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HOME > Ann Occup Environ Med > Volume 25; 2013 > Article
Research Article Prevalence of the Metabolic Syndrome among Korean Workers by Occupational Group: Fifth Korean National Health and Nutrition Examination Survey (KNHANES) 2010
Ji Young Ryu1, Sukwoo Hong1, Chang-Hyo Kim2, Sangyoon Lee1, Jeong-Ho Kim3, Jong-Tae Lee3, Dae Hwan Kim1
Annals of Occupational and Environmental Medicine 2013;25:13.
DOI: https://doi.org/10.1186/2052-4374-25-13
Published online: August 5, 2013

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• Received: April 5, 2013   • Accepted: July 1, 2013

Copyright © 2013 Ryu et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Objectives
    The prevalence of the metabolic syndrome has increased rapidly in South Korea over the past 10 years. However, the occurrence of the metabolic syndrome in workers grouped according to the specific type of work is not well understood in Korea. In this study, we assessed the differences in the prevalence of the metabolic syndrome by occupational group and evaluated the risk of the metabolic syndrome among occupational groups.
  • Methods
    From the Fifth Korean National Health and Nutrition Examination Survey (2010), 3,303 employed participants were included in this study. The unadjusted and age-adjusted prevalences of the metabolic syndrome were estimated and multiple logistic regression analysis was conducted using the presence of the metabolic syndrome as a dependent variable, and adjusting for age, education level, household income, drinking behavior, smoking status, physical activity, work hours, and work scheduling pattern.
  • Results
    Among male workers, non-manual workers had the greatest age-adjusted prevalence (26.4%, 95% CI: 22.3-30.5%) among the occupational groups. In a logistic regression analysis, male manual workers had a significantly lower odds ratio for the metabolic syndrome relative to non-manual workers (0.59, 95% CI: 0.41-0.85).
  • Conclusion
    Our study demonstrated differences in the prevalence of the metabolic syndrome by occupational group and identified the greatest risk for the metabolic syndrome in male non-manual workers.
  • Keywords: Metabolic syndrome; Prevalence; Workers; Occupation
The metabolic syndrome is a condition that is defined by the combination of five factors: abdominal obesity, hypertension, hypertriglyceridemia, low HDL-cholesterol level, and hyperglycemia [1]. These components of the metabolic syndrome are major risk factors for cardiovascular disease and impaired glucose metabolism [1-4].
Recently, the prevalence of the metabolic syndrome has increased rapidly in South Korea [5,6]. According to a study using the data from the Korean National Health and Nutrition Examination Survey (KNHANES), the age-adjusted prevalence of the metabolic syndrome in 2007 was 31.3%, while the age-adjusted prevalence of the metabolic syndrome in 1998 had been just 24.9% [6]. It is thought that the rapid increase in the prevalence of the metabolic syndrome may have arisen from lifestyle changes including a westernized diet and physical inactivity [5-7].
On the other hand, recent studies have shown that the prevalence of the metabolic syndrome varies in different occupational groups [8,9]. Among U.S. workers, the unadjusted and age-adjusted prevalences of the metabolic syndrome were greatest in “transportation and material occupations” and “food preparation and food service workers,” respectively [9]. In male Spanish workers, the highest age-adjusted prevalence of the metabolic syndrome was found among “machine installers, operators and assemblers” while the prevalence of the metabolic syndrome in female workers was highest among “skilled workers in the agricultural and fishing industries” [8]. It is expected that the prevalence of the metabolic syndrome among workers may differ by country, considering the distinctive working environment of each country. In Korea, only a few studies have assessed the association between the occupational group and the metabolic syndrome. Although previous research by Myoung et al. has evaluated the relationship between occupations and the metabolic syndrome among Korean workers, the study was limited by the fact that the occupations were grouped into manual or non-manual workers only, without considering service and sales workers as a separate work group [10].
In this study, we assessed the differences in the prevalence of the metabolic syndrome and its individual criteria by occupational group and evaluated the risk of the metabolic syndrome among occupational groups using KNHANES data.
Subjects
Data from the fifth KNHANES, gathered in 2010, was used for the analyses. The KNHANES is a multistage stratified complex design survey of a representative sample of the entire Korean population conducted by the Korea Centers for Disease Control and Prevention. The total number of participants was 8,958, and the participation rate was 81.9%. Trained interviewers and laboratory technicians conducted surveys in households, including administering questionnaires, performing health examinations, and collecting blood samples. Subjects who were at least 20 years old, who reported having jobs, and who had occupational information were included in this study (n = 3,667). Subjects who reported having no jobs (n = 4,595), who had no occupational information (n = 597), or who belonged to the armed forces group in the occupational classification (n = 31) were excluded from this study. After this exclusion, the workers who were aged below 20 years old were also excluded (n = 68). Among 3,667 included workers, 3,303 workers who had fully available data needed for diagnosis of the metabolic syndrome were analyzed. This study was approved by the Institutional Review Board of the Haeundae Paik Hospital.
Occupational classification
The subjects were classified into nine occupational subgroups based on the KNHANES data. The KNHANES employed the major categories of the Korean Standard Classification of Occupations (KSCO) [11] as the occupational classification. These occupations were grouped into three categories according to their degree of physical work: non-manual workers, service/sales workers, and manual workers. Non-manual workers were managers, professionals and related workers, and clerks. Service workers and sales workers constituted one distinctive group. Manual workers consisted of skilled agricultural, forestry and fishery workers, craft and related trades workers, equipment, machine operating and assembling workers, and elementary workers.
Definition of the metabolic syndrome
The presence of the metabolic syndrome was determined by the consensus definition [1] incorporating International Diabetes Federation (IDF) worldwide criteria [12] and American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria [13]. An individual who had any three or more of the following five criteria was defined as having the metabolic syndrome: 1) waist circumference ≥ 90 cm in men and ≥ 80 cm in women, 2) blood pressure ≥ 130/85 mmHg or receiving anti-hypertensive medication, 3) triglycerides ≥ 150 mg/dl, 4) HDL-cholesterol < 40 mg/dl in men and < 50 mg/dl in women, 5) fasting glucose ≥ 100 mg/dl or taking blood glucose lowering drugs.
Covariates
Age, level of education, household income, smoking status, high-risk drinking behavior, vigorous physical activity, work hours, work scheduling pattern, and body mass index (BMI) were included as covariates in this study. The levels of education were categorized into elementary school graduates (6-year course), middle school graduates (3-year), high school graduates (3-year), and some university education or above (2 or more years). Household income was classified by quartile as low, low-middle, middle-high, or high levels. Smoking status was divided into non-smokers, ex-smokers, and current smokers. High-risk drinking was defined as at least 7 glasses per day in men and at least 5 glasses per day in women and drinking behavior was categorized into no, once a month, once a week, or every day experience of high-risk drinking. Vigorous physical activity was defined as physical activities over 10 minutes that are more strenuous than usual activities or make one breathless, including carrying heavy loads, running, climbing, fast cycling, fast swimming, soccer, basketball, and so on. This variable was divided into none, below 5 days per week, and at least 5 days per week of vigorous physical activities. Work hours were categorized into 40 hours per week or less and over 40 hours per week. Work schedule patterns were grouped as either daytime fixed work or non-daytime work, including night-time and shift work. BMI was classified into normal/underweight (below 25 kg/m2), overweight (between 25 and 30 kg/m2), and obese (more than 30 kg/m2).
Statistical analyses
The statistical analyses were performed using SAS Enterprise Guide (version 4.2; SAS Institute Inc., Cary, NC) to take into account sample weights and complex sample design effects. All of the data are presented as an estimated percentage (standard error) or estimated mean (standard error) for the demographic variables and each component of the metabolic syndrome. The Rao-Scott chi-squared test was used to compare the prevalence of the categorical variables. The unadjusted and age-adjusted prevalences of the metabolic syndrome for nine occupational groups were estimated. Age-standardization by the direct method was done for the prevalence estimates using 2010 Census population data of Korea. The prevalence estimate for each occupational group was considered significantly higher than that for workers overall if the estimate was above the upper bounds of the 95% confidence interval for the overall prevalence estimate [14]. For the occupational groups, multiple logistic regression analysis was conducted with the presence of the metabolic syndrome as a dependent variable after stratification for gender. The multiple logistic regression analysis was performed, adjusting for age (continuous variable), level of education, household income, drinking behavior, smoking status, physical activity, work hours, and work schedule pattern.
Tables 1 and 2 present the demographic characteristics by the major job categories of the KSCO among male and female workers, respectively. In both the male and female workers, “managers”, “professional and related” workers, and “clerks” had high levels of education and household income. Among the male workers, the proportion doing vigorous physical activity at least 5 days per week was lowest in the “managers” (3.5%), followed by “professional and related” workers (3.8%) and “clerks” (5.8%) and highest in the “skilled agricultural, forestry and fishery workers” (17.5%), followed by “elementary” workers (14.8%), sales workers (12.7%), and service workers (12.3%). The proportion of those with less than 40 work hours per week was higher in the “managers” (48.4%), “professional and related” workers (41%), and “clerks” (42.6%) than in the other work groups in the men. Service workers reported the highest proportion of non-day work in both the male (51.4%) and female (29.8%) workers. “Managers”, “professional and related” workers, and “clerks” were more likely to be overweight or obese than those of the other occupational groups in the male workers. On the other hand, in female workers, the proportion of overweight or obese individuals was smaller among the “managers”, “professional and related” workers, and “clerks” than the other occupational groups.
Table 1
Demographic characteristics by major category of the Korean Standard Classification of Occupations among male workers
  Managers Professional and related workers Clerks Service workers Sales workers Skilled agricultural, forestry and fishery workers Craft and related trades workers Equipment, machine operation and assembling workers Elementary workers Total p-value
Age (years)*
 50.9 (1.3)
 38.2 (0.7)
 39.1(0.7)
 36.8 (1.4)
 41.2 (1.2)
 56.4 (1.4)
 42.7 (0.9)
 45.1 (1.1)
 46.1 (1.7)
 44.1 (0.4)
 < 0.001
Education
  
  
  
  
  
  
  
  
  
  
 < 0.001
  ≤ Elementary school
 0.0 (0.0)
 0.6 (0.4)
 0.4 (0.4)
 4.9 (2.1)
 6.5 (2.1)
 41.5 (3.3)
 14.2 (2.7)
 7.7 (1.8)
 21.7 (4.3)
 10.7 (1.1)
  
  Middle school
 16.3 (5.6)
 0.4 (0.3)
 1.7 (1.0)
 6.4 (2.4)
 7.6 (2.2)
 20.8 (3.9)
 13.9 (2.5)
 19.7 (3.0)
 17.5 (3.6)
 10.3 (0.9)
  
  High school
 31.8 (6.7)
 21.0 (3.6)
 27.6 (3.4)
 56.3 (5.4)
 45.7 (4.4)
 24.9 (3.2)
 53.3 (4.0)
 56.9 (4.0)
 50.5 (4.9)
 39.2 (1.5)
  
  ≥ University
 51.8 (6.7)
 78.0 (3.6)
 70.3 (3.6)
 32.4 (4.8)
 40.2 (3.9)
 12.8 (2.8)
 18.6 (3.0)
 15.7 (3.2)
 10.3 (2.8)
 39.8 (1.7)
  
Household income
  
  
  
  
  
  
  
  
  
  
 < 0.001
  Low
 3.7 (2.7)
 6.7 (1.8)
 2.7 (1.1)
 6.5 (2.7)
 9.3 (2.2)
 24.1 (4.0)
 12.3 (2.8)
 8.6 (2.4)
 26.5 (4.2)
 10.9 (1.0)
  
