Age- and menopause-associated variations in body composition and fat distribution in healthy women as measured by dual-energy X-ray absorptiometry

Body composition in the SOS (Swedish Obese Subjects) reference study

OBJECTIVE

The primary objective was to establish population-based, sex- and age-specific reference data with respect to body composition variables. Secondary objectives were to relate body mass index (BMI) to anthropometric measurements reflecting central adiposity and to body fat (BF). Another objective was to examine if secular changes in adipose tissue distribution occurred during the sampling period, 1994-1999.

DESIGN

Sex- and age-specific data on anthropometric measurements and body composition were cross-sectionally collected in the reference study of Swedish Obese Subjects.

SUBJECTS

In total, 1135 randomly selected subjects (524 men and 611 women), aged 37-61 y, BMI 17.6-45.4 kg/m(2).

MEASUREMENTS

Measures of body fatness and fat distribution (by dual energy X-ray absorptiometry and anthropometry) were collected.

RESULTS

At BMI 25 kg/m(2), relative (absolute) BF mass was 24% (19 kg) in men vs 36% (25 kg) in women, waist circumference was 90 vs 85 cm, and sagittal trunk diameter was 21 vs 19 cm. BF and measures of centralized adipose tissue distribution increased with age in both sexes (P<0.01). In women, waist circumference and sagittal diameter increased (P<0.01) over the sampling period while BMI did not.

CONCLUSIONS

Sex- and age-specific reference data on body composition are reported from a randomly selected sample of Swedish men and women. At given BMIs, women had more BF but smaller waist circumference than men. Secular increases in indices of central obesity were found in women but not in men.

B-6 vitamers and 4-pyridoxic acid in the plasma, erythrocytes, and urine of postmenopausal women

BACKGROUND

Although many studies have reported reduced vitamin B-6 status with aging, little information is available about the specific effects of menopause.

OBJECTIVE

We aimed to examine vitamin B-6 metabolism in premenopausal and early postmenopausal women.

DESIGN

We examined dietary intake and vitamin B-6 metabolites in the plasma, erythrocytes, and urine of 30 premenopausal women (x +/- SD age: 41.9 +/- 4.8 y) and 30 women (aged 54.0 +/- 3.8 y) who were 4.0 +/- 1.4 y past menopause.

RESULTS

Vitamin B-6 intake in the postmenopausal group (1.97 +/- 0.40 mg/d) was significantly greater than that in the premenopausal group (1.63 +/- 0.50 mg/d). Plasma pyridoxal phosphate (PLP) and pyridoxal concentrations and erythrocyte PLP, pyridoxal, and pyridoxamine phosphate concentrations were in the normal range in both groups and did not differ significantly between the 2 groups. Plasma and erythrocyte 4-pyridoxic acid (4-PA) concentrations were significantly higher in the postmenopausal group than in the premenopausal group, which may have been due at least partly to the slightly higher vitamin B-6 intake of the former group. Erythrocyte 4-PA was correlated (r = -0.37, P < 0.01) with serum estradiol in both groups. Urinary 4-PA did not differ significantly between the 2 groups. The serum phosphate concentration was higher in the postmenopausal group than in the premenopausal group, and it was correlated (r = 0.40, P < 0.01) with plasma PLP. Inhibition of alkaline phosphatase by the increased phosphate may help to increase plasma PLP.

CONCLUSION

Menopause may not necessarily be associated with a decrease in vitamin B-6 status.

Anthropometric, hormonal and biochemical differences in lean and obese women before and after menopause

The menopausal status is associated with an increased risk of metabolic and cardiovascular diseases. Since the post-menopausal modifications have not been clearly investigated in obese women, we evaluated the influences of menopausal status on anthropometric, hormonal and biochemical characteristics in selected groups of normal-weight and obese women. We studied 92 female outpatients: 24 normal-weight pre-menopausal (Pre-NW) [body mass index (BMI) 23.6 +/- 0.48, age 44.8 +/- 0.68], 24 normal-weight post-menopausal (Post-NW) (BMI 23.7 +/- 0.44, age 55.5 +/- 0.69), 24 obese pre-menopausal (pre-OB) (BMI 32.3 +/- 0.45, age 44.6 +/- 0.75), 20 obese post-menopausal women (Post-OB) (BMI 32.9 +/- 0.57, age 55.2 +/- 0.82). All the subjects were non smokers and free from hypertension, diabetes or impaired glucose tolerance (IGT). Anthropometric parameters, body composition, 17 beta-estradiol, LH, FSH, androstenedione, SHBG, testosterone and leptin were determined. Free androgen index (FAI) and insulin resistance index (HOMA) were calculated. In comparison with Pre-OB, Post-OB had higher values of waist circumferences (p < 0.02), while Post-NW showed no difference. Total and LDL-cholesterol were high in Post-NW women, whereas in the obese subjects they were already elevated in the premenopausal period. SHBG levels declined and FAI increased in Post-OB in comparison with Pre-OB. SHBG levels showed an inverse correlation with BMI, waist and waist-to-hip ratio (WHR), while FAI positively correlated with waist values. Serum leptin levels were higher in Post-OB than in Pre-OB, whereas they were similar in normal-weight women. The rise of leptin levels may be related to the greater abdominal fat deposition. In addition, menopausal status of uncomplicated obese women is associated with a greater abdominal fat deposition and with higher values of free androgen index, which may be considered as factors of cardiovascular risk.

The effects of phytoestrogen isoflavones on bone density in women: a double-blind, randomized, placebo-controlled trial

BACKGROUND

Isoflavone phytoestrogen therapy has been proposed as a natural alternative to hormone replacement therapy (HRT). HRT has a beneficial effect on bone, but few trials in humans have investigated the effects of isoflavones on bone.

OBJECTIVE

The objective of the study was to determine the effect on bone density of a red clover-derived isoflavone supplement that provided a daily dose of 26 mg biochanin A, 16 mg formononetin, 1 mg genistein, and 0.5 mg daidzein for 1 y. Effects on biochemical markers of bone turnover and body composition were also studied.

DESIGN

Women aged 49-65 y (n = 205) were enrolled in a double-blind, randomized, placebo-controlled trial; 177 completed the trial. Bone density, body composition, bone turnover markers, and diet were measured at baseline and after 12 mo.

RESULTS

Loss of lumbar spine bone mineral content and bone mineral density was significantly (P = 0.04 and P = 0.03, respectively) lower in the women taking the isoflavone supplement than in those taking the placebo. There were no significant treatment effects on hip bone mineral content or bone mineral density, markers of bone resorption, or body composition, but bone formation markers were significantly increased (P = 0.04 and P = 0.01 for bone-specific alkaline phosphatase and N-propeptide of collagen type I, respectively) in the intervention group compared with placebo in postmenopausal women. Interactions between treatment group and menopausal status with respect to changes in other outcomes were not significant.

CONCLUSION

These data suggest that, through attenuation of bone loss, isoflavones have a potentially protective effect on the lumbar spine in women.

Influence of adiposity on tonic sympathetic support of resting metabolism in healthy adults

BACKGROUND

beta-Adrenergic receptor sympathetic nervous system (beta-AR SNS) support of resting metabolic rate (RMR) is attenuated with older age, female sex, and a sedentary lifestyle. Total and abdominal adiposity and/or body fat pattern modulate some SNS-mediated physiological functions.

OBJECTIVE

To determine if total and abdominal adiposity and/or body fat distribution are independently related to SNS support of RMR.

DESIGN

Cross-sectional comparison of beta-AR SNS support of RMR.

SUBJECTS

A total of 54 healthy male and female subjects aged 18-75 y.

MEASUREMENTS

RMR (ventilated hood, indirect calorimetry) before (baseline) and during complete beta-AR blockade; body composition by dual energy X-ray absorptiometry.

