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ORIGINAL ARTICLE
Insulin resistance, obesity, and metabolic syndrome
among non-diabetic pre- and post-menopausal
women in North Taiwan
W-Y Lin1,2,3, W-S Yang4,5,6, L-T Lee1, C-Y Chen1, C-S Liu2,3, C-C Lin2,3 and K-C Huang1
1
Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan; 2Department of Family Medicine,
China Medical University Hospital, Taichung, Taiwan; 3Department of Family Medicine, College of Medicine, China
Medical University, Taichung, Taiwan; 4Division of Endocrinology and Metabolism, Department of Internal Medicine,
National Taiwan University Hospital, Taipei, Taiwan; 5Graduate Institute of Clinical Medicine, College of Medicine,
National Taiwan University, Taipei, Taiwan and 6Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
Objective: To investigate the relationship between the metabolic syndrome and its related factors among non-diabetic pre- and
post-menopausal women in North Taiwan.
Design: A cross-sectional study in a medical center in North Taiwan.
Subjects: Five hundred and ninety-four, non-diabetic middle-aged women (age range ¼ 40–64 years, mean ¼ 48.975.4 years)
were recruited.
Measurements: The fasting plasma glucose, insulin, lipids levels and anthropometric indices were measured. The homeostasis
model assessment was applied to estimate the degree of insulin resistance (HOMA-IR). Metabolic syndrome was defined by
using the National Cholesterol Education Panel (NCEP) criteria and modified NCEP criteria (waist circumference 480 cm).
Results: The prevalence of metabolic syndrome was 6.2% using NCEP criteria, and 8.9% using modified NCEP criteria. Post-
menopausal women had a higher prevalence of metabolic syndrome and its individual components compared to pre-
menopausal women except hyperglycemia and low HDL-C. In multiple logistic regression analysis with adjustment for age and
menopausal status, both BMI and HOMA-IR were independently associated with the metabolic syndrome.
Conclusion: The prevalence of metabolic syndrome was higher in post-menopausal than pre-menopausal women. Both obesity
and insulin resistance may play an important role in the development of metabolic syndrome among the middle-aged women in
North Taiwan.
International Journal of Obesity (2006) 30, 912–917. doi:10.1038/sj.ijo.0803240; published online 24 January 2006
Prevalence
15%
Systolic BP (mmHg)a 116.2715.7 122.5718.6 o0.001
Diastolic BP (mmHg)a 70.0711.3 76.6711.3 o0.001
Fasting glucose (mmol/l)a 5.2370.76 5.2570.60 0.372
TCHOL (mmol/l) 5.1870.84 5.5671.02 o0.001 10%
Triglycerides (mmol/l)a 1.0370.67 1.3270.81 o0.001
HDL-C (mmol/l) 1.4670.38 1.6070.44 o0.001
LDL-C (mmol/l) 3.2570.78 3.3970.93 0.051
TCHOL/HDL-Ca 3.7471.06 3.7271.14 0.533 5%
Insulin (pmol/l)a 50.0727.8 55.1747.7 0.497
HOMA-IRa 1.6171.04 1.7871.49 0.345
BMI, body mass index; WC, waist circumference; TCHO, total cholesterol; 0%
HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein 1 2 3 4
cholesterol; HOMA-IR, insulin resistance index by HOMA. Data are means Quartiles of HOMA-IR groups
7s.d. *Student’s t-test for unpaired data was used for the comparison of mean
values between groups. aStatistics were tested using the log-transformed p<0.001
values.
b
p<0.001
25%
p<0.001
Table 2 Prevalence (%) and crude odds ratios (OR) of metabolic syndrome 20%
and its individual components among pre- and post-menopausal women
(n ¼ 594)
15%
(%) (n ¼ 360) (%) (n ¼ 234) p<0.05
a w
Menopause 2.56 (1.44–4.56) 1.30 (0.61–2.81) 1.33 (0.62–2.86) 2.18 (066–7.24) 2.04 (0.61–6.83)
Age (years) F 1.10 (1.03–1.18)w 1.06 (0.99–1.14) 1.09 (0.98–1.22) 1.10 (0.98–1.22)
BMI (1) F F 1.00 (Reference) F 1.00 (Reference)
BMI (2) F F 3.88 (0.43–35.1) F 1.34 (0.12–14.6)
BMI (3) F F 13.3 (1.73–102.9)* F 2.13 (0.23–20.0)
BMI (4) F F 34.1 (4.58–254.3)w F 3.80 (0.42–34.2)
HOMA-IR (1) F F F 1.00 (Reference) 1.00 (Reference)
HOMA-IR (2) F F F 1.85 (0.16–21.2) 1.34 (0.11–16.1)
HOMA-IR (3) F F F 5.31 (0.60–47.2) 3.81 (0.41–35.8)
HOMA-IR (4) F F F 20.7 (2.64–162.2)w 12.1 (1.42–103.1)*
*Po0.05, wPo0.01, zPo0.001. aReference was pre-menopausal women. BMI and HOMA-IR were grouped in quartiles (o21.2, 21.2–22.7, 22.8–25.0, X25.1 kg/m2
in BMI, and o0.92, 0.93–1.39, 1.40–2.13, X2.14 in HOMA-IR). Group 1 is the lowest (reference), and Group 4 is the highest group.
