The Unique Role of Self-Rated Health in Metabolic Syndrome and its Diagnostic Cardiometabolic Abnormalities: An Analysis of Population-Based Data

Background: Historically, previous research demonstrating associations between self-rated health (SRH) and metabolic anomalies have rarely controlled for metabolic covariates. Thus, there is currently poor understanding of the unique contribution of SRH to metabolic syndrome (MetS) over and beyond diagnostic cardiometabolic abnormalities. Objective: This study explored unique associations between SRH and multiple cardiometabolic factors, after controlling for metabolic covariates. Methods: This study was based on an analysis of archived population-based data from the 2019 Health Survey for England. A total of 352 MetS cases were extracted from 10299 participants in the survey. Bootstrapped adjusted regression methods were used to predict MetS status and cardiometabolic abnormalities (HDL (high-density lipoprotein) cholesterol, waist/hip ratio, body mass index (BMI), systolic and diastolic blood pressure, and glycated haemoglobin (HbA1c)) from SRH. Structural Equation Modelling (SEM) was used to explore direct and indirect associations between SRH and cardiometabolic factors, with SRH treated as a mediating factor. Results: SRH predicted MetS status but this was negated after cardiometabolic adjustments. Poor SRH independently predicted HDL cholesterol deficiency, and elevated waist/hip ratio, BMI, and HbA1c, even after cardiometabolic adjustments. SEM generated two models with equivalent fit indices, but different structural pathways. In one model SRH mediated relations between anthropometric risk factors (waist/hip ratio and BMI). Conclusions: SRH can help identify people at risk of developing MetS, irrespective of cardiometabolic abnormalities. Poor SRH may represent a non-intrusive easily measurable risk factor for adiposity in MetS, especially where direct measurement of body fat is impractical or socially challenging.