Article

Relationships of age, menopause and central obesity on cardiovascular disease risk factors in Chinese women

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Abstract

To evaluate the inter-relationships of age- and menopause- related changes of general obesity and body fat distribution and their independent effects on cardiovascular risk factors. Cross-sectional study. One-hundred and thirty-six premenopausal and 193 postmenopausal Chinese women with body mass index (BMI) < 30 kg/m2. Anthropometric surrogates of general obesity (BMI, total body fat percentage) and central obesity (waist-to-hip ratio, centrality index) were measured. Blood pressure, 75 g oral glucose tolerance test, glycosylated hemoglobin A1c and lipid profiles were also measured. Significant correlation coefficients between age, general obesity, central obesity and cardiovascular disease risk factors were noted. Through the menopausal transition, the BMI and total body fat percentage were increased significantly. After adjustments for age and BMI, the postmenopausal women showed higher android fat percentage, centrality index, glycosylated hemoglobin A1c, serum concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol and atherogenic indices than the premenopausal women. In multiple stepwise regression models, age exerted independent effects on oral glucose tolerance test 2 h plasma glucose level, systolic and diastolic blood pressure, total cholesterol level, and LDL cholesterol. Menopause was an independent variable in relation to the changes of glycosylated hemoglobin A1c, total and LDL cholesterol levels, triglyceride levels and atherogenic indices. The centrality index was the major independent variable of all the cardiovascular disease risk factors, except total and LDL cholesterol level. However, the variation of total body fat percentage had no independent effect on any cardiovascular disease risk factors. Through the aging and menopausal effects, women will increase total body fat content, favoring the central body fat distribution. Age, menopause and central obesity were all independent and significant factors to the cardiovascular disease risk factors in Chinese women.

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... Of the remaining 286 studies, 210 were eligible for inclusion in the quantitative analysis with 201 studies reporting cross-sectional data (Abate et al., 2014;Abdulnour et al., 2012;Abildgaard et al., 2013;Adams-Campbell et al., 1996;Agrinier et al., 2010;Aguado et al., 1996;C. V. Albanese et al., 2009;Allali et al., 2009;Aloia et al., 1995;Amankwah et al., 2013;Amarante et al., 2011;Amiri et al., 2014;Angsuwathana et al., 2007;Armellini et al., 1996;Arthur et al., 2013;Aydin, 2010;Ayub et al., 2006;Bancroft & Cawood, 1996;Bednarek-Tupikowska et al., 2006;Bell et al., 2007;Ben Ali et al., 2011Ben Ali et al., 2016;Berg et al., 2004;Berge et al., 1994;Berger et al., 1995;Berstad et al., 2010;Bhagat et al., 2010;Bhurosy & Jeewon, 2013;Blumenthal et al., 1991;Bonithon-Kopp et al., 1990;Caire-Juvera et al., 2008;Campesi et al., 2016;Carr et al., 2000;Castracane et al., 1998;Catsburg et al., 2014;Cecchini et al., 2012;Cervellati et al., 2009;Chain et al., 2017;Chang et al., 2000;Cho et al., 2008;Cifkova et al., 2008;Copeland et al., 2006;Cremonini et al., 2013;Cui et al., 2007;D'Haeseleer et al., 2011;da Câmara et al., 2015;Dallongeville et al., 1995;Dancey et al., 2001;C. E. Davis et al., 1994;De Kat et al., 2017;den Tonkelaar et al., 1990;Dmitruk et al., 2018;Donato et al., 2006;Douchi et al., 1997;Douchi et al., 2002;Douchi et al., 2007;Dubois et al., 2001;Engmann et al., 2017;Ertungealp et al., 1999;Feng et al., 2008;Formica et al., 1995;C. ...
... The definitions of premenopausal and postmenopausal women were extracted from the 210 studies (Supplementary Tables 1 and 2) (Abate et al., 2014;Abdulnour et al., 2012;Abildgaard et al., 2013;Adams-Campbell et al., 1996;Agrinier et al., 2010;Aguado et al., 1996;Akahoshi et al., 2001;C. V. Albanese et al., 2009;Allali et al., 2009;Aloia et al., 1995;Amankwah et al., 2013;Amarante et al., 2011;Amiri et al., 2014;Angsuwathana et al., 2007;Armellini et al., 1996;Arthur et al., 2013;Aydin, 2010;Ayub et al., 2006;Bancroft & Cawood, 1996;Bednarek-Tupikowska et al., 2006;Bell et al., 2007;Ben Ali et al., 2011Ben Ali et al., 2016;Berg et al., 2004;Berge et al., 1994;Berger et al., 1995;Berstad et al., 2010;Bhagat et al., 2010;Bhurosy & Jeewon, 2013;Blumenthal et al., 1991;Bonithon-Kopp et al., 1990;Caire-Juvera et al., 2008;Campesi et al., 2016;Carr et al., 2000;Castracane et al., 1998;Catsburg et al., 2014;Cecchini et al., 2012;Cervellati et al., 2009;Chain et al., 2017;Chang et al., 2000;Cho et al., 2008;Cifkova et al., 2008;Copeland et al., 2006;Cremonini et al., 2013;Cui et al., 2007;D'Haeseleer et al., 2011;da Câmara et al., 2015;Dallongeville et al., 1995;Dancey et al., 2001;C. E. Davis et al., 1994;De Kat et al., 2017;den Tonkelaar et al., 1990;Dmitruk et al., 2018;Donato et al., 2006;Douchi et al., 1997;Douchi et al., 2002;Douchi et al., 2007;Dubois et al., 2001;Engmann et al., 2017;Ertungealp et al., 1999;Feng et al., 2008;Ford et al., 2005;Formica et al., 1995;Franklin et al., 2009;C. ...
Thesis
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Maintaining a healthy brain has been recognised as an important health challenge facing women, given global estimates indicate almost twice as many women die of dementia than men. In part, this is due to their increased longevity, however, this does not explain all of the difference. Other contributors include different exposure to risk factors as well as sex-related physiological differences. This thesis focused on the latter, specifically in relation to possible impacts of menopause, as this stage of life has been suggested to involve particular risks to brain health. To address this question, five studies were conducted to precisely characterise and quantify (1) changes in fat mass during menopause; (2) lipid profile differences during menopause; (3) heterogeneity of menopause nomenclature used in peer-reviewed literature; (4) changes in fat mass and the brain; and (5) menstruation history (including menopausal status and age at menopause) and the brain. Moreover, an important conceptual and theoretical question embedded throughout this thesis has been to determine how much of the observed effects were attributable to ageing, rather than a possible effect of menopause. This has been a significant challenge, given menopause and ageing co-occur. The first two studies revealed that fat mass was higher in postmenopausal compared to premenopausal women across most measures, with the exception of leg fat which decreased, indicative of a potential change in fat mass distribution after menopause. However, the change in fat mass quantity was predominantly attributable to increasing age with menopause having no detectable additional influence. Furthermore, lipoproteins were significantly higher in postmenopausal women than premenopausal women, with the exception of high-density lipoprotein, which was not significantly different between groups. Measures of ageing explained some, but not all of the differences in lipid levels. The third study found a significant amount of heterogeneity associated with the definition of "premenopause", compared with "postmenopause". The fourth study demonstrated that those who suffered from overweight or obesity had smaller hippocampal volumes than those who maintained a normal weight. Furthermore, those who suffered from overweight or obesity in the past, but currently had a normal level of fat mass also had a smaller hippocampus than those who had always maintained a normal weight. The fifth study revealed an association between menopause and the brain, beyond typical ageing effects. Notably, postmenopausal women had larger brain volumes than premenopausal women but also experience greater decreases in total brain volume, but not hippocampal volume, over time. In addition, delayed age of menopause was negatively associated with brain volume. The findings from this thesis have demonstrated an association between menopause and the brain, which cannot be uniquely explained by ageing. Specifically, although menopause alone was not found to be negatively associated brain health, it was associated with somewhat poorer brain health when considered concurrently with other changes around menopause. Moreover, when considering that women tend to gain abdominal fat around menopause, as well as develop an unfavourable lipid profile, and given extensive evidence in the literature that higher abdominal fat and lipid levels are associated with a greater risk of cerebro-vascular disease and dementia, hypothesising a link between menopause and poorer brain health seems warranted but will require further confirmation in future research. As a whole, the findings from this thesis paint an optimistic picture for women's health, since the risk factors identified and linked with deleterious brain health outcomes are modifiable. If adequate support is available at a health policy, clinical and community level, these specific risks to brain health may be reduced or prevented.
... Most trials were conducted in the USA [3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], with the remainder in Holland [21,22], Denmark [23,24], Australia [25], and Italy [26]; there were none conducted in Taiwan. Only 16 studies conducted in Taiwan, with English-language abstracts, were identified in a similar MEDLINE search using the key words estrogen replacement therapy and menopause [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] (Table 2). ...
... We found 16 studies reporting on HRT and the menopause in Taiwan (Tables 6 and 7). They covered: the perception of menopausal women toward menopause [27,37]; the risk of osteoporosis [29], high- [33,34]; age at menopause [30,40] and menopausal symptoms [30,39,41]; and the effectiveness of estrogen treatment for menopausal women [42]. ...
Article
Hormone replacement therapy (HRT) is frequently prescribed to healthy women to ameliorate menopausal symptoms. HRT is used long term (≥ 1 year) to prevent chronic disease in older women. The objective of this study was to review the benefits and risks of HRT and studies of menopause or HRT in Taiwan via a MEDLINE search. Recommendations are provided for future HRT research in Taiwan. Randomized, double‐blind, placebo‐controlled clinical trials are considered the gold standard of scientific evidence. A MEDLINE literature search (January 1966‐July 2002) identified 23 papers on trials (≥ 1 year) that met the inclusion criteria. The results showed that various HRT regimens used for more than 1 year caused more harm than good in healthy menopausal women and that there was no benefit for women with coronary artery disease, Alzheimer's disease, hysterectomy, hysterosalpingooophorectomy, and ischemic stroke. None of this research was conducted in Taiwan. A MEDLINE search using the key words “estrogen replacement therapy and menopause in Taiwan” identified 16 studies. There was only one, short‐term, HRT trial. No evidence suggested benefits from long‐term HRT in menopausal women in Taiwan.
... Bersamaan dengan peningkatan usia dan efek menopause, wanita mengalami peningkatan kandungan lemak tubuh, terutama sebaran lemak tubuh pusat. 22 Berdasarkan hasil uji multivariat, didapatkan model akhir hubungan pola k onsumsi makanan berisiko dengan obesitas sentral dengan PR sebesar 1,038 (95% CI 0,934 -1,155). Nilai asosiasi yang ditunjukkan dalam penelitian ini diduga masih dipengaruhi misklasifikasi non-differensial yang berasal pada saat pengambilan data konsumsi. ...
... Selain itu, lansia biasanya sudah kurang memperhatikan ukuran tubuh. 22 Berdasarkan hasil analisis multivariat, variabel pendidikan bukan merupakan confounder dari hubungan pola konsumsi makanan berisiko dengan obesitas sentral. Proporsi obesitas sentral lebih banyak ditemukan pada responden dengan pendidikan yang rendah sebesar 64,3%. ...
Article
Full-text available
Perubahan pola makan diketahui merupakan salah satu upaya untuk mengendalikan obesitas dan penyakit kronis lain. Tujuan penelitian ini adalah untuk mengetahui hubungan pola konsumsi makanan berisiko dengan obesitas sentral pada wanita usia 25-65 tahun. Penelitian ini menggunakan data baseline Studi Kohort PTM tahun 2011-2012 di Bogor, dengan desain studi cross sectional. Sampel penelitian sebanyak 2531 orang. Hasil penelitian menunjukkan 54% responden mengalami obesitas sentral dengan rata-rata lingkar perut sebesar 80,9 + 11,6 cm. Tidak terdapat perbedaan risiko antara responden yang sering dan jarang mengonsumsi makanan berisiko untuk menjadi obesitas sentral setelah dikontrol variabel usia dan status pernikahan (PR 1,038 : 95% CI 0,933 - 1,154 : p=0,498). Upaya pencegahan obesitas sentral pada wanita dapat dilakukan dengan rutin mengontrol berat badan ideal sebelum usia 40 tahun dan mulai memperbaiki pola makan terutama bagi wanita yang sudah menikah.
... Studies have shown relations between postmenopausal status and elevated concentrations of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) [3,4,5]. The difference in mean TC observed among postmenopausal women and premenopausal women may reach 0.8 mmol/l [6]. Women are at lesser risk of developing cardiovascular disease than their male counterparts before menopause. ...
... Cross-sectional studies have been done in Europe [10,11,12], Asia [6] and America [13] on the lipid profile in premenopausal women versus postmenopausal. Women represent more than half of the Cameroonian population and they will be now spending more of their life in the postmenopausal state because of an increase in life expectancy. ...
Article
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Aims: Lipids serve several important physiologic functions like energy homeostasis or biosynthesis of hormone within the human body. The deterioration of lipid metabolism which is favoured by menopause is the source of cardiovascular diseases. This study aimed to determine the plasma lipid profile and dyslipidemia prevalence of some Cameroonian women. Study Design: This was a cross-sectional study. Place and Duration of Study: The enrollment took place at the Yaounde Military Hospital from November 2016 to July 2017. Methodology: To achieve this goal, two sets of 105 postmenopausal and 127 premenopausal participants were enrolled in this study. 5ml of blood were collected on EDTA coated tubes from each participant. Enzymatic methods were used to evaluate total cholesterol, HDL cholesterol and triglyceride, while LDL cholesterol was determined using the Friedewald equation. These biological parameters were used to determine dyslipidemia. Thereafter, they were compared within age and year since menopause subgroups. Results: There was no significant difference in the mean values of total cholesterol, HDL-C, LDL-C as well as triglyceride between premenopausal and postmenopausal women. The mean HDL-C concentration was stable in the age subgroups while the mean total cholesterol and LDL-C were slightly increasing as postmenopausal participants got older. LDL-C level was significantly higher in women who had been in menopause for more than 15 years. The overall dyslipidemia prevalence was 53%. Dyslipidemia was significantly higher in the subgroup of women who had freshly entered menopause. Conclusion: Even though there was no change in the mean concentration of the plasma lipid parameters, of pre- and postmenopausal participants there was a general need to improve their lifestyle in order to reduce dyslipidemia prevalence.
... Menopause, the age-related loss of ovarian function, increases risk for various aging-associated conditions, including body weight gain/obesity, dyslipidemia, insulin resistance, osteoporosis, depression and cancer [1][2][3]. While studying molecular changes associated with menopause and postmenopausal in humans is difficult due to limited access to tissue samples and intrinsic variation among patients, the menopause model induced by bilateral ovariectomy (OVX) in rodents has been widely used to study mechanisms and test new interventions capable of minimizing the deleterious effects associated with menopause [4][5][6]. ...
