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Kim and Ahn: Impact of Menopausal Status, Metabolic Syndrome and its Risk Factors on Impaired Quality of Life above Middle-aged Women
Original Article

Korean Journal of Women Health Nursing 2016; 22(4): 275-286.

Published online: 27 December 2016

DOI: https://doi.org/10.4069/kjwhn.2016.22.4.275

Impact of Menopausal Status, Metabolic Syndrome and its Risk Factors on Impaired Quality of Life above Middle-aged Women

Jisoon Kim1, Sukhee Ahn2

1College of Nursing, Graduate School, Chungnam National University, Daejeon, Korea.

2College of Nursing, Chungnam National University, Daejeon, Korea.

Corresponding author: Ahn, Sukhee. College of Nursing, Chungnam National University, 266 Munwharo, Jung-gu, Daejeon 35015, Korea. Tel: +82-42-580-8324, Fax: +82-42-580-8309, sukheeahn@cnu.ac.kr

Received 30 September 2016       Revised 25 October 2016       Accepted 2 November 2016

© 2016 Korean Society of Women Health Nursing

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study explored influencing factors on quality of life (QoL) above middle-aged women in relation to demographic factors, health-related factors, menopausal status, metabolic syndrome (MS) and its risk factors.

Methods

This study was secondary data analysis from the Sixth Korea National Health and Nutrition Examination Survey 2013~2015 that utilized a complex, multi-stage probability sample design. Study sample of 2,310 was inclusive of (28.8%) of women who were over 40. To evaluate the factors that would influence an impaired quality of life, χ2 test, GLM, and logistic regression analysis were done.

Results

Level of quality of life was lower in women with late post-menopause(over 10 years since menopause) than women with pre-menopause. Factors influencing impaired QoL were as follows: graduated middle school and elementary school or less (OR=2.43, 4.42, respectively, p<.05), no job (OR=1.92, p<.001), stress (OR=1.92, p=.001), depression (OR=1.93, p=.001), insufficient sleep (OR=1.64, p=.003), late post-menopause (OR=2.61, p=.044) and over 85cm of waist circumference (OR=1.76, p=.01).

Conclusion

These results suggest that late post-menopause may be an independent factor influencing an impaired QoL. To promote post-menopausal womens' health, a nursing strategy is required to teach women how to manage levels of stress, depression, insufficient sleep, and abdominal obesity through health education, nutritional counselling, and physical activity program.

