Excess weight and physical health-related quality of life in postmenopausal women of diverse racial/ethnic backgrounds

Does body mass index influence quality-of-life recovery in individuals who underwent total knee arthroplasty: A prospective study

Background/Purpose:

To clarify the relationship between body mass index (BMI) and quality-of-life (QOL) recovery in individuals who underwent total knee arthroplasty (TKA).

Methods:

This prospective cohort study included 80 individuals who underwent TKA. The dependent variable was the Japanese Knee Osteoarthritis Measure used for assessing the QOL, and the independent variables were age, sex, BMI, and the Kellgren–Lawrence grade. A hierarchical multiple regression analysis was used to clarify whether BMI was a significant independent variable after accounting for other factors.

Results:

Sex was found to be the only significant predictor ( β = 0.29, p < 0.05), and BMI was not related to QOL recovery in individuals who underwent TKA.

Conclusion:

This result suggests that sex was related to QOL recovery and should be assessed and that BMI was not related to QOL recovery in individuals who underwent TKA. These results may help health-care providers to identify individuals who might struggle with QOL recovery.

Weight loss is associated with improved quality of life among rural women completers of a web-based lifestyle intervention

INTRODUCTION

The evidence for whether weight loss following longer-term lifestyle interventions results in improved health-related quality of life (HRQoL) is inconclusive. This study examines whether women who lose weight after completing an 18-month web-based lifestyle modification intervention would report a corresponding improvement in HRQoL as measured using the Patient-Reported Outcomes Measurement Information System 29-item profile (PROMIS-29 v1.0).

METHODS

Data from 216 rural women, ages 40 to 69, with baseline and 18-month PROMIS-29 data were analyzed in this secondary analysis of the Women Weigh-in for Wellness clinical trial. This trial promoted lifestyle modification for initial weight loss (baseline to 6 months) and guided weight loss (6 months to 18 months) using a web-delivery format.

RESULTS

After adjusting for age, number of comorbidities, change in physical activity from baseline, intervention group, and baseline PROMIS-29 scores, change in weight was associated with improved health-related quality of life (HRQoL) in the domains of depression, physical function, pain interference, fatigue, and satisfaction with social role. Logistic regressions, adjusting for the same factors, indicated women with ≥ 10% weight loss were more likely to report lower depression, higher physical function and less pain interference, compared to women who gained weight or lost < 5%.

CONCLUSIONS

Among our rural women, a loss in weight from baseline appeared to be associated with overall improvement in multiple PROMIS-29 v 1.0 domains, noting the likelihood of achieving improvement was significantly higher among women who attained ≥ 10% weight loss. These findings may positively influence a woman's adherence to lifestyle modification weight loss and weight maintenance program.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01307644.

Gynecological cancer and metabolic screening of 1001 elderly Brazilian women

OBJECTIVE

The aim of this study was to evaluate gynecological cancer and metabolic screening of Brazilian women aged 65 years or older.

METHODS

This retrospective descriptive study was conducted by including 1,001 Brazilian patients of the gynecological geriatric outpatient office of our institution to evaluate the influence of age on gynecological cancer and metabolic screening parameters at the first clinical visit. All patients were divided into three groups: a) 65 to 69 years; b) 70 to 74 years; c) ≥ 75 years. We considered clinical, laboratorial, and image data as variables of this study. The Chi-square test was used to assess the proportion of differences among the age groups, and Kruskal-Wallis was used for quantitative variables.

RESULTS

The values of BMI and height in the group over 75 years was lower than that of the 65 to 69 years (p = 0.001). Regardless of the age group, high arterial blood pressure levels were found in 85.45% of participants. Also, many patients had glucose intolerance in the blood. The pelvic ultrasonography showed abnormal endometrial echo thickness (> 5 mm) in 6.14% of patients, but with no significant statistical difference between the age groups. A total of 4.04% of patients had ovaries with high volume values ( > 6.1 mL). Abnormal mammography (BI-RADS 3 or 4) was observed in 12.21%.

CONCLUSIONS

our data suggest that a great reduction in BMI and stature is more frequent in the group over 75 years. Also, systemic arterial hypertension and carbohydrate disturbance are frequent morbidities in women over 65 years.

