ArticleLiterature Review

Menopause-Related Changes in Body Fat Distribution

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Abstract

Menopause-related changes in body fat distribution may partially explain the greater risk of cardiovascular and metabolic disease during the postmenopausal years. To date, however, the effect of the menopause transition on body fat distribution remains unclear. Cross-sectional and longitudinal studies using waist circumference or the waist-to-hip ratio show no effect of menopause on body fat distribution. By contrast, studies using dual-energy X-ray absorptiometry showed increased trunk fat in postmenopausal women. Moreover, studies using computed tomography (CT) and magnetic resonance imaging (MRI) show that postmenopausal women have greater amounts of intra-abdominal fat compared to premenopausal women. Collectively, these studies suggest that the menopause transition is associated with an accumulation of central fat and, in particular, intra-abdominal fat. Whether menopause-related differences in trunk or intra-abdominal fat are independent of age and/or adiposity, however, is unclear. Thus, we recently examined the effect of menopausal status on body composition and abdominal fat distribution in 53 middle-aged, premenopausal women (47 +/- 3 years) and 28 early postmenopausal women (51 +/- 4 years). Postmenopausal women had 36% more trunk fat (p < 0.01), 49% greater intra-abdominal fat area (p < 0.01), and 22% greater subcutaneous abdominal fat area (p < 0.05) than premenopausal women. The menopause-related difference in intra-abdominal fat persisted (p < 0.05) after statistical adjustment for age and fat mass, whereas no differences were noted in trunk or abdominal subcutaneous fat. A similar pattern of differences in trunk, subcutaneous, and intra-abdominal fat was observed in subsamples of pre- and postmenopausal women matched for age or fat mass. Our data and that of others suggest that early postmenopausal status is associated with a preferential increase in intra-abdominal fat that is independent of age and total adiposity. Thus, CT and MRI should be used when examining menopause-related changes in body fat distribution.

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... Among females, several studies suggest, that the changes in body composition and fat distribution are mainly due to menopausal transition, in particular, due to the hormonal alterations accompanying this phase of reproductive aging (Toth et al. 2000). There is no doubt, that the menopausal transition represents a fundamental physiological change in female life, characterized by profound hormonal and metabolic alterations. ...
... In the present study, especially trunk fat mass is higher among postmenopausal women. This is a typical fat distribution pattern found among postmenopausal women and menopause and is not ageassociated (Toth et al. 2000). It is well documented that during the premenopausal phase, a more gynoid type of fat distribution prevails but during the postmenopausal phase a more android kind of fat distribution is commonly found even among normal-weight women (Kirchengast et al. 1997(Kirchengast et al. , 1998. ...
... This means a higher amount of fat tissue in the lower body region as well as a lower amount of abdominal fat tissue is associated with higher estrogen levels and therefore typical of premenopausal phase of life (Ferrara et al. 2002). The dramatic decline of estrogen levels after menopause results in the trend towards an android or centralized fat patterning, characterized by a higher amount of upper body or trunk fat (Toth et al. 2000). Furthermore, free testosterone and DHEA-S levels correlate significantly with abdominal fat accumulation in women (Cao et a. 2013). ...
Article
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Aging and the menopausal transition are accompanied by marked changes in body composition and fat distribution, which might have a tremendous effect on health, health-related quality of life, and longevity. The aim of the present study is to test differences in body composition parameters between healthy normal-weight pre-and postmenopausal women. In a cross-sectional study, the impact of age and menopause on body fat mass, lean body mass, and fat/lean ratio were tested among 175 healthy normal-weight women aged between 40 and 60 years. Body composition was estimated by means of dual-energy x-ray absorptiometry (DEXA). With increasing age, fat mass and the fat/lean ratio increased, while lean body mass decreased. Postmenopausal women showed independently of age a higher fat mass and a higher fat-lean ratio than their premenopausal counterparts, but also a higher lean body mass. The menopausal transition is positively associated with an increase in fat mass and fat/lean ratio, but also in lean body mass among healthy normal-weight women. the reduction in lean body mass is age dependent and not associated with menopause.
... Surprisingly, consideration of sex as a crucial determining factor in studies across the lifespan has only recently experienced a rise of interest within the field (Bale & Epperson, 2017;Barth et al., 2015;Milman et al., 2014). While sports physiology differences between aging men and women were commonly and widely studied earlier this century (Stathokostas et al., 2004;Toth et al., 2000), the inclusion of biological sex as a deterministic factor on levels of markers of neuronal plasticity, sex differences in brain aging (Bale & Epperson, 2017;Choleris et al., 2018;Gabrowska, 2017;Gur & Gur 2017), or the intertwined relationship between the endocrine system and physical activity in aged male or female bodies only recently gained stronger attention (Barha & Liu-Ambroise, 2018;Barha 2017aBarha , 2017b. In the past, descriptive reports (Begliuomini et al., 2008;Green et al., 2014;Schwarz et al., 1996;Tumati et al., 2016;Yeap et al., 2010) and studies (Almeida et al., 2018;Amir et al., 2007;Babaei et al., 2014;Chan et al., 2008;De la Rosa et al., 2019;Nofuji et al., 2008) were mostly conducted in male samples alone instead of comparing both sexes, directly investigating possible sex-specific differences. ...
... Importantly, the remaining estrogen levels in postmenopausal women are primarily produced through aromatization of adrenal androgens in the adipose tissue (McTiernan, 2008) and not by the gonads. As a result of the late-life hormonal changes, men typically decrease stronger in total "lean" (muscle) mass from the sixth decade of life onwards (Fleg & Lakatta 1988;Toth et al., 1994), whereas post-menopausal women display higher increases in total body fat percentage (Messier et al., 2011;Toth et al., 2000;Kim & Won Won 2022). Nonetheless, even in older adults, there are still considerable levels of sex hormones remaining (Barha et al., 2017b;de Vries & Forger, 2015). ...
... Thus, relative differences between male groups were lessened. This effect is surprising and might be either explained by an increased ambition, self-confidence, or decreased anxiety at the physical T3 assessment in the male control cohort, resulting in better subjective peak performances when compared to T1. Especially, since maximum aerobic capacity has repeatedly been reported to decrease stronger in men above the age of 65 than in women (Alcazar et al., 2020;Fleg & Lakatta, 1988;Stathokostas et al., 2004;Toth et al., 2000;Weiss et al., 2004). Even more revealing however, were the differences between sexes in descriptive body measures over time: while women in the SP group significantly decreased in both BMI and body fat percentage when compared to control women over the course of the study ( Figure 11.e and g), changes between men remained insignificant (Figure 11.f and h). ...
Thesis
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Despite healthy aging being associated with brain atrophy and declines in overall cognitive function, past research has highlighted the beneficial effect of greater physical fitness on brain morphology and cognition, especially in older age. On the other hand, markers for neuronal plasticity, as IGF-1, IGFBP-3, and BDNF namely, have experienced a rise in attention when investigating the brain’s ability to induce structural and behavioural changes over the lifespan. In this thesis, dynamics of serum-derived markers for neuronal plasticity (IGF- 1,IGFBP-3, BDNF) and general fitness (VO₂ and power at peak, BMI and body fat percentage) were investigated in a sample of healthy older adults (N = 141; 63-78 years) at pre-intervention and after six months of aerobic exercise (AE) (SP group, N = 71; 52.1% women) versus no AE intervention (AC group, N = 70; 50.0% women), with special regards to differences between male and female participants. In sum, this work shows significant sex differences in dynamics of IGF-system markers (both at baseline and after exhaustive AE) and fitness in healthy older adults. Overall, dynamics between IGF-system markers and fitness measures showed sex differences and were altered after a six-month AE intervention, challenging the dogma of little physiological plasticity in aged bodies and indicating the pressing need to further investigate the effect of biological sex on markers for neuronal plasticity throughout the lifespan. Keywords: aerobic exercise, healthy aging, sBDNF, sIGF-1, sIGFBP-3, plasticity
... With age and hormonal changes, total fat mass tends to increase at the detriment of lean mass and accumulate preferentially in the abdomen. 3 Total fat mass and more particularly, the android fat, is associated with type 2 diabetes and cardiovascular disease. 4 Android fat has two components: visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). ...
... [5][6][7][8][9] In postmenopausal women, fat mass has a higher proportion of VAT than SAT. 3,9,10 The association between android fat or gynoid fat and cardiovascular disease differs between genders. 11 Several measurement tools are available in clinical practice to estimate total fat mass and regional fat mass. ...
... 16 BIA is easy in use, noninvasive, inexpensive, and reproducible, but the prediction equations are frequently unknown and manufacturer specific. 3,17,18 However, neither the anthropometric measurements nor BIA allow to distinguish SAT from VAT. Higher cost, radiation exposure, and logistical complexity limit the use of magnetic resonance imaging (MRI) or computed tomography (CT). ...
Article
Objective: After menopause, body composition changes with body fat accumulation, and an increase in cardiometabolic risk factors. Total fat mass, regional fat mass, and visceral adipose tissue (VAT) may be estimated with anthropometric measures, bioelectrical impedance analysis (BIA), and dual-energy X-ray absorptiometry (DXA). The aim of our study was to assess which measurement correlated best with cardiometabolic risk factors in healthy nonobese postmenopausal women. Methods: The CoLaus/OsteoLaus cohort included 1,500 postmenopausal women (age range 50-80). We analyzed correlations between: 1) measurements of body composition assessed by anthropometric measures, BIA, and DXA and 2) these measurements and different selected cardiometabolic risk factors, such as blood pressure, lipid markers (cholesterol subtypes and triglycerides), and metabolic markers (glucose, insulin, adiponectin, and leptin). Spearman correlation coefficient, stepwise forward regression, and linear regression analyses were used to determine association between anthropometric measurements and cardiometabolic risk factors. Results: In the 803 included participants (mean age 62.0 ± 7.1 y, mean body mass index 25.6 kg/m2 ± 4.4), correlations between total fat mass measured by BIA and total fat mass, android fat, gynoid fat, or VAT measured by DXA are very strong (from r = 0.531, [99% confidence interval (CI), 0.443-0.610] to r = 0.704, [99% CI, 0.640-0.758]). Body mass index and waist circumference have a higher correlation with VAT (r = 0.815, [99% CI, 0.772-0.851] and r = 0.823 [99% CI, 0.782-0.858], respectively) than BIA (r = 0.672 [99% CI, 0.603-0.731]). Among the anthropometric measurement and the measurements derived from DXA and BIA, VAT is the parameter most strongly associated with cardiometabolic risk factors. VAT better explains the variation of most of the cardiometabolic risk factors than age and treatment. For example, nearly 5% of the variability of the diastolic blood pressure (9.9 vs 4.9), nearly 15% of the variability of high-density lipoprotein cholesterol (20.3 vs 3.8) and triglyceride (21.1 vs 6.5), 25.3% of the variability of insulin (33.3 vs 8.1), and 37.5% of the variability of leptin (37.7 vs 1.1) were explained by VAT. Conclusions: BIA seems not to be a good tool to assess VAT. At the population level, waist circumference and body mass index seem to be good tools to estimate VAT. VAT measured by DXA is the parameter most correlated with cardiometabolic risk factors and could become a component of the cardiometabolic marker on its own.
... Some insights in the topic of fat redistribution associated with menopause were provided by Tremolliere in 1996, who noted a shifting of the fat mass to an upper body location even when total body fat remained unchanged in postmenopausal women, suggesting that the android adiposity may be influenced by menopause more than age alone [17]. Later, two other papers reiterated that abdominal fat redistribution is associated with menopause [18,19]. Even though these data do not necessarily support causality between menopause and abdominal fat, they may provide some explanation for the shift in the cardiovascular profile that occurs in women after ovarian senescence. ...
