Quality of Life Research

, Volume 20, Issue 4, pp 583–592 | Cite as

Gender differences among middle-aged Koreans for health-related quality of life related to metabolic syndrome

  • Yeo-Jin Sohn
  • Hyun Soon Sohn
  • Jin-Won KwonEmail author



The influence of metabolic syndrome (MS) on quality of life has not been studied much among Asians, especially Koreans. This study compared the association between MS and health-related quality of life (HRQL) by gender for middle-aged Koreans.


We used data containing 2,264 adults between the ages of 40 and 59 years who participated in the 2005 Korean National Health and Nutrition Examination Surveys. The criteria for MS were defined by the National Cholesterol Education Program Adult Treatment Panel III. HRQL was measured by the EQ-5D preference score. Good health status was defined as having higher scores than the mean EQ5D preference score. We used logistic regression methods to adjust for socioeconomic covariates and survey sample design.


The mean EQ-5D preference score was significantly lower in women with MS compared to women without MS (0.81 vs. 0.88), but this was not the case for men (0.92 vs. 0.92). These consistent results were observed after adjusting for socioeconomic covariates. In multiple logistic analyses, women with MS had a lower likelihood of having good health status compared to women without MS (OR = 0.60, 95% CI 0.38–0.96). For men, there was no difference.


Our study identified a nationally representative health preference score for MS in Korean middle-aged men and women while highlighting a gender difference that merits more research (i.e., MS appeared to have a significant negative impact for women’s HRQL, but not for men). At the very least, future studies should consider gender differences when addressing quality of life among patients with MS.