RESULTS

Forward stepwise multiple regression analysis using sex, exercise status, age group, %body fat, total adiposity, abdominal adiposity, and the ratio of abdominal adiposity to hip adiposity as variables revealed sex to be the strongest predictor, explaining 21% of the variability in beta-AR SNS support of RMR (P=0.0006). Age group explained an additional 4% and exercise status a further 4% (both P=0.10). %Body fat, total adiposity, abdominal adiposity, and the ratio of abdominal adiposity to hip adiposity did not enter the equation.

CONCLUSION

Total and abdominal adiposity and body fat pattern are not independent physiological determinants of beta-AR SNS support of RMR among healthy men and women. Moreover, further support is provided for our previous finding of attenuated beta-AR SNS support of RMR with age, female sex, and sedentary lifestyle.

Estrogen-receptor-? distribution in the human hypothalamus: Similarities and differences with ER? distribution

This study reports the first systematic rostrocaudal distribution of estrogen receptor beta immunoreactivity (ER beta-ir) in the human hypothalamus and adjacent areas in five males and five females between 20-39 years of age and compares its distribution to previously reported ER alpha in the same patients. ER beta-ir was generally observed more frequently in the cytoplasm than in the nucleus and appeared to be stronger in women. Basket-like fiber stainings, suggestive for ER beta-ir in synaptic terminals, were additionally observed in various areas. Men showed more robust nuclear ER beta-ir than women in the medial part of the bed nucleus of the stria terminalis, paraventricular and paratenial nucleus of the thalamus, while less intense, but more nuclear, ER beta-ir appeared to be present in, e.g., the BSTc, sexually dimorphic nucleus of the medial preoptic area, diagonal band of Broca and ventromedial nucleus. Women revealed more nuclear ER beta-ir than men of a low to intermediate level, e.g., in the suprachiasmatic, supraoptic, paraventricular, infundibular, and medial mamillary nucleus. These data indicate potential sex differences in ER beta expression. ER beta-ir expression patterns in subjects with abnormal hormone levels suggests that there may be sex differences in ER beta-ir that are "activational" rather than "organizational" in nature. Similarities, differences, potential functional, and clinical implications of the observed ER alpha and ER beta distributions are discussed in relation to reproduction, autonomic-function, mood, cognition, and neuroprotection in health and disease.

Body composition and muscle performance during menopause and hormone replacement therapy

Menopausal transition is characterized by ovarian failure and its consequent decrease in female sex steroid production. Earlier studies suggest that an increase and redistribution of body fat during menopause predispose women to cardiovascular disease and metabolic syndrome. In addition, peri- and post-menopausal women seem to have less lean body mass (LBM) compared with pre-menopausal women. Accordingly, a changing ovarian hormonal status may accelerate the loss of muscle mass and result in decreased muscle performance and functional capacity. Hormone replacement therapy (HRT) has been used to treat menopausal symptoms and as a primary prevention therapy in chronic conditions. Inconsistent findings have, however, been published on the effects of HRT on body composition in post-menopausal women. Some studies clearly suggest that HRT counteracts menopause-related changes in body composition whereas others fail to show any difference between post-menopausal HRT users and abstainers. Although cross-sectional studies show conflicting results concerning the association between HRT and muscle performance, experimental trials suggest that deterioration in muscle force during menopause can be prevented by HRT. In the future, longitudinal data need to be collected to confirm changes in body composition and muscle performance during menopausal transition irrespective of age. Although HRT seems to have beneficial effects on body composition and muscle performance in healthy post-menopausal women, there is considerable variation in the effects of HRT between different studies. The underlying mechanism of HRT action on muscle performance is still unclear.

Sociodemographic, behavioral, and reproductive factors associated with weight gain in Chinese women

OBJECTIVE

To examine whether certain sociodemographic, behavioral, and reproductive factors are associated with an increased weight gain in Chinese women.

DESIGN

Baseline survey data, including recalled past weight and measured current weight, from an ongoing prospective cohort study conducted in Shanghai, China.

SUBJECTS

The analytical sample included 75 039 nonpregnant women aged 40-70 y.

MEASUREMENTS

Statistical associations between certain sociodemographic, behavioral, and reproductive factors and weight gain were evaluated using multiple linear and logistic regression models.

RESULTS

Weight gain and waist-to-hip ratio (WHR) increased with age among pre- and postmenopausal women before age 55 y. Weight gain declined but WHR continued rising as aging among postmenopausal women over age 55 y. Lower education levels, more parity and earlier age at the first birth, and earlier menarcheal age were associated with a higher long-term weight gain and current body weight.

CONCLUSION

Age, education levels, parity, age at the first live birth, and menarcheal age were associated with long-term weight gain in Chinese women. However, these results concerning weight gain are based on recalled past weight and should be interpreted with caution. Further studies are needed to clarify the association of weight gain with lifestyle factors suggested by this study.

Can obesity be a risk factor in elderly people?

Obesity is increasing in middle-aged adults and in elderly subjects (over 65 years), owing to the concurrence of different factors: inactivity, wrong nutritional habits, and basal metabolism and nutritional need reduction. This condition is becoming a serious problem because of the increasing numbers of the aged population all over the world. In the past, obesity was considered as a 'secondary' pathology of no medical importance in old age; but nowadays, obesity is increasingly being studied in Geriatrics too, because it causes disability and because of its quality-of-life impairment consequences. The Euronut-Seneca study has confirmed the presence of obesity in both men and women in Europe. The definition of obesity, the reference values of body mass index and obesity as a mortality factor in elderly persons are still under discussion. Even when overweight does not represent a serious problem in old age, obese elderly people are certainly at risk of disability, morbidity and mortality. This review focuses on the potential risks of overweight and obesity in the aged population.

Isoflavone-rich soy protein prevents loss of hip lean mass but does not prevent the shift in regional fat distribution in perimenopausal women

OBJECTIVE

Menopause-induced estrogen deficiency increases the risk of cardiovascular disease, which is related to a shift in regional fat distribution. We tested the hypothesis that estrogen-like isoflavones in soy protein isolate (SPI+) would lessen both regional fat gain and lean loss compared with isoflavone-poor soy (SPI-).

DESIGN

Perimenopausal participants (N = 69) were randomly assigned (double-blind) to 24 weeks of treatment (40 g soy or whey protein per day): SPI+ (n = 24), SPI- (n = 24), or whey control (n = 21); each participant had blood drawn in the fasted (12 hours) state, had physical activity assessed, and kept a 5-day food diary. Dual-energy x-ray absorptiometry was used to examine the effects of SPI+ on regional fat and lean tissue distribution changes in the waist, hip, and thigh regions.

RESULTS

Mean body mass increased (P < 0.01) in each group, but treatment had no effect on gain in overall body mass, fat mass, or lean mass using analysis of variance. In all treatment groups combined, lean mass increased in each region; fat mass increased only in the waist region. Treatment had an effect (P = 0.039) on hip lean mass and a marginal effect (P = 0.077) on thigh fat. Regression analyses revealed that SPI+ diminished the increase in thigh fat (P = 0.018) and heightened the increase in hip lean (P = 0.035) mass. Carbohydrate intake (P = 0.006) and cohort (reflective of season; P = 0.011) contributed to the gain in thigh fat. Total protein intake (P = 0.0012), plasma insulin (P = 0.0034), and physical activity (P = 0.047) contributed to the gain in hip lean mass.

CONCLUSIONS

Gain in hip lean mass was greater (P = 0.014) in SPI+ than other groups, but SPI+ did not reduce the disease-promoting menopausal shift in regional fat mass.

Importance of preventing weight gain in adulthood

In the last 20 years, there has been a dramatic upsurge in the average weight of Australian adults. In this period, on average, Australian women have gained 4.8 kg, whilst Australian men have gained 3.6 kg. Consequently, the prevalence of obesity in men has increased from 8% to 19% and in women from 7% to 21%. This threatens to wipe away many recent health gains, as obesity has been associated with a wide range of chronic and debilitating illnesses, such as diabetes, heart disease, some cancers, sleep apnoea and osteoarthritis. Any weight gain in adulthood is usually as a result of an increase in fat stores, and the risk of ill-health from increasing weight actually begins at quite low BMI. Unfortunately, weight gain can be difficult or slow to reverse in the middle years because of physiological and behavioural changes that occur at this time of life. Adults should focus on preventing or minimizing weight gain over time by retaining physical activity within their daily living and by sensible dietary changes. Even if weight gain does occur with age, a regimen of regular exercise and a diet rich in fruit and vegetables and low in fat will provide some protection against a rapid decline in health.

