Table Of ContentJouyandehetal.JournalofDiabetes&MetabolicDisorders2013,12:1
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RESEARCH ARTICLE Open Access
Metabolic syndrome and menopause
Zahra Jouyandeh1, Farnaz Nayebzadeh2, Mostafa Qorbani3 and Mojgan Asadi1*
Abstract
Background: The metabolic syndrome is defined as an assemblage of risk factors for cardiovascular diseases, and
menopause is associated with an increase inmetabolic syndrome prevalence. The aim ofthis study was to assess
theprevalenceof metabolic syndrome and its components among postmenopausal women inTehran, Iran.
Methods: In this cross-sectional study in menopause clinic in Tehran, 118 postmenopausal women were
investigated. We used theadult treatment panel 3(ATP3) criteria to classify subjectsas having metabolic syndrome.
Results: Total prevalence of metabolic syndrome among our subjects was 30.1%. Waist circumference, HDL-
cholesterol, fasting blood glucose, diastolic blood pressure ,Systolicblood pressure, and triglyceride were
significantly higher among women with metabolic syndrome (P-value<0.05). Our study shows high abdominal
obesity and hypertension are the most prevalent components ofmetabolic syndrome. 15%, 13.3% and 1.8% of
subjects had three,four and five criteria for metabolic syndrome, respectively. There was a significant relationship
between number of components of metabolic syndrome and waist circumference.
Conclusions: Our study shows that postmenopausal status is associated with an increased risk ofmetabolic
syndrome. Therefore, to prevent cardiovascular disease there is a need to evaluate metabolic syndrome and its
components from the time ofthemenopause.
Keywords: Menopause, Metabolic syndrome, Prevalence
Background amongpostmenopausalwomeninTehranreferralhospi-
Metabolic syndrome is an assemblage of several factors tals, we decided to establish a study in menopause clinic
including hypertension, dyslipidemia, insulin resistance, of Tehran women general hospital to determine the
obesity and glucose intolerance that increase subjects' prevalence of metabolic syndrome and its components
risk to develop cardiovascular disease (CVD) and type 2 inpostmenopausalwomen.
diabetes [1,2]. Diagnostic criteria for metabolic syn-
drome has been defined by the national cholesterol edu- Methods
cation program adult treatment panel ΙΠ (ATP ΙΠ), This cross-sectional study was performed in menopause
which is easily used for classifying patients [3]. It's esti- clinic of Tehran women general hospital. The study was
mated that almost 20-30% of the middle-aged popula- performed on 118 postmenopausal women from January
tion are affected by this syndrome [4] varies from 8 to 2011 to January 2012 in the menopause clinic. Meno-
24% in males [5,6] and from 7 to 46% in females [7,8]. pause was defined as at least 12 consecutive months of
Many cross-sectional studies have shown an increased amenorrhea with no other medical cause. Exclusion cri-
risk of metabolic syndrome in postmenopausal women teria were considered as surgical menopause and chemo
which varies from 32.6% to 41.5% [9-11]. Some studies radiotherapy. No other conditions or disease have been
show an increasing prevalence of metabolic syndrome in considered. The women mostly were visited in the clinic
developing countries and Asia [12] and an estimated because of hot flashes, mood swing, vaginal dryness,
prevalence in Iran from 35-58% [13,14]. As there is not sleep disturbances, night sweat, forgetfulness, urinary
enough data on the prevalence of metabolic syndrome symptoms, pain with intercourse, palpitations, anxiety,
jointandmuscle pain,depressionandirritability.
*Correspondence:[email protected] A questionnaire was completed for each patient in-
1Endocrine&MetabolismResearchCenter,TehranUniversityofMedical
cluding demographic information, menopausal status,
Science,Tehran,Iran
Fulllistofauthorinformationisavailableattheendofthearticle medical history, reproductive history, drug history,
©2013Jouyandehetal.;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsofthe
CreativeCommonsAttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,
distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.