Metabolic syndrome Health-related quality of life EQ-5D Gender difference 



Metabolic Syndrome


Coronary Heart Disease


Cardiovascular Disease


Type 2 Diabetes Mellitus


Health-Related Quality of Life


National Health and Nutrition Examination Survey


United State


Body Mass Index


Quality Adjusted Life Year


High-Density Lipoprotein


Korean Won


Waist Circumference


Fasting plasma glucose


National Cholesterol Education Program


Visual Analogous Scale


EQ Visual Analogous Scale


Time Trade-off


United Kingdom


Odds Ratio


Confidence Interval


Quality of Life


C-reactive protein


  1. 1.
    Reaven, G. M. (2005). Why syndrome X? From Harold Himsworth to the insulin resistance syndrome. Cell Metabolism, 1(1), 9–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Park, Y. W., Zhu, S., Palaniappan, L., Heshka, S., Carnethon, M. R., & Heymsfield, S. B. (2003). The metabolic syndrome: Prevalence and associated risk factor findings in the US population from the third national health and nutrition examination survey, 1988–1994. Archives of Internal Medicine, 163, 427–436.PubMedCrossRefGoogle Scholar
  3. 3.
    Laaksonen, D. E., Lakka, H. M., Niskanen, L. K., Kaplan, G. A., Salonen, J. T., & Lakka, T. A. (2002). Metabolic syndrome and development of diabetes mellitus: Application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. American Journal of Epidemiology, 156(11), 1070–1077.PubMedCrossRefGoogle Scholar
  4. 4.
    Ford, E. S. (2005). Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: A summary of the evidence. Diabetes Care, 28(7), 1769–1778.PubMedCrossRefGoogle Scholar
  5. 5.
    Lakka, H. M., Laaksonen, D. E., Lakka, T. A., Niskanen, L. K., Kumpusalo, E., Tuomilehto, J., et al. (2002). The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA: The Journal of the American Medical Association, 288, 2709–2716.CrossRefGoogle Scholar
  6. 6.
    Wilson, P. W., D’Agostino, R. B., Parise, H., Sullivan, L., & Meigs, J. B. (2005). Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation, 112(20), 3066–3072.PubMedCrossRefGoogle Scholar
  7. 7.
    Murdaugh, C. (1997). Health-related quality of life as an outcome in organizational research. Medical Care, 35(11 Suppl), NS41–NS48.Google Scholar
  8. 8.
    Miettola, J., Niskanen, L. K., Viinamäki, H., Sintonen, H., & Kumpusalo, E. (2008). Metabolic syndrome is associated with impaired health-related quality of life: Lapinlahti 2005 study. Quality of Life Research, 17(8), 1055–1062.PubMedCrossRefGoogle Scholar
  9. 9.
    Ford, E. S., & Li, C. (2008). Metabolic syndrome and health-related quality of life among U.S. adults. Annals of Epidemiology, 18(3), 165–171.PubMedCrossRefGoogle Scholar
  10. 10.
    Jia, H., & Lubetkin, E. I. (2005). The impact of obesity on health-related quality-of-life in the general adult US population. Journal of Public Health, 27(2), 156–164.PubMedCrossRefGoogle Scholar
  11. 11.
    White, M. A., O’Neil, P. M., Kolotkin, R. L., & Byrne, T. K. (2004). Gender, race, and obesity-related quality of life at extreme levels of obesity. Obesity Research, 12(6), 949–955.PubMedCrossRefGoogle Scholar
  12. 12.
    Kolotkin, R. L., Crosby, R. D., Kosloski, K. D., & Williams, G. R. (2001). Development of a brief measure to assess quality of life in obesity. Obesity Research, 9(2), 102–111.PubMedCrossRefGoogle Scholar
  13. 13.
    Pingitore, R., Spring, B., & Garfield, D. (1997). Gender differences in body satisfaction. Obesity Research, 5(5), 402–409.PubMedGoogle Scholar
  14. 14.
    Wiggins, R. D., Higgs, P. D., Hyde, M., & Blane, D. B. (2004). Quality of life in the third age: Key predictors of the CASP-19 measure. Ageing and Society, 24, 693–708.CrossRefGoogle Scholar
  15. 15.
    Corica, F., Corsonello, A., Apolone, G., Mannucci, E., Lucchetti, M., Bonfiglio, C., et al. (2008). Metabolic syndrome, psychological status and quality of life in obesity: The QUOVADIS Study. International Journal of Obesity, 32(1), 185–191.PubMedCrossRefGoogle Scholar
  16. 16.
    Tsai, A. G., Wadden, T. A., Sarwer, D. B., Berkowitz, R. I., Womble, L. G., Hesson, L. A., et al. (2008). Metabolic syndrome and health-related quality of life in obese individuals seeking weight reduction. Obesity, 16(1), 59–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Ministry of Health and Welfare. (2005). Korea centers for disease control and prevention. Progress report on the national health and nutrition survey 2005 (Health examination).Google Scholar
  18. 18.
    Expert Panel on Detection E, and Treatment of High Blood Cholesterol in Adults. (2001). Executive summary of the third report of the national cholesterol education program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA: The Journal of the American Medical Association, 285, 2486–2497.CrossRefGoogle Scholar
  19. 19.
    Cheung, K., Oemar, M., Oppe, M., et al. (2009). EQ-5D user guide: Basic information on how to use EQ-5D, Euroqol Group. Accessed February 14, 2010.
  20. 20.
    Szende, A., Oppe, M., & Devlin, N. (2007). EQ-5D value sets: Inventory, comparative review and user guide. EuroQoL Group Monographs. New York: Springer.Google Scholar
  21. 21.
    Kim, M. H., Cho, Y. S., Uhm, W. S., Kim, S., & Bae, S. C. (2005). Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases. Quality of Life Research, 14(5), 1401–1406.PubMedCrossRefGoogle Scholar
  22. 22.
    EQ-5D Languages; available versions. Euroqol Group. Accessed February 14, 2010.
  23. 23.
    Kang, E. J., Shin, H. S., Park, H. J., Jo, M. W., & Kim, N. Y. (2006). A valuation of health status using EQ-5D. The Korean Journal of Health Economics and Policy, 12(2), 19–43.Google Scholar
  24. 24.
    S. A. S. Institute Inc. (2003). SAS/STAT user’s guide. Cary, NC: SAS Institute Inc.Google Scholar
  25. 25.
    StataCorp. LP. (2009). Survey data reference manual. Texas: Stata Press.Google Scholar
  26. 26.
    Levinger, I., Goodman, C., Hare, D. L., Jerums, G., & Selig, S. (2009). Functional capacity and quality of life in middle-age men and women with high and low number of metabolic risk factors. International Journal of Cardiology, 133(2), 281–283.PubMedCrossRefGoogle Scholar
  27. 27.