... There is compelling evidence that antioxidant, metabolic and inflammatory homeostasis are impaired in postmenopausal women as well as in animal models of OVX. Alterations in these biological processes are shared with various aging-related conditions such as cardiovascular disease, osteoporosis, depression, diabetes and cancer amidst others which, in fact, increase incidence in postmenopausal [2,3,39,40]. Dealing with physiological changes and symptoms during menopause is a major challenge for women and, while HRT can provide benefits, there still are several concerns and misconceptions with regard to pros and cons of HRT [4,[14][15][16]. ...
Article
Sexual hormone deficiency has been associated with metabolic changes, oxidative stress and subclinical inflammation in postmenopausal women. Hormone replacement therapies are effective in many instances, even though some patients either do not respond or are not eligible. The aim of this study was to evaluate the impact of short- (15 days) versus long-term (60 days) sexual hormone depletion and whether antioxidant supplementation with N-acetylcysteine (NAC) and alpha-lipoic acid (LA) improves oxidative stress, metabolic, and inflammatory parameters in ovariectomized (OVX) rats. Short-term OVX rapidly depleted circulating estrogen, causing uterine atrophy and body weight gain without affecting oxidative damage, inflammatory and lipid metabolism markers. In contrast, long-term OVX augmented oxidative damage in serum and peripheral tissues as well as increased serum total cholesterol, TNF-α and IL6 levels. Triglycerides, glucose and HDL cholesterol were not altered. Long-term OVX-induced oxidative stress was associated with depletion of GSH and total non-enzymatic antioxidants as well as decreased activity of Glutathione Peroxidase (GPx) and Glutathione Reductase (GR), but not Superoxide Dismutase (SOD) and Catalase (CAT). NAC and LA supplementation prevented GSH and total non-enzymatic antioxidants depletion as well as restored GPx and GR activities, TNF-α, IL6 and cholesterol in OVX rats. NAC and LA effects appear to be independent on NRF2 activation and estrogen-like activity, since NAC/LA did not promote NRF2 activation and were not able to emulate estrogen effects in OVX rats and estrogen-receptor-positive cells. The herein presented data suggest that NAC and LA may improve some deleterious effects of sexual hormone depletion via estrogen-independent mechanisms.
... 78,79 Post-menopause, women experience estrogen deficiency, leading to a redistribution of body fat that results in increased abdominal obesity, thereby elevating cardiovascular risk to levels comparable to men. [80][81][82] The surge in abdominal obesity in post-menopausal women is noteworthy, underscoring the need for tailored interventions and preventive measures for both sexes at different life stages to mitigate the associated risks effectively. It is crucial to have a sex-specific understanding and approach to managing the escalating obesity rate and its consequences in diverse populations. ...
Article
Full-text available
Interest in sex differences related to coronary artery disease (CAD) has steadily increased, and the risk factors for CAD show distinct sex differences. For women, cardiovascular risk increases significantly after menopause due to a decrease in estrogen levels. In older individuals, increased arterial stiffness results in a higher pulse pressure, leading to a more common occurrence of isolated systolic hypertension; these changes are more noticeable in women. While the incidence of diabetes is similar in both sexes, women with diabetes face a 50% higher relative risk of fatal coronary heart disease compared to men. Smoking significantly increases the risk of ischemic heart disease in women, particularly those who are younger. The decrease in estrogen in women leads to a redistribution of fat, resulting in increased abdominal obesity and, consequently, an elevated cardiovascular risk. Pregnancy and reproductive factors also have a significant impact on CAD risks in women. Additionally, disparities exist in medical practice. Women are less likely to be prescribed cardioprotective drugs, referred for interventional or surgical treatments, or included in clinical research than men. By increasing awareness of these sex differences and addressing the disparities, we can progress toward more personalized treatment strategies, ultimately improving patient outcomes.
... An adverse effect of menopause on CVD risk is due to the deterioration of blood lipids pro le during the menopausal transition [1] . Some reports have shown that the increase in TC and LDL may partly explain the increased risk of cardiovascular disease in postmenopausal women [2][3][4] . ...
Preprint
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With the aging population, understanding the factors influencing metabolism-related diseases in women during perimenopause and postmenopause is crucial for developing effective prevention and management strategies. This study aimed to investigate the relationship between body composition, hormone levels, age, and metabolism-related diseases in perimenopausal and postmenopausal women. A total of 773 women aged 40 to 54 years were included in the study. Data on serum hormone levels, blood lipids, blood glucose, anthropometric indexes, and bone density were collected and analyzed using ANOVA. Differences between perimenopausal women (Peri-M) and postmenopausal women (Post-M) or different age groups were compared, and the relationships among these factors were examined. The prevalence of cardiovascular and skeletal diseases was higher in Post-M compared to Peri-M (15.05% vs 8.29% and 41.75% vs 23.28%, respectively) (P < 0.05). Post-M women showed significantly elevated levels of Total cholesterol (TC) and low-density lipoprotein (LDL), along with decreased bone density compared to Peri-M (5.12 ± 0.73 vs 4.79 ± 0.82; 2.91 ± 0.67 vs 2.67 ± 0.74; 1.03 ± 0.15 vs 1.12 ± 0.14; 0.86 ± 0.11 vs 0.90 ± 0.13). In the Peri-M group, estradiol (E2) negatively correlated with TC (r1=-0.084), while age positively correlated with TC (r2 = 0.091); neither were associated with LDL, T-value of 2–4 lumbar spine (T1), or T-value of femoral neck (T2). Conversely, in the Post-M group, E2 negatively correlated with TC and LDL (r1’=-0.256, r3=-0.178), and positively correlated with T1 and T2 (r4 = 0.265, r5 = 0.275); age positively correlated with TC and LDL (r2’=0.231, r3’=0.152), negatively correlated with T1 (r4’=-0.218), and was not correlated with T2. E2 and age were independent predictors of metabolic indexes. Notably, the correlation coefficients of E2 and age with TC during the postmenopausal period were significantly higher than in the menopause transition period (P < 0.05). The increased prevalence of cardiovascular and skeletal diseases is closely associated with estrogen deficiency and chronological aging. The interaction between E2 and age in lipid and bone metabolism may contribute to the development of postmenopausal metabolism-related diseases. Early initiation of primary prevention therapy may offer substantial biological and clinical benefits to postmenopausal women.
... (1) Some studies have revealed that there is a higher risk of coronary artery disease for women after menopause, especially, if there are coexisting lifestyle factors such as physical inactivity, habits like smoking, high-calorie/high-fat diet, and stress full work conditions. [1,2,3] Menopause is caused by several factors. But the most common one is natural aging while others are through a hysterectomy, ovarian cancer patients, chemotherapy, pituitary gland disorders, and very poor health condition. ...
Article
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Background: Menopause is a natural stage in life and part of the aging process. it marks when a woman’s period stops as her ovaries stop producing eggs. Many changes take place in the physiological parameters some of which are known to enhance the risk of vascular-related diseases such as stroke and ischemic heart disease. This study aimed to estimate the platelets count, PT, APTT, fibrinogen level D-dimer, and protein C level among Healthy Menopausal Sudanese Women. Material and methods: This was a case-control study conducted at the laboratory of the national university at Khartoum state during the period of December 2022 to April 2023. Apparently, healthy menopausal women who lost their menstrual period for more than one year were included as a case group, and apparently healthy women during the reproductive period were included as a control group. The platelets were counted by using Automated Hematology Analyzer, Sysmex KX 21N (series SN B 2010), PT, APTT by coagulometer (Automated Bio Bas), Fibrinogen level by using the coagulometer (Automated Bio Bas) by BioMed-Fibrinogen kite BioMed-Fibrinogen kite, I chroma was used for the D-dimer, protein C was measured by using (URIT 660 AESKULISA Protein C and S Microplate read. Results: In the case group the means of platelets count, PT, APTT, Fibrinogen, D-dimer, and Protein C were; (251.3±38.2), (16.9±2.1), (32.9±7.7), (381.0±269.1) (0.59±0.17) and (89.9±16.3) respectively. while in the control group, the means of platelets count, PT, INR, APTT, Fibrinogen, D-dimer, and Protein C were; (291.8±73.5), (13.5±1.5), (31.3±2.7), (212.5±77.3) (0.33±0.12) and (82.2±14.2) also respectively. when comparing the parameters means between the case and control group the results revealed; there was a significant decrease in platelets counts (p. v = 0.001), a significant increase in PT and fibrinogen levels (p. v = 0.000), and insignificant differences for the APTT, D-dimer, and protein C (p. v > 0.05). In addition to that, there was a negative correlation between the parameters and the age and the A menorrhea (p. v > 0.05) Conclusion: In the Sudanese menopausal women, there was a significant decrease in platelets counts, and a significant increase in PT and fibrinogen levels, with insignificant differences for the APTT, D-dimer, and protein C when compared between the case and control group, in addition, the parameters had a negative correlation with the age and the A menorrhea.
... Changes in hormones and body mass in menopause were strongly associated with lipid profile alterations. In post-menopausal women, ApoB, which is involved in LDL metabolism, was increased [50], and the serum TC and LDL levels were positively correlated with FSH [51]. Moreover, high concentrations of free fatty acids, LDL, and ApoB were associated with increased abdominal fat, resulting in an increased risk of CVD [52,53]. ...
Article
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Middle-aged women belong to a risk group for metabolic dysregulation and menopausal symptoms, mainly due to a dramatic hormonal shift. Supplementation with functional compounds or a single nutrient has been dominantly explored as a nutritional approach for improving aging-related health parameters. However, a meal-based approach might be another strategy for promoting the overall health of the target population. This pilot study aimed to develop a meal-based intervention for middle-aged women and to evaluate its potential health benefits. Considering the nutrient intake status of Korean middle-aged women, diets enriched with four major nutrients (isoflavone, omega-3, fiber, and calcium) were designed and provided to forty-nine women aged 50 to 65 with mild levels of menopausal symptoms for 8 weeks. In the post-intervention phase, they showed reduced body weight and body fat, and improved biochemical metabolic parameters with decreased levels of cholesterol, low-density lipoprotein-cholesterol, ApoB, and fasting insulin. Moreover, bone resorption markers and menopause symptoms were lower in the post-intervention phase. In conclusion, the meal-based intervention might be a prominent strategy for overall health promotion in relatively healthy middle-aged women and further investigation is needed to test its efficacy with a randomized controlled study.
... Changes in the hormonal environment and menopausal transition adversely influence metabolic health, leading to conditions such as blood glucose elevation, dyslipidemia, and abdominal fat accumulation [2]. A study on Chinese women showed that the body mass index and total body fat percentage increased significantly during the menopausal transition, and postmenopausal women exhibited higher levels of glycosylated hemoglobin A 1c and blood lipid profile than premenopausal women [3]. Notably, metabolic disorders during menopause Figure 1 Animal experiment procedure. ...
... Furthermore, these OPs may be ref lective of different types of obesity. For instance, BF% and BMI primarily ref lected generalized obesity (Chang et al. 2000), whereas WC and WHtR focused on abdominal obesity (Carmienke et al. 2013). Abdominal obesity has been found to cause more severe systemic inf lammation (de Heredia et al. 2012), which in turn led to more severe neuroinf lammation and cognitive impairment (Miller and Spencer 2014;Guillemot-Legris and Muccioli 2017). ...
Article
The univariate obesity-brain associations have been extensively explored, while little is known about the multivariate associations between obesity and resting-state functional connectivity. We therefore utilized machine learning and resting-state functional connectivity to develop and validate predictive models of 4 obesity phenotypes (i.e. body fat percentage, body mass index, waist circumference, and waist-height ratio) in 3 large neuroimaging datasets (n = 2,992). Preliminary evidence suggested that the resting-state functional connectomes effectively predicted obesity/weight status defined by each obesity phenotype with good generalizability to longitudinal and independent datasets. However, the differences between resting-state functional connectivity patterns characterizing different obesity phenotypes indicated that the obesity-brain associations varied according to the type of measure of obesity. The shared structure among resting-state functional connectivity patterns revealed reproducible neuroimaging biomarkers of obesity, primarily comprising the connectomes within the visual cortex and between the visual cortex and inferior parietal lobule, visual cortex and orbital gyrus, and amygdala and orbital gyrus, which further suggested that the dysfunctions in the perception and attention and value encoding of visual information (e.g. visual food cues) and abnormalities in the reward circuit may act as crucial neurobiological bases of obesity. The recruitment of multiple obesity phenotypes is indispensable in future studies seeking reproducible obesity-brain associations.
... A prospective study including 1,303 British women (age: 53 years) showed that HbA1c levels increased across the natural menopause transition after adjustment for BMI [26]. In a cross-sectional study, postmenopausal women showed higher HbA1c levels than premenopausal women after adjustments for age and BMI in Chinese women with BMI < 30 kg/m 2 [27]. HbA1c estimates longterm glucose status and predicts cardiovascular disease better than fasting or post-challenge glucose in women without diabetes mellitus [28]. ...
Article
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Background Menopausal status and obesity are associated with an increased risk for cardiovascular diseases. However, there are few studies on the effect of menopause on cardiovascular risk factors according to the degree of obesity during the menopausal transition. We aimed to evaluate the effect of menopause on cardiovascular risk factors according to body mass index (BMI) in middle-aged Korean women. Methods We analyzed 361 postmenopausal women and 758 premenopausal women (age: 45–55 years) without diabetes mellitus, hypertension, or dyslipidemia, using a cohort database released by the Korean National Health and Nutrition Examination Survey 2016–2018. Subjects were divided into two groups based on BMI. Women who underwent a hysterectomy or were pregnant were excluded from this study. Differences between groups adjusted for age and BMI were assessed. Results Postmenopausal women (52 ± 2 years) were older than premenopausal women (48 ± 2 years), and BMI did not differ between the two groups (22.8 ± 2.9 vs. 23.0 ± 3.1 kg/m²). After adjustment for age and BMI in total and non-obese subjects (not obese subjects), postmenopausal women exhibited higher hemoglobin A1c and total cholesterol levels than premenopausal women. Subgroup analysis for 138 postmenopausal and 138 age- and BMI-matched premenopausal women showed that postmenopausal women had higher total cholesterol levels than premenopausal women with marginal significance (201 ± 25 vs. 196 ± 27 mg/dL). Conclusion Menopausal status was associated with increased glucose and cholesterol levels independent of age and BMI in middle-aged Korean women. Menopausal status showed a significant relationship with increased total cholesterol levels even after adjusting for age and BMI in non-obese women but not obese women. Therefore, intensive monitoring and treating of lipid status is necessary to prevent cardiovascular events during the menopausal transition, especially in non-obese subjects.
