Diabetes and Metabolism Journal

Korean Diabetes Association (대한당뇨병학회)
권호 표지

Relationship between Menopausal Status and Metabolic Syndrome Components in Korean Women

폐경 여성에서 폐경과 대사증후군 관련인자들의 상관관계

Koh, Jang-Hyun;Lee, Mi-Young;Nam, Soo-Min;Sung, Joong-Kyung;Jung, Pil-Moon;Noh, Jin-Kyu;Shin, Jang-Yel;Shin, Young-Goo;Chung, Choon-Hee
고장현;이미영;남수민;성중경;정필문;노진규;신장열;신영구;정춘희

  • Published : 2008.06.01
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Abstract

Background: Postmenopausal status is associated with a 60% increased risk for metabolic syndrome. It is thought to be associated with decreased estrogens and increased abdominal obesity in postmenopausal women with metabolic syndrome. The purpose of this study was to investigate the association between metabolic syndrome components and menopausal status.Methods: A total of 1,926 women were studied and divided into three groups according to their menstrual stage(premenopausal, perimenopausal or postmenopausal). The presence of metabolic syndrome was assessed using the National Cholesterol Education Program's(NCEP) Adult Treatment Panel Ⅲ criteria. Results: The prevalence of metabolic syndrome was 7.1% in premenopause, 9.8% in perimenopause, and 24.2% in postmenopause. The strong correlation was noted between the metabolic syndrome score and waist circumference in postmenopause(r = 0.56, P < 0.01) and perimenopause(r = 0.60, P < 0.01). Along the menopausal transition, the risk of metabolic syndrome increased with high triglyceride after the age-adjusted(odds ratio(OR) 1.517 [95% confidence interval(CI) 1.014~2.269] in perimenopausal women and OR 1.573 [95% CI 1.025~2.414] in postmenopausal women). In addition, the prevalence of metabolic syndrome increased in accordance with elevated alanine aminotransferase(ALT) and gamma-glutamyl transpeptidase(GGT) levels. Conclusion: Triglyceride and waist circumference were important metabolic syndrome components, though ALT and GGT may also be related for predicting metabolic syndrome during the transition to menopause. (KOREAN DIABETES J 32:243-251, 2008)

연구배경: 폐경 여성에 있어서 심혈관계질환의 유병률은 증가하는 것으로 알려져 있으며, 이러한 증가는 폐경 전기에서 폐경 후기로 변화하는 여성에서 나타나는 연속적인 호르몬 변화에 의한 것으로 생각되고 있다. 특히 폐경 후기에는 대사증후군의 위험도가 약 60% 정도 증가하는 것으로 알려져 있으며, 원인인자로서 저밀도지단백 콜레스테롤의 증가, 에스트로겐의 감소, 복부비만 등의 발생이 영향을 미치는 것으로 알려져 있으나 아직 확실히 밝혀져 있지는 않다. 따라서 본 연구의 목적은 폐경기를 지나가는 동안 각 단계에서 폐경과 대사증후군과 관련된 주요인자들의 관계를 알아보고자 하였다.방법: 2005년 3월부터 2006년 2월까지 연세대학교 원주의과대학 원주기독병원 종합건강검진센터를 방문한 여성을 대상으로 하였다. 총 1,926명을 대상으로 검진 당시 시행한 설문지를 바탕으로 폐경 유무에 따라 폐경전기(premeno- pausal status), 주폐경기(perimenopausal status), 폐경후기(postmenopausal status)의 3구분으로 분류하였다. 수축기 혈압, 이완기 혈압, 허리둘레, 체질량지수 등을 측정하였으며, 공복 시에 혈당, ALT, GGT, 중성지방, 고밀도지단백 콜레스테롤 등을 측정하였다. 대사증후군의 진단기준으로는 NCEP ATP III의 기준을 보완하여 이용하였다.결과: 대사증후군의 유병률은 폐경전기 7.1%, 주폐경기 9.8%, 폐경후기 24.2%이었다. 폐경전기에서 폐경후기로 갈수록 허리둘레, 혈압, 체질량지수, ALT, GGT와 공복혈당 등은 통계적으로 유의하게 증가하였으며(P < 0.001), 이중 허리둘레의 증가가 폐경후기에서 대사증후군 구성인자 수의 증가와 높은 상관관계를 나타냈다(r = 0.56, P < 0.01). 폐경전기에서 폐경후기로 갈수록 대사증후군 구성인자의 비교 위험률은 나이를 보정했을 경우 중성지방이 의미 있는 결과를 보였다(주폐경기, OR 1.517 [95% CI 1.014~2.269] 폐경후기, OR 1.573 [95% CI 1.025~2.414]). 또한 여성전체에서 ALT와 GGT의 상승에 따라 대사증후군 발생 위험률도 증가하였다.