... Our age-and BMI-matched study's results state that women in years 5-10 of MP had a statistically higher value of the android-togynoid ratio compared to those in the first 5 years of menopause. Previous studies indicated that the onset time of abdominal fat accumulation was early postmenopause, in which the ovaries were hormonally active for secreting testosterone [18,35]. Not only do changes in adiposity foreshadow changes in sex steroids during the menopausal transition, as waist circumferences predicted future levels of estradiol, testosterone, follicle-stimulating hormone (FSH), and SHBG, but sex steroids and FSH can also cause a change in fat distribution [4]. ...
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Background and Objectives: The literature suggests that physiological menopause (MP) seems linked with increased adiposity with a preference for intra-abdominal fat accumulation, greater than what can be attributed only by aging, which could magnify this period’s increased cardiovascular risk. Materials and Methods: We retrospectively analyzed two age and body mass index (BMI) propensity-matched subgroups each formed of 90 clinically healthy, 40–60-year-old postmenopausal women, within the first 5 and 5–10 years of MP. The 10-year ASCVD risk was assessed using medical history, anthropometric data, and lipid profile blood tests. The android-to-gynoid (A/G) ratio was computed using Lunar osteodensitometry lumbar spine and hip scans. Results: The A/G ratio was significantly higher for the subgroup evaluated in years 5–10 of MP than in the first 5 years of MP, even after controlling for BMI (1.05 vs. 0.99, p = 0.005). While displaying a significant negative correlation with HDL cholesterol (r = 0.406), the A/G ratio also had positive correlations with systolic blood pressure (BP) values (r = 0.273), triglycerides (r = 0.367), and 10-year ASCVD risk (r = 0.277). After adjusting for smoking, hypertension treatment, and type 2 diabetes, the 10-year ASCVD risk became significantly different for women in the first 5 years (3.28%) compared to those in years 5–10 of MP (3.74%), p = 0.047. Conclusions: In women with similar age and BMI, the A/G ratio appears to vary based on the number of years since menopause onset and correlates with either independent cardiovascular risk parameters like BP, triglycerides, and HDL cholesterol or with composite scores, such as 10-year ASCVD risk.
... However, the associations between menopausal status and obesity and weight gain remain controversial [3]. Several studies have concluded that menopause and menopausal transition are associated with increases in obesity and anthropometric indices [6,[8][9][10][11] due to hypoestrogenic effects because estrogens affect gluteofemoral adiposity [12] or due to the effect of bioavailable testosterone [13]. However, some studies have shown that obesity and anthropometric indices are not associated with menopausal status [3,12,[14][15][16][17], suggesting that the changes in anthropometric and body composition indices are due to aging or reductions in physical activity, not menopausal status [3,14,16]. ...
... They argued that premenopausal women had greater height and smaller WC and WHR than postmenopausal women did. Additionally, postmenopausal women had a high risk of central adiposity, independent of several confounders, [9,10] tested the effect of menopausal status on central fat distribution and body composition in premenopausal and postmenopausal women using computed tomography (CT) and dual-energy X-ray absorptiometry (DEXA). They stated that both the menopausal transition and postmenopausal status were related to an increase in central adiposity, independent of age, BMI and total body fat mass. ...
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Background Menopause induces various health problems and is associated with obesity, but the association between menopausal status and obesity is unclear due to several confounding factors, such as aging and reduced physical activity. The objective of this study was to examine the association of menopausal status with anthropometric indices and body composition indices in South Korean women. Methods In this cross-sectional study, a total of 734 subjects (297 postmenopausal women, 437 premenopausal women) from five university hospitals in South Korea were included. A binary logistic regression analysis was performed to examine the association of menopause with anthropometric indices and body composition indices. Results Height, body mass index, waist-to-height ratio, waist-to-hip ratio, and neck, armpit, chest, rib, waist, iliac, and hip circumferences were associated with menopausal status in the crude analysis, but these associations disappeared in the adjusted models. Among the body composition indices, menopausal status was strongly associated with total body water, skeletal muscle mass, body fat mass, and body fat percentage in the crude analysis. However, the associations with body fat mass and body fat percentage disappeared in the adjusted models. Only the associations with total body water and skeletal muscle mass remained in the adjusted models. Conclusion Most of the anthropometric indices and body composition indices were not associated with menopausal status, but total body water and skeletal muscle mass were significantly lower in postmenopausal women than in premenopausal women.
... Indeed, the onset of menopause is followed by a reduction in fat oxidation and a decrease in energy expenditure, without changes in energy intake (7). In studies using dual-energy X-ray absorptiometry, CT or MRI, postmenopausal women have 36% more thoracic fat and 49% greater intra-abdominal fat area compared with premenopausal women (8). These differences were independent of age and total fat mass (8). ...
... In studies using dual-energy X-ray absorptiometry, CT or MRI, postmenopausal women have 36% more thoracic fat and 49% greater intra-abdominal fat area compared with premenopausal women (8). These differences were independent of age and total fat mass (8). Moreover, biopsy studies in postmenopausal women have shown hypertrophy of adipocyte cells both in subcutaneous and visceral adipose tissue, as well as increased inflammation and fibrosis, compared with premenopausal women (9). ...
Article
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Cardiovascular disease (CVD) is of major concern in women entering menopause. The changing hormonal milieu predisposes them to increased CVD risk, due to a constellation of risk factors, such as visceral obesity, atherogenic dyslipidemia, dysregulation in glucose homeostasis, non-alcoholic fatty liver disease and arterial hypertension. However, an independent association of menopause per se with increased risk of CVD events has only been proven for early menopause (<45 years). Menopausal hormone therapy (MHT) ameliorates most of the CVD risk factors mentioned above. Transdermal estrogens are the preferable regimen, since they do not increase triglyceride concentrations and they are not associated with increased risk of venous thromboembolic events (VTE). Although administration of MHT should be considered on an individual basis, MHT may reduce CVD morbidity and mortality, if commenced during the early postmenopausal period (<60 years or within ten years since the last menstrual period). In women with premature ovarian insufficiency (POI), MHT should be administered at least until the average age of menopause (50–52 years). MHT is contraindicated in women with a history of VTE and is not currently recommended for the sole purpose of CVD prevention. The risk of breast cancer associated with MHT is generally low and is mainly conferred by the progestogen. Micronized progesterone and didrogesterone are associated with lower risk compared to other progestogens.
... Metanalysis conducted by Ambikairajah et al. demonstrated an increase in central adipose tissue and a decrease in the percentage of adipose tissue in women's legs in the postmenopausal period [13]. In Toth et al.'s study, women after menopause had 36% of visceral adipose tissue and 49% of visceral fat surface more than their premenopausal counterparts [40]. Also, in Pachocka's studies central obesity prevailed, especially in the perimenopausal women. ...
... The desired HDL-c concentration was achieved by 63% of women and 57% of men [33]. However, in the study by Dudzińska et al., 40.4% of patients after insulin treatment achieved the target levels of LDL-c and total cholesterol [58]. ...
Article
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Background and objectives: The aim was to compare body composition and levels of biochemical blood parameters and identify relationships between biochemical parameters and body composition of women with type 2 diabetes and healthy ones, both in perimenopausal period (172 women aged between 45 and 65 come from the West Pomeranian Voivodeship, Poland). Materials and methods: The study consisted of an interview, body composition analysis with Jawon Medical IOI-353 (Yuseong, South Korea) analyser and venous blood biochemical analysis (lipid profile, levels of glucose, insulin, CRP, glycated haemoglobin). Results: The vast majority of body composition measurements varied between study and control groups in a statistically significant way (p < 0.05) except protein and soft lean mass of the torso. Statistically significant differences between the two groups have been observed in case of all biochemical parameters (p < 0.001). Conclusions: Body composition of women suffering from type 2 diabetes significantly varied from body composition of healthy women. Results of the first group were characterised by higher values, especially in case of general parameters, abdominal area, content of adipose tissue and soft tissues. Relationship between body composition and biochemical results may be observed, especially in level of triglycerides, CRP and insulin. Higher concentrations of these parameters were associated with increased values of majority of body composition measurements regardless of type 2 diabetes incidence.
... Menopause, as a major stage of women's life is characterized by numerous phenomenon such as decrease in estrogen levels and some other symptoms such as hot flashes, sleep disturbances, and urogenital problems, and potential long-term complications, including sexual dysfunction, metabolic dyslipidemia, osteoporosis and cardiovascular problems (Friz and Speroff 2011; Arikawa and Kurzer, 2021). The anthropometric relationship between menopause and postmenopausal women with type II diabetes highlights how physical and metabolic changes during and after menopause influence diabetes risk and management (Toth et al., 2000). Menopause is associated with hormonal shifts, particularly a decline in estrogen, which contributes to changes in body fat distribution, leading to increased central adiposity. ...
Article
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BACKGROUND AND AIM: According to clinical criteria, menopause is when a woman stops having periods for at least 12 consecutive months which involves hormonal changes that can be challenging for diabetic women especially those reliant on insulin. Anthropometric parameters, including body mass index (BMI), waist-to-hip ratio (WHR), are critical indicators of metabolic health and disease risk in menopausal women. Postmenopausal women with type II diabetes often exhibit altered anthropometric parameters such as higher body mass index (BMI), waist circumference, and waist-to-hip ratio (WHR), compared to their non-diabetic counterparts. The aim was to study some anthropometric parameters among menopausal women with type II diabetes in Lagos mainland, Shomolu Local Government Area and its environ. METHODOLOGY: The study was a cross sectional study among the clinically diagnosed type II diabetic menopausal women who attends clinic in Lagos mainland: Shomolu local government and its environs. Seven hundred and two (702) clinically diagnosed type II diabetic menopausal women were recruited from some medical facilities at Lagos mainland. Anthropometric parameters such as height, weight, head, neck, mid upper arm, chest, waist, hip and thigh circumferences were taken using standard procedures. RESULTS: The results indicate the average age at menopause was 46.73±4.44 years and most of the women were diagnosed with Type II Diabetes after menopause (67.2%). CONCLUSION: In conclusion, weak relationship between some Anthropometric parameters, among menopausal women with type II diabetes in Lagos mainland, Lagos state Nigeria.
... Menopause transition may also result in decreased fat oxidation and a reduction in resting energy expenditure despite any alterations in energy intake [62]. The presence of 36% extra thoracic fat and 49% higher intra-abdominal fat in postmenopausal women compared with premenopausal women was shown to be, independent of their age and total fat mass [63]. Postmenopausal women had up to 50% increased insulin resistance and 50% reduced pancreatic insulin secretion compared with premenopausal women regardless of body mass index (BMI) and age [64]. ...
Article
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Cardiovascular disease (CVD) is a leading cause of death in women and risk of development is greatly increased following menopause. Menopause occurs over several years and is associated with hormonal changes, including a reduction in estradiol and an increase in follicle-stimulating hormone. This hormonal shift may result in an increased risk of developing abdominal adiposity, insulin resistance, dyslipidemia, vascular dysfunction, hypertension, type 2 diabetes mellitus (T2DM), metabolic dysfunction-associated fatty liver disease (MAFLD), and metabolic syndrome (MetS). Furthermore, with the onset of menopause, there is an increase in oxidative stress that is associated with impaired vascular function, inflammation, and thrombosis, further increasing the risk of CVD development. Despite the harmful consequences of the menopause transition being well known, women in premenopausal, perimenopausal, and postmenopausal stages are unlikely to be enrolled in research studies. Therefore, investigations on the prevention and treatment of cardiovascular and metabolic disease in middle-aged women are still relatively limited. Whilst lifestyle interventions are associated with reduced CVD risk in this population sample, the evidence still remains inconclusive. Therefore, it is important to explore the effectiveness of early intervention and potential therapeutic approaches to maintain cellular redox balance, preserve endothelium, and reduce inflammation. Glycine, N-acetylcysteine, and L-theanine are amino acids with potential antioxidant and anti-inflammatory activity and are identified as therapeutic interventions in the management of age-related and metabolic diseases. The benefits of the intake of these amino acids for improving factors associated with cardiovascular health are discussed in this review. Future studies using these amino acids are warranted to investigate their effect on maintaining the vascular health and cardiovascular outcomes of postmenopausal women.
