576920
research-article2015
WHSXXX10.1177/2165079915576920Workplace Health & SafetyWorkplace Health & Safety
Workplace Health & Safety
vol. 63 ■ no. 6
ARTICLE
Metabolic Syndrome Prevalence and Correlates in a Worksite Wellness Program Paige Johnson, PhD, RN1, Lori Turner, PhD, RD1, Melondie Carter, PhD, RN1, Rebecca Kelly, PhD, RD, CDE1, and Patrick J. Ewell, MA1
Abstract: The purpose of this study was to examine the prevalence of metabolic syndrome among faculty and staff who participated in a university wellness program. In addition, this study identified common correlates of metabolic syndrome in the participating employee population. Knowledge of behaviors and characteristics of individuals with metabolic syndrome is essential when developing health promotion strategies for them. Metabolic syndrome is unique in that it results from a clustering of risk factors that are difficult to address, and each additional risk factor increasingly affects health and well-being. A targeted, comprehensive approach is needed to counteract individual’s predisposition to metabolic syndrome. This research identified the association between employees’ metabolic risks and their demographic, physical, and psychosocial characteristics in an effort to determine metabolic syndrome prevalence, develop population-specific interventions, and decrease the risk of metabolic syndrome among workers. Keywords: metabolic syndrome, health promotion, health screening, worksite wellness
M
etabolic syndrome is a health care crisis of epidemic proportion in Western industrialized societies; it is imperative that metabolic syndrome be addressed to preserve the health and well-being of future generations (Falentin, 2010). Metabolic syndrome is defined as a condition of unknown cause that presents with symptoms of insulin resistance, obesity, hypertension, dyslipidemia, and systemic inflammation (Huether & McCance, 2008; Palaniappan, Wong, Shin, Fortmann, & Lauderdale, 2011). It is estimated that 34% of Americans above the age of 20 years have a combination of these risk factors and therefore metabolic syndrome (Ervin,
2009). Because metabolic syndrome is a major health concern in the United States, employers must address the growing number of workers with the syndrome. Occupational health nurses and health promotion professionals must identify individuals at risk for and with a diagnosis of metabolic syndrome and provide risk reduction strategies. Carter and Kelly (2013) defined the role occupational nurses play when screening employees for a variety of health issues and then providing education to empower employees to decrease disease risk factors. First recognized in 1920 and then given a description in 1936 by Himsworth, metabolic syndrome has been categorized as insulin resistance. However, it was not named until Reaven referred to it as “Syndrome X” in 1988 (Rountree, 2010). Other terms used to describe the cluster of risk factors include “the insulin resistance syndrome” and the “deadly quartet” (Eckel, Grundy, & Zimmett, 2005). In 1998, the World Health Organization (WHO) recommended the development of a universal definition and changed the name from Syndrome X to metabolic syndrome (Alberti, Zimmet, & Shaw, 2006). Presently, metabolic syndrome is the term used to describe the clustering of risk factors that result in cardiovascular disease and diabetes (Falentin, 2010). Individuals who have the constellation of risk factors known as metabolic syndrome have been shown to have higher morbidity and mortality rates from cardiovascular disease and Type 2 diabetes than those who do not have metabolic syndrome (Lewis, Rodbard, Fox, & Grandy, 2008). Cardiovascular disease and Type 2 diabetes are leading causes of death in the United States; approximately two thirds of adults in the United States have at least one major risk factor for cardiovascular disease (Berry et al., 2012; Lloyd-Jones et al., 2010), and one in four U.S. deaths is caused by cardiovascular disease (American Heart Association, 2014; Kochanek, Xu, Murphy, Miniño, & Kung, 2011).
DOI: 10.1177/2165079915576920. From 1The University of Alabama. Address correspondence to: Paige Johnson, PhD, RN, Assistant Professor, Capstone College of Nursing, The University of Alabama, Box 870358, Tuscaloosa, AL 35487, USA; email: [email protected]. For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Copyright © 2015 The Author(s)
245 Downloaded from whs.sagepub.com at The University of Auckland Library on June 4, 2016
Workplace Health & Safety
June 2015
Applying Research to Practice Worksite wellness programs should screen for the cluster of risk factors known as metabolic syndrome. Identifying high-risk employees is essential prior to implementing targeted health promotion initiatives. In addition, noninvasive assessments of employees’ self-perception of health should not be discounted. This assessment is an informative measurement of overall employee health.
medication; and fasting glucose greater than or equal to 100 mg/dL or taking glucose-lowering medication. Employees with health risks, including metabolic syndrome, were identified, and differences in several parameters (e.g., age, blood pressure, and history of chronic diseases) were compared between individuals with and without metabolic syndrome. The findings of this study provide data to support the design of prevention programs for employees at risk of developing metabolic syndrome and those employees already suffering from metabolic syndrome.