Prevalence and Severity of Menopausal Symptoms and the Quality of Life in Middle-aged Women: A Study from Sri Lanka

Menopausal symptoms and quality of life (QOL) of pre- and postmenopausal women in Sri Lanka have not been studied adequately. This study aimed to evaluate the prevalence and severity of menopausal symptoms and the QOL of pre- and postmenopausal women in Galle District, Sri Lanka. A cross-sectional study was conducted with a randomly selected sample of premenopausal (n=184) and postmenopausal (n=166) community-dwelling healthy women aged 30-60 years. The mean (SD) ages of pre- and postmenopausal women, respectively, were 46.1(3.7) and 55.8(3.8) years. Menopausal symptoms were evaluated using the menopause rating scale under three subscales: psychological symptoms, somatovegetative symptoms, and urogenital symptoms. The QOL was evaluated using the short form 36 survey under eight domains. Further, sociodemographic status, gynaecologic factors, physical activity pattern (walking, moderate, and vigorous), body mass index, and waist to hip ratio were also evaluated. The prevalence and severity of all the menopausal symptoms were higher among postmenopausal women. In premenopausal women, the most frequently reported menopausal symptoms were mental exhaustion (49.5%), joint and muscular discomforts (48.5%), and irritability (41.3%). Physical and mental exhaustion (53%), irritability (48.2%), depressive mood (43.4%), and hot flushes (42.2%) were the most frequently reported menopausal symptoms in postmenopausal women. The QOL was significantly impaired among postmenopausal women [mean (SD); 57.47(18.83)] compared to premenopausal women [mean (SD); 66.82(17.93)] (p<0.001). Psychological symptoms score and somatovegetative symptoms score were associated with the QOL of premenopausal women (adjusted R2; 0.35). Somatovegetative symptoms score, psychological symptoms score, moderate and vigorous physical activity scores, and monthly income were associated with the QOL in postmenopausal women (adjusted R2; 0.38). The current study showed that the prevalence and severity of menopausal symptoms and impaired QOL were significantly higher among postmenopausal women, compared to premenopausal women. Menopausal symptoms mostly contributed to the poorer QOL in both pre- and postmenopausal women.

Body mass index and waist circumference predict health-related quality of life, but not satisfaction with life, in the elderly

OBJECTIVES

While obesity has been linked with lower quality of life in the general adult population, the prospective effects of present obesity on future quality of life amongst the elderly is unclear. This article investigates the cross-sectional and longitudinal relationships between obesity and aspects of quality of life in community-dwelling older Australians.

METHOD

A 2-year longitudinal sample of community dwellers aged 70-90 years at baseline, derived from the Sydney Memory and Ageing Study (MAS), was chosen for the study. Of the 1037 participants in the original MAS sample, a baseline (Wave 1) sample of 926 and a 2-year follow-up (Wave 2) sample of 751 subjects were retained for these analyses. Adiposity was measured using body mass index (BMI) and waist circumference (WC). Quality of life was measured using the Assessment of Quality of Life (6 dimensions) questionnaire (AQoL-6D) as well as the Satisfaction with Life Scale (SWLS). Linear regression and analysis of covariance (ANCOVA) were used to examine linear and non-linear relationships between BMI and WC and measures of health-related quality of life (HRQoL) and satisfaction with life, adjusting for age, sex, education, asthma, osteoporosis, depression, hearing and visual impairment, mild cognitive impairment, physical activity, and general health. Where a non-linear relationship was found, established BMI or WC categories were used in ANCOVA.

RESULTS

Greater adiposity was associated with lower HRQoL but not life satisfaction. Regression modelling in cross-sectional analyses showed that higher BMI and greater WC were associated with lower scores for independent living, relationships, and pain (i.e. worse pain) on the AQoL-6D. In planned contrasts within a series of univariate analyses, obese participants scored lower in independent living and relationships, compared to normal weight and overweight participants. Longitudinal analyses found that higher baseline BMI and WC were associated with lower independent living scores at Wave 2.

CONCLUSIONS

Obesity is associated with and predicts lower quality of life in elderly adults aged 70-90 years, and the areas most affected are independent living, social relationships, and the experience of pain.