Central abdominal fat and endogenous hormones during the menopausal transition

OBJECTIVE

To investigate the effect of endogenous hormone levels on central abdominal fat during the menopausal transition in a population-based cohort of Australian-born women.

DESIGN

Prospective observational study.

SETTING

Population-based sample. Body composition was assessed in the Royal Melbourne Hospital, and interviews were conducted at the patient's home.

SUBJECT(S)

One hundred two women from the Melbourne Women's Midlife Health Project. Data, physical measures, and blood were obtained by interview when the longitudinal study commenced (baseline) and at the time of the total body scan approximately 5 years later. Body composition was measured using dual-energy X-ray absorptiometry.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURES

Total body fat and central abdominal fat.

RESULT(S)

The 102 women were either premenopausal or in the early menopausal transition at baseline. At the time of their dual-energy X-ray absorptiometry scan, 31 were in the early menopausal transition, 22 were in the late menopausal transition, and 49 were postmenopausal. Multiple regression analysis found that total percentage of body fat was associated with weight measures, whereas central abdominal fat was also positively associated with baseline free T index (FTI) and with the increase in FTI since baseline.

CONCLUSION(S)

The major hormonal change associated with central adiposity during the menopausal transition is the increase in the FTI. This effect is significant even after allowing for baseline and final weight.

The menopause and obesity

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

Variations in percentage of body fat within different BMI groups in young, middle-aged and old women

OBJECTIVES

The objective of the present study was to characterize age-dependent variations in percentage of body fat within different body mass index (BMI) classes in healthy Danish women.

DESIGN

Cross-sectional analysis.

SETTINGS

The study was done at the Center for Clinical and Basic Research, Ballerup, Denmark.

SUBJECTS

Four hundred and four healthy women aged 18-75 years were included in the present study.

MEASUREMENTS

Fat tissue mass was estimated using dual-energy X-ray absorptiometry. Menopausal status and physical characteristics were also registered.

RESULTS

Mean values of percentage of body fat calculated in the normal and overweight BMI groups were higher in middle-aged and old women compared with young women. No significant differences were seen in the underweight and obese BMI groups. The cut-off levels between normal and overweight and between overweight and obesity were 35-43% and 40-50%, respectively.

CONCLUSION

The percentage of body fat is dependent on both age and menopausal status within each of the following BMI classes: from 20 to 25 and from 25 to 30, further emphasizing that BMI has limitations when used generally as an indicator of body fatness, and argues for defining BMI cut-off values age-specifically.

Resistance training in postmenopausal women with and without hormone therapy

PURPOSE

The main purpose of this study was to analyze the impact of a 1-yr resistance-training program on body composition and muscle strength in postmenopausal women, and to describe the impact of hormone replacement therapy (HRT) on body composition changes, with and without exercise. Secondarily, we wanted to study dose-response relationships between measures of program compliance and changes in primary outcomes.

METHODS

Subjects were postmenopausal women (40-66 yr) randomly assigned to an exercise (EX) group (N = 117) and a nonexercise group (N = 116). The EX group participated in a 1 yr trainer-supervised resistance-training program, 60-75 min.d-1, 3 d.wk-1. Lean soft tissue (LST) and fat tissue (FT) changes were measured by dual-energy x-ray absorptiometry and strength by one-repetition maximum testing.

RESULTS

Significant (P < 0.001) gains in LST were observed for women who exercised, regardless of HRT status, whereas women who did not exercise lost LST (P < 0.05) if they were not taking HRT, and gained LST (P = 0.08) if they were on HRT. The only significant FT losses were observed for women who exercised while on HRT (P < 0.05). Strength increases were observed at all sites (P < 0.001). Total weight lifted by subjects in their training sessions was a significant predictor of changes in LST (P < 0.001) and strength (P < 0.01).

CONCLUSIONS

Resistance and weight-bearing exercise significantly changed total and regional body composition in postmenopausal women by increasing LST in all women and decreasing FT in women on HRT. Hormone therapy showed no independent effects on body composition, but it protected nonexercising women from losses in LST. The lean and muscle strength changes observed were partially dependent on the volume of training, as expressed by attendance and total weight lifted in 1 yr of training.

Racial differences in subcutaneous and visceral fat distribution in postmenopausal black and white women

Most studies examining racial disparities in abdominal fat distribution have focused on premenopausal women. The purpose of this report was to determine if racial differences exist in the abdominal fat distribution in postmenopausal white and black women. Fifty-four women (33 white and 21 black) were scanned by magnetic resonance imaging (MRI) to determine abdominal fat distribution, were measured by hydrostatic weighing for percent body fat, and had their fasting blood lipids, glucose, and insulin levels measured. These women were matched for age (mean age, 53.5 +/- 0.9 years) and percent body fat (black: 39.6% +/- 2.3%, white: 37.3% +/- 1.2%). When adjusted for total body fat mass and hormone replacement therapy (HRT), total abdominal fat (white: 10,352.1 +/- 535.2, black: 11,220.4 +/- 670.1 cm(3)) was not statistically different between groups, but the visceral fat content was significantly higher in the white women (white: 2,943.5 +/- 220.4, black: 2,332.6 +/- 176.1 cm(3)). The percent visceral fat was also higher in these women (white: 30.5% +/- 1.3%, black: 22.1% +/- 1.6%, P <.01). Subcutaneous adipose tissue (SAT) was significantly higher in the black women (white: 7,408.6 +/- 450.2, black: 8,887 +/- 563.1 cm(3), P <.05). No significant differences were found in the insulin concentrations or the blood lipid profile of these women. Regardless of race, visceral fat was a significant predictor of log triglyceride, low-density lipoprotein-cholesterol (LDL-C), cholesterol/LDL-C, insulin levels, and insulin resistance. Race was only found to contribute to 8% of the variability of LDL-C. HRT use had no effect on abdominal fat distribution or the blood lipid profile in this cohort of women. In conclusion, disparities in abdominal fat distribution between black and white women continue to exist in the early postmenopausal years, and the regression results indicate that the absolute amount of visceral fat, and not the relative amounts of visceral fat, is the best predictor of the blood lipid profile and insulin sensitivity. HRT use did not result in differences in abdominal fat distribution in these women. Factors, such as genetics and lifestyle, must play a larger role in explaining the increased health risk in black women.

Comparison of VO2max and disease risk factors between perimenopausal and postmenopausal women

OBJECTIVE

This study determines whether maximal oxygen consumption (VO2 max) is higher in perimenopausal women compared with similarly aged postmenopausal women and whether the lower VO2 max in postmenopausal women is associated with a higher total and visceral fat mass, less favorable lipid and glucose metabolism, and lower bone mineral density (BMD).

DESIGN

Participants were 18 perimenopausal women (mean +/- SD; irregular menstrual cycle in the past 6 months) aged 49 +/- 4 years and 18 postmenopausal women (no menstrual cycle in the past year) aged 52 +/- 2 years who were matched for body mass index and race. Women were sedentary, and none were on hormone replacement therapy. Body composition (dual-energy x-ray absorptiometry and CT), VO2 max, fasting concentrations of sex steroid hormones, lipoproteins, insulin, and glucose were determined.

