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Open Access 01-12-2017 | Research article

Prevalence of metabolic syndrome and health-related quality of life in war-related bilateral lower limb amputees

Authors: Hanieh-Sadat Ejtahed, Mohammad-Reza Soroush, Shirin Hasani-Ranjbar, Pooneh Angoorani, Batool Mousavi, Mehdi Masumi, Farhad Edjtehadi, Mahmood Soveid

Published in: Journal of Diabetes & Metabolic Disorders | Issue 1/2017

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Abstract

Background

Lower limb amputation is correlated with considerable impairments in health-related quality of life (HRQOL) in veterans. The aim of this study is to determine the prevalence of metabolic syndrome (MetS) in veterans with bilateral lower limb amputation and to identify its association with HRQOL.

Methods

This cross-sectional study was conducted on 235 Iranian male veterans with bilateral lower limb amputation. Demographics, anthropometrics, and biochemical measurements were assessed and MetS was defined by National Cholesterol Education Program Adult Treatment Panel III definition. HRQOL was assessed using the 36-item Short Form Health Survey (SF-36) questionnaire which measures eight health-related domains. The scores were compared between two groups of bilateral lower limb Amputees who have diagnosed with and without MetS.

Results

The response rate was 40.7% and the mean age of the amputees was 52.05 years. 62.1% of participants were suffering from MetS (95% CI: 55.9%–68.4%). Patients with MetS were observed to have higher weight, waist and hip circumferences, FBS, TG, LDL and liver enzymes concentrations (P < 0.05). Although scores on all 8 subscales of SF-36 were low, no significant difference was observed in HRQOL scores between amputees with and without MetS. Moreover, the risk of MetS was not significantly different across subjects in the highest compared to the lowest quartile category of HRQOL scores.

