Spousal Concordance of Metabolic Syndrome in 3141 Korean Couples: A Nationwide Survey

doi:10.1016/j.annepidem.2005.07.052

Annals of Epidemiology

Volume 16, Issue 4, April 2006, Pages 292-298

https://doi.org/10.1016/j.annepidem.2005.07.052 Get rights and content

Purpose

Epidemiologic data from various regions have shown familial correlations of cardiovascular risk factors and the metabolic syndrome (MES), but not spousal concordance that reflects shared environmental factors, which we describe in a Korean general population.

Methods

We selected 3141 couples; both partners of all couples had completed a national health examination. MES was determined according to National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP-III) definitions, except for waist circumference, where Asian cutoffs were used. For each MES component, unadjusted and age-adjusted spousal correlations and spousal concordance, were calculated, using logistic regression analysis after adjustment for spousal ages.

Results

There were strong positive spousal correlations for each component of the MES, even after adjustment for age. Significant spousal concordance of MES was also observed. Men whose wives had MES had 1.29 (95%CI, 1.07–1.57) times higher risk of having MES, compared to those whose wives did not. Women whose husbands had MES were also at 1.32 (95% CI, 1.09–1.61) times higher risk of having the MES.

Conclusions

There was significant spousal concordance of the MES in Koreans, which implies shared environmental factors contribute to the development of the MES. Targeting screening or disease prevention measures of partners of people with the MES may be beneficial.

Introduction

The metabolic syndrome, also known as the insulin resistance syndrome, is defined by a clustering of risk factors for cardiovascular disease. Epidemiologic data from various regions have shown familial correlations of cardiovascular risk factors and metabolic syndrome 1, 2, 3, 4, 5. Familial correlation of the metabolic syndrome can be explained by common genetic and environmental factors that predispose to the development of the condition. However, discrimination of the relative contribution of the genetic and environmental components of the correlation is problematic. Both components can contribute to disease independently or in conjunction. Studies on the spousal concordance of certain diseases as a result of shared lifestyle and socioeconomic environment, but on an unrelated genetic background, allows the investigation of determinants related to nongenetic factors 6, 7. Identification of the relative contributions of shared modifiable environmental risk factors may then improve our understanding and thus enable targeting of detrimental lifestyle minimizing the rapid increase in the prevalence of the metabolic syndrome. Thus, we studied the spousal concordance of metabolic syndrome and each of its metabolic risk components, using data on 3141 married couples in Korea.

Section snippets

Study Population

The Korean National Health and Nutrition Examination Surveys (KNHANES) were conducted in noninstitutionalized Korean civilians in 1998 and 2001. The KNHANES consisted of basic household interview, health interview and examination, and 24-hour recall and food frequency questionnaire-based nutrition survey. A stratified multistage probability sampling design was used, with selection made from sampling units based on geographical area, sex, and age groups using household registries. Based on the

Results

Table 1 shows the level of major cardiovascular risk factors and their spousal correlations in 3141 married Korean couples. All major risk factors were highly correlated between the spouses, even after adjusting for the age of the spouses. According to the NCEP ATP-III definition, 565 (18.0%) husbands and 585 (18.6%) wives had the metabolic syndrome. When we used the NCEP ATP-III criteria for abdominal obesity (102 cm for men and 88 cm for women), the prevalence of abdominal obesity was 1.7% in

Discussion

The present study showed an overall spousal concordance for the metabolic syndrome and each of its components in these 3141 married couples from Korea. When one spouse tested positive for the metabolic syndrome, his or her marital partner showed about a 30% increased risk of also having the metabolic syndrome. These findings suggest that not only genetic factors but also environmental factors may contribute to the development of metabolic syndrome.

