Health-related quality of life in adults with metabolic syndrome: Qazvin metabolic disease study, Iran

Farnoosh Rashvand; Azam Ghorbani; Neda Esmailzadehha

doi:10.4103/shb.shb_72_20

ORIGINAL ARTICLE

Year : 2021 | Volume : 4 | Issue : 2 | Page : 69-73

Health-related quality of life in adults with metabolic syndrome: Qazvin metabolic disease study, Iran

Farnoosh Rashvand¹, Azam Ghorbani¹, Neda Esmailzadehha²
¹ Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
² Student Research Committee, School of Health Branch, Iran University of Medical Sciences, Tehran, Iran

Date of Submission	24-Oct-2020
Date of Decision	23-Nov-2021
Date of Acceptance	19-Jan-2021
Date of Web Publication	28-May-2021

Correspondence Address:
Azam Ghorbani
Metabolic Diseases Research Center, Velayat Hospital, Qazvin
Iran

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/shb.shb_72_20

Abstract

Introduction: As components of the metabolic syndrome (MetS), obesity, hypertension, and diabetes have been associated with decreased health-related quality of life (HQoL). The purpose of this study was to investigate the association of HQoL and MetS in Qazvin, Iran. Methods: In a cross-sectional design, 1071 people in Qazvin were identified via multi-stage cluster random sampling. MetS was defined based on the Adult Treatment Panel III criteria. HQoL was assessed using a 36-Item Short Form Health Survey (SF-36) questionnaire. Data were analyzed using the Chi-square test and analyses of covariance. Results: Of 1071 people, 328 participants had MetS. Mean scores of whole domains of the SF-36 scale in MetS participants was lower than subjects without MetS. Mean scores of physical functioning (74.0 ± 23.4 vs. 82.2 ± 20.1, P < 0.001), bodily pain (61.3 ± 22.7 vs. 65.1 ± 20.6, P = 0.009), and general health (59.4 ± 18.2 vs. 63.5 ± 17.3, P < 0.001) domains were statistically different between participants without MetS and those with MetS. The mean scores of mental domains were not signiﬁcantly different between the two groups. After adjusting for age and gender, domains of HQoL were not significantly different between the two groups. Conclusion: After adjusting for age and gender, no association was observed between QoL domains and MetS. From a public health perspective, the increasing prevalence of MetS in the Iranian population requires effective health promotion policies and lifestyle modification to improve the patients' HQoL.

Keywords: Adult, metabolic syndrome, quality of life, risk factors

How to cite this article:
Rashvand F, Ghorbani A, Esmailzadehha N. Health-related quality of life in adults with metabolic syndrome: Qazvin metabolic disease study, Iran. Asian J Soc Health Behav 2021;4:69-73

How to cite this URL:
Rashvand F, Ghorbani A, Esmailzadehha N. Health-related quality of life in adults with metabolic syndrome: Qazvin metabolic disease study, Iran. Asian J Soc Health Behav [serial online] 2021 [cited 2023 Dec 3];4:69-73. Available from: http://www.healthandbehavior.com/text.asp?2021/4/2/69/317108

Introduction

Metabolic syndrome (MetS), also known as Syndrome X or Obesity Syndrome, is a chronic and progressive disorder mainly caused by inactivity and consuming a diet high in fat and sugar.^[1],[2] Insulin resistance, high blood pressure (BP), high blood cholesterol (Chol), and abdominal obesity are all subsidiary to MetS, which increases the risk of diabetes mellitus, cardiovascular diseases, and ultimately death.^[3],[4] MetS increases the risk of mortality from diabetes mellitus and cardiovascular problems, and recent studies allude to a correlation between MetS and the risk of mortality from other diseases. Gathirua-Mwangi et al., for example, recently reported a 33% elevated risk for death among cancer patients with MetS.^[5] MetS can result in significant physical and psychological impairment.^[1] The prevalence of MetS is high in the Iranian population compared to other Asian populations. One recent study in India reported a MetS prevalence of about 40%,^[6] while another epidemiological study in China reported the prevalence of MetS at 24.5%.^[7] A 2015 systematic review reported the prevalence of MetS in Iran at 10%–60%.^[8]

With regard to signs and symptoms that people with MetS experienced, MetS can affect suffered persons negatively. Nowadays, personal well-being has received more attention for evaluation of the outcome of clinical studies and practice in all health-care settings. Quality of life (QoL) is a subjective issue that is considered an important health outcome in recent years.^[5] After the definition of human health by the World Health Organization, personal QoL issue has become increasingly important and has received more attention in health-care practice and medical research.^[9] In one study conducted in the United States, Ford and Lee demonstrated that MetS had a significant negative effect on the health-related QoL (HQoL) of sufferers more than 20 years old.^[10] In another study, Tziallas et al. found that MetS had a deleterious effect on the QoL of adults in Greece.^[1] Although in recent years, the interest of researchers' in studying QoL among MetS people has increased, few studies have explored the HQoL in the Iranian population with MetS. On the other hand, most studies on HQoL and MetS in the Iranian setting are limited to patients with comorbidities; for example, lower limb amputees with MetS and studies of post-menopausal women with MetS.^[11],[12] These studies, however, have failed to demonstrate any consensus. For instance, while some studies might report a decreased QoL among MetS sufferers,^[13] others have reported no discernible deterioration in QoL.^[14] The purpose of the present study was to determine the association of HQoL and MetS in Qazvin, Iran.