Conclusions

Prevalence of MetS in veterans with bilateral lower limb amputation was higher and their HRQOL was lower compared to general population. Some strategies are needed to reduce the risk of cardiovascular diseases among this susceptible population.
Literature
1.
go back to reference Babiæ-Banaszak A, Kovaèiæ L, Kovaèeviæ L, Vuletiæ G, Mujkiæ A, Ebling Z. Impact of war on health related quality of life in Croatia: population study. Croat Med J. 2002;43(4):396–402. Babiæ-Banaszak A, Kovaèiæ L, Kovaèeviæ L, Vuletiæ G, Mujkiæ A, Ebling Z. Impact of war on health related quality of life in Croatia: population study. Croat Med J. 2002;43(4):396–402.
2.
go back to reference Soroush A, Falahati F, Zargar M, Soroush M, Khateri S, Khaji A. Amputations due to landmine and unexploded ordnances in post-war Iran. Arch Iran Med. 2008;11(6):595–7.PubMed Soroush A, Falahati F, Zargar M, Soroush M, Khateri S, Khaji A. Amputations due to landmine and unexploded ordnances in post-war Iran. Arch Iran Med. 2008;11(6):595–7.PubMed
3.
go back to reference Rahimi A, Mousavi B, Soroush M, Masumi M, Montazeri A. Pain and health-related quality of life in war veterans with bilateral lower limb amputations. Trauma Mon. 2012;17(2):282–6.CrossRefPubMedPubMedCentral Rahimi A, Mousavi B, Soroush M, Masumi M, Montazeri A. Pain and health-related quality of life in war veterans with bilateral lower limb amputations. Trauma Mon. 2012;17(2):282–6.CrossRefPubMedPubMedCentral
4.
go back to reference Ebrahimzadeh MH, Rajabi MT. Long-term outcomes of patients undergoing war-related amputations of the foot and ankle. J Foot Ankle Surg. 2007;46(6):429–33.CrossRefPubMed Ebrahimzadeh MH, Rajabi MT. Long-term outcomes of patients undergoing war-related amputations of the foot and ankle. J Foot Ankle Surg. 2007;46(6):429–33.CrossRefPubMed
5.
go back to reference Ebrahimzadeh MH, Moradi A, Khorasani MR, Hallaj-Moghaddam M, Kachooei AR. Long-term clinical outcomes of war-related bilateral lower extremities amputations. Injury. 2015;46(2):275–81.CrossRefPubMed Ebrahimzadeh MH, Moradi A, Khorasani MR, Hallaj-Moghaddam M, Kachooei AR. Long-term clinical outcomes of war-related bilateral lower extremities amputations. Injury. 2015;46(2):275–81.CrossRefPubMed
6.
go back to reference Rahimi A, Masoumi M, Soroush M, Mousavi B. Orthopedic complications in bilateral lower limb amputation. IJOS. 2009;7(2):58–63. Rahimi A, Masoumi M, Soroush M, Mousavi B. Orthopedic complications in bilateral lower limb amputation. IJOS. 2009;7(2):58–63.
7.
go back to reference Hanley MA, Ehde DM, Jensen M, Czerniecki J, Smith DG, Robinson LR. Chronic pain associated with upper-limb loss. Am J Phys Med Rehabil. 2009;88(9):742.CrossRefPubMedPubMedCentral Hanley MA, Ehde DM, Jensen M, Czerniecki J, Smith DG, Robinson LR. Chronic pain associated with upper-limb loss. Am J Phys Med Rehabil. 2009;88(9):742.CrossRefPubMedPubMedCentral
8.
go back to reference Ebrahimzadeh MH, Moradi A, Bozorgnia S, Hallaj-Moghaddam M. Evaluation of disabilities and activities of daily living of war-related bilateral lower extremity amputees. Prosthet Orthot Int. 2016;40(1):51–7.CrossRefPubMed Ebrahimzadeh MH, Moradi A, Bozorgnia S, Hallaj-Moghaddam M. Evaluation of disabilities and activities of daily living of war-related bilateral lower extremity amputees. Prosthet Orthot Int. 2016;40(1):51–7.CrossRefPubMed
9.
go back to reference Rose H, Schweitzer P, Charoenkul V, Schwartz E. Cardiovascular disease risk factors in combat veterans after traumatic leg amputations. Arch Phys Med Rehabil. 1987;68(1):20–3.PubMed Rose H, Schweitzer P, Charoenkul V, Schwartz E. Cardiovascular disease risk factors in combat veterans after traumatic leg amputations. Arch Phys Med Rehabil. 1987;68(1):20–3.PubMed
10.
go back to reference Kurdibaylo SF. Obesity and metabolic disorders in adults with lower limb amputation. J Rehabil Res Dev. 1996;33(4):387.PubMed Kurdibaylo SF. Obesity and metabolic disorders in adults with lower limb amputation. J Rehabil Res Dev. 1996;33(4):387.PubMed
11.