Conclusions

Our study revealed that there is significant spousal concordance for the metabolic syndrome and its components in Korean married couples. The increased risk of same metabolic abnormality within married couples supports the idea that shared environmental factors contribute to the development of the metabolic syndrome. These findings imply that we can reduce the risk of the metabolic syndrome having healthier lifestyles. The findings could also have implications for targeting screening or disease

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Cited by (36)

Spousal similarities in cardiometabolic risk factors: A cross-sectional comparison between Dutch and Japanese data from two large biobank studies
2021, Atherosclerosis
Citation Excerpt :
If concordance is mainly attributed to a cohabitation effect, then it should increase with the partnership duration. Observational studies have explored spousal similarities in cardiometabolic risk factors, such as blood pressure (BP) [12–18], cholesterol level [13–15,17,18], triglycerides (TG) level [13,15,17], abnormal glucose tolerance [12,13,15–20], and smoking [14,19]. Further, a 2008 meta-analysis, showed statistically significant positive spousal concordances for the main coronary risk factors, such as hypertension and diabetes [21].
Few studies have examined and compared spousal concordance in different populations. This study aimed to quantify and compare spousal similarities in cardiometabolic risk factors and diseases between Dutch and Japanese populations.
This cross-sectional study included 28,265 Dutch Lifelines Cohort Study spouse pairs (2006–2013) and 5,391 Japanese Tohoku Medical Megabank Organization (ToMMo) Cohort Study pairs (2013–2016). Spousal similarities in cardiometabolic risk factors were evaluated using Pearson's correlation or logistic regression analyses adjusted for spousal age.
The husbands' and wives’ average ages in the Lifelines and ToMMo cohorts were 50.0 and 47.7 years and 63.2 and 60.4 years, respectively. Significant spousal similarities occurred with all cardiometabolic risk factors and diseases of interest in both cohorts. The age-adjusted correlation coefficients ranged from 0.032 to 0.263, with the strongest correlations observed in anthropometric traits. Spousal odds ratios [95% confidence interval] for the Lifelines vs. ToMMo cohort ranged from 1.45 (1.36–1.55) vs. 1.20 (1.05–1.38) for hypertension to 6.86 (6.30–7.48) vs. 4.60 (3.52–6.02) for current smoking. An increasing trend in spousal concordance with age was observed for sufficient physical activity in both cohorts. For current smoking, those aged 20–39 years showed the strongest concordance between pairs in both cohorts. The Dutch pairs showed stronger similarities in anthropometric traits and lifestyle habits (smoking and drinking) than their Japanese counterparts.
Spouses showed similarities in several cardiometabolic risk factors among Dutch and Japanese populations, with regional and cultural influences on spousal similarities.
Incidence of diabetes after a partner's diagnosis
2017, Preventive Medicine
Citation Excerpt :
A clinic-based study in London found that the partners of people with diabetes were more than twice as likely to also have diabetes than partners of people without diabetes (Khan et al., 2003). Other studies have reported concordance in spouses' diabetes status in the United Kingdom, Sweden, China and Korea, and among Mexican adults in the U.S·(Hemminki et al., 2010; Hippisley-Cox et al., 2002; Jurj et al., 2006; Khan et al., 2003; Kim et al., 2006; Stimpson and Peek, 2005). Across studies, a spouse with a history of diabetes was associated with a 26% higher risk of also having diabetes (Leong et al., 2014).
People socially connected with each other often share health risks, possibly due to shared environments and behaviors. In a cohort study, we examined whether incidence of diabetes was different for individuals with recently diagnosed partners compared to individuals similar on other characteristics but whose partners were never diagnosed with diabetes. We analyzed 2007–11 data from Kaiser Permanente Northern California (KPNC), an integrated health system with > 3.5 million members. We estimated annual diabetes incidence controlling for demographic, socio-economic, behavioral, and health characteristics. Using propensity score matching and multivariate logistic regression, we compared odds of incident diabetes among co-residing partners