    Frisman, G. H., & Kristenson, M. (2009). Psychosocial status and health related quality of life in relation to the metabolic syndrome in a Swedish middle-aged population. European Journal of Cardiovascular Nursing, 8(3), 207–215.PubMedCrossRefGoogle Scholar
  28. 28.
    Gardner, A. W., Montgomery, P. S., & Parker, D. E. (2006). Metabolic syndrome impairs physical function, health-related quality of life, and peripheral circulation in patients with intermittent claudication. Journal of Vascular Surgery, 43(6), 1191–1196; discussion 1197.Google Scholar
  29. 29.
    Roriz-Cruz, M., Rosset, I., Wada, T., Sakagami, T., Ishine, M., Roriz-Filho, J. S., et al. (2007). Stroke-independent association between metabolic syndrome and functional dependence, depression, and low quality of life in elderly community-dwelling Brazilian people. Journal of American Geriatrics Society, 55(3), 374–382.CrossRefGoogle Scholar
  30. 30.
    Han, J. H., Park, H. S., Shin, C. I., Chang, H. M., Yun, K. E., Cho, S. H., et al. (2009). Metabolic syndrome and quality of life (QOL) using generalised and obesity-specific QOL scales. International Journal of Clinical Practice, 63(5), 735–741.PubMedCrossRefGoogle Scholar
  31. 31.
    Blazer, D. G., Hybels, C. F., & Fillenbaum, G. G. (2006). Metabolic syndrome predicts mobility decline in a community-based sample of older adults. Journal of American Geriatrics Society, 54(3), 502–506.CrossRefGoogle Scholar
  32. 32.
    Wijndaele, K., Duvigneaud, N., Matton, L., Duquet, W., Thomis, M., Beunen, G., et al. (2007). Muscular strength, aerobic fitness, and metabolic syndrome risk in Flemish adults. Medicine and Science in Sports and Exercise, 39(2), 233–240.PubMedCrossRefGoogle Scholar
  33. 33.
    Das, U. N. (2001). Is obesity an inflammatory condition? Nutrition, 17(11–12), 953–966.PubMedCrossRefGoogle Scholar
  34. 34.
    Das, U. N. (2002). Is metabolic syndrome X an inflammatory condition? Experimental Biology and Medicine, 227(11), 989–997.PubMedGoogle Scholar
  35. 35.
    Strouse, T. B. (2007). The relationship between cytokines and pain/depression: A review and current status. Current Pain and Headache Reports, 11(2), 98–103.PubMedCrossRefGoogle Scholar
  36. 36.
    Heiskanen, T. H., Niskanen, L. K., Hintikka, J. J., Koivumaa-Honkanen, H. T., Honkalampi, K. M., Haatainen, K. M., et al. (2006). Metabolic syndrome and depression: A cross-sectional analysis. Journal of Clinical Psychiatry, 67(9), 1422–1427.PubMedCrossRefGoogle Scholar
  37. 37.
    Brown, E. S., Varghesea, F. P., & McEwenb, B. S. (2004). Association of depression with medical illness: Does cortisol play a role? Biological Psychiatry, 55(1), 1–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Kinder, L. S., Carnethon, M. R., Palaniappan, L. P., King, A. C., & Fortmann, S. P. (2004). Depression and the metabolic syndrome in young adults: Findings from the Third National Health and Nutrition Examination Survey. Psychosomatic Medicine, 66(3), 316–322.PubMedCrossRefGoogle Scholar
  39. 39.
    Muhtz, C., Zyriax, B. C., Klähn, T., Windler, E., & Otte, C. (2009). Depressive symptoms and metabolic risk: Effects of cortisol and gender. Psychoneuroendocrinology, 34(7), 1004–1011.PubMedCrossRefGoogle Scholar
  40. 40.
    Akbaraly, T. N., Kivimäki, M., Brunner, E. J., Chandola, T., Marmot, M. G., Singh-Manoux, A., et al. (2009). Association between metabolic syndrome and depressive symptoms in middle-aged adults: Results from the Whitehall II study. Diabetes Care, 32(3), 499–504.PubMedCrossRefGoogle Scholar
  41. 41.
    Rieker, P. P., & Bird, C. E. (2005). Rethinking gender differences in health: Why we need to integrate social and biological perspectives. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 60(Spec No 2), 40–47.Google Scholar
  42. 42.
    Treaster, D. E., & Burr, D. (2004). Gender differences in prevalence of upper extremity musculoskeletal disorders. Ergonomics, 47(5), 495–526.PubMedCrossRefGoogle Scholar
  43. 43.
    Unruh, A. M. (1996). Gender variations in clinical pain experience. Pain, 65(2–3), 123–167.PubMedCrossRefGoogle Scholar
  44. 44.
    Otte, C., Hart, S., Neylan, T. C., Marmar, C. R., Yaffe, K., & Mohr, D. C. (2005). A meta-analysis of cortisol response to challenge in human aging: Importance of gender. Psychoneuroendocrinology, 30(1), 80–91.PubMedCrossRefGoogle Scholar
  45. 45.
    Carpenter, K. M., Hasin, D. S., Allison, D. B., & Faith, M. S. (2000). Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: Results from a general population study. American Journal of Public Health, 90(2), 251–257.PubMedCrossRefGoogle Scholar
  46. 46.
    Muennig, P., Lubetkin, E., Jia, H., & Franks, P. (2006). Gender and the burden of disease attributable to obesity. American Journal of Public Health, 96(9), 1662–1668.PubMedCrossRefGoogle Scholar
  47. 47.
    Regidor, E., Barrio, G., de la Fuente, L., Domingo, A., Rodriguez, C., & Alonso, J. (1999). Association between educational level and health related quality of life in Spanish adults. Journal of Epidemiology and Community Health, 53(2), 75–82.PubMedCrossRefGoogle Scholar
  48. 48.
    Strohschein, L., McDonough, P., Monette, G., & Shao, Q. (2005). Marital transitions and mental health: Are there gender differences in the short-term effects of marital status change? Social Science Medicine, 61(11), 2293–2303.PubMedCrossRefGoogle Scholar
  49. 49.
    D’Arcy, C., & Siddique, C. M. (2000). Marital status and psychological well-being: A cross-national comparative analysis. International Journal of Comparative Sociology, 41, 149–166.Google Scholar
  50. 50.
    Huang, I. C., Willke, R. J., Atkinson, M. J., Lenderking, W. R., Frangakis, C., & Wu, A. W. (2007). US and UK versions of the EQ-5D preference weights: Does choice of preference weights make a difference? Quality of Life Research, 16(6), 1065–1072.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Department of Health Science & Services, Graduate School of Public HealthSeoul National UniversitySeoulKorea
  2. 2.Lecturer, College of PharmacySookmyung Women’s UniversitySeoulKorea
  3. 3.Department of Pharmacy Practice and Administration, School of PharmacyRutgers UniversityPiscatawayUSA

Personalised recommendations