  Low-middle
 10.6 (4.4)
 17.1 (2.7)
 24.5 (2.8)
 34.6 (2.7)
 27.6 (3.6)
 28.2 (4.3)
 35.4 (3.7)
 26.9 (3.5)
 29.2 (4.3)
 26.4 (1.4)
  
  Middle-high
 29.2 (7.2)
 39.0 (3.0)
 33.9 (3.1)
 25.0 (4.4)
 36.1 (4.3)
 18.2 (2.6)
 29.0 (3.4)
 37.6 (3.6)
 29.5 (4.9)
 31.9 (1.4)
  
  High
 56.5 (6.1)
 37.3 (2.9)
 38.9 (3.7)
 33.9 (5.2)
 27.0 (3.7)
 29.5 (4.2)
 23.4 (3.3)
 26.9 (3.4)
 14.8 (3.6)
 30.7 (1.6)
  
High-risk drinking
  
  
  
  
  
  
  
  
  
  
 0.002
  Never
 17.5 (5.2)
 12.7 (2.1)
 14.1 (2.3)
 7.4 (2.6)
 13.0 (2.7)
 18.1 (3.6)
 14.1 (2.5)
 14.8 (2.3)
 26.4 (4.6)
 14.8 (1.0)
  
  Once a month
 13.4 (6.3)
 46.3 (3.4)
 38.9 (3.3)
 44.4 (5.8)
 33.7 (4.0)
 32.6 (4.3)
 42.5 (4.5)
 39.2 (4.3)
 35.9 (5.5)
 40.0 (1.5)
  
  Once a weak
 30.0 (6.6)
 30.2 (3.2)
 38.3 (3.6)
 35.5 (5.3)
 43.6 (4.3)
 26.2 (4.1)
 28.8 (3.8)
 29.7 (3.5)
 20.2 (4.7)
 31.8 (1.2)
  
  Everyday
 9.1 (4.2)
 10.7 (2.0)
 8.7 (2.2)
 12.7 (3.6)
 9.8 (2.6)
 23.2 (3.3)
 14.6 (2.7)
 16.3 (3.2)
 17.5 (4.0)
 13.4 (1.1)
  
Smoking status
  
  
  
  
  
  
  
  
  
  
 0.027
  Non-smoker
 15.0 (4.4)
 23.7 (2.4)
 17.7 (2.6)
 18.7 (3.9)
 17.9 (3.1)
 13.9 (2.8)
 12.0 (2.4)
 10.9 (2.5)
 15.5 (3.9)
 16.5 (1.0)
  
  Ex-smoker
 41.1 (6.1)
 30.1 (2.9)
 31.6 (2.8)
 23.9 (4.4)
 31.8 (3.7)
 41.8 (3.0)
 32.7 (3.6)
 34.4 (3.1)
 29.5 (4.3)
 32.6 (1.3)
  
  Current smoker
 43.9 (6.0)
 46.3 (3.4)
 50.8 (2.9)
 57.4 (5.1)
 50.3 (4.4)
 44.3 (3.5)
 55.4 (3.7)
 54.7 (3.4)
 55.0 (5.3)
 50.9 (1.4)
  
Vigorous physical activity
  
  
  
  
  
  
  
  
  
  
 < 0.001
  None
 66.2 (6.4)
 53.3 (3.8)
 44.4 (3.6)
 52.1 (5.1)
 50.2 (3.5)
 60.7 (3.3)
 53.3 (4.2)
 49.4 (3.7)
 58.8 (5.2)
 52.7 (1.4)
  
  < 5 days per week
 30.3 (6.1)
 42.8 (3.9)
 49.7 (3.6)
 35.7 (5.2)
 37.1 (4.1)
 21.8 (2.8)
 36.1 (4.1)
 41.4 (3.7)
 26.4 (5.2)
 37.6 (1.4)
  
  ≥ 5 days per week
 3.5 (2.1)
 3.8 (1.2)
 5.8 (1.4)
 12.3 (3.6)
 12.7 (3.0)
 17.5 (2.6)
 10.7 (2.2)
 9.2 (2.4)
 14.8 (4.1)
 9.7(0.8)
  
Work hours
  
  
  
  
  
  
  
  
  
  
 < 0.001
  ≤ 40 hours per week
 48.8 (6.5)
 41.0 (3.6)
 42.6 (3.3)
 28.5 (4.7)
 28.3 (3.9)
 37.8 (4.4)
 25.6 (2.9)
 23.6 (3.2)
 39.4 (4.8)
 34.4 (1.3)
  
  > 40 hours per week
 51.2 (6.5)
 59.0 (3.6)
 57.4 (3.3)
 71.5 (4.7)
 71.7 (3.9)
 62.2 (4.4)
 74.4 (2.9)
 76.4 (3.2)
 60.6 (4.8)
 65.6 (1.3)
  
Work schedule pattern
  
  
  
  
  
  
  
  
  
  
 < 0.001
  Day
 92.0 (4.5)
 81.7 (2.5)
 90.9 (2.2)
 48.6 (5.7)
 84.8 (3.0)
 99.8 (0.2)
 87.2 (3.5)
 72.9 (3.3)
 68.5 (4.1)
 82.2 (1.2)
  
  Night/overnight
 3.7 (2.0)
 13.6 (2.3)
 2.6 (1.1)
 26.3 (5.3)
 14.2 (3.0)
 0.1 (0.1)
 2.0 (1.3)
 8.7 (2.0)
 11.3 (2.8)
 8.6 (0.8)
  
  Shift
 0.0
 1.5 (0.9)
 5.2 (1.9)
 15.5 (4.1)
 0.3 (0.2)
 0.0
 8.4 (2.7)
 11.3 (2.5)
 19.4 (3.2)
 6.3 (0.8)
  
  Others
 4.2 (4.1)
 3.2 (1.0)
 1.3 (0.7)
 9.6 (2.7)
 0.7 (0.5)
 0.1 (0.1)
 2.4 (2.0)
 7.1 (2.2)
 0.8 (0.7)
 2.9 (0.5)
  
BMI category
  
  
  
  
  
  
  
  
  
  
 0.230
  Normal/underweight
 55.2 (7.6)
 56.6 (3.0)
 58.1 (3.5)
 60.5 (5.8)
 62.8 (4.2)
 68.5 (3.5)
 61.4 (3.3)
 62.2 (3.7)
 67.0 (4.5)
 61.3 (1.4)
  
  Overweight
 37.5 (6.4)
 39.3 (2.9)
 36.4 (3.6)
 37.7 (5.7)
 30.5 (3.7)
 30.8 (3.4)
 35.2 (3.2)
 33.5 (3.6)
 30.1 (4.5)
 34.7 (1.3)
  
  Obese 7.3 (3.7) 4.1 (1.3) 5.5 (1.7) 1.8 (1.3) 6.7 (2.0) 0.7 (0.5) 3.4 (1.5) 4.3 (1.5) 2.9 (1.4) 3.9 (0.6)  
*Estimated mean (standard error).
Table 2
Demographic characteristics by major category of the Korean Standard Classification of Occupations among female workers
  Managers Professional and related workers Clerks Service workers Sales workers Skilled agricultural, forestry and fishery workers Craft and related trades workers Equipment, machine operation and assembling workers Elementary workers Total p-value
Age (yr)*
 54.1 (3.9)
 34.2 (0.6)
 33.7 (0.7)
 43.2 (1.0)
 43.2 (1.0)
 57.4 (1.5)
 49.1 (2.9)
 41.8 (2.4)
 51.7 (1.0)
 45.4 (0.6)
 < 0.001
Education
  
  
  
  
  
  
  
  
  
  
 < 0.001
  ≤ Elementary school
 0.0 (0.0)
 0.6 (0.3)
 0.3 (0.3)
 21.7 (3.3)
 18.4 (2.6)
 67.2 (4.7)
 30.4 (9.7)
 16.5 (7.4)
 39.8 (3.0)
 22.3 (1.9)
  
  Middle school
 18.2 (15.1)
 0.6 (0.4)
 2.2 (1.0)
 18.3 (2.9)
 13.3 (2.5)
 15.5 (4.5)
 34.5 (8.4)
 17.2 (7.6)
 18.5 (3.4)
 11.6 (1.1)
  
  High school
 18.4 (12.9)
 17.1 (2.5)
 50.1 (3.9)
 47.3 (3.6)
 47.6 (3.7)
 15.0 (4.2)
 31.8 (7.6)
 60.4 (10.3)
 34.7 (3.7)
 34.5 (1.7)
  
  ≥ University
 63.3 (18.0)
 81.7 (2.5)
 47.4 (4.1)
 12.6 (2.7)
 20.7 (3.0)
 2.3 (1.4)
 3.3 (2.3)
 5.8 (4.1)
 6.9 (1.8)
 31.5 (1.8)
  
Household income
  
  
  
  
  
  
  
  
  
  
 < 0.001
  Low
 0.0 (0.0)
 4.0 (1.4)
 2.6 (1.2)
 10.0 (2.3)
 12.1 (2.3)
 35.7 (4.9)
 30.6 (9.4)
 0.0 (0.0)
 25.1 (2.9)
 14.2 (1.3)
  
  Low-middle
 1.2 (1.2)
 17.2 (2.7)
 20.7 (3.8)
 31.1 (3.6)
 23.0 (3.8)
 25.6 (3.2)
 23.6 (6.1)
 23.9 (7.7)
 36.9 (3.4)
 25.4 (1.5)
  
  Middle-high
 14.6 (13.3)
 37.4 (3.3)
 36.8 (4.2)
 30.7 (3.8)
 35.4 (3.8)
 18.0 (3.3)
 28.2 (7.6)
 45.2 (10.9)
 22.6 (2.5)
 30.8 (1.5)
  
  High
 84.2 (13.4)
 41.4 (3.4)
 40.0 (3.8)
 28.2 (3.3)
 29.6 (3.7)
 20.7 (3.2)
 17.6 (6.5)
 30.9 (9.5)
 15.4 (2.6)
 29.6 (1.6)
  
High-risk drinking
  
  
  
  
  
  
  
  
  
  
 < 0.001
  Never
 77.4 (15.6)
 39.6 (3.5)
 31.7 (3.9)
 35.9 (3.9)
 43.6 (3.8)
 57.0 (5.4)
 18.5 (6.7)
 37.1 (11.3)
 42.7 (5.0)
 39.8 (1.7)
  
  Once a month
 22.6 (15.6)
 45.0 (3.7)
 52.9 (4.3)
 43.5 (4.0)
 37.8 (4.2)
 38.4 (4.4)
 58.6 (9.3)
 59.8 (11.7)
 35.9 (3.9)
 43.6 (4.6)
  
  Once a weak
 0.0 (0.0)
 15.4 (3.2)
 14.7 (3.0)
 13.6 (2.6)
 17.2 (3.3)
 4.0 (2.2)
 19.5 (8.5)
 3.1 (3.1)
 14.3 (3.3)
 13.8 (1.3)
  
  Everyday
 0.0 (0.0)
 0.0 (0.0)
 0.7 (0.7)
 7.0 (2.0)
 1.3 (1.3)
 0.6 (0.6)
 3.4 (2.6)
 0.0 (0.0)
 7.1 (3.0)
 2.7 (0.6)
  
Smoking status
  
  
  
  
  
  
  
  
  
  
 0.015
  Non-smoker
 100.0 (0.0)
 88.5 (1.9)
 86.3 (2.7)
 86.0 (3.1)
 83.4 (3.0)
 96.4 (1.7)
 91.8 (5.6)
 96.7 (3.3)
 83.0 (3.2)
 87.4 (1.2)
  
  Ex-smoker
 0.0 (0.0)
 7.5 (1.6)
 7.9 (2.2)
 4.9 (1.7)
 9.5 (2.4)
 2.3 (1.4)
 8.0 (5.6)
 0.0 (0.0)
 5.4 (1.7)
 6.3 (0.8)
  
