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Lu Y, Tian J, Wu L, Xia Q, Zhu Q. Low appendicular skeletal muscle index increases the risk of carotid artery plaque in postmenopausal women with and without hypertension/hyperglycemia: a retrospective study. BMC Geriatr 2023; 23:379. [PMID: 37340377 DOI: 10.1186/s12877-023-04076-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/28/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND This study aimed to evaluate whether the low appendicular skeletal muscle index (ASMI) is closely associated with the risk of carotid artery plaque (CAP) in postmenopausal women with and without hypertension/hyperglycemia stratified by body mass index (BMI) categories. METHODS A total of 2048 Chinese postmenopausal women aged 40-88 years were eventually enrolled in this retrospective study. Skeletal muscle mass was estimated by using segmental multifrequency bioelectrical impedance analysis. ASMI was defined as follows: appendicular skeletal muscle mass(kg)/[height(m)]2. CAP was assessed by B-mode ultrasound. We explored the association between ASMI quartiles or low skeletal muscle mass and the risk of CAP by using multivariate-adjusted logistic regression models. A potential nonlinear relationship was also tested using restricted cubic spline regression. RESULTS CAP was observed in 289/1074 (26.9%) normal-weight and 319/974 (32.8%) overweight/obese postmenopausal women. Individuals with CAP had significantly lower ASMI values than those without (P < 0.001). The ASMI value also showed a linear relationship with the CAP risk in postmenopausal women stratified by BMI category (Pfor non-linearity > 0.05). In comparison with the highest ASMI quartile, the lowest ASMI quartile was significantly associated with a high risk of CAP development in non-hypertensive individuals with normal weight (odds ratio [OR] = 2.43; 95% confidence interval [CI]: 1.44 ~ 4.12) or overweight/obesity (OR = 4.82, 95% CI: 2.79 ~ 8.33), hypertensive individuals with normal weight (OR = 5.90, 95% CI: 1.46 ~ 11.49) or overweight/obesity (OR = 7.63, 95% CI: 1.62 ~ 35.86), non-hyperglycemic individuals with normal weight (OR = 2.61, 95% CI: 1.54 ~ 4.43) or overweight/obesity (OR = 2.94, 95% CI: 1.84 ~ 4.70), and hyperglycemic individuals with normal weight (OR = 6.66, 95% CI: 1.08 ~ 41.10) or overweight/obesity (OR = 8.11, 95% CI: 2.69 ~ 24.49). Moreover, low skeletal muscle was independently associated with the risk of CAP in postmenopausal women, regardless of the BMI category. CONCLUSION ASMI was inversely associated with the risk of CAP development in postmenopausal women, especially in patients with high blood sugar and/or hypertension, indicating that skeletal muscle mass maintenance may contribute to prevention of CAP in postmenopausal women.
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Affiliation(s)
- Yayun Lu
- Health Examination Center, Huadong Sanatorium, No.67 Jinyuan Road, Wuxi, 214065, People's Republic of China
| | - Jianguang Tian
- Department of Science and Education, Huadong Sanatorium, No.67 Jinyuan Road, Wuxi, 214065, People's Republic of China
| | - Liangyu Wu
- Health Examination Center, Huadong Sanatorium, No.67 Jinyuan Road, Wuxi, 214065, People's Republic of China
| | - Qing Xia
- Health Examination Center, Huadong Sanatorium, No.67 Jinyuan Road, Wuxi, 214065, People's Republic of China.
| | - Qinzhong Zhu
- Health Examination Center, Huadong Sanatorium, No.67 Jinyuan Road, Wuxi, 214065, People's Republic of China.
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Marlatt KL, Pitynski-Miller DR, Gavin KM, Moreau KL, Melanson EL, Santoro N, Kohrt WM. Body composition and cardiometabolic health across the menopause transition. Obesity (Silver Spring) 2022; 30:14-27. [PMID: 34932890 PMCID: PMC8972960 DOI: 10.1002/oby.23289] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/15/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022]
Abstract
Every year, 2 million women reach menopause in the United States, and they may spend 40% or more of their life in a postmenopausal state. In the years immediately preceding menopause-known as the menopause transition (or perimenopause)-changes in hormones and body composition increase a woman's overall cardiometabolic risk. In this narrative review, we summarize the changes in weight, body composition, and body fat distribution, as well as the changes in energy intake, energy expenditure, and other cardiometabolic risk factors (lipid profile, glucose metabolism, sleep health, and vascular function), that occur during the menopause transition. We also discuss the benefits of lifestyle interventions in women in the earlier stages of menopause before these detrimental changes occur. Finally, we discuss how to include perimenopausal women in research studies so that women across the life-span are adequately represented.
