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Healthy Behaviours, Lifestyle Patterns and Sociodemographic Determinants of The Metabolic Syndrome
Healthy Behaviours, Lifestyle Patterns and Sociodemographic Determinants of The Metabolic Syndrome
SUMMARY
Aim: The aim of this study was to examine the influence of healthy behaviours, lifestyle patterns and sociodemographic factors on risk of the
metabolic syndrome (MS) in adult residents of rural, small town and large urban areas in Poland.
Material and methods: Cross-sectional analysis of randomly selected representative sample of 1,187 men and women aged 2074 years par-
ticipating in the nationwide health survey WOBASZ. Metabolic syndrome was defined by AHA/NCEP criteria (2005). Analysed healthy behaviours
included nonsmoking, healthy weight, adequate fruits and vegetables consumption, regular leisure-time physical activity. The 4 lifestyle factors
were summed to create a lifestyle index (range 04).
Results: Regardless of gender healthy weight, adequate fruits and vegetables consumption and physical activity were associated with lower
odds of MS. Non-smoking was significantly related to the lower odds ratio of MS only among men. Following all 4 lifestyle factors was the stron-
gest protective factor against having MS. Being higher educated, in the 2034 years old cohort, living in the rural area were the most important
sociodemographic factors reducing risk of MS.
Conclusions: The obtained results support the need for effective promotion of healthy behaviors and lifestyle patterns, especially in demonstrated
high-risk sub-populations. Due to important differences in metabolic risk between various sociodemographic groups, health promotion interventions
should be specific in respect to the targeted subpopulations.
Address for correspondence: M. Kwaniewska, Department of Social and Preventive Medicine, WHO Collaborating Centre for Noncommunicable
Disease Prevention and Control, Medical University, ul. Zeligowskiego 7/9, 90752 d, Poland.
E-mail: magdalena.kwasniewska@unmed.lodz.pl.
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enrolled 2,474 individuals. The whole panel of the study proce- were reported. All p-values were two-sided and p<0.05 was set
dures (including data on dietary habits) was carried out in the as statistically significant. The statistical analysis was performed
50% randomly selected sub-sample of the whole population. Due with the STATGRAPHICS Plus 5.1 programme.
to missing data related to several variables of interest, analyses
were conducted on data obtained from 1,187 persons aged 2074
Table 1. Demographic and lifestyle profile of study population
years, 624 (52.6%) women and 563 (47.4%) men.
The investigation procedures took place in selected out-patient Sociodemographic variable n %
clinics and consisted of a detailed questionnaire interview, meas- Sex
urements of blood pressure, height, weight and waist circumfer-
women 624 52.6
ence, and a fasting blood sample collection. The questionnaire
used in this project was elaborated by main investigators of the men 563 47.4
WOBASZ Study. Most of questions (including eating habits and Age (years)
physical activity level) were based on internationally used stand- 2034 327 27.5
ardized methods. All the procedures were performed by trained 3564 694 58.5
interviewers and nurses. Detailed methodology of the WOBASZ
65 166 14.0
project has already been published in previous reports (13).
