Social inequalities impose negative impact in postmenopausal women with metabolic syndrome and osteoporosis

Social inequalities profoundly impact South Korean postmenopausal women who have metabolic syndrome and osteoporosis, according to a cross-sectional study in the journal Menopause.

The authors noted that prevalence of metabolic syndrome and osteoporosis in postmenopausal women has been rapidly accelerating. These two conditions frequently increase with age and coexist with menopause.

The study used data from the Korean National Health and Nutrition Examination Surveys (KNHANES IV-V, 2008-2011). A total of 1,991 postmenopausal women aged 45 to 65 were selected as a representative sample of the civilian, noninstitutional South Korean population.

The women were divided into four groups: neither metabolic syndrome nor osteoporosis (normal) (n = 253); metabolic syndrome (n = 203); osteoporosis (n = 883); and both metabolic syndrome and osteoporosis (metabolic syndrome + osteoporosis) (n = 652).

Data on socioeconomic status (education, household income, place of residence, employment status); health-related behaviors (physical activity, alcohol consumption, smoking); and diet-related factor (intake of nutrients and food groups, eating habits, food insecurity) were also obtained.

Prevalence of metabolic syndrome + osteoporosis was 32.5%, with the average number of metabolic syndrome risk factors being 3.5 in this group, which was significantly higher than that in the normal and osteoporosis groups (P < 0.001).

Bone mineral density (BMD) at all sites was also significantly lower in the metabolic syndrome + osteoporosis group compared to the normal and metabolic syndrome groups (P < 0.001).In addition, calcium, phosphorus, vitamin A, riboflavin and niacin levels were lowest in the metabolic syndrome + osteoporosis group versus the other three groups (P < 0.05).

Coexistence of metabolic syndrome and osteoporosis was positively linked to insufficient dairy intake, insufficient physical activity, and higher intake of alcohol. For instance, meal regularity and dairy product intake were insufficient compared to Dietary Reference Intakes for Koreans (KDRI): a 13.9% and 44.6% positive association between metabolic syndrome + osteoporosis and meal regularity and dairy product intake, respectively.

The study population showed a 70% ratio of carbohydrate total energy, which is higher than the recommended 55% to 65%. This higher ratio may have influenced the inadequate intake of food groups and nutrients.

Also, due to previous research that shows a significant inverse association between adherence to nutritional guidelines and overall risk of metabolic syndrome or low BMD, the authors recommended that postmenopausal women receive nutritional education and counseling.

Similarly, “Postmenopausal women who drink should be advised to drink moderately and not exceed seven units of alcohol per week,” the authors wrote.

After adjusting for covariates, the study found that low-income and low-education (elementary school or less) women were more likely to have metabolic syndrome + osteoporosis: odds ratio (OR) 1.97; 95% confidence interval (CI): 1.04 to 3.72.

Conversely, high-income and high-education (high school or more) women were 70% less likely than middle-income and middle-education women to have metabolic syndrome + osteoporosis: OR 0.30; 95% CI: 0.10 to 0.86.

Study results indicate that “social and political perspective approaches are required in this population for prevention and treatment of metabolic syndrome and osteoporosis,” the author wrote.

The authors said future studies should explore controllable factors for metabolic syndrome and osteoporosis to improve health status in postmenopausal women.