Methods

This cross-sectional study was conducted on 1071 people ≥20 years old between September 2010 and April 2011 in Minoodar district of Qazvin, Iran. The study was approved by the ethics committee of Qazvin University of Medical Sciences (IR.QUMS.REC.1397.408).

The study population was selected through multistage cluster random sampling method, and the sampling unit was the household. All participants were invited by telephone to attend the study site. After explaining the purpose and details of the study to the participants, they were free to participate. Written informed consent was taken from all participants. The exclusion criteria were pregnancy, history of malignancy, or mental diseases. Detailed information about the methods and sampling of this study is available elsewhere.^[15],[16]

Demographic and social data were self-reported in the questionnaire given to the subjects. Two general practitioners completed an organized questionnaire including medical history and physical examination. All anthropometric and laboratory measurements from each participant were taken after a 12–14 h overnight fast. Anthropometric indices including waist circumference (WC), weight, height, and body mass index (BMI) were measured. WC was measured to the nearest 0.1 cm using a flexible, nonelastic measuring tape midway between the costal margin and the iliac crest at the end of normal expiration. BMI was calculated as weight (kg) divided by height (m) squared. BP was measured three times on a single occasion by a mercury sphygmomanometer, in a seated position, and after a 15 min rest.

All the samples were analyzed at the same laboratory on the day of blood collection. Blood levels of glucose, total Chol, high-density lipoprotein Chol (HDL-C), and triglycerides (TGs) were measured in all subjects.

MetS was identified according to the Adult Treatment Panel III criteria.^[17] Any participant who had at least three components was considered as having MetS: (1) WC ≥102 cm in males and ≥88 cm in females; (2) TGs ≥150 mg/dl; (3) HDL <40 mg/dl in males and <50 mg/dl in females, (4) fasting blood sugar ≥100 mg/dl (includes diabetes); and (5) systolic BP (SBP) ≥130 mmHg and diastolic BP (DBP) ≥85 mmHg.

Participants answered the demographic questionnaire and the Iranian version of the 36-Item Short Form Health Survey (SF-36) individually. The SF-36 is a self-report multidimensional questionnaire used for assessing a patient's health across eight domains: physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health. These domains were summarized into physical component summary (PCS) and mental component summary, which have been constructed by multiplying each SF-36 scale z score by its respective physical and mental factors scoring coefficient and summing the eight products. SF-36 scores are tallied against a scale ranging 0–100, with higher scores being indicative of a better QOL. Previous studies have determined the validity and reliability of the Iranian version of the SF-36.^[18],[19]

For data analysis, we used descriptive test (frequency, mean and standard deviation), Chi-square, independent t-test, two-way multivariate analyses of covariance (ANOVA), and one-way ANOVA were performed using Predictive Analytics Software (IBM, SPPS CROP, NEWYORK USA). P value lower than 0.05 was considered significant.

Results

Among 1071 study participants, 556 (51.9%) were female. The participants had the mean age of 40.08 ± 10.33 and were between 20 and 78 years old. 328 subjects (30.6%) had MetS. The prevalence of MetS was 28.73% in males and 32.37% in females (P = 0.208). Subjects with MetS were older than those without MetS. The academic education level was higher in those without MetS than in those with MetS (22.7% vs. 11.1%, respectively, P < 0.001). [Table 1] shows the clinical and biochemical characteristics of the subjects. BMI, WC, systolic, diastolic pressure, and biochemical characteristics were significantly different between subjects with and without Mets.

Table 1: Clinical and biochemical characteristics of participants with and without metabolic syndrome

Click here to view

Comparison of HQoL domains in participants with and without MetS is shown in [Table 2]. There was a gradual decrease in the mean scores of the whole domain of the short-form 36 scale in MetS participants than in subjects without MetS. The mean scores in the physical functioning, bodily pain, and general health domains were signiﬁcantly different between participants without MetS and those with MetS. The mean scores of PCS were significantly different between the two groups (P < 0.001). In sub-group analysis, females with MetS were reported significantly (P: 0.020) worse bodily pain domain compared to those without Mets. The differences in mean scores for mental domains were not statistically signiﬁcant between the study groups. However, after adjusting for age and gender, there was no significant difference between the two groups.

