Effect of a weight loss intervention on anthropometric measures and metabolic risk factors in pre- versus postmenopausal women

Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use

OBJECTIVE

To compare weight loss response and changes in cardiometabolic risk markers in postmenopausal women using semaglutide with and without menopause hormone therapy (HT) use.

METHODS

Retrospective cohort study of postmenopausal women treated with semaglutide for overweight or obesity for ≥3 months. Endpoints: total body weight loss percentage (TBWL%) at 3, 6, 9, and 12 months after semaglutide initiation; and percentage of women achieving ≥5% and ≥10% TBWL and changes in cardiometabolic risk markers (glucose, blood pressure, and lipids) at 12 months.

RESULTS

There were 16 women on HT and 90 on no-HT; mean age 56 ± 8 vs 59 ± 8 yr, P = 0.2 and mean BMI 36 ± 5 vs 39 ± 8 kg/m 2 , P = 0.1; respectively. Among women on no-HT, White race, dyslipidemia, and depression were more prevalent. Women on HT had a higher TBWL% at 3, 6, 9, and 12 months: 7 ± 3% vs 5 ± 4%, P = 0.01; 13 ± 6% vs 9 ± 5%, P = 0.01; 15 ± 6% vs 10 ± 6%, P = 0.02; and 16 ± 6% vs 12 ± 8%, P = 0.04; respectively. After adjusting for potential confounders, this association remained significant across time. At 12 months, a greater percentage of women on HT achieved ≥5% and ≥10% TBWL. Both groups experienced an improvement in cardiometabolic risk markers.

CONCLUSION

In postmenopausal women with overweight or obesity treated with semaglutide, HT use was associated with an improved weight loss response. This association was maintained when adjusted for confounders. Larger studies should be conducted to confirm these results.

A Survey on Relation of Menopause to Metabolic Syndrome - SAFOMS STUDY (South Asian Federation of Menopause Societies) - Interim Analysis

Background

Metabolic syndrome (MS) is a spectrum of disorders that includes dysglycemia, dyslipidemia, central obesity, and hypertension. South Asian Indians are more prone to harbor MS at a younger age compared to Caucasians. However, there is a lack of large-scale data correlating menopause to MS in South Asian settings.

Aims and Objectives

The study aimed to determine the prevalence of MS and its components in pre- and postmenopausal women. It also assessed the relationship of age, menopausal status, personal and family history, anthropometric parameters, and biochemical markers to MS.

Materials and Methods

It was an interim analysis of a multicountry cross-sectional study in the South Asian Federation of Menopause Society (SAFOMS) countries: India, Pakistan, Bangladesh, Nepal, and Sri Lanka conducted through both online and physical methods. The survey questionnaire consisted of questions about details of personal history, demographics, and family history related to MS. Anthropometric measurements such as height, weight, basal metabolic index (BMI), waist circumference, and blood pressure readings were noted. Relevant history, history of polycystic ovarian syndrome, hypertensive disorders of pregnancy, and vasomotor symptoms were enquired. Biochemical evaluation of markers associated with MS was undertaken.

Results

In this interim analysis, 638 women were recruited. Out of them, 406 (63.6%) women were premenopausal and 232 (36.4%) were postmenopausal. 392 (61.4%) women had MS, while 246 (38.6%) women did not have MS. Increasing age, BMI, and visceral adiposity (waist circumference) were significantly correlated with incidence of MS. Raised fasting blood sugar, hemoglobin A1C, total cholesterol, low-density lipoprotein, serum triglyceride, and reduced high-density lipoprotein levels were significantly associated with the incidence of MS in both pre- and postmenopausal women. Peri- and postmenopausal hot flashes, night sweats, and sleep disturbances were also significantly associated with MS. Personal history of hypertension, diabetes, and dyslipidemia were the strongest factors to be associated with MS with a significantly high odds ratio.

Conclusion

The study has highlighted the role of BMI and waist circumference as the first warning signs, which will encourage to go for regular biochemical screening through lipid profile and fasting blood glucose measurements. Our study is a stepping stone for all future studies for relation of menopause to MS.

Association between Menopause, Postmenopausal Hormone Therapy and Metabolic Syndrome

(1) Background: We aimed to explore the associations between menopause, postmenopausal hormone therapy, and metabolic syndrome in a large community-based group of Asian women. (2) Methods: This is a cross-sectional study in which we enrolled women aged 30 to 70 years with sufficient information about menopausal status from the Taiwan Biobank. The definition for metabolic syndrome used in this study aligns with the Bureau of Health Promotion's (Taiwan) proposed definition. (3) Results: A total of 17,460 women were recruited. The postmenopausal group had a higher metabolic syndrome prevalence (30% vs. 14%) and 1.17 times higher odds ratio (OR) than the premenopausal group (95% confidence interval [CI] = 1.02 to 1.33). Regarding the types of menopause, surgical menopause was associated with metabolic syndrome (OR = 1.40; 95% CI = 1.20 to 1.63); however, natural menopause was not associated with metabolic syndrome. Interestingly, postmenopausal hormone therapy was associated with a lower risk of metabolic syndrome in the women with natural menopause (OR = 0.79; 95% CI = 0.70 to 0.89), but not in those with surgical menopause. (4) Conclusions: Our results suggest that menopause is associated with an increased prevalence of metabolic syndrome, while postmenopausal hormone therapy is associated with a lower prevalence of metabolic syndrome in women with natural menopause.

Association between Metabolic Obesity Phenotypes and the Burden of Hospitalized Postmenopausal Patients Concomitant with Osteoporosis: A Retrospective Cohort Study Based on the National Readmission Database

BACKGROUND

The present definition of obesity based on body mass index (BMI) is not accurate and effective enough to identify hospitalized patients with a heavier burden, especially for postmenopausal hospitalized patients concomitant with osteoporosis. The link between common concomitant disorders of major chronic diseases such as osteoporosis, obesity, and metabolic syndrome (MS) remains unclear. Here, we aim to evaluate the impact of different metabolic obesity phenotypes on the burden of postmenopausal hospitalized patients concomitant with osteoporosis in view of unplanned readmissions.

METHODS

Data was acquired from the National Readmission Database 2018. The study population was classified into metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) patients. We estimated the associations between metabolic obesity phenotypes and 30- and 90-day unplanned readmissions. A multivariate Cox Proportional Hazards (PH) model was used to assess the effect of factors on endpoints, with results expressed as HR and 95% CI.

RESULTS

The 30-day and 90-day readmission rates for the MUNO and MUO phenotypes were higher than that of the MHNO group (all p < 0.05), whereas no significant difference was found between the MHNO and MHO groups. For 30-day readmissions, MUNO raised the risk mildly (hazard ratio [HR] = 1.110, p < 0.001), MHO had a higher risk (HR = 1.145, p = 0.002), and MUO further elevated this risk (HR = 1.238, p < 0.001). As for 90-day readmissions, both MUNO and MHO raised the risk slightly (HR = 1.134, p < 0.001; HR = 1.093, p = 0.014, respectively), and MUO had the highest risk (HR = 1.263, p < 0.001).

CONCLUSIONS

Metabolic abnormalities were associated with elevated rates and risks of 30- or 90-day readmission among postmenopausal hospitalized women complicated with osteoporosis, whereas obesity did not seem to be innocent, and the combination of these factors led to an additional burden on healthcare systems and individuals. These findings indicate that clinicians and researchers should focus not only on weight management but also metabolism intervention among patients with postmenopausal osteoporosis.

Physical activity on cardiorespiratory fitness and cardiovascular risk in premenopausal and postmenopausal women: a systematic review of randomized controlled trials

IMPORTANCE

The apparent cardioprotective effects of endogenous estrogens to prevent cardiovascular disease in premenopausal women are reduced with the loss of estrogen post-menopause. Cardiorespiratory fitness and cardiovascular risk factors are closely related to physical activity levels.