  Current smoker
 0.0 (0.0)
 4.0 (1.1)
 5.8 (1.8)
 9.2 (2.9)
 7.1 (2.2)
 1.3 (0.8)
 0.1 (0.1)
 3.3 (3.3)
 11.6 (3.1)
 6.3 (0.9)
  
Vigorous physical  activity
  
  
  
  
  
  
  
  
  
  
 0.007
  None
 55.8 (18.7)
 74.1 (3.1)
 70.2 (3.7)
 70.1 (3.7)
 69.5 (3.8)
 76.1 (4.1)
 86.3 (5.4)
 61.5 (8.8)
 75.0 (3.2)
 72.9 (1.4)
  
  < 5 days per week
 44.2 (18.7)
 21.8 (2.9)
 26.2 (3.6)
 20.4 (3.6)
 23.7 (3.3)
 11.4 (2.7)
 6.5 (3.6)
 23.9 (8.4)
 16.2 (2.4)
 19.8 (1.2)
  
  ≥ 5 days per week
 0.0 (0.0)
 4.1 (1.3)
 3.6 (1.4)
 9.5 (2.3)
 6.8 (2.0)
 12.5 (3.3)
 7.2 (4.3)
 14.6 (5.6)
 8.8 (2.0)
 7.3 (0.8)
  
Work hours
  
  
  
  
  
  
  
  
  
  
 < 0.001
  ≤ 40 hours per week
 80.4 (13.9)
 57.0 (3.5)
 52.4 (4.2)
 33.7 (4.0)
 48.9 (4.0)
 50.9 (4.0)
 29.4 (7.3)
 35.9 (9.9)
 64.5 (3.6)
 51.2 (1.6)
  
  > 40 hours per week
 19.6 (13.9)
 43.0 (3.5)
 47.6 (4.2)
 66.3 (4.0)
 51.1 (4.0)
 49.1 (4.0)
 70.6 (7.3)
 64.1 (9.9)
 35.5 (3.6)
 48.8 (1.6)
  
Work schedule pattern
  
  
  
  
  
  
  
  
  
  
 <0.001
  Day
 93.8 (5.4)
 74.8 (3.2)
 94.3 (2.0)
 70.2 (3.7)
 77.7 (3.4)
 99.0 (0.7)
 93.0 (4.6)
 74.2 (9.6)
 85.8 (2.7)
 82.7 (1.5)
  
  Night/overnight
 5.1 (5.1)
 18.9 (3.0)
 3.2 (1.5)
 24.5 (3.4)
 15.6 (2.9)
 0.0
 4.6 (2.6)
 6.1 (3.8)
 12.0 (2.6)
 12.9 (1.3)
  
  Shift
 1.1 (1.2)
 3.8 (1.5)
 1.7 (1.3)
 2.2 (0.9)
 3.7 (1.7)
 0.3 (0.3)
 2.4 (2.4)
 8.1 (6.1)
 1.2 (0.6)
 2.4 (0.5)
  
  Others
 0.0
 2.5 (1.0)
 0.7 (0.5)
 3.1 (1.2)
 3.0 (1.4)
 0.7 (0.6)
 0.0
 11.6 (9.0)
 1.0 (0.5)
 2.0 (0.4)
  
BMI category
  
  
  
  
  
  
  
  
  
  
 0.009
  Normal/underweight
 82.8 (11.7)
 82.9 (2.5)
 79.7 (3.2)
 72.2 (3.2)
 68.5 (4.0)
 66.8 (4.4)
 69.4 (8.0)
 70.3 (9.6)
 70.9 (2.6)
 74.2 (1.3)
  
  Overweight
 17.2 (11.7)
 14.5 (2.2)
 15.0 (2.6)
 22.5 (3.0)
 27.6 (4.0)
 26.4 (3.3)
 30.5 (8.0)
 17.3 (7.8)
 24.4 (2.7)
 21.2 (1.1)
  
  Obese 0.0 (0.0) 2.6 (1.2) 5.2 (1.9) 5.3 (1.8) 3.9 (1.5) 6.8 (1.9) 0.1 (0.1) 12.4 (7.0) 4.7 (1.3) 4.5 (0.7)  
*Estimated mean (standard error).
The prevalence estimates of the metabolic syndrome by demographic characteristics stratified by gender are shown in Table 3. Among the male workers, the subgroup with the highest prevalence of the metabolic syndrome was the obese group (68.3%), followed by the overweight group (39.1%) and the group engaging in high-risk drinking everyday (38.1%). In the female workers, the group of those aged ≥ 70 years (53.5%) showed the highest prevalence of the metabolic syndrome, followed by the obese group (46.1%).
Table 3
The prevalence of the metabolic syndrome according to demographic characteristics
 
 Male
 Female
Demographics Number *† Prevalence (95% confidence intervals) ‡ Number *† Prevalence (95% confidence intervals) ‡
Age group
  
  
  
  
  20–29 years
 152/1,942,533
 9.2 (4.1–14.3)
 231/1,733,502
 3.5 (0.7–6.2)
  30–39 years
 428/3,276,013
 17.8 (13.5–22.1)
 291/1,634,571
 5.5 (2.0–9.0)
  40–49 years
 477/3,659,709
 25.9 (21.3–30.4)
 371/2,433,142
 12.5 (8.2–16.8)
  50–59 years
 392/2,681,787
 35.7 (30.2–41.2)
 374/1,891,022
 30.8 (25.2–36.5)
  60–69 years
 297/1,176,249
 36.4 (29.5–43.3)
 188/758,966
 38.0 (30.1–45.8)
  ≥ 70 years
 113/415,885
 17.4 (9.1–25.8)
 93/373,407
 53.5 (43.5–63.4)
Education
  
  
  
  
  ≤ Elementary school
 262/1,377,314
 28.7 (21.5–35.8)
 407/1,912,522
 40.9 (35.6–46.2)
  Middle school
 218/1,385,292
 35.9 (29.0–42.8)
 175/989,224
 24.4 (16.6–32.3)
  High school
 637/5,078,713
 20.1 (16.4–23.7)
 491/3,089796
 9.3 (6.1–12.5)
  ≥ University
 742/5,310,859
 23.6 (19.9–27.4)
 481/2,833,069
 7.6 (4.2–11.1)
Household income
  
  
  
  
  Low
 224/1,362,396
 25.9 (18.9–32.9)
 239/1,171,008
 35.3(28.6–41.9)
  Low–middle
 476/3,488,782
 21.4 (16.9–25.8)
 366/2,177,822
 19.8 (15.3–24.2)
  Middle–high
 568/4,173,072
 23.8 (19.4–28.2)
 448/2,712,764
 14.3 (10.7–18.0)
  High
 575/4,051,739
 25.5 (21.1–29.9)
 481/2,648,160
 10.4 (7.1–13.7)
High–risk drinking
  
  
  
  
  Never
 275/1,681,687
 14.7 (9.6–19.9)
 473/2,633,998
 15.4 (11.2–19.7)
  Once a month
 644/4,713,082
 21.2 (17.4–24.9)
 494/2,956,125
 12.8 (9.3–16.4)
  Once a weak
 490/3,727,662
 26.0 (21.6–30.4)
 130/932,867
 17.4 (9.6–25.2)
  Everyday
 226/1,602,909
 38.1 (30.7–45.5)
 23/152,018
 31.1 (8.8–53.4)
Smoking status
  
  
  
  
  Non–smoker
 320/2,194,133
 19.5 (14.4–24.5)
 1,394/7,721,944
 17.5 (14.9–20.2)
  Ex–smoker
 697/4,369,598
 27.0 (22.9–31.0)
 81/546,406
 16.0 (7.0–25.0)
  Current smoker
 841/6,585,245
 23.7 (20.1–27.3)
 78/547,078
 15.8 (6.7–24.9)
Vigorous physical activity
  
  
  
  
  None
 1,035/6,872,680
 25.0 (21.9–28.1)
 1,144/6,444,936
 17.8 (14.4–20.7)
  < 5 days per week
 659/4,976,027
 23.7 (19.5–28.0)
 293/1,726,743
 17.3 (12.5–22.2)
  ≥ 5 days per week
 164/1,300,269
 20.2 (12.7–27.8)
 115/633,191
 14.8 (7.9–21.7)
Work hours
  
  
  
  
  ≤ 40 hours per week
 666/4,555,070
 22.5 (18.6–26.5)
 819/4,514,730
 17.3 (13.9–20.7)
  > 40 hours per week
 1,193/8,597,108
 24.9 (21.8–28.0)
 735/4,309,882
 17.3 (14.3–20.4)
Work schedule pattern
  
  
  
  
  Day working
 1,526/10,805,797
 24.5 (21.9–271)
 1,312/7,305,852
 18.3 (15.4–21.2)
  Non–day working
 328/2,319,154
 22.0 (16.6–27.4)
 238/1,501,207
 12.4 (6.8–18.1)
BMI category
  
  
  
  
  Underweight
 40/272,239
 0.0 (0.0–0.0)
 85/539,963
 0.0 (0.0–0.0)
  Normal
 1,099/7,673,502
 12.9 (10.3–15.4)
 1,053/6,039,293
 9.4 (7.5–11.4)
  Overweight
 654/4,672,170
 39.1 (34.3–43.9)
 350/1,858,859
 41.9 (35.7–48.1)
  Obese 61/500,005 68.3 (54.1–82.5) 65/384,483 46.1 (32.3–59.9)
*Subject number/estimated population number. †Subject number varies due to item which was not answered. ‡Unadjusted prevalence of the metabolic syndrome (95% confidence intervals).
Unadjusted and age-adjusted prevalence estimates for each occupational group stratified by gender are presented in Table 4. In the male workers, the overall unadjusted and age-adjusted prevalence estimates of the metabolic syndrome were 24.1% (95% CI: 21.7-26.5%) and 23.2% (95% CI: 21.0-25.5%), respectively. The prevalence estimates in male non-manual workers were 26.3% (95% CI: 22.3-30.2%) and 26.4% (95% CI: 22.3-30.5%), respectively, after age adjustment, which were the highest among the three occupational groups. In the occupational subgroups, “equipment, machine operation and assembling” workers showed the highest unadjusted prevalence of the metabolic syndrome (35.4%, 95% CI: 28.4-42.4%), followed by “managers” (31.7%, 95% CI: 18.1-45.3%) and “clerks” (26.9%, 95% CI: 21.0-32.8%). The highest age-adjusted prevalence for male workers was found in “professional and related” workers (27.3%, 95% CI: 20.9-33.6%), followed by “equipment, machine operation and assembling” workers (26.5%, 95% CI: 21.1-32.0%) and “managers” (26.5%, 95% CI: 14.2-38.8%).
Table 4
Unadjusted and age-adjusted prevalence of the metabolic syndrome by category of the Korean Standard Classification of Occupations stratified by gender
 