Keywords

References

  1. Peters HW, Westendorp IC, Hak AE, Grobbee DE, Stehouwer CD, Hofman A, Witteman JC: Menopausal status and risk factors for cardiovascular disease. J Intern Med 246:521-8, 1999 https://doi.org/10.1046/j.1365-2796.1999.00547.x
  2. Cabrera MA, Gebara OC, Diament J, Nussbacher A, Rosano G, Wajngarten M: Metabolic syndrome, abdominal obesity, and cardiovascular risk in elderly women. Int J Cardiol 114:224-9, 2007 https://doi.org/10.1016/j.ijcard.2006.01.019
  3. Kuh D, Langenberg C, Hardy R, Kok H, Cooper R, Butterworth S, Wadsworth ME: Cardiovascular risk at age 53 years in relation to the menopause transition and use of hormone replacement therapy: a prospective British birth cohort study. Bjog 112:476-85, 2005
  4. Matthews KA, Wing RR, Kuller LH, Meilahn EN, Plantinga P: Influence of the perimenopause on cardiovascular risk factors and symptoms of middle-aged healthy women. Arch Intern Med 154:2349-55, 1994 https://doi.org/10.1001/archinte.154.20.2349
  5. Matthews KA, Kuller LH, Sutton-Tyrrell K, Chang YF: Changes in cardiovascular risk factors during the perimenopause and postmenopause and carotid artery atherosclerosis in healthy women. Stroke 32:1104-11, 2001 https://doi.org/10.1161/01.STR.32.5.1104
  6. Torng PL, Su TC, Sung FC, Chien KL, Huang SC, Chow SN, Lee YT: Effects of menopause on intraindividual changes in serum lipids, blood pressure, and body weight--the Chin-Shan Community Cardiovascular Cohort study. Atherosclerosis 161:409-15, 2002 https://doi.org/10.1016/S0021-9150(01)00644-X
  7. Carr MC: The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 88:2404-11, 2003 https://doi.org/10.1210/jc.2003-030242
  8. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB: The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 163:427-36, 2003 https://doi.org/10.1001/archinte.163.4.427
  9. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L: Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 24:683-9, 2001 https://doi.org/10.2337/diacare.24.4.683
  10. Despres JP: Abdominal obesity as important component of insulin-resistance syndrome. Nutrition 9:452-9, 1993
  11. Eckel RH, Grundy SM, Zimmet PZ: The metabolic syndrome. Lancet 365:1415-28, 2005 https://doi.org/10.1016/S0140-6736(05)66378-7
  12. Alberti KG, Zimmet P, Shaw J: Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med 23:469-80, 2006 https://doi.org/10.1111/j.1464-5491.2006.01858.x
  13. Mesch VR, Boero LE, Siseles NO, Royer M, Prada M, Sayegh F, Schreier L, Benencia HJ, Berg GA: Metabolic syndrome throughout the menopausal transition: influence of age and menopausal status. Climacteric 9:40-8, 2006 https://doi.org/10.1080/13697130500487331
  14. Brambilla DJ, McKinlay SM, Johannes CB: Defining the perimenopause for application in epidemiologic investigations. Am J Epidemiol 140:1091-5, 1994 https://doi.org/10.1093/oxfordjournals.aje.a117209
  15. Greendale GA, Lee NP, Arriola ER: The menopause. Lancet 353:571-80, 1999 https://doi.org/10.1016/S0140-6736(98)05352-5
  16. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, Oh SJ, Park CY, Yoo HJ: Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 75:72-80, 2007 https://doi.org/10.1016/j.diabres.2006.04.013
  17. Cameron AJ, Shaw JE, Zimmet PZ: The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin North Am 33:351-75, table of contents, 2004 https://doi.org/10.1016/j.ecl.2004.03.005
  18. Stern MP, Williams K, Gonzalez-Villalpando C, Hunt KJ, Haffner SM: Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease? Diabetes Care 27:2676-81, 2004 https://doi.org/10.2337/diacare.27.11.2676
  19. Roper NA, Bilous RW, Kelly WF, Unwin NC, Connolly VM: Cause-specific mortality in a population with diabetes: South Tees Diabetes Mortality Study. Diabetes Care 25:43-8, 2002 https://doi.org/10.2337/diacare.25.1.43
  20. Nakagami T: Hyperglycaemia and mortality from all causes and from cardiovascular disease in five populations of Asian origin. Diabetologia 47:385-94, 2004 https://doi.org/10.1007/s00125-004-1334-6
