The Influence Of Obesity On Clustering Of Metabolic Risk Factors In Pre- And Post-menopausal Women

Objective:Metabolic syndrome is a cluster of clinical syndromes with multiple metabolic risk factors,among which obesity is an important inducement of clustering of metabolic risk factors included hypertension,diabetes and dyslipidemia.Due to changes in hormone levels,the prevalence of obesity and metabolic syndrome significantly increases in women around menopause,and different obesity indexes can effectively predict of multiple metabolic risk factors.The purpose of this study is to investigate the prevalence of obesity and metabolic risk factors in menopausal women during reproductive aging,to explore the influence of reproductive aging status,obesity which are measured by anthropometry and bioelectrical impedance analysis,on clustering of metabolic risk factors,and to analyze and compare the prediction and optimal cutoff points of these obesity index to the clustering of metabolic risk factors of different stages,aim to provide reference for nurses to manage obesity and prevent and control metabolic syndrome in pre-and post-menopausal women.Methods:907 pre-and post-menopausal women aged 35 to 65 who underwent physical examination in the first hospital of Jilin University from July to September 2019 were selected to complete questionnaires,physical examination,bioelectrical impedance analysis and laboratory examination.The questionnaires included demographic data such as age,reproductive health status,disease history,medication history and lifestyle.Physical examination included height,weight,waist circumference(WC),hip circumference and blood pressure,and body mass index(BMI),waist-hip rate(WHR)and waist-to-height ratio(WHtR)were calculated.Bioelectrical impedance method was used to measure body fat percentage(BFP)and visceral fat area(VFA).Laboratory examination included fasting blood glucose,triglyceride and HDL cholesterol.EpiData 3.1 and IBM SPSS 24.0 were used for data entry and statistical analysis.The component ratio was used to describe qualitative data,and the chi-square test or Fisher’s exact test was used for the comparison between groups.The quantitative data were described by means ± standard deviation or quartile,and the comparison between groups was performed by one-way ANOVA or Kruskal-Wallis test.Binary logistic regression analysis was used to investigate the effects of obesity and reproductive aging on the clustering of at least 2 metabolic risk factors(except obesity)in women.Receiver operating characteristic curve(ROC)analysis was used to determine the predictor value of obesity indexes on the clustering of at least 2 metabolic risk factors(except obesity)in women at each stage of reproductive aging,cutoff points were obtained from the Youden’s index.Odds ratios and 95% confidence intervals were used to describe the intensity of the association between the cutoff value of each obesity index and clustering of at least two metabolic risk factors(except obesity),which were adjusted by socio-demographic and lifestyle variables.Results:1.Among 907 pre-and postmenopausal women aged 35-65 years in Changchun,9.92% and 20.73% are classified as metabolic syndrome and clustering of at least two metabolic risk factors except obesity.2.In addition to low HDL cholesterol level,the prevalence of metabolic syndrome,abdominal obesity,hypertension,diabetes and hypertriglyceridemia increase with the progression of reproductive aging,and the prevalence of abdominal obesity and hypertriglyceridemia significantly increase during the menopause(P<0.05).3.High BMI is an independent risk factor for clustering of metabolic risk factors around menopause(OR=1.76,95%CI: 1.03-3.00),but reproductive aging has no significant effect on it.4.Four obesity indexes measured by anthropometry(BMI,WC,WHR,WHtR)and two by bioelectrical impedance analysis(BFP,VFA)all have certain accuracy in the prediction of the clustering of at least two metabolic risk factors(except obesity)in women at each stage of reproductive aging(AUC>0.5).WC is the best index to predict clustering of at least two metabolic risk factors in women during reproductive period(AUC=0.706,95%CI: s0.63-0.78),while VFA is the best index in both menopausal transition and postmenopausal women(AUC=0.679,95%CI: 0.59-0.77;AUC=0.665,95%CI: 0.59-0.74).The predictive effect of BFP was not better than that of BMI.5.The cut-off values for women during reproductive period are 24.42kg/m2,80.5cm,0.82,0.51,35.84% and 88.65cm2 for BMI,WC,WHR,WHtR,BFP and VFA;23.58 kg/m2,80.5cm,0.86,0.51,33.15% and 100cm2 in women during menopausal transition;22.58kg/m2,78.50 cm,0.81,0.47,35.37% and 105.2cm2 in postmenopausal women.6.The cut off of BMI,VFA and WHtR have the most correlated with the clustering of at least two metabolic risk factors(except obesity)in women during reproductive,menopausal transition and postmenopausal period,respectively(OR=5.86,95%CI: 3.16-10.88;OR=3.97,95%CI: 1.91-8.26;OR=4.12,95%CI: 1.81-9.39).Conclusion:1.The prevalence for pre-and post-menopausal women of metabolic syndrome and clustering of risk factors is high,and increases in the process of reproductive aging in Changchun,Jilin province.In particular,the metabolic risk factors should be timely controlled during the menopausal transition.2.The prevalence rates of general and abdominal obesity measured by all indicators increase in the progression of female reproductive aging,and high BMI can significantly increase the risk of clustering of metabolic risk factors,so women should not only control of general but also abdominal obesity before and after menopause.3.The predictive effect of obesity indexes measured by bioelectrical impedance analysis on clustering of metabolic risk factors is not always better than that measured by anthropometry;WC has the best prediction effect on clustering of metabolic risk factors of women in the reproductive period,and the VFA has the best prediction effect on it in women during menopausal transition and post-menopause.4.The cutoff values of optimal obesity indexes for the clustering of at least two metabolic risk factors in women at each stage of reproductive aging are different,most of which are different from the current standard.5.The new cutoff values of the obesity indexes are highly correlated with clustering of at least two metabolic risk factors in women at each reproductive aging stage,which can be used as a reference for weight control in women in each period.However,they still need to be confirmed by a cohort study.