The effect of a randomized controlled physical activity trial on health related quality of life in metabolically unhealthy African-American women: FIERCE STUDY

PURPOSE

African-American women (AAW) are more likely to be metabolically unhealthy than White women (WW). Metabolic syndrome (MetS) is associated with increased breast cancer risk and mortality from breast cancer is greater in AAW compared to WW. Data show MetS affects health-related quality of life (HRQoL). Exercise studies report improvements in MetS, however, no study to date has examined HRQoL in metabolically unhealthy AAW enrolled in an exercise trial.

METHODS

This report examined the effect of a 6-month, 3-arm (supervised exercise, home-based exercise, control) randomized exercise controlled trial on HRQoL among 213 obese, metabolically unhealthy, postmenopausal AAW at high risk for breast cancer.

RESULTS

Certain baseline participant characteristics were related to baseline HRQoL dimensions. The "exercise group" (supervised group combined with the home-based group) showed significantly greater improvement in health change scores (M = 13.6, SD = 3.1) compared to the control group (M = 0.7, SD = 4.4) (p = 0.02) over the 6-month study period. There were no significant differences in HRQoL change scores between the 3 study groups, however, although non-significant, data indicated most HRQoL change scores were more favorable in the supervised group.

CONCLUSION

While significant improvement occurred in health change scores in the combined supervised and home-based group compared to the control group, we did not observe any significant differences on HRQoL change scores between all three study groups. However, while non-significant, there was a trend for more favorable HRQoL change scores in the supervised group versus the home-based and control groups. Additional research is needed to further explore this topic.

Surgical weight loss as a life-changing transition: The impact of interpersonal relationships on post bariatric women

Surgical Weight Loss as A Life-changing Transition: The Impact of Interpersonal Relationships on Post-Bariatric Women BACKGROUND: Although women account for 80% of patients having bariatric surgery (BS), the complex psychosocial mechanisms that accompany this transformation process have not been well established.

PURPOSE

The purpose of this study is to explore the lived experience of women transitioning in their interpersonal relationships post BS.

METHODS

A semi-structured interview with four questions was used. Six women, from six to 12 months post BS, were interviewed. The interviews were recorded, transcribed and analyzed using thematic analysis.

MAIN FINDINGS

By seeking support systems prior to undergoing BS, adequate social support was received during their recovery period. Attending bariatric support group meetings and using social media were significant to these women's satisfactory recovery. Relationship adjustments were sometimes needed, but overall these women established fulfilling social lives. Within the first year post bariatric surgery, women began to gain emotional strength and inspire others to lose weight as well.

CONCLUSIONS

By inquiring about the psychosocial concerns of women who have undergone BS, healthcare providers can provide a more practical wellness plan.

Combined exercise training reduces climacteric symptoms without the additive effects of isoflavone supplementation: A clinical, controlled, randomised, double-blind study

BACKGROUND

Exercise and supplementation with isoflavones are therapies used to prevent and treat climacteric symptoms.

AIM

To verify the effects of 10 weeks of combined aerobic and resistance training and isoflavone supplementation on climacteric symptoms in postmenopausal women.

METHODS

A randomised, double-blind, controlled clinical trial was performed. A total of 32 postmenopausal women, aged 54.4 ± 5.4 years, with a body mass index of 26.6 ± 3.0 kg/m² and 5.6 ± 4.6 years after menopause, were randomly assigned to groups: placebo and exercise (PLA + EXE, n = 15) or 100 mg of isoflavone and exercise (ISO + EXE, n = 17). At the beginning and after 10 weeks of aerobic + resistance (20 min each, moderate intensity) training, climacteric symptoms were evaluated using the Blatt-Kupperman Menopausal Index, Cervantes Scale and Menopause Rating Scale. ANCOVA was used for analysis between groups and at different times, with the covariate adjusted by the pre-value. The level of significance considered was p < 0.05.

RESULTS

A reduction in climacteric symptoms was observed in both groups, without differences between the interventions. The reductions were 45% and 50% for the Blatt-Kupperman Menopausal Index, 41% and 52% for the MRS and 39% and 39% for the Cervantes Scale in the ISO + EXE and PLA + EXE groups, respectively. In the descriptive analysis of the Blatt-Kupperman Menopausal Index values, there was an increase in the absence of symptoms from 48-77% in the ISO + EXE group and 24-58% in the PLA + EXE group.