OBJECTIVE

This study conducted a critical assessment of studies for health prevention that analyze the effects of physical activity programs on cardiorespiratory fitness and cardiovascular risk factors in women, comparing premenopausal and postmenopausal states, through a systematic review of randomized controlled trials.

EVIDENCE REVIEW

A computerized literature search was performed to include articles up until December 2021 in the following online databases: PubMed, Cochrane, Scopus, SportDiscus, and Web of Science. Regarding physical activity intervention, women of all ages were engaged. The PEDro scale and Oxford's evidence levels were used for the assessment of the risk of bias in the included articles.

FINDINGS

Fourteen scientific articles met the inclusion criteria. Great variability was found in physical activity variables. All the studies found an improvement in at least one variable. The risk of bias was high, with all the articles obtaining a low methodological quality, except two with high methodological quality. Only one article considered the differences in the menopausal state observing the effects of physical activity intervention and highlighting the importance of physical activity in both states.

CONCLUSIONS AND RELEVANCE

To strengthen the evidence for the benefits of physical activity programs in women and to observe the effects depending on their menopausal state, there is an ongoing need for more rigorous randomized controlled trials of appropriate length and dose, with individualized exercise intensity.

Adherence to the Mediterranean Diet and Risk of Metabolically Unhealthy Obesity in Women: A Cross-Sectional Study

Some obese individuals do not present any metabolic alteration and are considered metabolically healthy (MHO). Adherence to high-quality dietary pattern may favor this phenotype. We aimed to evaluate the association between the adherence to the Mediterranean diet and risk of metabolically unhealthy obesity (MUO) in women. We conducted a cross-sectional study on 2,115 obese women. All patients underwent a medical examination, anthropometric evaluation, bioelectrical impedance, ultrasound measurements of abdominal visceral (VAT) and subcutaneous (SAT) fat, blood sampling and evaluation of adherence to the Mediterranean diet through MEDAS questionnaire. The diagnosis of MHO and MUO was made using the harmonized criteria. A multivariable logistic regression adjusted for age, BMI, fat free mass, ultrasound-estimated VAT:SAT ratio, marital status, education, past diet, antidepressant use, family history of diabetes and cardiovascular disease, menopausal status, smoking, and physical activity was used to assess the association between Mediterranean diet and MUO risk. The prevalence of MHO was 21.2% (N = 449). Compared to MUO women, MHO women were younger, had lower BMI and VAT, and had higher fat free mass and SAT. In the multivariable model, the adherence to the Mediterranean diet was not associated with the risk of MUO (OR = 0.91, 95%CI: 0.62; 1.34, P = 0.624). Given the impact of menopause on metabolic health we also carried out the analysis in pre- and post-menopausal women separately. Higher adherence to the Mediterranean diet was associated with a lower risk of MUO in postmenopausal women (OR = 0.55, 95%CI: 0.31; 0.96, P = 0.034). No association was found in premenopausal women (OR = 1.18, 95%CI: 0.70; 1.99, P = 0.532). In conclusion, adherence to the Mediterranean diet was associated with a better metabolic health in postmenopausal women. Further studies are needed to confirm the ability of the Mediterranean diet in promoting maintenance of the healthy phenotype and reversion from MUO.

Effects of Health Behavior Interventions on Psychosocial Outcomes and Cortisol Regulation Among Chronically Stressed Midlife and Older Adults

BACKGROUND

Altered cortisol dynamics have been associated with increased risk for chronic health problems among midlife and older adults (≥ 45 years of age). Yet, studies investigating the impact of health behavior interventions on cortisol activity in this age group are limited.

OBJECTIVE AND METHODS

The current study examined whether 48 midlife and older adults (50% family caregivers, 69% women) randomized to one of four telephone-based health behavior interventions (stress management (SM), exercise (EX), nutrition (NUT), or exercise plus nutrition (EX+NUT)) showed improvements in their perceived stress, mood, and cortisol dynamics at 4 months post-intervention. Participants collected four salivary cortisol samples (waking, 30 min after waking, 4 p.m., and bedtime) across two collection days at baseline and at 4 months post-intervention to assess for total cortisol, cortisol awakening response (CAR), and diurnal cortisol slope.

RESULTS

Participants in SM showed lower levels of total cortisol and a smaller CAR compared with those in EX, NUT, or EX+NUT from baseline to 4 months post-intervention. Participants in EX showed lower levels of perceived stress, depression, and anxiety compared with those in NUT or SM. Finally, participants in NUT showed a greater diurnal decline in cortisol and lower levels of anxiety compared with those in SM.

CONCLUSIONS

These findings provide support for the efficacy of telephone-based, health behavior interventions in improving different stress outcomes among chronically stressed midlife and older adults and suggest the need to test the longer-term effects of these interventions for improving health outcomes in this population.

Weight loss outcomes in premenopausal versus postmenopausal women during behavioral weight loss interventions: a systematic review and meta-analysis

IMPORTANCE

Weight loss may be difficult for young women with obesity to achieve due to competing priorities (caring for children and/or full-time work), limiting their ability to engage in weight loss interventions. Older or postmenopausal women may also face challenges to weight loss such as caring responsibilities and menopause. Menopausal status may reflect differences in weight loss.

OBJECTIVE

This study compared changes in weight, fat mass, and lean mass in premenopausal versus postmenopausal women in dietary weight loss trials.

EVIDENCE REVIEW

We reviewed publications from January 2000 to June 2020 evaluating a weight loss intervention with a dietary component, with or without exercise, and reporting weight loss of premenopausal and postmenopausal women. Where available, data on mean change from baseline for weight, fat mass, and lean mass of premenopausal and postmenopausal groups were entered into Review Manger for meta-analyses. Differences between menopausal groups were compared in subgroups of studies for intervention characteristics (diet-only vs diet and exercise; dietary modification vs meal replacement; < 24 wks vs ≥24 wks duration).

FINDINGS

Seven publications (10 interventions, n = 791) were included; three single-arm trials, two randomized controlled trials, and two comparative effectiveness trials. In meta-analyses, there were no statistically significant differences between premenopausal and postmenopausal women (shown as premenopausal minus postmenopausal) for change in weight (0.58 [95% confidence interval -0.12 to 1.28] kg, n = 7 interventions), fat mass (0.73 [-0.25 to 1.70] kg, n = 6 interventions), or lean mass (-0.5 6[-1.48 to 0.36] kg, n = 4 interventions). However, a statistically significant subgroup difference was observed for fat mass change between menopausal groups (premenopausal minus postmenopausal) when comparing diet-only (1.28 [0.23 to 2.33] kg, n = 4 interventions) versus diet and exercise interventions (-0.09 [-0.51 to 0.32]kg, n = 2 interventions). No differences were shown in any other subgroups.

CONCLUSIONS AND RELEVANCE

This review provides some evidence to suggest weight loss interventions may not need to be tailored to women's menopausal status. However, given the small number of studies, short intervention duration in most publications (≤ 6 mo) and unclear retention rates in premenopausal versus postmenopausal groups of some publications, menopausal group differences should be examined in existing and future trials where the appropriate data have been collected.

Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association

Cardiovascular disease (CVD) is the leading cause of death in women, who have a notable increase in the risk for this disease after menopause and typically develop coronary heart disease several years later than men. This observation led to the hypothesis that the menopause transition (MT) contributes to the increase in coronary heart disease risk. Over the past 20 years, longitudinal studies of women traversing menopause have contributed significantly to our understanding of the relationship between the MT and CVD risk. By following women over this period, researchers have been able to disentangle chronological and ovarian aging with respect to CVD risk. These studies have documented distinct patterns of sex hormone changes, as well as adverse alterations in body composition, lipids and lipoproteins, and measures of vascular health over the MT, which can increase a woman's risk of developing CVD postmenopausally. The reported findings underline the significance of the MT as a time of accelerating CVD risk, thereby emphasizing the importance of monitoring women's health during midlife, a critical window for implementing early intervention strategies to reduce CVD risk. Notably, the 2011 American Heart Association guidelines for CVD prevention in women (the latest sex-specific guidelines to date) did not include information now available about the contribution of the MT to increased CVD in women. Therefore, there is a crucial need to discuss the contemporary literature on menopause and CVD risk with the intent of increasing awareness of the significant adverse cardiometabolic health-related changes accompanying midlife and the MT. This scientific statement provides an up-to-date synthesis of the existing data on the MT and how it relates to CVD.

Impact of Health-Promoting Lifestyle Education Intervention on Health-Promoting Behaviors and Health Status of Postmenopausal Women: A Quasi-Experimental Study from Sri Lanka

Health promotion through lifestyle education is an important measure to enhance health status of postmenopausal women (PMW). This study evaluated the effectiveness of health-promoting lifestyle education intervention (HPLEI) on adhering to health-promoting behaviors (HPB) and enhancing the health status in a group of Sri Lankan PMW. A quasi-experimental study was conducted with randomly selected, sociodemographic status matched, 72 PMW from two geographically separated areas in Galle District, Sri Lanka, allocated as experimental (n = 37, 54.6 ± 4.5 years) and control (n = 35, 56.5 ± 3.4 years) groups. Education intervention focused on postmenopausal health management including lifestyle modifications was performed only for the experimental group during 8 weeks, and a health education package was provided. The control group was not given any planned education programme. Both groups were followed up for a 6-month period. HPB and menopausal symptoms severity were evaluated by validated Health Promoting Lifestyle Profile-II and Menopause Rating Scale, respectively. Anthropometric adiposity indices (AAIs) including weight, body mass index (BMI), waist (WC) and hip (HC) circumferences, and waist to hip ratio (WHR); cardiovascular disease risk indicators (CVDRI) including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), total cholesterol and triglycerides, muscle strength; hand grip strength (HGS) and physical performance (PP); gait speed (GS) were measured. All parameters were evaluated before the intervention (baseline) and after follow-up of 6 months. All evaluated parameters were not different between experimental and control groups (p > 0.05) at the baseline. In the follow-up evaluation, HPB (p < 0.001), menopausal symptom scores (p < 0.001), AAI (p < 0.001), CVDRI (SBP, DBP, and FBS) (p < 0.05) and HGS and GS (p < 0.001) were significantly improved in the experimental group but not in the control group. Health education intervention focused on health-promoting lifestyle modifications is effective in improving the adherence to HPB and enhances the health status in PMW. This provides positive impact in lifestyle medicine.

Effectiveness and Characterization of Severely Energy-Restricted Diets in People with Class III Obesity: Systematic Review and Meta-Analysis

Severely energy-restricted diets are used in obesity management, but their efficacy in people with class III obesity (body mass index ≥40 kg/m2) is uncertain. The aims of this systematic review and meta-analysis were to determine the effectiveness and characteristics of severely energy-restricted diets in people with class III obesity. As there was a lack of publications reporting long-term dietary interventions and randomised controlled trial designs, our original publication inclusion criteria were broadened to include uncontrolled study designs and a higher upper limit of energy intake. Eligible publications reported studies including adults with class III obesity and that assessed a diet with daily energy intake ≤5000 kJ for ≥4 weeks. Among 572 unique publications from 4 databases, 11 were eligible and 10 were suitable for meta-analysis. Our original intention was to classify comparison arms into short-term (<6 months) and long-term (>1 year) interventions. Due to the lack of long-term data found, comparison arms were classified according to the commonalities in dietary intervention length among the included publications, namely dietary interventions of 4 weeks' duration and those of ≥6 weeks' duration. After a 4-week severely energy-restricted diet intervention, the pooled average weight loss was 9.81 (95% confidence interval 10.80, 8.83) kg, with a 95% prediction interval of 6.38 to 13.25 kg, representing a loss of approximately 4.1 to 8.6% of initial body weight. Diets ≥6 weeks' duration produced 25.78 (29.42, 22.15) kg pooled average weight loss, with a 95% prediction interval of 13.77 to 37.80 kg, representing approximately 10.2 to 28.0% weight loss. Daily dietary prescriptions ranged from 330 to 5000 kJ (mean ± standard deviation 2260 ± 1400 kJ), and had wide variations in macronutrient composition. The diets were administered mostly via liquid meal replacement products. While the included publications had a moderate risk of bias score, which may inflate reported weight loss outcomes, the published data to date suggest that severely energy-restricted diets, delivered via diets of varying composition, effectively produce clinically relevant weight loss (≥10% of initial body weight) when used for 6 weeks or more in people with class III obesity.

Impact of aerobic versus resisted exercise training on systemic inflammation biomarkers and quality of Life among obese post-menopausal women

Background

Although post-menopausal obesity is an important public national health problem in Saudi Arabia, to date no study has evaluated the effects of weight reduction on biochemical & clinical parameters and quality of Life for obese Saudi post-menopausal women.

Objective

The aim of this study was examine the effects of aerobic versus resisted exercise training effects upon systemic inflammation biomarkers and quality of life for obese post-menopausal Saudi women.

Material and Methods

One hundred Saudi post-menopausal obese women participated in this study, their age ranged from 50–58 years and their body mass index (BMI) ranged from 30–35 kg/m2. All participants were divided into two equal groups: The first group received aerobic exercise training on treadmill where, the second group received resisted exercise training. Health-related quality of life (SF-36 HRQL), tumor necrosis factor- alpha(TNF-α), Interleukin-2(IL-2), Interleukin-4 (IL-4), Interleukin-6 (IL-6) and C-reactive protein (CRP) were measured before and after 3 months at the end of the study.

Results

The mean values of SF-36 HRQL subscale scores were significantly increased, while the mean value of TNF-α, Il-2, IL-4, IL-6, CRP and BMI were significantly decreased in both groups after treatments. There were significant differences between mean levels of the investigated parameters in group (A) and group (B) after treatment with more changes in patients received aerobic exercise training.

Conclusion

The current study provides evidence that aerobic exercise is more appropriate than resisted exercise training in modulating inflammatory cytokines and quality of life among obese post-menopausal women.

Comprehensive lifestyle intervention vs soy protein-based meal regimen in non-alcoholic steatohepatitis

BACKGROUND

Non-alcoholic steatohepatitis (NASH) has become one of the leading causes of liver disease in the western world. In obese patients weight reduction is recommended. Up to now there are no specific guidelines for weight loss in order to reduce hepatic fat content.

AIM

To investigate the effects of a 24-wk guided lifestyle intervention program compared to a meal replacement regimen based on soy protein.

METHODS

Twenty-six subjects with NASH participated in a randomized single-center study. They were randomly assigned to either meal replacement group (MR-G) with soy-yogurt-honey preparation or to guided lifestyle change group (LC-G) with endurance activity and nutrition counselling. Serum alanine transaminase (ALT), aspartate transaminase (AST), lipid parameters, and adipokines were measured. Liver fat content and lipid composition were determined by magnetic resonance imaging and magnetic resonance spectroscopy. Body fat mass and lean body mass were assessed using Bod Pod^® device. Pre- and post-intervention monitoring of parameters was performed. Statistical analyses were conducted with SPSS software, results were expressed as median (interquartile range).