Jouyandehetal.JournalofDiabetes&MetabolicDisorders2013,12:1 Page2of4
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familyhistory,physicalexaminationandclinical labdata. Table1Baselinedataofpostmenopausalwomenwith
An inform consent was signed by each patient in the andwithoutmetabolicsyndrome
clinic. Postmenopausal women were considered to have P- Subjects Subjectswith Total Parameters
metabolic syndromeiftheyhad any three or moreof the value without metabolic numberof
followingcriteria,according totheATPΙΠcriteria [2]: metabolic syndrome subjects
syndrome
0.272 52.56±4.81 53.61±4.51 52.67±5 Age(years)
1.Abdominalobesity:waist circumference≥88 cm
2.Hypertriglyceridemia:serum TGlevel ≥150mg/dl 0.315 47.62±4.31 48.47±3.93 47.66±4.44 Menopausal
age(years)
3.Serum HDL:<50 mg/dl
0.001 88.34±9.20 94.91±8.89 90.45±9.56 WC(cm)
4.High bloodpressure:SBP ≥130mmHgand/orDBP
≥85mmHgorontreatmentforhypertension 0.042 118.79±18.78 125.91±15.83 120.64± SBP(mmHg)
18.08
5.High fastingglucose: serum glucose level>110mg/
0.003 79.81±11.33 85±7.48 81.06±10.54 DBP(mmHg)
dlor ontreatment fordiabetes
0.001 99.82±30.86 111.20±29.20 103.35±30.35 FBS(mg/dl)
Waist circumference was measured at a level midpoint <0.05 124.68±53.50 200.64±103.99 146.92±79.94 TG(mg/dl)
between the lower rib margin and the top of the iliac 0.571 215.06±39.97 211.08±31.12 213.83±37.16 Total
crest. Blood pressure of the patients was measured twice Cholesterol
(mg/dl)
with a standard barometer in a sitting position, and the
average blood pressure had been documented in the <0.05 58.20±12.11 47.35±8.22 55.03±12.04 HDL(mg/dl)
sheets. All data were analyzed by SPSS version 16 (SPSS 0.408 128.94±31.24 124.20±26.14 127.36±29.37 LDL(mg/dl)
Inc, Chicago, IL, USA). The continuous variables are *WC:waistcircumference,SBP:systolicbloodpressure,DBP:diastolicblood
reportedasMean±SDandcategoricalvariablesarepre- pressure,FBS:fastingbloodglucose,TG:triglyceride,HDL:highdensity
lipoprotein,LDL:lowdensitylipoprotein.
sented as percentage. The distribution of continuous **P-value<0.05wasconsideredstatisticallysignificant.
variables was assessed by Kolomogrov-Smirnov test and
it demonstrated a normal distribution. A P-value<0.05
wasconsideredstatistically significant. Discussion
In our study the overall prevalence of metabolic syn-
drome was 30.1% among postmenopausal women. Other
Results studies report a prevalence of metabolic syndrome near
A total of 118 postmenopausal women were studied. to our results. A cross-sectional study in Gorgan prov-
Table 1 shows the baseline characteristics of these ince in Iran shows a prevalence of 31% [15] which was
women with and without metabolic syndrome. The similar to our findings. Other Studies in Austria, China,
mean age of our subjects was 52.67±5 years and the Germany, Iran and Canada showed a prevalence of
mean age of menopause was 47.66±4.44 years. Total 32.6%,37.34%,36.1%,31%and29.6%respectively[9,16-19]
prevalence of metabolic syndrome among our subjects inanagreementwithourfinding.Althoughtherewasadis-
was30.1%. agreementbetweenourstudyandsomeotherstudiesdone
Waist circumference, HDL-cholesterol, fasting blood inIran,westernIndia,ArgentinaandEcuadorwithapreva-
glucose,diastolicblood pressure ,Systolic bloodpressure, lence of 69%, 55%, 22% and 41.5% respectively [20-23].
and triglyceride were significantly higher among women These differences in prevalence of metabolic syndrome in
with metabolic syndrome (P-value<0.05). There were no different studies can be due to different investigation met-
significant differences in the age, menopausal age, total hods of the syndrome (different investigation criteria),
cholesterol and LDL-cholesterol. The percentage of fasting
bloodsugar>110mg/dl,highdensitylipoprotein<50mg/dl,
Triglyceride≥150 mg/dl, waist circumference≥88 cm, and Table2Prevalenceofmetabolicsyndromeandthe
systolic blood pressure ≥130 mmHg/diastolic blood pre- componentsofmetabolicsyndromeinpostmenopausal
ssure≥85 mmHg were 29.1%, 35.6%, 35.6%, 64.3%, 47.9% women
respectively. The percentages of each metabolic syndrome 30.1% Metabolicsyndrome
components are shown in Table 2. Table 3 shows preva- 64.3% Waistcircumference≥88cm
lenceofsubjectswithcriteriaofmetabolicsyndromewhich
35.6% Triglyceride≥150mg/dl
shows15%,13.3%and1.8%hadthree,fourandfivecriteria
35.6% HDL-cholesterol<50mg/dl
for metabolic syndrome respectively. There was a signifi-
47.9% Systolicbloodpressure≥130mmHg/diastolicbloodpressure≥85
cant relevancy between number of metabolic syndrome
mmHg
components and increasing waist circumference (P-value:
29.1% Fastingbloodglucose>110mg/dl
0.001)withastatisticallysignificantlinearity(<0.05).