Method In addition to higher morbidity and mortality rates, health care expenses associated with metabolic syndrome increase health care costs. Individuals with metabolic syndrome incur approximately US$2,000 more per year in health care expenses than individuals who do have a diagnosis of metabolic syndrome; these individuals have a 24% increase in health care costs with each additional risk factor. Individuals with metabolic syndrome have more inpatient hospitalizations, primary care visits, and pharmacy expenses (Boudreau et al., 2009). Although metabolic syndrome increases health care costs significantly, each individual metabolic syndrome component has been associated with higher costs, independent of other syndrome components (Nichols & Moler, 2011). Working adults spend a significant portion of their day at work, making the workplace an ideal setting for screening and prevention programs (Cahalin et al., 2014). As part of their commitment to faculty and staff health and well-being, a large southeastern university established the Office of Health Promotion and Wellness (OHPW) in 2007, launching an employee health screening program in 2009. The overall goal of the university wellness program is to promote and advance the health and well-being of employees (Carter, Kelley, Alexander, & Holmes, 2011). Through the wellness program, employees are eligible for health screenings and health coaching sessions at no charge. As a result of health screenings, participants with abnormal findings, including the diagnosis of metabolic syndrome, are identified. These results provide health coaches and wellness professionals with opportunities to assist workers in setting health-related goals to reduce health-related risk factors. The screenings also identify the prevalence of metabolic syndrome correlates among participants. The American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI) definition requires three of the following five risk factors be present for diagnosis of metabolic syndrome: waist circumference greater than or equal to 102 cm in men or 40 inches or greater than or equal to 88 cm in women or 35 inches; triglycerides greater than or equal to 150 mg/dL; high-density lipoprotein (HDL) cholesterol less than 40 mg/dL for men, less than 50 mg/dL for women, or prescribed cholesterol-lowering medication; systolic blood pressure greater than or equal to 130 mmHg, diastolic blood pressure greater than or equal to 85 mmHg or taking anti-hypertensive
This study was approved by the university’s Institutional Review Board. Data were collected by OHPW staff. The sample for this study met the following inclusion criteria: (a) employee adult men and women 19 years of age or older who (b) attended a university wellness screening and (c) provided a blood sample. University employees participated in the 2009, 2010, or 2011 wellness screenings. After excluding those who did not meet the criteria, the total sample of participants completing the baseline measure was 1,156 employees.
Data Collection All employees were eligible to be screened at no cost. The employees were provided with an informed consent form describing the use of nonidentifiable data for research purposes. Employees registered, read, and signed the informed consent form, and completed the health screening forms. The two-part university health screening and assessment instrument included a biometric screening score sheet completed by both the participant and the health coach who recorded the biometric measurements and a self-reported health profile completed by the participant. After completion of applicable paperwork, biometric screenings (i.e., height, weight, body mass index [BMI], waist circumference, and blood pressure measurements) were completed, and the results entered on the participants’ score sheets. Fasting laboratory values were measured using the finger stick method. Triglycerides, total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol, and glucose levels were all tested. Additional recorded data included the use of blood pressure, lipid-lowering, and glucose-lowering medications. A multiple-item survey was completed to assess each employee’s self-reported health profile. Individuals rated their overall physical health, family history of disease, smoking history, physical activity, education, income, comorbid conditions, and sleep in their health profiles. These data collection tools were adapted from the Centers for Disease Control and Prevention (CDC; 2010), Healthier Worksite Initiative guidelines.
