Health in middle-aged women, with emphasis on features of the metabolic syndrome and related markers for diabetes. Women´s Health in the Lund Area Study

Sammanfattning: The aims were to study the biological, socio-demographic and psychosocial health profile in a geographically defined population of middle-aged women, with focus on features of the metabolic syndrome and diabetes, and to study the efficiency of a screening method for high-risk individuals and the outcome of baseline lifestyle advices on the diabetes incidence. All women aged 50-59 years (n=10766) were invited to a screening procedure including questionnaires and laboratory assessments. Subjects were discriminated as positive or negative on one to eight variables linked to the metabolic syndrome. Those with positive screening and impaired glucose tolerance (IGT) at oral glucose tolerance test, were followed for 2.5 years after a one-hour session of lifestyle advices. A sub-sample of women with negative screening and normal glucose tolerance (NGT) were also studied at follow-up. Altogether, 6917 women attended the study and 93% were postmenopausal. Nearly half had hormone replacement therapy (HRT). A positive screening profile was found in 51%, and 14% had IGT and 6,4% diabetes, out of whom 4.8% were previously unknown. High blood glucose, waist hip ratio and body mass index were the most important factors associated with glucose intolerance. The screening instrument showed a sensitivity of 80% and a specificity of 55%. A total of 27% had hypertension. The prevalence of osteoporosis was 6.6%. In the longitudinal study, 11.9% of women with IGT developed diabetes, while 38% turned normal. In the group with NGT no one developed diabetes. Biological factors interrelated with socio-demographic and psychosocial disparities, like low level of education, living single and low subjective physical well-being. Low or moderate alcohol consumption seemed beneficial on the metabolic profile. The results on smoking and HRT were contradictory concerning the effect on features of the metabolic syndrome, while more crucial for the bone density. A high prevalence of risk variables was found, and many cases of IGT and diabetes. Screening of women at high risk for diabetes should be performed, and the biological risk profile considered jointly with socio-demographic and psychosocial factors. A one-hour baseline occasion of lifestyle advices reduces significantly the risk for new cases of diabetes.