Metabolic Syndrome and Menopause are correlated in Moroccan women population.

: Background : Metabolic syndrome is a cluster of metabolic risk factors for type 2 diabetes mellitus and cardiovascular diseases. Physiological variations occurring in women during menopause are thought to be a predisposing factor for the metabolic syndrome. The aim of this study was to evaluate the prevalence of metabolic syndrome and its individual components according to menopausal status in a sample of Moroccan women. Methods : We analyzed data of 653 women aged 19 years and older. We used the recently published joint interim statement criteria to classify subjects as having metabolic syndrome. Results : Out of the total subjects, 262 (40.12%) were syndromic. The metabolic syndrome and abdominal obesity were more common in postmenopausal than in premenopausal women. The highest prevalence of metabolic syndrome was observed in menopausal transition especially among women aged 49-52 years (62.59%). During this period, half of women have at least three metabolic syndrome risk factors. Conclusion : Abdominal obesity associated with metabolic changes occurring in menopause was a risk factor for the development of metabolic syndrome in women. There is a need to adopt a healthy lifestyle to prevent weight gain in women. This can minimize the incidence of metabolic syndrome and its consequences as type 2 diabetes and cardiovascular diseases.


Introduction
Metabolic syndrome is a group of interrelated risk factors of metabolic origin that appear to directly advance the growth of atherosclerotic cardiovascular disease and type 2 diabetes mellitus [1,2]. It combines central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, high blood pressure, and impaired glucose tolerance [3]. Studies showed that metabolic syndrome is associated with a threefold increased risk of coronary heart disease, myocardial infarction, and stroke [4], and a three-to fivefold increased risk of cardiovascular death [5,6] even after adjustment for conventional risk factors [7]. Hence, it makes a full-fledged epidemic [8,9].
Metabolic syndrome is present in 35% of the Moroccan adults [10], in 38.5% of US adults [11], 21.1% of the French population [12], and 27.8% of the Spanish population [13] (by the joint interim statement definition) [14]. Among Arab populations, the prevalence estimates are 30.0% in Tunisia [15], 21% in Saudi Arabia [16] and 36.3% in Jordan [17] (by the third adult treatment panel of the National Cholesterol Education Program definition) [18].
In Morocco, our previous results on the prevalence of the metabolic syndrome have expressed a high incidence of this entity among women, especially among the elderly [10]. This is, of course, the consequence of age, but the impacts of the physiological variations occurring in women (especially during menopause) are not negligible. In fact, metabolic changes and increased abdominal obesity resulting from a decrease in estrogen are one of the hypotheses explaining these results [19]. The rapid Moroccan economic growth in recent decades has made drastic changes in the lifestyle of the Moroccan population [20]. Excess energy intake and sedentary lifestyle are becoming widespread in the population, and is raising metabolic risk factors such as obesity, diabetes, and high blood pressure to the epidemic level [21,22] that lead to metabolic syndrome. Moreover, the high prevalence of metabolic syndrome in postmenopausal women has been depicted in various subject areas. It has ranged from 18.3% among premenopausal [23] to more than 60% in postmenopausal women [24].
To our knowledge, no such studies have been performed in Morocco. The purpose of this study is to determine the prevalence of metabolic syndrome and its individual components according to menopausal status in a population of Moroccan women.

Patients and methods
It is a retrospective study based on the analysis of the files of 653 women consultants at the diagnosis center of Rabat during a period of 20 months from October 2010 to May 2012.
The file analyses consist of exploitation of: 1) anthropometric parameters (the age and the waist circumference which permits the evaluation of the abdominal obesity of the patient), and 2) the results of the measurement of blood pressure and the dosage of biochemical parameters (glycemia, triglyceridemia, total cholesterol and high-density lipoproteincholesterol).
To wait for an upshot of the menopause on the prevalence of the metabolic syndrome, women under and over 48.4 years has referred to as pre-and postmenopausal according to Reynolds and al [25].

Definition of the metabolic syndrome
Granting to the recently published joint interim statement endorsed by the International Diabetes Federation Task Force and several other international and national constitutions to define metabolic syndrome [26]. Women were considered to have metabolic syndrome if they had any three or more of the following criteria: • Elevated waist circumference (populationand country-specific cutoffs: ≥ 94 cm for men and ≥ 80 cm for women).

Statistical Analysis
The chi-square test was performed to compare the crude prevalence rate between pre-and postmenopausal women. The analyses reported in this study were performed using the Statistical Analysis System (SAS). P values less than 0.05 were considered statistically significant.