  
 Prevalence of the metabolic syndrome
(95% confidence intervals)
Occupational groups Number * Unadjusted Age-adjusted
Overall male workers
 1,859/13,152,179
 24.1 (21.7–26.5)
 23.2 (21.0–25.5)
Non-manual workers
 676/4,905,005
 26.3 (22.3–30.2) †
 26.4 (22.3–30.5) †
  Managers
 61/362,106
 31.7 (18.1–45.3) †
 26.5 (14.2–38.8) †
  Professional and related workers
 335/2,531,917
 25.0 (19.3–30.8) †
 27.3 (20.9–33.6) †
  Clerks
 280/2,010,981
 26.9 (21.0–32.8) †
 24.6 (18.1–31.1)
Service/sales workers
 304/2,302,276
 19.9 (14.6–25.2)
 21.5 (15.9–27.1)
  Service workers
 104/910,156
 15.7 (8.1–23.3)
 17.5 (9.0–26.0)
  Sales workers
 200/1,392,120
 22.7 (15.3–30.0)
 23.0 (16.2–29.8)
Manual workers
 879/5,944,897
 23.9 (20.6–27.1)
 20.1 (17.3–23.0)
  Skilled agricultural, forestry and fishery workers
 272/1,589,656
 24.3 (18.2–30.4)
 15.6 (10.9–20.2)
  Craft and related trades workers
 206/1,733,288
 15.7 (10.6–20.7)
 16.4 (11.0–21.9)
  Equipment, machine operating and assembling workers
 240/1,597,780
 35.4 (28.4–42.4) †
 26.5 (21.1–32.0) †
  Elementary workers
 161/1,024,171
 19.2 (11.3–27.2)
 16.9 (9.4–24.4)
Overall female workers
 1,544/8,824,612
 17.3 (14.8–19.8)
 19.5 (17.3–21.6)
Non-manual workers
 545/3,325,220
 7.7 (4.4–10.9)
 20.8 (11.3–30.2) †
  Managers
 8/22,859
 12.8 (−9.1–34.8)
 10.6 (−6.7–27.9)
  Professional and related workers
 334/1,998,628
 7.3 (3.5–11.2)
 27.9 (21.5–34.3) †
  Clerks
 203/1,303,732
 8.1 (2.6–13.5)
 9.8 (2.7–16.9)
Service/sales workers
 428/2,502,853
 16.9 (12.8–20.9)
 18.4 (13–22.9)
  Service workers
 215/1,340,314
 16.9 (11.4–22.3)
 20.5 (14.5–26.6) †
  Sales workers
 213/1,162,539
 16.9 (11.2–22.5)
 17.6 (11.9–23.2)
Manual workers
 581/2,996,538
 28.4 (23.9–32.9) †
 20.8 (16.9–24.7) †
  Skilled agricultural, forestry and fishery workers
 225/1,011,474
 39.2 (31.8–46.6) †
 22.0 (15.2–28.9) †
  Craft and related trades workers
 42/258,235
 19.1 (4.4–33.8)
 12.0 (2.8–21.2)
  Equipment, machine operating and assembling workers
 35/158,745
 7.8 (−2.5–18.1)
 6.2 (−1.7–14.2)
  Elementary workers 279/1,568,083 25.0 (19.1–31.0) † 20.0 (14.5–25.5) †
*Subject number/estimated population number. †The prevalence estimate for each occupational group was above the upper bound of the 95% confidence interval for the overall prevalence estimate.
In the female workers, the estimates of overall unadjusted and age-adjusted prevalence of the metabolic syndrome were 17.3% (95% CI: 14.8-19.8%) and 19.5% (95% CI: 17.3-21.6%), respectively. Among the female workers, the age-adjusted prevalence of the metabolic syndrome was similar in both non-manual (20.8%, 95% CI: 11.3-30.2%) and manual (20.8%, 95% CI: 16.9-24.7%) workers, while the unadjusted prevalence was highest in manual workers (28.4%, 95% CI: 23.9-32.9%) and was lowest in non-manual workers (7.7%, 95% CI: 4.4-10.9%). In the individual occupational groups, the highest unadjusted prevalence was documented in “skilled agricultural, forestry and fishery” workers (39.2%, 95% CI: 31.8-46.6%), followed by “elementary” workers (25.0%, 95% CI: 19.1-31.0%) and “craft and related trades” workers (19.1%, 95% CI: 4.4-33.8%). “Professional and related” workers showed the highest age-adjusted prevalence of the metabolic syndrome among the female workers (27.9%, 95% CI: 21.5-34.3%), followed by “skilled agricultural, forestry and fishery” workers (22.0%, 95% CI: 15.2-28.9).
Table 5 shows the age-adjusted prevalence of the individual components of the metabolic syndrome by occupational group. Among the three occupational groups of non-manual, service/sales, and manual workers, the non-manual workers had the highest prevalence of high blood pressure (40.1%), hypertriglyceridemia (39.4%), low HDL-cholesterol level (20.5%), and hyperglycemia (31.8%) among the male workers. The highest prevalence of abdominal obesity was found in the service/sales workers among the male workers (28.6%). In the occupational subgroups, the prevalence estimate of abdominal obesity for male workers was highest in the “managers” (35.4%), followed by “craft and related trades” workers (31.1%) and “equipment, machine operation and assembling” workers (31.1%). “Clerks” also showed the highest prevalence of high blood pressure (51.6%) and hyperglycemia (34.5%) for male workers. Among the male workers, the highest prevalence of hypertriglyceridemia was found in the “equipment, machine operation and assembling” workers (44.9%), and the highest prevalence of low HDL-cholesterol levels was identified in the “professional and related” workers (22.0%), followed by “equipment, machine operation and assembling” workers (19.5%). Unlike the male workers, the prevalence of abdominal obesity among the female workers was highest in the “skilled agricultural, forestry and fishery” workers (50.5%), followed by “service” workers (42.0%), “professional and related” workers (41.8%), and “elementary” workers (40.9%). The highest prevalence of high blood pressure among the female workers was documented in the “craft and related trades” workers (32.3%). The highest prevalence of hypertriglyceridemia was found in the “managers” (31.8%). In the female workers, the “skilled agricultural, forestry and fishery” workers (43.0%) and “professional and related” workers (43.0%) showed the highest prevalence of low HDL-cholesterol levels. However, the prevalence of low HDL-cholesterol levels among male workers was lowest in the “skilled agricultural, forestry and fishery” workers (9.0%). The prevalence of hyperglycemia among the female workers was highest in the “professional and related” workers (24.7%).
Table 5
Age-adjusted prevalence of the components of the metabolic syndrome by category of the Korean Standard Classification of Occupations
 
 Non-manual workers
 Service/sales workers
 Manual workers
  
Components Managers Professional and related workers Clerks Service workers Sales workers Skilled agricultural, forestry and fishery workers Craft and related trades workers Equipment, machine operation and assembling workers Elementary workers Total p-value
Male workers
  
  
  
  
  
  
  
  
  
  
  
  WC ≥ 90 cm (M)/80 cm (W)
  
 24.5 (2.5)
  
 28.6 (3.5)
  
 24.0 (1.9)
  
 25.1 (1.3)
 0.946
35.4 (8.7)
 21.1 (2.8)
 25.7 (3.7)
 25.7 (4.7)
 28.2 (3.9)
 22.8 (3.5)
 31.1 (4.3)
 31.0 (3.2)
 18.2 (4.2)
 0.705
  BP ≥ 130/85 mmHg or treated
  
 40.1 (2.5)
  
 33.3 (3.3)
  
 32.7 (1.7)
  
 36.3 (1.4)
 0.036
46.0 (6.9)
 33.2 (3.5)
 51.6 (2.6)
 29.8 (4.4)
 35.5 (3.8)
 26.6 (3.3)
 29.0 (3.5)
 32.7 (2.6)
 36.2 (4.1)
 <0.001
  TG ≥ 150 mg/dl
  
 39.4 (2.6)
  
 35.5 (2.7)
  
 35.3 (2.2)
  
 37.4 (1.4)
 0.225
41.8 (8.0)
 43.9 (3.3)
 33.7 (3.8)
 35.2 (5.0)
 37.7 (3.3)
 25.9 (4.6)
 34.7 (4.0)
 44.9 (2.9)
 29.9 (4.9)
 0.119
  HDL-C < 40 mg/dl
  
 20.5 (2.2)
  
 13.3 (2.5)
  
 18.3 (1.8)
  
 19.2 (1.2)
 0.024
14.9 (4.1)
 22.0 (3.2)
 16.9 (2.5)
 12.6 (3.8)
 13.5 (3.0)
 9.0 (1.5)
 17.1 (3.0)
 19.5 (2.9)
 18.8 (4.6)
 0.119
  FPG ≥ 100 mg/dl or treated
  
 31.8 (2.5)
  
 29.3 (3.4)
  
 26.2 (1.7)
  
 28.6 (1.3)
 0.191
31.2 (7.6)
 31.8 (3.2)
 34.5 (4.1)
 26.2 (5.1)
 29.2 (3.8)
 20.3 (2.4)
 25.8 (3.5)
 27.1 (2.8)
 26.8 (3.4)
 0.284
Female workers
  
  
  
  
  
  
  
  
  
  
  WC ≥ 90 cm (M)/80 cm (W)
  
 34.6 (4.8)
  
 39.0 (2.5)
  
 41.8 (3.3)
  
 36.8 (1.4)
 <0.001
19.5 (12.2)
 41.8 (3.4)
 24.6 (4.3)
 42.0 (3.4)
 36.9 (3.2)
 50.5 (6.7)
 32.0 (5.1)
 22.4 (5.4)
 40.9 (5.0)
 <0.001
  BP ≥ 130/85 mmHg or treated
  
 21.0 (1.8)
  
 23.8 (2.2)
  
 27.6 (1.9)
  
 25.6 (1.2)
 <0.001
29.4 (10.8)
 19.0 (2.2)
 23.2 (3.3)
 26.4 (2.9)
 21.3 (3.0)
 29.0 (4.2)
 32.3 (4.8)
 7.1 (4.0)
 27.0 (2.5)
 <0.001
  TG ≥ 150 mg/dl
  
 15.7 (2.7)
  
 23.3 (2.9)
  
 17.6 (2.1)
  
 17.9 (1.1)
 <0.001
31.8 (13.2)
 18.4 (2.1)
 5.6 (2.0)
 22.7 (4.5)
 23.6 (3.4)
 16.1 (2.6)
 9.5 (4.0)
 8.3 (4.8)
 18.4 (2.8)
 <0.001
  HDL-C < 50 mg/dl
  
 34.9 (4.7)
  
 32.2 (2.9)
  
 34.7 (3.1)
  
 32.8 (1.4)
 <0.001
15.1 (10.8)
 43.0 (2.6)
 21.2 (4.3)
 33.2 (3.6)
 33.0 (4.0)
 43.0 (5.8)
 37.9 (8.4)
 16.8 (5.1)
 32.1 (5.1)
 <0.001
  FPG ≥ 100 mg/dl or treated  
 19.8 (4.5)
  
 16.1 (1.9)
  
 19.0 (2.0)
  
 18.1 (1.1) <0.001
9.4 (8.6) 24.7 (3.7) 15.6 (3.5) 15.3 (3.1) 17.1 (2.8) 14.9 (1.8) 9.0 (2.2) 15.2 (5.8) 20.7 (2.5) <0.001
Abbreviation: All values were the estimated percentage (standard error). WC waist circumference, BP blood pressure, TG triglyceride, HDL-C high-density lipoprotein cholesterol, FPG fasting plasma glucose, M male, F female.
Table 6 shows the results of multiple logistic regression analyses. Manual workers were significantly less likely to have the metabolic syndrome (odds ratio: 0.62, 95% CI: 1.19-5.86) relative to non-manual workers among male workers after adjustment for age, level of education, household income, high risk drinking, smoking status, and vigorous physical activity (Model I). After additional adjustment for work hours and work schedule pattern, both manual (0.63, 95% CI: 0.39-0.99) and service/sales (0.59, 95% CI: 0.41-0.85) workers had significantly lower odds of having the metabolic syndrome compared to non-manual workers among the male workers (Model II). There were no significant associations between the metabolic syndrome and the occupational group among female workers in either model. When comparing the subgroups of service/sales and manual workers with the non-manual workers as a reference, “service” workers, “craft and related trades” workers, and “elementary” workers showed significantly lower odds among the male workers.
Table 6
Multiple logistic regression to assess the relationship between occupation and meeting criteria for the metabolic syndrome among Korean workers aged ≥20 years
 