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Affiliation(s)
- Kara L. Marlatt
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Dori R. Pitynski-Miller
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Eastern Colorado VA Health Care System, Geriatric Research Education and Clinical Center (GRECC), Denver, Colorado, USA
| | - Kathleen M. Gavin
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Eastern Colorado VA Health Care System, Geriatric Research Education and Clinical Center (GRECC), Denver, Colorado, USA
| | - Kerrie L. Moreau
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Eastern Colorado VA Health Care System, Geriatric Research Education and Clinical Center (GRECC), Denver, Colorado, USA
| | - Edward L. Melanson
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Eastern Colorado VA Health Care System, Geriatric Research Education and Clinical Center (GRECC), Denver, Colorado, USA
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wendy M. Kohrt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Eastern Colorado VA Health Care System, Geriatric Research Education and Clinical Center (GRECC), Denver, Colorado, USA
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Ko SH, Jung Y. Energy Metabolism Changes and Dysregulated Lipid Metabolism in Postmenopausal Women. Nutrients 2021; 13:nu13124556. [PMID: 34960109 PMCID: PMC8704126 DOI: 10.3390/nu13124556] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
Aging women experience hormonal changes, such as decreased estrogen and increased circulating androgen, due to natural or surgical menopause. These hormonal changes make postmenopausal women vulnerable to body composition changes, muscle loss, and abdominal obesity; with a sedentary lifestyle, these changes affect overall energy expenditure and basal metabolic rate. In addition, fat redistribution due to hormonal changes leads to changes in body shape. In particular, increased bone marrow-derived adipocytes due to estrogen loss contribute to increased visceral fat in postmenopausal women. Enhanced visceral fat lipolysis by adipose tissue lipoprotein lipase triggers the production of excessive free fatty acids, causing insulin resistance and metabolic diseases. Because genes involved in β-oxidation are downregulated by estradiol loss, excess free fatty acids produced by lipolysis of visceral fat cannot be used appropriately as an energy source through β-oxidation. Moreover, aged women show increased adipogenesis due to upregulated expression of genes related to fat accumulation. As a result, the catabolism of ATP production associated with β-oxidation decreases, and metabolism associated with lipid synthesis increases. This review describes the changes in energy metabolism and lipid metabolic abnormalities that are the background of weight gain in postmenopausal women.
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Affiliation(s)
- Seong-Hee Ko
- Department of Microbiology, College of Medicine, Gachon University, Incheon 21999, Korea;
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea
| | - YunJae Jung
- Department of Microbiology, College of Medicine, Gachon University, Incheon 21999, Korea;
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea
- Correspondence: ; Tel.: +82-32-899-6415
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Gavin KM, Melanson EL, Hildreth KL, Gibbons E, Bessesen DH, Kohrt WM. A Randomized Controlled Trial of Ovarian Suppression in Premenopausal Women: No Change in Free-Living Energy Expenditure. Obesity (Silver Spring) 2020; 28:2125-2133. [PMID: 33150745 PMCID: PMC7653843 DOI: 10.1002/oby.22978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether suppression of ovarian function (gonadotropin-releasing hormone agonist [GnRHAG ]) for 24 weeks in premenopausal women approaching menopause causes changes in body composition and a decline in free-living physical activity energy expenditure (PAEE) and whether endurance exercise training attenuates the changes. METHODS Premenopausal women who were approaching menopause (mean [SD]: age 46 [3] years, BMI 26.3 [4.8] kg/m2 ) were randomized to 24 weeks of GnRHAG (n = 14), GnRHAG + Exercise (n = 11), or placebo (n = 9). Endurance exercise was performed 4 days per week with the goal of expending 200 to 300 kcal per session. Primary outcome measurements included body composition by dual-energy x-ray absorptiometry, total daily energy expenditure (TDEE), and PAEE by doubly labeled water, and resting energy expenditure (REE) by indirect calorimetry. RESULTS Changes in TDEE, PAEE, REE, or body composition were not different between groups. However, within the GnRHAG group, fat mass increased (mean [SE]: total 1.7 [0.4] kg, trunk 0.9 [0.2] kg, leg 0.6 [0.2] kg) and fat-free leg mass decreased (mean [SE]: -0.4 [0.2] kg) significantly. CONCLUSIONS In premenopausal women approaching menopause, ovarian hormone suppression resulted in increased adiposity without alterations in TDEE, PAEE, or REE.