go back to reference Program NCE. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): 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) fi-nal report. Circulation. 2002;106(25):3143-421.. Program NCE. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): 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) fi-nal report. Circulation. 2002;106(25):3143-421..
12.
go back to reference Jahangiry L, Shojaeezadeh D, Montazeri A, Najafi M, Mohammad K. Health-related Quality of Life Among People Participating in a Metabolic Syndrome E-screening Program: A Web-based Study. Int J Prev Med. 2016;7:27.CrossRefPubMedPubMedCentral Jahangiry L, Shojaeezadeh D, Montazeri A, Najafi M, Mohammad K. Health-related Quality of Life Among People Participating in a Metabolic Syndrome E-screening Program: A Web-based Study. Int J Prev Med. 2016;7:27.CrossRefPubMedPubMedCentral
13.
go back to reference Slagter SN, van Vliet-Ostaptchouk JV, van Beek AP, Keers JC, Lutgers HL, van der Klauw MM, et al. Health-Related Quality of Life in Relation to Obesity Grade, Type 2 Diabetes, Metabolic Syndrome and Inflammation. PLoS One. 2015;10(10):e0140599.CrossRefPubMedPubMedCentral Slagter SN, van Vliet-Ostaptchouk JV, van Beek AP, Keers JC, Lutgers HL, van der Klauw MM, et al. Health-Related Quality of Life in Relation to Obesity Grade, Type 2 Diabetes, Metabolic Syndrome and Inflammation. PLoS One. 2015;10(10):e0140599.CrossRefPubMedPubMedCentral
14.
go back to reference Mousavi B, Soroush MR, Montazeri A. Quality of life in chemical warfare survivors with ophthalmologic injuries: the first results form Iran Chemical Warfare Victims Health Assessment Study. Health Qual Life Outcomes. 2009;7:2.CrossRefPubMedPubMedCentral Mousavi B, Soroush MR, Montazeri A. Quality of life in chemical warfare survivors with ophthalmologic injuries: the first results form Iran Chemical Warfare Victims Health Assessment Study. Health Qual Life Outcomes. 2009;7:2.CrossRefPubMedPubMedCentral
15.
go back to reference Dobbelsteyn CJ, Joffres MR, MacLean DR, Flowerdew G. A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys. Int J Obes Relat Metab Disord. 2001;25(5):652–61.CrossRefPubMed Dobbelsteyn CJ, Joffres MR, MacLean DR, Flowerdew G. A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys. Int J Obes Relat Metab Disord. 2001;25(5):652–61.CrossRefPubMed
16.
go back to reference Fazizi F, Esmaillzadeh A, Mirmiran FP. Obesity and cardiovascular disease risk factors in Tehran adults: a population-based study. East Mediterr Health J. 2004;10(6):887–97.PubMed Fazizi F, Esmaillzadeh A, Mirmiran FP. Obesity and cardiovascular disease risk factors in Tehran adults: a population-based study. East Mediterr Health J. 2004;10(6):887–97.PubMed
17.
18.
go back to reference Azizi F, Hadaegh F, Khalili D, Esteghamati A, Hosseinpanah F, Delavari A, et al. Appropriate definition of metabolic syndrome among Iranian adults: report of the Iranian National Committee of Obesity. Arch Iran Med. 2010;13(5):426–8.PubMed Azizi F, Hadaegh F, Khalili D, Esteghamati A, Hosseinpanah F, Delavari A, et al. Appropriate definition of metabolic syndrome among Iranian adults: report of the Iranian National Committee of Obesity. Arch Iran Med. 2010;13(5):426–8.PubMed
19.
go back to reference Ware Jr JE, Kosinski M, Gandek B, Aaronson NK, Apolone G, Bech P, et al. The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51(11):1159–65.CrossRefPubMed Ware Jr JE, Kosinski M, Gandek B, Aaronson NK, Apolone G, Bech P, et al. The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51(11):1159–65.CrossRefPubMed
20.
go back to reference Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Qual Life Res. 2005;14(3):875–82.CrossRefPubMed Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Qual Life Res. 2005;14(3):875–82.CrossRefPubMed
21.
go back to reference Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002;287(3):356–9.CrossRefPubMed Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002;287(3):356–9.CrossRefPubMed
22.
go back to reference Maleki F, Sayehmiri K, Sayehmiri F, Kiani F, Nasiri S, Mohhammadi H, Emraii M. Metabolic syndrome prevalence in Iran: a systematic review and meta-analysis. J Kermanshah Univ Med Sci. 2014;18:242–50. Maleki F, Sayehmiri K, Sayehmiri F, Kiani F, Nasiri S, Mohhammadi H, Emraii M. Metabolic syndrome prevalence in Iran: a systematic review and meta-analysis. J Kermanshah Univ Med Sci. 2014;18:242–50.