 Odds ratio (95% confidence intervals)
  Male Female
Model I*
  
  
Occupational group
  
  
 Non-manual workers
 1.00 (reference)
 1.00 (reference)
  Service/sales workers
 0.66 (0.42–1.02)
 0.98 (0.45–2.12)
  Service workers
 0.49 (0.25–0.96)
 0.92 (0.36–2.32)
  Sales workers
 0.74 (0.43–1.28)
 1.12 (0.51–2.46)
 Manual workers
 0.62 (0.44–0.88)
 1.00 (0.46–2.16)
  Skilled agricultural, forestry and fishery workers
 0.38 (0.20–0.70)
 1.56 (0.56–4.33)
  Craft and related trades workers
 0.39 (0.23–0.66)
 0.78 (0.21–2.83)
  Equipment, machine operating and assembling workers
 1.22 (0.82–1.83)
 0.88 (0.16–4.67)
  Elementary workers
 0.43 (0.21–0.91)
 0.84 (0.38–1.86)
Model II†
  
  
Occupational groups
  
  
 Non-manual workers
 1.00 (reference)
 1.00 (reference)
  Service/sales workers
 0.63 (0.39–0.99)
 1.04 (0.48–2.25)
  Service workers
 0.45 (0.22–0.93)
 0.98 (0.39–2.47)
  Sales workers
 0.73 (0.42–1.26)
 1.16 (0.53–2.57)
 Manual workers
 0.59 (0.41–0.85)
 1.02 (0.47–2.21)
  Skilled agricultural, forestry and fishery workers
 0.37 (0.20–0.69)
 1.54 (0.56–4.25)
  Craft and related trades workers
 0.37 (0.22–0.63)
 0.78 (0.22–2.81)
  Equipment, machine operating and assembling workers
 1.16 (0.77–1.75)
 0.90 (0.17–4.87)
  Elementary workers 0.42 (0.19–0.91) 0.87 (0.39–1.94)
* Model I: Adjusted for age, level of education, household income, high-risk drinking, smoking status, and vigorous physical activity.
† Model II: Adjusted for Model I factors, plus work hours, and work schedule.
In this study, we assessed the prevalence of the metabolic syndrome by occupational group among Korean workers and evaluated the risk of the metabolic syndrome among each of the occupational groups. Our study demonstrates variability in the prevalence of the metabolic syndrome by occupational group, and found the greatest risk for the metabolic syndrome in male non-manual workers.
Several studies have identified differences in the prevalence of the metabolic syndrome by occupational group [8-10]. In Spanish workers, the presence of the metabolic syndrome after age adjustment was greatest in the “machine installers, operators, and assemblers” (15.1%) group among males, with an overall prevalence of 9.5% (11.6% in male workers and 4.1% in female workers). Manual workers had a higher prevalence than non-manual workers in both males and females [8]. According to a study of the U.S. working population, the overall prevalence of the metabolic syndrome was 20.6% (20.2% in male workers and 21.4% in female workers) with the greatest unadjusted prevalence among “transportation and material occupations” (33.1%) and the greatest age-adjusted prevalence among “food preparation and food service workers” (31.1%) [9]. In a study using the KNHANES (2005) data, the prevalence of the metabolic syndrome among Korean workers was found to be 21.8% (22.5% in male worker and 15.9% in female), and the prevalence was higher in manual workers than in non-manual workers [10].
In this study, non-manual workers showed higher unadjusted and age-adjusted prevalences of the metabolic syndrome than service/sales and manual workers among the male workers. Most of the workers in the non-manual groups spend most of their work hours sedentary [15]. Furthermore, they may also engage in less physical activity relative to other workers. Actually, the proportion of those engaging in vigorous physical activity at least 5 days a week in these groups was lower than in the other workers in this study.
In the male non-manual group, the “managers” showed the highest prevalence estimate (31.7%), but the prevalence in the “equipment, machine operating and assembling” workers was the highest (35.4%) among the nine occupational subgroups before age adjustment. On the other hand, after age adjustment, the highest prevalence was observed in “professional and related” workers (27.3%), followed by “managers” (26.5%) and “equipment, machine operating and assembling” workers (26.5%). The subgroups of non-manual workers including “managers”, “professional and related” workers, and “clerks” had a higher level of education and household income than the manual working groups in both the male and female workers. Several studies have shown an inverse association between socioeconomic status and the metabolic syndrome in women, but no association in men [16-18]. However, a recent study of the Korean population using 2007–2008 KNHANES data has reported that socioeconomic status (SES) had a positive association with the metabolic syndrome for men and an inverse association for women [19]. The researchers suggested differences in health behaviors including smoking and drinking, food consumption, heath care assessment, and psychological stress according to SES as possible explanations for the inverse association in women. The authors explained that the finding of high prevalence of metabolic syndrome in men with highest household income was consistent with an earlier study using data from the 1998 to 2001 KNHANES, which showed a positive relationship between obesity and higher SES in men [20]. This positive association among men might be applied to explain the data on the male workers in our study. The subgroups of non-manual male workers including “managers”, “professional and related” workers, and “clerks” had a higher proportion of overweight and obese individuals than the other occupational groups in our study.
Among the subgroups of male manual workers, only “equipment, machine operating and assembling” workers showed a significantly higher prevalence of the metabolic syndrome than the prevalence for the male workers overall before and after age adjustment, and the prevalence was similar to the prevalence in non-manual workers. This observation was in concordance with a previous study in Spain, which showed the highest prevalence of the metabolic syndrome in the “machine installers, operators and assemblers” group among all of the occupational groups [8]. When the demographic characteristics of this group were considered, they were found to have a higher level of education (high school education and more) and household income (middle to high) in the manual worker groups. It seems that higher socioeconomic status, among other factors, might have influenced this result.
Among the female workers, although the unadjusted prevalence was greatest in the manual workers (28.4%) and lowest in the non-manual workers (7.3%), this difference disappeared after age standardization (20.8% versus 20.8%, respectively). Among the subgroups of the female non-manual workers, “professional and related” workers showed the lowest unadjusted prevalence of the metabolic syndrome (7.3%) and the highest age-adjusted prevalence (27.9%). This was the main cause for the increase in the overall prevalence in non-manual workers after age adjustment. Although not presented in this paper, the age distribution of female “professional and related” workers was skewed toward younger ages. At this age group, the prevalence of the metabolic syndrome was lower, but compared to the younger group, the prevalence in the older age group was extremely high. In the multiple logistic regression analysis, there was no significant association found between occupational groups and the metabolic syndrome in female workers.
Unlike the prevalence estimate of the male “skilled agricultural, forestry and fishery” workers, which was significantly lower than the overall male prevalence after age adjustment, female workers of the same occupational group continued to show significantly higher prevalence of the metabolic syndrome compared to the overall prevalence after age adjustment. This distinct feature was also evident in the analysis of individual components of the metabolic syndrome. Female “skilled agricultural, forestry and fishery” workers presented the highest age-adjusted prevalence of abdominal obesity and low HDL-cholesterol levels among the occupational subgroups. Conversely, male “skilled agricultural, forestry and fishery” workers showed the lowest age-adjusted prevalence of low HDL-cholesterol levels and a relatively lower prevalence of abdominal obesity. These gender differences may come from post-menopausal hormonal changes in female workers, given that recent studies have shown that the prevalence of the metabolic syndrome was higher in postmenopausal women than in premenopausal women [21-24]. In the present study, “skilled agricultural, forestry and fishery” workers were the most aged group; that is, more female workers of that group could be expected to be post-menopausal based on their age than in the other groups.
We categorized service and sales workers into a separate group, apart from the non-manual and manual workers. Our results showed that service/sales workers had characteristics intermediate to the other two occupational groups with regard to SES. Likewise, the age-adjusted prevalence of the metabolic syndrome among the male service/sales workers was between the prevalence in non-manual workers and the prevalence in manual workers. In the women also, considering that the dramatic increase of the prevalence in non-manual workers after age adjustment was mainly due to the uneven distribution of age, the prevalence of the metabolic syndrome in service/sales workers stood between those of manual and non-manual workers.
In this study, the work schedule pattern was included as a covariate. In both male and female workers, the percentages of night/overnight or shift work were the highest for the service workers. Generally, it is known that shift work causes the disturbance of sleep and normal circadian rhythms, and it may increase psychosocial stress, predisposing the worker to physiological disturbances related to the metabolic syndrome and cardiovascular disease [25,26]. Recent studies have shown that shift work is closely related to the increased risk of the metabolic syndrome [27-31]. However, the prevalence of the metabolic syndrome in this group was not higher compared to the other occupational groups. In addition, the result of multiple logistic regression analysis did not show a significant association between the metabolic syndrome and work schedule (data not shown).
The strengths of our investigation are the use of a large sample representative of the Korean population and the analysis of the prevalence of the metabolic syndrome in 9 occupational groups considering multiple variables such as age, gender, level of education, household income, and smoking status. The limitations are an inability to draw causal inferences due to the cross-sectional design and unavailability of detailed information about work-related condition in the KNHANES.
In conclusion, our study demonstrated variability in the prevalence of the metabolic syndrome by occupational group among Korean workers. In the male workers, non-manual workers appeared to be more vulnerable to the metabolic syndrome compared to service/sales workers or manual workers, but not in the female workers. Future research should evaluate factors that may influence the occurrence of the metabolic syndrome in each occupational group so that our findings can be utilized to establish appropriate preventive measures for the metabolic syndrome and co-occurring diseases including cardiovascular disease and diabetes.
The authors declare that they have no competing interests.
DH Kim and JY Ryu designed the research. S Hong and CH Kim collected the data. JY Ryu and S Lee performed the statistical analysis. JY Ryu, JT Lee, JH Kim, and DH Kim interpreted the data. JY Ryu and S Lee wrote the manuscript. All of the authors read and approved the final manuscript.
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      Prevalence of the Metabolic Syndrome among Korean Workers by Occupational Group: Fifth Korean National Health and Nutrition Examination Survey (KNHANES) 2010
      Ann Occup Environ Med. 2013;25:13  Published online August 5, 2013
      DOI: https://doi.org/10.1186/2052-4374-25-13
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    Prevalence of the Metabolic Syndrome among Korean Workers by Occupational Group: Fifth Korean National Health and Nutrition Examination Survey (KNHANES) 2010
    Prevalence of the Metabolic Syndrome among Korean Workers by Occupational Group: Fifth Korean National Health and Nutrition Examination Survey (KNHANES) 2010
     ManagersProfessional and related workersClerksService workersSales workersSkilled agricultural, forestry and fishery workersCraft and related trades workersEquipment, machine operation and assembling workersElementary workersTotalp-value
    Age (years)*
    		50.9 (1.3)
    		38.2 (0.7)
    		39.1(0.7)
    		36.8 (1.4)
    		41.2 (1.2)
    		56.4 (1.4)
    		42.7 (0.9)
    		45.1 (1.1)
    		46.1 (1.7)
    		44.1 (0.4)
    		< 0.001
    Education
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		< 0.001
      ≤ Elementary school
    		0.0 (0.0)
    		0.6 (0.4)
    		0.4 (0.4)
    		4.9 (2.1)
    		6.5 (2.1)
    		41.5 (3.3)
    		14.2 (2.7)
    		7.7 (1.8)
    		21.7 (4.3)
    		10.7 (1.1)
    		 
      Middle school
    		16.3 (5.6)
    		0.4 (0.3)
    		1.7 (1.0)
    		6.4 (2.4)
    		7.6 (2.2)
    		20.8 (3.9)
    		13.9 (2.5)
    		19.7 (3.0)
    		17.5 (3.6)
    		10.3 (0.9)
    		 