RESULTS

VO2 max was 17% lower (22 +/- 3 v 27 +/- 7 mL.kg.min; P </= 0.01) and resting metabolic rate was 5% lower (P = 0.06) in postmenopausal women compared with perimenopausal women. Percent body fat was 11% higher, and visceral fat area was 42% higher in postmenopausal women, whereas total body and lumbar spine (L2 -L4) BMD were 5% and 11% lower, respectively (P < 0.05). Low-density lipoprotein cholesterol, low-density lipoprotein cholesterol.high-density lipoprotein cholesterol ratio, and fasting glucose concentrations were 21%, 20%, and 8% higher, respectively, in postmenopausal versus perimenopausal women (P < 0.05). Except for total body and lumbar spine BMD, the effect of menopause status on these variables is independent of age. In all women, percent body fat, visceral adipose tissue, and low-density lipoprotein cholesterol.high-density lipoprotein cholesterol ratios related indirectly to VO2 max (P < 0.05).

CONCLUSIONS

Our data suggest that postmenopausal women have a lower VO2 max than perimenopausal women of a similar age and adiposity, which may be associated with an increased risk of total and central obesity and cardiovascular disease.

Differences in adipose tissue metabolism between postmenopausal and perimenopausal women

Changes in adipose tissue metabolism may contribute to the changes in body fat distribution seen during the menopause transition. We compared in vitro abdominal and gluteal sc adipose tissue metabolism [basal and stimulated lipolysis and activity of adipose tissue lipoprotein lipase (AT-LPL)] in postmenopausal and perimenopausal women (n = 12/group), matched for race, body mass index (29.5 +/- 3.8 kg/m(2); mean +/- SD), and percentage body fat (42 +/- 6%). The postmenopausal women were older (54 +/- 3 vs. 48 +/- 3 yr; P < 0.01) and had higher FSH (55.5 +/- 26.4 vs. 16.6 +/- 22.5 IU/ml; P < 0.01) and lower estradiol (33.8 +/- 14.9 vs. 97.4 +/- 61.7 pmol/liter; P < 0.05) concentrations than the perimenopausal women. Despite similar fat cell size and beta-adrenergic receptor and postreceptor (dibutyryl-cAMP)-stimulated lipolysis, basal lipolysis was 77% lower in gluteal adipose cells from postmenopausal compared with perimenopausal women (P < 0.05). Within each group, AT-LPL activity in the gluteal region was significantly higher than in the abdominal region (P < 0.05). In addition, AT-LPL activity was significantly higher in the postmenopausal compared with perimenopausal women in both gluteal (4.9 +/- 3.6 vs. 2.0 +/- 1.4 nmol free fatty acid/g.min; P < 0.05) and abdominal (3.2 +/- 2.6 vs. 1.3 +/- 0.9 nmol free fatty acid/g.min; P < 0.05) adipose cells. The results of this study suggest that menopause status is associated with differences in adipose tissue metabolism in both the abdominal and gluteal fat depots. The lower lipolysis and higher AT-LPL activity in postmenopausal women may predispose them to gain body fat after menopause.

Estrogen receptor beta is involved in the anorectic action of estrogen

OBJECTIVE

Estrogen has been implicated in feeding behavior and adiposity. This study was undertaken to elucidate the mechanism underlying the anti-obesity and anorectic action of estrogen and the role of estrogen receptor (ER) in the central nervous system.

METHODS AND RESULTS

Ovariectomy in 8-week-old female Wistar rats induced hyperphagia along with an increase in body weight and abdominal fat accumulation compared to control sham-operated rats. These changes were fully reversed by subcutaneous replacement of estradiol and were abrogated by pair-feeding. Then, the effects of intracerebroventricular infusion of estradiol, alone or in combination with antisense oligodeoxynucleotides (ODN), for ER in ovariectomized rats were examined. The estradiol group showed 10-20% lower daily food intake, and after the 2-week infusion period a 14% reduction in body weight with a similar reduction in abdominal fat compared to the vehicle group. The inhibitory effect of estradiol on food intake and body weight was blocked by co-administration of ER-beta antisense ODN, whereas ER-alpha antisense ODN did not show any influence.

CONCLUSION

These results indicate that ER-beta in the central nervous system is involved in the anorectic action of estrogen.

Body weight and food intake profiles are modulated by sex hormones and tamoxifen in chronically hypertensive rats

Sex hormones and the selective estrogen receptor modulator tamoxifen affect food consumption and body weight in normotensive rats. This study investigated the effects of hormone manipulation and tamoxifen on weight gain and food intake in the presence of chronic systemic hypertension. Male and female spontaneously hypertensive rats (SHR) were either neutered or sham operated before puberty, and subgroups of neutered females received either estrogen replacement therapy (ERT) or tamoxifen at the age of 12 wk. Weekly body weight and food consumption were assessed, and food consumption was normalized to metabolic weight (g body(2/3)). Neutering reduced weight gain in males (P = 0.0001), but increased it in females (P < 0.0001). Both ERT and tamoxifen treatment prevented this increase in weight, with body weight dropping to levels of sham-operated rats for ERT, whereas rats given tamoxifen maintained greater body weights than sham-operated rats (P < 0.0001). This contrasts with previous work in normotensive females in which sham-operated and tamoxifen-treated females did not differ. Neutering reduced normalized food consumption relative to sham-operated rats in both males and females (P < 0.05). Although ERT returned it to normalized intakes of sham-operated rats, tamoxifen reduced normalized food consumption relative to that of both sham-operated and ERT groups. In hypertensive rats, body weight is modulated by sex hormones in both males and females, but in opposite directions. Both estrogen and tamoxifen exert immediate effects in females. Interestingly, the effect of tamoxifen on body weight appears to be greater in hypertensive than in normotensive rats.

Assessing the validity of body mass index standards in early postmenopausal women

OBJECTIVE

To examine the relationship between percentage of total body fat (%Fat) and body mass index (BMI) in early postmenopausal women and to evaluate the validity of the BMI standards for obesity established by the NIH.

RESEARCH METHODS AND PROCEDURES

Three hundred seventeen healthy, sedentary, postmenopausal women (ages, 40 to 66 years; BMI, 18 to 35 kg/m(2); 3 to 10 years postmenopausal) participated in the study. Height, weight, BMI, and %Fat, as assessed by DXA, were measured. Receiver operating characteristic analysis was performed to evaluate the ability of BMI to discriminate obesity from non-obesity using 38%Fat as the criterion value.

RESULTS

A moderately high relationship was observed between BMI and %Fat (r = 0.81; y = 1.41x + 2.65) with a SE of estimate of 3.9%. Eighty-one percent of other studies examined fell within 1 SE of estimate as derived from our study. Receiver operating characteristic analysis showed that BMI is a good diagnostic test for obesity. The cutoff for BMI corresponding to the criterion value of 38%Fat that maximized the sum of the sensitivity and specificity was 24.9 kg/m(2). The true-positive (sensitivity) and false-positive (1--specificity) rates were 84.4% and 14.6%, respectively. The area under the curve estimate for BMI was 0.914.

DISCUSSION

There is a strong association between %Fat and BMI in postmenopausal women. Current NIH BMI-based classifications for obesity may be misleading based on currently proposed %Fat standards. BMI >25 kg/m(2) rather than BMI >30 kg/m(2) may be superior for diagnosing obesity in postmenopausal women.

Dietary intake of phytoestrogens is associated with a favorable metabolic cardiovascular risk profile in postmenopausal U.S.women: the Framingham study

Hypertension, central obesity and dyslipidemia are associated with high cardiovascular risk. Estrogen therapy in women has beneficial effects on some of these metabolic cardiovascular risk factors. It is not known whether dietary estrogens have similar effects, especially in Western populations. We studied the association between dietary phytoestrogen intake and metabolic cardiovascular risk factors in postmenopausal women. For this purpose, 939 postmenopausal women participating in the Framingham Offspring Study were included in this cross-sectional study. Mean blood pressure, waist-hip ratio (WHR) and lipoprotein levels were determined in quartile categories of dietary phytoestrogen (isoflavones and lignans) intake, determined by a food-frequency questionnaire. In addition, a metabolic syndrome score was defined according to WHO criteria (range 0-6). The WHR was lower in women in the highest quartile of intake of lignans compared with the lowest [-0.017; 95% confidence interval (CI) -0.030 to -0.0016]. In the highest quartile of intake of isoflavones, plasma triglyceride levels were 0.16 mmol/L lower (95% CI, -0.30 to -0.02) compared with the lowest quartile of isoflavones; for lignan intake, this difference was 0.23 mmol/L (95% CI, -0.37 to -0.09). In the highest quartile of isoflavone intake, the mean cardiovascular risk factor metabolic score was 0.43 points lower (95% CI, -0.70 to -0.16) than the lowest quartile. The difference in this score between the extreme quartiles of intake of lignans was -0.55 points (95% CI, -0.82 to -0.28). In conclusion, high intake of phytoestrogens in postmenopausal women appears to be associated with a favorable metabolic cardiovascular risk profile.