RESULTS

Twenty-two subjects (MR-G, n = 11 and LC-G, n = 11) completed the study (9 women, 13 men; age 52.1 (15.0) years, body mass index (BMI) 32.3 (3.3) kg/m²). In both groups a significant weight loss was achieved (MR-G: -6.4 (3.6) kg, P < 0.01; LC-G: -9.1 (10.4) kg, P < 0.01). BMI dropped in both groups (MR-G: -2.3 (1.5) kg/m², P = 0.003; LC-G: -3.0 (3.4) kg/m², P = 0.006). Internal fat and hepatic lipid content were markedly reduced in both groups in comparable amount. There was a strong correlation between reduction in liver fat and decrease in ALT. Likewise, both groups showed an improvement in glycemic control and lipid profile. Changes in adipokines, particularly in adiponectin and leptin were closely related to intrahepatic lipid changes.

CONCLUSION

Comprehensive lifestyle intervention and meal replacement regimen have comparable effects on body and liver fat, as well as decrease in markers of hepatic inflammation among NASH patients.

Weight loss and metabolic health effects from energy-restricted Mediterranean and Central-European diets in postmenopausal women: A randomized controlled trial

We conducted a randomized controlled trial to examine the effect of two energy-restricted diets on body weight (BW), visceral fat (VF) loss, and the risk factors for metabolic syndrome. A total of 144 centrally obese postmenopausal women were assigned to the moderate in fat Mediterranean diet (MED) or to the Central European diet (CED), which is moderate in carbohydrates and high in dietary fiber (DF), for 16 weeks. BW, waist circumference and VF were significantly reduced by 8.8%, 7.0%, and 24.6%, respectively, over the trial (P < 0.001), with no difference between groups. A similar trend was seen for total cholesterol, triglycerides, glucose, and blood pressure. Within each diet group, the more adherent participants lost significantly more BW than did their less adherent counterparts. VF was significantly reduced only in women who were more adherent to the CED, and the reduction in VF correlated with an increase in the proportion of DF. Short-term dietary treatment with the CED or the MED was associated with similar improvements in some anthropometric, lipid, and nonlipid parameters; however, adequate adherence to the prescribed diet is important in weight loss success and in achieving improvements in metabolic health.

Educational intervention on cardiovascular parameters in perimenopausal women with a cardiovascular risk factor. Randomised clinical trial

BACKGROUND AND OBJECTIVE

Randomised clinical trial performed in two urban health centres in Spain. To evaluate if educational intervention in women of perimenopausal age with hypertension, diabetes mellitus and/or dyslipidaemia could achieve significant changes in the reduction of biochemical and haemodynamic risk parameters.

PATIENTS AND METHODS

The study included 320 women aged between 45 and 60 years old who were diagnosed with hypertension, diabetes mellitus and/or dyslipidaemia. They were randomly assigned to the experimental group (n=160) and the control group (n=160). The intervention group received three educational sessions and the control group received an informative leaflet sent by mail. Haemodynamic and biochemical variables were evaluated at baseline and one year later in both groups.

RESULTS

Women in the intervention group showed a decrease in low density lipoprotein (P=.034), (-5.89±29.8; 95% CI: -13.1/0.27) and an increase in high density lipoprotein (P=.013), (2.71±10.6; 95% CI: -1.36/6.20), as well as improvements in systolic blood pressure (P=.016), (-2.16±11.8; 95% CI: -4.4/0.01) and frequency (P=.003), (-1.46±10.3; 95% CI: -3.34/0.42) compared to women in the control group. Women in the control group significantly increased glucose (P=.04), (4.84±15.5; 95% CI: -0.75/31.3) and gamma-glutamyltranspeptidase (P=.031), (3.61±14.7; 95% CI: 0.87/6.36) levels more than those in the experimental group.

CONCLUSIONS

An educational intervention can be an effective method of reducing the parameters associated with an increased likelihood of cardiovascular disease in women at perimenopausal age with hypertension, diabetes mellitus and/or dyslipidaemia.

Metabolic syndrome in HIV-infected middle-aged women on antiretroviral therapy: prevalence and associated factors

Objectives

To determine the prevalence of metabolic syndrome (MetS) and its associated factors in a group of HIV-infected middle-aged women.

Methods

Cross-sectional study including 273 HIV-infected climacteric women of 40–60 years of age under care in two HIV outpatient reference centers in Brazil. Metabolic syndrome diagnosis was based on 2006 International Diabetes Federation criteria. Sociodemographic, clinical and behavioral factors were evaluated as well as HIV infection-related parameters.

Results

Mean age was 47.7 years; 59.1% of women were premenopausal, 91% were on antiretroviral therapy. Current CD4 count was >500 cells/mm³ in 61.7%, current viral load undetectable in 76.9% of women, and a quarter had previous diagnosis of aids. The prevalence of metabolic syndrome in the subgroup of menopausal women was 46.9%. Univariate analysis showed an association between metabolic syndrome and age ≥50 years (p = 0.002), schooling <8 years (p = 0.003), post-menopause (p < 0.001), body mass index (BMI) >25 kg/m² (p < 0.001), and FSH ≥40 mIU/mL (p = 0.002). In the multivariate analysis only increased BMI (PR = 1.09; 95% CI: 1.05–1.13; p < 0.001) and FSH levels ≥40 mIU/mL (PR = 1.66; 95% CI: 1.14–2.40; p = 0.008) maintained statistical significance. There was no association between PI use or any other factor related to HIV-infection and MetS in any of the analyses performed.

Conclusion

High BMI and FSH levels compatible with menopause were the only factors associated with MetS in these middle aged HIV-infected women. In the context of well-controlled, early treated HIV infection, traditional rather than HIV-related factors were associated with MetS.

Single-blind, placebo controlled randomised clinical study of chitosan for body weight reduction

Background

Chitosan is a dietary fibre which acts by reducing fat absorption and thus used as a means for controlling weight. Weight loss clinical trial outcomes, however, have contradictory results regarding its efficacy. The primary objective of the present study was to evaluate the efficacy and safety of a chitosan from fungal origin in treatment of excess weight in the absence of dietary restrictions.

Methods

A phase IV, randomised, multicentre, single-blind, placebo-controlled, clinical study was conducted by administering chitosan capsules (500 mg, five/day) and indistinguishable placebo capsules as daily supplements to 96 overweight and obese subjects for 90 days. The study participants were divided in 2:1 ratio to receive either chitosan (n = 64) or placebo (n = 32). Efficacy was assessed by measuring body weight, body composition parameters, anthropometric measurements, HbA1C level and lipid profile at day 45 and day 90. Also, short form-36 quality of life (QoL) questionnaire was assessed to evaluate improvement in life-style and dietary habits were recorded for calorie intake. Safety was assessed by evaluating safety parameters and monitoring adverse events.

Results

The mean changes in body weight were -1.78 ± 1.37 kg and -3.10 ± 1.95 kg at day 45 and day 90 respectively in chitosan group which were significantly different (p < 0.0001) as compared to placebo. BMI was decreased by10.91 fold compared to placebo after 90 day administration. In concert with this, there was also reduction in body composition and anthropometric parameters together with improvement in QoL score. Chitosan was also able to reduce HbA1C levels (below 6 %) in subjects who had initial higher values. The mean caloric intake shows that there was no change in dietary habits of subjects in both groups. Lipid levels were unaffected and all adverse events were mild in nature and unrelated to study treatment.

Conclusion

Chitosan from fungal origin was able to reduce the mean body weight up to 3 kg during the 90 day study period. Together with this, there was also improvement in body composition, anthropometric parameters and HbA1C, reflecting overall benefits for the overweight individuals. Additionally, there was also improvement in QoL score. It was safe and well tolerated by all subjects.