CONCLUSIONS

A period of 10 weeks of combined training was effective in improving climacteric symptoms in post-menopausal women. However, isoflavone supplementation did not promote additional effects in improving symptoms.

Perceived discrimination and health-related quality-of-life: gender differences among older African Americans

PURPOSE

Emerging data suggest that African-American women may fare worse than African-American men in health-related quality-of-life (HRQOL). Perceived discrimination is an important contributor to poor health overall among African Americans, but few studies examined the intersecting effects of perceived discrimination and gender in explaining HRQOL disparities. We investigated gender differences in HRQOL and tested whether perceived discrimination accounted for these differences.

METHODS

We examined data from the Chicago Health and Aging Project in which 5652 African-American adults aged 65 and older completed structured questionnaires about demographic and socioeconomic characteristics, HRQOL, perceived discrimination, and health-related variables. Logistic regression models were used to identify associations between perceived discrimination and gender differences in poor HRQOL outcomes (defined as 14+ unhealthy days in overall, physical, or mental health over the past 30 days) when controlling for the other variables.

RESULTS

More women reported poor overall HRQOL than men (24 vs. 16% respectively). Higher perceived discrimination was significantly associated with worse overall HRQOL (OR 1.11; 95% CI 1.08, 1.15), with stronger effects for women in overall and mental HRQOL. These gender disparities remained significant until controlling for potentially confounding variables. Perceived discrimination did not account for gender differences in poor physical HRQOL.

CONCLUSIONS

Perceived discrimination is associated with poor HRQOL in older African Americans, with this association appearing stronger in women than men for mental HRQOL. These findings warrant further investigation of effects of perceived discrimination in gender disparities in overall health, and such research can inform and guide efforts for reducing these disparities.

Association between quality of life, menopausal status, and sociodemographic factors among middle-aged women in Iran

OBJECTIVE

Assessment of overall health, well-being, and quality of life (QoL) during middle age and menopause deserves special attention. The aim of this study was to investigate the effect of menopausal status and some sociodemographic variables on QoL among middle-aged women in Semnan, Iran.

PARTICIPANTS AND METHODS

This cross-sectional survey was conducted in 2012 in Semnan, Iran. The participants included 770 women aged 45-60 years. The data were collected by interview using a structured questionnaire that included sociodemographic characteristics, data on menopausal status, and QoL measurement using the Menopause-Specific Quality of Life questionnaire.

RESULTS

The mean±SD age of the women was 50.9±4.7 years. The overall unadjusted mean scores obtained for each domain were as follows: vasomotor: 1.83±1.86; psychosocial: 1.62±1.41; physical: 1.98±1.28; and sexual: 1.63±1.87. Logistic regression analysis showed that menopausal status was significantly associated with QoL in all domains, except the psychosocial domain. Age, BMI, household income, and number of children were significantly associated with impairment in QoL. Marital status, educational level, and residential area did not show any association with QoL in multivariate analysis.

CONCLUSION AND RECOMMENDATIONS

Our findings confirm previous literature on the negative impact of menopausal symptoms on QoL, and show the interaction of some sociodemographic characteristics including age, number of children, household income, and BMI, on QoL. Health professionals should ensure that they consider a range of factors in middle-aged women's lives and provide insight into possible treatment strategies and lifestyle interventions for improving QoL.

The development of youth-onset severe obesity in urban US girls

•

Youth-onset severe obesity warrants particular concern in urban female populations.

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Among 2226 girls, prevalence was 8.3% at age 7–10, 10.8% at age 12–15 and fairly stable over teen years.

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Severe obesity prevalence increased more rapidly with age for girls born in 1995 versus 1992.

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Severely obese girls' BMI grew 2.6 times as fast as normal-BMI peers in the transition to adolescence.

•

Late childhood and early adolescence is a key developmental window for prevention and treatment.

Objective

To understand the incidence and persistence of severe obesity (≥1.2 × 95th BMI percentile-for-age) in girls across the transition to adolescence, and map developmental trajectories of adolescent severe obesity in a high-risk sample.