Prevalence of CVD risk factors and impact of a two-year education program for premenopausal women

Indicators of cardiovascular disease risk in premenopausal women before, during, and after a 2-year educational intervention measured prevalence of risk and program effectiveness. Women (n = 277) were assigned to either treatment/education (n = 174) or control (n = 103) group. Many had at least one cardiovascular disease risk factor: high BMI (n = 123); high-fat diet (n = 160); and/or high body fat percent (n = 136). The treatment group was significant for change in calories from fat (P <.01). This study shows that premenopausal women have cardiovascular disease risks that should be addressed, and that nutrition education can successfully change dietary behavior.

[Evaluation of weight and morphotype of French women in gynecological consultation]

Weight and morphology change with age in proportions which depend on numerous environmental factors. This French study on 3,000 women age between 40 and 70, seeing their gynecologist, has shown that the average body mass index of this population is 23.97 kg/m2, and that the waist hip ratio is 0.81. Those two parameters increase with age and are reduced when women have a physical activity for more than 2 hours a week and are on oral contraception or hormone replacement therapy. Women on percutaneous hormone replacement therapy have a lower body mass index and a lower waist hip ratio. Cigarette smoking goes with a lower body mass index. When it dates back to more than 5 years, menopause is associated with a body mass index increase. In this population, the proportion of women under hormone replacement therapy is 69%, mostly percutaneous estrogenotherapy on a discontinuous sequential rhythm.

Sex hormones and the selective estrogen receptor modulator tamoxifen modulate weekly body weights and food intakes in adolescent and adult rats

This study documented the effect of changes in male and female sex hormones and the selective estrogen receptor modulator (SERM) tamoxifen on weight gain and food consumption of rats from puberty to adulthood, and assessed whether age at onset of treatment affected outcome. In Study 1, male and female WKY rats were either neutered or sham-operated before puberty, and a subgroup of neutered females underwent estrogen replacement (ERT) at the age of puberty. In Study 2, subgroups of neutered females received either ERT or tamoxifen beginning well into the postpuberty period. Weekly body weight and food consumption were assessed, and food consumption was normalized to metabolic weight (body weight(0.67)). Neutering reduced the rate of weight gain in males (P < 0.05), but significantly increased it in females (P < 0.0001). ERT immediately reduced weight gain and prevented any further increase, resulting in weights below that of sham-operated females (P < 0.05). Tamoxifen prevented further weight gain and returned profiles to that of sham-operated females. Food consumption, normalized to metabolic weight, was similar in females and males, and both sexes showed a decrease through maturation to adulthood. Neutering decreased food consumption below that of sham-operated animals in both males and females (P < 0.05), and ERT returned it to sham levels. Despite the fact that tamoxifen had an effect on body weight similar to that of ERT, females receiving tamoxifen treatment consumed less food than both sham-operated and ERT females (P < 0.05). Weight gain is modulated by sex hormones in male and female rats, with both estrogen and tamoxifen exerting immediate effects in females, irrespective of the age at which treatment is initiated. Differences in food consumption do not appear to account for the effects of hormones and tamoxifen on body weight, suggesting that they exert a direct effect on overall body metabolism.

Body composition characteristics are associated with the bone density of the proximal femur end in middle- and old-aged women and men

OBJECTIVES

In the present study the associations between bone density of the proximal femur end and weight status, fat distribution patterns (FDI) and body composition parameters i.e. amount of body fat and lean body mass were tested in a sample of old aged women and men.

METHODS

In 77 healthy women ranging in age from 60 to 92 years (x=71.8 years) and 62 healthy men ranging in age from 60 to 86 years (x=71.5 years) the bone mineral density (BMD of the proximal femur end and the body composition parameters absolute fat mass, relative fat mass, lean body mass and bone mineral content were estimated by dual energy X-ray absorptiometry. Additionally, the weight status (body mass index, BMI) and the FDI were calculated. The bone density of the proximal femur end was correlated with the absolute fat mass and the lean body mass as well as with the BMI and the FDI.

RESULTS

BMD correlated in females significantly positively with parameters of body composition, in males no significant correlations between fat mass (absolute and relative) and BMD as well as BMD/stature was found. Furthermore, it was shown that the weight status (BMI; r(2)=0.13, P<0.0003 in males and r(2)=0.27, P<0.000 in females), and the lean body mass (r(2)=0.21, P<0.001 in males, r(2)=0.36, P<0.004 in females) were associated significantly positively with the BMD of the proximal femur end in both sexes. The absolute fat mass had a significant impact on BMD in the female subsample only (r(2)=0.24, P<0.000).

CONCLUSIONS

A lower weight status and a low amount of lean body mass, indicating not only lack of biomechanical forces of the proximal femur end, but also a lack of physical activity can be assumed to be associated increased bone loss and the development of osteoporosis in both sexes. An association between low amount of fat tissue and decreased BMD was especially found in women and may be due to the reduced conversion rates from androgens to estrogens in a low amount of fat tissue.

Modulation of adipocyte lipoprotein lipase expression as a strategy for preventing or treating visceral obesity

As compared to subcutaneous adipocytes, visceral adipocytes have high basal lipolysis, are highly sensitive to catecholamines, and are poorly sensitive to insulin; these traits are amplified when visceral adipocytes hypertrophy. As a result, enlarged visceral fat stores tend to flood the portal circulation with free fatty acids at metabolically inappropriate times when fatty acids are unlikely to be oxidized, thus exposing tissues to excessive free fatty acid levels and giving rise to the insulin resistance syndrome. A logical approach to preventing or correcting visceral obesity is to down-regulate the lipoprotein lipase (LPL) activity of visceral adipocytes relative to that expressed in subcutaneous adipocytes and skeletal muscle. IGF-I activity appears to be a primary determinant of visceral LPL activity in humans; systemic IGF-I activity is decreased when diurnal insulin secretion is low, when hepatocytes detect a relative paucity of certain essential amino acids, and when estrogens are administered orally. The ability of alpha-glucosidase inhibitor therapy to selectively reduce visceral adiposity suggests that down-regulation of diurnal insulin secretion and/or IGF-I activity may indeed have a greater impact on LPL activity in visceral fat than in subcutaneous fat. Thus, low-glycemic-index, vegan, high-protein, or hypocaloric diets can be expected to decrease visceral LPL activity, as can postmenopausal estrogen therapy. Furthermore, estrogen enhances the LPL activity of non-pathogenic gluteofemoral fat cells, whereas testosterone decreases visceral LPL activity in men; this may explain why sex hormone replacement in middle-aged people of both sexes has a favorable impact on visceral fat and insulin sensitivity. Beta-adrenergic activity suppresses transcription of LPL in adipocytes; this phenomenon may contribute to the favorable impact of exercise training on visceral obesity; conceivably, preadministration of safe drugs that boost catecholamine activity (caffeine, yohimbine) could potentiate this beneficial effect of exercise. Glucocorticoids selectively increase the LPL activity of visceral adipocytes; while there is currently no convincing evidence that psychological stress is a major determinant of visceral adiposity, or that stress management techniques can help to correct visceral obesity, reports that anxiolytic therapy can improve glycemic control in type 2 diabetes should encourage further research along these lines.

Ethnic differences in dietary intakes, physical activity, and energy expenditure in middle-aged, premenopausal women: the Healthy Transitions Study

BACKGROUND

Menopause is a time of increased risk of obesity in women. The effect of menopause in African American women, in whom obesity is already highly prevalent, is unknown.

