Prescott Eva, Godtfredsen Nina, Osler Merete, Schnohr Peter, Barefoot John
The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark.
Eur J Cardiovasc Prev Rehabil. 2007 Jun;14(3):405-12. doi: 10.1097/HJR.0b013e32800ff169.
Psychosocial stressors may mediate the effect of social status on the metabolic syndrome (MS). The paper explores this hypothesis in a random sample of the general population.
A total of 3462 women and 2576 men aged 20-97 years from the Copenhagen City Heart Study.
An MS index was defined from the seven components: waist-hip ratio, high-density lipoprotein (HDL)-cholesterol, triglycerides, systolic blood pressure (SBP), blood glucose, C-reactive protein (CRP) and fibrinogen. Social status was measured by educational level. Psychosocial factors included fatigue and depression, perceived stress, social network and cohabitation. Behavioural factors were smoking, alcohol and physical activity.
There was an inverse social gradient in the prevalence of the seven components of the MS. The age-adjusted odds ratio (OR) (95% confidence interval) for occupying the most disadvantaged quintile, comparing highest with lowest educational level, were for men and women, respectively: waist-hip ratio 0.48 (0.34-0.69) and 0.48 (0.33-0.69); HDL-cholesterol 0.61 (0.45-0.84) and 0.46 (0.33-0.64); triglycerides 0.71 (0.51-0.98) and 0.37 (0.25-0.53); SBP 0.64 (0.44-0.92) and 0.76 (0.50-1.15); blood glucose 0.57 (0.41-0.80) and 0.55 (0.38-0.78); CRP 0.53 (0.37-0.74) and 0.44 (0.31-0.63), and fibrinogen 0.50 (0.35-0.70) and 0.56 (0.38-0.82). The pooled OR for having an MS index score of 3 or more was 0.32 (0.24-0.42) for highest versus lowest educational level. A higher fatigue and depression score in both sexes and a lack of social support in men were associated with the MS, as were smoking, low alcohol consumption and a lack of physical activity. However, OR for educational level were not affected by adjustment for the psychosocial or behavioural factors.
There is a strong inverse social gradient in the prevalence of the MS, which is not explained by psychosocial or major behavioural factors.
心理社会压力源可能介导社会地位对代谢综合征（MS）的影响。本文在普通人群的随机样本中探讨这一假设。
来自哥本哈根城市心脏研究的3462名年龄在20 - 97岁的女性和2576名男性。
MS指数由七个成分定义：腰臀比、高密度脂蛋白（HDL）胆固醇、甘油三酯、收缩压（SBP）、血糖、C反应蛋白（CRP）和纤维蛋白原。社会地位通过教育水平衡量。心理社会因素包括疲劳和抑郁、感知压力、社交网络和同居情况。行为因素包括吸烟、饮酒和体育活动。
MS的七个成分患病率存在反向社会梯度。按年龄调整的优势比（OR）（95%置信区间），比较最高与最低教育水平，处于最不利五分位数的男性和女性分别为：腰臀比0.48（0.34 - 0.69）和0.48（0.33 - 0.69）；HDL胆固醇0.61（0.45 - 0.84）和0.46（0.33 - 0.64）；甘油三酯0.71（0.51 - 0.98）和0.37（0.25 - 0.53）；SBP 0.64（0.44 - 0.92）和0.76（0.50 - 1.15）；血糖0.57（0.41 - 0.80）和0.55（0.38 - 0.78）；CRP 0.53（0.37 - 0.74）和0.44（0.31 - 0.63），以及纤维蛋白原0.50（0.35 - 0.70）和0.56（0.38 - 0.82）。最高与最低教育水平相比，MS指数得分3或更高的合并OR为0.32（0.24 - 0.42）。男女疲劳和抑郁得分较高以及男性缺乏社会支持与MS相关，吸烟、低酒精消费和缺乏体育活动也与之相关。然而，教育水平的OR不受心理社会或行为因素调整的影响。
MS患病率存在强烈的反向社会梯度，心理社会或主要行为因素无法解释这一现象。