Methods

We examined ten years of prospectively collected data from a population sample of urban girls (n = 2226; 53% African American, aged 7–10 in 2003–2004). We determined severe obesity prevalence and incidence by age. Logistic regression evaluated for secular trend in the association between age and severe obesity prevalence. Unconditional latent growth curve models (LGCMs) compared BMI development through the adolescence transition between girls with severe obesity versus healthy BMI.

Results

Severe obesity prevalence was 8.3% at age 7–10 and 10.1% at age 16–19 (white: 5.9%; African American: 13.2%; p < 0.001). Age-specific prevalence increased more rapidly among the latest-born, versus earliest-born, girls (p = 0.034). Incidence was 1.3% to 2.4% annually. When we compared 12–15 year-old girls with severe obesity versus healthy BMI, average body weight was already distinct 5 years earlier (16.5 kg versus 25.7 kg; p < 0.001) and the BMI difference between groups increased annually. LGCMs between ages 7–10 and 11–14 indicated an increase of 3.32 kg/m² in the healthy-BMI group and 8.50 kg/m² in the severe obesity group, a 2.6-fold difference.

Conclusions

Youth-onset severe obesity warrants particular concern in urban girls due to high prevalence and an increasing secular prevalence trend. Late childhood and early adolescence may represent a key developmental window for prevention and treatment, but is too late to prevent youth-onset severe obesity entirely.

Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women's Health Initiative

OBJECTIVE

To evaluate the incidence of cardiovascular disease (CVD) morbidity and mortality over the course of 10 years among the more than 160,000 postmenopausal women in the Women's Health Initiative (WHI) in relation to self-reported rheumatoid arthritis (RA), taking disease-modifying antirheumatic drugs (DMARDs), anti-cyclic citrullinated peptide (anti-CCP) positivity, rheumatoid factor (RF) positivity, CVD risk factors, joint pain, and inflammation (white blood cell count and interleukin-6 levels).

METHODS

Anti-CCP and RF were measured in a sample of WHI participants with self-reported RA (n = 9,988). RA was classified as self-reported RA plus anti-CCP positivity and/or taking DMARDs. Anti-CCP-negative women with self-reported RA and not taking DMARDs were classified as having "unverified RA."

RESULTS

Age-adjusted rates of coronary heart disease (CHD), stroke, CVD, fatal CVD, and total mortality were higher in women with RA than in women with no reported RA, with multivariable-adjusted hazard ratios of 1.46 (95% confidence interval [95% CI] 1.17-1.83) for CHD and 2.55 (95% CI 1.86-3.51) for fatal CVD. Among women with RA, anti-CCP positivity and RF positivity were not significantly associated with higher risk of any outcomes, despite slightly higher risk of death for those who were anti-CCP positive than for those who were anti-CCP negative. Joint pain severity and CVD risk factors were strongly associated with CVD risk, even in women with no reported RA. CVD incidence was increased in women with RA versus women with no reported RA at almost all risk factor levels, except for low levels of joint pain or inflammation. Among women with RA, inflammation was more strongly associated with fatal CVD and total mortality than with CHD or CVD.

CONCLUSION

Among postmenopausal women, RA was associated with 1.5-2.5-fold higher CVD risk. CVD risk was strongly associated with CVD risk factors, joint pain severity, and inflammation, but not with anti-CCP positivity or RF positivity.

How to evaluate quality of life in overweight and obese women during climacterium?

Objective: identifying the instruments used to measure quality of life during menopausal transition and post-menopause in women with obesity or overweight. Methods: a systematic search using the Embase, Pubmed and Cochrane databases, and the following key-words: menopause/climacteric, quality of life, overweight/obesity. Nineteen papers that fulfilled the including criteria were found. Results: eighteen studies using generic health questionnaires (global quality of life) were identified, six of them were specific for menopause and one specific for obesity. Eleven studies used generic questionnaires, while only eight questionnaires were specific for menopause. Conclusion: there was no consensus in the literature about the use of quality of life questionnaires in women with overweight and obesity in climacterium, which makes de comparison and reproducibility of the results difficult. This is an alert about the need for standardization to better evaluate this specific population.

Metabolic disorder and obesity in 5027 Brazilian postmenopausal women

OBJECTIVES

To evaluate the frequency of obesity in postmenopausal women and assess the potential effects of increased body mass index (BMI) on lipoprotein profile and on risk factors for arterial hypertension and diabetes.