Jouyandehetal.JournalofDiabetes&MetabolicDisorders2013,12:1 Page3of4
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Table3Numberofmetabolicsyndromecomponentsversuswaistcircumference
P-value Five Four Three Two One None Metabolicsyndromecomponents
0.001 105.50±2.12 94.26±6.80 94.23±10.37 89.94±9.29 89.03±10.01 82.64±4.32 Mean±SD Waistcircumference
1.8 13.3 15 33.6 23.9 12.4 Percent
socioeconomic and environmental differences, genetic fac- This may suggest us that diastolic blood pressure is a
torsandlifestyle.Inourstudy,wefoundthatwaistcircum- risk factor for CHD in postmenopausal women with
ference, systolic blood pressure, diastolic blood pressure, metabolicsyndromethat shouldbe considered.
fasting blood sugar, triglyceride and HDL levels were sig- A significant difference of impaired fasting glucose
nificantly higher among postmenopausal women with was found among postmenopausal women with and
metabolic syndrome in comparison to postmenopausal without metabolic syndrome in our study. Walton and
women without metabolic syndrome. The most prevalent colleges also report an increase in FBS among postme-
component of metabolic syndrome was abdominal obesity nopausalwomenwithmetabolic syndrome [31].
withafrequencyof64.3%,whichisinagreementwithstud- Finally, Our findings show low HDL and high TG
iesinnortheastofIran[24],Babol[18]andArgentina[25] levels in postmenopausal women with metabolic syn-
about the most prevalent component of metabolic syn- drome, which is in agreement with findings in studies
dromeamongpostmenopausalwomenwithmetabolicsyn- done by Marjani et al. [15] in Iran and Figueiredo Neto
drome. This is not exactly similar to the findings of other et al. [25] in Brazil. There are controversial findings
studies in Ecuador [23] with high TG level and in Korea about menopausal effect on HDL [32,33] and TG levels
[26], Brazil [25] and Iran [15] with low HDL-cholesterol [32,34]. Our findings about high prevalence of dyslipide-
level reported as the most prevalent component of meta- mia among postmenopausal women with metabolic syn-
bolic syndrome. These differences may be due to genetic, drome indicate a need to treat metabolic syndrome in
ethnic and lifestyle differences in these countries. Table 4 postmenopausal women as a target for reducing cardio-
shows the prevalence of metabolic syndrome and its com- vascular risks with an special effort on lifestyle changing
ponentsdoneindifferentstudiesovertheworld. anddailydiets.
We found a statistically significant relationship be- A limitation of this study was the small population
tween waist circumference and number of metabolic studied, done as a cross-sectional study which may limit
syndrome components, which was in agreement with generalization of this study to all parts of Iran. There is
study done by Marjani et al. in Gorgan [15]. Abdominal a need of further studies to confirm the results found
obesity is a risk factor for cardiovascular disorders and, then, take actions to prevent metabolic syndrome
[28,29] and can cause metabolism abnormality and inpostmenopausalwomen.
threaten human’s health [30]. Therefore, it is necessary
to reduce this risk among postmenopausal women with Conclusion
metabolic syndrome by changing the lifestyle leading Our study has shown a high prevalence of metabolic
to weight loss by a healthy diet and frequent physical syndrome among postmenopausal women referring to
activity. menopause clinicinTehranwomengeneralhospitalthat
In our study we found that both systolic and diastolic abdominal obesity and hypertension were the most
blood pressure was higher among post menopausal prevalent components of metabolic syndrome among
women with metabolic syndrome specially DBP. Marjani these patients. These components can lead to an in-
et al. also showed a significantly high diastolic blood crease in cardiovascular diseases. Interventions are
pressure among postmenopausal women in Gorgan [15]. needed to modify these risk factors such as abdominal
Table4Prevalenceofmetabolicsyndromeanditscomponentsindifferentstudies[15,18,22-27]
Study Number Metabolicsyndrome Htn HighTG ImpairedFBS LowHDL HighWC
Iran Gorgan 100 31% 16% 16% 17% 30% 29%
NorthEast 160 20.62% 3.12% 20% 14.30% 29.37% 34.37%
Babol 984 31% 12.1% 41.5% 12.1% 48.6% 76.6%
Tehran 940 53.5% 16.5% 104.4% 66.2% 12.5% 9.8%
Brazil 323 44.4% 65% 12.4% 11.8% 79.6% 50.9%
Argentina 124 22% 8% 8% 2% 10% 13%
Ecuador 325 41.5% 65.9% 83% 29.6% 80% 83.7%
Korea 778 54.6% 63.6% 39.3% 26% 69.8% 67.1%
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