... À la mé nopause, le gain de poids est essentiellement abdominal [10]. Il est responsable de l'augmentation du risque cardiovasculaire [11] et de l'hypertension arté rielle [12]. À ces facteurs de risque classiques s'ajoute la sé dentarité . ...
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Aim The aim of these recommendations is to set forth an individualized approach to the management of early postmenopausal women (i.e., within the first 10 years after natural menopause) covering all aspects of lifestyle and therapeutic management, with or without menopause hormone therapy (MHT). Materials and methods Literature review and consensus of French expert opinion. Recommendations were graded according to the HAS methodology and levels of evidence derived from the international literature, except when there was no good-quality evidence. Summary recommendations The beginning of menopause is an ideal time for each woman to evaluate her health status by assessing her bone, cardiovascular, and cancer-related risk factors that may be amplified by postmenopausal estrogen deficiency and by reviewing her lifestyle habits. Improving lifestyle, including nutrition and physical activity, and avoiding risk factors (notably smoking), should be recommended to all women. MHT remains the most effective treatment for vasomotor symptoms but it could be also recommended as first-line treatment for the prevention of osteoporosis in early postmenopausal women at low to moderate risk for fracture. The risks of MHT differ depending on its type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. There is reasonable evidence that using transdermal estradiol in association with micronized progesterone or dydrogesterone may limit both the venous thromboembolic risk associated with oral estrogens and the risk of breast cancer associated with synthetic progestins. Treatment should be individualized to each woman, by using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of its benefit–risk balance. For bothersome genitourinary syndrome of menopause (GSM) symptoms, vaginal treatment with lubricants and moisturizers is recommended as first-line treatment together with low-dose vaginal estrogen therapy, depending on the clinical course. No recommendation of an optimal duration of MHT can be made, but it must take into consideration the initial indication for MHT as well as each woman's benefit–risk balance. Management of gynecological side-effects of MHT is also examined. These recommendations are endorsed by the Groupe d'Etude sur la Ménopause et le Vieillissement hormonal (GEMVI) and the Collège National des Gynécologues-Obstétriciens Français (CNGOF).
... Likewise, Lizcano and Guzm an (2014) reported that fat accumulation is related to OS, and the decrease in oestrogen level after menopause leads to changes in the lipid profile and, consequently, to an increase of lipid peroxidation (Keaney et al. 2003;Furukawa et al. 2004). Previous studies reported that the serum levels of total cholesterol, low-density lipoprotein-cholesterol, TG, and Apo B are higher in postmenopausal than in premenopausal women (Chang et al. 2000). Additionally, elevated TG levels were related to total severe symptom scores (Kaya et al. 2017). ...
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During the postmenopausal period, there are metabolic alterations that predispose individuals to metabolic syndrome (MS), oxidative stress (OS), and the risk of developing cardiovascular diseases. We aimed to compare the concentrations of OS markers in postmenopausal women with and without MS. Malondialdehyde, carbonyl groups, and total antioxidant capacity (TAC) were quantified. We conducted a cross-sectional study: Group 1 (n = 42) included women without MS, and Group 2 (n = 58) comprised women with MS. Participants’ age was similar between groups. Glucose, insulin, the homeostasis model assessment of insulin resistance, triglycerides, uric acid, and body mass index were significantly lower in postmenopausal women without MS. OS markers were significantly lower in Group 1 vs. Group 2: malondialdehyde, 31.32 ± 14.93 vs. 40.27 ± 17.62 pmol MDA/mg dry weight (p = .01); protein carbonylation, 6325 ± 1551 vs. 7163 ± 1029 pmol PC/mg protein (p = .0003); and TAC, 1497 ± 297.3 vs. 1619 ± 278.8 pmol Trolox equivalent/mg protein (p = .041). OS markers were significantly higher in postmenopausal women with MS. • Impact statement • What is already known on this subject? Oxidative stress has been implicated in numerous disease processes; however, information on the relationship between oxidative stress and metabolic syndrome among postmenopausal women remains limited. • What do the results of this study add? Our results indicate that in postmenopausal Mexican women, oxidative stress markers were significantly lower in those without metabolic syndrome, whereas total antioxidant capacity was higher in those with metabolic syndrome, which could be explained as an antioxidant defense mechanism capable of neutralising excess oxidative damage markers. • What are the implications of these findings for clinical practice and/or further research? This study is of interest to a broad audience because it compares the concentrations of oxidative stress markers in postmenopausal women with and without metabolic syndrome. Our study could support intervention with supplements or foods rich in antioxidants as lifestyle modifications in postmenopausal women with metabolic syndrome.
... It may be the primary metabolic defects that leads to low HDL and increased LDL which are the key features of the atherogenic lipo-protein phenotype. 5,6 Moreover obesity is an independent risk factor for the cardiovascular disease including coronary artery disease, stroke and congestive cardiac failure. Cardiovascular disease remains the major cause of death in post menopausal women. ...
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Objectives: Menopause is a natural process. After menopause the morbidity and mortality from cardiovascular disease in women is increased due to lack of oestrogen protection, aging effect, increased body weight, android pattern of body fat distribution, changes in metabolism and lipid profile.1,2 So the present study is aimed at measuring the serum lipid profile and BMI in postmenopausal women of Bangladesh, thus detecting dyslipidemia and obesity to ascertain the relative risk of developing cardiovascular disease in this group. Methods: A cross-sectional study was conducted at the Obst and Gynae Department of Green life Medical College Hospital among 150 otherwise healthy postmenopausal women from October 2017 to April 2018. Fasting blood obtained for testing lipid profile. Serum total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol were measured using enzymatic procedures. Low-density lipoprotein (LDL) cholesterol concentration was estimated by Friedewald formula. Questionnaire-cum interview method was used to obtain relevant informations. BMI was calculated from weight in kg and height in cm by Metric BMI calculator. Dyslipidemia was identified based on serum lipid levels following the standard protocol proposed by the national guidelines. Result: A total of 150 participants aged between 43 years to 70 years, were included in this study. Average age of the study subjects were 53.53±3.2 years. A mean duration of menopause was 7.23±0.92 years. The range BMI level was 19.1 to 36.6. Among them BMI <24.9 , was found in 28.30% of women, BMI 25 to 29.9 was found in 49.5 % women and 22.23 % women had BMI of >30. According to standard guideline BMI <24.9 is considered normal, 25-29.9 is overweight and BMI more than 30 is obese. In this study among normal BMI group 59.4% had normal lipid profile and 29.7% had isolated hypertriglyceridemia and mixed dyslipidemia in 10.9% patients. In the group with BMI 25 to 29.9 (overweight) normal lipid level was in 52.3% women, isolated hypertriglyceridemia found in 17.6% women and dyslipidaemia was in 30.1% women. In the group with BMI >30 (obese) normal lipid level was in 5.8% of the women, isolated hypertriglyceridemia found in 29.4% women and dyslipidaemia was in 64.8% women. HDL-C level was low in 83.3% women of >30 BMI group and normal in 66.67% women of normal BMI group. Conclusion: The prevalence of dyslipidemia, based primarily on the high cholesterol level and high LDL was observed among the overweight and obese group of study population. Therefore, it can be concluded that menopause leads to changes in lipid profile by increasing total and LDL cholesterol and by reducing HDL cholesterol which indicates menopause may be an additional risk factor for dyslipidemia causing cardiovascular disease in Bangladeshi women. Bangladesh J Obstet Gynaecol, 2020; Vol. 35(1): 20-24
... Using IFG as a screening tool for screening population, detection of DM could be made 5-6 years earlier before the clinical diagnosis (18). Some studies (19,20) strongly recommended that IFG should be aggressively treated as a disease because it is an autonomous risk factor for T2DM and CVD. Gregory A. observed the relation of diabetes with IFG and found that numerous newly identified IFG patients progressed to diabetes in less than three years (21). ...
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Objective: Prediabetes is a state that people have blood glucose levels higher than normal but still not in diabetes range. There is a close relationship between impaired lung function and diabetes mellitus (DM). Reduced lung function can be present before the clinical evidence of diabetes or insulin resistance. Materials and Methods: The total number of subjects in this longitudinal study was 503 and compared with apparently healthy Kashmiri adults. All the subjects, at the time of their first visit, underwent Fasting Plasma Glucose (FPG) estimation, 2- hour oral glucose tolerance test (OGTT) and spirometry (FVC, FEV1 & FEV1/FVC). Those subjects who had normal glucose tolerance (NGT) were retested for glycemic status and spirometric values after a follow-up period of 2-18 (mean=10) months. Results: Out of total 503 subjects on follow up 483 (96%) had NGT and 20 (4%) had prediabetes. Percent predicted forced vital capacity (FVC) and % predicted forced expiratory volume in 1st second (FEV1) were significantly lower (P-value< 0.001) while as % predicted FEV1/FVC was significantly higher (P-value< 0.001) in prediabetes as compared to NGT group. Conclusion: Results of our study point out a predominantly restrictive pattern of lung dysfunction in the prediabetes group as compared to the NGT group.
... Se ha postulado que es la obesidad abdominal, y no la total, la que se asocia con la insulinodependencia y la aparició n de diabetes y ECV 23 ; precisamente es el inicio de la posmenopausia un factor que predispone a la distribució n central de la obesidad. La conjunció n de edad, menopausia y obesidad central se ha asociado con la acumulació n de factores de riesgo cardiovascular clá sicos como hipertensió n arterial, dislipemia o diabetes 13 . Al igual que pasa en otros contextos como la insuficiencia cardiaca, el ictus o la fibrilació n auricular, la obesidad valorada por IMC se comporta como un factor protector 24,25 . ...
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Introduction and objectives There are models for cardiovascular risk prediction in the general population, but the prediction of risk in postmenopausal women has not been specifically studied. This study aimed to determine the association of lifestyle habits and chronic diseases with cardiovascular risk in menopausal women, as well as to build a risk scale. Methods Retrospective population-based cohort study using data from the 2011 National Health Survey of Spain as a data source, Women ≥ 50 years were included. The characteristics that best defined the life habits of the study women were collected, as well as their health status and self-reported medical history at the time of the survey. Follow-up data on all-cause mortality were obtained from participants from 2011 to 2017. Results A total of 5953 women ≥ 50 years of age were included, with a mean age of 66.4 ± 11.4 years. The incidence of cardiovascular mortality in the follow-up period was 4%. Vegetable consumption less than 1 time/week (HR, 1.758), smoking (HR, 1.816) or excess hours of sleep (≥ 9 h/day, HR, 1.809), or o have main daily activity sitting most of the time (HR, 2.757) were related to cardiovascular mortality. The predictive model presents an honest C-index in test sample of 0.8407 (95%CI, 0.8025-0.8789). Conclusions Life habits such as the consumption of vegetables, daily main activity, sleeping hours or smoking are risk factors for cardiovascular mortality of great relevance among menopausal women. A simple 6-year self-reported risk scale with high predictive capacity is provided.
... À la mé nopause, le gain de poids est essentiellement abdominal [10]. Il est responsable de l'augmentation du risque cardiovasculaire [11] et de l'hypertension arté rielle [12]. À ces facteurs de risque classiques s'ajoute la sé dentarité . ...
Article
Résumé La ménopause est une période clé pour la santé avec des modifications physiologiques comprenant notamment une modification de la composition corporelle (baisse de la masse maigre et augmentation de la masse grasse) et un changement de la répartition des graisses corporelles conduisant à un risque pour la santé ostéomusculaire et cardiométabolique notamment. Des conseils nutritionnels adéquats, associés à des conseils relatifs à l’activité physique, peuvent s’opposer en partie à ces effets. La balance énergétique sera modérément négativée en cas de prise de poids tout en maintenant un apport protidique suffisant ainsi qu’une activité physique régulière. Une alimentation d’inspiration méditerranéenne sera bénéfique sur la santé cardiovasculaire. Les produits laitiers seront préservés. Les régimes restrictifs et les exclusions alimentaires non justifiées seront évités.
... It is a natural process in the reproductive phase of women's life. Many changes take place in the physiological parameters after menopause like alterations in fat distribution and metabolism and also coagulative and fibrinolytic properties of blood [1] , which may enhance the risk of vascular-related diseases such as cerebrovascular stroke and ischemic heart disease [2] . Endothelial dysfunction along with undesirable alteration in fibrinolysis, coagulation, and other metabolic processes has been known to occur [2] . ...
Article
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Background: Menopause is the natural cessation or stopping of a woman’s menstrual cycle and marks the end of fertility. Ovarian function declines can lead to undesirable alterations in metabolism, vascular endothelium function, fibrinolytic and coagulative properties of blood. Menopause may enhance risk for ischemic heart disease in women due to such altered properties of blood and vascular function. Aims and Objectives: To compare some haematological values in pre- and post-menopausal women to know the risk of vascular and ischemic heart disease in postmenopausal women. Materials and Methods: Blood samples were drawn in 50 women who have attained menopause and have weight of 55–60 kg and height of 150–160 cm and 50 control subjects who were disease-free women aged 35–40 years with matching weight and height. These women had natural menopause and were not subjected to any hormonal or surgical intervention. The vital parameters were recorded, and general examination was done. Results: There was a statistically significant increase in hematocrit, and there was no statistically significant change in platelet count, activated partial thromboplastin time (APTT), and prothrombin time (PT). Conclusion: A higher viscosity of blood can enhance the risk of coronary artery disease by elevating platelet aggregability and adhesiveness to sub-endothelium. However, the above effect may partially be offset by unchanged APTT and PT.
... Não temos conhecimento de nenhum trabalho na literatura descrevendo a redistribuição da gordura. Os efeitos que o envelhecimento e a menopausa exercem sobre as mulheres levam ao aumento do teor de gordura corporal total, favorecendo a distribuição central de gordura(Chang, Wu et al., 2000). Contudo, a redistribuição de gordura em mulheres mais velhas pode aumentar significativamente o teor de gordura abdominal total sem que haja alteração na massa corporal total, ou a circunferência da cintura(Franklin, Ploutz- Snyder et al., 2009).O consumo de dietas hiperlipídicas de origem animal altera muito a morfologia e o tamanho dos adipócitos, bem como o metabolismo de carboidratos(Nascimento, Barbosa-Da-Silva et al.). ...
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Efeitos da associação da ovariectomia com uma dieta hiperlipídica sobre alterações no metabolismo lipídico, remodelamento e redistribuição do tecido adiposo e sobre os marcadores inflamatórios em camundongas C57BL/6
... The menopause transition is associated with obesity, blood pressure and metabolic syndrome (Kuh et al., 2005), furthermore elevated blood pressure was reported in pre menopausal woman than post menopause (Trémollières, et al., 1999) however some other studies could not show rise in blood pressure in menopause transition (Kuh et al., 2005). Total cholesterol level was reported high at the time of onset of menopause (Bittner, 2002) However the association of cardiovascular risk factors with onset of menopause is debatable (Barrett-Connor, 2003;Barrett-Connor and Bush, 1991), moreover HbA1c is a reliable indicator to estimate blood glucose level particularly in menopausal women, higher level of HbA1c (glycosylated hemoglobin) was reported in post menopausal women (Chang et al., 2000) (Simon, et al., 1989). ...
