Menopausal changes in body composition and energy expenditure

Impedance Analysis to Evaluate Nutritional Status in Physiological and Pathological Conditions

A thorough knowledge of body composition assessment techniques is the cornerstone for initiating a customized nutritional program. The second step is to consider the potential of their application in different physiological and pathological conditions and their effectiveness in the management of a monitoring pathway during dietary interventions. To date, bioimpedance analysis is the most effective and reliable method for assessing body composition due to its advantages in terms of speed of execution, non-invasiveness and low cost. Therefore, this review article aims to analyze the main concepts and application areas of bioimpedance measurement techniques, in particular vector frequency-based analysis (BIVA) systems, in order to assess their validity in both physiological and pathological conditions.

Different correlation of body mass index with body fatness and obesity-related biomarker according to age, sex and race-ethnicity

The relationship between body mass index (BMI) and body fatness could differ according to age, sex, and race-ethnicity. We aimed to evaluate in which contexts BMI could be a good measure for body fatness compared to dual-energy X-ray absorptiometry (DXA) derived measures. The study population included 18,061 participants (9141 men and 8920 women) aged 18 and older who tested DXA from the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2006, and 8107 men and 10,754 women with DXA data from Korea NHANES from 2008 to 2011 to represent the Asian population. We calculated Pearson correlation coefficients between BMI and DXA derived fat mass index (FMI) and percentage body fat (PBF) depending on age, sex, and race-ethnicity. The correlation between BMI, FMI and PBF and obesity-related biomarkers was also estimated among the subgroup with both DXA and information on each biomarker. BMI was strongly correlated with FMI (r = 0.944 in men and 0.976 in women), PBF (r = 0.735 in men and 0.799 in women), and truncal fat mass (r = 0.914 in men and 0.941 in women) with correlations stronger in women than in men except for with waist-height ratio (r = 0.921 in men and 0.911 in women). The correlation between BMI and DXA derived adiposity weakened with age in both sexes. BMI was less correlated with FMI (r = 0.840 in men and 0.912 in women), PBF (r = 0.645 in men and 0.681 in women), and truncal fat mass (r = 0.836 in men and 0.884 in women) in Korean compared to other race-ethnicities. Among obesity-related biomarkers, insulin was the most strongly correlated to body adiposity indices in both sexes and strength of these correlations generally decreased with age. BMI predicted obesity-related biomarkers as well as FMI and truncal fat mass and superior to PBF. BMI could be a good measure for body fatness, particularly among young age groups, women, the US population, but less so in Korean populations. The lower correlation between BMI and body fatness in older compared to younger age groups could be related to increasing PBF and decreasing lean body mass.

Examining negative affect, sleep duration, and using food to cope as predictors of weight in midlife women

Midlife women are vulnerable to developing obesity. Behavioral and psychosocial factors including sleep duration, stress eating, and negative emotionality are risk factors. However, little is known about the complex daily interplay between sleep, eating, emotion, and weight among midlife women. The current study examined how daily sleep, using food to cope, and negative emotionality are associated with weight using a daily process research design. An archival analysis was performed using the Midlife in the United States-II study (MIDUS II). The sample consisted of 489 midlife women (40-64 years of age). Variables included ecological momentary assessments of daily sleep duration, using food to cope, and negative affect (means and intraindividual variability) and a standardized measurement of BMI. Sleep duration variability was a significant predictor of BMI, albeit the model only accounted for .8% of the variance in BMI (b = .019, p < .05). In the final adjusted model, sleep duration variability, using food to cope, age, and physical activity were all significant predictors of BMI F(5, 559) = 21.503, p < .001, R² = .161, ⨂R² = .024, p = .001. Variability in negative affect, mean sleep duration or negative affect and the interactions between sleep duration (mean, variability) and negative affect (mean, variability) were not significant. Greater variability in sleep duration and greater use of food to cope predicted higher BMI in this sample across age and physical activity levels. Results highlight that daily health and psychosocial factors play an important role in weight.

Energy Metabolism in Gynecological Cancers: A Scoping Review

Determining energy requirements is vital for optimizing nutrition interventions in pro-catabolic conditions such as cancer. Gynecological cancer encompasses the most common malignancies in women, yet there is a paucity of research on its metabolic implications. The aim of this review was to explore the literature related to energy metabolism in gynecological cancers. We were particularly interested in exploring the prevalence of energy metabolism abnormalities, methodological approaches used to assess energy metabolism, and clinical implications of inaccurately estimating energy needs. A search strategy was conducted from inception to 27 July 2021. Studies investigating energy metabolism using accurate techniques in adults with any stage of gynecological cancer and the type of treatment were considered. Of the 874 articles screened for eligibility, five studies were included. The definition of energy metabolism abnormalities varied among studies. Considering this limitation, four of the five studies reported hypermetabolism. One of these studies found that hypermetabolism was more prevalent in ovarian compared to cervical cancer. Of the included studies, one reported normometabolism at the group level; individual-level values were not reported. One of the studies reported hypermetabolism pre- and post-treatment, but normometabolism when re-assessed two years post-treatment. No studies explored clinical implications of inaccurately estimating energy needs. Overall, commonly used equations may not accurately predict energy expenditure in gynecological cancers, which can profoundly impact nutritional assessment and intervention.

Synergism effect of swimming exercise and genistein on the inflammation, oxidative stress, and VEGF expression in the retina of diabetic-ovariectomized rats

AIMS

Retinal neovascularization is one of the visual disorders during the postmenopausal period or types two diabetes. Physical activities and also phytoestrogens with powerful antioxidant features have been widely considered to improve nervous system diseases. Therefore, this study investigated the effects of genistein, swimming exercise, and their co-treatment on retina angiogenesis, oxidative stress, and inflammation in diabetic-ovariectomized rats.

MAIN METHODS

Wistar rats were randomly divided into six groups (n = 8 per group): sham, ovariectomized group (OVX), OVX + diabetes (OVX.D), OVX.D+ genistein (1 mg/kg, eight weeks; daily SC), OVX.D + exercise (eight weeks), and OVX.D+ genistein+exercise (eight weeks). At the end of 8 weeks, the retina was removed under anesthesia. The assessed effects of treatment were by measuring MiR-146a and miR-132 expression via RT-PCR, the protein levels of ERK, MMP-2, VEGF, and NF-κB via western blotting, inflammation, and oxidative stress markers levels via the Eliza.

KEY FINDINGS

The results showed miR-132, miR-146b, and MMP-2, NF-κB, ERK, VEGF, TNF-α, IL-1β proteins, and MDA factor in the OVX.D group were increased, but glutathione (GSH) was decreased in comparison with the sham and OVX groups. Both exercise and genistein treatment has reversed the disorder caused by diabetes. However, the combination of exercise and genistein was more effective than each treatment alone.

SIGNIFICANCE

It can be concluded that the interaction of exercise and genistein on microRNAs and their target protein was affected in the inflammation, stress oxidative, and extracellular matrix metalloproteinase pathways, can leading to a decrease in impairment of retinal neovascularization of the ovariectomized diabetic rats.

Physical activity energy expenditure and fat-free mass: relationship with metabolic syndrome in overweight or obese postmenopausal women

Menopause transition is associated with detrimental changes in physical activity, body composition, and metabolic profile. Although physical activity energy expenditure (PAEE) is inversely associated with metabolic syndrome (MetS) in individuals at higher risk of cardiovascular disease, the association is unknown in low-risk individuals. The aim of the study was to investigate the association between PAEE and MetS (prevalence and severity) in inactive overweight or obese postmenopausal women with a low Framingham Risk Score (<10%). Cross-sectional data of 126 participants were divided into quartiles based on PAEE (Quartile (Q)1 = lowest PAEE) while fat-free mass (FFM) and fat mass were measured by dual-energy X-ray absorptiometry. MetS prevalence was significantly different between Q1 and Q4 (37.9% vs 13.3%, p = 0.03). After controlling for potential confounders, MetS severity was negatively associated with PAEE (B = -0.057, p < 0.01) and positively with FFM (B = 0.038, p < 0.001). Moderation analyses indicated that a greater FFM exacerbated the association between PAEE and MetS severity in Q1 and Q2 (PAEE × FFM; B = -0.004; p = 0.1). Our results suggest that displaying a low FRS and lower PAEE increase MetS prevalence and severity. In addition, greater FFM interacts with lower PAEE to worsens MetS severity, while higher PAEE lessened this effect. Novelty: Inactive individuals displaying higher daily PAEE also have a lower MetS prevalence. Greater FFM is associated with a worse MetS severity where a higher PAEE mitigated this deleterious effect in our cohort.