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Affiliation(s)
- Kathleen M Gavin
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Eastern Colorado VA Geriatric, Research, Education, and Clinical Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward L Melanson
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Eastern Colorado VA Geriatric, Research, Education, and Clinical Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kerry L Hildreth
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ellie Gibbons
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel H Bessesen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Anschutz Health and Wellness Center, Aurora, Colorado, USA
| | - Wendy M Kohrt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Eastern Colorado VA Geriatric, Research, Education, and Clinical Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients 2020; 12:nu12010202. [PMID: 31941004 PMCID: PMC7019719 DOI: 10.3390/nu12010202] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/19/2019] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Menopause is clinically diagnosed as a condition when a woman has not menstruated for one year. During the menopausal transition period, there is an emergence of various lipid metabolic disorders due to hormonal changes, such as decreased levels of estrogens and increased levels of circulating androgens; these may lead to the development of metabolic syndromes including cardiovascular diseases and type 2 diabetes. Dysregulation of lipid metabolism affects the body fat mass, fat-free mass, fatty acid metabolism, and various aspects of energy metabolism, such as basal metabolic ratio, adiposity, and obesity. Moreover, menopause is also associated with alterations in the levels of various lipids circulating in the blood, such as lipoproteins, apolipoproteins, low-density lipoproteins (LDLs), high-density lipoproteins (HDL) and triacylglycerol (TG). Alterations in lipid metabolism and excessive adipose tissue play a key role in the synthesis of excess fatty acids, adipocytokines, proinflammatory cytokines, and reactive oxygen species, which cause lipid peroxidation and result in the development of insulin resistance, abdominal adiposity, and dyslipidemia. This review discusses dietary recommendations and beneficial compounds, such as vitamin D, omega-3 fatty acids, antioxidants, phytochemicals—and their food sources—to aid the management of abnormal lipid metabolism in postmenopausal women.
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Melanson EL, Lyden K, Gibbons E, Gavin KM, Wolfe P, Wierman ME, Schwartz RS, Kohrt WM. Influence of Estradiol Status on Physical Activity in Premenopausal Women. Med Sci Sports Exerc 2019; 50:1704-1709. [PMID: 29509642 DOI: 10.1249/mss.0000000000001598] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine the effects of 5 months of ovarian hormone suppression in premenopausal women on objectively measured physical activity (PA). METHODS Participants (age, 35 ± 8 yr; body mass index, 27 ± 6 kg·m) received monthly intramuscular injections of gonadotropin-releasing hormone agonist (GnRHAG) therapy, which suppresses pituitary gonadotropins and results in suppression of ovarian sex hormones. Women were randomized to receive concurrent transdermal E2 (GnRHAG + E2; n = 30) or placebo (GnRHAG + PL, n = 31). PA was assessed for 1 wk before and during each month of the 5-month intervention using a hip-worn accelerometer (Actical, Mini Mitter Co., Inc., Bend, OR). Estimates of time spent in sedentary, light, and moderate-to-vigorous PA (MVPA) were derived using a previously published equation. Subsets of participants in each group were also randomized to a supervised progressive resistance exercise training program. RESULTS Total MVPA tended toward being higher (P = 0.08) in the GnRHAG + E2 group at month 4. There were no significant effects of intervention or time in sedentary or light PA. In the subset of women who did not participate in structured exercise training for which Actical data were obtained (n = 16 in each group), total MVPA was higher at month 4 (P = 0.01). CONCLUSIONS PA levels seem to be maintained at a higher level in women undergoing pharmacological suppression of ovarian function with E2 add-back when compared with women treated with placebo. These data provide proof-of-concept data that E2 contributes to the regulation of PA in humans. However, given the exploratory nature of this study, future confirmatory investigations will be necessary.