Table 2: Comparison of health-related quality of life domains in participants with and without metabolic syndrome

Click here to view

Discussion

The prevalence of MetS and associated diseases has become a serious health challenge in many countries around the world. MetS is associated with an increased risk of heart disease, diabetes, kidney disease, and even cancer.^[20] The aim of the present study was to compare HQoL in adults with and without MetS. According to the results, Iranian people with MetS have a significantly lower QoL (especially physical domain) than those without it.

In the present study, we measured WC, BMI, fasting blood glucose, HDL-C, triglycerides, total Chol, SBPs, and DBP. Results revealed that participants without MetS have a better situation in all of these mentioned items in comparison to those with MetS. These clinical signs and symptoms that occur as a result of MetS can exert a deleterious effect on the QoL of people with MetS.^[17]

The results of the present study revealed that approximately one-third of investigated people had MetS. The results of national and international MetS prevalence studies are consistent with the findings of the present study.^[20] In the present study, the mean scores in the physical functioning, bodily pain, and general health domains were signiﬁcantly different between the participants without MetS and those with MetS, which is in agreement with the findings of previous studies.^{[21],[22],[23],[24]} In a large study by Amiri et al. among 950 Iranian people using SF-36, QoL in subjects with MetS had been affected negatively just in the physical domain, and negative changes of QoL in women were more than men.^[21] In another study, using structural equation modeling, Amiri et al. found that gender differences in the association between MetS components and physical HRQoL could mostly be attributed to the different structures of the constructs in men and women.^[24] The effect of age and education on physical HRQoL in women was via MetS components.^[24]

Among the previous studies, only one had inconsistent results with the present study. In this study, social relations and physical health scores in women without MetS were lower compared to those with MetS.^[14] Sarrafzadegan et al. considered four possible explanations for their different results including difference in QoL assessment tools in different studies, differences in criteria for MetS definition in different studies, the difference in designs used by different studies, and socioeconomic and cultural status of samples in different studies.^[14]

The reasons for this reduced QoL in MetS can be multi-factorial. Some articles suggested that obesity among people with MetS often prevented them from properly performing their daily activities; changes in blood glucose levels caused tiredness and weakness, while high SP often resulted in pain. Consequently, these problems can not only impair a person's social functioning, but they have a significant adverse effect on the QoL.^[25]

Given the importance of QoL, researchers have shown considerable interest in identifying preventive and therapeutic interventions that might improve the QoL in people with MetS. Several studies have shown that taking simple steps, such as modifying diet and having exercise programs can significantly improve QoL in people with MetS.^{[7],[26],[27]} However, it should be noted that most of these studies have been conducted in developed countries. The lifestyle changes demanded by people living in developed countries may not be consistent or culturally appropriate for people with MetS in Iran. As such, there is a clear need to conduct further investigations to determine culturally appropriate lifestyle changes.

Conclusion

In the present study, after adjusting for age and gender, no association was observed between QoL domains and MetS. From a public health perspective, the increasing prevalence of MetS in the Iranian population requires effective health promotion policies and lifestyle modification to improve the patients' HQoL.

Acknowledgment

The authors would like to thank the participants involved in the study and the Research Department of Qazvin University of Medical Science for endorsing the project.

Financial support and sponsorship

This study was supported by a grant from the Research Department of Qazvin University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.