... In previous studies, triglyceride, total cholesterol, and LDL cholesterol levels were reported to be higher in postmenopausal women compared to premenopausal women [21]. Choi et al. have shown negative changes in lipid profile since late menopausal transition period [22], Chedraui et al., on the other hand, reported that high serum TG levels lead to a decrease in sexual desire and an increase mood changes and depression rates [23]. ...
Article
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Introduction: Many postmenopausal women experience hot flashes, night sweats, decreased sexual desire and vaginal dryness. In this study, we aimed to compare the menopause symptom levels of surgical menopause patients and natural menopause patients by using a Menopause Rating Scale (MRS) and investigate whether there is a relationship between lipid levels and menopausal symptoms in surgical menopause patients. Material and methods: This cross-sectional study was conducted on postmenopausal women who applied to the gynecology outpatient clinic. A total of 187 patients were analyzed. Of these,112 were the surgical menopause group and the remaining 75 were the natural menopause group. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides were measured by using an enzymatic color test. In order to evaluate the postmenopausal symptoms of postmenopausal women included in the study, the MRS questionnaire adapted to the Turkish population was used. Results: Considering the results of the MRS of the two groups, the results of surgical menopause patients were found to be statistically significantly higher. The results were statistically significantly higher in both the total score and in the two subgroups(somatic and psychological subgroups)in the surgical menopause group. When the MRS results(subgroups and total score)of women in the surgical menopause group were classified as mild and severe, no statistically significant relationship was found between symptom severity and blood lipid levels. Conclusions: In the surgically induced menopause group, it was shown by this study that menopausal symptoms were more severe than the natural menopause group. Unlike natural menopausal patients, no relationship was found between lipid levels and severity of menopausal symptoms in surgical menopausal patients.
... [1][2][3] Obesity is commonly associated with the excessive increase of visceral adipose tissue especially adipocyte size. 4,5 Amongst women, most, but not all, gain weight and accumulate central abdominal fat after the menopause, 6 and reports have indicated that menopause-related central obesity is an enhanced cardiovascular risk factor. 7,8 Previous animal 9,10 and human studies 11 reported that females were protected from hypertension until they reached menopause. ...
Article
Impact statement: Over activation of renal sensory nerve in obesity blunts the normal regulation of renal sympathetic nerve activity. To date, there is no investigation that has been carried out on baroreflex regulation of renal sympathetic nerve activity in obese ovarian hormones deprived rat model, and the effect of renal denervation on the baroreflex regulation of renal sympathetic nerve activity. Thus, we investigated the role of renal innervation on baroreflex regulation of renal sympathetic nerve activity in obese intact and ovariectomized female rats. Our data demonstrated that in obese states, the impaired baroreflex control is indistinguishable between ovarian hormones deprived and non-deprived states. This study will be of substantial interest to researchers working on the impact of diet-induced hypertension in pre- and postmenopausal women. This study provides insight into health risks amongst obese women regardless of their ovarian hormonal status and may be integrated in preventive health strategies.
... Moreover, the elevated incidence of high WHR, type 2 diabetes mellitus, and abnormal lipid levels in women aged >50 years in our sample may relate to hormonal changes during perimenopause and menopause. Studies in Chinese women [44][45][46] found that menopause was associated with increased central body fat, fasting glucose, HbA1c, TC, TC/ HDL-C, LDL-C, and triglycerides. In addition, the comparable patterns of incident high WHR and incident type 2 diabetes mellitus by age group in men and women in our study may suggest a positive correlation between WHR and diabetes mellitus, regardless of sex. ...
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Background China faces a substantial burden from cardiometabolic diseases, but longitudinal studies on a wide range of cardiometabolic risk factors are limited. We examined the 6‐year incidence of 8 cardiometabolic risk factors in a diverse, population‐based cohort. Methods and Results In the China Health and Nutrition Survey, anthropometry, blood pressure, and fasting blood samples were collected from 9621 adults (47.6% men) aged 18 to 99 years in 2009 who were followed into 2015. Using inverse probability weights to account for loss to follow‐up, we estimated the 6‐year incidence of 8 cardiometabolic risk factors and compared the incidence of each risk factor across age groups using inverse probability–weighted sex‐stratified logistic regression models. Incidence was noted for the following cardiometabolic risk factors during 2009–2015: hypertension (systolic/diastolic blood pressure ≥140/90 mm Hg; men: 29.2%; women: 24.9%), high waist circumference/height ratio (≥0.5; men: 42.4%; women: 43.8%), and high total to HDL (high‐density lipoprotein) cholesterol ratio (≥5; men: 17.0%; women: 14.5%). Older men and women (aged ≥65 years) had the highest incidence of hypertension. Incidence of high waist circumference/height ratio and high LDL (low‐density lipoprotein) cholesterol (≥130 mg/ dL ) was highest among older (aged ≥65 years) women, whereas incidence of overweight (body mass index ≥25) and high triglycerides (≥150 mg/ dL ) was highest among younger (aged 18–35 and 35–50 years) men. Conclusions We found increases in cardiometabolic risk among Chinese adults during this recent, short, 6‐year period that are higher than previous studies in China. The higher incidence of overweight and elevated dyslipidemia markers in younger versus older men portends an increasing burden of cardiometabolic diseases in China as the younger population ages.
... In common, the rate of obesity was higher in postmenopausal group. Chang et al. 14 showed similar results that BMI and TBF percentage were significantly increased through menopausal transition. ...
Article
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Objectives Body mass index (BMI) is commonly used in epidemiological study or clinical center. However, it is not exactly correlated with body fat composition and does not reflect sex, age, or race. The aim of this article is to evaluate the validity of BMI standards relative to total body fat (TBF) and to estimate new BMI criteria that correspond to TBF for obesity, especially for Asian postmenopausal women. Methods A total 3,936 patients were included in this cross-sectional study, including 1,565 premenopausal and 2,371 postmenopausal women. At the time of visit, demographic data were collected. We demonstrated the validity of BMI cut-point of 25 kg/m² by using area under the curve (AUC), and presented the empirical optimal BMI cut-point by using Youden's index and overall accuracy in both premenopausal and postmenopausal women. Results BMI-defined obesity (≥ 25 kg/m²) represents high AUC values (> 0.9) for each TBF. In premenopausal women, TBF ≥ 38% and corresponding BMI value was 29.45 kg/m² indicated the highest both Youden's index and overall accuracy. In comparison, postmenopausal women who were TBF ≥ 38% showed the highest Youden's index and overall accuracy, and corresponding BMI value was 26.45 kg/m². Conclusions We proposed new BMI criteria for obesity by using TBF reference. With application of bioelectrical impedance analysis, the diagnosis of obesity using BMI criteria may differ between premenopausal and postmenopausal women.
... The menopause transition is associated with obesity, blood pressure and metabolic syndrome (Kuh et al., 2005), furthermore elevated blood pressure was reported in pre menopausal woman than post menopause (Trémollières, et al., 1999) however some other studies could not show rise in blood pressure in menopause transition (Kuh et al., 2005). Total cholesterol level was reported high at the time of onset of menopause (Bittner, 2002) However the association of cardiovascular risk factors with onset of menopause is debatable (Barrett-Connor, 2003;Barrett-Connor and Bush, 1991), moreover HbA1c is a reliable indicator to estimate blood glucose level particularly in menopausal women, higher level of HbA1c (glycosylated hemoglobin) was reported in post menopausal women (Chang et al., 2000) (Simon, et al., 1989). ...
... The menopause transition is associated with obesity, blood pressure and metabolic syndrome (Kuh et al., 2005), furthermore elevated blood pressure was reported in pre menopausal woman than post menopause (Trémollières, et al., 1999) however some other studies could not show rise in blood pressure in menopause transition (Kuh et al., 2005). Total cholesterol level was reported high at the time of onset of menopause (Bittner, 2002) However the association of cardiovascular risk factors with onset of menopause is debatable (Barrett-Connor, 2003;Barrett-Connor and Bush, 1991), moreover HbA1c is a reliable indicator to estimate blood glucose level particularly in menopausal women, higher level of HbA1c (glycosylated hemoglobin) was reported in post menopausal women (Chang et al., 2000) (Simon, et al., 1989). ...
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... 22,23) Third, increased inflammatory cytokines due to pregnancy lead to insulin resistance, which may have deleterious effects on the normal development of maternal organs. 1,24) In the present study, we obtained data regarding the number of pregnancies instead of parity due to questionnaire limitations. We focused on the association between age at first childbirth and central obesity. ...
Article
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Background: Waist circumference is one of the key components of metabolic syndrome. Recent studies demonstrated that the reproductive profile was associated with metabolic syndrome in postmenopausal women. This study focused on the association between central obesity and age at first childbirth. It also considered other factors associated with central obesity in postmenopausal women. Methods: This study was based on the 2013-2015 Korean National Health and Nutrition Examination Survey and involved 3,143 naturally postmenopausal women. These women were divided into three groups according to their age at first childbirth: 19 years or younger (n=252), 20-29 years (n=2,695), and 30 years or older (n=196). Multivariate analysis using logistic regression was performed to evaluate the effects of various reproductive factors, including other confounding factors. Results: During adjustment for confounding factors, in the early age at first childbirth group, odds ratios (95% confidence intervals) for central obesity decreased. In the final model, younger age at first childbirth was not significantly related to central obesity (waist circumference more than 85 cm) in naturally postmenopausal women after adjusting for other confounding factors. Conclusion: Younger age at first childbirth was not significantly associated with central obesity after adjustment for confounding factors.
... The menopause transition is associated with obesity, blood pressure and metabolic syndrome (Kuh et al., 2005), furthermore elevated blood pressure was reported in pre menopausal woman than post menopause (Trémollières, et al., 1999) however some other studies could not show rise in blood pressure in menopause transition (Kuh et al., 2005). Total cholesterol level was reported high at the time of onset of menopause (Bittner, 2002) However the association of cardiovascular risk factors with onset of menopause is debatable (Barrett-Connor, 2003;Barrett-Connor and Bush, 1991), moreover HbA1c is a reliable indicator to estimate blood glucose level particularly in menopausal women, higher level of HbA1c (glycosylated hemoglobin) was reported in post menopausal women (Chang et al., 2000) (Simon, et al., 1989). ...
Article
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Anthropometric measurements are the litmus during the transition of any woman from normal menstrual cycle to menopause. Several changes occur in the body during this transition from change of body shape to hormonal fluctuations, from social status to psychological and neurological alterations. The present study thus explored the pre and post menopausal changes in the anthropometric indicators and its significance level. Methodology: A survey based cross sectional study was carried out. Total 190 female aged 40-60, were randomly selected from the district Hyderabad. Results: age, weight, BMI and WC (in rural, urban and accumulative) in post menopausal women are significantly less (p=0.0001, p=0.01, p=0.004 and p=0.01 respectively) than those who were having normal menstrual cycles. Waist to height ratio (WHtR), height, Bicep and triceps measurements were not significantly different in the aforementioned groups. Conclusion: In a representative study of woman, the natural transition is strongly associated with decrease in BMI (Body Mass Index), WC (Waist circumference) and weight.
... Epidemiological studies suggest that menopause is associated with increases in CVD risk factors with incidence markedly increased after the ages of 45 to 54 years [36]. Higher levels of TC, LDL-C, TG, and Apo B were found in post-menopausal, compared to pre-menopausal, women, while inconsistent results were found for HDL-C [37,38]. Recent results from the Study of Women's Health Across the Nation (SWAN) showed considerable increases in levels of TC, LDL-C, and TG in the one-year interval before and after the final menstrual period that are consistent with menopause-induced changes [39]. ...
Article
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The efficacy of phytosterols extracted from Diascorea alata on antioxidant activities, plasma lipids and hematological profiles was assessed in postmenopausal women. Gas chromatography and mass spectrophotometry was employed to determine the steroid content of Taiwanese yam (Diascorea alata cv. Tainung No. 2). A two-center, randomized, double-blind, placebo-controlled clinical investigation on 50 postmenopausal women randomly assigned to two groups treated for 12 months with placebo or two sachets daily of Diascorea extracts containing 12 mg/dose was carried out. The main outcome measures were the plasma antioxidant activities, hematological profiles, and the concentrations of plasma lipids, including cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, very low density lipoprotein„ and apolipoprotein A1 and B. A one-way analysis of covariance (ANCOVA) test was performed to investigate the significance. γ-sitosterol, stigmasterol, 22-23-dihydro-, and -sitosterol were major phytosterols determined from Diascorea extracts. At six months in those receiving Diascorea, there were significantly decreased leukocyte counts (p < 0.01) and improvement on antioxidant activity of malondialdehyde (p < 0.001). After 12 months’ treatment, elevations of hematocrit and mean corpuscular volume (p < 0.01) were noted in those receiving Diascorea. Moreover, the low dose Diascorea consumption in menopausal women for one year generally did not present positive effects on lipid profiles.
... But in postmenopausal women due to lack of the estrogen, cardio protective function is lost and increased the coronary artery diseases . 6 However, several other physiological changes which develop during menopause may also influence the risk of cardiovascular disease, such as aging effect, decreasing resting metabolic rate and physical activity. 7 Again, following menopause due to lacking of estrogen, women have increased risk for central obesity, hyperlipidemia, glucose intolerance and hypertension. ...
Article
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p> Background : Hyperlipidemia is a major risk factor for cardiovascular diseases in postmenopausal women. Increased incidence of cardiovascular diseases in postmenopausal women may be due to hyperlipidemia caused by lower level of estrogen hormone. Objectives: The study was carried out to observe the association of serum estrogen with total cholesterol (TC) and triglyceride (TG) levels in postmenopausal women. Methods: This cross sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, during the period of January to December 2011. A total of 90 females were selected from different areas of Dhaka city. Among them, 60 postmenopausal women with age ranging from 50 to 60 years were taken as study group and 30 apparently healthy premenopausal women with age ranging from 20 to 30 years were included as control group for comparison. The study parameters total cholesterol and triglyceride were estimated by enzymatic method in both groups. Serum estrogen level was estimated by Radioimmunoassay ( RIA) method in order to assess the hormonal level of both groups. Data was analyzed by Unpaired Student’s t- test and Pearson’s correlation co-efficient (r) test as applicable. Results: In this study, the mean serum TC level was higher in postmenopausal women than those of premenopausal women and result was statistically significant. The level of mean serum TG was significantly (p<0.001) higher in postmenopausal women in comparison to those of premenopausal women. In postmenopausal women serum estrogen level was lower than premenopausal women and serum estrogen level showed negative correlation with TC level. .Again serum TG level also showed negative correlation with serum estrogen level. All these correlation were statistically non-significant. Conclusion: From the results of the present study it may be concluded that the serum total cholesterol and triglyceride levels are significantly higher in postmenopausal women that may be due to low level of estrogen. J Dhaka Medical College, Vol. 26, No.1, April, 2017, Page 25-31 </p
... Previous studies reported that the serum levels of TC, LDL-C, TG and Apo B are higher in postmenopausal than in premenopausal women [27]. Choi et al. suggested that abnormal changes in lipid profiles occur mainly in late menopausal women [28]. ...