Differential Impact of Calcium and Vitamin D on Body Composition Changes in Post-Menopausal Women Following a Restricted Energy Diet and Exercise Program

Vitamin D and calcium supplementation have been posited to improve body composition and different formulations of calcium may impact bioavailability. However, data are lacking regarding the combinatorial effects of exercise, diet, and calcium and/or vitamin D supplementation on body composition changes in post-menopausal women. Herein, 128 post-menopausal women (51.3 ± 4.5 years, 36.4 ± 5.7 kg/m², 46.2 ± 4.5% fat) were assigned to diet and supplement groups while participating in a supervised circuit-style resistance-training program (3 d/week) over a 14-week period. Diet groups included: (1) normal diet (CTL), (2) a low-calorie, higher protein diet (LCHP; 1600 kcal/day, 15% carbohydrates, 55% protein, 30% fat), and (3) a low-calorie, higher carbohydrate diet (LCHC; 1600 kcal/day, 55% carbohydrates, 15% protein, 30% fat). Supplement groups consisted of: (1) maltodextrin (PLA), (2) 800 mg/day of calcium carbonate (Ca), and (3) 800 mg/day of calcium citrate and malate and 400 IU/day of vitamin D (Ca+D). Fasting blood samples, body composition, resting energy expenditure, aerobic capacity, muscular strength and endurance measures were assessed. Data were analyzed by mixed factorial ANOVA with repeated measures and presented as mean change from baseline [95% CI]. Exercise training promoted significant improvements in strength, peak aerobic capacity, and blood lipids. Dieting resulted in greater losses of body mass (CTL -0.4 ± 2.4; LCHC -5.1 ± 4.2; LCHP -3.8 ± 4.2 kg) and fat mass (CTL -1.4 ± 1.8; LCHC -3.7 ± 3.7; LCHP -3.4 ± 3.4 kg). When compared to LCHC-PLA, the LCHC + Ca combination led to greater losses in body mass (PLA -4.1 [-6.1, -2.1], Ca -6.4 [-8.1, -4.7], Ca+D -4.4 [-6.4, -2.5] kg). In comparison to LCHC-Ca, the LCHC-Ca+D led to an improved maintenance of fat-free mass (PLA -0.3 [-1.4, 0.7], Ca -1.4 [-2.3, -0.5], Ca+D 0.4 [-0.6, 1.5] kg) and a greater loss of body fat (PLA -2.3 [-3.4, -1.1], Ca -1.3 [-2.3, -0.3], Ca+D -3.6 [-4.8, -2.5]%). Alternatively, no significant differences in weight loss or body composition resulted when adding Ca or Ca+D to the LCHP regimen in comparison to when PLA was added to the LCHP diet. When combined with an energy-restricted, higher carbohydrate diet, adding 800 mg of Ca carbonate stimulated greater body mass loss compared to when a PLA was added. Alternatively, adding Ca+D to the LCHC diet promoted greater% fat changes and attenuation of fat-free mass loss. Our results expand upon current literature regarding the impact of calcium supplementation with dieting and regular exercise. This data highlights that different forms of calcium in combination with an energy restricted, higher carbohydrate diet may trigger changes in body mass or body composition while no impact of calcium supplementation was observed when participants followed an energy restricted, higher protein diet.

The Role of Energy Intake on Fitness-Adjusted Racial/Ethnic Differences in Central Adiposity Using Quantile Regression

BACKGROUND

Energy intake (EI) is suggested to be associated with adiposity and may explain previously observed fitness-adjusted racial disparities in waist circumference (WC).

OBJECTIVE

The purpose of this study was to comprehensively evaluate the role of EI on the fitness-adjusted racial/ethnic disparities in WC in a nationally representative sample of females using quantile regression.

METHODS

Our sample consisted of 3874 female participants (aged 12 to 49 years) from the 1999-2004 National Health and Nutrition Examination Survey. The role of EI was assessed in separate analyses via estimation using a 24-hour dietary recall (DR) and the Institute of Medicine total daily energy expenditure equations. Age-stratified quantile regression models were used to estimate the differences in WC between minority groups and non-Hispanic (NH) white, adjusting for EI, CRF, age, and height.

RESULTS

Results from the quantile regression analyses adjusting for EI via DR showed significant differences in WC between NH black and NH white at the 25th-90th WC percentiles (5.9-11.1 cm) for females 20-49 and at the 90th WC percentile (10.1 cm) for females 16-19. For females 12-15, no significant differences were observed between NH black and NH white. Analyses adjusting for EI via IOM showed significant differences in WC between NH black and NH white only for females aged 20-49 years, at the 50th and 75th percentile (1.7-3.6 cm). Compared to NH White, Mexican American females, in all age groups, tended to have significantly greater WC.

CONCLUSIONS

These results highlight the importance of rigor in energy intake assessments, suggesting that EI, if adequately assessed, may explain a substantial part of the racial/ethnic differences in WC between NH black and NH white females. Additionally, the observed persistence of estimated differences in WC with advancing age suggests other factors (e.g., hormones) may play a role.

Trajectory and determinants of change in lean soft tissue over the postpartum period

The aim of this study was to characterise changes in lean soft tissue (LST) and examine the contributions of energy intake, physical activity and breast-feeding practices to LST changes at 3 and 9 months postpartum. We examined current weight, LST (via dual-energy X-ray absorptiometry), dietary intake (3-d food diary), physical activity (Baecke questionnaire) and breast-feeding practices (3-d breast-feeding diary) in forty-nine women aged 32·9 (sd 3·8) years. Changes in LST varied from -2·51 to +2·50 kg with twenty-nine women gaining LST (1·1 (sd 0·7) kg, P&lt;0·001) and twenty women losing LST (-0·9 (sd 0·8) kg, P&lt;0·001). Energy intake (133 (SD 42) v. 109 (SD 33) kJ/kg, P=0·019) and % kJ from fat at 3 months postpartum was higher in women who gained LST at 9 months postpartum (gained LST=34 (sd 5) % kJ; lost LST=29 (sd 4) % kJ, P=0·002). Women who gained LST reported breast-feeding their infants more frequently (gained LST=8 (sd 3) feeds/d; lost LST=5 (sd 1) feeds/d, P=0·014) and for more time per d (gained LST=115 (sd 78) min/d; lost LST=59 (sd 34) min/d, P=0·016) at 9 months postpartum. Energy intake and % kJ from fat at 3 months were significant predictors of LST gain (β=0·08 (se 0·04) and 0·24 (se 0·09), respectively). This suggests that gain in LST may be associated with more frequent and longer episodes of breast-feeding at 9 months postpartum as well as dietary intake early in the postpartum period.

Association of Mid-Life Changes in Body Size, Body Composition and Obesity Status with the Menopausal Transition

The mid-life period is a critical window for increases in body weight and changes in body composition. In this review, we summarize the clinical experience of the menopausal transition by obesity status, and examine the evidence regarding the menopausal transition and reproductive hormones effects on body weight, body composition, or fat distribution. Mid-life obesity is associated with a different menopausal experience including associations with menstrual cycle length prior to the final menstrual period (FMP), age at the FMP, and higher prevalence of vasomotor symptoms. The menopausal transition is associated with weight gain and increased central body fat distribution; the majority of evidence suggests that changes in weight are due to chronological aging whereas changes in body composition and fat distribution are primarily due to ovarian aging. Continuous and regular physical activity during mid-life may be an efficacious strategy to counteract the age-related and menopause-related changes in resting energy expenditure and to prevent weight gain and abdominal adiposity deposition.