Data Analysis Data from employees who voluntarily completed an annual university wellness screening and met the inclusion criteria were
246 Downloaded from whs.sagepub.com at The University of Auckland Library on June 4, 2016
Workplace Health & Safety
vol. 63 ■ no. 6
619 (54%)
700 600 500 400 300
423 (37%) 283 (24%)
531 (46%) 293 (25%)
403 (35%)
200 100 0 Fasng Waist Triglycerides HDL
research-article2015
WHSXXX10.1177/2165079915576920Workplace Health & SafetyWorkplace Health & Safety
Workplace Health & Safety
vol. 63 ■ no. 6
ARTICLE
Metabolic Syndrome Prevalence and Correlates in a Worksite Wellness Program Paige Johnson, PhD, RN1, Lori Turner, PhD, RD1, Melondie Carter, PhD, RN1, Rebecca Kelly, PhD, RD, CDE1, and Patrick J. Ewell, MA1
Abstract: The purpose of this study was to examine the prevalence of metabolic syndrome among faculty and staff who participated in a university wellness program. In addition, this study identified common correlates of metabolic syndrome in the participating employee population. Knowledge of behaviors and characteristics of individuals with metabolic syndrome is essential when developing health promotion strategies for them. Metabolic syndrome is unique in that it results from a clustering of risk factors that are difficult to address, and each additional risk factor increasingly affects health and well-being. A targeted, comprehensive approach is needed to counteract individual’s predisposition to metabolic syndrome. This research identified the association between employees’ metabolic risks and their demographic, physical, and psychosocial characteristics in an effort to determine metabolic syndrome prevalence, develop population-specific interventions, and decrease the risk of metabolic syndrome among workers. Keywords: metabolic syndrome, health promotion, health screening, worksite wellness
M
etabolic syndrome is a health care crisis of epidemic proportion in Western industrialized societies; it is imperative that metabolic syndrome be addressed to preserve the health and well-being of future generations (Falentin, 2010). Metabolic syndrome is defined as a condition of unknown cause that presents with symptoms of insulin resistance, obesity, hypertension, dyslipidemia, and systemic inflammation (Huether & McCance, 2008; Palaniappan, Wong, Shin, Fortmann, & Lauderdale, 2011). It is estimated that 34% of Americans above the age of 20 years have a combination of these risk factors and therefore metabolic syndrome (Ervin,
2009). Because metabolic syndrome is a major health concern in the United States, employers must address the growing number of workers with the syndrome. Occupational health nurses and health promotion professionals must identify individuals at risk for and with a diagnosis of metabolic syndrome and provide risk reduction strategies. Carter and Kelly (2013) defined the role occupational nurses play when screening employees for a variety of health issues and then providing education to empower employees to decrease disease risk factors. First recognized in 1920 and then given a description in 1936 by Himsworth, metabolic syndrome has been categorized as insulin resistance. However, it was not named until Reaven referred to it as “Syndrome X” in 1988 (Rountree, 2010). Other terms used to describe the cluster of risk factors include “the insulin resistance syndrome” and the “deadly quartet” (Eckel, Grundy, & Zimmett, 2005). In 1998, the World Health Organization (WHO) recommended the development of a universal definition and changed the name from Syndrome X to metabolic syndrome (Alberti, Zimmet, & Shaw, 2006). Presently, metabolic syndrome is the term used to describe the clustering of risk factors that result in cardiovascular disease and diabetes (Falentin, 2010). Individuals who have the constellation of risk factors known as metabolic syndrome have been shown to have higher morbidity and mortality rates from cardiovascular disease and Type 2 diabetes than those who do not have metabolic syndrome (Lewis, Rodbard, Fox, & Grandy, 2008). Cardiovascular disease and Type 2 diabetes are leading causes of death in the United States; approximately two thirds of adults in the United States have at least one major risk factor for cardiovascular disease (Berry et al., 2012; Lloyd-Jones et al., 2010), and one in four U.S. deaths is caused by cardiovascular disease (American Heart Association, 2014; Kochanek, Xu, Murphy, Miniño, & Kung, 2011).
DOI: 10.1177/2165079915576920. From 1The University of Alabama. Address correspondence to: Paige Johnson, PhD, RN, Assistant Professor, Capstone College of Nursing, The University of Alabama, Box 870358, Tuscaloosa, AL 35487, USA; email: [email protected]. For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Copyright © 2015 The Author(s)
245 Downloaded from whs.sagepub.com at The University of Auckland Library on June 4, 2016
Workplace Health & Safety
June 2015
Applying Research to Practice Worksite wellness programs should screen for the cluster of risk factors known as metabolic syndrome. Identifying high-risk employees is essential prior to implementing targeted health promotion initiatives. In addition, noninvasive assessments of employees’ self-perception of health should not be discounted. This assessment is an informative measurement of overall employee health.
medication; and fasting glucose greater than or equal to 100 mg/dL or taking glucose-lowering medication. Employees with health risks, including metabolic syndrome, were identified, and differences in several parameters (e.g., age, blood pressure, and history of chronic diseases) were compared between individuals with and without metabolic syndrome. The findings of this study provide data to support the design of prevention programs for employees at risk of developing metabolic syndrome and those employees already suffering from metabolic syndrome.