Article
Introduction: Many postmenopausal women experience hot flashes, night sweats, non-specific emotional and psychological distresses. Our aim was to investigate the relation among steroid hormone levels, lipid profile and menopausal symptom severity using the menopause rating scale (MRS). Methods: A cross-sectional study was performed at our outpatient clinic with natural postmenopausal women. A total of 444 women were included in this study. The basic characteristics of the study population, such as age, gravidity, parity, time to menopause onset and body mass index (BMI) were recorded. Venous blood samples were collected from subjects after overnight fasting. The levels of high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, total cholesterol, triglyceride (TG), fasting plasma glucose, C-reactive protein, thyroid-stimulating hormone (TSH), cortisol, estradiol (E2), progesterone, testosterone and dehydroepiandrostenedione sulfate (DHEA-S) were analyzed. The MRS questionnaire validated for the Turkish population was used to assess the menopausal symptoms. Results: There was a statistically significant difference between mild and severe total symptom scores for TG, and elevated TG levels were observed in the severe group (p = 0.04). Elevated testosterone levels were observed with severe psychological symptom and total symptom scores. There were significant differences in progesterone level in psychological, urogenital, and total scores and lower levels were seen in severe symptom groups. There was a significant negative correlation between urogenital symptom scores and progesterone levels (p < 0.001). Discussion: Elevated levels of testosterone were related to severe psychological symptom and total menopausal symptom scores. A decrease in progesterone levels was related to high psychological, urogenital and total menopausal symptom scores. Elevated TG levels were also related to the total severe symptom scores.
... The android body fat distribution, glucose intolerance, hyperlipidaemia and hypertension appear to be clustered together in the same subject. 8 The metabolic phenotype of postmenopausal women, which includes an increased tendency for body fat deposition in the abdominal region, suggests that insulin resistance may underlie the characteristic features of postmenopausal dyslipidaemia. Adverse effects of insulin resistance on lipid metabolism, with consequent effects on circulating TAG concentrations, may be the primary metabolic defects that lead to low HDL-cholesterol and increased prevalence of small dense LDL which are the key features of the atherogenic lipoprotein phenotype. ...
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Background: Following menopause there are changes in values of lipid profile parameters. Abdominal obesity has also been linked to significant metabolic abnormalities including changes in lipid parameter values. So, we designed this study to observe the pattern of lipid profile parameters in postmenopausal central obese women.Objective: To assess the lipid profile status of postmenopausal women with central obesity. Materials and Methods: This cross sectional study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period of January 2005 to December 2005. Seventy four postmenopausal women with central obesity and age matched 56 nonobese postmenopausal women were included in the study. Central obesity was defined having waist hip ratio more than 0.8. All statistical analyses were done by SPSS 12.0. p values <0.05 were considered significant. Results: Statistically no significant difference was observed between the central obese women and nonobese women in total cholesterol and LDL-cholesterol levels. But HDL-cholesterol was found lower and triacylglycerol was found higher in postmenopausal central obese women. Conclusion: Dyslipidaemia is a feature of postmenopausal women with central obesity. DOI: http://dx.doi.org/10.3329/jemc.v3i1.13836 J Enam Med Col 2013; 3(1): 08-12
... (2012) menyatakan bahwa perubahan hormon pada wanita selama masa pre-menopause secara substansial berkontribusi terhadap peningkatan obesitas sentral 32 . Setelah periode menopause umur cenderung tidak berhubungan dengan terjadinya obesitas sentral 33 . 35 . ...
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Prevalensi obesitas sentral pada penduduk dewasa di Indonesia mengalami peningkatan pada periode tahun 2007 sampai dengan tahun 2013. Tujuan penelitian untuk mengetahui faktor risiko yang berhubungan dengan obesitas sentral pada orang dewasa umur 25-65 tahun di Indonesia. Penelitian ini menggunakan data Riskesdas 2013. Desain penelitian adalah cross-sectional. Sampel adalah orang dewasa berumur 25-65 tahun dengan kriteria tidak cacat fisik dan mental, sampel wanita tidak dalam keadaan hamil. Jumlah sampel yang dianalisis adalah 434.970 sampel. Hasil analisis menunjukkan prevalensi obesitas sentral pada penduduk Indonesia umur 25-65 tahun sebesar 48,5 persen. Rata-rata lingkar perut responden perempuan (81,92±9,45 cm) lebih tinggi daripada laki-laki (80,17±8,80 cm). Rata-rata umur responden adalah 42,50±10,43 tahun. Dari hasil analisis regresi logistik menunjukkan bahwa faktor risiko yang berhubungan dengan obesitas sentral adalah umur, wilayah, status ekonomi, dan aktivitas fisik. Upaya untuk mencegah dan mengendalikan obesitas harus ditekankan di daerah perkotaan dengan status ekonomi menengah ke atas dan mulai dari usia dini. Di samping itu program berbasis populasi skrining dan program intervensi diperlukan, sehingga populasi berisiko obesitas sentral menjadi prioritas dalam penanganan program pencegahan.
... Nevertheless, we did not observe a significant association between baseline hemoglobin and incident hypertension in the longitudinal analysis. We also performed a stratified analysis according to menopausal status, which is another known CVD risk factor [15,16] ; however, the results did not change. ...
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We investigated the cross-sectional and longitudinal associations between hemoglobin concentration and hypertension in a Korean population. Between 2006 and 2013, we examined 4899 participants with mean age of 56.6 years (range 35–88 years) from a rural community. We excluded 298 participants with a history of myocardial infarction or stroke and 264 participants with very low hemoglobin levels (men: <13.3 g/dL; women: <11.6 g/dL). Finally, we performed a cross-sectional analysis on 1629 men and 2708 women. Longitudinal associations were evaluated in 654 men and 1099 women, after excluding 2584 people with hypertension at baseline and those who did not participate in follow-up examinations. Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive treatment. The mean hemoglobin level was significantly higher in people with hypertension than in those without hypertension (P = 0.002 for men, P = 0.006 for women). On cross-sectional analysis, the odds ratio (95% confidence interval) for hypertension per 1 standard deviation increase in hemoglobin concentration (1.2 g/dL) was 1.11 (1.05–1.18) before adjustment and 1.20 (1.09–1.32) after adjusting for age, sex, body mass index, kidney markers, lifestyle factors, and comorbidities. On longitudinal analysis, the relative risk (95% confidence interval) for incident hypertension per 1 standard deviation increase in hemoglobin concentration was 1.09 (0.96–1.23) before adjustment and 0.91 (0.78–1.08) after adjusting for age, sex, body mass index, lifestyle factors, baseline blood pressure, baseline comorbidities, and baseline kidney markers. This study suggests that hemoglobin per se does not cause hypertension development.
... (2012) menyatakan bahwa perubahan hormon pada wanita selama masa pre-menopause secara substansial berkontribusi terhadap peningkatan obesitas sentral 32 . Setelah periode menopause umur cenderung tidak berhubungan dengan terjadinya obesitas sentral 33 . 35 . ...
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The prevalence of central obesity in the adult population in Indonesia has increased in the period 2007 to 2013. The objective of the study was to identify risk factors associated with central obesity in Indonesian adults aged 25-65 years. The study used Basic Health Research (Riskesdas) 2013 data. The study design was cross-sectional. Samples were adults aged 25-65 years. Samples criteria were not physically and mentally disable, and they were not pregnant. A number of samples analyzed were 434 970 subjects. Result of the analysis showed that the prevalence of central obesity at the aged of 25-65 years was found 48.5 percent. The mean of abdominal circumference was higher among women (81,92±9,45 cm) than men (80,17±8,80 cm). The mean of sample age was 42.50±10.43 years. The results of logistic regression analysis showed that the risk factors associated with central obesity were age, region, economic status, and physical activity. The efforts to prevent and control obesity should be emphasized in urban areas with middle to high economic status, and from an early age. In addition, population-based screening program and intervention programs are necessary, so that the specific characteristics of the population at high risk of central obesity should be a priority in the management of the preventive program. ABSTRAK Prevalensi obesitas sentral pada penduduk dewasa di Indonesia mengalami peningkatan pada periode tahun 2007 sampai dengan tahun 2013. Tujuan penelitian untuk mengetahui faktor risiko yang berhubungan dengan obesitas sentral pada orang dewasa umur 25-65 tahun di Indonesia. Penelitian ini menggunakan data Riskesdas 2013. Desain penelitian adalah cross-sectional. Sampel adalah orang dewasa berumur 25-65 tahun dengan kriteria tidak cacat fisik dan mental, sampel wanita tidak dalam keadaan hamil. Jumlah sampel yang dianalisis adalah 434.970 sampel. Hasil analisis menunjukkan prevalensi obesitas sentral pada penduduk Indonesia umur 25-65 tahun sebesar 48,5 persen. Rata-rata lingkar perut responden perempuan (81,92±9,45 cm) lebih tinggi daripada laki-laki (80,17±8,80 cm). Rata-rata umur responden adalah 42,50±10,43 tahun. Dari hasil analisis regresi logistik menunjukkan bahwa faktor risiko yang berhubungan dengan obesitas sentral adalah umur, wilayah, status ekonomi, dan aktivitas fisik. Upaya untuk mencegah dan mengendalikan obesitas harus ditekankan di daerah perkotaan dengan status ekonomi menengah ke atas dan mulai dari usia dini. Di samping itu program berbasis populasi skrining dan program intervensi diperlukan, sehingga populasi berisiko obesitas sentral menjadi prioritas dalam penanganan program pencegahan. [Penel Gizi Makan 2015, 38(2):111-120] Kata kunci: faktor risiko, obesitas sentral, orang dewasa
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Background: Research on the association between age at menarche and menopause, reproductive lifespan, and the risk of obesity in China is unclear and requires further clarification. Materials and Methods: Data were obtained from the China Hypertension Survey, a cross-sectional study using a stratified multistage random sampling method, conducted from October 2012 to December 2016, with a total of 187,162 women included in the analysis. Logistic regression models and restricted cubic spines were used to estimate the relationship between obesity and age at menarche, age at menopause, and reproductive lifespan. Results: The mean (standard deviation) age at menarche and menopause, and reproductive lifespan were 15.5 (1.8), 48.7 (3.5), and 33.2 (3.9) years, respectively. Age at menarche was negatively related to the risk of obesity (odds ratio [OR]: 0.968; 95% confidence interval [CI]: 0.961-0.975). There was a positive association between age at menopause and the risk of obesity in postmenopausal women (OR: 1.019; 95% CI: 1.014-1.023). Reproductive lifespan was positively related to obesity (OR: 1.020; 95% CI: 1.017-1.025). The restricted cubic spines showed the association between age at menarche, age at menopause, reproductive lifespan, and obesity was nonlinear when fully adjusted. Conclusions: Based on the large nationally representative sample, Chinese women with earlier age at menarche, later age at menopause, and longer reproductive lifespan have a higher risk of obesity.
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Menopause nomenclature varies in the scholarly literature making synthesis and interpretation of research findings difficult. Therefore, the present study aimed to review and discuss critical developments in menopause nomenclature; determine the level of heterogeneity amongst menopause definitions and compare them with the Stages of Reproductive Aging Workshop criteria. Definitions/criteria used to characterise premenopausal and postmenopausal status were extracted from 210 studies and 128 of these studies were included in the final analyses. The main findings were that 39.84% of included studies were consistent with STRAW classification of premenopause , whereas 70.31% were consistent with STRAW classification of postmenopause . Surprisingly, major inconsistencies relating to premenopause definition were due to a total lack of reporting of any definitions/criteria for premenopause (39.84% of studies). In contrast, only 20.31% did not report definitions/criteria for postmenopause. The present findings indicate that there is a significant amount of heterogeneity associated with the definition of premenopause , compared with postmenopause . We propose three key suggestions/recommendations, which can be distilled from these findings. Firstly, premenopause should be transparently operationalised and reported. Secondly, as a minimum requirement, regular menstruation should be defined as the number of menstrual cycles in a period of at least 3 months. Finally, the utility of introducing normative age-ranges as supplementary criterion for defining stages of reproductive ageing should be considered. The use of consistent terminology in research will enhance our capacity to compare results from different studies and more effectively investigate issues related to women’s health and ageing.
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Resumen Introducción y objetivos Existen modelos de predicción de riesgo cardiovascular en población general, pero no se ha estudiado de modo específico la predicción del riesgo de las mujeres posmenopáusicas. El objetivo de este estudio es conocer los hábitos de vida y las enfermedades crónicas asociados con mayor riesgo cardiovascular en mujeres menopáusicas, así como construir una escala de riesgo. Métodos Estudio de cohortes retrospectivo de base poblacional cuya fuente de datos es la Encuesta Nacional de Salud de España de 2011. Se incluyó a mujeres de edad ≥ 50 años. Se recogieron las características que mejor definían los hábitos de vida de las mujeres del estudio, así como su estado de salud y los antecedentes médicos declarados por ellas en el momento de la encuesta. Se realizó seguimiento de la mortalidad de las mujeres del estudio desde 2011 hasta 2017. Resultados Se incluyó a 5.953 mujeres con una media de edad de 66,4 ± 11,4 años. La incidencia de mortalidad cardiovascular en el periodo de seguimiento fue del 4%. Se relacionaron con la mortalidad cardiovascular el consumo de verduras menor de 1 vez/semana (HR = 1,758), el tabaquismo (HR = 1,816) el exceso de horas de sueño (≥ 9 h/día, HR = 1,809) o tener actividad principal diaria sentada la mayor parte del tiempo (HR = 2,757). El modelo predictivo presenta un estadístico C «sincero» en muestra de prueba de 0,8407 (IC95%, 0,8025-0,8789). Conclusiones Hábitos de vida como el consumo de verduras, la actividad principal diaria, las horas de sueño o el tabaquismo son factores de riesgo de mortalidad cardiovascular de gran relevancia entre las mujeres menopáusicas. Se aporta una sencilla escala de riesgo autorreferida a 6 años con elevada capacidad predictiva.