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Affiliation(s)
- Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.,Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.,Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Aurora, CO
| | - Kate Lyden
- KAL Research and Consulting LLC, Denver, CO
| | - Ellie Gibbons
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kathleen M Gavin
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.,Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Aurora, CO
| | - Pamela Wolfe
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Margaret E Wierman
- Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.,VA Eastern Colorado Health Care System, Aurora, CO
| | - Robert S Schwartz
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.,Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Aurora, CO
| | - Wendy M Kohrt
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.,Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Aurora, CO
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Immunometabolic Links between Estrogen, Adipose Tissue and Female Reproductive Metabolism. BIOLOGY 2019; 8:biology8010008. [PMID: 30736459 PMCID: PMC6466614 DOI: 10.3390/biology8010008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/26/2019] [Accepted: 02/03/2019] [Indexed: 12/25/2022]
Abstract
The current knowledge of sex-dependent differences in adipose tissue biology remains in its infancy and is motivated in part by the desire to understand why menopause is linked to an increased risk of metabolic disease. However, the development and characterization of targeted genetically-modified rodent models are shedding new light on the physiological actions of sex hormones in healthy reproductive metabolism. In this review we consider the need for differentially regulating metabolic flexibility, energy balance, and immunity in a sex-dependent manner. We discuss the recent advances in our understanding of physiological roles of systemic estrogen in regulating sex-dependent adipose tissue distribution, form and function; and in sex-dependent healthy immune function. We also review the decline in protective properties of estrogen signaling in pathophysiological settings such as obesity-related metaflammation and metabolic disease. It is clear that the many physiological actions of estrogen on energy balance, immunity, and immunometabolism together with its dynamic regulation in females make it an excellent candidate for regulating metabolic flexibility in the context of reproductive metabolism.
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Body composition and bone mineral density after ovarian hormone suppression with or without estradiol treatment. Menopause 2016; 22:1045-52. [PMID: 25783468 DOI: 10.1097/gme.0000000000000430] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Suppression of ovarian hormones in premenopausal women on gonadotropin-releasing hormone agonist (GnRH(AG)) therapy can cause fat mass (FM) gain and fat-free mass (FFM) loss. Whether this is specifically caused by a decline in serum estradiol (E2) is unknown. This study aims to evaluate the effects of GnRH(AG) with placebo (PL) or E2 add-back therapy on FM, FFM, and bone mineral density (BMD). Our exploratory aim was to evaluate the effects of resistance exercise training on body composition during the drug intervention. METHODS Seventy healthy premenopausal women underwent 5 months of GnRH(AG) therapy and were randomized to receive transdermal E2 (GnRH(AG) + E2, n = 35) or PL (GnRH(AG) + PL, n = 35) add-back therapy. As part of our exploratory aim to evaluate whether exercise can minimize the effects of hormone suppression, some women within each drug arm were randomized to undergo a resistance exercise program (GnRH(AG) + E2 + Ex, n = 12; GnRH(AG) + PL + Ex, n = 12). RESULTS The groups did not differ in mean (SD) age (36 [8] and 35 [9] y) or mean (SD) body mass index (both 28 [6] kg/m). FFM declined in response to GnRH(AG) + PL (mean, -0.6 kg; 95% CI, -1.0 to -0.3) but not in response to GnRH(AG) + E2 (mean, 0.3 kg; 95% CI, -0.2 to 0.8) or GnRH(AG) + PL + Ex (mean, 0.1 kg; 95% CI, -0.6 to 0.7). Although FM did not change in either group, visceral fat area increased in response to GnRH(AG) + PL but not in response to GnRH(AG) + E2. GnRH(AG) + PL induced a decrease in BMD at the lumbar spine and proximal femur that was prevented by E2. Preliminary data suggest that exercise may have favorable effects on FM, FFM, and hip BMD. CONCLUSIONS Suppression of ovarian E2 results in loss of bone and FFM and expansion of abdominal adipose depots. Failure of hormone suppression to increase total FM conflicts with previous studies of the effects of GnRH(AG). Further research is necessary to understand the role of estrogen in energy balance regulation and fat distribution.