... Research indicates that postmenopausal women experience decreased energy expenditure, increased fat deposition, insulin resistance, and impaired glucose and lipid metabolism [10,11]. This leads to a higher incidence of obesity and insulin resistance (metabolic syndrome) in women compared to agematched men [12]. ...
Article
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Background: G1, a specific agonist targeting the G protein–coupled receptor 30 (GPR30), has demonstrated significant involvement in combating obesity and regulating glucose homeostasis. Nevertheless, the beneficial effects of G1 treatment have solely been investigated in animal models under normal feeding conditions, leaving its therapeutic potential in high-fat feeding scenarios unexplored. Material and Methods: To address this gap, our study employed an ovariectomized high-fat diet mouse model to assess the therapeutic effects of G1 in combating obesity and metabolic dysfunction. Results: The findings revealed that G1 treatment resulted in weight loss, but concurrently led to increased blood glucose levels and insulin resistance. Treatment with G1 resulted in an amplification of fat mobilization and an enhancement of pyruvate carboxylase activity in mice fed a high-fat diet. Moreover, the combined impact of G1 treatment and a high-fat diet on pyruvate metabolism, as well as the regulation of crucial gluconeogenesis enzymes such as pyruvate dehydrogenase kinase 4 (PDK4), phosphoenolpyruvate carboxykinase (PEPCK), and glucose transporter 2 (GLUT2), expedites the elevation of blood glucose and the progression of insulin resistance. Conclusions: These findings indicate that G1 treatment is influenced by a high-fat diet, potentially disrupting glucolipid metabolism and promoting insulin resistance alongside its antiobesity effects. Consequently, further investigation is imperative to thoroughly explore this potential toxic side effect of G1 therapy.
... This suggests that the menopausal transition, with its hormonal changes leading to central fat distribution, increases CKD risk in older women. Studies confirm that menopause increases visceral fat, contributing to metabolic syndrome and CKD [30,32]. ...
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Introduction Obesity is a known risk factor for chronic kidney disease (CKD), but the impact of obesity severity and duration on CKD incidence is unclear. Methods Cumulative Excess Weight (CEW) and Cumulative Excess Waist Circumference (CEWC) scores were calculated, which represent the accumulation of deviations from expected body mass index and waist circumference values over time until the development of CKD or the end of the follow-up period. Time-dependent Cox models were used to investigate the sex-stratified association of CEW and CEWC with CKD incidence while controlling for confounding variables. Results Out of the 8697 participants who were evaluated in this study, 56% (4865) were women and the mean age was 40 ± 14. During the 15-year follow-up period, 41.7% (3629) of the participants developed CKD. Among the CKD patients, 65.4% (829) of men and 77.9% (1839) of women had a BMI higher than 25, and high WC was found to be 73.7% (934) and 55.3% (1306) for men and women, respectively. We found a significant association between one standard deviation change of CEW and the development of CKD in both sexes (fully adjusted hazard ratios and 95% CI of CEW in men and women were 1.155 [1.081–1.232) and 1.105 (1.047–1.167)]. However, the association between CEWC and CKD development was only significant among men participants [HR = 1.074 (1.006–1.147)]. Conclusion Over a 15-year follow-up, the accumulation of general and central obesity was associated with an increased incidence of CKD development.
... Although body mass index (BMI) is frequently utilized to classify overweight or obesity, it cannot neither distinguish the lean mass and total fat mass nor capture the distribution of body fat [10]. Furthermore, menopause transition lead to an increased abdominal fat deposition compared to peripheral fat deposition [11,12], and accumulative evidence demonstrated that adipose tissue distribution rather than overall adiposity is more critical in determining CVD risk [13]. ...
Article
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Background Several abdominal obesity indices including waist circumference (WC), waist–hip ratio (WHR), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) were considered effective and useful predictive markers for cardiovascular disease (CVD) in general populations or diabetic populations. However, studies investigating the associations between these indices among postmenopausal women are limited. Our study aimed to investigate the associations of the five indices with incident CVD and compare the predictive performance of CVAI with other abdominal obesity indices among postmenopausal women. Methods A total of 1252 postmenopausal women without CVD at baseline were analyzed in our investigation based on a 10-year follow-up prospective cohort study. Link of each abdominal obesity index with CVD were assessed by the Cox regression analysis and the Kaplan–Meier curve. The receiver operating characteristic (ROC) curves were drawn to compare the predictive ability for CVD. Results During the median follow-up of 120.53 months, 121 participants newly developed CVD. Compared to quartile 1 of LAP and CVAI, quartile 4 had increased risk to develop CVD after fully adjusted among postmenopausal women. When WC, VAI and CVAI considered as continuous variables, significant increased hazard ratios (HRs) for developing CVD were observed. The areas under the curve (AUC) of CVAI (0.632) was greatly higher than other indices (WC: 0.580, WHR: 0.538, LAP: 0.573, VAI: 0.540 respectively). Conclusions This study suggested that the abdominal obesity indices were associated with the risk of CVD excluded WHR and highlighted that CVAI might be the most valuable abdominal obesity indicator for identifying the high risk of CVD in Chinese postmenopausal women.
... (2) Although progesterone has an anti-cancer effect, postmenopausal women have reduced progesterone levels [21]. (3) Early postmenopausal is associated with a preferential visceral fat increase regardless of age or total adiposity [22]. These three theories can support our hypothesis. ...
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Objective: Obesity is a risk factor for endometrial cancer. Recently, visceral fat is strongly associated with obesity-related carcinogenesis, more than subcutaneous fat. In this study, we hypothesized that the visceral fat measured by computed tomography (CT) contributes to the occurrence of endometrial cancer. Methods: A retrospective chart review of patients undergoing primary surgery for endometrial cancer was conducted. The volume of visceral fat was measured by CT scans performed at the fourth lumbar level for all participants. Body fat distributions assessed by a direct method in 52 endometrial cancer cases were compared with those of age- and BMI-matched healthy community controls. Results: Case group showed significantly higher mean visceral fat area (VFA; 76.2 ± 25.0 vs. 62.2 ± 13.9 cm², P = 0.007). The mean total fat area (TFA; 270.3 ± 99.9 vs. 238.9 ± 53.8 cm², P = 0.137) and subcutaneous fat area (SFA; 194.2 ± 86.5 vs. 176.7 ± 45.8 cm², P = 0.315), however, presents no significant differences. VFA showed lower correlation with BMI (r² = 0.299, P < 0.001) than to SFA (r² = 0.528, P < 0.001) or TFA (r² = 0.584, P < 0.001). In receiver operator characteristic (ROC) curve, at a VFA value of 70.8 cm², sensitivity and specificity of the case group was 55.8% and 75%, respectively. Conclusion: Increased abdominal visceral fat is associated with endometrial cancer risk and can be predicted by measuring CT scans. Furthermore, as the most independent factor of BMI, VFA may provide additional information for representative risks of endometrial cancer.
... Weight gain in postmenopausal women often leads to an increase in visceral fat (fat around internal organs). Many cross-sectional and longitudinal studies showed that visceral fat is metabolically active and releases free fatty acids and inflammatory markers that impair insulin action, thus increasing the risk of type 2 diabetes [17]  Osteoarthritis Extra weight puts additional stress on the joints, which can exacerbate or lead to the development of osteoarthritis, particularly in the knees and hips [18]. Excess body fat, particularly visceral fat, is metabolically active and produces inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha). ...
Article
Post-menopause is a critical period in a woman's life marked by significant hormonal changes that affect metabolism and weight management. This review paper examines the physiological changes impacting weight and metabolism in postmenopausal women, the associated health risks, and effective strategies for managing weight during this stage of life. Google Scholar, PubMed, Medline and Cochrane electronic databases related to weight management in postmenopausal women were searched. Adopting a holistic approach that includes lifestyle modifications; dietary adjustments like a phytoestrogen-rich diet, physical activity, behavioural changes, and potentially hormone replacement therapy can help manage weight effectively.
... Consequently, the hormonal changes that occur during perimenopause cause a spectrum of menopausal symptoms, including facial flushing, urinary disorders, osteoporosis, dyslipidemia, depression, cognitive decline, insomnia, and skin aging [2,3]. Furthermore, the decrease in estrogen is associated with increased accumulation of abdominal fat, leading to central obesity, which elevates the risk of type 2 diabetes, hypertension, hypertriglyceridemia, elevated low-density lipoprotein (LDL) cholesterol levels, and cardiovascular diseases [4,5]. ...
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Existing hormone replacement therapy for menopause has drawbacks, necessitating new treatment agents. Silkworms have demonstrated estrogenic properties, offering promising alternatives. We assessed the therapeutic effects of freeze-dried silkworm powder (SWP) on menopausal symptoms using an ovariectomized (OVX) mouse model. The experimental design comprised a sham surgery group (Sham), an OVX control group, a low-dose SWP group post-OVX (80 mg/kg, OVX-SWP-L), a high-dose SWP group post-OVX (160 mg/kg, OVX-SWP-H), and an estradiol treatment group post-OVX (OVX-E2). Treatments were administered orally thrice weekly over eight weeks; body weight was monitored weekly. The SWP-treated groups (SWP-L and SWP-H) exhibited less weight gain and increased uterine thickness than the OVX control. Molecular analyses demonstrated that SWP significantly enhanced the phosphorylation of estrogen receptor alpha (ERα), ERK, and AKT. Furthermore, biochemical assays revealed reduced serum neutral lipids across all SWP treatment groups. Notably, HDL-cholesterol levels were significantly increased in the SWP-L group compared to the OVX group. Serum estradiol concentrations were elevated in all the SWP groups, with significant increases in the high-dose group. These findings indicate that SWP may promote the activation of estrogen receptor signaling and improve symptoms associated with estrogen deficiency during menopause.
... It was found that the premenopausal women had lower BMI, lower body weight, more muscle mass, and lower body fat in comparison with the postmenopausal women. These results are consistent with findings from other studies [22][23][24]. A possible molecular mechanism discussed is an estrogenrelated change in the fat metabolism of postmenopausal women [18]. ...
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Purpose Age-related changes in thyroid function are well-investigated. Likewise, influences of physical activity on the thyroid gland could be determined. Studies that investigated the influence of (endurance) training on thyroid function in postmenopausal women do not exist. Therefore, the aim of this study is to investigate age-related changes in thyroid function during acute endurance training and through an exercise intervention in postmenopausal women and to identify differences to premenopausal women. Methods 12 pre- and 12 postmenopausal women were included. In all subjects, height, weight, and body composition were assessed. TSH, fT4, and fT3 were assessed at 9:00 am and 9:40 am at rest and after an acute endurance exercise. Subsequently the postmenopausal women conducted a six-week walking intervention and repeated the tests. Results Weight, BMI, and muscle mass were significantly lower and fat mass significantly higher in postmenopausal women (p < 0.05). Fat mass decreased and muscle mass increased (p < 0.05) in postmenopausal women after intervention. An elevated TSH response was found significantly in premenopausal women (p = 0.028) and non-significantly in postmenopausal women (p = 0.135) after acute exercise. There were no changes in fT3 and fT4 in both groups. After intervention, postmenopausal women showed a significant reduction in fT3 response (p =0.015) and a non-significant reduction of TSH response (p = 0.432). Conclusion This study provides evidence that both pre- and postmenopausal women respond with thyroid stimulation to acute endurance training. Furthermore, this study provides preliminary evidence that an endurance training intervention can reduce thyroid response after acute endurance exercise in postmenopausal women.