According to the AHA/NHLBI (2005) criteria the metabolic Education
syndrome was diagnosed in individuals with at least 3 of the fol- elementary 258 21.7
lowing metabolic risk factors: abdominal obesity (waist circum- secondary 764 64.4
ference 88 cm in women and 102 cm in men), elevated blood
university 165 13.9
pressure (130/85 mmHg), elevated triglycerides (1.7 mmol/l),
Place of residence
reduced high-density lipoprotein cholesterol (<1.3 mmol/l in
women and <0.9 mmol/l in men) and elevated fasting glucose rural area 347 29.2
concentration (5.6 mmol/l) (14). small town 343 28.9
Lifestyle was assessed by analyzing the prevalence of four large urban 307 25.9
behavioural patterns: nonsmoking, adequate fruit and vegetable
capital city 190 16.0
consumption, healthy weight and satisfactory leisure time physi-
cal activity (LTPA). Except for anthropometrical measurements,
the analysis of other lifestyle characteristics was based on self-
reported data. RESULTS
People who had never smoked and ex-smokers were included
to the group of non-smokers. Descriptive statistics on the study sample and healthy behav-
Healthy weight was defined as a body mass index (BMI), iours are displayed in Tables 1 and 2. About 70.8% of all adults,
calculated as weight in kilograms divided by square of height in significantly more women, declared not smoking which showed
meters, between 18,5 and 25 kg/m2 (15). strong positive trends with increasing age and education. Adequate
While assessing eating habits two kinds of questionnaires were fruit and vegetables consumption declared 57.8% of respondents
used: food frequency questionnaire and last 24-hour food ques- with significantly lower prevalence among seniors and largest
tionnaire. Adequate fruit and vegetable consumption was defined urban agglomerations. Only 43.3% of adults had healthy weight
as eating at least 5 portions of these products per day (16). which was more common among women and showed strong
In the assessment of leisure-time physical activity people were inverse trend with age and positive trend with education. Satisfac-
asked whether they regularly practiced any physical activities tory LTPA was undertaken by 35.4%, significantly less prevalent
(walking, jogging, swimming, bicycling etc) accumulating at in seniors, higher educated and residents of the largest cities.
least 30 minutes per session. Those who did were asked to recall The lifestyle index was distributed as follows: 9.1% of the
the frequency of such activities. Satisfactory LTPA was defined population did not meet any of the 4 recommendations while
as performing physical exercises for at least 30 minutes on most 35%, 38% and 14% met one, two and three recommendations,
days of week (17). respectively. Only 3.01% of the whole population met all four
Each participant of the study was given 1 or 0 points for each recommendations which showed strong inverse trend with age and
of the four mentioned behaviours (1 point for the presence and 0 size of agglomeration and positive trend with education.
points for the absence of the analyzed behaviour). The four men- There are 16 possible unique combinations of the 4 analysed
tioned behaviours were summed to create a lifestyle index which lifestyle characteristics. Only 2 of the lifestyle patterns were fol-
could range from 0 (no healthy behaviours) to 4 (all four healthy lowed by more than 10% of the population and the most prevalent
behaviours). Similar lifestyle assessments have already been used pattern was non-smoking with no adherence to any other healthy
in the large-scale surveys by other authors (18, 19). factor (16.5%).
In order to compare the frequency and assess statistical sig- Metabolic syndrome was found in 19.7% of women and
nificance of the given categories of quantitative characteristics 18.1% of men. Relative risk of metabolic syndrome according to
in the analyzed groups the test was implemented. To identify sociodemographic variables is presented in Table 3. Young adults
factors that can contribute to metabolic risk, the logistic regres- (OR=0.14 in men; OR=0.05 in women) and residents of rural areas
sion analysis was performed. Multivariate adjusted odd ratios (OR=0.53 in men; OR=0.79 in women) were significantly less
(OR) with 95% Confidence Interval (CI) stratified by gender likely to have MS. Educational level importantly contributed to
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Table 2. Prevalence (%) of healthy lifestyle behaviors in the studied population
the metabolic risk in women, but not in men. Women with at least women) and with satisfactory LTPA (OR=0.58 for men; OR=0.55
secondary education had significantly lower odds of MS relative for women). Non-smokers had significantly lower odds of having
to those with elementary education (OR=0.78 for secondary; MS only among men (OR=0.65; p=0.047).
OR=0.72 for university education). Significantly lower odds of MS were found in men engaged
Table 4 shows the contribution of single and multiple lifestyle in at least 3 healthy lifestyle factors (OR=0.64; p=0.043) while in
behaviours to the metabolic risk. Regardless of age, education, women risk reduction is significant only while meeting all four
place of residence and other lifestyle factors, the likelihood of MS criteria (OR=0.57, p<0.05).