Keywords: Menopause, Metabolic syndrome X, Quality of life, Depression, Sleep

Figures and Tables

Table 1

Quality of Life and Related Factors associated with Menopausal Status

kjwhn-22-275-i001
Variables Categories Total Menopausal status x2 (p)
Premenopause Early postmenopause Late postmenopause
M (SE) or n (%) M (SE) or n (%) M (SE) or n (%)
Age 56.73 (0.39) 45.21 (0.15) 54.70 (0.22) 69.23 (0.34)
Menopausal age 48.72 (0.15) - 50.66±0.20 47.29 (0.22)
Demographic factors
 Age (yr) 40~49 631 (32.5) 540 (85.3) 49 (10.7) 1 (0.1) 2,457.26
(<.001)
50~59 640 (29.9) 100 (14.6) 405 (75.5) 86 (12.0)
60~69 495 (17.6) 2 (0.2) 88 (13.4) 375 (39.4)
≥70 544 (19.9) 0 (0.0) 1 (0.4) 460 (48.5)
 Income quartile Lower 572 (25.3) 155 (24.8) 120 (22.2) 236 (26.2) 5.22
(.692)
Lower middle 573 (24.7) 146 (23.4) 148 (26.6) 237 (25.9)
Upper middle 575 (25.1) 166 (24.9) 134 (25.6) 220 (23.2)
Upper 575 (25.2) 173 (26.9) 139 (25.6) 224 (24.7)
 Educational level ≥College 330 (16.8) 225 (34.6) 67 (12.0) 36 (4.0) 920.54
(<.001)
High school 641 (32.5) 326 (51.5) 203 (38.2) 108 (11.6)
Middle school 285 (13.2) 52 (8.6) 110 (19.9) 116 (12.4)
≤Elementary school 896 (37.5) 38 (5.2) 163 (29.9) 662 (72.1)
 Occupation Yes 960 (46.3) 401 (61.4) 293 (53.0) 257 (28.7) 176.29
(<.001)
No 1,193 (53.7) 241 (38.6) 250 (47.0) 665 (71.3)
 Spouse Yes 1,633 (73.5) 558 (90.3) 454 (83.9) 498 (52.7) 316.64
(<.001)
No 635 (26.5) 63 (9.7) 82 (16.1) 420 (47.3)
Health-related factors
 Drinking Yes 1,134 (55.5) 458 (71.0) 326 (61.3) 338 (37.2) 187.87
(<.001)
No 1,012 (44.5) 184 (29.0) 217 (38.7) 584 (62.8)
 Walking activity Yes 316 (27.6) 103 (30.9) 81 (27.6) 130 (25.2) 3.29
(.280)
No 827 (72.4) 238 (69.1) 198 (72.4) 373 (74.8)
 Weight status Underweight 68 (3.1) 27 (4.7) 7 (1.4) 28 (3.0) 33.66
(<.001)
Obesity 784 (33.7) 169 (26.4) 184 (34.1) 347 (38.0)
Normal 1,450 (63.2) 445 (68.9) 352 (64.5) 546 (59.0)
 Perceived stress More 506 (24.1) 142 (22.6) 106 (19.9) 243 (27.9) 12.82
(.010)
Less 1,636 (75.9) 500 (77.4) 437 (80.1) 677 (72.1)
 Depression Yes 344 (16.0) 69 (11.1) 87 (16.5) 182 (20.2) 23.93
(<.001)
No 1,797 (84.1) 573 (88.9) 456 (83.5) 738 (79.8)
 Sleep duration Insufficient 515 (22.4) 74 (11.6) 116 (19.5) 317 (34.9) 165.00
(<.001)
Over-sufficient 143 (6.2) 25 (3.5) 26 (4.9) 84 (9.3)
Sufficient 1,482 (71.4) 543 (84.8) 401 (75.6) 518 (55.8)
Menopausal status Late postmenopause 922 (37.2)
Early postmenopause 543 (27.2)
Premenopause 642 (35.5)
Metabolic syndrome Yes 495 (22.9) 68 (11.0) 120 (22.8) 281 (36.5) 121.51
(<.001)
No 1,497 (77.1) 535 (89.0) 399 (77.2) 470 (63.5)
Risk factor of metabolic syndrome
 Blood pressure (≥130/85 mmHg) Yes 804 (32.1) 125 (17.4) 177 (32.3) 435 (45.9) 142.37
(<.001)
No 1,491 (67.9) 513 (82.6) 366 (67.7) 487 (54.1)
 HDL-C (<50 mg/dL) Yes 1,120 (55.3) 289 (48.0) 270 (53.5) 491 (65.0) 39.96
(<.001)
No 879 (44.7) 315 (52.0) 249 (46.5) 262 (35.0)
 Triglyceride (≥150 mg/dL) Yes 573 (27.9) 120 (20.3) 148 (28.2) 265 (34.7) 34.42
(<.001)
No 1,426 (72.1) 484 (79.7) 371 (71.8) 488 (65.3)
 Fasting blood glucose (≥110 mg/dL) Yes 344 (16.8) 47 (8.1) 81 (15.4) 197 (27.4) 89.39
(<.001)
No 1,652 (83.2) 556 (91.9) 438 (84.6) 554 (72.6)
 Waist circumference (≥85 cm) Yes 633 (26.0) 94 (14.7) 124 (22.4) 354 (38.3) 115.59
(<.001)
No 1,667 (74.0) 548 (85.3) 418 (77.6) 568 (61.7)
Table 2