OBJECTIVE

We compared dietary intakes and energy expenditure (EE) between middle-aged, premenopausal African American and white women participating in a longitudinal study of the menopausal transition.

DESIGN

Dietary intakes by food record, EE by triaxial accelerometer, physical activity by self-report, and body composition by dual-energy X-ray absorptiometry were compared in 97 white and 52 African American women. Twenty-four-hour and sleeping EE were measured by whole-room indirect calorimetry in 56 women.

RESULTS

Sleeping EE (adjusted for lean and fat mass) was lower in African American than in white women (5749 +/- 155 compared with 6176 +/- 75 kJ/d; P = 0.02); however, there was no significant difference in 24-h EE between groups. Reported leisure activity over the course of a week was less in African American than in white women (556 +/- 155 compared with 1079 +/- 100 kJ/d; P = 0.02), as were the daily hours spent standing and climbing stairs. Dietary intakes of protein, fiber, calcium, magnesium, and several fatty acids were significantly less in African Americans, whereas there were no observed ethnic differences in intakes of fat or carbohydrate. Body fat within the whole group was positively correlated with total, saturated, and monounsaturated fat intakes and inversely associated with fiber and calcium intakes. Fiber was the strongest single predictor of fatness.

CONCLUSION

Ethnic differences in EE and the intake of certain nutrients may influence the effect of menopausal transition on obesity in African American women.

Hormones, weight change and menopause

OBJECTIVE

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

DESIGN

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

SUBJECTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSIONS

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

Comparison of soft tissue body composition in postmenopausal women with or without hormone replacement therapy considering the influence of reproductive history and lifestyle

OBJECTIVES

To examine long-term effects of at least 5 years' conventional hormone replacement therapy (HRT), reproductive history and lifestyle on fat mass and muscle mass in postmenopausal women.

RESEARCH DESIGN AND METHODS

A cross-sectional retrospective approach was used, including 64 healthy women (56-69 years, mean age 63.4 years). Hormone users were compared with age-matched non-users with respect to (a) type of HRT used (oestrogen vs oestrogen plus gestagen vs no hormones), (b) categories of oestrogens used (oestradiol-based oestrogens vs conjugated equine oestrogens vs no oestrogens) and (c) categories of gestagens used (testosterone derivatives vs progesterone derivatives vs no gestagens). Data on hormone use, reproductive history (age at menarche, age at menopause, number of years postmenopausal, number of children) and lifestyle (physical activity level, alcohol consumption, smoking habits) were collected by questionnaires. Body composition was analysed by multiple-frequency bioelectrical impedance analysis, estimating fat mass, fat-free mass and body cell mass as absolute values (FM, FFM, BCM, respectively) and percentages of body weight (%FM, %FFM, %BCM).

RESULTS

Analysis of covariance, adjusting body composition variables for body mass index, showed that (a) unopposed oestrogen users, oestrogen plus gestagen users and non-users did not differ significantly in body composition variables, (b) users of oestradiol-based oestrogens had significantly more BCM than oestrogen abstainers (p < 0.05), (c) users of testosterone-based gestagens had more BCM than gestagen abstainers (p = 0.05). Stepwise multiple regression analyses, including HRT-related, reproductive and lifestyle variables, indicated that the duration of HRT (p < 0.05) and physical activity level (p = 0.01) were significant positive predictors of %BCM, whereas the number of children significantly positively predicted FM and %FM (each p < 0.05). No significant associations between fat-free mass and HRT were found.

CONCLUSIONS

The results suggest that conventional doses of oestrogens and gestagens used in HRT might be a factor in preserving muscle mass after long-term administration. It is recommended that BCM is used instead of FFM as an indicator of muscle mass. Studies relating muscle mass to HRT in postmenopausal women should consider physical activity as a possible confounding variable.

The effects of sequential combined oral 17beta-estradiol norethisterone acetate on insulin sensitivity and body composition in healthy postmenopausal women: a randomized single blind placebo-controlled study

OBJECTIVE

The androgenic effect of progestogen, necessary in early postmenopausal hormone replacement therapy (HRT), may adversely affect insulin sensitivity as well as body fat distribution and thereby increase the cardiovascular risk profile. The impact of HRT with sequential combined oral 17beta-estradiol and norethisterone acetate on insulin sensitivity and body composition in early menopause has not been studied.

DESIGN

A randomized single blind placebo-controlled 6-month study of sequential combined 17beta-estradiol norethisterone acetate on insulin sensitivity and body composition was carried out. Thirty fit healthy postmenopausal women were enrolled and completed this 6-month study. Body composition was measured by dual-energy x-ray absorptiometry scanning, and insulin sensitivity was measured using the euglycemic hyperinsulinemic clamp. Studies were undertaken at baseline and after 6 months of therapy. The studies were performed during the estrogen-only phase of therapy.

RESULTS

All women demonstrated a degree of decreased insulin sensitivity that was not modified by 6 months of hormone replacement therapy. Body composition remained unchanged over 6 months. There was no alteration in total body fat or the distribution of body fat. The percentage of central abdominal fat (android) was not altered.

CONCLUSION

Six months of HRT with sequential combined oral 17beta-estradiol norethisterone acetate does not have an adverse effect on insulin sensitivity and does not promote an increase in weight or the more android distribution of body fat, which could contribute to the increased cardiovascular risk profile that is evident in postmenopausal women.

Comparison of regional fat distribution and health risk factors in middle-aged white and African American women: The Healthy Transitions Study

OBJECTIVE

Both ethnicity and menopause appear to influence intra-abdominal fat distribution. This study evaluated intra-abdominal fat distribution and obesity-related health risks in perimenopausal white and African American women.

RESEARCH METHODS AND PROCEDURES

Baseline data from a longitudinal study of changes in body composition and energy balance during menopause are reported. Healthy women (55 African Americans and 103 whites) who were on no medication and had at least five menstrual cycles in the previous 6 months were recruited. Body composition was assessed by DXA, and visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were assessed by computed tomography scan. SAT was divided into deep and superficial layers demarcated by the fascia superficialis.

RESULTS

African American women were slightly younger (46.7 +/- 0.2 vs. 47.7 +/- 0.2 years, p = 0.002) and fatter (42.4% +/- 1.0% vs. 39.4% +/- 0.8% body fat, p = 0.02) than white women. In unadjusted data, African Americans had significantly more total abdominal fat and total, deep, and superficial SAT than whites. After adjustment for percent body fat and age, only total and superficial SAT remained significantly higher in African Americans. VAT, although slightly less in African American women, did not differ significantly by race. In multiple regression analysis, VAT was the strongest predictor of serum lipids, glucose, and insulin in women of both races, although superficial SAT was significantly associated with fasting glucose in whites.

CONCLUSIONS

Middle-aged African American women have larger SAT depots, adjusted for total body fatness, but do not differ from white women with regard to VAT. The complexity of the relationship between abdominal fat and metabolic risk is increased by ethnic differences in such associations.

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

OBJECTIVE

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

DESIGN

Cross-sectional study.

SUBJECTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

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

What is the evidence, reasons for and impact of weight gain during menopause?

Weight gain in midlife is common among women. Weight gain is associated with age, not menopause. Decreasing physical activity and smoking cessation are major factors in weight gain with age.

Body composition in italian and Danish women

The objective of this cross-sectional study was to compare the body composition and fat distribution measured by dual energy X-ray absorptiometry (DPX, Lunar) in different age decades of age-matched Danish and Italian women. The subjects comprised 133 healthy Italian women (age 20-60 years) age-matched to a representative sub-sample of healthy Danish women (n=375). Total and abdominal body fat tissue mass were measured by dual-energy X-ray absorptiometry. Italian women were shorter and fatter compared with age-matched Danish women, but in middle-age, had a less abdominal fat distribution. There was no difference in total body bone mineral density.

