Association between metabolic syndrome and quality of life
Aims: Despite all progress made in understanding and treating metabolic syndrome, the study of its impact on quality of life is still controversial and not well understood. The aim of this study was to test the hypothesis that metabolic syndrome can be associated with a worse quality of life.
Methods: A controlled cross-sectional study included individuals with metabolic syndrome, from the sub-analysis of a randomized clinical trial about lifestyle modification and cardiovascular risk factors, as well as individuals with no metabolic syndrome, attended as outpatients in several clinics at a general university hospital in Southern Brazil. Measurements were made in individual interviews and included data collection, laboratory tests, and application of general scales such as Mini-Mental State Examination and Medical Outcomes Study Short Form, General Health Survey (SF-36). Comparisons of quantitative data used the Student's t test, followed by analysis of covariance or multiple linear regression for adjustment, and correlation coefficient. For categorical data, the Chi-square or Fisher's exact test were used.
Results: The study included 229 individuals, 118 metabolic syndrome and 111 no metabolic syndrome. In univariate analysis, metabolic syndrome was significantly associated with lower scores in the social functioning (p<0.001) and role emotional (p=0.019) quality of life domains, and with the Mental Component Summary score of the SF-36 (p=0.013). However, after adjustments for confounding factors, especially body mass index, the significance of these associations was lost. The only significant association between metabolic syndrome and quality of life that has remained after the adjustments was with worse QOL in the role emotional domain, but only in men (p=0.049).Conclusions: After adjusting for multiple variables, metabolic syndrome was significantly associated with decreased quality of life scores in men in the role emotional domain.
Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97. http://dx.doi.org/10.1001/jama.285.19.2486
Alberti G,Zimmet P,Shaw J, Grundy SM. The IDF consensus worldwide definition of the metabolic syndrome. International Diabetes Federation, 2006.
Diretriz Brasileira para diagnóstico e tratamento da síndrome metabólica. Hipertensão. 2004;7(4):121-63.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002;16;287(3):356-9.
Roohafza H, Sadeghi M, Talaei M, Pourmoghaddas Z, Sarrafzadegan N. Psychological status and quality of life in relation to the metabolic syndrome: Isfahan cohort study. Int J Endocrinol. 2012;2012:380902. http://dx.doi.org/10.1155/2012/380902
Tziallas D, Kastanioti C, Kostapanos MS, Skapinakis P, Elisaf MS, Mavreas V. The impact of the metabolic syndrome on health-related quality of life: a cross-sectional study in Greece. Eur J Cardiovasc Nurs. 2012;11(3):297-303.
Katano S, Nakamura Y, Nakamura A, Suzukamo Y, Murakami Y, Tanaka T, Okayama A, Miura K, Okamura T, Fukuhara S, Ueshima H. Relatioship between health-related quality of life and clustering of metabolic syndrome diagnostic components. Qual Life Res. 2012;21(7):1165-70. http://dx.doi.org/10.1007/s11136-011-0029-y
Ford ES, Li C. Metabolic syndrome and health-related quality of life among U.S. adults. Ann Epidemiol. 2008;18(3):165-71. http://dx.doi.org/10.1016/j.annepidem.2007.10.009
Han JH, Park HS, Shin CI, Chang HM, Yun KE, Cho SH, Choi EY, Lee SY, Kim JH, Sung HN, Kim JH, Choi SI, Yoon YS, Lee ES, Song HR, Bae SC. Metabolic syndrome and quality of life (QOL) using generalised and obesity-specific QOL scales. Int J Clin Pract. 2009;63(5):735-41. http://dx.doi.org/10.1111/j.1742-1241.2009.02021.x
Corica F, Corsonello A, Apolone G, Mannucci E, Lucchetti M, Bonfiglio C, Melchionda N, Marchesini G, QUOVADIS Study Group. Metabolic Syndrome, psychological status and quality of life in obesity: the QUOVADIS Study. Int J Obes (Lond). 2008;32(1):185-91. http://dx.doi.org/10.1038/sj.ijo.0803687
Miettola J, Niskanen LK, Viinamäki H, Sintonen H, Kumpusalo E. Metabolic syndrome is associated with impaired health-related quality of life: Lapinlahti 2005 study. Qual Life Res. 2008;17(8):1055-62. http://dx.doi.org/10.1007/s11136-008-9386-6
Pinar T, Pinar G, Dogan N. The presence of metabolic syndrome and associated quality of life in Turkish women with cardiovascular disease. Acta Medica. 2012;1:1-10.