  21. Poehlman ET, Toth MJ, Gardner AW: Changes in energy balance and body composition at menopause: a controlled longitudinal study. Ann Intern Med 123:673-5, 1995 https://doi.org/10.7326/0003-4819-123-9-199511010-00005
  22. Lapidus L, Bengtsson C, Larsson B, Pennert K, Rybo E, Sjostrom L: Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J (Clin Res Ed) 289:1257-61, 1984 https://doi.org/10.1136/bmj.289.6454.1257
  23. You T, Ryan AS, Nicklas BJ: The metabolic syndrome in obese postmenopausal women: relationship to body composition, visceral fat, and inflammation. J Clin Endocrinol Metab 89:5517-22, 2004 https://doi.org/10.1210/jc.2004-0480
  24. Tanko LB, Bagger YZ, Qin G, Alexandersen P, Larsen PJ, Christiansen C: Enlarged waist combined with elevated triglycerides is a strong predictor of accelerated atherogenesis and related cardiovascular mortality in postmenopausal women. Circulation 111:1883-90, 2005 https://doi.org/10.1161/01.CIR.0000161801.65408.8D
  25. Florez H, Castillo-Florez S, Mendez A, Casanova-Romero P, Larreal-Urdaneta C, Lee D, Goldberg R: C-reactive protein is elevated in obese patients with the metabolic syndrome. Diabetes Res Clin Pract 71:92-100, 2006 https://doi.org/10.1016/j.diabres.2005.05.003
  26. Bengtsson C, Lapidus L, Stendahl C, Waldenstrom J: Hyperuricaemia and risk of cardiovascular disease and overall death. A 12-year follow-up of participants in the population study of women in Gothenburg, Sweden. Acta Med Scand 224:549-55, 1988
  27. Lehto S, Niskanen L, Ronnemaa T, Laakso M: Serum uric acid is a strong predictor of stroke in patients with non-insulin-dependent diabetes mellitus. Stroke 29:635-9, 1998 https://doi.org/10.1161/01.STR.29.3.635
  28. Onat A, Uyarel H, Hergenc G, Karabulut A, Albayrak S, Sari I, Yazici M, Keles I: Serum uric acid is a determinant of metabolic syndrome in a population-based study. Am J Hypertens 19:1055-62, 2006 https://doi.org/10.1016/j.amjhyper.2006.02.014
  29. Yamada J, Tomiyama H, Yambe M, Koji Y, Motobe K, Shiina K, Yamamoto Y, Yamashina A: Elevated serum levels of alanine aminotransferase and gamma glutamyltransferase are markers of inflammation and oxidative stress independent of the metabolic syndrome. Atherosclerosis 189:198-205, 2006 https://doi.org/10.1016/j.atherosclerosis.2005.11.036
  30. Choi KM, Lee KW, Kim HY, Seo JA, Kim SG, Kim NH, Choi DS, Baik SH: Association among serum ferritin, alanine aminotransferase levels, and metabolic syndrome in Korean postmenopausal women. Metabolism 54:1510-4, 2005 https://doi.org/10.1016/j.metabol.2005.05.018
  31. Marchesini G, Avagnina S, Barantani EG, Ciccarone AM, Corica F, Dall'Aglio E, Dalle Grave R, Morpurgo PS, Tomasi F, Vitacolonna E: Aminotransferase and gamma-glutamyltranspeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome. J Endocrinol Invest 28:333-9, 2005 https://doi.org/10.1007/BF03347199
  32. Sakugawa H, Nakayoshi T, Kobashigawa K, Nakasone H, Kawakami Y, Yamashiro T, Maeshiro T, Tomimori K, Miyagi S, Kinjo F, Saito A: Metabolic syndrome is directly associated with gamma glutamyl transpeptidase elevation in Japanese women. World J Gastroenterol 10:1052-5, 2004 https://doi.org/10.3748/wjg.v10.i7.1052
  33. Kim DJ, Noh JH, Cho NH, Lee BW, Choi YH, Jung JH, Min YK, Lee MS, Lee MK, Kim KW: Serum gamma-glutamyltransferase within its normal concentration range is related to the presence of diabetes and cardiovascular risk factors. Diabet Med 22:1134-40, 2005 https://doi.org/10.1111/j.1464-5491.2005.01581.x
  34. Cho GJ, Lee JH, Park HT, Shin JH, Hong SC, Kim T, Hur JY, Lee KW, Park YK, Kim SH: Postmenopausal status according to years since menopause as an independent risk factor for the metabolic syndrome. Menopause 15:524-9, 2008 https://doi.org/10.1097/gme.0b013e3181559860
  35. Kim HM, Park J, Ryu SY, Kim J: The effect of menopause on the metabolic syndrome among Korean women: the Korean National Health and Nutrition Examination Survey, 2001. Diabetes Care 30:701-6, 2007 https://doi.org/10.2337/dc06-1400