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Work-related stress (WS) has been proposed as a risk factor for the development of the metabolic syndrome (MetS). The number of studies, however, is limited, and results are conflicting. The occupational health physician can give an effective contribute to clarify this point by systematically collecting data from workers waiting for medical examination.During 2016, the workers were invited to complete a questionnaire that included the Effort-Reward Imbalance scale (ERI) of Siegrist and the Support scale from the DCS model of Karasek, before their medical examination in the workplace. 1904 persons (male 32.6%, female 67.4%) participated in the study. The mean age was 47.35±9.38. Health data were obtained from medical surveillance records.The prevalence of workers with high blood pressure (316, 16.6%), high cholesterol/reduced HDL-cholesterol (511, 26.8%), high triglycerides (195, 10.2%), high blood glucose (91, 4.8%), and obesity (677, 35.6%) led to a diagnosis of MetS in 196 workers (10.3%). In univariate logistic regression analysis, WS was significantly associated with the occurrence of MetS (OR 1.82; 95% CI: 1.41 to 2.35). ERI was also significantly associated with hypertriglyceridemia (OR 1.64; 95% CI: 1.27 to 2.13) and with overweight (OR 1.33; 95% CI: 1.11 to 1.59). The association was still significant in multivariate models, after correction for confounders.The observed association between WS and MetS deserves particular attention. The root causes of stress in workers must be investigated so as to have information for prevention.