Tekdemir EY, Karadag B, Ozcelik B, Ozturk AO, Karamustafalioglu O, Altuntas Y. Metabolic syndrome and health-related quality of life among Turkish adults. Abstracts of the 7th Metabolic Syndrome Symposium. Abstract 470. Obesity Reviews. 2010;11(6):467-88. http://dx.doi.org/10.1111/j.1467-789X.2010.00771.x
Huang CY, Chi SC, Sousa VD, Wang CP, Pan KC. Depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Southern Taiwan. J Clin Nurs. 2011;20(9-10):1293-302. http://dx.doi.org/10.1111/j.1365-2702.2010.03451.x
Roriz-Cruz M, Rosset I, Wada T, Sakagami T, Ishine M, Roriz-Filho JS, Cruz TR, Rodrigues RP, Resmini I, Sudoh S, Wakatsuki Y, Nakagawa M, Souza AC, Kita T, Matsubayashi K. Stroke-independent association between metabolic syndrome and functional dependence, depression, and low quality of life in elderly community-dwelling Brazilian people. J Am Geriatr Soc. 2007;55(3):374-82. http://dx.doi.org/10.1111/j.1532-5415.2007.01068.x
Amiri P, Hosseinpanah F, Rambod M, Montazeri A, Azizi F. Metabolic syndrome predicts poor health-related quality of life in women but not in men: Tehran Lipid and Glucose Study. J Womens Health (Larchmt). 2010;19(6):1201-7 http://dx.doi.org/10.1089/jwh.2009.1710
Park SS, Yoon YS, Oh SW. Health-related quality of life in metabolic syndrome: the Korea National Health and Nutricion Examination Survey 2005. Diabetes Res Clin Pract. 2011;91(3):381-8. http://dx.doi.org/10.1016/j.diabres.2010.11.010
Sohn YJ, Sohn HS, Kwon JW. Gender differences among middle-aged Koreans for Health-related quality of life related to metabolic syndrome. Qual Life Res. 2011; 20(4):583-92. http://dx.doi.org/10.1007/s11136-010-9789-z
Frisman GH, Kristenson M. Psychosocial status and health related quality of life in relation to the metabolic syndrome in a Swedish middle-aged population. Eur J Cardiovasc Nurs. 2009;8(3):207-15. http://dx.doi.org/10.1016/j.ejcnurse.2009.01.004
Sarrafzadegan N, Gharipour M, Ramezani MA, Rabiei K, Zolfaghar B, Tavassoli AA, Boshtam M, Zarfeshani S, Khosravi A, Yousefi A. Metabolic syndrome and health-related quality of life in Iranian population. J Res Med Sci. 2011;16(3):254-61.
Hjellset VT, Ihlebæk CM, Bjorge B, Eriksen HR, Hostmark AT. Health-related quality of life, subjective health complaints, psychological distress and coping in Pakistani immigrant women with and without the metabolic syndrome : The InnvaDiab-DEPLAN Study on Pakistani Immigrant Women Living in Oslo, Norway. J Immigr Minor Health. 2011;13(4):732-41. http://dx.doi.org/10.1007/s10903-010-9409-6
Qader SS, Shakir YA, Samsioe G. Could quality of life impact the prevalence of metabolic syndrome? Results from a population-based study of Swedish women: the Women's Health in the Lund Area Study. Metab Syndr Relat Disord. 2008;6(3):203-7. http://dx.doi.org/10.1089/met.2008.0014
Lidfeldt J, Nyberg P, Nerbrand C, Samsioe G, Scherstén B, Agardh CD. Socio-demographic and psychosocial factors are associated with features of the metabolic syndrome. The Women's Health in the Lund Area (WHILA) study. Diabetes Obes Metab. 2003;5(2):106-12. http://dx.doi.org/10.1046/j.1463-1326.2003.00250.x
Okosun IS, Annor F, Esuneh F, Okoegwale EE. Metabolic syndrome and impaired health-related quality of life and in non-Hispanic white, non-Hispanic blacks and Mexican-American adults. Diabetes Metab Syndr. 2013;7(3):154-60. http://dx.doi.org/10.1016/j.dsx.2013.06.007
Rouch I, Achour-Crawford E, Roche F, Castro-Lionard C, Laurent B, Ntougou Assoumou G, et al. Seven-year predictors of self-rated health and life satisfaction in the elderly: the PROOF study. J Nutr Health Aging. 2014;18(9):840-7. http://dx.doi.org/10.1007/s12603-014-0557-6