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Objective: To investigate whether the early-onset menopausal transition is associated with deteriorated glucose tolerance in women in their mid-forties. Methods: A cross-sectional analysis of a cohort study including 2,632 women of the Northern Finland Birth Cohort 1966. The participants were divided into two groups by their menstrual history and follicle-stimulating hormone values at age 46: climacteric and preclimacteric women. Glucose and insulin parameters, as well as mathematical indices derived from them to evaluate insulin sensitivity, were compared between the groups. The results were adjusted for measured body mass index and smoking. The possible effect of hormone therapy was investigated in subanalyses excluding hormone therapy users. Results: Climacteric women (n = 379) were more often current smokers at age 46 (P = 0.008), and their body mass indices increased more from 31 to 46 years (P = 0.013), compared to preclimacteric women (n = 2,253). In a multivariable generalized linear model, being climacteric at age 46 was associated with several findings suggesting decreased insulin sensitivity: increased glycated hemoglobin (P < 0.001), 2-hour oral glucose tolerance test 30- and 60-minute insulin (P = 0.040 and 0.006, respectively), and area under the insulin curve (P = 0.005). Being climacteric also was associated with a decreased the McAuley (P = 0.024) and Belfiore indices (P = 0.027) and glucose tolerance test 60-minute glucose (P = 0.015). In subanalyses excluding hormone therapy users (n = 94), the results did not change significantly. Conclusions: Earlier onset of climacteric transition is associated with impaired insulin sensitivity in middle-aged women. : Video Summary:http://links.lww.com/MENO/A648.
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Background: The physiological changes associated with menopause are responsible for increase in cardiovascular disease after menopause. BMI, physical inactivity, metabolic syndrome, hypertension and diabetes mellitus increase in post-menopausal women which are all powerful predictors of cardiovascular events. The risk factor profile between pre-menopausal and post-menopausal women presenting with acute coronary syndrome was thus studied.Methods: This study was a prospective cross-sectional hospital based study and was conducted in the Department of Medicine and Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana wherein 50 pre-menopausal women and 50 post- menopausal women who presented with acute coronary syndrome were enrolled. The risk factor profile and angiography findings amongst the 2 groups were compared.Results: There was no difference in the incidence of Diabetes Mellitus and Hypertension among the pre & post-menopausal groups. The prevalence of family history of cardiovascular disease was higher in the pre-menopausal group. The post-menopausal women showed a significant decrease in physical activity due to sedentary lifestyle. Both the groups had high BMI and increased waist circumference. Lipid parameters did not show any significant difference between the two groups. However, pre-menopausal women had higher LDL-C and triglyceride levels and lower HDL-C levels. On analysis of the angiographic findings in diabetics and non-diabetics, of both the groups diabetes mellitus was much higher in subjects presenting with triple vessel disease suggesting extensive atherosclerosis.Conclusions: study showed physical inactivity as an important cardiovascular risk factor in post-menopausal women. Obesity is an important risk factor for coronary artery disease in both pre- and post-menopausal women.
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In the current study, Seventy menopausal women have Coronary Heart Disease (CHD) were admitted to the coronary care unit of AL-Sader teaching hospital in AL-najaf AL-Ashraf during the period from January to April/ 2016 for the ages were ranging from 40 to 69 years old. The samples were divided into three groups (SA 25, UA 22 and AMI 23), while the healthy group was composed of 20. The data of the current study was separated into subgroups consistent with type of disease, age, hypertension and BMI. The current study indicated a significant increase (P<0.05) in serum CNTN-1 concentration of CHD compared with healthy group. The serum of CNTN-1 concentration showed a significantly increase (p<0.05) in AMI compare with UA and SA groups of CHD. The results indicated a significant increased (p<0.05) in serum CNTN-1 level of hypertensive group compared with normotensive group in CHD. The results revealed a significant increased (p<0.05) in serum of CNTN-1 concentration of CHD as compare with HT group in same age group and the results indicated a significant increase (p<0.05) in serum CNTN-1 concentration at different age groups when compare with among the ages (60-69 y), (50-59) and (40-49 y) of both CHD and HT groups while there was a significant increase (p>0.05) in serum CNTN-1 concentrations among different BMI (morbid weight, obese weight, over weight and normal weight). The present study concluded that CNTN-1 levels were markers for detection and diagnosis of coronary heart disease in menopausal women.
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Objective: Data: Fat mass has been shown to increase in aging women; however, the extent to which menopausal status mediates these changes remains unclear. The purpose of this review was to determine (1) how fat mass differs in quantity and distribution between premenopausal and postmenopausal women, (2) whether and how age and/or menopausal status moderates any observed differences, and (3) which type of fat mass measure is best suited to the detection of differences in fat mass between groups. Study: This review with metaanalyses is reported according to Metaanalysis of Observational Studies in Epidemiology guidelines. Study appraisal and synthesis methods: Studies (published up to May 2018) were identified via PubMed to provide fat mass measures in premenopausal and postmenopausal women. We included 201 cross-sectional studies in the metaanalysis, which provided a combined sample size of 1,049,919 individuals and consisted of 478,734 premenopausal women and 571,185 postmenopausal women. Eleven longitudinal studies were included in the metaanalyses, which provided a combined sample size of 2472 women who were premenopausal at baseline and postmenopausal at follow up. Results: The main findings of this review were that fat mass significantly increased between premenopausal and postmenopausal women across most measures, which included body mass index (1.14 kg/m2; 95% confidence interval, 0.95-1.32 kg/m2), bodyweight (1 kg; 95% confidence interval, 0.44-1.57 kg), body fat percentage (2.88%; 95% confidence interval, 2.13-3.63%), waist circumference (4.63 cm; 95% confidence interval, 3.90-5.35 cm), hip circumference (2.01 cm; 95% confidence interval, 1.36-2.65 cm), waist-hip ratio (0.04; 95% confidence interval, 0.03-0.05), visceral fat (26.90 cm2; 95% confidence interval, 13.12-40.68), and trunk fat percentage (5.49%; 95% confidence interval, 3.91-7.06 cm2). The exception was total leg fat percentage, which significantly decreased (-3.19%; 95% confidence interval, -5.98 to -0.41%). No interactive effects were observed between menopausal status and age across all fat mass measures. Conclusion: The change in fat mass quantity between premenopausal and postmenopausal women was attributable predominantly to increasing age; menopause had no significant additional influence. However, the decrease in total leg fat percentage and increase in measures of central fat are indicative of a possible change in fat mass distribution after menopause. These changes are likely to, at least in part, be due to hormonal shifts that occur during midlife when women have a higher androgen (ie, testosterone) to estradiol ratio after menopause, which has been linked to enhanced central adiposity deposition. Evidently, these findings suggest attention should be paid to the accumulation of central fat after menopause, whereas increases in total fat mass should be monitored consistently across the lifespan.
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In the current study, Seventy menopausal women have CHD were admitted to the Coronary Care Unit of AL-Sadder Teaching Hospital in AL-najaf AL-Ashraf during the period from January to April/2016 for the ages were ranging from 40 to 69 years old. The samples were divided into three groups (SA 25, UA 22, AMI 23), while the healthy group was composed of 20.The current study indicated a significant increase(p<0.05) in serum CD147 of CHD compared with healthy group, while a significant decrease (P<0.05)in serum E2 concentration of CHD compared with healthy group. The results also revealed a significant increase (p>0.05)of serum CD147concentration in AMI group as compare with UA group and SA group of CHD, While serum of E2 concentration showed a significantly decrease (p<0.05)in AMI compare with UA and SA groups of CHD. The result showed also a negative correlation between E2 and CD147.
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Overweight and obesity are one of the most neglected public health problems in both developed and developing countries. Prevalence of overweight and obesity among post-menopausal women are increasing at a rapid pace. The present study aims to assess effects of socio-economic, demographic and lifestyle variables on prevalence of overweight and obesity among post-menopausal rural women belonging to an ethnic population of eastern India. This study has been carried out among 510 Rajbanshi women aged between 45-56 years and residing in the district of Darjeeling, West Bengal. Height and weight along with a number of socio-economic, demographic and lifestyle variables were recorded and body mass index (BMI = weight/height kg/m2) was calculated. The WHO (2000) cut-offs were utilized to assess prevalence of overweight (BMI ≥ 23.00-24.99 kg/m2) and obesity (BMI ≥ 25.00 kg/m2). The statistical tests (ANOVA, chi-square and binary logistic regression) were done using SPSS (version 17.0).The prevalence of overweight and obesity were observed to be high among those aged 45-50 years (30.63%, 4.26%) and 50-56 years (32.36%; 18.91%). The binary logistic regression analysis indicated that age, marital status, parity, age at menarche, occupational status, age at first pregnancy, monthly income, education, use of oral contraceptives and tobacco use had significant effects on overweight and obesity (p < 0.05). Age, parity, education, use of oral contraceptives, age at menarche, tobacco use, occupation, monthly income, age at first and last pregnancy were observed to have greater influence on prevalence of overweight and obesity. Overweight and obesity associated with post-menopausal women require increased attention and a multidisciplinary approach for better health conditions among such women.
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In the current study, Seventy menopausal women have CHD were admitted to the Coronary Care Unit of AL-Sadder Teaching Hospital in AL-najaf AL-Ashraf during the period from January to April/2016 for the ages were ranging from 40 to 69 years old. The samples were divided into three groups (SA 25, UA 22, AMI 23), while the healthy group was composed of 20.The current study indicated a significant increase(p<0.05) in serum CD147 of CHD compared with healthy group, while a significant decrease (P<0.05)in serum E2 concentration of CHD compared with healthy group. The results also revealed a significant increase (p>0.05)of serum CD147concentration in AMI group as compare with UA group and SA group of CHD, While serum of E2 concentration showed a significantly decrease (p<0.05)in AMI compare with UA and SA groups of CHD. The result showed also a negative correlation between E2 and CD147.
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Obesity can increase the incidence of angina pectoris, myocardial infarction, hypertension and cerebrovascular diseases. This study is undertaken with the aim to evaluate the effect of physical training on BMI, Waist-hip ratio. The study was conducted on 50 male physically trained adults and 50 male sedentary adults in the age group between 30-40 years and the following parameters were evaluated BMI, Waist-hip ratio. There is statistically highly significant decrease in BMI, Waist-hip ratio, in physically trained adults as compared to sedentary adults. Aerobic exercise and games in combination causes highly significant decrease in BMI, W-H ratio. Thus, combination of aerobic exercise and games is more beneficial instead of only aerobic exercise and hence should be recommended.
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In the current study, Seventy menopausal women have CHD were admitted to the coronary care unit of AL-Sader teaching hospital in AL-najaf AL-Ashraf during the period from January to April/2016 for the ages were ranging from 40 to 69 years old. The samples were divided into three groups (SA 25, UA 22, AMI 23), while the healthy group was composed of 20.The current study indicated a significant increase(p<0.05) in serum CYP-A of CHD compared with healthy group, while a significant decrease (P<0.05)in serum E2 concentration of CHD compared with healthy group. The results also revealed a significant increase(p>0.05)of serum CYP-A concentration in AMI group as compare with UA group and SA group of CHD, While serum of E2 concentration showed a significantly decrease (p<0.05)in AMI compare with UA and SA groups of CHD. The result showed also a negative correlation between E2 and CYP-A. The present study concluded that E2 and CYP-A were markers for detection and diagnosis of Coronary heart disease in menopausal women.
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We investigated sex- and menopause-related differences in body composition and regional fat distribution, using dual-energy X-ray absorptiometry (DEXA) in nonobese healthy volunteers. Men (n = 103) had a 50% greater lean tissue mass (P < 0.001) but a 13% lower fat mass (P < 0.001) than the women (n = 131). Postmenopausal (n = 70) women had a 20% greater fat mass (P < 0.001) than premenopausal (n = 61) women. The proportion of android (upper body) fat was greatest in men (48.6%, P < 0.001) but was significantly lower in premenopausal (38.3%) than in postmenopausal (42.1%) women (P < 0.001). The reverse was found for gynoid (lower body) fat (P < 0.001 ). DEXA measurements thus clearly demonstrated that sex differences in total fat mass were opposite those of android fat, and that marked menopausal changes in fat mass and its distribution existed. Body mass indices did not demonstrate that men had less total fat than women whereas postmenopausal women had more total fat than did premenopausal women. Our findings suggest that DEXA measurements of fat distribution may be useful for studies related to obesity-associated disease risk.
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The known postmenopausal increase in cardiovascular risk may relate in part to changes in fat distribution. Environmental factors which are known to influence cardiovascular disease risk may do so in part by influencing body fat and its distribution. To determine the relationships between tobacco smoking, oestrogen replacement (ERT) and body fat and its distribution in postmenopausal women, independent of genetic factors, physical activity, diet composition and socioeconomic factors. Cross-sectional study in normal post menopausal twins. 712 postmenopausal female twins (aged 58.7 +/- 0.2 y, body mass index (BMI) 24.4 +/- 0.1 kg/m2). Anthropometry; body composition and fat distribution by dual energy x-ray absorptiometry; physical activity, muscle strength, socioeconomic status, dietary composition and dehydroepiandrosterone sulfate (DHEAS). In monozygotic pairs discordant for smoking, intrapair differences in total and central fat were greater than that in concordant pairs, with the lower fat mass in the smoking twin. Overall, smokers had a lower weight, BMI, total and central abdominal fat, despite a higher total and saturated dietary fat intake and similar DHEAS levels. The reduction in central fat was not independent of that in total fat. In monozygotic twins discordant for ERT-use the intrapair differences in total and central body fat were significantly greater than in concordant pairs, with the lower fat measure in the ERT-using twin. Overall, current ERT-users had similar body weight, BMI and total fat compared to non-users but had lower central fat. There were no differences in activity levels, diet or socioeconomic factors between ERT-users and non-users. Smoking and ERT-use are associated with lower total and central fat in monozygotic postmenopausal twins. In current smokers, the lower central adiposity appears related to its influence on total body fat. In ERT-users, lower central fat may contribute to the reduced cardiovascular risk associated with postmenopausal oestrogen use.
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Seidell J C (Department of Human Nutrition, Wageningen University, PO Box 8129, 6700 EV Wageningen, The Netherlands), Cigolini M, Charzewska J, Ellsinger B M and Di Biase G. Fat distribution in European women: A comparison of anthropometric measurements in relation to cardiovascular risk factors. International Journal of Epidemiology 1990, 19: 303–308. In this study in 437 women born in 1948 selected from five European towns we show that several anthropometric measurements are consistently and significantly associated with a metabolic risk profile in premenopausal women of 38 years of age. Among the circumferences, breast and waist circumference were, after adjustment for body mass index positively correlated with diastolic blood pressure, serum total cholesterol, HDL-cholesterol (negative associations), serum triglycerides, and serum insulin. The optimal level for measuring waist circumference was determined as being midway between the lower rib margin and the superior anterior iliac crest. Circumference ratios generally did show less consistent and similar or lower correlations with diastolic blood pressure, serum cholesterol and serum insulin. Waist/thigh circumference ratio showed the strongest partial associations with HDL-cholesterol and serum triglycerides among all anthropometric variables studied. The authors conclude that, independently of the degree of fatness, indicators of truncal fat distribution (in the region of the breast as well as the abdomen) are related to an unfavourable risk profile in European Premenopausal women. The study gives a rationale for selecting the most informative anthropometric measurements to be added to height and weight in epidemiological studies.