      High school
    		31.8 (6.7)
    		21.0 (3.6)
    		27.6 (3.4)
    		56.3 (5.4)
    		45.7 (4.4)
    		24.9 (3.2)
    		53.3 (4.0)
    		56.9 (4.0)
    		50.5 (4.9)
    		39.2 (1.5)
    		 
      ≥ University
    		51.8 (6.7)
    		78.0 (3.6)
    		70.3 (3.6)
    		32.4 (4.8)
    		40.2 (3.9)
    		12.8 (2.8)
    		18.6 (3.0)
    		15.7 (3.2)
    		10.3 (2.8)
    		39.8 (1.7)
    		 
    Household income
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		< 0.001
      Low
    		3.7 (2.7)
    		6.7 (1.8)
    		2.7 (1.1)
    		6.5 (2.7)
    		9.3 (2.2)
    		24.1 (4.0)
    		12.3 (2.8)
    		8.6 (2.4)
    		26.5 (4.2)
    		10.9 (1.0)
    		 
      Low-middle
    		10.6 (4.4)
    		17.1 (2.7)
    		24.5 (2.8)
    		34.6 (2.7)
    		27.6 (3.6)
    		28.2 (4.3)
    		35.4 (3.7)
    		26.9 (3.5)
    		29.2 (4.3)
    		26.4 (1.4)
    		 
      Middle-high
    		29.2 (7.2)
    		39.0 (3.0)
    		33.9 (3.1)
    		25.0 (4.4)
    		36.1 (4.3)
    		18.2 (2.6)
    		29.0 (3.4)
    		37.6 (3.6)
    		29.5 (4.9)
    		31.9 (1.4)
    		 
      High
    		56.5 (6.1)
    		37.3 (2.9)
    		38.9 (3.7)
    		33.9 (5.2)
    		27.0 (3.7)
    		29.5 (4.2)
    		23.4 (3.3)
    		26.9 (3.4)
    		14.8 (3.6)
    		30.7 (1.6)
    		 
    High-risk drinking
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		0.002
      Never
    		17.5 (5.2)
    		12.7 (2.1)
    		14.1 (2.3)
    		7.4 (2.6)
    		13.0 (2.7)
    		18.1 (3.6)
    		14.1 (2.5)
    		14.8 (2.3)
    		26.4 (4.6)
    		14.8 (1.0)
    		 
      Once a month
    		13.4 (6.3)
    		46.3 (3.4)
    		38.9 (3.3)
    		44.4 (5.8)
    		33.7 (4.0)
    		32.6 (4.3)
    		42.5 (4.5)
    		39.2 (4.3)
    		35.9 (5.5)
    		40.0 (1.5)
    		 
      Once a weak
    		30.0 (6.6)
    		30.2 (3.2)
    		38.3 (3.6)
    		35.5 (5.3)
    		43.6 (4.3)
    		26.2 (4.1)
    		28.8 (3.8)
    		29.7 (3.5)
    		20.2 (4.7)
    		31.8 (1.2)
    		 
      Everyday
    		9.1 (4.2)
    		10.7 (2.0)
    		8.7 (2.2)
    		12.7 (3.6)
    		9.8 (2.6)
    		23.2 (3.3)
    		14.6 (2.7)
    		16.3 (3.2)
    		17.5 (4.0)
    		13.4 (1.1)
    		 
    Smoking status
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		0.027
      Non-smoker
    		15.0 (4.4)
    		23.7 (2.4)
    		17.7 (2.6)
    		18.7 (3.9)
    		17.9 (3.1)
    		13.9 (2.8)
    		12.0 (2.4)
    		10.9 (2.5)
    		15.5 (3.9)
    		16.5 (1.0)
    		 
      Ex-smoker
    		41.1 (6.1)
    		30.1 (2.9)
    		31.6 (2.8)
    		23.9 (4.4)
    		31.8 (3.7)
    		41.8 (3.0)
    		32.7 (3.6)
    		34.4 (3.1)
    		29.5 (4.3)
    		32.6 (1.3)
    		 
      Current smoker
    		43.9 (6.0)
    		46.3 (3.4)
    		50.8 (2.9)
    		57.4 (5.1)
    		50.3 (4.4)
    		44.3 (3.5)
    		55.4 (3.7)
    		54.7 (3.4)
    		55.0 (5.3)
    		50.9 (1.4)
    		 
    Vigorous physical activity
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		< 0.001
      None
    		66.2 (6.4)
    		53.3 (3.8)
    		44.4 (3.6)
    		52.1 (5.1)
    		50.2 (3.5)
    		60.7 (3.3)
    		53.3 (4.2)
    		49.4 (3.7)
    		58.8 (5.2)
    		52.7 (1.4)
    		 
      < 5 days per week
    		30.3 (6.1)
    		42.8 (3.9)
    		49.7 (3.6)
    		35.7 (5.2)
    		37.1 (4.1)
    		21.8 (2.8)
    		36.1 (4.1)
    		41.4 (3.7)
    		26.4 (5.2)
    		37.6 (1.4)
    		 
      ≥ 5 days per week
    		3.5 (2.1)
    		3.8 (1.2)
    		5.8 (1.4)
    		12.3 (3.6)
    		12.7 (3.0)
    		17.5 (2.6)
    		10.7 (2.2)
    		9.2 (2.4)
    		14.8 (4.1)
    		9.7(0.8)
    		 
    Work hours
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		< 0.001
      ≤ 40 hours per week
    		48.8 (6.5)
    		41.0 (3.6)
    		42.6 (3.3)
    		28.5 (4.7)
    		28.3 (3.9)
    		37.8 (4.4)
    		25.6 (2.9)
    		23.6 (3.2)
    		39.4 (4.8)
    		34.4 (1.3)
    		 
      > 40 hours per week
    		51.2 (6.5)
    		59.0 (3.6)
    		57.4 (3.3)
    		71.5 (4.7)
    		71.7 (3.9)
    		62.2 (4.4)
    		74.4 (2.9)
    		76.4 (3.2)
    		60.6 (4.8)
    		65.6 (1.3)
    		 
    Work schedule pattern
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		< 0.001
      Day
    		92.0 (4.5)
    		81.7 (2.5)
    		90.9 (2.2)
    		48.6 (5.7)
    		84.8 (3.0)
    		99.8 (0.2)
    		87.2 (3.5)
    		72.9 (3.3)
    		68.5 (4.1)
    		82.2 (1.2)
    		 
      Night/overnight
    		3.7 (2.0)
    		13.6 (2.3)
    		2.6 (1.1)
    		26.3 (5.3)
    		14.2 (3.0)
    		0.1 (0.1)
    		2.0 (1.3)
    		8.7 (2.0)
    		11.3 (2.8)
    		8.6 (0.8)
    		 
      Shift
    		0.0
    		1.5 (0.9)
    		5.2 (1.9)
    		15.5 (4.1)
    		0.3 (0.2)
    		0.0
    		8.4 (2.7)
    		11.3 (2.5)
    		19.4 (3.2)
    		6.3 (0.8)
    		 
      Others
    		4.2 (4.1)
    		3.2 (1.0)
    		1.3 (0.7)
    		9.6 (2.7)
    		0.7 (0.5)
    		0.1 (0.1)
    		2.4 (2.0)
    		7.1 (2.2)
    		0.8 (0.7)
    		2.9 (0.5)
    		 
    BMI category
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		0.230
      Normal/underweight
    		55.2 (7.6)
    		56.6 (3.0)
    		58.1 (3.5)
    		60.5 (5.8)
    		62.8 (4.2)
    		68.5 (3.5)
    		61.4 (3.3)
    		62.2 (3.7)
    		67.0 (4.5)
    		61.3 (1.4)
    		 
      Overweight
    		37.5 (6.4)
    		39.3 (2.9)
    		36.4 (3.6)
    		37.7 (5.7)
    		30.5 (3.7)
    		30.8 (3.4)
    		35.2 (3.2)
    		33.5 (3.6)
    		30.1 (4.5)
    		34.7 (1.3)
    		 
      Obese7.3 (3.7)4.1 (1.3)5.5 (1.7)1.8 (1.3)6.7 (2.0)0.7 (0.5)3.4 (1.5)4.3 (1.5)2.9 (1.4)3.9 (0.6) 
     ManagersProfessional and related workersClerksService workersSales workersSkilled agricultural, forestry and fishery workersCraft and related trades workersEquipment, machine operation and assembling workersElementary workersTotalp-value
    Age (yr)*
    		54.1 (3.9)
    		34.2 (0.6)
    		33.7 (0.7)
    		43.2 (1.0)
    		43.2 (1.0)
    		57.4 (1.5)
    		49.1 (2.9)
    		41.8 (2.4)
    		51.7 (1.0)
    		45.4 (0.6)
    		< 0.001
    Education
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		< 0.001
      ≤ Elementary school
    		0.0 (0.0)
    		0.6 (0.3)
    		0.3 (0.3)
    		21.7 (3.3)
    		18.4 (2.6)
    		67.2 (4.7)
    		30.4 (9.7)
    		16.5 (7.4)
    		39.8 (3.0)
    		22.3 (1.9)
    		 
      Middle school
    		18.2 (15.1)
    		0.6 (0.4)
    		2.2 (1.0)
    		18.3 (2.9)
    		13.3 (2.5)
    		15.5 (4.5)
    		34.5 (8.4)
    		17.2 (7.6)
    		18.5 (3.4)
    		11.6 (1.1)
    		 
      High school
    		18.4 (12.9)
    		17.1 (2.5)
    		50.1 (3.9)
    		47.3 (3.6)
    		47.6 (3.7)
    		15.0 (4.2)
    		31.8 (7.6)
    		60.4 (10.3)
    		34.7 (3.7)
    		34.5 (1.7)
    		 
      ≥ University
    		63.3 (18.0)
    		81.7 (2.5)
    		47.4 (4.1)
    		12.6 (2.7)
    		20.7 (3.0)
    		2.3 (1.4)
    		3.3 (2.3)
    		5.8 (4.1)
    		6.9 (1.8)
    		31.5 (1.8)
    		 
    Household income
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		< 0.001
      Low
    		0.0 (0.0)
    		4.0 (1.4)
    		2.6 (1.2)
    		10.0 (2.3)
    		12.1 (2.3)
    		35.7 (4.9)
    		30.6 (9.4)
    		0.0 (0.0)
    		25.1 (2.9)
    		14.2 (1.3)
    		 
      Low-middle
    		1.2 (1.2)
    		17.2 (2.7)
    		20.7 (3.8)
    		31.1 (3.6)
    		23.0 (3.8)
    		25.6 (3.2)
    		23.6 (6.1)
    		23.9 (7.7)
    		36.9 (3.4)
    		25.4 (1.5)
    		 
      Middle-high
    		14.6 (13.3)
    		37.4 (3.3)
    		36.8 (4.2)
    		30.7 (3.8)
    		35.4 (3.8)
    		18.0 (3.3)
    		28.2 (7.6)
    		45.2 (10.9)
    		22.6 (2.5)
    		30.8 (1.5)
    		 
      High
    		84.2 (13.4)
    		41.4 (3.4)
    		40.0 (3.8)
    		28.2 (3.3)
    		29.6 (3.7)
    		20.7 (3.2)
    		17.6 (6.5)
    		30.9 (9.5)
    		15.4 (2.6)
    		29.6 (1.6)
    		 
    High-risk drinking
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		< 0.001
      Never
    		77.4 (15.6)
    		39.6 (3.5)
    		31.7 (3.9)
    		35.9 (3.9)
    		43.6 (3.8)
    		57.0 (5.4)
    		18.5 (6.7)
    		37.1 (11.3)
    		42.7 (5.0)
    		39.8 (1.7)
    		 