... Síndrome metabólico: el aumento de peso y la redistribución central del peso son comunes en las mujeres durante la posmenopausia; de hecho, el estado posmenopáusico temprano se asocia con un aumento preferencial de la grasa intraabdominal 56 , lo que resulta en una mayor resistencia a la insulina, dislipidemia, HTA y enfermedad cardiovascular 57,58 . En un metaanálisis donde se incluyeron 107 ensayos controlados aleatorizados mostraron que la THM redujo la grasa abdominal [-6,8% (IC95%: -11,8 a -1,9)], aumentó la masa corporal magra en pacientes no diabéticos y redujo la circunferencia de la cintura y la grasa abdominal 51 ; con relación a los efectos específicos de la THM, se observó que estos varían según la formulación, el régimen y la vía de administración; de hecho, los agentes orales afectaron negativamente a la PCR y la proteína S, mientras que los agentes transdérmicos no tuvieron dichos efectos. ...
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Introducción: los síntomas vasomotores (SVM) asociados a la menopausia suelen disminuir la calidad de vida de las mujeres, al generar un elocuente malestar. La terapia hormonal de la menopausia (THM) es el estándar en el tratamiento de los síntomas de la menopausia, siendo el único tratamiento que ha demostrado ser eficaz para los SVM. Objetivo: describir la eficacia y seguridad de la terapia hormonal de la menopausia vía transdérmica (THM TD) para aliviar los síntomas de la menopausia. Materiales y métodos: se hizo una revisión sistemática de la literatura en diferentes bases de datos electrónicas (CINAHL Plus, EMBASE, Scopus, Lilacs, Medline, Pubmed, entre otras), a través de términos de búsqueda estandarizados. Los desenlaces evaluados incluyeron los estudios donde se publicó cualquier tratamiento o intervención con la THM TD en mujeres tratadas por síntomas de la menopausia, porcentajes de alivio de los síntomas climatéricos y proporción de eventos adversos asociados. Resultados: se incluyeron 45 publicaciones, y convienen en aconsejar el tratamiento con la THM TD, en vista de un alivio de los síntomas climatéricos cerca del 90%, asimismo de ser más segura y potencialmente más eficaz que la terapia oral; con resultados normales en la evaluación mamográfica, y sin eventos adversos relacionados después de 5 años de seguimiento. Conclusiones: la terapia hormonal en la menopausia vía transdérmica es segura y eficaz para aliviar los síntomas de la menopausia. Al evitarse el metabolismo hepático, alcanza mejores beneficios clínicos, a la vez que minimiza la exposición de eventos adversos. Las publicaciones revisadas demuestran que la vía transdérmica es la mejor forma de tratar los síntomas de la menopausia.
... 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
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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.
... Females tend to preferentially accumulate fat in the subcutaneous region as compared with visceral; however, despite having greater adiposity than males, females have a decreased risk for metabolic disease compared with males (Palmer and Clegg 2015). Menopause is associated with a redistribution of fat mass from subcutaneous to visceral depots, implicating a role for sex hormones in determining adipose tissue distribution (Toth et al. 2000). In support of this, removal of the testes during sex reassignment therapy is more metabolically protective as compared with cross-sex hormone therapy alone in transwomen (Nelson et al. 2016). ...
Article
The circadian clock plays an essential role in coordinating feeding and metabolic rhythms with the light/dark cycle. Disruption of clocks is associated with increased adiposity and metabolic disorders, whereas aligning feeding time with cell-autonomous rhythms in metabolism improves health. Here, we provide a comprehensive overview of recent literature in adipose tissue biology as well as our understanding of molecular mechanisms underlying the circadian regulation of transcription, metabolism, and inflammation in adipose tissue. We highlight recent efforts to uncover the mechanistic links between clocks and adipocyte metabolism, as well as its application to dietary and behavioral interventions to improve health and mitigate obesity.
... [13] Enlarged visceral adiposity regarded as a key factor to the development of MS. [14] Menopause associated with an increase in intra-abdominal fat. [15] Obesity was defined classically through employing many anthropometric indices that based on fat distribution, each one has their own advantages and disadvantages in predicting serious chronic non communicable diseases. [16] Obesity is the most common disorder associated with women in their menopausal stage and occurs in approximately 65% of all women. ...
... The effect of menopause on body fat accumulation and distribution is well-documented. It has been shown that postmenopausal women had 36 % greater trunk fat, 49 % more intra-abdominal fat and 22 % greater subcutaneous abdominal fat than premenopausal women (16) . There are several studies that have shown associations of sarcopenic obesity with increased risk of falls, fracture (17) , joint instability and malalignment of and knee OA, particularly in women. ...
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The present study aimed to determine the effect of whole meat GSM powder on gut microbiota abundance, body composition and iron status markers in healthy overweight or obese postmenopausal women. This was a 3-months trial involving forty-nine healthy postmenopausal women with body mass index (BMI) between 25 and 35 kg/m2 who were randomly assigned to receive 3 g/d of either GSM powder (n 25) or placebo (n 24). The gut microbe abundance, serum iron status markers and body composition were measured at the baseline and the end of the study. The between-group comparison at the baseline showed a lower abundance of Bacteroides and Clostridium XIVa in the GSM group compared with the placebo (P = 0⋅04). At the baseline, the body fat (BF)% and gynoid fat% were higher in the GSM group compared with the placebo (P < 0⋅05). No significant changes were found in any of the outcome measures, except for ferritin levels that showed a significant reduction over time (time effect P = 0⋅01). Some trend was observed in bacteria including Bacteroides and Bifidobacterium which tended to increase in the GSM group while their abundance decreased or remained at their baseline level in the control group. Supplementation with GSM powder did not result in any significant changes in gut microbe abundance, body composition and iron markers compared with placebo. However, some commensal bacteria such as Bacteroides and Bifidobacteria tended to increase following supplementation with GSM powder. Overall, these findings can expand the knowledge surrounding the effects of whole GSM powder on these outcome measures in healthy postmenopausal women.
... According to other mechanisms, the functional absence of 17β-oestradiol in post-postmenopausal women would be a risk factor for obesity [27] [28]. Indeed, previous studies have shown that the incidence of obesity increases significantly after menopause [29]. ...
... [18][19][20] Sex hormones also play a significant role in determining BMAC. Although androgen and estrogen levels both decline after menopause, the estrogen level falls sharply; 1,9,19,21 thus, estradiol/testosterone showed a slightly negative effect on the relationship with BMAC in our study. However, testosterone level showed a negative correlation with BMAC in the highest 4th quartile. ...
Article
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Purpose To investigated the factors that influence BMAC. Patients and Methods Quantitative computed tomography (QCT) and magnetic resonance imaging (MRI) were applied to measure abdominal fat areas, liver fat content, erector muscle fat content, and BMAC of the L2-4 vertebrae. Sex hormone, adipokine, and inflammatory factor levels were measured on the same day. Results Although age, erector muscle fat content, estradiol, testosterone, and adiponectin/leptin levels showed correlations with BMAC in the correlation analysis, the equations obtained from the whole population by multivariate analysis were unclear. Patients were stratified according to BMAC quartiles, and differences were found in vBMD, age, estradiol, testosterone, and erector muscle fat content among the four quartiles. Logistic analyses confirmed that age, estradiol/testosterone ratio, and TNF-α had independent effects on BMAC in all quartiles. In addition, height was related to higher BMAC quartiles, and glucose was related to lower BMAC quartiles. Conclusion Compared to other body fats, BMAC is a unique fat depot. Age, estradiol/testosterone ratio, and TNF-α are all key influencing factors related to BMAC in postmenopausal women. Furthermore, height and glucose levels were related to BMAC in the higher and lower BMAC quartiles, respectively.
... The mechanism that links menopause to OSA is still not clear. In some studies [11,12], the disruptions in the female reproductive hormones are considered as a possible factor, whereby a hormonal imbalance during menopause and post-menopause can alter the distribution of body fat and increase fat accumulation in the trunk and abdomen area [13,14]. Nonetheless, it remains unclear if this increase in fat accumulation is independent of age and/or obesity. ...
Article
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Objective: Menopause is associated with multiple health risks. In several studies, a higher incidence or a higher risk for obstructive sleep apnea (OSA) in post-menopausal than pre-menopausal women is reported. This study was designed to verify such a connection between menopause and OSA in a population-based sample. Methods: For a subsample (N = 1209) of the Study of Health in Pomerania (N = 4420), complete polysomnography data was available. Of these, 559 females completed a structured interview about their menstrual cycle. Splines and ordinal regression analysis were used to analyze the resulting data. Results: In the ordinal regression analysis, a significant association between the apnea–hypopnea index (AHI) and menopause indicated that post-menopausal women had a substantially higher risk of OSA. In accordance with previous studies, risk indicators such as body mass index (BMI), age, and the influence of hysterectomies or total oophorectomies were included in the model. Conclusions: Our results clearly confirmed the assumed connection between menopause and OSA. This is important because OSA is most often associated with male patients, and it warrants further research into the underlying mechanisms.
... b) Although progesterone has an anti-cancer effect, postmenopausal women have reduced progesterone levels [18]. c) Early postmenopausal is associated with a preferential visceral fat increase regardless of age or total adiposity [19]. ...
... Among the limitations, the study cohort was limited to individuals aged between 20 and 59 years, which included the full set of parameters selected for our analysis. Secondly, menopausal status was not considered, which could influence the distribution of visceral and subcutaneous fat in postmenopausal women [35]. Lastly, we are also limited by the DXA scan exclusion criteria, such as possible or ongoing pregnancy, and the size of the DXA table, which is limited to respondents less than 450 pounds and less than 6 5 [23]. ...
Article
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The purpose of this study was to examine demographic-specific relationships between direct abdominal fat measures and anthropometric indices. A cross-sectional study was conducted utilizing abdominal fat measures (visceral fat area, VFA; visceral to subcutaneous adipose area ratio, VSR) and anthropometrics (body mass index, BMI; waist circumference, WC) data from the 2011–2018 National Health and Nutrition Examination Survey. Linear or polynomial linear regression models were used to examine the relationships of abdominal fat measures to anthropometrics with adjustment for demographics. The results revealed that while VFA was linearly related to BMI and WC across all demographics (p < 0.001), the relationships between VSR and both BMI and WC were concave in men and convex in women. The relationships between VFA, VSR, and BMI, WC varied by sex and race/ethnicity. In conclusion, increasing BMI and WC were linearly associated with increased VFA, but their relationships with VSR were nonlinear and differed by sex.
... [15][16][17] Furthermore, decreased estrogen level in postmenopausal women is associated with unfavorable changes in body composition, especially the redistribution of fat to the visceral area, which predisposes these women to abdominal obesity. 18,19 Similar to the loss of muscle strength, obesity is also associated with hemodynamic, structural, physiological, and pathological changes in the kidney, 20 leading to an increased risk of CKD progression. 21,22 Considering that poor muscle strength and obesity impose higher risk factors for CKD separately, the coexistence of both conditions (dynapenic-abdominal obesity) may increase the negative impact on renal function and enhance the progression of CKD, especially in postmenopausal women. ...