DESIGN

A cross-sectional study was conducted with 5027 postmenopausal Brazilian women. Analyses were performed of BMI and cardiovascular factors (systemic blood pressure [BP], total cholesterol, low-density lipoprotein, high-density lipoprotein [HDL-C], triglyceride, and fast glucose). The statistical analysis included the chi-square and Mann-Whitney tests. The significance level was set at 5%.

RESULTS

Obesity (BMI >30) in our study characterized approximately 30% of the 5027 postmenopausal women. The comparison of patients with normal BMI and those with high BMI showed that high BMI had a significant negative effect on BP, as evidenced by the increased frequency of hypertension in overweight and obese patients (>25) (p < 0.001), that it also negatively and significantly affected triglyceride (p < 0.001) and fast glucose levels (p < 0.001), and that it was linked significantly to low levels of HDL-C.

CONCLUSION

Our data showed the high frequency of obesity in our population and of the cardiovascular risks (glucose, systemic arterial hypertension, and low HDL-C) associated with high BMI.

Changes in body weight and health-related quality of life: 2 cohorts of US women

Studies have shown that body weight is a determinant of health-related quality of life (HRQoL). However, few studies have examined long-term weight change with changes in HRQoL. We followed 52,682 women aged 46-71 years in the Nurses' Health Study (in 1992-2000) and 52,587 women aged 29-46 years in the Nurses' Health Study II (in 1993-2001). Body weight was self-reported, HRQoL was measured by the Medical Outcomes Study's 36-Item Short Form Health Survey, and both were updated every 4 years. The relationship between changes in weight and HRQoL scores was evaluated at 4-year intervals by using a generalized linear regression model with multivariate adjustment for baseline age, ethnicity, menopausal status, and changes in comorbidities and lifestyle factors. Weight gain of 15 lbs (1 lb = 0.45 kg) or more over a 4-year period was associated with 2.05-point lower (95% confidence interval: 2.14, 1.95) physical component scores, whereas weight loss of 15 lbs or more was associated with 0.89-point higher (95% confidence interval: 0.75, 1.03) physical component scores. Inverse associations were also found between weight change and physical function, role limitations due to physical problems, bodily pain, general health, and vitality. However, the relations of weight change with mental component scores, social functioning, mental health, and role limitations due to emotional problems were small.

Determinants of mortality among postmenopausal women in the women's health initiative who report rheumatoid arthritis

OBJECTIVE

Rheumatoid arthritis (RA) patients have an increased risk of cardiovascular disease (CVD) and mortality. We measured anti-cyclic citrullinated peptide (anti-CCP) antibody levels and determined use of disease-modifying antirheumatic drugs (DMARDs) among women in the Women's Health Initiative (WHI). Using these data, we undertook this study to assess total mortality over 10 years of followup among white, black, or Hispanic women with self-reported RA in the WHI.

METHODS

Using stored baseline serum, we measured anti-CCP, rheumatoid factor (RF), and antinuclear antibodies (ANAs) in 9,988 women who reported having RA. Based on a previous chart review study, probable RA was defined as either self-reported RA and anti-CCP positivity, or anti-CCP negativity and DMARD use. Cox proportional hazards regression was used to model the relationship of self-reported RA, DMARD exposure, and anti-CCP positivity to total mortality, using followup data through April 2009.

RESULTS

At baseline, the mean age was 62.8 years; 24.5% of subjects were black and 10% were Hispanic. Prevalence of anti-CCP positivity was 8.1% (n = 812), and 217 women were anti-CCP negative but had reported use of DMARDs; therefore, 1,029 women (of 9,988) were classified as having probable RA, and 8,958 were classified as unlikely to have RA (with data on DMARD use missing for 1 subject). Age-adjusted mortality rates were ∼2-fold higher for anti-CCP-positive women, with 20.2 deaths per 1,000 person-years, as compared to 11.4 deaths per 1,000 person-years among anti-CCP-negative women with self-reported RA who never used DMARDs. Among women who did not report any arthritis at baseline, we found 8.3 deaths per 1,000 person-years. The increased risk among anti-CCP-positive women with RA was not explained by age, RF positivity, ANA positivity, or DMARD use.