Trial registration

CTRI/2014/08/004901.

Metabolic Syndrome and Menopause: Pathophysiology, Clinical and Diagnostic Significance

Menopause is a risk factor for cardiometabolic diseases, including metabolic syndrome (MetS), type 2 diabetes, and cardiovascular diseases. MetS is a constellation of interdependent factors such as insulin resistance, abdominal obesity, dyslipidemia, and hypertension. The prevalence of MetS in postmenopause is due to loss of the protective role of estrogens and increased circulating androgens resulting in changes to body fat distribution and development of abdominal obesity. Excessive visceral adipose tissue plays an important role due to synthesis and secretion of bioactive substances such as adipocytokines, proinflammatory cytokines, reactive oxygen species, prothrombotic, and vasoconstrictor factors. MetS may also impact risk assessment of breast cancer, osteoporosis and chronic kidney disease, and quality of life during the menopausal transition. Increased MetS has stimulated the exploration of new laboratory tests for early detection and therapies.

Effects of lifestyle intervention improve cardiovascular disease risk factors in community-based menopausal transition and early postmenopausal women in China

OBJECTIVE

The aim of this study was to test the efficacy of a 12-month lifestyle intervention in improving cardiovascular disease risk factors in community-based menopausal transition and early postmenopausal women in China.

METHODS

One hundred healthy menopausal transition and early postmenopausal women aged 40 to 60 years were randomly assigned to receive either lifestyle change intervention (n = 53) or usual care (n = 47). Menopause status was defined by the menstrual change criteria of the Stages of Reproductive Aging Workshop + 10 based on prospective menstrual calendars. Women in the intervention group were provided with a colorful booklet that included dietary and physical activity recommendations, were individually interviewed, and completed biophysical cardiovascular risk assessments at the Women's Health Center (Beijing, China). Women were encouraged to follow a healthy eating pattern and to increase their aerobic activity (moderate level, 3 d/wk, 40 min/d). Women in the control group continued their usual eating patterns and activities. Weight, body mass index (BMI), waist circumference-to-hip circumference ratio (WHR), waist circumference (WC), body composition, blood pressure (BP), blood glucose, and serum lipids were assessed at baseline, 3 months, 6 months, and 12 months in both groups.

RESULTS

Women in the intervention group were observed to have significant decreases in weight, BMI, WC, WHR, systolic BP, total cholesterol, and low-density lipoprotein cholesterol compared with women in the control group. At 3 months, there were significant decreases in weight (-0.28 vs 0.68 kg, P = 0.002), BMI (-0.06 vs 0.44 kg/m2, P = 0.003), WC (-0.28 vs 1.43 cm, P = 0.001), and WHR (-0.01 vs 0.01, P = 0.045) in the intervention group compared with the control group. At 6 months, there were significant decreases in WC (-0.73 vs 1.02 cm, P = 0.012), WHR (-0.02 vs -0.003, P = 0.020), and systolic BP (-7.52 vs -0.63 mm Hg, P = 0.012) favoring the intervention group over the control group. At 12 months, there were significant decreases in total cholesterol (-0.07 vs 0.03 mmol/L, P = 0.045) and low-density lipoprotein cholesterol (-0.13 vs 0.01 mmol/L, P = 0.022) in the intervention group versus the control group.

CONCLUSIONS

Lifestyle intervention may be an effective means for reducing cardiovascular disease risk factors in menopausal transition and early postmenopausal women in China.

Influence of aerobic exercise training on cardiovascular and endocrine-inflammatory biomarkers in hypertensive postmenopausal women

Given that few studies have examined the interaction between endocrine-inflammatory mediators and aerobic exercise training in hypertensive postmenopausal women, the aim of this study was to investigate whether aerobic exercise training (AET) for twenty-four sessions would alter cortisol, leptin and interleukin-1β (IL-1β) levels. To further analyze endothelium function in response to AET, we also examined redox state as well as NO/cGMP pathway in this population. Eighteen hypertensive postmenopausal women finished this study. AET program consisted of 24 sessions in treadmill, 3 times per week, duration of 30 up to 40 min for each session, for 8 weeks at intensity of 100% of the MLSS according to previous incremental test. Heart rate was monitored in all studied time (resting and during exercise sessions). After 48 h of the last exercise session, blood samples were collected for biochemical analyses (levels of cortisol, leptin, IL-1β, nitrite/nitrate (NOx⁻), cGMP, malondialdehyde (MDA) and asymmetric dimethylarginine (ADMA); superoxide and catalase activity). We also measured systolic and diastolic blood pressure. A significant reduction in body mass was observed. As expected, systolic and diastolic blood pressure values were significantly reduced after AET in hypertensive women. We also found a marked increase in NOx⁻ levels as well as cGMP concentration in trained women, approximately 37.7 and 30.8%, respectively. No changes in cortisol, leptin, ADMA and IL-1β levels were observed after AET. Similarly, MDA levels and catalase activity were not affected by AET. In contrast, a marked increase in SOD activity was found (86.6%). In conclusion, our findings show that aerobic exercise training for twenty-four sessions promoted a significant reduction in blood pressure by activating NO/cGMP pathway as well as by promoting an up-regulation of SOD activity without changing in cortisol/leptin levels in postmenopausal hypertensive women.

The impact of a weight reduction program with and without meal-replacement on health related quality of life in middle-aged obese females

BACKGROUND

In addition to an increased risk for chronic illnesses, obese individuals suffer from social stigmatization and discrimination, and severely obese people may experience greater risk of impaired psychosocial and physical functioning. Lower health-related quality of life (HRQOL) has been reported among obese persons seeking intensive treatment for their disease. To aid in the treatment of obesity, meal replacements have been recommended as an effective therapeutic strategy for weight loss, particularly when consumed in the beginning of an intervention. Hence, the objective of this study was to assess the impact of two 12-month weight reduction interventions (one arm including a meal replacement) on changes in HRQOL among obese females.

METHODS

This controlled trial compared two versions of a standardized 12-month weight reduction intervention: the weight-reduction lifestyle program without a meal replacement (LS) versus the same lifestyle program with the addition of a soy-based meal replacement product (LSMR). 380 women (LS: n = 190, LSMR: n = 190) were matched by age, gender, and weight (51.4 ± 7.0 yrs., 35.5 ± 3.03 kg/m2). This sample of women all completed the 12-month lifestyle intervention that was part of a larger study. The lifestyle intervention included instruction on exercise/sport, psychology, nutrition, and medicine in 18 theoretical and 40 practical units. Led by a sport physiologist, participants engaged in group-based exercise sessions once or twice a week. To evaluate HRQOL, all participants completed the SF-36 questionnaire pre- and post-intervention. Anthropometric, clinical, physical performance (ergometric stress tests), and self-reported leisure time physical activity (hours/day) data were collected.

RESULTS

The LSMR sample showed lower baseline HRQOL scores compared to the LS sample in six of eight HRQOL dimensions, most significant in vitality and health perception (p < 0.01). After the intervention, body weight was reduced in both lifestyle intervention groups (LS: -6.6±6.6 vs. LSMR -7.6±7.9 kg), however, weight loss and HRQOL improvements were more pronounced in the LSMR sample (LSMR: seven of eight, LS: four of eight dimensions).

CONCLUSIONS

Our results show that HRQOL may improve among middle-aged obese females during a standardized lifestyle weight reduction program and may be enhanced by consuming a soy-based meal replacement product.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00356785.