Vetter ML, Wadden TA, Lavenberg J, Moore RH, Volger S, Perez JL, Sarwer DB, Tsai AG. Relation of health-related quality of life to metabolic syndrome, obesity, depression and comorbid illnesses. Int J Obes (Lond). 2011;35(8):1087-94. http://dx.doi.org/10.1038/ijo.2010.230
Tsai AG, Wadden TA, Sarwer DB, Berkowitz RI, Womble LG, Hesson LA, Phelan S, Rothman R. Metabolic syndrome and health-related quality of life in obese individuals seeking weigh reduction. Obesity (Silver Spring). 2008;16(1):59-63. http://dx.doi.org/10.1038/oby.2007.8
Bischoff SC, Damms-Machado A, Betz C, Herpertz S, Legenbauer T, Löw T, Wechsler JG,Bischoff G, Austel A, Ellrott T. Multicenter evaluation of an interdisciplinary 52-week weight loss program for obesity with regard to body weight, comorbidities and quality of life – a prospective study. Int J Obes (Lond). 2012;36(4):614-24. http://dx.doi.org/10.1038/ijo.2011.107
Sarwer DB, Moore RH, Diewald LK, Chittams J, Berkowitz RI, Vetter M, Volger S, Wadden TA for the POWER-UP Research Group. The impact of a primary care-based weight loss intervention on quality of life. Int J Obes (Lond). 2013;37(01):S25-30. http://dx.doi.org/10.1038/ijo.2013.93
Kalter-Lebovici O, Younis-Zeidan N, Atamna A, Lubin F, Alpert G, Chetrit A, Novikov I, Daoud N, Freedman LS. Lifestyle intervention in obese Arab women: a randomized controlled Trial. Arch Intern Med. 2010;170(11):970-6. http://dx.doi.org/10.1001/archinternmed.2010.103
Cezaretto A. Intervenção interdisciplinar para prevenção de diabetes mellitus sob a perspectiva da psicologia: benefícios na qualidade de vida. [Dissertação]. [São Paulo]: Universidade de São Paulo; 2010.
Eriksson KM, Westborg CJ, Eliasson MC. A randomized trial of lifestyle intervention in primary healthcare for the modification of cardiovascular risk factors. Scand J Public Health. 2006;34(5):453-61. http://dx.doi.org/10.1080/14034940500489826
Levinger I, Goodman C, Hare DL, Jerums G, Selig S. The effect of resistance training on functional capacity and quality of life in individuals with high and low numbers of metabolic risk factors. Diabetes Care. 2007;30(9):2205-10. http://dx.doi.org/10.2337/dc07-0841
Landaeta-Díaz L, Landaeta-Díaz L, Fernández JM, Da Silva-Grigoletto M, Rosado-Alvarez D, Gómez-Gardu-o A et al. Mediterranean diet, moderate-to-high intensity training, and health-related quality of life in adults with metabolic syndrome. Eur J Prev Cardiol. 2013;20(4):555-64. http://dx.doi.org/10.1177/2047487312445000
Madero M, Arriaga JC, Jalal D, Rivard C, McFann K, Pérez-Méndez O, Vázquez A, Ruiz A, Lanaspa MA, Jimenez CR, Johnson RJ, Lozada LG. The effect of two energy-restricted diets, a low-fructose diet versus a moderate natural fructose diet, on weight loss and metabolic syndrome parameters: a randomized controlled trial. Metabolism. 2011;60(11):1551-9. http://dx.doi.org/10.1016/j.metabol.2011.04.001
Kanaya AM, Araneta MR, Pawlowsky SB, Barrett-Connor E, Grady D, Vittinghoff E, Schembri M, Chang A, Carrion-Petersen ML, Coggins T, Tanori D, Armas JM, Cole RJ. Restorative yoga and metabolic risk factors: the Practicing Restorative Yoga vs. Stretching for the Metabolic Syndrome (PRYSMS) randomized trial. J Diabetes Complications. 2014;28(3):406-12. http://dx.doi.org/10.1016/j.jdiacomp.2013.12.001
Stuckey MI, Gill DP, Petrella RJ. Does systolic blood pressure response to lifestyle intervention indicate metabolic risk and health-related quality-of-life improvement over 1 year? J Clin Hypertens (Greenwich). 2015;17(5):375-80. http://dx.doi.org/10.1111/jch.12531
Zhang JP, Pozuelo L, Brennan DM, Hoar B, Hoogwerf BJ. Association of SF-36 with coronary artery disease risk factors and mortality: a PreCIS study. Prev Cardiol. 2010;13(3):122-9.