Level of Quality of Life by Menopausal Status and Metabolic Syndrome

kjwhn-22-275-i002
Variables Categories n (%) EQ-5D Index
M (SE) F/t (p)
Menopausal status Premenopause 642 (35.5) 0.96 (.00)
Early postmenopause 543 (27.2) 0.94 (.01) −4.283 (<.001)†
Late postmenopause 922 (37.2) 0.83 (.01) −15.980 (<.001)‡
Metabolic syndrome Yes 495 (22.9) 0.88 (.01) −4.151 (<.001)
No 1,497 (77.1) 0.92 (.00)
Risk factors of metabolic syndrome Blood pressure (≥130/85 mmHg) Yes 804 (32.1) 0.88 (.01) −4.152 (<.001)
No 1,491 (67.9) 0.92 (.00)
HDL-C (<50 mg/dL) Yes 1,120 (55.3) 0.91 (.00) −2.374 (.019)
No 879 (44.7) 0.92 (.01)
Triglyceride (≥150 mg/dL) Yes 573 (27.9) 0.90 (.01) −2.434 (.016)
No 1,426 (72.1) 0.92 (.00)
Fasting blood glucose (≥110 mg/dL) Yes 344 (16.8) 0.88 (.01) −3.683 (<.001)
No 1,652 (83.2) 0.92 (.00)
Waist circumference (≥85 cm) Yes 633 (26.0) 0.86 (.01) −5.859 (<.001)
No 1,667 (74.0) 0.92 (.00)

†t-test between premenopuase and early postmenopause group; ‡t-test between premenopuase and late postmenopause group.

Table 3

Factors influencing on Impaired Quality of Life in Univariate Level

kjwhn-22-275-i003
Variables Categories Impaired quality of life Statistics
Under 25% (n=498) Over 25% (n=1,542)
M (SE) or n (%) M (SE) or n (%) t (p) or OR (95% CI) p
EQ-5D index 0.68 (0.01) 0.97 (0.00) 28.78 (<.001)
Demographic factors
 Age (yr) 40~49 37 (11.1) 551 (40.8) reference
50~59 83 (18.7) 504 (34.4) 2.01 (1.27~3.18) .003
60~69 154 (28.2) 284 (14.7) 7.06 (4.56~10.92) <.001
≥70 224 (42.0) 203 (10.2) 15.23 (9.71~23.89) <.001
 Income quartile Upper 94 (18.4) 426 (27.7) reference
Upper middle 105 (19.8) 399 (25.8) 1.15 (0.83~1.60) .399
Lower middle 137 (28.3) 380 (24.6) 1.73 (1.24~2.41) .001
Lower 160 (33.5) 330 (21.9) 2.29 (1.65~3.19) <.001
 Level of education ≥College 15 (3.6) 312 (21.5) reference
High school 59 (39.3) 571 (39.3) 2.12 (1.05~4.30) .037
Middle school 64 (12.3) 205 (13.5) 5.44 (2.69~11.00) <.001
≤Elementary school 360 (70.1) 453 (25.8) 16.15 (8.66~30.09) <.001
 Occupation Yes 136 (27.7) 785 (52.5) reference
No 362 (72.3) 757 (47.5) 2.89 (2.22~3.77) <.001
 Having spouse Yes 267 (54.4) 1,203 (80.8) reference
No 227 (45.6) 310 (19.2) 3.53 (2.72~4.60) <.001
Health-related factors
 Drinking Yes 191 (40.2) 888 (60.4) reference
No 307 (59.8) 649 (39.6) 2.27 (1.78~2.90) <.001
 Walking activity Yes 66 (22.9) 238 (29.7) reference
No 222 (77.1) 550 (70.3) 1.42 (0.97~2.08) .070
 Weight status Non-obesity 285 (57.6) 1,082 (70.3) reference
Obesity 212 (42.4) 460 (29.7) 0.57 (0.45~0.73) <.001
 Perceived stress Less 309 (62.4) 1,241 (79.9) reference
More 186 (37.6) 296 (20.1) 2.39 (1.81~3.16) <.001
 Depression No 355 (71.3) 1,353 (88.0) reference
Yes 139 (28.7) 184 (12.0) 2.94 (2.17~4.00) <.001
 Sleep duration Sufficient 263 (54.5) 1,158 (77.3) reference
Over-sufficient 41 (7.4) 87 (5.4) 1.95 (1.23~3.07) 0.004
Insufficient 191 (38.1) 291 (17.3) 3.12 (2.44~3.99) <.001
Menopausal status Premenopause 41 (11.9) 594 (43.9) reference
Early postmenopause 73 (16.6) 457 (31.1) 1.96 (1.30~2.96) <.001
Late postmenopause 368 (71.5) 469 (25.0) 10.56 (7.39~15.10) <.001
Metabolic syndrome No 249 (66.0) 1,125 (80.9) reference
Yes 149 (34.0) 288 (19.1) 2.18 (1.64~2.91) <.001
Risk factor of metabolic syndrome
 Blood pressure (≥130/85 mmHg) No 281 (59.6) 1,048 (70.8) reference
Yes 217 (40.4) 489 (29.2) 1.64 (1.31~2.06) <.001
 HDL-C (<50 mg/dL) No 134 (35.1) 672 (47.6) reference
Yes 265 (64.9) 742 (52.4) 1.68 (1.32~2.15) <.001
 Triglyceride (≥150 mg/dL) No 255 (66.1) 1,052 (74.9) reference
Yes 144 (33.9) 362 (25.1) 1.53 (1.15~2.04) 0.004
 Fasting blood glucose (≥110 mg/dL) No 300 (75.8) 1,207 (85.8) reference
Yes 98 (24.2) 206 (14.2) 1.94 (1.38~2.72) <.001
 Waist circumference (≥85 cm) No 289 (59.8) 1,211 (79.7) reference
Yes 208 (40.2) 330 (20.3) 2.63 (2.04~3.40) <.001
Table 4

