**Table 3.**

*Body mass index and obesity [43].*

developing MetSy [48]. This is important because there are established ethnic differences in the relationship between abdominal adiposity and metabolic disease risk [49, 50]. Baloyi and Mokwena [51] conducted a prospective cross-sectional study among the pregnant women attending antenatal care at Regional Hospital in Bloemfontein, South Africa in which they excluded BMI and WC in defining MetSy but considered the presence of 3 of the 5 risk factors based on the Harmonized Definition of Metabolic Syndrome. The prevalence of MetSy in this sample was 15.46% and the screening tool enables the screening of pregnant women for metabolic syndrome in all trimesters.

Adapted from "Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organization Consultation of Obesity." WHO, Geneva, June 1997.

#### **7. Gender as risk factors for metabolic syndrome**

Studies have demonstrated that there are sex differences concerning risk factor predictors of MetSy, suggesting that levels of sex steroids hormones, estrogen/ androgen, balance potentially play a vital role in determining MetSy [52–56]. In women, raised BMI, low HDL cholesterol, increased WC and hyperglycaemia were significantly greater contributors to the MetSy, whereas in men hypertension and elevated triglycerides were the main factors [55]. Case and Menendez [57] found two factors in SA that contributed to the gender prevalence disparity, nutritionally deprived during childhood and a higher socio-economic status than males. They identified women to have been nutritionally deprived during childhood; and having a higher socio-economic status. The contributing risk factors prevalent in women are abdominal obesity and insulin resistance, as well as physical inactivity, aging and polycystic ovarian syndrome in some [58]. Other factors contributing to the higher prevalence of MetSy in women is that women live longer than men, and it is reported that women develop cardiovascular disease (CVD) at an older age compared to men [59, 60]. There is a wide disparity in economic status among the black population compared to the other ethnic groups, and this correlates with the wide gap in the prevalence of obesity and disease between these ethnic groups that may be partly attributed to or mediated by these social inequalities [61].

**197**

respectively [68].

*10.1.1 Luteinizing hormone*

*Metabolic Syndrome in Reproductive Health: Urgent Call for Screening*

**8. Lifestyle habits as risk factors for metabolic syndrome in women**

There is an inverse relationship between socio-economic status and obesity in high-income countries but consistent positive association between obesity and socio-economic status in low- resource countries [62]. The transition towards Western lifestyle and urbanization which is accompanied by access to clean water and electricity, reduced housing density, more money available to spend on food, higher energy intake, commuting by taxi/vehicle and reduced physical activity or increased sedentary behavior have positively associated with obesity [56, 63]. The risk of developing specific components of MetSy such as obesity, hyperlipidaemia, hypertension, and elevated fasting blood sugar, has been largely attributed to environmental stressors including poor nutrition with consumption of high-calorie diets which are cheaper and fill the stomach at a cheaper price than healthy food, lack of exercise, and smoking [4]. There is a growing trends among the youths and young adult engaging in alcohol binge drinking, this conduct was found to be significantly associated with lower levels of high-density lipoprotein cholesterol (HDL-C). The low HDL-C increases the risk of developing cardiovascular diseases

Available data support the theory of "developmental origins of adult disease" hypothesis, the "Barker Hypothesis", which posits that a significant portion of the risk for adult metabolic conditions is determined by exposure occurring in the perinatal period [65]. The "Barker Hypothesis" proposes that a poor in-utero environment produced by maternal dietary or placental insufficiency may "program" susceptibility in the foetus to later development of cardiovascular and metabolic disease. The "Barker Hypothesis" further proposes that maternal MetSy has an epigenetic effect, making the next generation unwell and leading to an increase in T2DM and cardiovascular disease in juvenile age and in later life from obesity [65, 66]. The MetSy is further associated with polycystic ovary syndrome in girls, obstructive sleep apnoea, hypogonadism and some form of gynecological cancers

*DOI: http://dx.doi.org/10.5772/intechopen.95971*

among these participants [64].

especially endometrial cancer [67].

**9. Consequences of the metabolic syndrome**

**10. Metabolic syndrome and reproductive health**

**10.1 The physiology of the hypothalamic – pituitary – gonadal axis**

Under normal conditions in both males and females, gonadotropin-releasing hormone is produced and released from the hypothalamus, which stimulates the production and release of the gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary. FSH and LH act on the respective gonads, testicles in men and ovaries in women, to stimulate spermatogenesis and steroidogenesis, and folliculogenesis and steroidogenesis

In both sexes, LH stimulates secretion of sex steroids from the gonads. In the testes, LH binds to receptors on Leydig cells, stimulating synthesis and secretion *Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

**Class**

Underweight < 18.5 — — Normal† 18.5–24.9 — — Overweight 25.0–29.9 Increased High

**Disease Risk\* (Relative to Normal Weight and Waist Circumference)**

> **> 40 in (> 102 cm) > 35 in (> 88 cm)**

> > High

**Men** ≤**40 in (**≤.**102 cm) Women** ≤.**35 in (**≤.**88 cm)**

≥.40 III Extremely High Extremely High

I II High Very High Very High Very

**BMI (kg/m2) Obesity** 

developing MetSy [48]. This is important because there are established ethnic differences in the relationship between abdominal adiposity and metabolic disease risk [49, 50]. Baloyi and Mokwena [51] conducted a prospective cross-sectional study among the pregnant women attending antenatal care at Regional Hospital in Bloemfontein, South Africa in which they excluded BMI and WC in defining MetSy but considered the presence of 3 of the 5 risk factors based on the Harmonized Definition of Metabolic Syndrome. The prevalence of MetSy in this sample was 15.46% and the screening tool enables the screening of pregnant women for meta-

*Increased waist circumference can also be a marker for increased risk even in persons of normal weight.*

Adapted from "Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organization Consultation of Obesity." WHO, Geneva, June 1997.

Studies have demonstrated that there are sex differences concerning risk factor

predictors of MetSy, suggesting that levels of sex steroids hormones, estrogen/ androgen, balance potentially play a vital role in determining MetSy [52–56]. In women, raised BMI, low HDL cholesterol, increased WC and hyperglycaemia were significantly greater contributors to the MetSy, whereas in men hypertension and elevated triglycerides were the main factors [55]. Case and Menendez [57] found two factors in SA that contributed to the gender prevalence disparity, nutritionally deprived during childhood and a higher socio-economic status than males. They identified women to have been nutritionally deprived during childhood; and having a higher socio-economic status. The contributing risk factors prevalent in women are abdominal obesity and insulin resistance, as well as physical inactivity, aging and polycystic ovarian syndrome in some [58]. Other factors contributing to the higher prevalence of MetSy in women is that women live longer than men, and it is reported that women develop cardiovascular disease (CVD) at an older age compared to men [59, 60]. There is a wide disparity in economic status among the black population compared to the other ethnic groups, and this correlates with the wide gap in the prevalence of obesity and disease between these ethnic groups that

may be partly attributed to or mediated by these social inequalities [61].

bolic syndrome in all trimesters.

Obesity 30.0–34.9

*Body mass index and obesity [43].*

Extreme Obesity

*\**

*†*

**Table 3.**

35.0–39.9

*Disease risk for type 2 diabetes, hypertension, and CVD.*

**7. Gender as risk factors for metabolic syndrome**

**196**