Menopause-related changes in body fat distribution

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

Effect of menopausal status on body composition and abdominal fat distribution

OBJECTIVE

Preliminary studies suggest that the menopause transition is associated with deleterious changes in body composition and abdominal fat distribution. Limitations of the methodology used in these studies, however, render their conclusions controversial. Thus, the present study used radiologic imaging techniques to examine the effect of menopausal status on body composition and abdominal fat distribution.

DESIGN

Cross-sectional.

SUBJECTS

Fifty-three healthy, middle-aged, premenopausal women (mean+/-SD; 47+/-3 y) and 28 early-postmenopausal women (51+/-4 y).

MEASUREMENTS

Total and regional body composition by dual energy X-ray absorptiometry and abdominal fat distribution by computed tomography.

RESULTS

No differences in total body fat-free mass or appendicular skeletal muscle mass were noted between groups. In contrast, total body fat mass was 28% higher (23+/-7 vs 18+/-7 kg) and percentage fat 17% higher (35+/-6 vs 30+/-9%; both P<0.01) in postmenopausal women compared with premenopausal women. Postmenopausal women had a 49% greater intra-abdominal (88+/-32 vs 59+/-32 cm2; P<0.01) and a 22% greater abdominal subcutaneous fat area (277+/-93 vs 227+/-108 cm2; P<0.05) compared to premenopausal women. The menopause-related difference in intra-abdominal fat persisted (P<0.05) after statistical adjustment for age and total body fat mass, whereas no difference in abdominal subcutaneous fat was noted. A similar pattern of differences in total and abdominal adiposity was noted in sub-samples of pre- and postmenopausal women matched for age or fat mass.

CONCLUSION

Our data suggest that early-postmenopausal status is associated with a preferential increase in intra-abdominal fat that is independent of age and total body fat mass. International Journal of Obesity (2000) 24, 226-231

Quantifying the 'appleness' or 'pearness' of the human body by subcutaneous adipose tissue distribution

To quantify subcutaneous adipose tissue topography (SAT-Top) describing individual SAT distribution for a subject or even a group we measured subcutaneous adipose tissue thickness at 15 specified body sites of 303 healthy women aged 20-69 yrs and 20 women with proven non-insulin-dependent diabetes mellitus (NIDDM) by the optical device 'LIPOMETER'. The type of upper-body- and lower-body-fat pattern, (apples or pears), was determined by factor analysis of the data. Upper body sites were highly loaded in factor 1, whereas factor 2 included highly loaded body sites from the lower extremities. For an individual, factor 1 scores > factor 2 scores, was described as an 'apple'-type, while factor 2 > factor 1 was described as a 'pear'-type. We found about 80% 'pears' and 20% 'apples' in 20-29 year olds and 20% 'pears' and 80% 'apples' in 60-69 year old women. Women with NIDDM tended to be 'super-apples'. SAT-Top provides a useful differentiation between apples and pears and we recommend this approach as a screening method.

Postmenopausal weight status, body composition and body fat distribution in relation to parameters of menstrual and reproductive history

OBJECTIVES

In the present study the association between menstrual and reproductive history patterns and weight status, fat distribution and body composition during postmenopause was tested.

METHODS

In 106 healthy postmenopausal women ranging in age from 48 to 58 years (x = 53.7 year) the weight status was classified according to the recommendations of the WHO. Additionally body composition was estimated by dual energy X-ray absorptiometry and fat distribution was calculated using the fat distribution index. Weight status, body composition and fat distribution were correlated with self-reported parameters of menstrual and reproductive history (age at menarche, average cycle length, number of births, age at first and last birth, average pregnancy weight gain, age at menopause).

RESULTS

It was shown that number of births, age at first birth and pregnancy weight gain were related significantly to the postmenopausal weight status, body composition and fat distribution.

CONCLUSION

An early first birth a low number of births and a high weight gain during pregnancies can be assumed as risk factors for overweight, a higher amount of adipose tissue, android fat patterning and therefore for the development of the metabolic syndrome during postmenopause. In contrast no adverse effect of menstrual and reproductive parameters on postmenopausal bone mass was found.

GH, IGFBP-1, and IGFBP-3 response to oral glucose tolerance test in perimenopausal women: no influence of body mass index

OBJECTIVES

an increasing interest is being focused on the role of the somatotropic axis in the modulation of body weight and fat distribution, particularly in climacteric women. The influence of the glycometabolic state on the somatotropic axis in postmenopausal and in obese subjects has not been investigated. The aim of the present study is to evaluate whether menopause and body mass index (BMI) affect the response of growth hormone (GH), insulin-like growth factor-binding protein-1 (IGFBP-1) and -3 (IGFBP-3) to the oral glucose tolerance test (OGTT).

METHODS

the study included 24 women, aged 45-55 years, categorized into 4 groups, premenopausal pre-obese (BMI = 28.5 +/- 0.8 Kg/m2) and normal body weight (BMI = 22.2 +/-1.1 Kg/m2), and postmenopausal pre-obese and normal body weight. All women underwent: (1) a biophysical evaluation with determination of waist/hip ratio; (2) an assessment of fat and lean tissue mass and body fat distribution by total body DEXA; and to (3) an OGTT.

RESULTS

in response to OGTT plasma GH levels significantly decreased in all groups, but the relative decrease was more prominent in the lean subjects. A significant decrease of IGFBP-1 levels in response to OGTT was observed in all women, regardless of menopausal age and BMI, while IGFBP-3 levels did not significantly change in either group.

CONCLUSIONS

in conclusion, the impact of both BMI and menopausal condition on GH, IGFBP-1, and -3 response to OGTT is limited to a blunted GH response in overweight women compared with normally-weighing ones. These findings appear to rule out the hypothesis that a common glycometabolic derangement may affect both the modifications of body weight and of the somatotropic axis observed in perimenopausal women.

The contribution of menopause to changes in body-fat distribution

OBJECTIVE

To investigate whether menopause contributes to changes in body-fat distribution, irrespective of aging or obesity.

METHODS

The subjects were 545 premenopausal (aged 16-55 years; mean +/- standard deviation, 37.7 +/- 9.1 years) and 219 postmenopausal (aged 45-65 years, 58.0 +/- 5.0 years) women. Baseline characteristics included age, body mass index (BMI), and menopausal status (premenopause or postmenopause). The ratio of trunk fat to leg fat (trunk-leg ratio) was estimated by dual-energy X-ray absorptiometry. The trunk-leg ratio and baseline characteristics were compared between the 2 groups. In all subjects (n = 764), possible correlations between the trunk-leg ratio and the baseline characteristics were determined using univariate and multivariate analysis. In postmenopausal women, the relationship of the trunk-leg ratio to YSM or age after adjusting for BMI was investigated.

RESULTS

The trunk-leg ratio and BMI were significantly higher in postmenopausal women than in premenopausal women. In all subjects, age and BMI were positively correlated with the trunk-leg ratio (r = 0.445 and 0.587, respectively, p < 0.0001). Menopause was also positively correlated with the trunk-leg ratio on univariate regression analysis (standardized regression coefficient = 0.369, p < 0.0001). On multiple regression analysis, age, BMI, and menopause were independently correlated with the trunk-leg ratio (p < 0.05). In postmenopausal women, age and YSM were positively correlated with the trunk-leg ratio, independent of the BMI (p < 0.01).

CONCLUSIONS

Menopause contributes to a change in body-fat distribution, irrespective of aging or obesity.

Weight gain and the menopause: a 5-year prospective study

OBJECTIVE

To investigate prospectively changes in weight, skin-fold measurements, waist circumference and waist/hip ratio in relation to changes in menopausal status, hormone therapy use and life-style factors.

METHOD

The study was a 5-year follow-up of volunteers from a population-based cohort of Australian-born women aged 46-57 years at baseline: 106 premenopausal, 106 perimenopausal and 21 hormone therapy users.

