesterol Education Program Adult Treatment Panel III (NCEP) [9], and the International Diabetes Federation (IDF) [10] focusing specifically on abdominal obesity measured using waist circumference in addition two other factors.

Prevalence of MetS in the United States range from between 34.3% and 38.5% depending on the criteria that is employed [11]. Prevalence increases with age among Americans, and tend to peak among those aged 60–69 years [12]. Prevalence of MetS is lower among African American men than White or Mexican American men, and lower among White women than among African American or Mexican American women [12]. In the period between 1988–1992 and 1999–2000, the prevalence of MetS among U.S. adults increased by 15.9%, and among U.S. adolescents the prevalence increased by approximately 52% [12].

Although the effects of many individual components of MetS on quality of life have been investigated, the impact of MetS on health-related quality of life (HRQoL) is yet to be clearly delineated because of inconsistencies in findings that are reported in the literature. For example two previous studies reported that subjects with MetS have reduced quality of health [13], [14]. These studies show that psychiatric co-morbidities that includes psychosocial, physical, emotional problems, and depressive conditions are more common in subjects with MetS as compared with subjects without MetS [13], [14], [15]. Some studies also reported negative association between MetS and HRQoL [16], [17]. Discrepancy in findings may be attributed to differences in the definitions of MetS or HRQoL.

Although minorities in the United States have higher rates for many cardiometabolic risk factors and lower rates of HRQoL than non-Hispanic Whites, only little is known about the impact of MetS in racial/ethnic differences for HRQoL. Because of the escalating prevalence of MetS in the United States, understanding its impact on quality of life is essential for developing public health initiatives for managing subjects with MetS. This study was therefore designed to examine the association between MetS and impaired HRQoL in American adults. Specifically, we sought to determine association between MetS and self reported HRQoL assessed using overall health, physical health, and mental health in non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican-Americans (MA). Due to the well know racial/ethnic differences in quality of life as well as MetS, we hypothesize that the association between MetS and impaired HRQoL will vary by race/ethnicity.

Section snippets

Study design

Data from the 2009–2010 United States National Health and Nutrition Examination Surveys (NHANES) were used for this investigation. NHANES are multifaceted cross-sectional sampling designs administered to a representative sample of the civilian non-institutionalized individuals within the U.S. population. Participants in NHANES were interviewed in their homes and subsequently received physical and laboratory examination in mobile examination centers. Descriptions of the plan and operation of the

Results

The basic descriptive characteristics of the study populations of eligible (n = 5170) subjects are shown in Table 1. NHW participants were older and more highly educated than NHB and MA participants (P < 0.01). NHW had higher values of HDL, and lower BMI and had fewer unmarried couples than NHB and MA. NHW participants also presented with lower rates abdominal obesity and elevated glucose, and lower values of SBP, and FPG compared NHB and MA. NHB participants were heavier as determined by weight

Discussion

MetS is a fast growing public health burden for almost all the developed countries and many developing nations. A developing aspect in the epidemiology of MetS is its increasing prevalence not only in the U.S. but also in many advanced developed countries [24]. An increasing prevalence of MetS is also being observed in many developing countries [25], [26]. Indeed, it has been projected that MetS will continue to increase in many developing countries [27] and in the future may overtake smoking

Conclusion

MetS is associated with POH, PPH, and PMH in NHW, NHB and MA adults. As such the association between MetS and HRQoL has clinical and public health relevance. From clinical standpoint, this study suggests that HRQoL should be considered in the management of subjects with MetS. From public health perspective, the increasing prevalence of MetS requires effective and multifaceted health promotion policies and strategies for alleviating the impact MetS on health-related quality of life in NHW, NHB

Conflict of interest

The authors declared no conflict of interest.

Acknowledgement

We are grateful to the United States National Center for Health Statistics for providing the data.

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