Article
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Objective: Low muscle strength and obesity lead to a higher risk of chronic kidney disease (CKD). Perimenopause is associated with a natural decline in muscle strength and an increase in visceral adiposity. Dynapenic obesity, which is the coexistence of low muscle strength and obesity, is expected to synergistically increase the prevalence of CKD in postmenopausal women. The aim of this study was to determine combined associations of dynapenia and obesity with CKD in postmenopausal women. Methods: This study used data from the Korean National Health and Nutrition Examination Survey, 2016 to 2019. The study included 4,525 postmenopausal women aged 42 to 80 years that were classified into four groups based on waist circumference (≥85 cm) and hand grip strength (<18 kg): normal, dynapenic, obese, or dynapenic-obese. According to the Kidney Disease: Improving Global Outcomes, we defined CKD as an estimated glomerular filtration rate <60 mL/min per 1.73 m2. Complex sample logistic regression models were conducted to determine the relationships among coexistence of dynapenia, abdominal obesity, and the risk of CKD. Results: Dynapenic-abdominal obese group displayed lower estimated glomerular filtration rate levels than other groups (P < 0.05 for all data). The prevalence rates of CKD were 15.5%, 7.8%, 6.2%, and 2.4% in the dynapenic-abdominal obese, dynapenic, abdominal obese, and normal groups, respectively (P < 0.001). Complex sample logistic regression analyses, after adjusting for age, height, health behaviors, and comorbidities, showed that the odds ratio for CKD with respect to dynapenic-abdominal obesity was 1.82 (95% confidence interval, 1.19-2.79) and to abdominal obesity was 1.54 (95% confidence interval, 1.07-2.22) than in the normal group. Conclusions: This study demonstrated that dynapenic-abdominal obesity, as determined by low handgrip strength and high waist circumference values, was associated with increased risk of CKD in postmenopausal women.
... However, the location of adipose tissue changes to visceral in women over 60. In the postmenopausal period, the mass of visceral adipose tissue increases by up to 50%, and excessive accumulation of abdominal fat is associated with an increased risk of developing cardiovascular diseases and diabetes [28][29][30]. In males, low circulating levels of total testosterone and sex hormone-binding globulin (SHBG), a determinant of testosterone bioavailability, are generally associated with abdominal and/or visceral obesity and affect metabolic syndrome [31]. ...
Article
Weight loss is recommended for obese patients with cardiovascular risk; however, it remains questionable how hyperglycemia affects this process. To address this problem, we aimed to determine the association between weight loss, lipid profile, and body mass parameters in obese normoglycemic and hyperglycemic patients. Obese (body mass index, BMI ˃ 30 kg/m²) normoglycemic and hyperglycemic volunteers were placed on a weight reduction program that included a balanced, low-calorie diet and moderate exercise for six months. Participants were assessed for serum glucose, β-cell functions, insulin resistance, lipid metabolism, lipoprotein profile, and body mass parameters. This weight reduction program fully normalized serum glucose levels only in a subpopulation of patients. These individuals also exhibited a significant reduction in body weight, and significant improvement in serum lipid profile and insulin resistance. In contrast, the patients that remained hyperglycemic were characterized by persistent insulin resistance, increased levels of atherogenic fractions of LDL and HDL lipoproteins, and elevated values of a modified Atherogenic Index of Plasma (AIP). Correlation analysis indicated a strong positive association between the modified AIP with atherogenic lipid profile, insulin resistance, and body mass parameters, indicating its usefulness in clinical studies in obese patients. Overall, our data indicate that successful treatment of hyperglycemia facilitates weight loss and improves the composition of blood lipids, while persisting hyperglycemia negatively affects the weight loss process and maintains an atherogenic lipid profile. Because hyperglycemia predisposes to cardiovascular disorders, its correction should be the primary goal during weight reduction therapy.
... In clinical settings, the use of anthropometry-based markers of central obesity are widely accepted (23), but are not routinely obtained to determine disease risk (24)(25)(26). Although their ability to discriminate changes in VAT has previously been questioned (27,28), there is a renewed interest in the use of waist circumference (WC) in the context of sarcopenic obesity (29,30). Visceral adiposity and muscle mass change in opposite ways with aging (31), whereas anthropometry-based markers of central obesity gradually increase during lifespan (32)(33)(34)(35). ...
Article
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Background Recent evidence suggests that excess visceral adipose tissue (VAT) is associated with future loss of subcutaneous adipose tissue (SAT) and skeletal muscle (SM) with aging. In clinical settings (abdominal) circumferences are commonly used to estimate body composition (BC). We aimed to study the linearity of VAT distribution ratios (i.e., VAT/SAT ratio and VAT/SM ratio), waist-to-hip ratio (WHR) and waist circumference (WC) with age and the relationship of VAT distribution ratios with anthropometry (i.e., WHR and WC). Materials and Methods BC was determined using whole body magnetic resonance imaging in a large multi-ethnic group of 419 adults (42% white, 30% black, 15% Hispanic, 13% Asian, 1% other) with a BMI ranging from 15.9 to 40.8kg/m². Linear and non-linear regression analysis was used to examine the linearity of VAT distribution ratios and anthropometry from 18 to 88 years. The relation between VAT distribution ratios and anthropometry was assessed separately. Results In both sexes non-linear relationships were found between BC estimates and age, and between BC measures mutually. The ratios of VAT/SAT and VAT/SM showed quadratic relationships with age. VAT distribution ratios showed exponential or quadratic relationships with anthropometry with coefficients of determination ranging between 18 and 55%. Conclusion In both sexes, VAT distribution ratios showed curvilinear relationships with age and with anthropometry. Given the sex differences in VAT distribution ratios, WHR and WC represent different BC proportions in men and women. These results emphasize the challenge when interpreting changes in BC based upon linear extrapolations in clinical practice.
... Some of the disparity in the literature on body fat distribution and BMD is likely to relate to the populations studied, as both fat distribution and BMD are influenced by ethnicity, sex [24], age, and menopausal status [25][26][27]. Study designs vary, with some studies being underpowered or failing to isolate the contribution of regional fat depots independent of total body fat or lean mass. Study findings can also be influenced by varying statistical approaches. ...
Article
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Background Body composition is associated with bone mineral density (BMD), but the precise associations between body fat distribution and BMD remain unclear. The regional adipose tissue depots have different metabolic profiles. We hypothesised that they would have independent associations with BMD. Research design and methods We used data from 4,900 healthy individuals aged 30-50 years old from the Oxford Biobank to analyse associations between regional fat mass, lean mass and total BMD. Results Total lean mass was strongly positively associated with BMD. An increase in total BMD was observed with increasing mass of all the fat depots, as measured either by anthropometry or DXA, when accounting for lean mass. However, on adjustment for both total fat mass and lean mass, fat depot specific associations emerged. Increased android and visceral adipose tissue mass in men, and increased visceral adipose tissue mass in women, were associated with lower BMD. Conclusions Fat distribution alters the association between adiposity and BMD.
... Postural instability is associated with the risk of falling, and stabilometric parameters have been shown to predict falls in postmenopausal women aged 50-65 years old [14]. In the menopause, there is an increase in intra-abdominal fat and total body weight [15], and agedrelated loss of muscle mass and strength accelerate [16], and all these changes may affect functional mobility. Functional mobility is an adequate method to assess dynamic balance when performing activities during daily life, and thus, it is a key factor for preventing not only falls but also disability and dependency [17,18]. ...
Article
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The aim of the present study was to determine the associations between the severity of the menopausal symptoms and postural balance and functional mobility in middle-aged postmenopausal women. A cross-sectional study was performed (171 participants, 57.18 ± 4.68 years). Severity of the menopausal symptoms (on the Menopause Rating Scale), postural balance (stabilometric platform) with eyes open and closed, and functional mobility (timed up and go test) were determined. A multivariate linear regression was performed, with body mass index, waist to hip ratio, age and fall history as possible confounders. Our findings showed that a greater severity of the menopausal symptoms at a psychological level was associated, under both eyes open and closed conditions, with worse postural control assessed by the length of the stabilogram (adjusted R2 = 0.093 and 0.91, respectively), the anteroposterior center of pressure displacements (adjusted R2 = 0.051 and 0.031, respectively) and the center of pressure velocity (adjusted R2 = 0.065 for both conditions). Older age was related to greater mediolateral displacements of the center of pressure with eyes open and closed (adjusted R2 = 0.45 and 0.58, respectively). There were no associations between the menopausal symptoms’ severity and functional mobility. We can conclude that a greater severity of psychological menopausal symptoms was independently associated with worse postural balance in middle-aged postmenopausal women.
... Both fat pads have common type of beige adipocytes and different from white adipocytes of visceral fat. In postmenopausal women, preferential site of fat deposition is shifted from subcutaneous fat depot to visceral fat depot (intra-abdominal fat) regardless of age, (69) but this study showed that OVX rats increased inguinal fat mass more pronounced than visceral fat when compared with sham rats and, probably, total subcutaneous fat may be greater than visceral fat in OVX rats. Furthermore, women reach the peak of bone mass at the hip by approximately 20 years old (9) followed by a decline, whereas rats are sexually mature by 2.5 months of age but bone growth still occurs until 10 months of age. ...
Article
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Obesity is considered to impair long‐term health by disturbing multiple physiological functions. However, it remains controversial issue, as to whether obesity has beneficial or detrimental effects on bone health in post‐menopausal women. The aims of this study were to investigate the relationships between obesity and bone mineral density (BMD) under conditions of ovarian hormone deficiency in an animal model and to evaluate the potential health benefits of Greenshell™ mussel (GSM) on bone health. A total of 144 adult female Sprague–Dawley rats were fed from age 12 weeks on one of four diets (normal (ND); ND + GSM; high fat/high sugar (HF/HS); HF/HS + GSM; N = 36 per diet). At age 20 weeks, following a DXA scan, 12 of the rats on each diet underwent ovariectomy (OVX) and the remaining rats were left intact. 12 of the intact rats in each diet group were culled at age 26 weeks (Short‐term cohort). The remaining rats were culled at age 48 weeks (Long‐term cohort). Rats were DXA scanned prior to cull then various fat pads were dissected. The results revealed that HF/HS rats and OVX rats dramatically increased body weight and fat deposition in correlation with leptin. In the long term cohort, vertebral spine BMD rapidly declined after OVX. At termination, the OVX rats had decreased plasma bone turnover markers of CIX‐1 and TRAP when compared to sham rats. Significantly higher BMD was found in OVX rats fed HF/HS diet when compared to ND but this difference was not recapitulated in intact rats. BMD of right femur was significantly increased 5–10% by GSM in the short term cohort. The data demonstrated that obesity can be beneficial by increasing BMD in OVX rats, and this may extrapolate to post‐menopausal women as adipocyte‐produced estrogen may slightly compensate for the reduction in ovarian hormones. Finally, the data showed that GSM may be beneficial to bone health by increasing BMD accrual. This article is protected by copyright. All rights reserved.
... While female sex hormones are believed to cause fat to be stored in the buttocks, thighs, and hips of women, which may be essential for normal reproduction purposes, menopauserelated changes in body fat distribution may partially explain the increased risk of cardiovascular and metabolic disease during the postmenopausal years. [44][45][46] In 2011, Wehr et al., 47 published results from a longitudinal study of gender-specific differences in the relationship between the lipid accumulation product, which is calculated from WC, and cardiovascular mortality, as well as the presence of type 2 diabetes. The study included 2,279 men and 875 postmenopausal women, with a median follow-up of 77 years. ...
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Resumo A prevalência de obesidade e insuficiência cardíaca com fração de ejeção preservada (ICFEP) aumenta significativamente em mulheres na pós-menopausa. Embora a obesidade seja um fator de risco para disfunção diastólica do ventrículo esquerdo (DDFVE), o mecanismo que liga a interrupção da produção de hormônios ovarianos, especialmente o estrogênio, ao desenvolvimento da obesidade, DDFVE, e ICFEP em mulheres em processo de envelhecimento não é claro. Estudos clínicos e epidemiológicos demonstram que mulheres na pós-menopausa com obesidade abdominal (definida pela circunferência de cintura) têm risco maior de desenvolver a ICFEP do que homens ou mulheres sem obesidade abdominal. Este estudo analisa dados clínicos que corroboram a existência de uma ligação de mecanismo entre a perda de estrogênio mais obesidade e o remodelamento ventricular esquerdo com ICFEP. Ele também discute os possíveis mecanismos celulares e moleculares para a proteção mediada por estrogênio contra tipos de células, depósitos de tecidos, função e metabolismo de adipócitos negativos que podem contribuir para a DDFVE e a ICFEP.
