Metabolic Syndrome Trajectories and Objective Physical Performance in Mid-to-Early Late Life: The Study of Women’s Health Across the Nation (SWAN)

Abstract

Background Little is known about how adverse, midlife metabolic profiles impact future physical functioning. We hypothesized that a higher number of midlife metabolic syndrome (MetS) components are associated with poorer physical performance in early old age for multi-ethnic women. Methods MetS status from 1996-2011 (8 visits) and objective physical performance in 2015/2016 (short physical performance battery (SPPB; 0-12), 40-foot walk (m/s), 4-meter gait speed (m/s), chair stands (sec), stair climb (sec)) were assessed in the Study of Women’s Health Across the Nation (SWAN; n=1722; age 65.4±2.7 years; 26.9% African American, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified MetS component trajectory groups: none (23.9%), 1=low-MetS (28.7%), 2=mid-MetS (30.9%), and >3=high-MetS (16.5%). Adjusted linear regression related MetS groups to physical performance outcomes. Results High-MetS versus none had higher BMI, pain, financial strain, and lower physical activity and self-reported health (p<0.0001). Compared to White, African American and Hispanic women were more likely to be in the high-MetS groups and had worse physical functioning along with Chinese women (SPPB, chair stand, stair climb, and gait speed - not Hispanic). After adjustments, high-MetS versus none demonstrated significantly worse 40-ft walk (β:-0.08; 95% CI:-0.13, -0.03), gait speed (β:-0.09; 95% CI:-0.15, -0.02), SPPB (β:-0.79; 95% CI: -1.15, -0.44), and chair stands (β:0.69; 95% CI: 0.09, 1.28), but no difference in stair climb. Conclusions Midlife MetS groups were related to poor physical performance in early old age multi-ethnic women. Midlife management of metabolic function may improve physical performance later in life.

Factors Associated With 10-Year Declines in Physical Health and Function Among Women During Midlife

“…Future analyses could examine differences in those who experience early vs late PCS decline and whether certain covariates may mediate changes in PCS. 25 …”

“…We examined a diverse, multiethnic group of women, but they may not be representative of all women. 25 They were all from the US but only from 6 sites. There were differences noted between women who were included and those excluded, with the excluded participants having more comorbidities.…”

“…Mediators of declines in physical health and function may differ from markers of women likely to experience such declines. Future analyses could examine differences in those who experience early vs late PCS decline and whether certain covariates may mediate changes in PCS …”

“…This study has strengths and limitations. We examined a diverse, multiethnic group of women, but they may not be representative of all women . They were all from the US but only from 6 sites.…”

Carotid intima media thickness and cardiometabolic dysfunction: the Study of Women's Health Across the Nation

“…Notably, for women the menopausal transition has been identified as a critical window of risk for adverse metabolic function. Both the prevalence and severity of MetS and its constituent components increase during this time 13 . To our knowledge, while individual risk has been assessed no studies have evaluated the joint effects of having obesity and MetS on the outcome of cIMT and AD.…”