23.
go back to reference Naschitz JE, Lenger R. Why traumatic leg amputees are at increased risk for cardiovascular diseases. QJM. 2008;101(4):251–9.CrossRefPubMed Naschitz JE, Lenger R. Why traumatic leg amputees are at increased risk for cardiovascular diseases. QJM. 2008;101(4):251–9.CrossRefPubMed
24.
go back to reference Magalhães P, Capingana DP, Silva AB, Capunge IR, Gonçalves MA. Arterial stiffness in lower limb amputees. Clin Med Insights Circ Respir Pulm Med. 2011;5:49-56. Magalhães P, Capingana DP, Silva AB, Capunge IR, Gonçalves MA. Arterial stiffness in lower limb amputees. Clin Med Insights Circ Respir Pulm Med. 2011;5:49-56.
25.
go back to reference Won KB, Chang HJ, Hong SJ, Ko YG, Hong MK, Jang Y, et al. Prognostic usefulness of metabolic syndrome compared with diabetes in Korean patients with critical lower limb ischemia treated with percutaneous transluminal angioplasty. Yonsei Med J. 2014;55(1):46–52.CrossRefPubMed Won KB, Chang HJ, Hong SJ, Ko YG, Hong MK, Jang Y, et al. Prognostic usefulness of metabolic syndrome compared with diabetes in Korean patients with critical lower limb ischemia treated with percutaneous transluminal angioplasty. Yonsei Med J. 2014;55(1):46–52.CrossRefPubMed
26.
go back to reference Estirado E, Lahoz C, Laguna F, Garcia-Iglesias F, Gonzalez-Alegre MT, Mostaza JM. Metabolic syndrome in patients with peripheral arterial disease. Rev Clin Esp. 2014;214(8):437–44.CrossRefPubMed Estirado E, Lahoz C, Laguna F, Garcia-Iglesias F, Gonzalez-Alegre MT, Mostaza JM. Metabolic syndrome in patients with peripheral arterial disease. Rev Clin Esp. 2014;214(8):437–44.CrossRefPubMed
27.
go back to reference Peles E, Akselrod S, Goldstein DS, Nitzan H, Azaria M, Almog S, et al. Insulin resistance and autonomic function in traumatic lower limb amputees. Clin Auton Res. 1995;5:279–88.CrossRefPubMed Peles E, Akselrod S, Goldstein DS, Nitzan H, Azaria M, Almog S, et al. Insulin resistance and autonomic function in traumatic lower limb amputees. Clin Auton Res. 1995;5:279–88.CrossRefPubMed
28.
go back to reference Modan M, Peles E, Halkin H, Nitzan H, Azaria M, Gitel S, et al. Increased cardiovascular disease mortality rates in traumatic lower limb amputees. Am J Cardiol. 1998;82(10):1242–7.CrossRefPubMed Modan M, Peles E, Halkin H, Nitzan H, Azaria M, Gitel S, et al. Increased cardiovascular disease mortality rates in traumatic lower limb amputees. Am J Cardiol. 1998;82(10):1242–7.CrossRefPubMed
29.
go back to reference Ejtahed HS, Bahadoran Z, Mirmiran P, Azizi F. Sugar-Sweetened Beverage Consumption Is Associated with Metabolic Syndrome in Iranian Adults: Tehran Lipid and Glucose Study. Endocrinol Metab (Seoul). 2015;30(3):334–42.CrossRef Ejtahed HS, Bahadoran Z, Mirmiran P, Azizi F. Sugar-Sweetened Beverage Consumption Is Associated with Metabolic Syndrome in Iranian Adults: Tehran Lipid and Glucose Study. Endocrinol Metab (Seoul). 2015;30(3):334–42.CrossRef
30.
go back to reference Angoorani P, Ejtahed HS, Mirmiran P, Mirzaei S, Azizi F. Dietary consumption of advanced glycation end products and risk of metabolic syndrome. Int J Food Sci Nutr. 2016;67(2):170–6.CrossRefPubMed Angoorani P, Ejtahed HS, Mirmiran P, Mirzaei S, Azizi F. Dietary consumption of advanced glycation end products and risk of metabolic syndrome. Int J Food Sci Nutr. 2016;67(2):170–6.CrossRefPubMed
31.
go back to reference Ejtahed HS, Soroush AR, Angoorani P, Larijani B, Hasani-Ranjbar S. Gut Microbiota as a Target in the Pathogenesis of Metabolic Disorders: A New Approach to Novel Therapeutic Agents. Horm Metab Res. 2016;48(6):349–58.CrossRefPubMed Ejtahed HS, Soroush AR, Angoorani P, Larijani B, Hasani-Ranjbar S. Gut Microbiota as a Target in the Pathogenesis of Metabolic Disorders: A New Approach to Novel Therapeutic Agents. Horm Metab Res. 2016;48(6):349–58.CrossRefPubMed
32.
go back to reference Fallah MS, Sedaghatikhayat B, Guity K, Akbari F, Azizi F, Daneshpour MS. The Relation between Metabolic Syndrome Risk Factors and Genetic Variations of Apolipoprotein V in Relation with Serum Triglyceride and HDL-C Level. Arch Iran Med. 2016;19(1):46–50.PubMed Fallah MS, Sedaghatikhayat B, Guity K, Akbari F, Azizi F, Daneshpour MS. The Relation between Metabolic Syndrome Risk Factors and Genetic Variations of Apolipoprotein V in Relation with Serum Triglyceride and HDL-C Level. Arch Iran Med. 2016;19(1):46–50.PubMed