Method In addition to higher morbidity and mortality rates, health care expenses associated with metabolic syndrome increase health care costs. Individuals with metabolic syndrome incur approximately US$2,000 more per year in health care expenses than individuals who do have a diagnosis of metabolic syndrome; these individuals have a 24% increase in health care costs with each additional risk factor. Individuals with metabolic syndrome have more inpatient hospitalizations, primary care visits, and pharmacy expenses (Boudreau et al., 2009). Although metabolic syndrome increases health care costs significantly, each individual metabolic syndrome component has been associated with higher costs, independent of other syndrome components (Nichols & Moler, 2011). Working adults spend a significant portion of their day at work, making the workplace an ideal setting for screening and prevention programs (Cahalin et al., 2014). As part of their commitment to faculty and staff health and well-being, a large southeastern university established the Office of Health Promotion and Wellness (OHPW) in 2007, launching an employee health screening program in 2009. The overall goal of the university wellness program is to promote and advance the health and well-being of employees (Carter, Kelley, Alexander, & Holmes, 2011). Through the wellness program, employees are eligible for health screenings and health coaching sessions at no charge. As a result of health screenings, participants with abnormal findings, including the diagnosis of metabolic syndrome, are identified. These results provide health coaches and wellness professionals with opportunities to assist workers in setting health-related goals to reduce health-related risk factors. The screenings also identify the prevalence of metabolic syndrome correlates among participants. The American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI) definition requires three of the following five risk factors be present for diagnosis of metabolic syndrome: waist circumference greater than or equal to 102 cm in men or 40 inches or greater than or equal to 88 cm in women or 35 inches; triglycerides greater than or equal to 150 mg/dL; high-density lipoprotein (HDL) cholesterol less than 40 mg/dL for men, less than 50 mg/dL for women, or prescribed cholesterol-lowering medication; systolic blood pressure greater than or equal to 130 mmHg, diastolic blood pressure greater than or equal to 85 mmHg or taking anti-hypertensive
This study was approved by the university’s Institutional Review Board. Data were collected by OHPW staff. The sample for this study met the following inclusion criteria: (a) employee adult men and women 19 years of age or older who (b) attended a university wellness screening and (c) provided a blood sample. University employees participated in the 2009, 2010, or 2011 wellness screenings. After excluding those who did not meet the criteria, the total sample of participants completing the baseline measure was 1,156 employees.
Data Collection All employees were eligible to be screened at no cost. The employees were provided with an informed consent form describing the use of nonidentifiable data for research purposes. Employees registered, read, and signed the informed consent form, and completed the health screening forms. The two-part university health screening and assessment instrument included a biometric screening score sheet completed by both the participant and the health coach who recorded the biometric measurements and a self-reported health profile completed by the participant. After completion of applicable paperwork, biometric screenings (i.e., height, weight, body mass index [BMI], waist circumference, and blood pressure measurements) were completed, and the results entered on the participants’ score sheets. Fasting laboratory values were measured using the finger stick method. Triglycerides, total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol, and glucose levels were all tested. Additional recorded data included the use of blood pressure, lipid-lowering, and glucose-lowering medications. A multiple-item survey was completed to assess each employee’s self-reported health profile. Individuals rated their overall physical health, family history of disease, smoking history, physical activity, education, income, comorbid conditions, and sleep in their health profiles. These data collection tools were adapted from the Centers for Disease Control and Prevention (CDC; 2010), Healthier Worksite Initiative guidelines.
Data Analysis Data from employees who voluntarily completed an annual university wellness screening and met the inclusion criteria were
246 Downloaded from whs.sagepub.com at The University of Auckland Library on June 4, 2016
Workplace Health & Safety
vol. 63 ■ no. 6
619 (54%)
700 600 500 400 300
423 (37%) 283 (24%)
531 (46%) 293 (25%)
403 (35%)
200 100 0 Fasng Waist Triglycerides HDL