Relationship between serum DHEAS and oxidative stress levels of body mass index in healthy postmenopausal women

OBJECTIVES

Menopause is a natural step in the process of aging. Postmenopausal women have decreased levels of antioxidants and increased oxidative stress, the latter of which plays an important role in atherogenesis. The aim of the present study was to evaluate the relationship of the body mass index (BMI) with serum catalase activity, malondialdehyde (MDA), and dehydroepiandrosterone sulfate (DHEAS) levels in healthy postmenopausal women and estimate whether the MDA/DHEAS ratio is a possible marker of oxidative stress for determining cardiovascular risk in these women.

METHODS

We investigated serum catalase activity, MDA, and DHEAS levels, parity history, age, and BMI in 96 healthy postmenopausal women aged 50-82 years. The serum MDA levels and catalase activity were measured spectrophotometrically. The serum DHEAS levels were measured using an enzyme-linked immunosorbent assay. The ratio percentage of the serum DHEAS levels to serum MDA levels was designated as a biomarker for oxidative stress.

RESULTS

The mean BMI of the patients was 31.72 ± 6.16 kg/m(2) (range = 20.5-47.94). The MDA/DHEAS ratio was significantly decreased in patients with a BMI over 30 compared to that of patients with a BMI between 25 and 30 (P = 0.025). Moreover, BMI was positively correlated with serum DHEAS levels (r = 0.285, P < 0.01) and negatively correlated with the MDA/DHEAS ratio (r = -0.241, P < 0.05) in postmenopausal women. Furthermore, BMI was observed to be a potential predictor of the MDA/DHEAS ratio based on covariance analysis (P = 0.039).

CONCLUSIONS

Our results indicate that healthy, obese, postmenopausal women have a decreased MDA/DHEAS ratio. Additionally, BMI was observed to be a potential predictor of the MDA/DHEAS ratio.

Weight gain after oophorectomy among women with a BRCA1 or BRCA2 mutation

AIM

To measure weight gain among unaffected women with a BRCA1 or BRCA2 mutation after undergoing an oophorectomy.

PATIENTS & METHODS

We compared the bodyweight of women with (n = 405) and without an oophorectomy (n = 741) at baseline as well as the rate of weight change prior to and following surgery among 1454 BRCA mutation carriers who had an oophorectomy.

RESULTS

There was a small and non-significant difference in bodyweight between BRCA mutation carriers who had an oophorectomy compared with those women who did not (151.5 vs 149.1 pounds; p = 0.26). There was an increase in bodyweight with increasing age, but this relationship did not differ prior to and following surgery (p comparing the slope parameters = 0.78).

CONCLUSION

Oophorectomy is not associated with significant weight gain in high-risk women.

Predictors of weight variation and weight gain in peri- and post-menopausal women

This research encompasses a community sample of 497 women in peri- and post-menopause and uses structural equation modelling to investigate the structural models of weight variation and weight gain. Variables such as body shape concerns, depression, stress and life events are explored. Weight gain (from pre-menopause to current menopausal status) was observed in 69 per cent of participants. The predictors of weight gain were lower education level ( β = −.146, p = .017), less or no physical exercise ( β = −.111, p = .021), having a recent psychological problem ( β = .191, p < .001), transition from peri- to post-menopause ( β = .147, p = .013) and more frequent body shape concerns ( β = .313, p < .001). Prevention of weight gain in pre-menopause is recommended; risk groups should be targeted considering the predictors of weight increase.

Effects of the menopausal transition on energy expenditure: a MONET Group Study

Objectives

Factors that influence weight gain during the menopausal transition are not fully understood. The purpose of this study was to investigate changes in energy expenditure (EE) across the menopausal transition.

Methods

One hundred and two premenopausal women (age: 49.9 ± 1.9 yrs; BMI: 23.3 ± 2.2 kg/m²) were followed for 5 years. Body composition (DXA), physical activity EE (accelerometer), resting EE and thermic effect of food (indirect calorimetry) were measured annually.

Results

Total EE decreased significantly over time in postmenopausal women (P < 0.05), which was mostly due to a decrease in physical activity EE (P < 0.05). Although average resting EE remained stable over time in postmenopausal women, a significant increase, over the 5-year period, was noted in women who were in the menopausal transition by year 5 (P < 0.05). Finally, the time spent in moderate physical activity decreased and the time spent in sedentary physical activity increased during the menopausal transition (P < 0.05).

Conclusion

These results suggest that menopausal transition is accompanied with a decline in EE mainly characterized by a decrease in physical activity EE and a shift to a more sedentary lifestyle.

Changes in body fat distribution through menopause increase blood pressure independently of total body fat in middle-aged women: the Korean National Health and Nutrition Examination Survey 2007-2010

Blood pressure in women increases sharply in middle age, especially after menopause. As the menopausal transition is known to induce changes in body fat distribution, the aim of this study was to investigate the effect of body fat distribution as compared with the effect of total body fat on blood pressure through the menopausal transition. We analyzed 1422 subjects aged 45-55 years using the database from the Korean National Health and Nutrition Examination Survey 2007-2010. The waist circumference (WC) of post-menopausal women was larger than that of pre-menopausal women (80.44 cm, 95% confidence interval (CI) 79.36-81.52 vs. 78.94 cm, 95% CI 78.27-79.61, P=0.013), but there was no statistically significant difference in body mass index (BMI). Systolic and diastolic blood pressure (SBP and DBP) were significantly higher in post-menopausal women than in pre-menopausal women: SBP was 118.33 mm Hg, 95% CI 116.52-120.15 vs. 115.22 mm Hg, 95% CI 114.17-116.28 (P=0.003) and DBP was 76.94 mm Hg, 95% CI 75.88-77.99 vs. 75.25 mm Hg, 95% CI 74.57-75.93 (P=0.009). BMI and WC were positively correlated with BP. After adjustment for BMI, the correlation of WC with SBP remained significant (β=0.250, 95% CI 0.024-0.476, P=0.030). In a stratified analysis, WC correlated with SBP in women with BMI<25 kg m(-2) (β=0.358, 95% CI 0.138-0.579, P=0.001), but not in women with BMI25 kg m(-2). We conclude that the changes in body fat distribution through the menopausal transition are associated with SBP, independent of total body fat. This finding indicates that alterations in the localization of body fat are another cause of menopause-related changes in BP.

Brief cognitive-behavioral therapy for weight loss in midlife women: a controlled study with follow-up

OBJECTIVE

Cognitive-behavioral therapy (CBT) has proven to be effective in weight reduction. This study explores whether individual, 8-session CBT can promote weight loss in midlife women.

METHODS

Anthropometric (weight, abdominal perimeter, and body mass index calculation), psychological (health-related and sexual quality of life, stress, anxiety, and depression), and behavioral measures (binge eating disorder and restrained, external, and emotional eating) were assessed at baseline (T1), posttreatment (T2), and 4-month follow-up (T3), for a total of 21 women at baseline; the CBT group (n = 11) and the control group (n = 10; waiting list) were compared.

RESULTS

Statistically significant effects that were dependent on the intervention were observed on weight (F = 4.402; P = 0.035; η(p) (2) = 0.404; π = 0.652) and body mass index (F = 3.804; P = 0.050; η(p) (2) = 0.369; π = 0.585); furthermore, marginally significant effects were observed on external eating (F = 2.844; P = 0.095; η(p) (2) = 0.304; π = 0.461). At follow-up, women in the CBT group presented with lower weight, abdominal perimeter, body mass index, and external eating; higher health-related quality-of-life and restrained eating were also observed in this group. Most differences identified were at a marginally significant level. Moreover, at follow-up, none of the participants of the CBT group met the criteria for binge eating disorder, whereas the number of women with binge eating disorder in the control group remained the same through all three assessments.

CONCLUSION

An effective, though small, weight loss was achieved. Changes in quality of life were also observed. Moreover, changes in external eating behavior were successful.