was significantly lower in persons with healthy weight (OR=0.57
for men; OR=0.59 for women), consuming at least 5 portions
of fruits or vegetables per day (OR=0.69 for men; OR=0.72 for
Table 3. Odd ratios (OR) and 95% Confidence Interval (95% CI) of metabolic syndrome according to sociodemographic factors
Sociodemographic factors Women OR (95% CI) p-value Men OR (95% CI) p-value
Age (years)
2034 0.05 (0.020.14) p<0.001 0.14 (0.050.39) p<0.001
3564 0.59 (0.360.97) p<0.05 0.91 (0.632.11) p>0.05
65 1.00 1.00
Education
elementary 1.00 p<0.05 1.00 p>0.05
secondary 0.78 (0.520.89) p<0.05 0.85 (0.51.43) p>0.05
university 0.72 (0.210.51) 0.82 (0.381.76)
Place of residence
rural area 0.79 (0.540.99) p<0.05 0.63 (0.400.97) p<0.05
small town 0.95 (0.651.63) p>0.05 0.96 (0.782.07) p<0.05
large urban 0.97 (0.661.65) p>0.05 0.97 (0.762.08) p<0.05
capital city 1.00 1.00
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Table 4. Odd ratios (OR) and 95% Confidence Interval (95% CI) of metabolic syndrome according to healthy lifestyle factors
Healthy lifestyle factors Women OR (95% CI) p-value Men OR (95% CI) p-value
Non-smoking
yes 0.74 (0.441.26) p>0.05 0.65 (0.410.99) p<0.05
no 1.00 1.00
Healthy weight
yes 0.59 (0.190.89) p<0.05 0.57 (0.170.78) p<0.05
no 1.00 1.00
Fruits/vegetables
yes 0.72 (0.650.99) p<0.05 0.69 (0.670.98) p<0.05
no 1.00 1.00
Regular LTPA
yes 0.58 (0.250.98) p<0.05 0.55 (0.170.97) p<0.05
no 1.00 1.00
Lifestyle index
0 1.00 1.00
1 0.97 (0.562.72) p>0.05 0.99 (0.412.41) p>0.05
2 0.86 (0.582.62) p>0.05 0.81 (0.381.72) p>0.05
3 0.81 (0.460.99) p>0.05 0.64 (0.621.49) p>0.05
4 0.57 (0.340.79) p>0.05 0.52 (0.620.92) p>0.05
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physical activity level. In spite of some findings about protective than labeling patients with the term metabolic syndrome (28).
role of moderate alcohol consumption in the development of MS Another argument concerns the variability of definitions of MS
(27), this factor was not included into the lifestyle index because created by various scientific associations which results in dif-
of the difficulty in elaborating reasonable and safe recommenda- ferent findings. Taking into consideration all these opinions, the
tions for the public. concept of MS still seems very useful as the goal of diagnosing
According to the assessment of lifestyle patterns, important the syndrome is to identify persons at increased risk of cardio-
reduction of the risk of MS can be achieved only by meeting all vascular diseases. In clinical practice it can prompt a physician to
four healthy lifestyle recommendations. Detailed analysis of the look for and treat additional risk factors in patients with only one
16 possible lifestyle combinations revealed that higher preva- or two risk factors as well as help to persuade patients to change
lence of healthy weight and regular physical activity, singly or in lifestyle or begin a long-term treatment before they develop
combination, could provide additional 24.2% of people following overt diabetes mellitus or cardiovascular disease. Relationship
all four healthy lifestyle factors. It is, therefore, highly probable between the presence of MS and morbidity as well as mortality
that interventions designed to increase physical activity level rates has been well documented, even using different definitions
and weight reduction have the potential to effectively reduce the of MS. Results from several studies including a large population-
metabolic risk of the enrolled population. based Italian study, the Framingham Offspring Study, the Botnia
Based on the obtained results, it seems reasonable to elaborate Study, the Kuopio Ischemic Heart Disease Study, the National
effective messages about healthy lifestyles strictly for certain Health and Nutrition Examination Survey II Mortality Study, the
high-risk sociodemographic groups, like seniors, persons with San Antonio Heart Study, and the DECODE study have shown
lower educational attainment, residents of large urban areas. Ac- that the presence of metabolic syndrome is associated with a
cording to recent findings of Wannamethee et al., modification significantly increased risk of total mortality and cardiovascular
of lifestyle factors, even later in life, has considerable potential morbidity and mortality.
