Menopause and metabolic syndrome: anthropometric, lipid, and dietary profiles

SUMMARY OBJECTIVE: The aim of this study was to characterize the anthropometric, lipid, and dietary profiles of postmenopausal women with metabolic syndrome attending a public health service and compare them with a group of women without metabolic syndrome. METHODS: A cross-sectional study was conducted with 60 postmenopausal women who were divided into two groups: control group and metabolic syndrome group, attending the Climacteric Outpatient Clinic at Santa Casa de São Paulo Hospital, Brazil, between February 2019 and December 2021. Participants were evaluated using a validated semi-quantitative food frequency questionnaire, body mass index, waist circumference, and serum laboratory tests. RESULTS: Significant differences were observed between the groups regarding body mass index and all parameters of metabolic syndrome. The nutritional profile revealed an imbalance in the number of food portions consumed, particularly in the intake of carbohydrates in the form of flour and sweets, which was higher in the metabolic syndrome group. CONCLUSION: The analysis of the three profiles of postmenopausal women revealed significant imbalances, particularly in the metabolic syndrome group, highlighting the importance of regular adjustments and evaluations during this phase of a woman's life.


INTRODUCTION
Metabolic syndrome (MetS) is a risk factor for a number of chronic noncommunicable diseases with high levels of mortality and decreased quality of life.Prevalence in women is around 1.5 to 2 times higher than in men 1 .
Metabolic syndrome appears more frequently during the menopausal transition and worsens after menopause.It represents a public health problem, with significant implications for quality of life, healthcare, as well as social and economic aspects 2 .
In clinical practice, the criteria for MetS defined by the US National Cholesterol Education Program Adult Treatment Panel III (ATP III) are widely used for their simplicity and practicality.MetS is diagnosed based on the presence of three out of five factors 3 .
The consumption of a diet rich in saturated fat, starchy carbohydrates, and high daily caloric intake is associated with numerous chronic noncommunicable diseases 4 .
To investigate possible relationships between dietary habits and MetS, we employed anthropometric assessment; conducted routine serum tests for total cholesterol, lipid fractions, triglycerides, and glucose; and applied a validated semi-quantitative food frequency questionnaire (FFQ) 5,6 .

METHODS
The protocols followed the ethical standards of the Declaration of Helsinki and were approved by the Research Ethics Committee of the Irmandade da Santa Casa de Misericórdia de São Paulo (CEP: 5.322.400).All volunteers recruited signed the informed consent form.Data collection was performed at the moment the patient agreed to participate in the study.
The sample consisted of 60 postmenopausal women aged between 44 and 64 years, who were divided into two groups: MetS group (MetSG, n=30) and control group (CG, n=30).A cross-sectional study was conducted in the public health service with patients attending the Climacteric Outpatient Clinic of Santa Casa de São Paulo Hospital between February 2019 and December 2021.
Inclusion criteria were as follows: postmenopausal women aged up to 64 years, BMI≥18.5 to <35 kg/m 2 , amenorrhea ≥12 months, and FSH≥30 mU/mL.Exclusion criteria were as follows: BMI>35 kg/m 2 , illicit drug use or alcohol abuse, a history of bariatric surgery, cancer, or cardiovascular disease.The diagnosis of MetS was determined according to the ATP III (Adult Treatment Panel) guidelines, widely used for their simplicity and practicality: (1) waist circumference>88 cm; (2) HDL cholesterol concentrations <50 mg/dL; (3) triglycerides Menopause and metabolic syndrome ≥150 mg/dL; (4) blood pressure levels ≥130/85 mmHg; and (5) fasting blood glucose ≥110 mg/dL.MetS is diagnosed based on the presence of three out of five factors 3 .
Through a standardized anamnesis, the following were observed: anthropometric profile, in which weight was measured in kilograms (Balmak digital scale, model BK 200, accuracy of 0.1 kg) with the patient in an upright position and minimally dressed, height was measured in centimeters using a vertical stadiometer, and waist circumference (WC) was measured in centimeters at the midpoint between the last rib and the iliac crest using a measuring tape.Body mass index (BMI) was calculated as weight in kilograms divided by the height in square meters (kg/m 2 ) 7 .For the nutritional profile, a validated semi-quantitative FFQ was completed in a person, which contains nine frequency options: never or<1 month, 1-3 per month, 1 per month, 2-4 per month, 5-6 per month, 1 per day, 2-3 per day, 4-5 per day, and 6+ per day, with 103 questions and 98 foods 7 .Based on the Food Guide for the Brazilian Population, an average intake of food was found to be 2,000 kcal/day 8 .
In the lipid profile, blood samples were analyzed by enzymatic method using the BT 3000 plus device (Wiener lab ® , Rosario, Argentina).The LDL value was calculated and obtained using the Friedewald formula (LDLc= CT-HDLc -TG/5) 9 .Blood pressure was measured using a semi-automatic oscillometer (Omron Hbp-112) while the participant was in a seated position 10 .