      Once a month
    		22.6 (15.6)
    		45.0 (3.7)
    		52.9 (4.3)
    		43.5 (4.0)
    		37.8 (4.2)
    		38.4 (4.4)
    		58.6 (9.3)
    		59.8 (11.7)
    		35.9 (3.9)
    		43.6 (4.6)
    		 
      Once a weak
    		0.0 (0.0)
    		15.4 (3.2)
    		14.7 (3.0)
    		13.6 (2.6)
    		17.2 (3.3)
    		4.0 (2.2)
    		19.5 (8.5)
    		3.1 (3.1)
    		14.3 (3.3)
    		13.8 (1.3)
    		 
      Everyday
    		0.0 (0.0)
    		0.0 (0.0)
    		0.7 (0.7)
    		7.0 (2.0)
    		1.3 (1.3)
    		0.6 (0.6)
    		3.4 (2.6)
    		0.0 (0.0)
    		7.1 (3.0)
    		2.7 (0.6)
    		 
    Smoking status
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		0.015
      Non-smoker
    		100.0 (0.0)
    		88.5 (1.9)
    		86.3 (2.7)
    		86.0 (3.1)
    		83.4 (3.0)
    		96.4 (1.7)
    		91.8 (5.6)
    		96.7 (3.3)
    		83.0 (3.2)
    		87.4 (1.2)
    		 
      Ex-smoker
    		0.0 (0.0)
    		7.5 (1.6)
    		7.9 (2.2)
    		4.9 (1.7)
    		9.5 (2.4)
    		2.3 (1.4)
    		8.0 (5.6)
    		0.0 (0.0)
    		5.4 (1.7)
    		6.3 (0.8)
    		 
      Current smoker
    		0.0 (0.0)
    		4.0 (1.1)
    		5.8 (1.8)
    		9.2 (2.9)
    		7.1 (2.2)
    		1.3 (0.8)
    		0.1 (0.1)
    		3.3 (3.3)
    		11.6 (3.1)
    		6.3 (0.9)
    		 
    Vigorous physical  activity
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		0.007
      None
    		55.8 (18.7)
    		74.1 (3.1)
    		70.2 (3.7)
    		70.1 (3.7)
    		69.5 (3.8)
    		76.1 (4.1)
    		86.3 (5.4)
    		61.5 (8.8)
    		75.0 (3.2)
    		72.9 (1.4)
    		 
      < 5 days per week
    		44.2 (18.7)
    		21.8 (2.9)
    		26.2 (3.6)
    		20.4 (3.6)
    		23.7 (3.3)
    		11.4 (2.7)
    		6.5 (3.6)
    		23.9 (8.4)
    		16.2 (2.4)
    		19.8 (1.2)
    		 
      ≥ 5 days per week
    		0.0 (0.0)
    		4.1 (1.3)
    		3.6 (1.4)
    		9.5 (2.3)
    		6.8 (2.0)
    		12.5 (3.3)
    		7.2 (4.3)
    		14.6 (5.6)
    		8.8 (2.0)
    		7.3 (0.8)
    		 
    Work hours
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		< 0.001
      ≤ 40 hours per week
    		80.4 (13.9)
    		57.0 (3.5)
    		52.4 (4.2)
    		33.7 (4.0)
    		48.9 (4.0)
    		50.9 (4.0)
    		29.4 (7.3)
    		35.9 (9.9)
    		64.5 (3.6)
    		51.2 (1.6)
    		 
      > 40 hours per week
    		19.6 (13.9)
    		43.0 (3.5)
    		47.6 (4.2)
    		66.3 (4.0)
    		51.1 (4.0)
    		49.1 (4.0)
    		70.6 (7.3)
    		64.1 (9.9)
    		35.5 (3.6)
    		48.8 (1.6)
    		 
    Work schedule pattern
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		<0.001
      Day
    		93.8 (5.4)
    		74.8 (3.2)
    		94.3 (2.0)
    		70.2 (3.7)
    		77.7 (3.4)
    		99.0 (0.7)
    		93.0 (4.6)
    		74.2 (9.6)
    		85.8 (2.7)
    		82.7 (1.5)
    		 
      Night/overnight
    		5.1 (5.1)
    		18.9 (3.0)
    		3.2 (1.5)
    		24.5 (3.4)
    		15.6 (2.9)
    		0.0
    		4.6 (2.6)
    		6.1 (3.8)
    		12.0 (2.6)
    		12.9 (1.3)
    		 
      Shift
    		1.1 (1.2)
    		3.8 (1.5)
    		1.7 (1.3)
    		2.2 (0.9)
    		3.7 (1.7)
    		0.3 (0.3)
    		2.4 (2.4)
    		8.1 (6.1)
    		1.2 (0.6)
    		2.4 (0.5)
    		 
      Others
    		0.0
    		2.5 (1.0)
    		0.7 (0.5)
    		3.1 (1.2)
    		3.0 (1.4)
    		0.7 (0.6)
    		0.0
    		11.6 (9.0)
    		1.0 (0.5)
    		2.0 (0.4)
    		 
    BMI category
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		0.009
      Normal/underweight
    		82.8 (11.7)
    		82.9 (2.5)
    		79.7 (3.2)
    		72.2 (3.2)
    		68.5 (4.0)
    		66.8 (4.4)
    		69.4 (8.0)
    		70.3 (9.6)
    		70.9 (2.6)
    		74.2 (1.3)
    		 
      Overweight
    		17.2 (11.7)
    		14.5 (2.2)
    		15.0 (2.6)
    		22.5 (3.0)
    		27.6 (4.0)
    		26.4 (3.3)
    		30.5 (8.0)
    		17.3 (7.8)
    		24.4 (2.7)
    		21.2 (1.1)
    		 
      Obese0.0 (0.0)2.6 (1.2)5.2 (1.9)5.3 (1.8)3.9 (1.5)6.8 (1.9)0.1 (0.1)12.4 (7.0)4.7 (1.3)4.5 (0.7) 
     
    		Male
    		Female
    DemographicsNumber *† Prevalence (95% confidence intervals) ‡ Number *† Prevalence (95% confidence intervals) ‡
    Age group
    		 
    		 
    		 
    		 
      20–29 years
    		152/1,942,533
    		9.2 (4.1–14.3)
    		231/1,733,502
    		3.5 (0.7–6.2)
      30–39 years
    		428/3,276,013
    		17.8 (13.5–22.1)
    		291/1,634,571
    		5.5 (2.0–9.0)
      40–49 years
    		477/3,659,709
    		25.9 (21.3–30.4)
    		371/2,433,142
    		12.5 (8.2–16.8)
      50–59 years
    		392/2,681,787
    		35.7 (30.2–41.2)
    		374/1,891,022
    		30.8 (25.2–36.5)
      60–69 years
    		297/1,176,249
    		36.4 (29.5–43.3)
    		188/758,966
    		38.0 (30.1–45.8)
      ≥ 70 years
    		113/415,885
    		17.4 (9.1–25.8)
    		93/373,407
    		53.5 (43.5–63.4)
    Education
    		 
    		 
    		 
    		 
      ≤ Elementary school
    		262/1,377,314
    		28.7 (21.5–35.8)
    		407/1,912,522
    		40.9 (35.6–46.2)
      Middle school
    		218/1,385,292
    		35.9 (29.0–42.8)
    		175/989,224
    		24.4 (16.6–32.3)
      High school
    		637/5,078,713
    		20.1 (16.4–23.7)
    		491/3,089796
    		9.3 (6.1–12.5)
      ≥ University
    		742/5,310,859
    		23.6 (19.9–27.4)
    		481/2,833,069
    		7.6 (4.2–11.1)
    Household income
    		 
    		 
    		 
    		 
      Low
    		224/1,362,396
    		25.9 (18.9–32.9)
    		239/1,171,008
    		35.3(28.6–41.9)
      Low–middle
    		476/3,488,782
    		21.4 (16.9–25.8)
    		366/2,177,822
    		19.8 (15.3–24.2)
      Middle–high
    		568/4,173,072
    		23.8 (19.4–28.2)
    		448/2,712,764
    		14.3 (10.7–18.0)
      High
    		575/4,051,739
    		25.5 (21.1–29.9)
    		481/2,648,160
    		10.4 (7.1–13.7)
    High–risk drinking
    		 
    		 
    		 
    		 
      Never
    		275/1,681,687
    		14.7 (9.6–19.9)
    		473/2,633,998
    		15.4 (11.2–19.7)
      Once a month
    		644/4,713,082
    		21.2 (17.4–24.9)
    		494/2,956,125
    		12.8 (9.3–16.4)
      Once a weak
    		490/3,727,662
    		26.0 (21.6–30.4)
    		130/932,867
    		17.4 (9.6–25.2)
      Everyday
    		226/1,602,909
    		38.1 (30.7–45.5)
    		23/152,018
    		31.1 (8.8–53.4)
    Smoking status
    		 
    		 
    		 
    		 
      Non–smoker
    		320/2,194,133
    		19.5 (14.4–24.5)
    		1,394/7,721,944
    		17.5 (14.9–20.2)
      Ex–smoker
    		697/4,369,598
    		27.0 (22.9–31.0)
    		81/546,406
    		16.0 (7.0–25.0)
      Current smoker
    		841/6,585,245
    		23.7 (20.1–27.3)
    		78/547,078
    		15.8 (6.7–24.9)
    Vigorous physical activity
    		 
    		 
    		 
    		 
      None
    		1,035/6,872,680
    		25.0 (21.9–28.1)
    		1,144/6,444,936
    		17.8 (14.4–20.7)
      < 5 days per week
    		659/4,976,027
    		23.7 (19.5–28.0)
    		293/1,726,743
    		17.3 (12.5–22.2)
      ≥ 5 days per week
    		164/1,300,269
    		20.2 (12.7–27.8)
    		115/633,191
    		14.8 (7.9–21.7)
    Work hours
    		 
    		 
    		 
    		 
      ≤ 40 hours per week
    		666/4,555,070
    		22.5 (18.6–26.5)
    		819/4,514,730
    		17.3 (13.9–20.7)
      > 40 hours per week
    		1,193/8,597,108
    		24.9 (21.8–28.0)
    		735/4,309,882
    		17.3 (14.3–20.4)
    Work schedule pattern
    		 
    		 
    		 
    		 
      Day working
    		1,526/10,805,797
    		24.5 (21.9–271)
    		1,312/7,305,852
    		18.3 (15.4–21.2)
      Non–day working
    		328/2,319,154
    		22.0 (16.6–27.4)
    		238/1,501,207
    		12.4 (6.8–18.1)
    BMI category
    		 
    		 
    		 
    		 
      Underweight
    		40/272,239
    		0.0 (0.0–0.0)
    		85/539,963
    		0.0 (0.0–0.0)
      Normal
    		1,099/7,673,502
    		12.9 (10.3–15.4)
    		1,053/6,039,293
    		9.4 (7.5–11.4)
      Overweight
    		654/4,672,170
    		39.1 (34.3–43.9)
    		350/1,858,859
    		41.9 (35.7–48.1)
      Obese61/500,00568.3 (54.1–82.5)65/384,48346.1 (32.3–59.9)
     