for primary prevention of the MS (10). Seniors could be reached Despite the above limitations, these data indicate that metabolic
with messages about healthy lifestyle in the context of self-man- syndrome of the studied population is in significant relation to
agement of chronic conditions. sociodemographic and lifestyle behaviours. The study provides
Since abdominal obesity is the most prevalent element of insight into prevalence and clustering of meeting recommenda-
MS in this population (38% among women and 24% among tions for multiple healthy lifestyle factors and their contribution to
men), it should become a priority to improve health promotion metabolic risk. It also provides opportunity to compare lifestyle of
programmes focused on weight reduction, especially in women, developed western societies with health behaviours of residents of
persons over 65 years old and individuals with lower education. Poland post-communist country during political and economic
Special attention should be paid to elaborate effective message transformation. High response rate in this randomised, representa-
concerning proper dietary patterns and active lifestyle during and tive study increases generalizability of the results.
after smoking cessation period as about 20% of obese persons in The obtained results demonstrate the challenges for healthcare
this analysis were ex-smokers. Residents of large cities should and support the need for implementing effective interventions
be encouraged to increase their physical activity level and higher in the society, especially in the area of weight reduction and
intake of fruit and vegetables. increasing physical activity level. Due to important differences
Some study limitations need to be emphasized. The cross- in metabolic risk between various sociodemographic groups,
sectional nature of the analysis does not allow to investigate health promotion interventions should be specific for the targeted
possible mechanisms of shown relationships between sociodemo- subpopulations.
graphic and lifestyle factors and the risk of metabolic syndrome.
Well-known limitation is also the possibility of recall bias due Acknowledgements
to self-reported data on smoking, nutrition and physical activity The Project was supported by the Polish Ministry of Health Programme
level. Including only fruits and vegetables consumption and BMI POLKARD 2003-2005.
into the lifestyle index (as a measure of dietary patterns) may
not reflect nutritional habits with enough accuracy. Moreover
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health: a report of the Surgeon General. Atlanta: National Center for Accepted in revised form October 20, 2008
The 31st Session of the Codex Alimentarius Commission held formula, will help keeping children safe from potentially serious
its annual meeting in Geneva. infections.
The Commission is an intergovernmental body, jointly es-
tablished in 1963 by the Food and Agriculture Organization of Other topics on this years agenda include:
the United Nations (FAO) and the World Health Organization Mycotoxin contamination in cereals and other foods these are
(WHO), that sets international food standards to protect the health carcinogens commonly found in many foods. Their presence
of consumers and ensure fair trade practices in the food trade. in food need to be regulated and minimized..
Whether establishing new standards such as safe limits for food Use of flavourings like most additives, there is a need to ensure
additives, contaminants, pesticides or veterinary drugs residues, their safe use;
recommending how to assess the risks of genetically modified Quantitative ingredient declarations;
foods or defining the commercial quality of fresh or produced Gluten-free foods;
products: The Codex Alimentarius Commission deals with all Processing and handling of quick frozen foods;
of food safety and quality from producer to consumer. The Commodities such as raw and live bivalve molluscs (e.g. mus-
results of its work form the international food safety standard, sels, oysters and clams), bitter cassava, tomatoes and natural
Codex Alimentarius (Latin for food code). These standards, mineral waters.
when introduced in national legislation, contribute to the safety
of our foods. Contacts:
One of the over thirty texts to be adopted this year, the Code Ms Teresa Buerkle
of Hygienic Practice for Powdered Formulae for Infants and Young Information Officer, FAO/Geneva, Tel.: +41 22 917 2770, Mo-
Children, aims at protecting the most vulnerable of consumers: bile: +41 76 531 9934, Email: tbuerkle@unog.ch.
infants and small children who for any reason cannot be breastfed.
The code, by setting maximum limits for bacteria in formula and Joint Media Advisory WHO/FAO/17
guidance on how to produce, distribute and prepare powdered 26 June 2008
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