ages 18–89 years of people who had been diagnosed with diabetes during the previous year (in robustness checks up to the previous three years) and people who had never been diagnosed but were similar on observed characteristics. Partners of newly-diagnosed people had annual diabetes incidence of 16.4/1000, equivalent to10.8 times higher (95%CI: 9.2–12.6) than people whose spouses had never been diagnosed (1.5/1000). Odds remained higher three years after a spouses' diagnosis (45.4 vs. 11.7/1000). Adjusting for other characteristics, odds of diabetes for those with a partner diagnosed in the previous year were 8.7 times higher (CI: 7.4–10.2) than among those whose partner had never been diagnosed. Also, partners of persons with recently-diagnosed diabetes developed diabetes at much higher rates than the general KPNC and U.S. populations. Individuals with a recently diagnosed partner could be considered a high-risk population for screening and prevention.
Spousal health and older adults’ biomarker change over six years: Investigation of gender differences
2019, Archives of Gerontology and Geriatrics
Citation Excerpt :
Biomarkers are generally objectively measured and evaluated as indicators of normal biological or pathogenic processes (Crimmins, Vasunilashorn, Kim, & Alley, 2008; Eckel, Grundy, & Zimmet, 2005). Research on the connection between health concordance and biomarkers began metabolic syndromes such as diabetes (Jee, Suh, Won, & Kim, 2002; Katzmarzyk, Hebebrand, & Bouchard, 2002; Kim et al., 2006; Okuda et al., 2013). Increased HbA1c levels have been observed in women when the health of their husband declines (Lee, Rodríguez, Glei, Weinstein, & Goldman, 2014).
Relationship of spousal health and biomarkers over six years were examined.
Nationally representative sample of 483 adults aged 54+ in Taiwan were followed for six years. Four classes of spousal health changes and three categories of biomarker indexes were examined. Biomarkers were assessed by counting the adverse progression on items of allostatic load (AL), cardiovascular disease biomarkers (CVD), and metabolic syndromes, respectively.
When the health status of an individual’s spouse became worse, women increased their AL by 0.48 (P < 0.05), CVD by 0.56 (P < .001), and metabolic syndrome by 0.43 (P < 0.05). If the health status of a woman’s spouse remained poor, it increased her allostatic load by 0.60 (P < 0.05). These effects were only observed in women. In addition, when the health status of a men’s spouse became better, man’s biomarker profile on AL significantly improved by 0.80 (P < 0.05). No significant moderating effect of education was observed in this sample.
Married couples display concordance in both physical and mental health-related biomarkers, specifically, allostatic load. Women were more likely than men to experience adverse biomarker progress on all the biomarkers examined in this study when the status of their spouse became worse based on their subjective judgment, and men were more sensitive to positive health changes in their spouse than women.
Chronic disease concordance within Indian households: A cross-sectional study
2017, PLoS Medicine
The household is a potentially important but understudied unit of analysis and intervention in chronic disease research. We sought to estimate the association between living with someone with a chronic condition and one’s own chronic condition status.
We conducted a cross-sectional analysis of population-based household- and individual-level data collected in 4 socioculturally and geographically diverse settings across rural and urban India in 2013 and 2014. Of 10,703 adults ages 18 years and older with coresiding household members surveyed, data from 7,522 adults (mean age 39 years) in 2,574 households with complete covariate information were analyzed. The main outcome measures were diabetes (fasting plasma glucose ≥ 126 mg/dL or taking medication), common mental disorder (General Health Questionnaire score ≥ 12), hypertension (blood pressure ≥ 140/90 mmHg or taking medication), obesity (body mass index ≥ 30 kg/m²), and high cholesterol (total blood cholesterol ≥ 240 mg/dL or taking medication). Logistic regression with generalized estimating equations was used to model associations with adjustment for a participant’s age, sex, education, marital status, religion, and study site. Inverse probability weighting was applied to account for missing data. We found that 44% of adults had 1 or more