Sample size calculation and statistical analysis
The criterion used was a test power of 80%, and a significance level of 5% was considered adequate for evaluating the frequency of the main study variables.Analyses were performed using SPSS version 25.0 (IBM Corp. 2017, Armonk, NY, USA).To compare qualitative variables, we used the chi-square test and, for quantitative variables, we used the Mann-Whitney nonparametric test and the Student's t-test.

RESULTS
With respect to the analyzed characteristics, there were significant differences between the groups in terms of weight, BMI, VLDL cholesterol, and clinical parameters for MetS, as shown in Table 1.The most prevalent parameter in this study was WC>88 cm, which was present in 100% of the MetSG participants.The results of the FFQ with 19 most common foods on the Brazilian table revealed significant differences in the consumption frequencies of up to three times a day analyzed between the two groups with regard to vegetables, fruit juice, wheat flour, sugary cereals, cakes, cookies, mono-and polyunsaturated fats, sweets in general, fast food, and added sugar, as described in Table 2.

DISCUSSION
To help promote a better understanding of MetS and its possible treatments in postmenopausal women, we analyzed a series of variables that constitute risk factors for chronic noncommunicable diseases, as previous studies have adopted a selective approach, considering the individual's nutritional, anthropometric, and lipid profiles separately 11,12 .
The overweight and obesity in women with MetS were also found in other studies [13][14][15] .The prevalence of WC >88 cm present in 100% of MetSG can be observed in studies that analyzed the anthropometric profile of participants 13,16 .Regarding changes in the lipid profile, we found similar reports in the literature concerning postmenopausal women with MetS 17,18 .
When we analyzed the nutritional profile of postmenopausal women using the FFQ and examined the consumption of 19 foods up to three times a day, we observed differences between the two groups in relation to the intake of certain nutrients.The MetSG had higher carbohydrate consumption, mainly refined starchy, bakery products, sugary cereals, cakes, sweet biscuits, sweets in general, above the recommended limit (up to 55% of total daily energy intake), and added sugar, above the recommended limit (up to 10% of the total energy ingested), than the CG.The fat intake for this group was also higher than recommended (up to 35% of total daily energy intake), mainly due to consumption of fast food rich in saturated fat and sodium according to the Brazilian Food Guide 8 .
The World Health Organization recommends that sugar consumption be <10% of daily energy intake 19 , while <5% is recommended in the United States and the United Kingdom 20 .Simple sugar intake is associated with increased blood pressure, WC, serum triglyceride, glucose concentrations, and a significantly increased risk of developing MetS 18 .

Table 1 .
Socio-demographic, anthropometric, and lipid profiles and clinical parameters of postmenopausal women in the control group and the metabolic syndrome group (Ambulatório de climatério-FCMSCSP-2022).

Table 2 .
Frequency of ingestion of 19 food items from the FFQ, up to three times a day, of postmenopausal women in the control group (n=30) and the metabolic syndrome group (n=30) (Ambulatório de Climatério -FCMSCSP-2022).
p<0.05; Chi-square test (mean and SD); N partial: number of participants who responded positively to the frequency of consumption of the 19 food items; MS 1 : metabolic syndrome group; FFQ: Food Frequency Questionnaire; FCMSCSP: Faculdade de Ciências Médicas da Santa Casa de São Paulo.Bold indicates statistically significant p-value.