... Meanwhile, coincident age-related increases in adiposity are also observed in both men and women. A rapid increase in central abdominal fat and abdominal obesity is observed during the menopause transition (12)(13)(14), and a greater increase in FSH is associated with greater increase in fat mass (15). ...
Article
Context Follicle-stimulating hormone (FSH) may have independent actions on bone remodeling and body fat regulation. Cross-sectionally, we have shown that serum FSH is associated with bone mineral density (BMD) and body fat in older postmenopausal women, but it remains unknown whether FSH predicts bone and fat changes. Objective We examined whether baseline FSH level is associated with subsequent bone loss or body composition changes in older adults. Setting, Design, Participants We studied 162 women and 158 men (mean age 82 ±4 years) from the AGES-BMA cohort, a substudy of the AGES-Reykjavik Study of community-dwelling older adults. Skeletal health and body composition were characterized at baseline and 3 years later. Main Outcomes Annualized change in BMD and body composition by dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). Models were adjusted for serum estradiol and testosterone levels. Results There was no evidence for an association between baseline FSH level and change in BMD or body composition by DXA or QCT. For femoral neck areal BMD, adjusted mean difference (95% CI) per SD increase in FSH was 1.3 (-0.7, 3.3) mg/cm 2/year in women, and -0.2 (-2.6, 2.2) mg/cm 2/year in men. For visceral fat, adjusted mean difference (95% CI) per SD increase in FSH was 1.80 (-0.03, 3.62) cm 2/year in women, and -0.33 (-3.73, 3.06) cm 2/year in men. Conclusions Although cross-sectional studies and studies in perimenopausal women have demonstrated associations between FSH and BMD and body composition, in older adults, FSH level is not associated with bone mass or body composition changes.
... Weight gain and central weight re-distribution is common for women post-menopause (64)(65)(66). Disruption of estradiol signaling after menopause, either naturally or surgically, may cause increased and accelerated fat accumulation in the abdominal area, resulting in increased insulin resistance, dyslipidemia, hypertension and cardiovascular disease (13,65,67). HT appears to be weight neutral when used in menopause, although it does impact weight distribution with an increase in lean body mass and decrease in visceral fat (62,68). ...
Article
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Menopausal hormone therapy (HT) prescribing practices have evolved over the last few decades guided by the changing understanding of the treatment’s risks and benefits. Since the Women’s Health Initiative (WHI) trial results in 2002, including post-intervention analysis and cumulative 18-year follow up, it has become clear that the risks of HT are low for healthy women less than age 60 or within ten years from menopause. For those who are experiencing bothersome vasomotor symptoms, the benefits are likely to outweigh the risks in view of HT’s efficacy for symptom management. HT also has a role in preventing osteoporosis in appropriate candidates for treatment. A comprehensive overview of the types, routes, and formulations of currently available HT, as well as HT’s benefits and risks by outcomes of interest are provided to facilitate clinical decision making.
... Due to post-menopause, women tend to be sensitive to accumulate fat mass in waist area. 53 With no stratification of age, it might explain the lower sensitivity in our study. ...
Article
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Objective To examine the optimal cut-off values of visceral fat area (VFA) for predicting metabolic syndrome (MetS) among type 2 diabetes (T2D) patients in Ningbo China. Methods A total of 1017 subjects were selected from T2D patients who accepted standardized management by the National Standardized Metabolic Disease Management Center at Ningbo First Hospital from March 2018 to January 2020. Demography and medical information were collected through questionnaires. Regional adiposity was examined by a visceral fat analyzer using the dual bioelectrical impedance method. Results Overall, 769 (75.6%) T2D patients were defined to have MetS. Patients with MetS had higher anthropometric values and biomarkers, compared to those without MetS. VFA was significantly correlated with risk factors of MetS. Further logistic regression models showed that VFA was significantly associated with MetS in men (OR=1.02) and in women (OR=1.03) (P<0.001 for both genders) after controlling for related factors. Receiver-operating characteristic curve analysis demonstrated that the optimal cut-off values of VFA were 84.7 cm² for men and 81.1 cm² for women to predict MetS in T2D patients. Conclusion VFA was associated with MetS and could be an independent predictor of MetS in T2D patients. Clinical Trial Registration www.ClinicalTrials.gov, number: NCT03811470.
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Background: An accurate assessment of body fat distribution is crucial for managing cardiovascular disease and metabolic disorders. Although several methods are available for segmental fat analysis, few studies have examined the validity of affordable methods such as Bioelectrical Impedance Analysis (BIA) against the reference method, Dual-Energy X-ray Absorptiometry (DXA). This study aimed to assess the validity of BIA as compared to DXA for segmental fat mass assessment, and to develop anthropometric regression models that offer a cost-effective alternative for health professionals in clinical and public health settings. Methods: Cross-sectional study that included 264 young adults (161 males, mean age=23.04±5.61 years; and 103 females, mean age=22.29±5.98 years). Segmental fat mass was measured using DXA and BIA, and anthropometric measurements were collected following the ISAK protocol. Results: Significant differences were found between DXA and BIA for segmental fat mass (p<0.001). Sex significantly influenced the results (p<0.05), while BMI and hydration status had no significant impact. The Bland-Altman analysis revealed significant differences (p<0.001) between BIA and DXA for fat mass in the upper and lower limbs. Trunk fat mass also differed significantly in the segmental analysis (p<0.001), except for the overall sample (p=0.0881). Anthropometric regression models showed a high predictive accuracy for both females (R²=0.766-0.910; p<0.001) and males (R²=0.758-0.887; p<0.001). Key predictors of segmental fat mass included body mass (r=0.606-0.867; p<0.001), skinfold thickness (r=0.688-0.893; p<0.001), and waist girth (r=0.883-0.810; p<0.001). Peripheral skinfolds were highly predictive for upper and lower limbs, while waist girth was relevant for trunk fat mass. Conclusions: The significant differences between DXA and BIA means that these methods are not interchangeable for segmental fat analysis. However, the anthropometric regression models offer a practical and accurate alternative for predicting segmental fat mass in clinical settings where DXA is unavailable. Trial registration: Not applicable.
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Fase menopause adalah masa transisi ditandai dengan penurunan produksi estrogen yang dapat berdampak buruk pada kesehatan kardiovaskular termasuk tekanan darah. Lansia rentan terhadap gangguan kesehatan yang berdampak dari beberapa aspek seperti pilihan gaya hidup, hormon dan aktivitas fisik. Penurunan tingkat aktifitas fisik yang dapat berdampak negatif pada tekanan darah, kesejahteraan fisik dan mental wanita. Tujuan penelitian untuk memahami bagaimana tekanan darah dan aktifitas fisik berhubungan. Pada penelitian ini, analisis regresi digunakan dengan pendekatan cross-sectional. Penelitian ini difokuskan pada wanita menopause yang berdomisili di Posyandu Dusun Banjartengah Kabupaten Malang. Untuk penyelidikan ini, ukuran sampel sebanyak 32 peserta dibuat dengan menggunakan metode purposive sampling. Tensimeter digunakan untuk mengukur tekanan darah, dan Global Physical Activity Questionnaire (GPAQ) digunakan untuk mengukur aktivitas fisik. Data diperoleh melalui penggunaan analisis statistik Chi-Square. Pada wanita menopause terdapat korelasi antara tekanan darah dengan aktivitas fisik yang ditunjukkan dengan uji korelasi data analisis Chi-Square yang memiliki nilai p-value 0,045 kurang dari 0,05. Pada wanita yang mengalami menopause, terdapat hubungan antara tekanan darah dan aktivitas fisik.
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Estrogen depletion following menopause predisposes to increased risk of cardiovascular disease (CVD), mainly due to ischemic heart disease. This is mostly evident in cases with premature menopause. The pathophysiological basis for this atherosclerotic process is the accumulation of several risk factors, such as abdominal obesity, atherogenic dyslipidemia, insulin resistance and arterial hypertension. The presence of vasomotor symptoms may further augment this risk, especially in women younger than 60 years. Menopausal hormone therapy (MHT) exerts many beneficial effects on lipid profile and glucose homeostasis as well as direct arterial effects, and may reduce CVD risk if initiated promptly (i.e.,<60 years or within ten years of the final menstrual period). Transdermal estradiol and micronized progesterone or dydrogesterone are the safest regimens in terms of venous thromboembolic events (VTE) and breast cancer risk. In any case, an individualized approach, taking into account the patient's total CVD, VTE and breast cancer risk, is recommended.
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Thesis
p>In a group of middle-aged men we measured blood pressure, fasting lipids and glucose, BMI, waist circumference, skin fold thickness, total fat on DEXA, bioimpedance, and plethysmography and visceral fat on MRI. We measured insulin sensitivity in muscle and liver using a euglycaemic, hyperinsulinaemic clamp technique with deuterated glucose, and suppression of non-esterified fatty acids during an oral glucose tolerance test. We demonstrated that BMI and waist correlate strongly with measures of visceral and truncal fat and also to insulin sensitivity and other metabolic syndrome features. We measured hepatic steatosis using ultrasonography and demonstrated that fatty liver is associated with impaired suppression of non-esterified fatty acids, independently of body fat, indicating that men with fatty liver have abnormal adipocytes function. We found that a strong correlation between metabolism of cortisol measured by clearance of a tracer bolus of deuterated cortisol and insulin sensitivity in muscle and adipose tissue which was independent of body fat, suggesting that exposure to cortisol is higher in insulin-resistant individuals. We measured fitness by oxygen uptake during maximal exercise, and physical activity energy expenditure using heart-rate monitoring. We did not find that either fitness of energy expenditure were related to insulin sensitivity independently of body fat suggesting that the beneficial effects of exercise are mediated through changes in body composition.</p
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Aim: This study aims to explore the incidence and risk factors for permanent colostomy complicated with a parastomal hernia (PSH) after rectal cancer resection. Methods: This was a retrospective study of gastrointestinal surgery performed from January 2013 to December 2017 in patients with colorectal cancer treated at the Affiliated Hospital of Qingdao University. The relevant clinical variables of the patient were analyzed. Kaplan-Meier, univariate, and Cox multivariate analyses were used to evaluate the influencing factors and morbidity of PSH. Results: Among the 211 patients, 65 developed PSH. The cumulative incidence reached 33.5% at 62 months. In the multivariate Cox survival analysis, the results showed that being a woman, aged ≥65 years, having a body mass index (BMI) ≥ 25 kg/m2 , diabetes, and Clavien-Dindo Grade III and IV complications were risk factors for the occurrence of PSH. Conclusion: In our study, the incidence of PSH increased annually and reached a maximum of 33.5% after 62 months. Among the patient-related factors, female sex, age ≥65 years, BMI ≥ 25 kg/m2 , diabetes, and postoperative Clavien-Dindo Grade III and IV complications were significantly associated with the development of PSH. Therefore, intervention measures to prevent patients with this risk factor are advisable.
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Background: Body composition parameters changes in women before and after menopause which makes ageing more complex and stressful in women. Objective: to compare the body composition parameters among pre and post menopausal women. Methods: A cross-sectional study, conducted in the population around Rural Health Training Centre (RHTC), Barabanki district between May to December 2016 among women in the age group 25-65 years. Body composition parameters of 348 women (total and visceral fat distribution) by bioelectric impedance method (for Model: OMRON Hbf 375) was noted for all the pre-menopausal and post-menopausal women. The variables included -weight, BMI, body fat percentage (BF %) and visceral fat percentage (VF %), Body Surface Area (BSA), Body volume index (BVI), Body volume (BV) and Lean body weight (LBM). Result: The difference in body composition parameters in the pre and post-menopausal groups is found to be statistically significant in waist circumference, waist-hip ratio, BMI and visceral fat p<0.05. Conclusion: There is increase in body composition parameters during post-menopausal period. A deeper aspect on prevention of obesity after menopause is required to be studied.