Effects of green tea or Sasa quelpaertensis bamboo leaves on plasma and liver lipids, erythrocyte Na efflux, and platelet aggregation in ovariectomized rats

This study was conducted to investigate the effects of Sasa quelpaertensis bamboo and green tea on plasma and liver lipids, platelet aggregation, and erythrocyte membrane Na channels in ovariectomized (OVX) rats. Thirty female rats were OVX, and ten female rats were sham-operated at the age of 6 weeks. The rats were divided into four groups at the age of 10 weeks and fed the experiment diets: sham-control, OVX-control, OVX-bamboo leaves (10%), or OVX-green tea leaves (10%) for four weeks. Final body weight increased significantly in the OVX groups compared with that in the sham-control, whereas body weight in the OVX-green tea group decreased significantly compared with that in the OVX-control (P < 0.01). High density lipoprotein (HDL)-cholesterol level decreased in all OVX groups compared with that in the sham-control rats (P < 0.05) but without a difference in plasma total cholesterol. Plasma triglycerides in the OVX-green tea group were significantly lower than those in the sham-control or OVX-control group (P < 0.05). Liver triglycerides increased significantly in the OVX-control compared with those in the sham-control (P < 0.01) but decreased significantly in the OVX-green tea group compared with those in the OVX-control or OVX-bamboo group (P < 0.01). Platelet aggregation in both maximum and initial slope tended to be lower in all OVX rats compared with that in the sham-control rats but was not significantly different. Na-K ATPase tended to increase and Na-K cotransport tended to decrease following ovariectomy. Na-K ATPase decreased significantly in the OVX-green tea group compared with that in the OVX-control group (P < 0.01), and Na-K cotransport increased significantly in the OVX-bamboo and OVX-green tea groups compared with that in the OVX-control (P < 0.05). Femoral bone mineral density tended to be lower in OVX rats than that in the sham-control, whereas the green tea and bamboo leaves groups recovered bone density to some extent. The results show that ovariectomy caused an increase in body weight and liver triglycerides, and that green tea was effective for lowering body weight and triglycerides in OVX rats. Ovariectomy induced an increase in Na efflux via Na-K ATPase and a decrease in Na efflux via Na-K cotransport. Furthermore, consumption of green tea and bamboo leaves affected Na efflux channels, controlling electrolyte and body water balance.

Aging is associated with an increase in T cells and inflammatory macrophages in visceral adipose tissue

Age-related adiposity has been linked to chronic inflammatory diseases in late life. To date, the studies on adipose tissue leukocytes and aging have not taken into account the heterogeneity of adipose tissue macrophages (ATMs), nor have they examined how age impacts other leukocytes such as T cells in fat. Therefore, we have performed a detailed examination of ATM subtypes in young and old mice using state of the art techniques. Our results demonstrate qualitative changes in ATMs with aging that generate a decrease in resident type 2 (M2) ATMs. The profile of ATMs in old fat shifts toward a proinflammatory environment with increased numbers of CD206(-)CD11c(-) (double-negative) ATMs. The mechanism of this aging-induced shift in the phenotypic profile of ATMs was found to be related to a decrease in peroxisome proliferator-activated receptor-γ expression in ATMs and alterations in chemokine/chemokine receptor expression profiles. Furthermore, we have revealed a profound and unexpected expansion of adipose tissue T cells in visceral fat with aging that includes a significant induction of regulatory T cells in fat. Our findings demonstrate a unique inflammatory cell signature in the physiologic context of aging adipose tissue that differs from those induced in setting of diet-induced obesity.

Correlation of increased oxidative stress to body weight in disease-free post menopausal women

OBJECTIVES

Oxidative stress increases postmenopausally, an effect attributed to aging. Increase in body weight generally accompanies menopause. Obesity per se also seems to increase oxidative stress. The question is whether postmenopausal increase in oxidative stress is related to body weight, or is only a function of age.

DESIGN AND METHODS

Age, body weight, and superoxide dismutase (SOD), catalase (CAT) and malonyldialdehyde (MDA) in erythrocytes of a cross-section of 90 disease-free women aged 25-65 years, divided into three groups of n=30 each of normally menstruating Controls (C), perimenopausal (periM) and postmenopausal women (postM) were recorded.

RESULTS

PostM had the highest oxidative stress and body weight. SOD, CAT and MDA correlated significantly with body weight (-0.74, 0.64 and 0.69 respectively). The odds of having a lower SOD (OR9.5, 95% CI:2.9-30.8) and higher CAT (OR6.2, 95% CI:1.6-23.0) and MDA (OR6.8, 95% CI:2.7-16.8) for weight >60 kg was highly significant.

CONCLUSIONS

Oxidative stress is enhanced as body weight increases.

Increased visceral fat and decreased energy expenditure during the menopausal transition

OBJECTIVE

This study assessed longitudinal changes in body composition, fat distribution and energy balance in perimenopausal women. We hypothesized that total fat and abdominal body fat would increase at menopause due to decreased energy expenditure (EE) and declining estrogen, respectively.

DESIGN

Observational, longitudinal study with annual measurements for 4 years.

SUBJECTS

Healthy women (103 Caucasian; 53 African-American), initially premenopausal. During follow-up, lack of menstruation for 1 year and follicle-stimulating hormone >30 mIU ml(-1) defined a subject as postmenopausal.

MEASUREMENTS

Fat and lean mass (dual-energy X-ray absorptiometry), visceral (VAT) and subcutaneous abdominal fat (SAT) (computed tomography), dietary intake (4-day food record), serum sex hormones and physical activity (tri-axial accelerometry). Twenty-four hour EE was measured by whole-room calorimeter in a subset of 34 women at baseline and at year 4.

RESULTS

Body fat and weight increased significantly over time only in those women who became postmenopausal by year 4 (n=51). All women gained SAT over time; however, only those who became postmenopausal had a significant increase in VAT. The postmenopausal group also exhibited a significant decrease in serum estradiol. Physical activity decreased significantly 2 years before menopause and remained low. Dietary energy, protein, carbohydrate and fiber intake were significantly higher 3-4 years before the onset of menopause compared with menopause onset. Twenty-four hour EE and sleeping EE decreased significantly with age; however, the decrease in sleeping EE was 1.5-fold greater in women who became postmenopausal compared with premenopausal controls (-7.9 vs -5.3%). Fat oxidation decreased by 32% in women who became postmenopausal (P<0.05), but did not change in those who remained premenopausal.

CONCLUSION

Middle-aged women gained SAT with age, whereas menopause per se was associated with an increase in total body fat and VAT. Menopause onset is associated with decreased EE and fat oxidation that can predispose to obesity if lifestyle changes are not made.

Effect of weight reduction on quality of life and eating behaviors in obese women

OBJECTIVE

To examine the impact of a 3-week weight-reducing program on body composition, physical condition, health-related quality of life, and eating behaviors of sedentary, obese (body mass index, 29-35 kg/m) women, according to menopausal status and menopause duration (<5, >or=5, and >or=10 y).

DESIGN

Thirteen premenopausal and 27 postmenopausal women received a dietary plan of 1,400 +/- 200 kcal/day and completed 110-minute endurance exercise 6 days per week. Body mass index, fat mass, lean mass, distance walked in the Six-Minute Walk Test, health-related quality of life estimated by the 36-item Short Form Health Survey (SF-36), and eating behaviors (restriction, disinhibition, and susceptibility to hunger) assessed by the Three-Factor Eating Questionnaire were determined before and after weight reduction.

RESULTS

Body mass index and fat mass decreased (P < 0.0001), whereas distance walked increased in both groups after weight reduction (P < 0.001). Although the SF-36 mental component score increased after weight loss in both groups (P < 0.0001), the SF-36 physical component score increased in postmenopausal women only (P < 0.001). Restriction increased (P < 0.0001), whereas disinhibition and susceptibility to hunger decreased after weight reduction (P < 0.001 and P < 0.01, respectively) in both groups. Distance walked and SF-36 physical component score after weight loss were higher in women whose menopause ranged between 5 and 9 years and exceeded 10 years, respectively (P < 0.01).

