社会决定因素和生活方式在围绝经期过渡期间对女性代谢风险的作用：一项队列研究的结果

Kim Sue, Ko Yunhee, Yi Gihong

1College of Nursing, Mo-Im Kim Nursing Research Institute 2College of Nursing, Yonsei University, Seoul 3Department of Sociology, Hallym University, Chuncheon, Korea.

Menopause. 2016 Apr;23(4):403-9. doi: 10.1097/GME.0000000000000544.

OBJECTIVE

Social determinants have been understudied in relation to metabolic risk and menopause; this study aimed to identify metabolic risk factors during menopausal transition, changes in lifestyle, and other social determinants.

METHODS

The Korean Genetic Epidemiologic Survey Community cohort data available for baseline, 2-year, and 4-year follow-up time points were analyzed. Healthy women ages 45 to 55 years, not taking hormonal therapy, were selected; 1,228 were analyzed. Menopausal transition was categorized as premenopausal, perimenopausal, and postmenopausal. Lifestyle patterns consisted of alcohol consumption, exercise, ever smoking, indirect smoking, and eating breakfast. Generalized estimating equations were used for analysis.

RESULTS

During the period of study, roughly 30% had become postmenopausal and metabolic syndrome was found in 11.5% to 14.4%. Controlling for other variables, lower income levels showed more than 2 times greater risk for metabolic syndrome in postmenopausal women and those who continued to menstruate. Body mass index was a consistent factor of metabolic risk, which was more pronounced when analyzed by menopausal status, especially in obese menstruating women (odds ratio 30.72, P < 0.0001). Among women who experienced menopause during the observed time frame, less education and sedentary lifestyle were also significant factors in metabolic risk differences, showing 1.7 times and 1.59 times greater risk, respectively. Such differences in education, income, and sedentary lifestyle as significant risk factors in subgroups according to menstrual status change, may suggest vulnerable points in the transition.

CONCLUSIONS

Implications include the need for stronger emphasis on weight control before midlife and experiencing menopause, promoting exercise across the menopausal transition, and supportive policy measures for economically disadvantaged women.

目的

社会决定因素在代谢风险和更年期方面的研究较少；本研究旨在确定绝经过渡期间的代谢风险因素、生活方式变化及其他社会决定因素。

方法

分析韩国遗传流行病学调查社区队列中可获得的基线、2年和4年随访时间点的数据。选取年龄在45至55岁、未接受激素治疗的健康女性；共分析了1228例。绝经过渡分为绝经前、围绝经期和绝经后。生活方式模式包括饮酒、运动、曾经吸烟、被动吸烟和吃早餐。采用广义估计方程进行分析。

结果

在研究期间，约30%的女性进入绝经后阶段，11.5%至14.4%的女性患有代谢综合征。在控制其他变量后，低收入水平使绝经后女性和仍有月经的女性患代谢综合征的风险增加2倍以上。体重指数是代谢风险的一个持续因素，按绝经状态分析时更为明显，尤其是在肥胖的有月经女性中（比值比30.72，P<0.0001）。在观察期内经历绝经的女性中，受教育程度较低和久坐不动也是代谢风险差异的重要因素，风险分别高出1.7倍和1.59倍。根据月经状态变化，教育、收入和久坐生活方式等差异作为亚组中的重要风险因素，可能表明了绝经过渡中的脆弱点。