Factors influencing on Impaired Quality of Life in Women Over 40 in Multivariate Level

kjwhn-22-275-i004
Variables Categories Impaired quality of life
Model I Model II
OR (95% CI) p OR (95% CI) p
Demographic factors
 Age 40~49 reference reference
50~59 1.08 (0.66~1.76) .758 0.90 (0.36~2.25) .819
60~69 2.31 (1.37~3.89) .002 1.14 (0.40~3.20) .809
≥70 3.27 (1.76~6.06) <.001 1.38 (0.42~4.52) .594
 Educational level ≥College reference reference
High school 1.72 (0.83~3.60) .146 1.61 (0.76~3.42) .213
Middle school 3.46 (1.62~7.37) .001 2.43 (1.11~5.31) .027
≤Elementary school 6.42 (3.16~13.05) <.001 4.42 (2.18~8.94) <.001
 Occupation Yes reference reference
No 1.79 (1.30~2.45) <.001 1.92 (1.37~2.70) <.001
 Spouse Yes reference reference
No 1.37 (1.03~1.82) .033 1.17 (0.84~1.64) .345
Health-related factors
 Drinking Yes reference
No 1.09 (0.79~1.51) .610
 Perceived stress Less reference
More 1.92 (1.30~2.84) .001
 Weight status Non-obesity reference
Obesity 1.02 (0.68~1.53) .918
 Depression No reference
Yes 1.93 (1.30~2.87) .001
 Sleep duration Sufficient reference
Over-sufficient 0.88 (0.46~1.70) .704
insufficient 1.64 (1.19~2.27) .003
Menopausal status Pre-menopause reference
Early-menopause 1.27 (0.56~2.87) .561
Late-menopause 2.61 (1.03~6.64) .044
Metabolic syndrome Yes 0.81 (0.49~1.34) .407
Risk factor of metabolic syndrome
 Blood pressure ≥130/85 mmHg 1.01 (0.72~1.41) .968
 HDL-C <50 mg/dL 1.10 (0.79~1.53) .556
 Triglyceride ≥150 mg/dL 1.04 (0.69~1.58) .853
 Fasting blood glucose ≥110 mg/dL 0.95 (0.64~1.41) .797
 Waist circumference ≥85 cm 1.76 (1.15~2.70) .010

Notes

This study was supported by Chungnam National University Research Fund.

Summary Statement

▪ What is already known about this topic?
Some studies have shown that transitioning through menopause have negatively impacted health-related quality of life, while others reported metabolic syndrome impacting quality of life for menopausal women. Moreover, quality of life is related to biological(age, obesity), psychological(stress, depression), and social(having spouse and jobs) factors.
▪ What this paper adds?
Women with postmenopausal status with metabolic syndrome and its risk factors obtained worse scores in quality of life. With multivariate analysis, being late postmenopause, higher waist circumference, increased stress, depression, and insufficient sleep were significant influencing factors.
▪ Implications for practice, education and/or policy
There is a need to develop nursing strategies to manage levels of stress, depression, insufficient sleep, and abdominal obesity through health education, nutritional counselling, and the need for physical activity programs developed for women who go through menopause.

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