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Pedersen SB, Borglum JD, Brixen K, Richelsen B. Relationship between sex hormones, body composition and metabolic risk parameters in premenopausal women. Eur J Endocrinol 1995;133: 200–6. ISSN 0804–4643 The metabolic complications associated with obesity are dependent upon the degree of obesity and the distribution of adipose tissue. In order to evaluate the associations between sex hormone status, metabolic risk parameters, obesity and distribution of adipose tissue, 25 premenopausal women with a wide range of body mass index (19.3–48.1 kg/m ² were studied. Body composition was determined by dual-energy x-ray absorptiometry scan and anthropometric measurements; in addition, lipid and sex hormone status were determined and an oral glucose tolerance test was performed. We found that sex hormone-binding globulin was correlated negatively with total fat mass (r = –0.77, p < 0.001) and especially with abdominal localization of adipose tissue (r = –0.85, p < 0.001). Free testosterone was correlated positively with total fat mass (r = 0.40, p < 0.05) and with abdominal fat accumulation (r = 0.64, p < 0.001). Free estrogen was correlated negatively with total amount of adipose tissue (r = –0.40, p < 0.05) but not with the distribution of adipose tissue, Finally, total fatness, abdominal localization of adipose tissue and free testosterone were all associated with elevated metabolic risk factors. However, multiple regression analysis revealed that only abdominal localization of adipose tissue was independently associated with a higher risk profile, whereas the effects of sex hormones or total fatness disappeared when abdominal localization of adipose tissue was included in the analysis. In conclusion, these findings in premenopausal women indicate that the connection between sex hormones and metabolic risk factors might be indirect, probably operating through alterations in the amount of adipose tissue in the abdominal region. SB Pedersen, University Clinic of Endocrinology and Internal Medicine, Aarthus, Amtssygehus, Tage Hansensgade, DK-8000 Aarhus C, Denmark
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The aim of the present study was to describe and quantify the typical changes in fat patterning from premenopause to postmenopause. The absolute and relative fat and lean body mass were estimated using dual-energy X-ray absorptiometry in 461 healthy non-obese females between the ages of 18 and 64 years (x = 43.2). Significant differences (p < 0.001) in absolute and relative fat mass, body weight and body mass index between pre-, peri- and postmenopausal females were observed. Postmenopausal women were significantly heavier (BMI, x = 26.8) than perimenopausal (BMI, x = 24.4) and younger and older premenopausal women (BMI, x = 22.8) and showed significantly higher fat percentages (fat% x = 38.1) in comparison to perimenopausal (x = 36.8) and premenopausal females (x = 31.4). Three indices, upper body composition index, lower body composition index and fat distribution index were calculated. Typical differences in fat distribution patterns between females of differential menopausal status were found. During the premenopausal phase a more gynoid type of fat distribution prevailed, during the postmenopausal phase a more android kind of fat distribution occurred predominantly. The fat distribution during the perimenopause can be interpreted as less gynoid than during the premenopause.
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To determine whether measuring body fat distribution by dual-energy X-ray absorptiometry (DEXA) can be used to discriminate glucose tolerance status. Using a 75-g oral glucose tolerance test, a total of 1,015 Chinese subjects (559 men and 456 women) were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or diabetes. Blood pressure and lipid profiles of these subjects were measured. Waist-to-hip ratio (WHR) and DEXA were used to evaluate the varying patterns of body fat distribution among the groups. Body fat distribution, as reflected by WHR and the centrality index, showed significant partial correlation coefficients with glycosylated hemoglobin, blood pressure, and lipid profiles in all subjects. After adjusting for age and BMI, there were significant differences among the three glycemic groups for all the cardiovascular risk factors except for total cholesterol level. The diabetic group had a significantly higher WHR and centrality index, but lower femoral fat percentage than the NGT and IGT groups. The diabetic group also showed higher abdominal fat percentage than the NGT group. Moreover, the IGT group had a higher centrality index than the NGT group. However, no significant differences were found in the percentage of lean tissue mass among the three groups. Using multiple stepwise logistic regression models, the centrality index remained a significant factor for discriminating different glucose tolerance status independent of the percentage total body fat. Central obesity has shown significant correlation with cardiovascular risk factors among the three different glycemic groups. Centrality index measured by DEXA appears to be the better predictor of glucose intolerance, compared with WHR, abdominal fat, and general obesity (reflected by percentage total body fat or BMI) in a large cohort of the Chinese population.
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Total and regional body composition were measured in 373 early postmenopausal women aged 49–60 y by dual-energy x-ray absorptiometry to evaluate whether the changes in body composition in the early postmenopausal years are related to menopause itself or merely to age. Both fat mass and fat distribution correlated with age (r = 0.12–0.21, P < 0.05 – P < 0.001), but not with years since menopause (YSM). Lean tissue mass, on the other hand, decreased with YSM (r = −0.17, P < 0.001) but was not related significantly to age. Total body bone mineral density decreased with both YSM (r = −0.30, P < 0.001) and age (r = −0.21, P < 0.001). Our study suggests that postmenopausal changes in body fat and fat distribution are more dependent on age than on menopause, but we cannot exclude a separate effect of the menopause. Changes in fat-free mass, including a postmenopausal decline in both soft lean tissue mass and bone mass, are, however, mainly menopause-related.
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In Reply. —Dr Sullivan chastises us for an overemphasis on the role of lipids in mediating the protective effect of estrogen. We plead not guilty as charged; in our review we wrote: "These two reports suggest that between 25% and 50% of the beneficial effect of estrogen on CHD [coronary heart disease] risk is through changes in HDL [high-density lipoprotein] and LDL [low-density lipoprotein] cholesterol. However, this further implies that 50% to 75% of the beneficial effect of estrogen is through other, nonlipid mechanisms." We listed about 10 other possible mechanisms, but made no attempt to list all possible ways in which estrogen could reduce the risk of heart disease. Sullivan suggests lower levels of iron, caused by menstrual blood loss, as a possible explanation for the sex differences in heart disease, an interesting but as yet untested hypothesis.Sullivan notes that women with hypercholesterolemia have a lower risk of
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. Objective : To describe the effects of menopause on resting metabolic rate, body composition, fat distribution, physical activity during leisure time, and fasting insulin levels. . Design : A longitudinal comparison of metabolic changes in women who experienced menopause with changes in age-matched women who did not experience menopause. . Setting : General clinical research center. . Patients : An initial cohort of 35 sedentary healthy premenopausal women (age range, 44 to 48 years). After 6 years of follow-up, 18 women had spontaneously stopped menstruating for at least 12 months and 17 women remained premenopausal. No women received hormone replacement therapy. . Results : Women who experienced menopause lost more fat-free mass than women who remained premenopausal (-3.0 ± 1.1 kg and -0.5 ± 0.5 kg, respectively), had greater decreases in resting metabolic rate (-103 ± 55 kcal/d and -8 ± 17 kcal/d) and physical activity during leisure time (-127 ± 79 kcal/d and 64 ± 60 kcal/d), and had greater increases in fat mass (2.5 ± 2 kg and 1.0 ± 1.5 kg), fasting insulin levels (11 ± 9 pmol/L and -2 ± 5 pmol/L), and waist-to-hip ratios (0.04 ± 0.01 and 0.01 ± 0.01) (P < 0.01 for all comparisons). Menopause did not affect energy intake, fasting glucose levels, or peak oxygen consumption. . Conclusions : Natural menopause is associated with reduced energy expenditure during rest and physical activity, an accelerated loss of fat-free mass, and increased central adiposity and fasting insulin levels. These changes may indicate a worsening cardiovascular and metabolic risk profile.
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We review herein the evidence that estrogen is protective against the development of cardiovascular disease in women. To our knowledge, no studies in women have looked at endogenous estrogen levels as predictors of cardiovascular disease. Studies of surrogate measures of endogenous estrogen such as parity, age at menarche, and age at menopause have provided inconsistent results. Current use of oral contraceptives increases risk in older women who smoke cigarettes, but most studies of past use show no increased risk. Most, but not all, studies of hormone replacement therapy in postmenopausal women show around a 50% reduction in risk of a coronary event in women using unopposed oral estrogen. These important observations need to be confirmed in a double-blind, randomized clinical trial, since the protection is biologically plausible and the magnitude of the benefit would be quite large if selection factors can be excluded. (JAMA. 1991;265:1861-1867)
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Objectives. In this study we investigated the relationships between blood lipids and menopausal status. Setting and subjects. All data were obtained from the first cross-sectional examination of the Virgilio Menopause Health Project in a large cohort of middle-aged women in pre, peri-, and postmenopausal age. The data refer to 426 women without metabolic or endocrine diseases, relevant hepatic, renal and cardiovascular abnormalities, none were dieting or taking medications. Main outcome measures. A precoded questionnaire including full clinical history, socio-economic and personal information, habitual diet, physical activity, drug use and smoking habits, careful recording of gynaecological events and family history for disease was completed. Several anthropometric parameters and the bioelectrical impedance analysis was used to measure free fatty mass. Blood samples for hormones and biochemistry were also obtained. Results. There were no significant differences on body mass index, fatty mass, free fatty mass and parameters of body fat distribution between the three groups. Again, there were no differences in smoking habits, dietary intake or indices of physical activity amongst the groups. There was a significant increase from pre to postmenopause of LH and FSH and a decrease of oestradiol and testosterone, whereas no difference was found in sex hormone-binding globulin. Age-adjusted values of glucose, triglycerides and high density lipoprotein (HDL-) cholesterol were similar in all groups, whereas postmenopausal women had significantly higher values of total and low density lipoprotein (LDL-) cholesterol. On the contrary, there was a significant fall in insulin levels passing from pre to postmenopause. In multiple regression models, total and LDL-cholesterol correlated positively with body mass index, waist-to-hip ratio and age, and negatively with free fatty mass and oestradiol blood levels. Conclusions. These results are consistent with the hypothesis that menopausal status may have a significant and independent effect in determining increased total and LDL-cholesterol concentrations in postmenopausal women.
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In women, sex hormone—binding globulin (SHBG) concentrations are the result of a balanced effect of stimulatory and inhibitory factors. Estrogens represent the principal stimulatory hormones, whereas androgens, insulin, excess body fat, and the pattern of body fat distribution have inhibitory effects. Menopause is characterized by major changes in blood sex steroid concentrations, notably a marked reduction of estradiol levels. In this study, we therefore investigated the relationship between hormonal and nonhormonal regulatory factors of SHBG and its blood levels in two groups of premenopausal and postmenopausal women characterized by normal-high or reduced estrogen concentrations. The data were obtained from an analysis of the cross-sectional database obtained during the first survey of the Virgilio-Menopause-Heaith Project, an epidemiologic longitudinal study aimed at investigating the impact of menopause on body weight, fat distribution, and related major metabolic, hormonal, and cardiovascular risk factors. A total of 329 women, 133 in premenopause and 196 in postmenopause without diabetes, thyroid diseases, or relevant cardiovascular, renal, and hepatic dysfunction, were included in the study. A clinical history (including dietary and physical-activity habits), anthropometry (body mass index [BMI], waist to hip ratio [WHR], and bioelectrical impedance analysis [BIA]), and morning blood samples in the fasting state for sex hormones, insulin, and biochemistry were available for all the women. Premenopausal and postmenopausal women showed no significant difference in SHBG concentrations (38.7 ± 17.9v 36.6 ± 17.5 nmol/L, respectively). On the contrary, postmenopausal women were characterized by a marked reduction of estradiol levels and significantly lower levels of testosterone. After adjusting for age, insulin was lower and the glucose to insulin ratio was higher in postmenopause than in premenopause. Age-adjusted values for all anthropometric parameters were not significantly different in the two groups. In simple correlation models, SHBG was significantly and negatively correlated with BMI, WHR, and insulin and testosterone levels in both premenopausal and postmenopausal women, whereas estradiol levels correlated positively and significantly with SHBG only in the premenopausal group. A significant positive correlation between the glucose to insulin ratio and SHBG was present in both groups. Using multiple regression models, in the premenopausal group, SHBG levels were correlated positively with estradiol and negatively with testosterone and insulin, but not with the WHR. On the contrary, in the postmenopausal group, SHBG values had a significant negative correlation with the WHR, whereas the relationship with estradiol was not significant; moreover, the relationship with testosterone and insulin, although significant, became less marked. In conclusion, this study indicates that (1) there is no significant difference in SHBG blood concentrations between premenopause and postmenopause; (2) SHBG values are correlated positively with estradiol and negatively with insulin and testosterone concentrations, but the predictive value of these variabiles on SHBG appears to be different in premenopause and postmenopause; and (3) SHBG levels decrease with increasing WHRs, particularly in the postmenopausal group. Therefore, determinants of SHBG blood concentrations are likely to change on passing from premenopausal to postmenopausal status. In particular, there seems to be a threshold level for which estradiol is an important determinant of SHBG blood concentrations.
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Adult American women as a group tend to gain weight with age, and many women report that their weight gain started around the time of their menopause. Moreover, as women age, there are changes in body composition that include losses in bone mineral and body cell mass, and increases in total body fat, visceral fat, and extracellular fluid. It appears as if these body composition changes begin or accelerate during the menopausal years. The importance of weight gain and changes in body composition are their associations with an increased risk of developing some malignancies, cardiovascular disease, osteoporosis, and several other clinical conditions. This overview describes selected studies of menopause and aging-associated weight gain, changes in body composition, and alterations of energy expenditure in women. Gaps in the present understanding of these changes are highlighted, and an emphasis is placed on new research methodologies for investigating body composition and energy expenditure in vivo. A concluding section of the report summarizes areas in need of future investigation.
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Forty-nine trained masters women endurance runners (mean = 42 km.wk-1) between the ages of 35 and 70 yr (mean = 46.4 +/- 8.3) were tested on a treadmill to examine cardiorespiratory fitness (VO2max and VO2 submax) in relation to age, training, and menopausal status. Although VO2max was lower with increasing age, no age group differences occurred in VO2 submax at 5.4 km.h-1, 8% treadmill grade. The younger runners (35-39 and 40-44 yr) had significantly higher VO2max than the other 5-yr competitive age groups (45-49, 50-55, 55-70 yr) (P < 0.01). HR max did not differ across age, but HR submax was higher with increasing age. Premenopausal, transitional, and post-menopausal women were not significantly different on any exercise variable when age and/or training differences among the groups were statistically controlled. A decrease in VO2max of 0.58 ml.kg-1 x min-1 x yr-1 was determined (r = -0.62). It was concluded that 1) these highly trained women runners had higher cardiorespiratory fitness than previously reported for women of comparable age, 2) menopausal status did not effect cardiorespiratory fitness when age and training were accounted for, and 3) regular physical training seems to prevent age-related changes in HR max in women, but not age-related changes in maximal oxygen uptake.