Menopausa e síndrome metabólica

A incidência de doença cardiovascular aumenta consideravelmente após a menopausa. Um dos motivos para o crescente risco cardiovascular parece ser determinado pela síndrome metabólica, da qual todos os componentes (obesidade visceral, dislipidemia, hipertensão arterial e distúrbio do metabolismo glicídico) se associam à maior incidência de coronariopatia. Após a menopausa, a síndrome metabólica é mais prevalente do que na pré-menopausa, podendo ter importante papel na ocorrência de infarto do miocárdio e outras morbidades ateroscleróticas e cardiovasculares. A obesidade, componente primordial da síndrome metabólica, se associa ainda ao aumento da incidência de câncer de mama, endométrio, intestino, esôfago e rim. O tratamento da síndrome metabólica se baseia na mudança de hábitos de vida e, quando necessário, no emprego de medicação dirigida aos seus componentes. Na presença de sintomas de síndrome do climatério, a terapia hormonal, quando indicada, concorrerá também para a melhora da síndrome metabólica.

Effects of a walking intervention using mobile technology and interactive voice response on serum adipokines among postmenopausal women at increased breast cancer risk

Practical methods to reduce the risk of obesity-related breast cancer among high-risk subgroups are lacking. Few studies have investigated the effects of exercise on circulating adipokines, which have been shown to be associated with obesity and breast cancer. The aim of this study was to examine the effects of a walking intervention on serum adiponectin, leptin, and the adiponectin-to-leptin ratio (A/L). Seventy-one overweight and obese postmenopausal women at increased risk of developing breast cancer were stratified by BMI (25-30 kg/m(2) or >30 kg/m(2)) and randomized to a 12-week, two-arm walking intervention administered through interactive voice response (IVR) and mobile devices. The intervention arms were IVR + coach and IVR + no-coach condition. Pre-post changes in serum adiponectin, leptin, and the A/L ratio were examined using mixed regression models, with ratio estimates (and 95 % confidence intervals [CI]) corresponding to postintervention adipokine concentrations relative to preintervention concentrations. While postintervention effects included statistically significant improvements in anthropometric measures, the observed decreases in adiponectin and leptin (ratio = 0.86, 95 % CI 0.74-1.01, and ratio = 0.94, 95 % CI 0.87-1.01, respectively) and increase in A/L ratio = 1.09, 95 % CI 0.94-1.26) were not significant. Thus, these findings do not support significant effects of the walking intervention on circulating adipokines among overweight and obese postmenopausal women. Additional studies are essential to determine the most effective and practical lifestyle interventions that can promote beneficial modification of serum adipokine concentrations, which may prove useful for obesity-related breast cancer prevention.

Aplicabilidade do indice adiposidade corporal na estimativa do percentual de gordura de jovens mulheres brasileiras

INTRODUÇÃO: A estimativa da composição corporal é um campo de estudo importante no prognóstico e diagnóstico de enfermidades degenerativas. OBJETIVO: Analisar a aplicabilidade do Índice de adiposidade corporal (IAC) e o método de dobras cutâneas. MÉTODOS: A amostra foi constituída por 19 adultas jovens com média de idade 24,53 ± 2,65 anos, submetidas à avaliação antropométrica (circunferências e dobras cutâneas) e absorsiometria por dupla emissão de raio X (DXA). Os valores estimados foram comparados ao valor de referência por meio do teste t pareado e pela análise do nível de associação entre os métodos pela correlação de Pearson; o nível de significância foi p < 0,05. RESULTADOS: Não apontaram diferenças significativas entre o percentual de gordura estimado pelo IAC e os valores de referência, porém, tiveram nível de associação moderado (r = 0,627). No entanto, o método de dobras cutâneas apresentou diferença estatística significante (p > 0,05) com nível de associação forte (r = 0,879). CONCLUSÃO: Embora o IAC não apresente diferença para os valores estimados, fica evidente a necessidade de mais estudos sobre a aplicabilidade do método na população brasileira.

The prevalence of metabolic syndrome and its predominant components among pre-and postmenopausal Ghanaian women

BACKGROUND

Metabolic Syndrome (MetS) is a clump of risk factors for development of type 2 diabetes mellitus and cardiovascular diseases. Menopause and age are thought to predispose women to the development of metabolic syndrome. This study aimed to estimate the prevalence of MetS and identify its predominant components among pre-and postmenopausal women in the Kumasi Metropolis, Ghana.Two hundred and fifty (250) Ghanaian women were randomly selected for the study. They were evaluated for the prevalence of metabolic syndrome using the World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF) and Harmonization (H_MS) criteria.

RESULTS

Out of the total subjects, 143 (57.2%) were premenopausal and 107 (42.8%) menopausal. The study population was between the ages of 20-78 years. The overall percentage prevalence of MetS were 14.4%, 25.6%, 29.2% and 30.4% according to the WHO, NCEP-ATP III, IDF and H_MS criteria, respectively. The prevalence was found to increase with age, irrespective of criterion used. Generally, MetS was significantly higher among postmenopausal women (p < 0.05 by all criteria) compared to their premenopausal cohort, but with marked inter-criteria variations. Abdominal obesity, blood pressure, fasting blood glucose, triglyceride, very low density lipoprotein cholesterol, and triglyceride-high density lipoprotein cholesterol ratio were significantly (p < 0.05) different among the two groups of women.Central obesity, higher blood pressure and raised fasting blood glucose were the predominant components that contributed to the syndrome in Ghanaian women.

CONCLUSION

The higher prevalence of the metabolic syndrome in postmenopausal women is an indication that they are at risk of developing cardiovascular disease and type 2 diabetes. Therefore women in that group should be monitored for the two conditions and also be advised to adopt healthy lifestyles to minimize the incidence of these conditions.

Effects of martial arts exercise on body composition, serum biomarkers and quality of life in overweight/obese premenopausal women: a pilot study

Various exercise interventions have been shown to benefit weight control and general health in different populations. However, very few studies have been conducted on martial arts exercise (MAE). The objective of this pilot study is to evaluate the efficacy of 12 weeks of MAE intervention on body composition, serum biomarkers and quality of life (QOL) in overweight/obese premenopausal women. We found that subjects in the MAE group did not lose body weight, while they significantly decreased fat-free mass and muscle mass as compared to those in the control group, who demonstrated an increase in these parameters. The MAE group demonstrated an increase in serum IGF-I concentration, but no change in others. MAE may be a feasible and effective approach to improve body composition and QOL in overweight/obese premenopausal women. Our study underscores the need for further studies using larger samples to establish possible benefits of MAE in various populations.

Decreasing cardiovascular risk factors in obese individuals using a combination of PGX® meal replacements and PGX® granules in a 12-week clinical weight modification program

In this open, clinically based, weight modification program, we determined in six sedentary obese adults (five women; one male; age range 30-62 years) that the combination of a modified calorie diet plus PGX® meal replacement and PGX® supplementation resulted in a significant reduction in several cardiovascular risk factors over a 12-week time period. This included a significant improvement in lipids (-0.98 mmol/l LDL-C), reduction in average weight (-9.2 kg), mean reduction in fat (-4.1%) and an increase in fat-free mass (2.8%).

Effects of age, sex, and treatment on weight-loss dynamics in overweight people

The objective of this work was to evaluate how sex, age, and the kind of treatment followed affect weight loss in overweight men and women, as well as to develop an explanation for the evolution of weight-loss dynamics. The study consisted of 119 overweight participants (18-50 years old, body mass index >25 and <29.9 kg·m(-2)), who were randomly assigned to 1 of 4 treatment programs, namely, strength training (n = 30), endurance training (n = 30), a combination of strength training and endurance training (n = 30), and a careful treatment including diet and physical recommendations (n = 29). Each of the training groups exercised 3 times per week for 24 weeks, and their daily diet was restricted to a specific protocol during the testing period and controlled carefully. Body weight changes in the participants were evaluated every 15 days. Based on this study, we developed and validated different sets of equations to accurately capture the weight-loss dynamics. There were no significant differences in terms of global body weight changes from the statistical viewpoint, either regarding the carried out treatment or the individuals' ages. However, significant differences in weight-loss tendency were found depending on participant sex. We concluded that the effectiveness of different possible treatments for weight loss varies by sex and, based on our experimental observations, a quadratic function provides the most accurate model for capturing specific weight-loss dynamics. This trial is registered at Clinical Trials Gov.: number NCT01116856.