RESULTS

Mean (SD) weight gain of the entire cohort over 5 years was 2.1 (5.1) kg. Baseline age was negatively associated with weight change (regression coefficient = -0.4, SE 0.1, p < 0.05). After 5 years, 20 women remained premenopausal, 80 were perimenopausal, 112 had become naturally postmenopausal and 21 remained on hormone therapy. Changes in weight were greater than zero (p < 0.05) in all groups except for the women who remained on hormone therapy. There was no significant difference in weight gain between women who remained premenopausal and those who had a natural menopause. Increases in suprailiac skin-fold measurements (p < 0.05) and in waist circumference and waist/hip ratio occurred in women who experienced the menopausal transition but not in those who took hormone therapy continuously. There was no association between weight change and baseline weight, exercise, alcohol intake or smoking.

CONCLUSION

Weight gain was not related to change in menopausal status nor to any life-style factors measured. Women who were older at baseline gained less weight than the younger members. Suprailiac skin-fold measurements, waist circumference and waist/hip ratio all increased during the menopausal transition. Continuous hormone therapy users showed no gain in mean weight, suprailiac skin-fold measurements or waist measurements over the follow-up period.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis

PURPOSE

Weight gain is common during the first year after breast cancer diagnosis. In this study, we examined clinical factors associated with body size at diagnosis and weight gain during the subsequent year.

PATIENTS AND METHODS

An inception cohort of 535 women with newly diagnosed locoregional breast cancer underwent anthropometric measurements at baseline and 1 year. Information was collected on tumor- and treatment-related variables, as well as diet and physical activity.

RESULTS

Mean age was 50.3 years; 57% of women were premenopausal. Mean baseline body mass index (weight [kg] divided by height [m] squared) was 25.5 kg/m2. Overall, 84.1% of the patients gained weight. Mean weight gain was 1.6 kg (95% confidence interval, 1.2 to 1.9 kg), 2.5 kg (95% confidence interval, 1.8 to 3.2 kg) in those receiving chemotherapy, 1.3 kg (95% confidence interval, 0.7 to 1.8 kg) in those receiving tamoxifen only, and 0.6 kg (95% confidence interval, 0.01 to 1.3 kg) in those receiving no adjuvant treatment. Menopausal status at diagnosis (P = .02), change in menopausal status over the subsequent year (P = .002), axillary nodal status (P = .009), and adjuvant treatment (P = .0002) predicted weight gain in univariate analysis. In multivariate analysis, onset of menopause and administration of chemotherapy were independent predictors of weight gain (all P < or = .05). Caloric intake decreased (P < .01) and physical activity increased (P < .05) during the year after diagnosis; these factors did not explain the observed weight gain.

CONCLUSION

Weight gain is common after breast cancer diagnosis; use of adjuvant chemotherapy and onset of menopause are the strongest clinical predictors of this weight gain.

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

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

Differential impact of conventional oral or transdermal hormone replacement therapy or tibolone on body composition in postmenopausal women

OBJECTIVE

To compare the effects on body composition and body weight of tibolone vs two different sequential oral or transdermal oestrogen-progestogen hormone replacement therapies versus no therapy.

PATIENTS AND METHODS

One hundred postmenopausal women were assigned to a control group (n = 26), or randomized to 1) tibolone (TIB) 2.5 mg/day (n = 28), 2) oral oestradiol 2 mg/day (PO) plus sequential dydrogesterone 10 mg/day for 14 of 28 days per cycle (n = 26), or 3) transdermal oestradiol patch (TTS) releasing 50 micrograms/day plus oral sequential dydrogesterone 10 mg/day for 14 of 28 days per cycle (n = 20). Body composition was measured at the base-line and every 6 months for 2 years by DXA (Hologic QDR 1000 W).

RESULTS

Total body fat mass increased (P < 0.05) in controls (+3.6 +/- 1.5%) and in TTS treated (+4.7 +/- 2.2%), but not in PO (-1.2 +/- 2.4%) and TIB (-1.6 +/- 2.2%) treated subjects. This increase in total fat mass in controls and TTS treated women was mostly due to an increase in fat mass of the trunk (P < 0.05), but not legs. As a result, a redistribution of body fat to the trunk occurred in controls, TTS and TIB, but not in PO treated women (P < 0.05). Total lean body mass decreased (P < 0.02) in controls (-1.7 +/- 0.7%) and PO (-1.4 +/- 0.6%) but not in TTS (+0.3 +/- 0.8%) and TIB (+0.4 +/- 0.5%) treated subjects.

CONCLUSIONS

The menopause is associated with an increase in total body fat and a decline in lean body mass. Oral oestradiol/dydrogesterone and tibolone prevent total body fat changes, whereas transdermal oestradiol/oral dydrogesterone and tibolone prevent the lean mass changes. Furthermore, oral oestradiol/dydrogesterone prevents the shift to a central, android fat distribution.

Effects of the menopause transition on body fatness and body fat distribution

OBJECTIVE

The menopause transition increases cardiovascular and metabolic disease risk, partly because of the adverse effects of estrogen deficiency on the plasma lipid-lipoprotein profile and cardiovascular function. This increased cardiovascular and metabolic disease risk may also be partially mediated by increased body fat, increased intra-abdominal adipose tissue accumulation, or both. The objective of this mini-review is to summarize studies that have investigated the relationships among the menopause transition, body fatness, and body fat distribution.

RESEARCH METHODS AND PROCEDURES

A review of cross-sectional and longitudinal studies on menopause that examined body fatness and body fat distribution.

RESULTS

Cross-sectional reports show that the menopause transition is related to modest increases in body mass index or total fatness, although not all studies found significant effects. Increased central adiposity appears to be related to menopause, independent of advancing age, but these results are methodology dependent. An independent effect of menopause on central body fatness was noted by the use of techniques such as DEXA or computed tomography, whereas studies using circumference measures showed discrepant results. Longitudinal studies showed that the menopause transition accelerated the increase in central adiposity, although no studies quantified changes in intra-abdominal fat by imaging techniques.

DISCUSSION

Thus, additional longitudinal studies using more accurate measures of adiposity are needed to critically examine the effects of the menopause transition on total and central body fatness. Collectively, previous studies suggest that menopause is related to modest increase in total fatness and accelerated accumulation of central body fat that exceeds changes normally attributed to the aging process. These changes may increase the risk for cardiovascular and metabolic disease in aging women.

Beta-endorphin response to oral glucose tolerance test in obese and non-obese pre- and postmenopausal women

Beta-endorphin (beta-EP) is a neuropeptide involved in several brain functions, regulating the reproductive axis and behavioral changes. Estrogens play a modulatory role on circulating levels of beta-EP in women. Previous clinical studies have demonstrated high plasma beta-EP levels in obese subjects and increased beta-EP release after an oral glucose tolerance test (OGTT) in normal or obese women. The aim of the present study was to evaluate plasma beta-endorphin levels in response to an OGTT in pre- and postmenopausal obese and non-obese women, in order to investigate if the decrease in gonadal steroid levels at menopause could modify in a different manner the control of beta-endorphin release in response to glucose administration. A group of 24 normal women (age range 45-55 years) were included in the study. The patients were subdivided in four groups of six subjects each: group A, premenopausal women with body mass index (BMI) < 25 (control); group B, premenopausal women with BMI > 25 (obese); group C, post-menopausal women with BMI < 25 (control); group D, postmenopausal women with BMI > 25 (obese). All women were studied between 8.30 and 9.00 am, after overnight fasting, and underwent an OGTT. In obese premenopausal women, basal plasma beta-EP levels were significantly higher than in non-obese women (p < 0.01). In postmenopausal women, regardless of body weight, low basal plasma beta-EP levels were found. A significant increase in plasma beta-EP levels, at 30 and 60 minutes after oral glucose ingestion, was shown in control premenopausal women. No significant modifications to OGTT were shown in plasma beta-EP levels in the other three groups of women. In conclusion, while in premenopausal women the response of plasma beta-EP levels to OGTT is maintained, in postmenopause there is a lack of response to OGTT. This suggests that beta-EP release is dependent upon gonadal steroids, while it is only in part influenced by body weight.