References

1.	Tziallas D, Kastanioti C, Kostapanos MS, Skapinakis P, Elisaf MS, Mavreas V. The impact of the metabolic syndrome on health-related quality of life: A cross-sectional study in Greece. Eur J Cardiovasc Nurs 2012;11:297-303.
2.	O'Neill S, O'Driscoll L. Metabolic syndrome: A closer look at the growing epidemic and its associated pathologies. Obes Rev 2015;16:1-2.
3.	Cornier MA, Dabelea D, Hernandez TL, Lindstrom RC, Steig AJ, Stob NR, et al. The metabolic syndrome. Endocr Rev 2008;29:777-822.
4.	Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-28.
5.	Gathirua-Mwangi WG, Monahan PO, Murage MJ, Zhang J. Metabolic syndrome and total cancer mortality in the Third National Health and Nutrition Examination Survey. Cancer Causes Control 2017;28:127-36.
6.	Krishnadath IS, Toelsie JR, Hofman A, Jaddoe VW. Ethnic disparities in the prevalence of metabolic syndrome and its risk factors in the Suriname Health Study: A cross-sectional population study. BMJ Open 2016;6:e013183.
7.	Li R, Li W, Lun Z, Zhang H, Sun Z, Kanu JS, et al. Prevalence of metabolic syndrome in Mainland China: A meta-analysis of published studies. BMC Public Health 2016;16:296.
8.	Hajian-Tilaki K. Metabolic syndrome and its associated risk factors in Iranian adults: A systematic review. Caspian J Intern Med 2015;6:51-61.
9.	De Wit M, Hajos T. Health-Related Quality of Life. New York: Springer; 2013. p. 929-31.
10.	Ford ES, Li C. Metabolic syndrome and health-related quality of life among U.S. adults. Ann Epidemiol 2008;18:165-71.
11.	Ejtahed HS, Soroush MR, Hasani-Ranjbar S, Angoorani P, Mousavi B, Masumi M, et al. Prevalence of metabolic syndrome and health-related quality of life in war-related bilateral lower limb amputees. J Diabetes Metab Disord 2017;16:17.
12.	Amiri P, Deihim T, Nakhoda K, Hasheminia M, Montazeri A, Azizi F. Metabolic syndrome and health-related quality of life in reproductive age and post-menopausal women: Tehran Lipid and Glucose Study. Arch Iran Med 2014;17:423-8.
13.	Jahangiry L, Shojaeezadeh D, Montazeri A, Najafi M, Mohammad K. Health-related quality of life among people participating in a metabolic syndrome E-screening program: A web-based study. Int J Prev Med 2016;7:27. [PUBMED] [Full text]
14.	Sarrafzadegan N, Gharipour M, Ramezani MA, Rabiei K, Zolfaghar B, Tavassoli AA, et al. Metabolic syndrome and health-related quality of life in Iranian population. J Res Med Sci 2011;16:254-61.
15.	Ghorbani A, Ziaee A, Esmailzadehha N, Javadi H. Association between health-related quality of life and impaired glucose metabolism in Iran: The Qazvin Metabolic Diseases Study. Diabet Med 2014;31:754-8.
16.	Ziaee A, Esmailzadehha N, Ghorbani A, Asefzadeh S. Association between Uric Acid and Metabolic Syndrome in Qazvin Metabolic Diseases Study (QMDS), Iran. Glob J Health Sci 2012;5:155-65.
17.	Grundy SM, Hansen B, Smith SC Jr., James IC, Kahn RA, American Heart Association; National Heart, Lung, and Blood Institute; American Diabetes Association. Clinical management of metabolic syndrome: Report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Arterioscler Thromb Vasc Biol 2004;24:e19-24.
18.	Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The short form health survey (SF-36): Translation and validation study of the Iranian version. Qual Life Res 2005;14:875-82.
19.	Mehralian H, Salehi S, Moghaddasi J, Amiri M, Rafiei H. The comparison of the effects of education provided by nurses on the quality of life in patients with congestive heart failure (CHF) in usual and home-visit cares in Iran. Glob J Health Sci 2014;6:256-60.
20.	Villarini M, Lanari C, Barchiesi L, Casciari E, Tabascio A, Castellini M, et al. Effects of the “PreveDi” lifestyle modiﬁcation trial on metabolic syndrome. Ann Ig 2015;27:595-606.
21.	Amiri P, Hosseinpanah F, Rambod M, Montazeri A, Azizi F. Metabolic syndrome predicts poor health-related quality of life in women but not in men: Tehran Lipid and Glucose Study. J Womens Health (Larchmt) 2010;19:1201-7.
22.	Frisman GH, Kristenson M. Psychosocial status and health related quality of life in relation to the metabolic syndrome in a Swedish middle-aged population. Eur J Cardiovasc Nurs 2009;8:207-15.
23.	Chen YC, Tung HH, Wei J, Chang CY, Liu CY, Tseng LH. Quality of life and related factors in metabolic syndrome patients who underwent coronary artery bypass grafting surgery. Hu Li Za Zhi 2010;57:40-9.
24.	Amiri P, Deihim T, Taherian R, Karimi M, Gharibzadeh S, Asghari-Jafarabadi M, et al. Factors affecting gender differences in the association between health-related quality of life and metabolic syndrome components: Tehran lipid and glucose study. PLoS One 2015;10:e0143167.
25.	El-Sobkey SB, Hassan SM, Ewais NF. Influence of metabolic syndrome versus musculoskeletal disorders on Saudi health-related quality of life. Open J Thera Rehab 2015;3:87-96.
26.	Ebrahimof S, Mirmiran P. Nutritional approaches for prevention and treatment of metabolic syndrome in adults. J Paramed Sci 2013;4:123-34.
27.	Wang Q, Chair SY, Wong EM. The effects of a lifestyle intervention program on physical outcomes, depression, and quality of life in adults with metabolic syndrome: A randomized clinical trial. Int J Cardiol 2017;230:461-7.