Metabolic syndrome and menopause

Background

The metabolic syndrome is defined as an assemblage of risk factors for cardiovascular diseases, and menopause is associated with an increase in metabolic syndrome prevalence. The aim of this study was to assess the prevalence of metabolic syndrome and its components among postmenopausal women in Tehran, Iran.

Methods

In this cross-sectional study in menopause clinic in Tehran, 118 postmenopausal women were investigated. We used the adult treatment panel 3 (ATP3) criteria to classify subjects as having metabolic syndrome.

Results

Total prevalence of metabolic syndrome among our subjects was 30.1%. Waist circumference, HDL-cholesterol, fasting blood glucose, diastolic blood pressure ,Systolic blood pressure, and triglyceride were significantly higher among women with metabolic syndrome (P-value<0.05). Our study shows high abdominal obesity and hypertension are the most prevalent components of metabolic syndrome. 15%, 13.3% and 1.8% of subjects had three, four and five criteria for metabolic syndrome, respectively. There was a significant relationship between number of components of metabolic syndrome and waist circumference.

Conclusions

Our study shows that postmenopausal status is associated with an increased risk of metabolic syndrome. Therefore, to prevent cardiovascular disease there is a need to evaluate metabolic syndrome and its components from the time of the menopause.

Effects of circuit-based exercise programs on the body composition of elderly obese women

Aim

The aim of this study was to investigate the impact of circuit-based exercise on the body composition in obese older women by focusing on physical exercise and body weight (BW) gain control in older people.

Methods

Seventy older women (>60 years old) voluntarily took part in the study. Participants were randomized into six different groups according to body mass index (BMI): appropriate weight (AW) control (AWC) and trained (AWT) groups, overweight (OW) control (OWC) and trained (OWT) groups, and obesity (O) control (OC) and trained (OT) groups. The exercise program consisted of 50 minutes of exercise three times per week for 12 weeks. The exercises were alternated between upper and lower body using rest between sets for 40 seconds with intensity controlled by heart rate (70% of work). The contraction time established was 5 seconds to eccentric and concentric muscular action phase. The following anthropometric parameters were evaluated: height (m), body weight (BW, kg), body fat (BF, %), fat mass (FM, kg), lean mass (LM, kg), and BMI (kg/m²).

Results

The values (mean ± standard deviation [SD]) of relative changes to BW (−8.0% ± 0.8%), BF (−21.4% ± 2.1%), LM (3.0% ± 0.3%), and FM (−31.2% ± 3.0%) to the OT group were higher (P < 0.05) than in the AWT (BW: −2.0% ± 1.1%; BF: −4.6% ± 1.8%; FM: −7.0% ± 2.8%; LM: 0.2% ± 1.1%) and OWT (BW: −4.5% ± 1.0%; BF: −11.0% ± 2.2%; FM: −16.1% ± 3.2%; LM: −0.2% ± 1.0%) groups; additionally, no differences were found for C groups. While reduction (P < 0.03) in BMI according to absolute values was observed for all trained groups (AWT: 22 ± 1 versus 21 ± 1; OWT: 27 ± 1 versus 25 ± 1, OT: 34 ± 1 versus 30 ± 1) after training, no differences were found for C groups.

Conclusion

In summary, circuit-based exercise is an effective method for promoting reduction in anthropometrics parameters in obese older women.

The Metabolic Syndrome among Postmenopausal Women in Gorgan

Introduction. The present study aimed to assess the metabolic syndrome among postmenopausal women in Gorgan, Iran. Materials and Methods. The study was conducted on hundred postmenopausal women who were referred to the health centers in Gorgan. Metabolic syndrome was diagnosed using Adult Treatment Panel III (ATP III) guidelines. Results. The mean body mass index, waist circumference, hip, circumference waist-to-hip ratio, diastolic blood pressure, and triglyceride and fasting blood glucose levels were significantly high among postmenopausal women with metabolic syndrome, but the mean HDL-cholesterol was significantly low (P < 0.05). Overall prevalence of metabolic syndrome was 31%. Body mass index and waist circumference had a positive correlation with a number of metabolic syndrome factors (P < 0.001). Body mass index, waist circumference, and waist-to-hip ratio had a positive correlation with each other (P < 0.001). BMI had relatively high correlation with WC (P < 0.001). Conclusions. Our results show that postmenopausal status might be a predictor of metabolic syndrome. Low HDL-cholesterol level and high abdominal obesity are the most frequent characteristics in comparison to other metabolic components. Our study also showed some related factors of metabolic syndrome among postmenopausal women. These factors may increase cardiovascular risk among postmenopausal women with metabolic syndrome.

Human serum albumin: from bench to bedside

Human serum albumin (HSA), the most abundant protein in plasma, is a monomeric multi-domain macromolecule, representing the main determinant of plasma oncotic pressure and the main modulator of fluid distribution between body compartments. HSA displays an extraordinary ligand binding capacity, providing a depot and carrier for many endogenous and exogenous compounds. Indeed, HSA represents the main carrier for fatty acids, affects pharmacokinetics of many drugs, provides the metabolic modification of some ligands, renders potential toxins harmless, accounts for most of the anti-oxidant capacity of human plasma, and displays (pseudo-)enzymatic properties. HSA is a valuable biomarker of many diseases, including cancer, rheumatoid arthritis, ischemia, post-menopausal obesity, severe acute graft-versus-host disease, and diseases that need monitoring of the glycemic control. Moreover, HSA is widely used clinically to treat several diseases, including hypovolemia, shock, burns, surgical blood loss, trauma, hemorrhage, cardiopulmonary bypass, acute respiratory distress syndrome, hemodialysis, acute liver failure, chronic liver disease, nutrition support, resuscitation, and hypoalbuminemia. Recently, biotechnological applications of HSA, including implantable biomaterials, surgical adhesives and sealants, biochromatography, ligand trapping, and fusion proteins, have been reported. Here, genetic, biochemical, biomedical, and biotechnological aspects of HSA are reviewed.

Soy protein based supplementation supports metabolic effects of resistance training in previously untrained middle aged males

OBJECTIVE

To determine changes in body composition, physical performance, metabolic and hormonal parameters induced by lifestyle counselling, resistance training and resistance training with soy protein based supplemention in middle aged males.

DESIGN

Randomised controlled study consisting of resistance training without (RT-G) or with (RTS-G) a soy protein based supplement and a control group with lifestyle education only (LE-G).

SUBJECTS

Forty healthy middle aged men (50-65 years, BMI 25-29.9 kg/m2).

MEASUREMENTS

Changes in body weight (BW) and waist circumference (WC) were measured and body composition (BC), fat mass (FM), lean body mass (LBM) were measured by skin fold anthropometry at baseline and after 12 weeks of intervention. In addition, changes in physical fitness, metabolic and hormonal parameters (lipids, glucose, fructosamines, insulin, insulin-like growth factor-1, Leptin, human growth hormone, dehydroepiandrosterone, testosterone, hs-CRP, Il-6) were evaluated.