33.
go back to reference Taghipour H, Moharamzad Y, Mafi AR, Amini A, Naghizadeh MM, Soroush MR, et al. Quality of life among veterans with war-related unilateral lower extremity amputation: a long-term survey in a prosthesis center in Iran. J Orthop Trauma. 2009;23:525–30.CrossRefPubMed Taghipour H, Moharamzad Y, Mafi AR, Amini A, Naghizadeh MM, Soroush MR, et al. Quality of life among veterans with war-related unilateral lower extremity amputation: a long-term survey in a prosthesis center in Iran. J Orthop Trauma. 2009;23:525–30.CrossRefPubMed
34.
go back to reference Hagberg K, Branemark R. Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems. Prosthet Orthot Int. 2001;25(3):186–94.CrossRefPubMed Hagberg K, Branemark R. Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems. Prosthet Orthot Int. 2001;25(3):186–94.CrossRefPubMed
35.
go back to reference van der Schans CP, Geertzen JH, Schoppen T, Dijkstra PU. Phantom pain and health-related quality of life in lower limb amputees. J Pain Symptom Manage. 2002;24(4):429–36.CrossRefPubMed van der Schans CP, Geertzen JH, Schoppen T, Dijkstra PU. Phantom pain and health-related quality of life in lower limb amputees. J Pain Symptom Manage. 2002;24(4):429–36.CrossRefPubMed
36.
go back to reference Asano M, Rushton P, Miller WC, Deathe BA. Predictors of quality of life among individuals who have a lower limb amputation. Prosthet Orthot Int. 2008;32(2):231–43.CrossRefPubMed Asano M, Rushton P, Miller WC, Deathe BA. Predictors of quality of life among individuals who have a lower limb amputation. Prosthet Orthot Int. 2008;32(2):231–43.CrossRefPubMed
37.
go back to reference Tsai AG, Wadden TA, Sarwer DB, Berkowitz RI, Womble LG, Hesson LA, et al. Metabolic syndrome and health-related quality of life in obese individuals seeking weight reduction. Obesity. 2008;16(1):59–63.CrossRefPubMed Tsai AG, Wadden TA, Sarwer DB, Berkowitz RI, Womble LG, Hesson LA, et al. Metabolic syndrome and health-related quality of life in obese individuals seeking weight reduction. Obesity. 2008;16(1):59–63.CrossRefPubMed
38.
go back to reference Porter AC, Lash JP, Xie D, Pan Q, DeLuca J, Kanthety R, et al. Predictors and Outcomes of Health-Related Quality of Life in Adults with CKD. Clin J Am Soc Nephrol. 2016;11(7):1154–62.CrossRefPubMed Porter AC, Lash JP, Xie D, Pan Q, DeLuca J, Kanthety R, et al. Predictors and Outcomes of Health-Related Quality of Life in Adults with CKD. Clin J Am Soc Nephrol. 2016;11(7):1154–62.CrossRefPubMed
39.
go back to reference Lopez-Garcia E, Guallar-Castillon P, Garcia-Esquinas E, Rodriguez-Artalejo F. Metabolically healthy obesity and health-related quality of life: A prospective cohort study. Clin Nutr. 2016. doi:10.1016/j.clnu.2016.04.028. Lopez-Garcia E, Guallar-Castillon P, Garcia-Esquinas E, Rodriguez-Artalejo F. Metabolically healthy obesity and health-related quality of life: A prospective cohort study. Clin Nutr. 2016. doi:10.​1016/​j.​clnu.​2016.​04.​028.
40.
go back to reference Sarrafzadegan N, Gharipour M, Ramezani MA, Rabiei K, Zolfaghar B, Tavassoli AA, et al. Metabolic syndrome and health-related quality of life in Iranian population. J Res Med Sci. 2011;16(3):254–61.PubMedPubMedCentral Sarrafzadegan N, Gharipour M, Ramezani MA, Rabiei K, Zolfaghar B, Tavassoli AA, et al. Metabolic syndrome and health-related quality of life in Iranian population. J Res Med Sci. 2011;16(3):254–61.PubMedPubMedCentral
Metadata
Title
Prevalence of metabolic syndrome and health-related quality of life in war-related bilateral lower limb amputees
Authors
Hanieh-Sadat Ejtahed
Mohammad-Reza Soroush
Shirin Hasani-Ranjbar
Pooneh Angoorani
Batool Mousavi
Mehdi Masumi
Farhad Edjtehadi
Mahmood Soveid
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Journal of Diabetes & Metabolic Disorders / Issue 1/2017
Electronic ISSN: 2251-6581
DOI
https://doi.org/10.1186/s40200-017-0298-2

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