CONCLUSION

Anti-CCP-positive RA was associated with substantial excess mortality among postmenopausal women in the WHI. This result was not explained by the risk factors we measured.

Severe obesity, heart disease, and death among white, African American, and Hispanic postmenopausal women

OBJECTIVE

To compare mortality, nonfatal coronary heart disease (CHD), and congestive heart failure (CHF) risk across BMI categories in white, African American, and Hispanic women, with a focus on severe obesity (BMI ≥ 40), and examine heterogeneity in weight-related CHD risk.

METHODS

Among 156,775 Women's Health Initiative observational study and clinical trial participants (September 1993-12 September 2005), multivariable Cox models estimated relative risk for mortality, CHD, and CHF. CHD incidence was calculated by anthropometry, race, and cardiovascular risk factors (CVRF).

RESULTS

Mortality, nonfatal CHD, and CHF incidence generally rose with BMI category. For severe obesity versus normal BMI, hazard ratios (HRs, 95% confidence interval) for mortality were 1.97 (1.77-2.20) in white, 1.55 (1.20-2.00) in African American, and 2.59 (1.55-4.31) in Hispanic women; for CHD, HRs were 2.05 (1.80-2.35), 2.24 (1.57-3.19), and 2.95 (1.60-5.41) respectively; for CHF, HRs were 5.01 (4.33-5.80), 3.60 (2.30-5.62), and 6.05 (2.49-14.69). CVRF variation resulted in substantial variation in CHD rates across BMI categories, even in severe obesity. CHD incidence was similar by race/ethnicity when differences in BMI or CVRF were accounted for.

CONCLUSIONS

Severe obesity increases mortality, nonfatal CHD, and CHF risk in women of diverse race/ethnicity. CVRF heterogeneity contributes to variation in CHD incidence even in severe obesity.

Impact of age and body mass on the intensity of menopausal symptoms in 5968 Brazilian women

OBJECTIVE

To assess the relationship of onset of menopause and body mass on the menopausal symptoms in post-menopausal Brazilian women.

DESIGN

Observational study conducted by the selection and inclusion of 5968 Brazilian women after menopause. The following variables were analyzed in this study: time at menopause; the relationship between age at menarche and age at menopause; vasomotor symptoms compared with age at the time of menopause and the time of menopause; Kupperman menopausal index (KMI) versus total time of menopause; body mass index (BMI) compared to the time of menopause, vasomotor symptoms, and KMI total score. We used the Chi-square test, and the significance level was set at 5%.

RESULTS

The age at natural menopause ranged from 41 to 62 years (mean 48.1 ± 4.07 years). A younger age at menopause was associated with a high intensity of vasomotor symptoms. These symptoms were more intense in the first 5 years of menopause and decreased with time. The KMI total also decreased with time after menopause, with the exception of arthralgia, myalgia, and insomnia, which did not tend to improve over time. In addition, the vasomotor symptoms and total KMI were more frequent with increasing BMI.

CONCLUSIONS

Our results suggested that the age of menopause and BMI may influence the intensity of vasomotor symptoms.

The relationship between body mass index and quality of life in community-living older adults living in the United States

BACKGROUND

Carrying excess weight is associated with various chronic conditions especially in older adults, and can have a negative influence on the quality of life of this population.

OBJECTIVE

The objective of this study was to estimate the independent (i.e. adjusted for demographic, socioeconomic and health status differences) impact of Body Mass Index (BMI) on health-related quality of life.

DESIGN

A mail survey was sent to 60,000 older adults living in 10 states.

METHODS

The survey assessed quality of life using the average physical component scores (PCS) and mental component scores (MCS) obtained from the Veterans Rand 12-item (VR-12) health status tool embedded in the survey. Ordinary least squares (OLS) regression techniques were used to estimate the independent impact of each BMI category on quality of life, compared to the impact of other chronic conditions.

RESULTS

A total of 22,827 (38%) eligible sample members responded to the survey. Of those, 2.2% were underweight, 38.5% had a normal BMI, 37.0% were overweight, 18.5% were obese and 1.9% were morbidly obese. Following OLS regression techniques, respondents' PCS values were statistically significantly lower for the underweight, overweight, obese and morbidly obese BMI categories, compared to the normal BMI group. Compared with all other chronic conditions, being morbidly obese (-6.0 points) had the largest negative impact on the PCS. Underweight was the only BMI category with a statistically significantly lower MCS value.