of the chronic conditions examined. Irrespective of familial relationship, adults who resided with another adult with any chronic condition had 29% higher adjusted relative odds of having 1 or more chronic conditions themselves (adjusted odds ratio [aOR] = 1.29; 95% confidence interval [95% CI] 1.10–1.50). We also observed positive statistically significant associations of diabetes, common mental disorder, and hypertension with any chronic condition (aORs ranging from 1.19 to 1.61) in the analysis of all coresiding household members. Associations, however, were stronger for concordance of certain chronic conditions among coresiding household members. Specifically, we observed positive statistically significant associations between living with another adult with diabetes (aOR = 1.60; 95% CI 1.23–2.07), common mental disorder (aOR = 2.69; 95% CI 2.12–3.42), or obesity (aOR = 1.82; 95% CI 1.33–2.50) and having the same condition. Among separate analyses of dyads of parents and their adult children and dyads of spouses, the concordance between the chronic disease status was striking. The associations between common mental disorder, hypertension, obesity, and high cholesterol in parents and those same conditions in their adult children were aOR = 2.20 (95% CI 1.28–3.77), 1.58 (95% CI 1.15–2.16), 4.99 (95% CI 2.71–9.20), and 2.57 (95% CI 1.15–5.73), respectively. The associations between diabetes and common mental disorder in husbands and those same conditions in their wives were aORs = 2.28 (95% CI 1.52–3.42) and 3.01 (95% CI 2.01–4.52), respectively. Relative odds were raised even across different chronic condition phenotypes; specifically, we observed positive statistically significant associations between hypertension and obesity in the total sample of all coresiding adults (aOR = 1.24; 95% CI 1.02–1.52), high cholesterol and diabetes in the adult-parent sample (aOR = 2.02; 95% CI 1.08–3.78), and hypertension and diabetes in the spousal sample (aOR = 1.51; 95% CI 1.05–2.17). Of all associations examined, only the relationship between hypertension and diabetes in the adult-parent dyads was statistically significantly negative (aOR = 0.62; 95% CI 0.40–0.94). Relatively small samples in the dyadic analysis and site-specific analysis call for caution in interpreting qualitative differences between associations among different dyad types and geographical locations. Because of the cross-sectional nature of the analysis, the findings do not provide information on the etiology of incident chronic conditions among household members.
We observed strong concordance of chronic conditions within coresiding adults across diverse settings in India. These data provide early evidence that a household-based approach to chronic disease research may advance public health strategies to prevent and control chronic conditions.
Clinical Trials Registry India CTRI/2013/10/004049; http://ctri.nic.in/Clinicaltrials/login.php
In a cross-sectional analysis, Shivani Patel and colleagues estimate the extent of chronic disease concordance within Indian households.
Aggregation of type-2 diabetes, prediabetes, and metabolic syndrome in German couples
2024, Scientific Reports
Dyadic, biobehavioral, and sociocultural approaches to romantic relationships and health: Implications for research, practice, and policy
2024, Social and Personality Psychology Compass

View all citing articles on Scopus

: This study was supported, in part, by Yonsei University Research Fund of 2004.

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Spousal Concordance of Metabolic Syndrome in 3141 Korean Couples: A Nationwide Survey

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Study Population

Results

Discussion

Conclusions

Ann Epidemiol

Ann Epidemiol

Diabetes Res Clin Pract

Diab Res Clin Prac

Diabetes Res Clin Pract

Diabetes Res Clin Pract

Adult family members and their resemblance of coronary heart disease risk factors: The Cardiovascular Disease Study in Finnmark

Eur J Epidemiol

Cross-trait familial resemblance for body fat and blood lipids: familial correlations in the Quebec Family Study

Arterioscler Thromb Vasc Biol

Familial patterns of covariation for cardiovascular risk factors in adults: The Victorian Family Heart Study

Am J Epidemiol

Familial correlation and heritability for cardiovascular risk factors

Yonsei Med J

Married couples' risk of same disease: Cross sectional study

BMJ

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