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Giriş ve Amaç: Çalışmamız premenopozal dönemdeki kadınlarda dairesel antrenman eğitiminin vücut kompozisyonuna etkisini araştırmak amacıyla planlanmıştır. Gereç ve Yöntemler: Bu çalışmaya Denizli’de yaşayan premenopozal dönemde olan 35-53 yaşları arasında 49 kadın (ortalama yaş: 39,32±4,16 yıl.) dâhil edilmiştir. Kadınlara 8 hafta dairesel antrenman eğitimi (haftada 5 gün, günde 1 kez 30 dakika) bir Fizyoterapist tarafından verilmiştir. Bu eğitim kişilerin kendi kapasite ve hızlarına uygun olarak 9 adet izokinetik istasyon çalışması ve aerobik egzersizlerden oluşmaktadır. Çalışma, 30 saniye yüklenme, 30 saniye aerobik egzersizden oluşmuştur. Egzersiz istasyonları abdominal, sırt, kalça, diz, omuz ve dirsek çalışmalarını içermektedir. Eğitimden önce ve 8 hafta sonra vücut kompozisyonuna ait ölçümler (göğüs, bel, kalça, üst ekstremite ve alt ekstremite çevre ölçümleri ve baskül ile vücut ağırlığı, yağ ve su miktarı) alınmıştır. Nutrisyonel Risk Taraması Ölçeği (Nutritional Risk Screening) kullanılarak toplanmıştır. Bulgular: 8 haftalık eğitim sonunda çalışmaya alınan kadınların vücut ağırlığı önemli düzeyde azalmıştır (p=0,0001). Vücut kompozisyonuna ait ölçümler karşılaştırıldığında su ve kas miktarı (p>0,05) hariç tüm ölçümlerde eğitim sonunda önemli düzeyde azalma meydana gelmiştir (p=0,0001). Sonuç: Çalışmamızın sonuçları göstermiştir ki premenopozal dönemdeki kadınlarda dairesel antrenman eğitimi vücut kompozisyonuna olumlu yönde etki etmektedir.
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Skin changes that accompany aging lead many to seek treatments that restore a more youthful appearance. Common issues of concern include skin tone, wrinkles, skin thinning, sagging, laxity and decreased elasticity, and hollowing of the face. This work discusses these concerns and their anatomic bases and highlights evidence for a causal role played by menopause-associated hormonal changes where such evidence exists. In addition, treatment options are discussed, with an emphasis on minimally invasive approaches. A variety of modalities are discussed, including botulinum toxins, fillers, multiple types of lasers, radiofrequency devices, focused ultrasound, chemical peels, and thread lifts. These interventions, often in combination, can achieve goals of patients seeking aesthetic rejuvenation.
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The body is comprised of water, lipids, protein and minerals. The absolute amounts and relative proportions of these compounds change throughout the life cycle. Growth, maturation, and aging, as well as other factors such as disease, nutrition and behavior alter the chemical composition of the body. This chapter will review methods of assessing body composition, the changes in body composition associated with growth and maturation, the role of body composition in determining nutritional needs, and the importance of body composition in human health and disease.
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Adult weight gain is a good indicator of excess body fatness for breast cancer risk. However, little is known about the effect of weight gain during other special periods in women's lifetime. A publication search in PubMed and Embase through April 2020 was conducted. A primary meta-analysis comparing the highest and lowest category and a secondary meta-analysis based on dose-response meta-analysis were performed to calculate risk estimates with 95% confidence intervals using a random-effects model. For postmenopausal breast cancer, the relative risk for highest vs. lowest category of adult weight gain and weight gain since menopause were 1.55 and 1.59 (RR = 1.55, 95% CI: 1.40, 1.71; RR = 1.59, 95% CI: 1.23, 2.05). For per 5 kg increase in adult weight gain, the summary RR of postmenopausal breast cancer was 1.08 (RR = 1.08, 95% CI: 1.07, 1.09), which is much stronger in Asian women (RR = 1.34, 95% CI: 1.22, 1.47). There was no significant finding among premenopausal women (RR = 1.00, 95% CI: 0.83, 1.21). Same as adult weight gain, weight gain since menopause might be an equivalent predictor for postmenopausal breast cancer risk. More studies are warranted to confirm the magnitude of this association further.
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Résumé Introduction La polyarthrite rhumatoïde (PR) peut provoquer des modifications de la composition corporelle (masse maigre [MM]/masse grasse [MG]) liées à l’inflammation chronique. Nos objectifs étaient d’évaluer la variation de la composition totale du corps et sa répartition aux niveaux androïde et gynoïde chez les patients atteints de PR comparativement à un groupe témoin, ainsi que d’étudier l’influence de l’activité de la maladie sur la composition corporelle. Méthodes Il s’agissait d’une étude cas-témoins portant sur 50 malades appariés par l’âge et le sexe à 50 témoins. Nous avons recueilli pour chaque patient les données sociodémographiques, les caractéristiques cliniques de la maladie, ainsi que les données biologiques, radiologiques et thérapeutiques. La mesure de la répartition de la masse corporelle a été réalisée par absorptiométrie biphotonique à rayons X (DEXA). Résultats L’âge moyen des patients étudiés était de 55 ans. Les malades étaient comparables en termes de mesure de la MM et de la MG, ainsi que sa répartition androïde et gynoïde par rapport à leurs témoins. Les patients avec un âge supérieur à la médiane présentaient une réduction statistiquement significative de la MG au niveau androïde par rapport aux témoins. La MM du corps entier était corrélée à la protéine C réactive, à l’indice Simplified disease activity index (SDAI), à la corticothérapie, à l’indice de Sharp (érosion), et au T-score de l’extrémité supérieure du fémur. Conclusion Nous avons mis en évidence une corrélation entre la composition corporelle et plusieurs paramètres cliniques, biologiques, radiologiques et thérapeutiques au cours de la PR. D’autres études prospectives et multicentriques permettront de mieux étudier ces modifications corporelles.
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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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We performed a cross-sectional study using whole-body computerized tomographic (CT) scans in order to clarify age-related changes in whole-body fat distribution in both genders. The subjects were 66 men and 96 women, whose body mass index (BMI) was over 25 kg/m2. CT scans were performed at seven levels (head, fore-arms, upper arms, chest, abdomen, thighs and calves), and the fat volumes of the segments were calculated from the cross-sectional areas of the fat tissues. After calibrating to the total fat volumes, the relationship between age and the relative segmental fat volumes was analysed. In both genders, the relative intra-abdominal visceral fat volume increased and that of the legs decreased with age. The relative abdominal subcutaneous fat volume decreased with age only in male subjects. The increase in the relative visceral fat volume with age was about 2.6 times larger in males than in pre-menopausal females, while post-menopausal females showed the same increase as male subjects. These data suggest that there is a definite gender difference in the age-related changes in whole-body fat distribution, especially in the abdominal fat tissues. In addition, the accumulation of visceral fat is markedly accelerated by menopause in women.
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Preliminary studies suggest that the menopause transition is associated with deleterious changes in body composition and abdominal fat distribution. Limitations of the methodology used in these studies, however, render their conclusions controversial. Thus, the present study used radiologic imaging techniques to examine the effect of menopausal status on body composition and abdominal fat distribution. Cross-sectional. Fifty-three healthy, middle-aged, premenopausal women (mean+/-SD; 47+/-3 y) and 28 early-postmenopausal women (51+/-4 y). Total and regional body composition by dual energy X-ray absorptiometry and abdominal fat distribution by computed tomography. No differences in total body fat-free mass or appendicular skeletal muscle mass were noted between groups. In contrast, total body fat mass was 28% higher (23+/-7 vs 18+/-7 kg) and percentage fat 17% higher (35+/-6 vs 30+/-9%; both P<0.01) in postmenopausal women compared with premenopausal women. Postmenopausal women had a 49% greater intra-abdominal (88+/-32 vs 59+/-32 cm2; P<0.01) and a 22% greater abdominal subcutaneous fat area (277+/-93 vs 227+/-108 cm2; P<0.05) compared to premenopausal women. The menopause-related difference in intra-abdominal fat persisted (P<0.05) after statistical adjustment for age and total body fat mass, whereas no difference in abdominal subcutaneous fat was noted. A similar pattern of differences in total and abdominal adiposity was noted in sub-samples of pre- and postmenopausal women matched for age or fat mass. Our data suggest that early-postmenopausal status is associated with a preferential increase in intra-abdominal fat that is independent of age and total body fat mass. International Journal of Obesity (2000) 24, 226-231
Article
. 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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The aim of the study was to compare body fat distribution and metabolic variables in pre- and post-menopausal women. Body fat distribution was measured using abdominal circumference and computerized tomography. No significant differences were found between the two groups as regards body weight, body mass index, waist-hip ratio and total abdominal adipose tissue areas. Subcutaneous abdominal adipose tissue areas were significantly higher in premenopausal women whereas visceral abdominal adipose tissue areas and the subcutaneous to visceral abdominal adipose tissue area ratios were significantly higher in post-menopausal subjects. After adjusting for body mass index, no significant differences emerged between the two groups as regards total abdominal adipose tissue areas, waist circumference, hip circumference and waist-hip circumference ratio; subcutaneous abdominal adipose tissue areas were significantly lower and both visceral abdominal adipose tissue areas and visceral to subcutaneous abdominal adipose tissue area ratios significantly higher in post-menopausal women (P less than 0.01). Basal glucose, sum of blood glucose values during oral glucose tolerance test and blood cholesterol values were significantly higher in the post-menopausal group (P less than 0.05), while no significant difference was observed in sum of blood insulin values during oral glucose tolerance test. Basal plasma insulin values, systolic blood pressure and diastolic blood pressure were higher in post-menopausal women, though the differences were not significant. Only blood cholesterol was significantly higher in post-menopausal women after adjusting for visceral abdominal adipose tissue areas. Positive correlations emerged between age and waist-hip ratio (P less than 0.05), visceral abdominal adipose tissue areas and the visceral to subcutaneous abdominal adipose tissue area ratio (P less than 0.001). A negative correlation was established between age and subcutaneous abdominal adipose tissue areas (P less than 0.01). There was a significant correlation between visceral abdominal adipose tissue areas and metabolic and haemodynamic variables in both pre- and post-menopausal women. In pre-menopausal women, body mass index correlated with basal glucose, basal insulin, sum of glucose during oral glucose tolerance test and systolic and diastolic blood pressure (P less than 0.05). When stepwise multiple regression analysis was used to evaluate the joint effect of anthropometric variables on metabolic variables, visceral abdominal adipose tissue area proved to be the most powerful variable for predicting metabolic disorders. Our data suggest that visceral abdominal adipose tissue areas and visceral to subcutaneous abdominal adipose tissue area ratios increase with age. Obesity correlates directly with the amount of subcutaneous fat, but not with the distribution pattern.(ABSTRACT TRUNCATED AT 400 WORDS)
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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 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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In over 30 years of surveillance of 2873 women, 574 developed initial clinical manifestations of CHD. A number of antecedent metabolic risk factors proved atherogenic, including blood lipids, glucose tolerance, uric acid, and menopause. Serum total cholesterol predicts as strongly in women as in men. The predictive power of cholesterol is strengthened when the total cholesterol is partitioned into its atherogenic LDL and protective HDL fractions. Contrary to the case in men, triglyceride may be a contributor to risk in older women. A total-to-HDL cholesterol ratio exceeding 7.5 equalizes the risk in men and women. Impaired glucose tolerance also eliminates the female CHD risk advantage over men, conferring a three-fold increased risk. Serum uric acid, although lower in women than in men, is equally predictive in the sexes. Central obesity confers an increased CHD risk in women and predisposes to diabetes, hyperuricemia, hypertension, and an unfavorable LDL/HDL cholesterol ratio. A combination of obesity, low HDL cholesterol, and impaired glucose tolerance predisposes especially. Age-adjusted risk of CHD is increased two- to threefold compared to pre menopausal women, even when induced surgically without removing the ovaries. It is not clear whether post menopausal estrogen replacement eliminates this excess risk. Fibrinogen is higher in women than in men, and is increased with hypertension, diabetes, hypercholesterolemia, high hematocrit, and cigarette smoking. At any level of multivariate risk, fibrinogen added to the CHD risk in women.
