• Pouria Alipour, Zahra Azizi, Valeria Raparelli, Colleen M Norris, Alexandra Kautzky-Willer, Karolina Kublickiene, Maria Trinidad Herrero, EmamKhaled ElKEChildren's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario. Canada; Replica Analytics Ltd, Ottawa, Ontario, Canada., Peter Vollenweider, Martin Preisig, Carole Clair, and Louise Pilote.
• Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada; Faculty of Medicine, McGill University, Montreal, Canada.
• Eur. J. Intern. Med. 2024 Mar 1; 121: 637563-75.

IntroductionThe burden of metabolic syndrome (MetS) and its components has been increasing mainly amongst male individuals. Nevertheless, clinical outcomes related to MetS (i.e., cardiovascular diseases), are worse among female individuals. Whether these sex differences in the components and sequalae of MetS are influenced by gender (i.e., psycho-socio-cultural factors)) is a matter of debate.  Therefore, the purpose of this study was to determine the association between gender-related factors and the development of MetS, and to assess if the magnitude of the associations vary by sex.MethodData from the Colaus/PsyColaus study, a prospective population-based cohort of 6,734 middle-aged participants in Lausanne (Switzerland) (2003-2006) were used. The primary endpoint was the development of MetS as defined by the Adult Treatment Panel III of the National Cholesterol Education Program. Multivariable models were estimated using logistic regression to assess the association between gender-related factors and the development of MetS. Two-way interactions between sex,  age and gender-related factors were also tested.ResultsAmong 5,195 participants without MetS (mean age=51.3 ± 10.6, 56.1 % females), 27.9 % developed MetS during a mean follow-up of 10.9 years. Female sex (OR:0.48, 95 %CI:0.41-0.55) was associated with decreased risk of developing MetS. Conversely, older age, educational attainment less than university, and low income were associated with an increased risk of developing MetS. Statistically significant interaction between sex and strata of age, education, income, smoking, and employment were identified showing that the reduced risk of MetS in female individuals was attenuated in the lowest education, income, and advanced age strata. However, females who smoke and reported being employed demonstrated a decreased risk of MetS compared to males. Conversely smoking and unemployment were significant risk factors for MetS development among male adults.ConclusionsGender-related factors such as income level and educational attainment play a greater role in the development of MetS in female than individuals. These factors represent novel modifiable targets for implementation of sex- and gender-specific strategies to achieve health equity for all people.Copyright © 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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