Results
A total of 653 women were retained in the study. The average age of the population was 52.78y ± 12.33. Postmenopausal women were more obese and suffer high blood glucose levels compared to those in premenopause. (Table 1).
The prevalence of metabolic syndrome in the entire women population was 40.12%. Abdominal obesity was the most common abnormality (56.81%) followed by Low High-Density Lipoprotein-cholesterol (43.34%). Prevalence of metabolic syndrome and abdominal obesity were more common in women in postmenopause than in premenopause. (Table 2).
To explore the variation of metabolic syndrome prevalence according to menopausal status, we introduced the menopausal transition period. It was obtained from the standard deviations around the mean age of menopause in Morocco.
The prevalence of metabolic syndrome was significantly higher among women in menopausal transition period (49.81%) compared to those in premonopause (25.33%) and postmenopause (38.75%) (P<0.0001). Women aged 49-52 years have the highest prevalence of metabolic syndrome (62.59%) (P<0.0001) ( Table 3). Women during menopausal transition have a significantly higher prevalence of abdominal obesity and hypertriglyceridemia compared with those in premenopause and menopause (P<0.05).
In our population, 87.44% of women have at least one abnormality of metabolic syndrome. An accumulation of factors of metabolic syndrome was observed in perimenopausal women. During this period, half of women (49.81%) have at least three metabolic syndrome risk factors (Table 4).

Discussion
The outcomes of this study indicate a high prevalence of metabolic syndrome among Moroccan women. Similar results were cited by several studies using the same definition [10,27,28]. Our findings also show that the prevalence of metabolic syndrome in Moroccan women has changed according to the menopausal status, becoming higher in postmenopausal women (45.08%) than those in the premenopause (32.96 %), (P<0.05). This is consistent with studies conducted in Iran [23,29], India [27] and in Brazil [30]. The change in body metabolic status and the type of fat substitution in different tissues occurring with menopause is one of the theories about the incidence of metabolic syndrome during postmenopause.
In our population, postmenopausal women experienced significantly higher prevalence of abdominal obesity. This indicates that this abnormality could be the primary case of the emergence of E3S Web of Conferences 319, 01 (2021) VIGISAN 2021 metabolic syndrome in women in menopause. The issue of abdominal obesity after menopause has been shown in several studies [24,31], except for H. Ramin and al. who found no substantial dispute in the prevalence of abdominal obesity between the different menopausal status [32]. A great deal of metabolic changes in postmenopausal women are linked to the decrease in estrogen secretion and consequent accumulation of abdominal fatty tissue [19,24,28].     In this study, we explored the variation in the prevalence of metabolic syndrome during perimenopausal transition. We noticed a height in the metabolic syndrome prevalence during this period (49.81%) in comparison to 25.33% and 38.75% in premenopausal and postmenopausal women, respectively (P<0.05). A maximum of this prevalence is showed between 49-52 years which correspond to the first three years after the age of natural menopause in Morocco. This result refutes the theory of age as the unique main factor underlying the development of metabolic syndrome in women. In contrast, other studies have reported an intermediate prevalence between premenopausal and postmenopausal status [24,32]. This may partially be due to the conception of the study (age of menopause determined from the average age of natural menopause in Morocco).
Our study shows that 64.64% of women in menopausal transition have abdominal obesity (as opposed to 40.67% in premenopausal and to 58.33% in postmenopausal women P<0.0001). This finding confirms that this risk factor is the main factor responsible for the development of metabolic syndrome during the transition from premonopause to postmenopause. Reference [33] has shown that abdominal obesity was the most common abnormality during the passage to postmenopause [33]. Natural menopause is associated with an increase in abdominal obesity [23,34,35]. Thus, it seems thereby necessary to take a weight loss strategy to prevent metabolic syndrome and its cardiovascular complications. Likewise, 89.35% of women in the perimenopause have at least one metabolic syndrome abnormalities and half of them (49.81%) have three or more metabolic syndrome risk factors. This suggests that this menopausal status has a dual risk for the women health: 1) A tangible cardiovascular risk, represented by the high prevalence of metabolic syndrome. 2) A further risk bound to the large number of women with different metabolic syndrome abnormalities candidates to develop this entity during the next years.
The exploitation of menopause by median age rather than a measure in our sample may limit generalization of the results of this study.

Conclusion
Metabolic syndrome has become a significant health problem in Morocco [10]. Our study showed a high prevalence of this entity among Moroccan women, especially in menopausal transition and postmenopause. Abdominal obesity, linked up with metabolic changes, was the most common risk factor underlying the development of metabolic syndrome in women after menopause. All attempts should be constructed to prevent weight gain in women by lifestyle modification. This can decrease the prevalence of metabolic syndrome and its complications as type 2 diabetes and cardiovascular diseases.