title: The association between metabolic syndrome and pressure ulcers among individuals living with spinal cord injury.
abstract: OBJECTIVE
  The objective of this study was to identify the relationship between metabolic syndrome (MetS) and pressure ulcers (PrU), after controlling for demographic and injury characteristics, socioeconomic factors, health behaviors and fatigue among participants with spinal cord injury (SCI).
  
  
  METHODS
  This cross-sectional study recruited 350 participants with SCI from a hospital in the western region of the USA. Blood tests and physical examination were performed. Waist circumference, high-density cholesterol, triglycerides, blood pressure and fasting glucose were used to diagnose MetS according to Criteria for Clinical Diagnosis of Metabolic Syndrome defined by the American Heart Association. All other variables were self-reported. Three-stage multivariate logistic regression models were conducted to evaluate the effects of three sequential sets of predictors, including demographic/injury, socio-environmental/behavioral and health factors, basing the order of analysis on the Theoretical Risk and Prevention Model.
  
  
  RESULTS
  The prevalence of PrU and MetS was 11.0% (n=36) and 35.3% (n=115), respectively. Ethnicity, smoking, alcohol consumption and MetS were statistically associated with PrU in the full model. Participants who were non-Hispanic (odds ratio (OR)=10.30, 95% confidence interval (CI): 3.46-30.65), smokers (OR=2.69, 95% CI: 1.00-7.27) and drank over 30 drinks per month (OR=5.26, 95% CI: 1.24-22.26) had greater odds of having a PrU compared with those who were Hispanic, non-smokers and non-drinkers, respectively. We also observed a positive association between MetS and PrU (ORMetS=3.71, 95% CI: 1.45-9.52), even after controlling for all other factors.
  
  
  CONCLUSIONS
  Participants who had MetS had higher odds of PrU than those without MetS after adjusting for multiple covariates. Unhealthy behaviors such as smoking and excess drinking were positively associated with PrU.
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: N D
authors.initials: ND
authors.lastname: DiPiro
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Szlachcic
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: J
authors.initials: J
authors.lastname: Krause
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology* / Q000209:etiology*; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000209:etiology*; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D014280:Triglycerides