    		 
    		Prevalence of the metabolic syndrome
    (95% confidence intervals)
    Occupational groupsNumber * UnadjustedAge-adjusted
    Overall male workers
    		1,859/13,152,179
    		24.1 (21.7–26.5)
    		23.2 (21.0–25.5)
    Non-manual workers
    		676/4,905,005
    		26.3 (22.3–30.2) †
    		26.4 (22.3–30.5) †
      Managers
    		61/362,106
    		31.7 (18.1–45.3) †
    		26.5 (14.2–38.8) †
      Professional and related workers
    		335/2,531,917
    		25.0 (19.3–30.8) †
    		27.3 (20.9–33.6) †
      Clerks
    		280/2,010,981
    		26.9 (21.0–32.8) †
    		24.6 (18.1–31.1)
    Service/sales workers
    		304/2,302,276
    		19.9 (14.6–25.2)
    		21.5 (15.9–27.1)
      Service workers
    		104/910,156
    		15.7 (8.1–23.3)
    		17.5 (9.0–26.0)
      Sales workers
    		200/1,392,120
    		22.7 (15.3–30.0)
    		23.0 (16.2–29.8)
    Manual workers
    		879/5,944,897
    		23.9 (20.6–27.1)
    		20.1 (17.3–23.0)
      Skilled agricultural, forestry and fishery workers
    		272/1,589,656
    		24.3 (18.2–30.4)
    		15.6 (10.9–20.2)
      Craft and related trades workers
    		206/1,733,288
    		15.7 (10.6–20.7)
    		16.4 (11.0–21.9)
      Equipment, machine operating and assembling workers
    		240/1,597,780
    		35.4 (28.4–42.4) †
    		26.5 (21.1–32.0) †
      Elementary workers
    		161/1,024,171
    		19.2 (11.3–27.2)
    		16.9 (9.4–24.4)
    Overall female workers
    		1,544/8,824,612
    		17.3 (14.8–19.8)
    		19.5 (17.3–21.6)
    Non-manual workers
    		545/3,325,220
    		7.7 (4.4–10.9)
    		20.8 (11.3–30.2) †
      Managers
    		8/22,859
    		12.8 (−9.1–34.8)
    		10.6 (−6.7–27.9)
      Professional and related workers
    		334/1,998,628
    		7.3 (3.5–11.2)
    		27.9 (21.5–34.3) †
      Clerks
    		203/1,303,732
    		8.1 (2.6–13.5)
    		9.8 (2.7–16.9)
    Service/sales workers
    		428/2,502,853
    		16.9 (12.8–20.9)
    		18.4 (13–22.9)
      Service workers
    		215/1,340,314
    		16.9 (11.4–22.3)
    		20.5 (14.5–26.6) †
      Sales workers
    		213/1,162,539
    		16.9 (11.2–22.5)
    		17.6 (11.9–23.2)
    Manual workers
    		581/2,996,538
    		28.4 (23.9–32.9) †
    		20.8 (16.9–24.7) †
      Skilled agricultural, forestry and fishery workers
    		225/1,011,474
    		39.2 (31.8–46.6) †
    		22.0 (15.2–28.9) †
      Craft and related trades workers
    		42/258,235
    		19.1 (4.4–33.8)
    		12.0 (2.8–21.2)
      Equipment, machine operating and assembling workers
    		35/158,745
    		7.8 (−2.5–18.1)
    		6.2 (−1.7–14.2)
      Elementary workers279/1,568,08325.0 (19.1–31.0) †20.0 (14.5–25.5) †
     
    		Non-manual workers
    		Service/sales workers
    		Manual workers
    		 
    ComponentsManagersProfessional and related workersClerksService workersSales workersSkilled agricultural, forestry and fishery workersCraft and related trades workersEquipment, machine operation and assembling workersElementary workersTotalp-value
    Male workers
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
      WC ≥ 90 cm (M)/80 cm (W)
    		 
    		24.5 (2.5)
    		 
    		28.6 (3.5)
    		 
    		24.0 (1.9)
    		 
    		25.1 (1.3)
    		0.946
    35.4 (8.7)
    		21.1 (2.8)
    		25.7 (3.7)
    		25.7 (4.7)
    		28.2 (3.9)
    		22.8 (3.5)
    		31.1 (4.3)
    		31.0 (3.2)
    		18.2 (4.2)
    		0.705
      BP ≥ 130/85 mmHg or treated
    		 
    		40.1 (2.5)
    		 
    		33.3 (3.3)
    		 
    		32.7 (1.7)
    		 
    		36.3 (1.4)
    		0.036
    46.0 (6.9)
    		33.2 (3.5)
    		51.6 (2.6)
    		29.8 (4.4)
    		35.5 (3.8)
    		26.6 (3.3)
    		29.0 (3.5)
    		32.7 (2.6)
    		36.2 (4.1)
    		<0.001
      TG ≥ 150 mg/dl
    		 
    		39.4 (2.6)
    		 
    		35.5 (2.7)
    		 
    		35.3 (2.2)
    		 
    		37.4 (1.4)
    		0.225
    41.8 (8.0)
    		43.9 (3.3)
    		33.7 (3.8)
    		35.2 (5.0)
    		37.7 (3.3)
    		25.9 (4.6)
    		34.7 (4.0)
    		44.9 (2.9)
    		29.9 (4.9)
    		0.119
      HDL-C < 40 mg/dl
    		 
    		20.5 (2.2)
    		 
    		13.3 (2.5)
    		 
    		18.3 (1.8)
    		 
    		19.2 (1.2)
    		0.024
    14.9 (4.1)
    		22.0 (3.2)
    		16.9 (2.5)
    		12.6 (3.8)
    		13.5 (3.0)
    		9.0 (1.5)
    		17.1 (3.0)
    		19.5 (2.9)
    		18.8 (4.6)
    		0.119
      FPG ≥ 100 mg/dl or treated
    		 
    		31.8 (2.5)
    		 
    		29.3 (3.4)
    		 
    		26.2 (1.7)
    		 
    		28.6 (1.3)
    		0.191
    31.2 (7.6)
    		31.8 (3.2)
    		34.5 (4.1)
    		26.2 (5.1)
    		29.2 (3.8)
    		20.3 (2.4)
    		25.8 (3.5)
    		27.1 (2.8)
    		26.8 (3.4)
    		0.284
    Female workers
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
    		 
      WC ≥ 90 cm (M)/80 cm (W)
    		 
    		34.6 (4.8)
    		 
    		39.0 (2.5)
    		 
    		41.8 (3.3)
    		 
    		36.8 (1.4)
    		<0.001
    19.5 (12.2)
    		41.8 (3.4)
    		24.6 (4.3)
    		42.0 (3.4)
    		36.9 (3.2)
    		50.5 (6.7)
    		32.0 (5.1)
    		22.4 (5.4)
    		40.9 (5.0)
    		<0.001
      BP ≥ 130/85 mmHg or treated
    		 
    		21.0 (1.8)
    		 
    		23.8 (2.2)
    		 
    		27.6 (1.9)
    		 
    		25.6 (1.2)
    		<0.001
    29.4 (10.8)
    		19.0 (2.2)
    		23.2 (3.3)
    		26.4 (2.9)
    		21.3 (3.0)
    		29.0 (4.2)
    		32.3 (4.8)
    		7.1 (4.0)
    		27.0 (2.5)
    		<0.001
      TG ≥ 150 mg/dl
    		 
    		15.7 (2.7)
    		 
    		23.3 (2.9)
    		 
    		17.6 (2.1)
    		 
    		17.9 (1.1)
    		<0.001
    31.8 (13.2)
    		18.4 (2.1)
    		5.6 (2.0)
    		22.7 (4.5)
    		23.6 (3.4)
    		16.1 (2.6)
    		9.5 (4.0)
    		8.3 (4.8)
    		18.4 (2.8)
    		<0.001
      HDL-C < 50 mg/dl
    		 
    		34.9 (4.7)
    		 
    		32.2 (2.9)
    		 
    		34.7 (3.1)
    		 
    		32.8 (1.4)
    		<0.001
    15.1 (10.8)
    		43.0 (2.6)
    		21.2 (4.3)
    		33.2 (3.6)
    		33.0 (4.0)
    		43.0 (5.8)
    		37.9 (8.4)
    		16.8 (5.1)
    		32.1 (5.1)
    		<0.001
      FPG ≥ 100 mg/dl or treated 
    		19.8 (4.5)
    		 
    		16.1 (1.9)
    		 
    		19.0 (2.0)
    		 
    		18.1 (1.1)<0.001
    9.4 (8.6)24.7 (3.7)15.6 (3.5)15.3 (3.1)17.1 (2.8)14.9 (1.8)9.0 (2.2)15.2 (5.8)20.7 (2.5)<0.001
     
    		Odds ratio (95% confidence intervals)
     MaleFemale
    Model I*
    		 
    		 
    Occupational group
    		 
    		 
     Non-manual workers
    		1.00 (reference)
    		1.00 (reference)
      Service/sales workers
    		0.66 (0.42–1.02)
    		0.98 (0.45–2.12)
      Service workers
    		0.49 (0.25–0.96)
    		0.92 (0.36–2.32)
      Sales workers
    		0.74 (0.43–1.28)
    		1.12 (0.51–2.46)
     Manual workers
    		0.62 (0.44–0.88)
    		1.00 (0.46–2.16)
      Skilled agricultural, forestry and fishery workers
    		0.38 (0.20–0.70)
    		1.56 (0.56–4.33)
      Craft and related trades workers
    		0.39 (0.23–0.66)
    		0.78 (0.21–2.83)
      Equipment, machine operating and assembling workers
    		1.22 (0.82–1.83)
    		0.88 (0.16–4.67)
      Elementary workers
    		0.43 (0.21–0.91)
    		0.84 (0.38–1.86)
    Model II†
    		 
    		 
    Occupational groups
    		 
    		 
     Non-manual workers
    		1.00 (reference)
    		1.00 (reference)
      Service/sales workers
    		0.63 (0.39–0.99)
    		1.04 (0.48–2.25)
      Service workers
    		0.45 (0.22–0.93)
    		0.98 (0.39–2.47)
      Sales workers
    		0.73 (0.42–1.26)
    		1.16 (0.53–2.57)
     Manual workers
    		0.59 (0.41–0.85)
    		1.02 (0.47–2.21)
      Skilled agricultural, forestry and fishery workers
    		0.37 (0.20–0.69)
    		1.54 (0.56–4.25)
      Craft and related trades workers
    		0.37 (0.22–0.63)
    		0.78 (0.22–2.81)
      Equipment, machine operating and assembling workers
    		1.16 (0.77–1.75)
    		0.90 (0.17–4.87)
      Elementary workers0.42 (0.19–0.91)0.87 (0.39–1.94)
    Table 1 Demographic characteristics by major category of the Korean Standard Classification of Occupations among male workers

    *Estimated mean (standard error).

    Table 2 Demographic characteristics by major category of the Korean Standard Classification of Occupations among female workers

    *Estimated mean (standard error).

    Table 3 The prevalence of the metabolic syndrome according to demographic characteristics

    *Subject number/estimated population number. †Subject number varies due to item which was not answered. ‡Unadjusted prevalence of the metabolic syndrome (95% confidence intervals).

    Table 4 Unadjusted and age-adjusted prevalence of the metabolic syndrome by category of the Korean Standard Classification of Occupations stratified by gender

    *Subject number/estimated population number. †The prevalence estimate for each occupational group was above the upper bound of the 95% confidence interval for the overall prevalence estimate.

    Table 5 Age-adjusted prevalence of the components of the metabolic syndrome by category of the Korean Standard Classification of Occupations

    Abbreviation: All values were the estimated percentage (standard error). WC waist circumference, BP blood pressure, TG triglyceride, HDL-C high-density lipoprotein cholesterol, FPG fasting plasma glucose, M male, F female.

    Table 6 Multiple logistic regression to assess the relationship between occupation and meeting criteria for the metabolic syndrome among Korean workers aged ≥20 years

    * Model I: Adjusted for age, level of education, household income, high-risk drinking, smoking status, and vigorous physical activity.

    † Model II: Adjusted for Model I factors, plus work hours, and work schedule.

    Table 1

    Table 2

    Table 3

    Table 4

    Table 5

    Table 6

    Ann Occup Environ Med : Annals of Occupational and Environmental Medicine
    © Korean Society of Occupational & Environmental Medicine.
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