CONCLUSIONS

Our study shows that a short-term weight-reducing program combining caloric restriction and physical activity has a favorable impact on women's body composition, physical condition, health-related quality of life, and eating behaviors irrespective of their menopausal status.

Is the current BMI obesity classification appropriate for black and white postmenopausal women?

OBJECTIVE

To evaluate the relation between body fatness (%Fat) and body mass index (BMI) and to evaluate the validity of the BMI standards for obesity established by the NIH in older black and white postmenopausal women.

RESEARCH METHODS

Height, weight, BMI, and %Fat, assessed by DXA, were determined for 296 healthy, independently living women ranging in age from 50 to 80 years (M+/-s.d.; 64.4+/-7.8 years).

RESULTS

Per NIH guidelines, 32% were classified as obese (> or = 30 kg/m2, mean BMI = 28.1+/-5.5 kg/m2). In contrast, using the %Fat criterion of 38% advocated by Lohman to define obesity, 47% of our sample was obese (mean %Fat=37.3+/-6.2%). A moderately high curvilinear relation existed between BMI and %Fat (R = 0.82, SEE = 3.57 %Fat, P<0.05). Race added meaningfully to the prediction of %Fat (P<0.05) such that for the same BMI, black women will have 1% lower body fatness than white women. Based on a %Fat > or = 38 as the criterion for obesity, receiver operating characteristic (ROC) analysis, performed separately by race, indicated that the currently accepted BMI cutpoint for obesity produced low sensitivity (69% and 61% for black and white women, respectively). Alternatively, BMI values > or = 28.4 kg/m2 for black women and > or = 26.9 kg/m2 for white women to define obesity maximized classification accuracy.

CONCLUSION

We conclude that current BMI categories may not be appropriate for identifying obesity among postmenopausal women. Furthermore, the relation between BMI and %Fat is different in black compared to white women but remains constant from the sixth through the eighth decade of life.

Plasminogen-activator inhibitor-1 polymorphisms are associated with obesity and fat distribution in the Quebec Family Study: evidence of interactions with menopause

OBJECTIVE

Obesity is associated with increased plasma levels of plasminogen-activator inhibitor-1 (PAI1), the major fibrinolysis inhibitor. PAI1 levels are also increased at menopause, a condition that is associated with fat mass gain, especially in the abdominal area.

DESIGN

We hypothesized that genetic variations within PAI1 gene are related to the amount of body fat and its regional distribution. We genotyped 666 subjects of the Quebec Family Study for five PAI1 gene polymorphisms. Stratified analyses were performed with analysis of covariance in men (n = 280) and women (n = 386) separately.

RESULTS

PAI1-675 4G/5G polymorphism was strongly associated with body mass index (P < or = 0.01) and fat mass (P < or = 0.05) in women. The PAI1-675 4G/5G promoter polymorphism and the c.43G<A (p.A15T, rs6092) variant within the exon 1 were associated with abdominal visceral fat but only in postmenopausal women (P < or = 0.05). More specifically, homozygotes for the -675 5G and the 43A alleles had about 50% more visceral fat compared to carriers of the -675 4G allele as well as carriers of the 43G allele. No association was observed in men.

CONCLUSION

Taken together, these results suggest that the PAI1 gene is associated with obesity and may modulate the changes in adipose tissue distribution generally observed at menopause.

Resting Energy Expenditure: A Better Marker than BMI for BMD in African-American Women

PURPOSE

African-American women tend to be more overweight and to have lower resting energy expenditures (REE) compared with Caucasian women. Weight is associated with bone mineral density (BMD), but the relation between BMD and REE has not been reported.

METHODS

Four hundred postmenopausal African-American women aged 45-87 (yr) from San Diego, CA participated in this community-based cross-sectional study. Body composition (fat mass, lean body mass), bone mineral content (BMC) and BMD of the lumbar spine, hip (femoral neck, greater trochanter, intertrochanter), and total body were measured using dual energy x-ray absorptiometry (DXA). REE was calculated using the Harris-Benedict equation; grip strength was measured by isometric dynamometry.

RESULTS

REE (r range: 0.32-0.79) showed the strongest correlation with spine, total hip, and total body BMC and BMD. In stepwise multiple linear regressions adjusted for age and grip strength, REE explained 15% of the variance in spine BMD, 33% of the variance in total hip, and 32% of the total body BMD variance. REE explained 63% of the total body BMC variance. When body weight replaced REE in the models, weight became the strongest covariate of BMC and BMD but explained 1% less of the variance in spine BMD, 5% less of the variance in total hip BMD, 4% less of the variance in total body BMD, and 3% less of the variances in spine, total hip, and total body BMC than did REE.

CONCLUSION

In this cohort of African-American women, weight explained less of the BMC and BMD variance than REE. Poor energy economy may contribute to being overweight and may explain the lower rates of osteoporosis observed in African-American women.

Blood leptin and adiponectin as possible mediators of the relation between fat mass and BMD in perimenopausal women

Fat mass is a predictor of BMD; however, the mechanisms involved remain uncertain. Two adipokines, leptin and adiponectin, were examined as potential mediators of this relation in 80 perimenopausal women. Adiponectin did not exert any effect on BMD, whereas leptin exerted a negative one, with insulin acting as a confounder to this relation.

INTRODUCTION

Fat mass is an important determinant of bone density, but the mechanism involved in this relation is uncertain. Leptin and adiponectin, as circulating peptides of adipocyte origin, are potential contributors to this relation. We investigated the role of leptin and adiponectin in mediating fat mass effects on the skeleton of perimenopausal women.

MATERIALS AND METHODS

Twenty-five premenopausal and 55 postmenopausal, healthy women (42-68 years old) participated in our study. Lumbar spine BMD (BMD(L2-L4)) and total body BMC (TBBMC) were measured with DXA, leptin levels with ELISA, and adiponectin levels with radioimmunoassay (RIA). Additionally, body composition analysis was performed, as well as measurements of several hormones.

RESULTS

It was shown that serum leptin levels were negatively correlated with BMD (beta = -0.005, p = 0.027) and TBBMC (beta = -14.32, p = 0.013). The above correlation was observed only when serum insulin levels were included, as an independent variable, in the regression analysis model. Adiponectin was not significantly correlated with BMD(L2-L4) nor with TBBMC, either in the presence or absence of insulin.

CONCLUSION

Circulating adiponectin does not seem to exert any effect on bone mass. In contrast, circulating leptin showed a negative correlation with bone mass, dependent on serum insulin levels.

Lifestyle intervention can prevent weight gain during menopause: Results from a 5-year randomized clinical trial

CONTEXT

Menopausal-related weight gain and increased waist circumference have major cardiovascular health implications for older women. The efficacy of a dietary and physical activity lifestyle intervention to prevent weight gain and elevations in cardiovascular disease (CVD) risk factors from the peri- to postmenopause is unknown.

OBJECTIVE

To report the 54-month results of a lifestyle dietary and physical activity program on weight, body composition, physical activity, diet, and other CVD risk factors.

DESIGN

Data are from a 5-year randomized clinical trial known as the Women's Healthy Lifestyle Project, conducted from 1992 to 1999.

PARTICIPANTS

535 healthy, premenopausal women ages 44 to 50 at study entry enrolled into the trial.

INTERVENTION

Participants were randomly assigned to either a lifestyle intervention group receiving a 5-year behavioral dietary and physical activity program or to an assessment-only control group. The lifestyle intervention group was given modest weight loss goals (5-15 lb, or approximately 2.3-6.8 kg) to prevent subsequent gain above baseline weight by the end of the trial. To achieve weight loss and lower low-density lipoprotein cholesterol levels, intervention participants followed an eating pattern consisting of 1,300 kcal/day (25% total fat, 7% saturated fat, 100 mg of dietary cholesterol) and increased their physical activity expenditure (1,000-1,500 kcal/week).