Daniel M, Paquet C, Coffee N, Howard N, Cargo M, Taylor A, Hugo G, Adams R. Metabolic syndrome incidence in a population-based, representative biomedical cohort over 4.5 years: assessing area-level socioeconomic disadvantage and individual psychosocial wellbeing. Abstracts of the 4th International Congress on Prediabetes and the Metabolic Syndrome. J Diabetes. 2011;3 Suppl.1:11 http://dx.doi.org/10.1111/j.1753-0407.2011.00122.x
Lee YJ, Woo SY, Ahn JH, Cho S, Kim SR. Health-Related Quality of Life in Adults with Metabolic Syndrome: The Korea National Health and Nutrition Examination Survey, 2007-2008. Ann Nutr Metab. 2012;61:275-80. http://dx.doi.org/10.1159/000341494
Saboya PM, Zimmermann PR, Bodanese LC. Association between anxiety or depressive symptoms and arterial hypertension, and their impact on the quality of life. Int J Psychiatry Med. 2010;40(3):307-20. http://dx.doi.org/10.2190/PM.40.3.f
Bertolucci PH, Brucki, SM, Campacci SR, Juliano Y. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuro-Psiquiatr. 1994;52(1):1-7. http://dx.doi.org/10.1590/S0004-282X1994000100001
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-72. http://dx.doi.org/10.1001/jama.289.19.2560
Lee IM, Rexrode KM, Cook NR, Manson JE, Buring JE. Physical activity and coronary heart disease in women: Is "no pain, no gain" passe? JAMA. 2001;285:1447-54. http://dx.doi.org/10.1001/jama.285.11.1447
Lohman TG, Roche AF, Martorell R. Anthropometric Standardization Reference Manual. Champaign, Il: Human Kinetics Books; 1988.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Kjeldsen SE, Erdine S, Narkiewicz K, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Cifkova R, Dominiczak A, Fagard R, Heagerty AM, Laurent S, Lindholm LH, Mancia G, Manolis A, Nilsson PM, Redon J, Schmieder RE, Struijker-Boudier HA, Viigimaa M, Filippatos G, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Kiowski W, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O'Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL, The task force for the management of arterial hypertension of the European Society of Hypertension, The task force for the management of arterial hypertension of the European Society of Cardiology. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28:1462-536. http://dx.doi.org/10.1097/hjh.0b013e3281fc975a
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502.
Ciconelli RM, Ferraz MB, Santos W, Meinão I, Quaresma MR. Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36). Rev Bras Reumatol. 1999;39:143-50.
United Nations. Department of Economic and Social Affairs. Provisional Guidelines on Standard International Age Classifications. United Nations: New York; 1982.
Sprangers MA, de Regt EB, Andries F, Van Agt HM, Bijl RV, de Boer JB, Foets M, Hoeymans N, Jacobs AE, Kempen GI, Miedema HS, Tijhuis MA, de Haes HC. Which chronic conditions are associated with better or poorer quality of life? J Clin Epidemiol. 2000;53(9):895-907. http://dx.doi.org/10.1016/S0895-4356(00)00204-3
Jia H, Lubetkin EI. The impact of obesity on health-related quality-of-life in the general adult U.S. population. J Public Health. 2005;27:156-64. http://dx.doi.org/10.1093/pubmed/fdi025
Søltoft F, Hammer M, Kragh N. The association of body mass index and health-related quality of life in the general population: data from the 2003 Health Survey of England. Qual Life Res. 2009;18(10):1293-9. http://dx.doi.org/10.1007/s11136-009-9541-8
Ford ES, Moriarty DG, Zack MM, Mokdad AH, Chapman DP. Self-reported body mass index and health-related quality of life: Findings from the Behavioral Risk Factor Surveillance System. Obes Res. 2001;9:21-31. http://dx.doi.org/10.1038/oby.2001.4
Nishina M., Nishina K., Ohira T., Makino K., Iso H. Associations of psychological distress with metabolic syndrome among Japanese urban residents. J Atheroscler Thromb. 2011;18(5):396-402. http://dx.doi.org/10.5551/jat.6692
Van Reedt Dortland A.K., Giltay E.J., Van Veen T., Zitman F.G., Penninx B.W. Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use. Acta Psychiatr Scand. 2010;122(1):30-9. http://dx.doi.org/10.1111/j.1600-0447.2010.01565.x
Luppino FS, van Reedt Dortland AK, Wardenaar KJ, Bouvy PF, Giltay EJ, Zitman FG, Penninx BW. Symptom dimensions of depression and anxiety and the metabolic syndrome. Psychosom Med. 2011;73(3):257-64. http://dx.doi.org/10.1097/PSY.0b013e31820a59c0
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;66(1):91-3. http://dx.doi.org/10.1016/j.biopsych.2009.02.020
The submission of originals to Scientia Medica implies the transfer by the authors of the right for publication. Authors retain copyright and grant the journal right of first publication. If the authors wish to include the same data into another publication, they must cite Scientia Medica as the site of original publication.
Creative Commons License
Except where otherwise specified, material published in this journal is licensed under a Creative Commons Attribution 4.0 International license, which allows unrestricted use, distribution and reproduction in any medium, provided the original publication is correctly cited.