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Melanson EL, Gavin KM, Shea KL, Wolfe P, Wierman ME, Schwartz RS, Kohrt WM. Regulation of energy expenditure by estradiol in premenopausal women. J Appl Physiol (1985) 2015; 119:975-81. [PMID: 26338457 DOI: 10.1152/japplphysiol.00473.2015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/01/2015] [Indexed: 11/22/2022] Open
Abstract
Suppressing sex hormones in women for 1 wk reduces resting energy expenditure (REE). The effects of more chronic suppression on REE and other components of total energy expenditure (TEE), and whether the reduction in REE is specifically due to loss of estradiol (E2), are not known. We compared the effects of 5 mo of sex hormone suppression (gonadotropin releasing hormone agonist therapy, GnRHAG) with placebo (PL) or E2 add-back therapy on REE and the components of TEE. Premenopausal women received GnRHAG (leuprolide acetate 3.75 mg/mo) and were randomized to receive transdermal therapy that was either E2 (0.075 mg/d; n = 24; means ± SD, aged = 37 ± 8 yr, BMI = 27.3 ± 6.2 kg/m(2)) or placebo (n = 21; aged = 34 ± 9 yr, BMI = 26.8 ± 6.2 kg/m(2)). REE was measured by using a metabolic cart, and TEE, sleep EE (SEE), exercise EE (ExEE, 2 × 30 min bench stepping), non-Ex EE (NExEE), and the thermic effect of feeding (TEF) were measured by using whole room indirect calorimetry. REE decreased in GnRHAG+PL [mean (95% CI), -54 (-98, -15) kcal/d], but not GnRHAG+E2 [+6 (-33, +45) kcal/d] (difference in between-group changes, P < 0.05). TEE decreased in GnRHAG+PL [-128 (-214, -41) kcal/d] and GnRHAG+E2 [-96 (-159, -32) kcal/d], with no significant difference in between-group changes (P = 0.55). SEE decreased similarly in both GnRHAG+PL [-0.07 (-0.12, -0.03) kcal/min] and GnRHAG+E2 [-0.07 (-0.12, -0.02) kcal/min]. ExEE decreased in GnRHAG+PL [-0.46 (-0.79, -0.13) kcal/min], but not GnRHAG+E2 [-0.30 (-0.65, +0.06) kcal/min]. There were no changes in TEF or NExEE in either group. In summary, chronic pharmacologic suppression of sex hormones reduced REE and this was prevented by E2 therapy.
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Affiliation(s)
- Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado and Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Kathleen M Gavin
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado and Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Karen L Shea
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado and Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Pamela Wolfe
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado and
| | - Margaret E Wierman
- Division of Endocrinology, Metabolism, and Diabetes Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Robert S Schwartz
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado and Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Wendy M Kohrt
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado and Denver Veterans Affairs Medical Center, Denver, Colorado
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Van Pelt RE, Gavin KM, Kohrt WM. Regulation of Body Composition and Bioenergetics by Estrogens. Endocrinol Metab Clin North Am 2015; 44:663-76. [PMID: 26316249 PMCID: PMC4555869 DOI: 10.1016/j.ecl.2015.05.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Evidence points to an important role of estradiol (E2) in the regulation of body composition and bioenergetics. Basic and preclinical research shows that the disruption of E2 signaling through either genetic manipulation or surgical intervention accelerates fat accumulation, with a disproportionate increase in abdominal fat. Clinical evidence for the regulation of body composition and bioenergetics by E2 is less consistent. Evidence exists both for and against menopause as the mediator of changes in body composition. Thus, a need remains to better understand the metabolic actions of estrogens in women and the potential impact on health after the menopause.
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Affiliation(s)
- Rachael E Van Pelt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Mailstop B179, Academic Office One, 12631 East 17th Avenue, Room 8111, Aurora, CO 80045, USA
| | - Kathleen M Gavin
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Mailstop B179, Academic Office One, 12631 East 17th Avenue, Room 8111, Aurora, CO 80045, USA
| | - Wendy M Kohrt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Mailstop B179, Academic Office One, 12631 East 17th Avenue, Room 8111, Aurora, CO 80045, USA.