status, BMI, and HOMA-IR quartiles as independent variables atherogenic lipid profile, and high blood pressure.12,28–30
are shown in Table 3. With age, menopausal status, and BMI The emergence of these CVD risk factors may be a direct
quartiles as the independent variables, the odds ratios of result of ovarian failure, or an indirect result of the metabolic
having metabolic syndrome increase with the increments of consequences of body fat centralization with estrogen
BMI groups in model 3. With age, menopausal status, and deficiency. Previous studies have also demonstrated that
HOMA-IR quartiles as the independent variables, the odds menopause is associated with a modest increase in total
ratios of having metabolic syndrome increase with the fatness and an accelerated accumulation of central body fat
increments of HOMA-IR groups in model 4. However, only that exceeds changes normally attributed to the aging
the highest HOMA quartile is significantly associated with process.28 Similarly in our studies, post-menopausal women,
the odds ratio of metabolic syndrome when putting age, when compared to pre-menopausal women, had a higher
menopausal status, BMI and HOMA-IR groups into the WC, plasma triglycerides level and blood pressure (Table 1).
independent variables in model 5. Although menopausal In addition, most studies have shown that plasma HDL-C
status is significantly associated with the metabolic syn- levels either fall slightly12,13,31 or remain stable11 with
drome in model 1 (Po0.01), no statistical significance of menopause. However, plasma HDL-C levels have been found
menopausal status versus the metabolic syndrome was found to increase with menopause in Koreans and Iranians.29,32 In
in other models. our study, plasma HDL-C level increased with menopause
and the prevalence of low HDL-C decreased with menopause
(Tables 1 and 2).
The literature to date is not clear as to whether menopause
Discussion itself is directly associated with increased insulin resistance.
Lindheim et al.,33 for example, have found reduced insulin
Post-menopausal women have been found to be at higher sensitivity (i.e. higher insulin resistance) in post-menopausal
risk for metabolic syndrome than pre-menopausal women in women, compared with BMI-matched pre-menopausal
Americans.27 Similarly in our study, we also demonstrated women. However, others have shown no significant differ-
that the prevalence of metabolic syndrome was higher in ence in insulin sensitivity among post-menopausal women
post-menopausal than pre-menopausal women (9.4 versus compared to pre-menopausal women.34,35 In our study, there
4.2% using the NCEP criteria, and 13.7 versus 5.8% using the was no significant difference in fasting plasma glucose,
modified NCEP criteria). Furthermore, we found that both insulin levels, HOMA-IR, and prevalence of hyperglycemia
BMI and insulin resistance index were independently between pre-menopausal and post-menopausal women
associated with the prevalence of metabolic syndrome in (Tables 1 and 2).
non-diabetic, aged 40–64 years women. However, with It has been recognized that the underlying pathophysiol-
adjustment for age, BMI, insulin resistance, there was an ogy of metabolic syndrome is related to hyperinsulinemia
increased odds ratio of having metabolic syndrome without and insulin resistance.1,22–24,36 However, other studies have
statistically significant difference in post-menopausal wo- shown that obesity is the central feature of metabolic
men. It could be due to the small sample size or multi- syndrome.37,38 In our study, both BMI and insulin resistance
colinearity in these variables in our study. index were independently associated with the prevalence of
The transition from pre- to post-menopause may be metabolic syndrome in non-diabetic middle-aged women,
associated with features of the metabolic syndrome, includ- adjusted for age and menopausal status (Table 3). Therefore,
ing an increased central body fat, a shift toward a more our results implicated that insulin resistance and obesity