RESULTS

Thirty-five participants completed the 12 week study. No significant changes in BW were noted although RM and WC dropped and LBM increased after training, particularly in the RTS group (FM 22.6 ± 5.5 kg to 21.2 ± 4.7 kg; LBM 68.5 ± 7.2 kg to 70.1 ± 7.4; p < 0.01). Subjects in the RTS group experienced more pronounced improvements in the strength measurements than the RT group. After the training intervention there were significant changes in hormonal and metabolic parameters as well as in glycemic control, particularly in the RTS group.

CONCLUSIONS

Our data suggest that resistance training, particularly in combination with a soy protein based supplement improves body composition and metabolic function in middle aged untrained and moderately overweight males.

Fuel selection and appetite-regulating hormones after intake of a soy protein-based meal replacement

OBJECTIVE

The present study investigated the postprandial glycemic and insulinemic responses, the levels of satiety-related proteins, and substrate use after a single dose of a meal replacement (MR) with a high soy protein content and a low glycemic index (GI). The results were compared with a standardized breakfast showing a high GI and a low protein content.

METHODS

Eleven overweight or obese male subjects with the metabolic syndrome and insulin resistance were included in the study. In the morning, each subject consumed, in a randomized design, 65 g of a MR or an isocaloric standardized breakfast. Four hours after breakfast, all subjects consumed the same standardized lunch. Blood levels of glucose, insulin, ghrelin, protein YY(PYY), oxygen uptake, and carbon dioxide production were determined and the respiratory quotient and substrate use were calculated.

RESULTS

The glycemic and insulinemic responses were considerably higher after the standardized breakfast. In addition, in these obese insulin-resistant subjects, the postprandial decease in fat oxidation was significantly less pronounced after intake of the MR. This effect was also detectable after lunch in terms of a second meal effect. Ghrelin levels were significantly lower 2 h after the intake of the MR and PYY levels tended higher.

CONCLUSION

Compared with the high GI/low-protein SB, a high soy protein MR with a low GI was associated with lower glycemia and insulinemia and relatively higher fat oxidation in the postprandial period. Together with a favorable course of appetite-regulating hormones, this could further help to explain the beneficial role of MR regimines high in soy protein for weight reduction and improvement of metabolic risk factors.

Menopause and metabolic syndrome: A study of 498 urban women from western India

Introduction:

Metabolic syndrome (MS) is a cluster of risk factors for future development of type 2 diabetes mellitus and cardiovascular diseases. Menopausal transition with its incidental hormonal changes is considered to contribute to the development of MS. However, age is known to influence MS risk factors.

Objective:

The present study explores the prevalence of MS in pre- and postmenopausal women from western India.

Methods:

Four hundred and ninety eight women above 35 years of age, participating in women's health care program were assessed for the prevalence of MS using two criteria- International Diabetes Federation criteria (IDF) and Harmonization (H_MS) criteria.

Results:

Prevalence of MS amongst postmenopausal women was significantly higher (P < 0.001) than that in premenopausal women by both, IDF (premenopausal 45% and postmenopausal 55%) and H_MS criteria (premenopausal 44% and postmenopausal 56%). However, this significance disappeared when data was adjusted for the confounding variable of age.

Leptin, fat mass, and bone mineral density in healthy pre- and postmenopausal women

The purpose was to examine relationships between age, fat mass, and bone mineral density (BMD) with resting leptin levels in premenopausal and postmenopausal women. Young (aged 18-30 yr, n=30) and estrogen-deficient postmenopausal (aged 55-75 yr, n=43) women were recruited. Total body and segmental fat mass and bone-free lean body mass (BFLBM) and total body, lumbar spine, and proximal femur BMD were assessed using dual-energy X-ray absorptiometry. Serum-resting, fasted leptin levels were measured by Immunoradiometric Assay (IRMA), and leptin-to-fat mass ratios were calculated. Young and older women had similar amounts of BFLBM, but older women had greater (p<0.05) amounts of fat mass and 35% higher leptin levels. Age differences in leptin concentrations were no longer significant after controlling for fat mass. Older women had significantly (p<0.05) lower hip BMD values. Age was negatively related (r=-0.29, p<0.05) to leptin:trunk fat ratio. Increases in fat mass, not menopause per se, contributes to higher leptin levels in older women. Relationships between leptin and BMD may be age dependent.

Blood lipids and adipokines concentrations during a 6-month nutritional and physical activity intervention for metabolic syndrome treatment

Background

To report changes in body weight, total and central fat mass, metabolic, hormonal and inflammatory parameters in overweight people who participated in a six months weight loss intervention associating diet management and exercise.

Subjects and Methods

Fourteen subjects (10 M, 4 F, mean age 62.9 ± 6.9 years, BMI 30.4+/- 3.8 kg/m²) presenting the characteristics of the Metabolic Syndrome (MS) were included in the survey. They followed a three weeks (D0 to D20) cure in a medical establishment and a six months (D20 to M3 and M6) follow up at home. During the cure, they receive a balanced diet corresponding to 500 Kcal deficit vs their dayly energy expenditure (DEE) and they exercised 2 to 3 hours per day.

At D0, D20, M3 and M6, body composition (lean mass, total and central fat mass) was analyzed with DEXA, blood pressure was taken and blood was collected to evaluate glycaemia, triglycerides, total, LDL and HDL cholesterol, insulin, leptin and adiponectin levels, CRP and pro-inflammatory interleukines IL1, IL.6 and TNFalpha.

Results

All parameters listed above except the cytokine were improved at D20, so that 4 subjects among 14 still presented the MS. After returning to home, these parameters remained stable.

Conclusion

The efficacy of therapeutic lifestyle modifications with education and exercise and diet was demonstrated, but the compliance to the new healthy lifestyle initiated during the cure was not optimal.

The prevalence of metabolic syndrome in Chinese postmenopausal women and the optimum body composition indices to predict it

OBJECTIVE

The aim of this study was to determine the prevalence of metabolic syndrome (MetS) in Chinese postmenopausal women and explore the optimum body composition indices to predict MetS.

METHODS

Participants were independent, community-dwelling women. Recruitment occurred through advertisements in newspapers and flyers posted in the local community. A total of 181 postmenopausal women were recruited. Their parameters were measured, including body height, weight, waist circumference (WC), hip circumference, sagittal abdominal diameter, blood pressure, follicle-stimulating hormone, luteinizing hormone, estradiol, triglyceride, high-density lipoprotein cholesterol, fasting plasma glucose, and body fat (BF; %). Logistic regression analyses were applied for correlation between stated variables. Optimization of body composition indices to predict MetS in postmenopausal women was analyzed with the area under the curve of the receiver.

RESULTS

The prevalence of MetS in postmenopausal women was 33.7%. The risk factors of MetS in postmenopausal women were age, family history of metabolic disorders (obesity, hypertension, hyperlipemia, and diabetes mellitus), body composition indices (body mass index [BMI], WC, waist-to-hip ratio, sagittal abdominal diameter, and BF), and metabolic indices (systolic and diastolic blood pressure, fasting plasma glucose, and triglyceride; odds ratio > 1, P < 0.05), and the protective factor is high-density lipoprotein cholesterol (odds ratio = 0.114, P < 0.05). All body composition indices in our study had a positive correlation with number of MetS factors. The body composition indices in our study showed a positive correlation with each other (P < 0.001). BMI and WC were highly correlated with BF (r > 0.900, P < 0.001). Through receiver operating characteristic curve analysis, it was determined that body composition indices (WC, 80.75 cm; BF, 36.695%; sagittal abdominal diameter, 18.35 cm; or BMI, 24.835 kg/m) could be used to predict MetS.

CONCLUSIONS

The prevalence of MetS in Chinese postmenopausal women is 33.7%. Body composition indices (WC > or = 80.75 cm, BF > or = 36.695%, sagittal abdominal diameter > or = 18.35 cm, or BMI > or = 24.835 kg/m) were discovered to predict MetS.