CONCLUSIONS

The greatest negative impacts of the various BMI categories on quality of life were on physical rather than mental aspects, especially for those in the underweight, obese and morbidly obese categories, more so than many other chronic conditions.

Impact of lifestyle intervention and metformin on health-related quality of life: the diabetes prevention program randomized trial

BACKGROUND

Adults at high risk for diabetes may have reduced health-related quality of life (HRQoL).

OBJECTIVE

To assess changes in HRQoL after interventions aimed at diabetes risk reduction.

DESIGN, SETTING, AND PARTICIPANTS

A randomized clinical trial, the Diabetes Prevention Program, was conducted in 27 centers in the United States, in 3,234 non-diabetic persons with elevated fasting and post-load plasma glucose, mean age 51 years, mean BMI 34 Kg/m(2); 68 % women, and 45 % members of minority groups.

INTERVENTIONS

Intensive lifestyle (ILS) program with the goals of at least 7 % weight loss and 150 min of physical activity per week, metformin (MET) 850 mg twice daily, or placebo (PLB).

MEASUREMENTS

HRQoL using the 36-Item Short-Form (SF-36) health survey to evaluate health utility index (SF-6D), physical component summaries (PCS) and mental component summaries (MCS). A minimally important difference (MID) was met when the mean of HRQoL scores between groups differed by at least 3 %.

RESULTS

After a mean follow-up of 3.2 years, there were significant improvements in the SF-6D (+0.008, p=0.04) and PCS (+1.57, p<0.0001) scores in ILS but not in MET participants (+0.002 and +0.15, respectively, p=0.6) compared to the PLB group. ILS participants showed improvements in general health (+3.2, p<0.001), physical function (+3.6, p<0.001), bodily pain (+1.9, p=0.01), and vitality (+2.1, p=0.01) domain scores. Treatment effects remained significant after adjusting sequentially for baseline demographic factors, and for medical and psychological comorbidities. Increased physical activity and weight reduction mediated these ILS treatment effects. Participants who experienced weight gain had significant worsening on the same HRQoL specific domains when compared to those that had treatment-related (ILS or MET) weight loss. No benefits with ILS or MET were observed in the MCS score.

CONCLUSION

Overweight/obese adults at high risk for diabetes show small improvement in most physical HRQoL and vitality scores through the weight loss and increased physical activity achieved with an ILS intervention.

Effect of exercise combined with phytoestrogens on quality of life in postmenopausal women

BACKGROUND

Postmenopausal women seem to favor alternative therapies such as exercise and phytoestrogens as a substitute for potentially harmful hormone replacement therapy. Based on previous research, we hypothesized that phytoestrogens combined with exercise could have a synergic effect on women's health.

OBJECTIVE

To verify whether phytoestrogens enhance the response to mixed training regarding menopausal symptoms and quality of life in postmenopausal women.

METHODS

From a pool of women participating in a 6-month randomized, controlled exercise study, 21 received a placebo (mean age 58.3 ± 5.4 years, body mass index 29.8 ± 5.1 kg/m(2)) and 19 received phytoestrogen supplements (mean age 60.1 ± 3.4 years; body mass index 30.3 ± 4.6 kg/m(2)). Body weight, fat mass and lean body mass (dual-energy X-ray absorptiometry) were assessed. Quality of life was estimated by the Short Form-36 (SF-36) and Perceived Stress Scale-10 (PSS-10) questionnaires, and menopausal symptoms by the Kupperman index. All measurements were performed before and after the intervention.

RESULTS

Although the Kupperman index and PSS-10 remained unchanged in both groups, the SF-36 Physical Component Summary and almost all the SF-36 subscales (except for role-emotional and mental health) increased only in the exercise group taking phytoestrogens (0.001 < p < 0.04).

CONCLUSION

While phytoestrogens combined with mixed exercise were not sufficient to improve menopausal symptoms, it seemed to be a better strategy than exercise alone to improve the general quality of life in postmenopausal women.