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Coronary heart disease (CHD) is the leading cause of death in women, and the risk of this disease rises markedly after loss of ovarian function. Hormone replacement therapy (HRT) can reduce the incidence of CHD in postmenopausal women by 50%. HRT causes changes in lipids and lipoproteins, but it is now clear that many other effects of gonadal steroid hormones have important influences on the cardiovascular system. These nonlipid effects include a variety of changes in other metabolic risk factors for CHD, as well as direct arterial effects. Insulin resistance and hyperinsulinaemia may be pivotal disturbances in the pathogenesis of CHD. Estradiol reverses the effects of menopause on glucose and insulin metabolism, resulting in an increase in pancreatic insulin secretion and a decrease in insulin resistance, although other types of estrogen may not do this. Androgenic progestogens may oppose this potentially beneficial effect on insulin resistance. Central obesity is linked with many CHD risk factors, and HRT reverses the increased fat distribution that results from loss of ovarian function at the menopause. HRT may also improve the balance between coagulation and fibrinolysis, resulting in a reduction in arterial thrombosis. Finally, estradiol acts directly on the arterial wall, modifying both endothelium-dependent and calcium-dependent processes. These actions result in improved blood flow and reduced blood pressure and, importantly, have the potential to reduce myocardial ischaemia.
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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.
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To assess the variation with age and menopause, 407 healthy normal women aged 18 to 75 years had body composition and fat distribution measured by dual-energy x-ray absorptiometry (DEXA). The mean +/- SD are given for different age decades. Postmenopausal women had significantly more fat, a more central fat distribution, and less lean tissue mass (LTM) than premenopausal women. In premenopausal and postmenopausal women, age only correlated with the abdominal to total-body fat tissue ratio (r approximately .24, P < .05), whereas the years since onset of menopause correlated with fat tissue mass (FTM), fat%, abdominal fat%, and the abdominal to total-body fat tissue ratio (r approximately .2, P < .05). To assess the independent impact of age, menopausal status, and years since menopause, multiple linear regressions were performed. FTM, fat%, and abdominal fat% were significantly related to menopausal status and years since menopause independently of age. The abdominal to total-body fat tissue ratio was statistically significantly related to age, but tended also to be independently related to years since menopause. LTM was statistically significantly related to menopausal status independently of age and years since menopause. In summary, we suggest that in healthy women total-body and abdominal fat may increase and LTM may decrease in the years after menopause, primarily in the perimenopausal years, without significant changes before menopause.
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The amount of abdominal visceral adipose tissue measured by computed tomography is a critical correlate of the potentially "atherogenic" metabolic disturbances associated with abdominal obesity. In this study conducted in samples of 81 men and 70 women, data are presented on the anthropometric correlates of abdominal visceral adipose tissue accumulation and related cardiovascular disease risk factors (triglyceride and high-density lipoprotein cholesterol levels, fasting and postglucose insulin and glucose levels). Results indicate that the waist circumference and the abdominal sagittal diameter are better correlates of abdominal visceral adipose tissue accumulation than the commonly used waist-to-hip ratio (WHR). In women, the waist circumference and the abdominal sagittal diameter also appeared more closely related to the metabolic variables than the WHR. When the samples were divided into quintiles of waist circumference, WHR or abdominal sagittal diameter, it was noted that increasing values of waist circumference and abdominal sagittal diameter were more consistently associated with increases in fasting and postglucose insulin levels than increasing values of WHR, especially in women. These findings suggest that the waist circumference or the abdominal sagittal diameter, rather than the WHR, should be used as indexes of abdominal visceral adipose tissue deposition and in the assessment of cardiovascular risk. It is suggested from these data that waist circumference values above approximately 100 cm, or abdominal sagittal diameter values > 25 cm are most likely to be associated with potentially "atherogenic" metabolic disturbances.
Article
To determine whether percent body fat (%BF) is overestimated in older people by hydrodensitometry (HD) because of an age-related decrease in bone mineral content (BMC), body composition of 113 women and 72 men (21-81 yr) was assessed by HD and dual-energy X-ray absorptiometry (DEXA). DEXA provides an estimate of %BF adjusted for differences in BMC. HD %BF and DEXA %BF were not different in young people [21-39 yr; 17.6 +/- 6.4 (SD) vs. 17.6 +/- 7.2%, NS], were slightly, but significantly, different in middle-aged people (40-59 yr; 25.5 +/- 6.4 vs. 24.1 +/- 6.7%, P < 0.05), and showed the largest disparity in older people (> or = 60 yr; 34.9 +/- 7.9 vs. 30.8 +/- 8.7%, P < 0.05). The discrepancy in older people was apparently not due to mineral loss, however, inasmuch as correction of HD %BF for variance in BMC as a fraction of fat-free mass resulted in only small adjustments (approximately 1%) of %BF. Assessment of DEXA %BF was further evaluated in nine subjects with packets of lard (2-3 kg) overlying either the thigh or the trunk region. Only 55% of the exogenous fat was identified as fat when it was in the trunk region compared with 96% when it was positioned over the legs. These data suggest that the age-related increase in upper body adipose tissue is underestimated by DEXA.
Article
To investigate the relationship between reproductive history and body composition. Prospective population study in Sweden. 1462 randomly selected women representing five separate age cohorts (38, 46, 50, 54 and 60 at the 1968-1969 baseline examination) have been followed longitudinally. Relative weight, fat distribution, and fat cellularity were related to menarche, parity, lactation, menopause and oestrogen medication. Age of menarche did not show any association with subsequent fat distribution, nor did length of lactation time. On the other hand parity was positively associated to total as well as central obesity, and lactation time was positively associated to abdominal fat cell diameter. Premenopausal women showed higher mean body weight and hip circumference than postmenopausal women of the same age. Change from pre- to postmenopausal status was associated with increase of waist circumference as well as reduction of hip circumference, resulting in an increased waist-hip ratio (WHR). Oestrogen replacement suggested some postponement of this increase. Parity and menopause are the reproductive factors most associated with gradual changes in body fat distribution. Oestrogen medication seems to play an additional role in diminishing waist circumference increase and could thus contribute to decreased cardiovascular morbidity in women.
Article
Determine whether the independent inter-relationships between intra-abdominal adipose tissue (IAF) cardiovascular disease (CVD) risk, and physical activity (PA) support the hypothesis that the beneficial effect of PA of CVD risk is mediated through the effects of activity on IAF. Cross-sectional. 220 female Caucasian women 17-77 years old. Computed tomography IAF and subcutaneous abdominal adipose tissue (SAF), percent fat, CVD risk factors (blood lipids and blood pressure) and PA using the Baecke questionnaire. Zero-order correlations indicated that IAF, SAF, percent fat, age, menopausal status (MS), and all 4 of the PA indexes were consistently related to CVD risk. After adjusting for age, MS, SAF, and percent fat, IAF was negatively related to PA (r2 = 0.04), indicating that more active women had relatively small IAF compared to other fat depots. After adjusting for IAF, MS, and age none of the PA indexes were related to any of the CVD risk factors except cholesterol/HDL ratio (partial r2 = 0.02). However, after adjusting for PA, MS and age, IAF was related to all CVD risk factors except cholesterol (partial r2 = 0.03-0.23). These results support the hypothesis that PA may obtain at least part of its effect on CVD risk by reducing IAF.
Article
Whether menopause per se influences fat distribution independently of the effect of aging remains controversial. The lack of consistency in the menopause related changes in body fat distribution may be the result of differences in the methods for measuring fat distribution or in the characteristics of the women studied. The aim of this cross sectional study in obese women was to compare total body composition and regional fat and lean distribution, in premenopausal, perimenopausal and postmenopausal women. Body composition was assessed by dual energy X-ray absorptiometry (DEXA) in premenopausal (n = 26), perimenopausal (n = 24) and postmenopausal (n = 73) obese women with no intercurrent diseases. It was shown that postmenopausal obese (n = 73) women had a higher proportion of total fat mass in the trunk and a lower proportion of total fat and lean mass in the femoral and leg regions than premenopausal women after adjustment for age and total fat mass. In the same analysis, perimenopausal women had a lower proportion of total fat in the leg and femoral regions and of total lean in the femoral region than premenopausal women; they had a regional body composition similar to that of postmenopausal women. The present data indicate that in obese women, post menopause and perimenopause are associated with differences in fat and lean distribution, independently of age and total fat.
Article
We measured total and regional body composition to evaluate the differences in body composition associated with menopause and to determine whether the changes in fat distribution were more related to age or to menopause. Two hundred five healthy white women who had never received estrogen replacement therapy were studied according to menopausal status and age. Bone mass and body composition were measured by dual x-ray absorptiometry. The proportions of android and gynoid fat were calculated in all women and differences were sought by statistical analysis. Compared with premenopausal women, postmenopausal women were characterized by a significant increase in the proportion of android fat and the ratio trunk fat/leg fat, whereas the absolute amount of body fat mass did not significantly change. The different variables of android fat distribution tended to correlate better with years since menopause than with age. In multiple linear regression, years since menopause was a predictor of body fat mass and fat trunk, whereas age was not a predictor of any of the fat distribution variables. This study underlines the early changes in body fat distribution with a shift of body fat toward a more central location in postmenopausal women. This change in fat distribution appears to be more related to menopause than to age and might, together with other factors, contribute to explain the increased cardiovascular risk reported in postmenopausal women.
Article
The menopause transition increases cardiovascular and metabolic disease risk, partly because of the adverse effects of estrogen deficiency on the plasma lipid-lipoprotein profile and cardiovascular function. This increased cardiovascular and metabolic disease risk may also be partially mediated by increased body fat, increased intra-abdominal adipose tissue accumulation, or both. The objective of this mini-review is to summarize studies that have investigated the relationships among the menopause transition, body fatness, and body fat distribution. A review of cross-sectional and longitudinal studies on menopause that examined body fatness and body fat distribution. Cross-sectional reports show that the menopause transition is related to modest increases in body mass index or total fatness, although not all studies found significant effects. Increased central adiposity appears to be related to menopause, independent of advancing age, but these results are methodology dependent. An independent effect of menopause on central body fatness was noted by the use of techniques such as DEXA or computed tomography, whereas studies using circumference measures showed discrepant results. Longitudinal studies showed that the menopause transition accelerated the increase in central adiposity, although no studies quantified changes in intra-abdominal fat by imaging techniques. Thus, additional longitudinal studies using more accurate measures of adiposity are needed to critically examine the effects of the menopause transition on total and central body fatness. Collectively, previous studies suggest that menopause is related to modest increase in total fatness and accelerated accumulation of central body fat that exceeds changes normally attributed to the aging process. These changes may increase the risk for cardiovascular and metabolic disease in aging women.
Dual energy X‐ray absorptiometry body composition model: review of physical concepts
  • Pieterobelli A.