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FRIDAY, MARCH 24, 2006, 8 AM PST

Contact: Amy Stone
Phone: (414) 918-3156

How Behavior and Emotions Link Low Socioeconomic Status with Central Adiposity and the Metabolic Syndrome

(San Francisco, Mar. 24, 2006) - The association between socioeconomic status (SES) and health has existed for centuries. Yet the reasons that explain this relationship have not always been defined.

Drs. Karen Matthews, Linda Gallo, Elissa Epel, and Nancy Adler have studied this relationship linking behavior, emotions and psychological factors linking low socioeconomic status with the metabolic syndrome and its components, including central adiposity. Their research was presented at the Society of Behavioral Medicine's Annual Meeting and Scientific Sessions.

The metabolic syndrome (MS) is defined as a syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to an increased risk of cardiovascular disease and type 2 diabetes.

"Psychosocial and behavioral factors and their biological consequences may be relevant to understanding how low SES results in early death and disability," commented Matthews of the University of Pittsburgh. "We have a series of studies that address how metabolic syndrome might contribute to SES-related health disparities."

LINKS BETWEEN EMOTIONS
Matthews conducted a sample among a group of more than 400 premenopausal, primarily Caucasian, healthy women who were followed for 12 years in Pittsburgh PA. "We examined paths leading from low SES to MS," Matthews said.

"One path went from low SES to lower reserve capacity (aggregate of optimism, self-esteem, and social support) to greater negative emotions to greater risk for MS. A second path went directly from low SES to MS risk. Taken together, these results suggest that low SES increases risk for MS in part through negative reserve capacity and negative emotions."

FACTORS AMONG LATINAS AT MIDLIFE
Dr. Linda Gallo and colleagues from San Diego State University conducted a study among middle-aged Latino women.

"We examined the direct effects of SES and psychosocial resources on metabolic syndrome variables and emotional risk factors. We tested the indirect effects of SES through resources," explained Gallo.

Among Latina women, those with lower SES reported fewer psychosocial resources, (aggregate of mastery, self esteem, optimism, and social support). A path ran from SES through low psychosocial resources to heightened levels of several indicators of MS (e.g. waist circumference) as well as depression and anxiety. SES also had a direct link to higher levels of blood pressure, waist circumference, and fasting plasma glucose.

Latinas with low SES may be vulnerable to cardiovascular disease due to the direct association between SES and metabolic syndrome and emotional risk factors.

SES STATUS, HORMONES AND MS IN A CARDIA STUDY
Further detailing the mechanisms linking SES and MS, a third paper by Dr. Elissa Epel and colleagues from the University of California-San Francisco examined insulin-like growth factor (IGF-1) and cortisol diurnal slope. Cortisol has previously been linked to MS and to SES. IGF-1 is a potent growth factor that is important to maintain lean body mass and good health. People with growth hormone deficiency (and thus low IGF_1 as well) tend to have greater heart disease and abdominal obesity. IGF-1 has been linked to subordinate social status in baboons, but has not been linked to social class in humans. Participants studied African American and White, male and female, middle-aged adults enrolled in CARDIA (The Coronary Artery Risk Development In Young Adults) Study. CARDIA is designed to increase understanding of contributors to changes in cardiovascular disease (CVD) risk factors during the critical years of transition from adolescence through young adulthood to middle age.)

The study found that IGF-1 was related to higher education, especially in whites. This was even after controlling for age, gender, smoking, alcohol use, and exercise, "This is a first demonstration of a link between insulin-like growth factor 1 (IGF-1) and SES in humans," commented Epel. IGF was more related to SES and MS than was cortisol, which is traditionally thought to link these two factors.

For whites, there was a path from education to IGF-1 to MS. However, among African Americans, IGF-1 but not education was related to MS. Thus, in this third study, low education may confer differential risk for Whites versus African Americans.

In their aggregate, these studies indicate that SES effects on psychosocial resources and behavior may be an important link between SES and MS and, thus, between SES and health. Remaining direct links between SES and MS suggest mediators of that relationship that have yet to be identified. And the links may vary in different ethnic groups, so that, e.g., the role of education in contributing to MS may be very different for African Americans than for whites in the US.

The metabolic syndrome is very common in the United States. Research in behavioral medicine offers new insights in to the relationships among socioeconomic status, behavioral and psychological factors, obesity and clinical measures of metabolic syndrome - a clustering of symptoms that indicates an individual may be at risk for coronary heart disease and diabetes.

Increases in obesity, diabetes and metabolic syndrome are of great concern to health care professionals as they are closely associated with the risk of coronary heart disease and other deadly health conditions.

What is Behavioral Medicine?
Behavioral medicine is the multidisciplinary field concerned with the behavioral and social aspects of medical conditions. Consumers and a wide variety of health professionals are involved in behavioral medicine research and practice, including cardiologists, counselors, epidemiologists, exercise physiologists, family physicians, health educators, internists, nurses, nutritionists, pediatricians, psychiatrists, and psychologists. Behavioral medicine takes a life-span approach to health and health care, working with children, teens, adults, and seniors individually and in groups, and working with racially and ethnically diverse communities in the United States and abroad.

Founded in 1978, SBM has more than 2,000 members and provides the many disciplines of behavioral health care with an interactive network of education and collaboration on common research, clinical, and public policy concerns related to prevention, diagnosis, treatment, rehabilitation and health promotion. For more information, visit www.sbm.org.

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