MAIN OUTCOME MEASURES

Regarding weight gain prevention, 55% (136/246) of intervention participants were at or below baseline weight compared with 26% (68/261) of controls after 4.5 years, chi2(2, N = 507) =45.0, p <.001. The mean weight change in the intervention group was 0.1 kg below baseline (SD = 5.2 kg) compared with an average gain of 2.4 kg (SD = 4.9 kg) observed in the control group. Waist circumference also significantly decreased more in the intervention group compared with controls (M = -2.9 cm, SD = 5.3 vs. M = -0.5 cm, SD = 5.6, p <.001). Moreover, participants in the lifestyle intervention group were consistently more physically active and reported eating fewer calories and less fat than controls. Long-term adherence to physical activity and a low-fat eating pattern was associated with better weight maintenance.

CONCLUSIONS

In healthy women, weight gain and increased waist circumference during the peri- to postmenopause can be prevented with a long-term lifestyle dietary and physical activity intervention.

The menopause and obesity

In summary, menopause tends to be associated with an increased risk of obesity and a shift to an abdominal fat distribution with associated increase in health risks. Changes in body composition at menopause may be caused by the decrease in circulating estrogen, and, for fat distribution shifts, the relative increase in the androgen-estrogen ratio is likely to be important. Clinicians need to be aware of the likelihood of weight gain during the perimenopausal and postmenopausal years because behavioral strategies for weight loss can be effectively used in this population. Weight loss or prevention of weight gain is likely to have significant health benefits for older women.

Postmenopausal women lose less visceral adipose tissue during a weight reduction program

OBJECTIVE

Visceral adipose tissue (VAT) is increased in the postmenopausal state, which may contribute to an increase in cardiovascular diseases. This study was undertaken to investigate whether there is a difference in the change of VAT during a weight reduction program between premenopausal and postmenopausal obese women.

DESIGN

This study was a longitudinal clinical intervention of a weight reduction program, including lifestyle modification and adjuvant pharmacotherapy, for 12 weeks in 21 premenopausal and 19 postmenopausal obese women. Weight, height, body fat percentage, and waist and hip circumferences were measured. Visceral, subcutaneous, and total adipose tissue of the abdomen were determined by CT scan at the level of L4-L5 before and after weight reduction.

RESULTS

The percent changes in VAT and the visceral-to-subcutaneous adipose tissue ratio, as well as waist circumference and waist-to-hip ratio, in the postmenopausal women were significantly less than those in the premenopausal women, whereas the percent changes in hip circumference, fat mass, total adipose tissue, and subcutaneous adipose tissue were similar in the two groups. The association between percent changes of VAT and the percent change of waist circumference is stronger in postmenopausal than in premenopausal women.

CONCLUSIONS

The postmenopausal women lost less VAT compared with the premenopausal women during the weight reduction program. This may make it more difficult for postmenopausal women to overcome the increased risk of cardiovascular diseases compared with premenopausal women.

Fat-free mass index and fat mass index percentiles in Caucasians aged 18-98 y

OBJECTIVE

To determine reference values for fat-free mass index (FFMI) and fat mass index (FMI) in a large Caucasian group of apparently healthy subjects, as a function of age and gender and to develop percentile distribution for these two parameters.

DESIGN

Cross-sectional study in which bioelectrical impedance analysis (50 kHz) was measured (using tetrapolar electrodes and cross-validated formulae by dual-energy X-ray absorptiometry in order to calculate FFMI (fat-free mass/height squared) and FMI (fat mass/height squared).

SUBJECTS

A total of 5635 apparently healthy adults from a mixed non-randomly selected Caucasian population in Switzerland (2986 men and 2649 women), varying in age from 24 to 98 y.

RESULTS

The median FFMI (18-34 y) were 18.9 kg/m(2) in young males and 15.4 kg/m(2) in young females. No difference with age in males and a modest increase in females were observed. The median FMI was 4.0 kg/m(2) in males and 5.5 kg/m(2) in females. From young to elderly age categories, FMI progressively rose by an average of 55% in males and 62% in females, compared to an increase in body mass index (BMI) of 9 and 19% respectively.

CONCLUSIONS

Reference intervals for FFMI and FMI could be of practical value for the clinical evaluation of a deficit in fat-free mass with or without excess fat mass (sarcopenic obesity) for a given age category, complementing the classical concept of body mass index (BMI) in a more qualitative manner. In contrast to BMI, similar reference ranges seems to be utilizable for FFMI with advancing age, in particular in men.

Weight change in relation to natural menopause and other reproductive and behavioral factors in Japanese women

PURPOSE

To evaluate the effect of menopause on weight change in Japanese women.

METHODS

Community-based sample of 828 Japanese women who were premenopausal and aged 40 to 54 years completed a self-administered questionnaire asking information on demographic factors, body size, reproductive history and dietary and behavioral factors in 1992. They responded to a follow-up questionnaire asking weight and menopausal status in 1998.

RESULTS

Women gained weight modestly, on average, 0.17 kg during the 6-year study period. Weight gain was significantly higher in women who remained premenopausal at follow-up than those who had natural menopause during the study period. Weight gain was significantly associated with early menarche in women who had natural menopause and with high parity in women remained premenopausal.

CONCLUSION

Reproductive factors rather than sociodemographic and behavioral factors appeared to be associated with weight change during the perimenopausal period. Onset of menopause may diminish weight gain. In contrast, early menarche and high parity showed relationships with weight gain.

The effect of hormone replacement therapy on appendicular lean tissue mass in early postmenopausal women

OBJECTIVE

The impact of hormone replacement therapy (HRT) on skeletal muscle mass is still a controversial issue in women's health. Some authors hypothesize anabolic effects, others catabolic. These hypotheses, however, await confirmation by longitudinal observations based on more direct measurements of muscle mass. The aim of the present preliminary study was to evaluate the effect of a 3-year HRT program on appendicular lean tissue mass (LTM(A)) in early postmenopausal women aged 45-54 years.

DESIGN

This was a randomized, double-blind and placebo-controlled trial. Women received HRT with 2 mg estradiol valerate combined either continuously with 1 mg cyproterone acetate (days 1-28; n = 15) or sequentially with 75 mug levonorgestrel (days 17-28; n = 15), or placebo (n = 18). Serum estradiol was measured by radioimmunoassay. LTM(A) was measured by dual photon absorptiometry (baseline) and dual energy X-ray absorptiometry (years 2 and 3).

RESULTS

Baseline serum estradiol did not show significant correlation with the respective LTM(A) (r = 0.018, p = 0.88, n = 75). Cross-sectional analysis found no significant differences between the intervention groups at any time points. The longitudinal changes between years 2 and 3 showed a trend toward decreasing LTM(A) in those receiving HRT (-0.08 +/- 0.12 kg, n = 30) compared to those receiving placebo (0.12 +/- 0.25 kg, n = 18, p = 0.44).

CONCLUSIONS

The present preliminary study did not find significant effects on LTM(A) caused by HRT. The trends toward decreasing LTM(A) in the HRT groups might suggest catabolic rather than anabolic effects. These trends, however, await confirmation by larger clinical trials.

Age-related differences in fat-free mass, skeletal muscle, body cell mass and fat mass between 18 and 94 years

OBJECTIVE

To determine (1) lean and fat body compartments, reflected by fat-free mass (FFM), appendicular skeletal muscle mass (ASMM), body cell mass (BCM), total body potassium (TBK), fat mass and percentage fat mass, and their differences between age groups in healthy, physically active subjects from 18 to 94 y of age; and (2) if the rate of decrease in any one of the parameters by age might be accelerated compared to others.

METHODS

A total of 433 healthy ambulatory Caucasians (253 men and 180 women) aged 18--94 y were measured by dual-energy X-ray absorptiometry (DXA) and whole body scintillation counter (TBK counter) using a large sodium iodide crystal (203 mm diameter).

RESULTS

The ASMM change (-16.4 and -12.3% in men and women, respectively) in >75 y-old compared to 18 to 34-y-old subjects was greater than the FFM change (-11.8 and -9.7% in men and women, respectively) and this suggests that skeletal muscle mass decrease in older subjects was proportionally greater than non-skeletal muscle mass. BCM (-25.1 and -23.2% in men and women, respectively) and TBK differences were greater than the differences in FFM or ASMM suggesting altered composition of FFM in older subjects. Women had lower peak FFM, ASMM, BCM and TBK than men.