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In this study, total body fat content and fat topography were related to glucose metabolism in the basal and insulin-stimulated states in 18 nonobese and 18 obese premenopausal nondiabetic women. All subjects received a euglycemic insulin (20 mU.min-1.m2) clamp study in combination with [3-3H]-D-glucose infusion and indirect calorimetry to quantitate total body glucose uptake, glucose oxidation, and nonoxidative glucose disposal. Total body fat content was determined with tritiated water, whereas body fat distribution was estimated from the WHR, the STR, and the VSR (measured by magnetic resonance imaging). In the postabsorptive state, total body glucose utilization, glucose oxidation, and nonoxidative glucose disposal rates were similar in nonobese and obese women, whereas during the insulin clamp all three metabolic parameters were reduced significantly in the obese group. In nonobese women, total body fat content was related inversely to both total and nonoxidative glucose disposal during the insulin clamp, whereas no relationship was found between glucose metabolism (total, oxidative, and nonoxidative) and WHR, STR, or VSR. In contrast, in obese women, no relationship was observed between total body fat content and any measure of insulin-mediated glucose metabolism. However, both WHR and VSR were related inversely to total, oxidative, and nonoxidative glucose disposal rates during the insulin clamp. These results suggest that total body fat content and body fat topography are associated differently with insulin-mediated glucose metabolism in nonobese and obese women. In the nonobese women, total body fat mass appears to be a primary determinant of tissue sensitivity to insulin, whereas in obese women, body fat topography exerts a more dominant effect.
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The authors considered whether the difference in body fat distribution between men and women, measured as waist:hip ratio, might explain part of the sex difference in coronary heart disease incidence in prospective population studies of 1,462 women and 792 men. In these studies, conducted in Sweden, men were found to have about four times higher odds for coronary heart disease than women during a 12-year follow-up period (men, 1967 to 1979; women, 1968-1969 to 1980-1981). Controlling for differences in blood pressure, serum cholesterol, smoking, and body mass index only marginally altered the magnitude of the male-female difference. When waist:hip ratio, which predicted coronary heart disease rates in both sexes, was also considered, the sex difference in coronary heart disease risk was significantly reduced and virtually disappeared (odds ratios = 1.0-1.1; nonsignificant). The findings suggest that body fat distribution or a factor highly correlated with waist:hip ratio (genetic, hormonal, or behavioral) may help to explain the sex differences in coronary heart disease.
Article
We investigated sex- and menopause-related differences in body composition and regional fat distribution, using dual-energy X-ray absorptiometry (DEXA) in nonobese healthy volunteers. Men (n = 103) had a 50% greater lean tissue mass (P less than 0.001) but a 13% lower fat mass (P less than 0.001) than the women (n = 131). Postmenopausal (n = 70) women had a 20% greater fat mass (P less than 0.001) than premenopausal (n = 61) women. The proportion of android (upper body) fat was greatest in men (48.6%, P less than 0.001) but was significantly lower in premenopausal (38.3%) than in postmenopausal (42.1%) women (P less than 0.001). The reverse was found for gynoid (lower body) fat (P less than 0.001). DEXA measurements thus clearly demonstrated that sex differences in total fat mass were opposite those of android fat, and that marked menopausal changes in fat mass and its distribution existed. Body mass indices did not demonstrate that men had less total fat than women whereas postmenopausal women had more total fat than did premenopausal women. Our findings suggest that DEXA measurements of fat distribution may be useful for studies related to obesity-associated disease risk.
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To the Editor. —In focusing on the lipid effects of estrogen, Drs Barrett-Connor and Bush1 sharply restrict the scope of the debate on the sex difference in the risk of heart disease. An implicit assumption that sex is a nonmodifiable coronary risk factor further limits the discussion. The nature of the potent protective factor in menstruating women has not been established. We must take care not to overlook a mechanism that may also be protective in men and postmenopausal women.The suggestion that the effect of estrogen on lipid metabolism is the protective factor1 is not tenable in light of well-documented findings on heart disease expression in women with familial hypercholesterolemia (FH).2,3 Genetic lesions provide us with extreme cases that can clarify basic questions. In heterozygous FH, the sex difference in heart disease expression is preserved despite the lack of a corresponding sex difference in lipid phenotype.
Article
The reduction in cardiovascular risk induced by hormone replacement therapy is only partly explained by changes in serum lipids and lipoproteins. As body composition and body fat distribution in particular are independent predictors of cardiovascular disease, we investigated the effect of postmenopausal hormone therapy on body composition parameters directly measured. Sixty-two early postmenopausal women were followed up for 2 years in a prospective, randomized, placebo-controlled study. We found that combined estrogen-progestogen therapy prevented the increase in abdominal fat after menopause (P less than .05), and that this effect was independent of the effect on serum lipids and lipoproteins. The therapy reduced postmenopausal bone loss significantly (P less than .001), whereas it did not have a statistically significant influence on total body fat mass or total lean body mass. The findings of the present study suggest that some of the protective impact of postmenopausal hormone therapy on cardiovascular disease may be explained by the effect on body composition, in particular abdominal fat.
Article
We review herein the evidence that estrogen is protective against the development of cardiovascular disease in women. To our knowledge, no studies in women have looked at endogenous estrogen levels as predictors of cardiovascular disease. Studies of surrogate measures of endogenous estrogen such as parity, age at menarche, and age at menopause have provided inconsistent results. Current use of oral contraceptives increases risk in older women who smoke cigarettes, but most studies of past use show no increased risk. Most, but not all, studies of hormone replacement therapy in postmenopausal women show around a 50% reduction in risk of a coronary event in women using unopposed oral estrogen. These important observations need to be confirmed in a double-blind, randomized clinical trial, since the protection is biologically plausible and the magnitude of the benefit would be quite large if selection factors can be excluded.
Article
The role of body fat distribution, as assessed by the ratio of waist-to-hip circumferences (WHR), in statistically explaining differences in levels of lipoproteins between men and women was studied using data collected in 1985-1986 from employed adults (mean age, 40 years). As compared with the 415 women, the 709 men had higher mean levels of triglycerides (+38 mg/dl) and apolipoprotein B (+11 mg/dl) as well as lower mean levels of high density lipoprotein (HDL) cholesterol (-15 mg/dl) and apolipoprotein A-I (-19 mg/dl). Additionally, men were more overweight, consumed more alcohol, and exercised more frequently than women but were less likely to smoke cigarettes. Controlling for these characteristics, however, did not alter the differences in lipoprotein levels between men and women. In contrast, adjustment for WHR (which was greater among men) reduced the sex differences in levels of apolipoprotein B (by 98%), triglycerides (by 94%), HDL cholesterol (by 33%), and apolipoprotein A-I (by 21%). Similar results were obtained using analysis of covariance, stratification, or matching; at comparable levels of WHR, differences in lipid and lipoprotein levels between men and women were greatly reduced. Although these results are based on cross-sectional analyses of employed adults and need to be replicated in other populations, the findings emphasize the relative importance of body fat distribution. Whereas generalized obesity and body fat distribution are associated with lipid levels, fat distribution (or a characteristic influencing fat patterning) can be an important determinant of sex differences in levels of triglycerides, HDL cholesterol, and apolipoproteins B and A-I.
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The metabolism of subcutaneous abdominal and femoral fat cells was studied in postmenopausal women and matched men of similar age and weight index. Lipoprotein lipase (LPL) activity was similar in both regions in the postmenopausal women. However, a group of women who underwent treatment with estrogen and progestins had considerably higher LPL activity in the femoral cells. Testosterone treatment for 7 days did not change LPL in either region in middle-aged men. Femoral adipocytes from both men and postmenopausal women were markedly unresponsive to catecholamine in comparison with abdominal cells. No clear effect of the sex hormones was seen on lipolysis in the women. Treating men with testosterone increased basal lipolysis in the abdominal cells. Abdominal fat cells were more responsive to the antilipolytic effect of insulin. Both responsiveness and sensitivity to insulin were somewhat greater in the abdominal fat cells from men (ED50 approximately 0.02 nm) than from women (ED50 approximately 0.17 nm). Insulin binding, however, was similar in fat cells from the abdominal and the femoral regions when the results were expressed per unit surface area. Thus, regional differences in fat cell metabolism are seen in both postmenopausal women and elderly men. LPL activity in the femoral region seems to be under the control of female sex hormones while lipolysis appears to be less influenced by sex hormones.
Article
A population-based survey, using data from the Framingham study, assessed sex-specific patterns of coronary heart disease occurring over a 26-year period of time. Among subjects ages 35 to 84 years, men have about twice the total incidence of morbidity and mortality of women. The sex gap in morbidity tends to diminish during the later years of the age range, mainly because of a surge in growth of female morbidity after age 45 years, while by that age, the growth in the male rate begins to taper off. An approximate 10-year difference between the sexes persists in mortality rates throughout the life span. The relative health advantage that is possessed by women, however, is buffered by a case fatality rate from coronary attacks that exceeds the male rate (32% vs 27%). Coronary disease manifestations differ between the sexes. Myocardial infarction is more likely to be unrecognized in women than in men (34% vs 27%). Angina pectoris in women more frequently is uncomplicated (80%), whereas in men angina tends to evolve out of infarction (66%). Also, sudden death comprises a greater proportion of male deaths than female deaths (50% vs 39%). Because women maintain a lesser probability of the disease than do men at any level of the major cardiovascular risk factors, distinctions in their risk factor profiles do not explain completely the observed disease patterns.
Article
Adipose tissue lipolysis and lipoprotein lipase (LPL) activity were studied in biopsies from the femoral and abdominal depots in healthy women during early or late menstrual cycle, pregnancy, and the lactation period. When the differences in cell size were taken into account, basal lipolysis was similar in both regions in nonpregnant women. During lactation, however, lipolysis was significantly higher in the femoral region. The lipolytic effect of noradrenaline (10(-6) M) was significantly less in the femoral region in the nonpregnant women and during early pregnancy. However, the lipolytic response was the same in both regions in lactating women. LPL activity was higher in the femoral than in the abdominal region except during lactation when a marked decrease in the LPL activity was seen in the femoral region. The LPL activity in the abdominal region remained unchanged in all patient groups. The results imply that in both nonpregnant and pregnant women lipid assimilation is favored in the femoral depot. During lactation, however, the metabolic pattern changes; the LPL activity decreases and lipid mobilization increases in this depot. These changes are much less pronounced in the abdominal region. Thus, fat cells from different regions show a differential response during pregnancy and lactation. These results suggest that the adipose tissue in different regions may have specialized functions.
Article
There is no doubt that body composition changes with aging. Some general trends have been described, including an increase in body weight and fat mass in middle age followed by a decrease in stature, weight, FFM, and body cell mass at older ages. Losses in muscle, protein, and bone mineral contribute to the decline in FFM; however, the onset and rates of decline remain controversial. Most data are available for men and women < 80 yr and we know relatively little about the normal status and the changes that occur in body composition in elderly men and women. This situation has developed in part because the changes that occur in various body constituents with aging confound the estimation of body composition by traditional techniques. Hence, there is a need for longitudinal reference data in persons 80 yr of age, both to describe the normal status and to develop valid prediction equations for estimating body composition in older men and women in settings outside the laboratory. This should be possible using new technologies and approaches based on multiple component models of body composition. An understanding of the normal changes in body composition with increasing age, the normal variation in these changes, and their health implications is important for the health, nutritional support, and pharmacologic treatment of elderly men and women in the United States. The information is especially important because elderly men and women, in terms of both numbers and health care dollars, represent the most rapidly expanding segment of the U.S. population.
Article
To describe the effects of menopause on resting metabolic rate, body composition, fat distribution, physical activity during leisure time, and fasting insulin levels. A longitudinal comparison of metabolic changes in women who experienced menopause with changes in age-matched women who did not experience menopause. General clinical research center. An initial cohort of 35 sedentary healthy premenopausal women (age range, 44 to 48 years). After 6 years of follow-up, 18 women had spontaneously stopped menstruating for at least 12 months and 17 women remained premenopausal. No women received hormone replacement therapy. Women who experienced menopause lost more fat-free mass than women who remained premenopausal (-3.0 +/- 1.1 kg and -0.5 +/- 0.5 kg, respectively), had greater decreases in resting metabolic rate (-103 +/- 55 kcal/d and -8 +/- 17 kcal/d) and physical activity during leisure time (-127 +/- 79 kcal/d and 64 +/- 60 kcal/d), and had greater increases in fat mass (2.5 +/- 2 kg and 1.0 +/- 1.5 kg), fasting insulin levels (11 +/- 9 pmol/L and -2 +/- 5 pmol/L), and waist-to-hip ratios (0.04 +/- 0.01 and 0.01 +/- 0.01) (P < or = 0.01 for all comparisons). Menopause did not affect energy intake, fasting glucose levels, or peak oxygen consumption. Natural menopause is associated with reduced energy expenditure during rest and physical activity, an accelerated loss of fat-free mass, and increased central adiposity and fasting insulin levels. These changes may indicate a worsening cardiovascular and metabolic risk profile.
Article
TROISI, REBECCA J, ANNE M WOLF, JOANN E MANSON, KELLY M. KLINGLER AND GRAHAM A. COLDITZ. Relation of body fat distribution to reproductive factors in pre- and postmenopausal women. Obes Res. 1995;3:143–151. The cross-sectional relations of several reproductive characteristics with self-reported waist-to-hip circumference ratio were evaluated in 44, 487 pre- and postmenopausal women 40 to 65 years of age who were free of cancer, cardiovascular disease, and diabetes. All results were adjusted for age, body mass index, cigarette smoking, physical activity, and alcohol intake. Current use of postmenopausal hormones was associated with a significantly lower waist-to-hip ratio than either past or never use independent of type of menopause (0.778 versus 0.784, p=0.0001 and 0.787, p=0.0001, respectively), although associations with type (unopposed estrogens versus combined estrogen and progesterone) and duration of hormone therapy were not noted. Waist-to-hip ratio did not differ between pre- and postmenopausal women, but demonstrated weak positive associations with age at menarche, parity, and age at first birth, and a weak inverse association with past duration of breast-feeding. These data confirm relations of several reproductive factors and use of hormone replacement therapy with body fat distribution. Epidemiologic studies relating body fat distribution to disease outcomes in women should consider these factors as potential confounders.