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Abstract
Based on the results of a French cohort of postmenopausal women, it has been claimed that micronized progesterone does not enhance breast cancer risk. The impact of reproductive factors on breast cancer risk and a high prevalence of occult breast carcinomas at the time of menopause suggest an involvement of endogenous progesterone in the development of breast cancer. High mammographic density in the luteal phase and during treatment with estrogen/progestogen combinations reflect a change in the composition of mammary stroma and an increased water accumulation in the extracellular matrix which is caused by hygroscopic hyaluronan-proteoglycan aggregates. Proteoglycans are also involved in the regulation of proliferation, migration, and differentiation of epithelial cells and angiogenesis, and may influence malignant transformation of breast cells and progression of tumors. Reports on a lack of effect of estrogen/progesterone therapy on breast cancer risk may be rooted in a selective prescription to overweight women and/or to the very low progesterone serum levels after oral administration owing to a strong inactivation rate. The contradictory results concerning the proliferative effect of progesterone may be associated with a different local metabolism in normal compared to malignant breast tissue. Similar to other progestogens, hormone replacement therapy with progesterone seems to promote the development of breast cancer, provided that the progesterone serum levels have reached the threshold for endometrial protection.
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Affiliation(s)
- H Kuhl
- Department of Obstetrics and Gynecology, J. W. Goethe University of Frankfurt, Germany
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Van Pelt RE, Gozansky WS, Hickner RC, Schwartz RS, Kohrt WM. Acute modulation of adipose tissue lipolysis by intravenous estrogens. Obesity (Silver Spring) 2006; 14:2163-72. [PMID: 17189542 PMCID: PMC2832608 DOI: 10.1038/oby.2006.253] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether intravenous (IV) conjugated estrogens (EST) acutely enhance the suppression of whole-body or regional subcutaneous adipose tissue (SAT) lipolysis by insulin in postmenopausal women. RESEARCH METHODS AND PROCEDURES We assessed whole-body lipolysis by [(2)H(5)]glycerol rate of appearance (Glyc(RA)) and abdominal and femoral SAT lipolysis (interstitial glycerol; Glyc(IS)) by subcutaneous microdialysis. Postmenopausal women (n = 12) were studied on two occasions, with IV EST or saline control (CON), under basal conditions and during a 3-stage (4, 8, and 40 mU/m(2)/min) hyperinsulinemic, euglycemic clamp. Ethanol outflow/inflow ratio and recovery of [(13)C]glycerol during microdialysis were used to assess blood flow changes and interstitial glycerol concentrations, respectively. RESULTS Compared with CON, EST did not affect systemic basal or insulin-mediated suppression of lipolysis (Glyc(RA)) or SAT nutritive blood flow. Basal Glyc(IS) in SAT was reduced on the EST day. However, insulin-mediated suppression of lipolysis in SAT was not significantly influenced by EST. DISCUSSION These findings suggest that estrogens acutely reduce basal lipolysis in SAT through an unknown mechanism but do not alter whole-body or SAT suppression of lipolysis by insulin.
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Affiliation(s)
- Rachael E Van Pelt
- Department of Medicine, Division of Geriatric Medicine, University of Colorado at Denver and Health Sciences Center, 4200 E. Ninth Ave., Campus Box B-179, Denver, CO 80262, USA.
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Kohrt WM, Van Pelt RE, Gozansky WS. Effects of estrogen replacement on metabolic factors that influence physical performance in female hypogonadism. J Endocrinol Invest 2003; 26:902-10. [PMID: 14964444 DOI: 10.1007/bf03345242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is a lack of knowledge regarding the effects of estrogens on physical performance. This is related, in part, to the challenge of isolating the effects of estrogens from those of progestins, because levels of both hormones fluctuate across the menstrual cycle, both decline during the menopausal transition, and the administration oh hormones to hypogonadal women typically involves a combination of estrogens and progestins. Some research findings suggest that fluctuations in estrogen levels acutely influence factors that may affect physical performance, such as substrate utilization or maximal aerobic power, but solid evidence is lacking. The simple observation that hypogonadism is not uncommon among elite athletes in some sports suggests that estrogen deficiency does not have a major negative impact on athletic performance. However, chronic hypogonadism may ultimately lead to impaired performance by menas that are not necessarily obvious. For example, chronic estrogen deficiency has potent, deleterious effects on the skeleton that can increase risk for stress fracture and may limit the ability to sustain a high level of physical training. Estrogen deficiency also appears to promote fat accumulation and may accelerate the loss of fat-free mass, and both of these changes in body composition could impair physical performance. There is evidence that hormone replacement attenuates the negative effects of hypogonadism on body composition and bone density, and that effects are mediated primarily by estrogens rather than progestins. Further research is necessary to broaden the understanding of the role of the estrogens in physical performance.
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Affiliation(s)
- W M Kohrt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
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