CONCLUSIONS

The decline in FFM, ASMM, BCM and TBK is accelerated in men and women after 60 y of age and FFM, ASMM, BCM and TBK are significantly lower than in younger subjects. Fat mass continued to increase until around 75 y.

Fat-free and fat mass percentiles in 5225 healthy subjects aged 15 to 98 years

OBJECTIVES

Fat-free mass (FFM) and fat mass (FM) are important in the evaluation of nutritional status. Bioelectrical impedance analysis (BIA) is a simple, reproducible method used to determine FFM and FM. Because normal values for FFM and FM have not yet been established in adults aged 15 to 98 y, its use is limited in the evaluation of nutritional status. The aims of this study were to determine reference values for FFM, FM, and percentage of FM by BIA in a white population of healthy adults, observe their differences with age, and develop percentile distributions for these parameters between ages 15 and 98 y.

METHODS

Whole-body resistance and reactance of 2735 healthy white men and 2490 healthy white women, aged 15 to 98 y, was determined by 50-kHz BIA, with four skin electrodes on the right hand and foot. FFM and FM were calculated by a previously validated, single BIA formula and analyzed for age decades.

RESULTS

Mean FFM peaked in 35- to 44-y-old men and 45- to 54-y-old women and declined thereafter. Mean FFM was 8.9 kg or 14.8% lower in men older than 85 y than in men 35 to 44 y old and 6.2 kg or 14.3% lower in women older than 85 y than in women 45 to 54 y old. Mean FM and percentage of FM increased progressively in men and women between ages 15 and 98 y. The results suggested that the greater weight noted in older subjects is due to larger FM.

CONCLUSIONS

The percentile data presented serve as reference to evaluate deviations from normal values of FFM and FM in healthy adult men and women at a given age.

Hormones, weight change and menopause

OBJECTIVE

To determine total body weight change occurring in women at mid-life, specifically with respect to occurrence of menopause and use of estrogen.

DESIGN

Retrospective analysis of body weight measurements accumulated in two cohorts of healthy women participating in studies of skeletal metabolism.

SUBJECTS

Cohort 1: 191 healthy nuns enrolled in a prospective study of osteoporosis risk, aged 35-45 in 1967; cohort 2: 75 women aged 46 or older and still menstruating, enrolled in 1988 in a study of bone cell dynamics across menopause. Roughly one-third of each group received hormone replacement after menopause.

MEASUREMENTS

Body weight and height, age, menstrual status and use of estrogen replacement. Cohort 1: 608 measurements at 5 y intervals spanning a period from 17 y before to 22 y after menopause; cohort 2: 1180 measurements at 6-month intervals spanning a period from 5 y prior to 5 y after menopause.

RESULTS

In cohort 1 weight rose as a linear function of age (both chronological and menopausal), both before and after cessation of ovarian function, at a rate of approximately 0.43% y(-1). Neither the menopausal transition nor the use of estrogen had an appreciable effect on this rate of gain. In cohort 2 the rate of gain seemed to diminish slightly at menopause. As with cohort 1, hormone replacement (or its absence) had no appreciable effect on weight.

CONCLUSIONS

The long-term, total body weight trajectory at mid-life is not influenced appreciably by either cessation of ovarian function or by hormone replacement.

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

OBJECTIVE

To evaluate the inter-relationships of age- and menopause- related changes of general obesity and body fat distribution and their independent effects on cardiovascular risk factors.

DESIGN

Cross-sectional study.

SUBJECTS

One-hundred and thirty-six premenopausal and 193 postmenopausal Chinese women with body mass index (BMI) < 30 kg/m2.

MEASUREMENTS

Anthropometric surrogates of general obesity (BMI, total body fat percentage) and central obesity (waist-to-hip ratio, centrality index) were measured. Blood pressure, 75 g oral glucose tolerance test, glycosylated hemoglobin A1c and lipid profiles were also measured.

RESULTS

Significant correlation coefficients between age, general obesity, central obesity and cardiovascular disease risk factors were noted. Through the menopausal transition, the BMI and total body fat percentage were increased significantly. After adjustments for age and BMI, the postmenopausal women showed higher android fat percentage, centrality index, glycosylated hemoglobin A1c, serum concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol and atherogenic indices than the premenopausal women. In multiple stepwise regression models, age exerted independent effects on oral glucose tolerance test 2 h plasma glucose level, systolic and diastolic blood pressure, total cholesterol level, and LDL cholesterol. Menopause was an independent variable in relation to the changes of glycosylated hemoglobin A1c, total and LDL cholesterol levels, triglyceride levels and atherogenic indices. The centrality index was the major independent variable of all the cardiovascular disease risk factors, except total and LDL cholesterol level. However, the variation of total body fat percentage had no independent effect on any cardiovascular disease risk factors.

CONCLUSION

Through the aging and menopausal effects, women will increase total body fat content, favoring the central body fat distribution. Age, menopause and central obesity were all independent and significant factors to the cardiovascular disease risk factors in Chinese women.

Weight gain during menopause. Is it inevitable or can it be prevented?

The years surrounding the menopause are associated with weight gain, increased central adiposity, and decreased physical activity. While weight change occurs independent of menopausal status, adverse changes in body fat distribution and body composition may be due to hormonal changes occurring during the menopausal transition. The one factor most consistently related to weight gain is physical activity. To avoid weight gain, women should make regular physical activity a priority. Although HRT use is widely believed to cause weight gain, data from the PEPI trial do not support this belief. Moreover, HRT may have a protective effect in reducing central adiposity, although more long-term studies using CT or MRI to measure visceral fat are needed to confirm this hypothesis. Data from the Women's Healthy Lifestyle Project provide clear evidence that weight gain and increased waist circumference, along with elevations in lipid levels and other CHD risk factors, are preventable through use of lifestyle intervention in healthy menopausal-aged women. Given the prevalence and chronic course of obesity, weight gain prevention should be recognized as an important health goal for women before they approach menopause.

Aging, body composition, and lifestyle: the Fels Longitudinal Study

BACKGROUND

Changes in body composition in men and women occur with age, but these changes are affected by numerous covariate factors.

OBJECTIVE

The study examined patterns of change in body composition and determined the effects of long-term patterns of change in physical activity in older men and women and in menopausal status and estrogen use in women.

DESIGN

Serial measures of height, weight, body mass index (BMI), total body fat (BF), percentage BF, and fat-free mass (FFM) from underwater weighing of 102 men and 108 women enrolled in the Fels Longitudinal Study were analyzed. Physical activity levels and menopausal status were included as covariates.

RESULTS

There were significant age-related decreases in FFM and height and increases in total BF, percentage BF, weight, and BMI. Physical activity was associated with decreases in total BF, percentage BF, weight, and BMI in men and were associated with increases in FFM and decreases in total BF and percentage BF in women. Postmenopausal women had significantly higher total BF and percentage BF than did pre- and perimenopausal women. The longer the time since menopause the greater were the increases in weight, BMI, total BF, and percentage BF; however, estrogen use attenuated these increases.

CONCLUSIONS

Low FFM can be improved by increased physical activity. The effects of an intervention program on body composition can be masked if only body weight or BMI is measured. The effects of physical activity were more profound in postmenopausal than in premenopausal women, and estrogen use had beneficial effects on body composition.

Melancholic depression and abdominal fat distribution: a mini-review

Fat is stored around the abdomen in both subcutaneous and intra abdominal (visceral) sites. Visceral fat is associated in its own right with a set of metabolic abnormalities, including non insulin dependent diabetes, hypertension and dyslipidaemias. States of marked hypercortisolaemia, for example Cushing's syndrome, lead to the preferential accumulation of visceral fat. Since melancholic depression is known to be associated with elevated plasma Cortisol levels, this review explores whether depressed patients are prone to excess visceral fat storage, with the subsequent risk of developing the associated metabolic disturbances. Though the literature is limited, there is evidence that intra abdominal fat is increased in major depression. There is also evidence that depression is associated with increased risk of death from cardiovascular disease. Is visceral fat and its association with metabolic abnormalities the link between depression and physical illness?

Social physique anxiety in postmenopausal women

Social physique anxiety (SPA), the degree to which individuals become anxious when others observe their bodies, is an important concept for postmenopausal women because it may be directly related to their physical activity behavior. Women with high levels of social physique anxiety may not participate in health-enhancing physical activity. Therefore, the main purpose of this study was to examine SPA in postmenopausal women relative to leisure time physical activity (LTPA, activities such as exercise, recreation, and sports). Other factors, such as percent body fat, body fat distribution, age, and hormone replacement therapy status were also examined for their relationship to SPA. Women who expended < or = 500 kcal.wk-1 in LTPA had significantly higher SPA than women who expended > or = 2,000 kcal.wk-1, independent of percent body fat. Women with more than 37.5% body fat had significantly higher SPA than those with less than 37.5% body fat. Women with upper BFD (waist-to-hip ratio or WHR > 0.85) had higher SPA than women with lower BFD (WHR < 0.75). There were no differences in SPA relative to age or HRT status. It appears that a sedentary lifestyle, high percent body fat, and upper body fat distribution are associated with increased SPA in postmenopausal women, thus health promotion professionals should be aware of these concerns when developing physical activity interventions for postmenopausal women.

The influence of sex hormones on obesity across the female life span

Women have a higher prevalence of obesity than men in most developed countries. Obesity affects many aspects of women's health by increasing risk for heart disease, diabetes, breast cancer, and infertility. One reason for the gender difference in obesity may be that fluctuations in reproductive hormone concentrations throughout women's lives uniquely predispose them to excess weight gain. Studies in experimental animals and women have shown that hormonal changes across the menstrual cycle affect calorie and macronutrient intake and alter 24-hour energy expenditure. Pregnancy is a significant factor in the development of obesity for many women. Various factors are associated with excess weight retention following pregnancy, including weight gain during pregnancy, ethnicity, dietary patterns, and interval between pregnancies. There is a need to tailor recommendations for energy intake during pregnancy to individual women, and recent evidence also suggests that the timing of weight gain during pregnancy is a critical factor. Menopause is also a high-risk time for weight gain in women. Although the average woman gains 2-5 pounds during menopausal transition, some women are at risk for greater weight gains. There is also a hormonally driven shift in body fat distribution from peripheral to abdominal at menopause, which may increase health risks in older women. Hormone therapies have varying impacts on body weight and fat distribution. In summary, hormonal fluctuations across the female life span may explain the increased risk for obesity in women. Awareness of these factors allows development of targets for prevention and early intervention.

Association of diet and other lifestyle with onset of menopause in Japanese women

OBJECTIVES

To evaluate the cross-sectional relationships of dietary and other lifestyle variables to menopause.

METHODS

A total of 4186 female residents aged 45-55 in Takayama City, Japan, responded to a self-administered questionnaire (the response rate was 89.3%). Diet in the past year was assessed by semiquantitative food frequency questionnaire. Using the logistic regression model, associations between study variables and menopausal status were estimated in terms of odds ratio (OR).

RESULTS

Nulliparity and lower relative weight were significantly associated with menopause after controlling for age (P < 0.05). The association of smoking with menopause was marginally significant after controlling for age (P = 0.06). Higher intakes of fat, cholesterol, and coffee were inversely and significantly associated with later menopause after controlling for age, total energy, parity, menarche age, and relative weight (ORs for the highest tertiles of fat, cholesterol and coffee intakes were 0.78, 0.79, and 0.70, respectively, P < 0.05). The highest tertiles of calcium and soy product intakes were significantly associated with menopause after controlling for the covariates (ORs = 1.25 and 1.42, respectively, P < 0.05), but postmenopausal women who had menopause at later age showed higher calcium intake than those who had menopause at early age.

CONCLUSION

Dietary factors appear to be associated with onset of menopause.

Lipolysis in elderly postmenopausal women

The rate of fat oxidation at rest decreases with age in women. The mechanisms for this decrease are not clear. Theoretically, a decrease in the availability of fatty acids could explain the decline in fat oxidation. In consequence, the in vivo rate of production of fatty acids as a proxy for lipolysis was measured in 21 healthy women. Eleven of the volunteers were elderly (> 65 years) and 10 were young (< 24 years), and all were characterized for body composition. The nonadjusted rate of delivery of fatty acids into the systemic circulation was similar among elderly and young individuals (609 +/- 80.3 v 597 +/- 69.9 mumol/min, respectively, P > .1). When lipolysis was adjusted for the differences in fat-free mass using analysis of covariance (ANCOVA), rates were slightly increased in the elderly group (626 +/- 80 mumol/min) and decreased in the young group (578 +/- 84 mumol/min), but remained nonstatistically significant. It is concluded that mechanisms other than lipolysis must explain the decrease of fat oxidation in aging women, i.e., a decrease in the capacity of muscle to oxidize fat and/or a decrease in its capacity for transport of long-chain fatty acids.

Effect of dehydroepiandrosterone sulfate on carnitine acetyl transferase activity and L-carnitine levels in oophorectomized rats

Alteration in energy metabolism of postmenopausal women might be related to the reduction of dehydroepiandrosterone sulfate (DHEAS). DHEA and DHEAS decline with age, leveling at their nadir near menopause. DHEA and DHEAS modulate fatty acid metabolism by regulating carnitine acyltransferases and CoA. The purpose of this study was to determine whether dietary supplementation with DHEAS would also increase tissue L-carnitine levels, carnitine acetyltransferase (CAT) activity and mitochondrial respiration in oophorectomized rats. Plasma L-carnitine levels rose following oophorectomy in all groups (P < 0.0001). Supplementation with DHEAS was not associated with further elevation of plasma L-carnitine levels, but with increased hepatic total and free L-carnitine (P = 0.021 and P < 0.0001, respectively) and cardiac total L-carnitine concentrations (P = 0.045). In addition, DHEAS supplementation increased both hepatic and cardiac CAT activities (P < 0.0001 and P = 0.05 respectively). CAT activity positively correlated with the total and free carnitine levels in both liver and heart (r = 0.764, r = 0.785 and r = 0.700, r = 0.519, respectively). Liver mitochondrial respiratory control ratio, ADP:O ratio and oxygen uptake were similar in both control and supplemented groups. These results demonstrate that in oophorectomized rats, dietary DHEAS supplementation increases the liver and heart L-carnitine levels and CAT activities. In conclusion, DHEAS may modulate L-carnitine level and CAT activity in estrogen deficient rats. The potential role of DHEAS in the regulation of fatty acid oxidation in postmenopausal women is worthy of investigation.

Aging, fat oxidation and exercise

Aging is characterized by deleterious changes in body composition and in fat distribution. The mechanisms that determine the aging-associated changes in body composition are not well defined, but the evidence suggests that the loss of fat-free mass is at least partially attributable to physical inactivity. The increase in fat mass may be the result of alterations in fatty acid metabolism. Indeed, fat oxidation is decreased in elderly individuals in several physiological conditions: a) at rest, b) during exercise, and c) in response to meal ingestion (after weight loss). These defects are related in part to loss of fat-free mass, but may also be the consequence of estrogen loss (in women) and/or a decrease in the intrinsic capacity of muscle for fat oxidation, and are amenable to partial correction by exercise training. Special emphasis should be placed in future studies upon the role of steroid hormone in the regulation of fatty acid metabolism in elderly individuals (especially women), as well as therapeutic interventions that may increase the quantity of the fat-free mass and/or fat oxidation.

Menopause: the aging of multiple pacemakers

Menopause signals the permanent end of menstrual cyclicity in a woman's life. Its impact reaches far beyond just the reproductive system. An understanding of the factors that interact and govern the process of aging in the reproductive system will help us to develop strategies for alleviating the negative aspects of menopause and may help us to better comprehend the process of biological aging.