Longitudinal changes in body composition in women approaching the midlife

FSH-blocking therapeutic for osteoporosis

Pharmacological and genetic studies over the past decade have established the follicle-stimulating hormone (FSH) as an actionable target for diseases affecting millions, namely osteoporosis, obesity, and Alzheimer's disease. Blocking FSH action prevents bone loss, fat gain, and neurodegeneration in mice. We recently developed a first-in-class, humanized, epitope-specific FSH-blocking antibody, MS-Hu6, with a KD of 7.52 nM. Using a Good Laboratory Practice (GLP)-compliant platform, we now report the efficacy of MS-Hu6 in preventing and treating osteoporosis in mice and parameters of acute safety in monkeys. Biodistribution studies using 89Zr-labeled, biotinylated or unconjugated MS-Hu6 in mice and monkeys showed localization to bone and bone marrow. The MS-Hu6 displayed a β phase t½ of 7.5 days (180 hr) in humanized Tg32 mice. We tested 217 variations of excipients using the protein thermal shift assay to generate a final formulation that rendered MS-Hu6 stable in solution upon freeze-thaw and at different temperatures, with minimal aggregation, and without self-, cross-, or hydrophobic interactions or appreciable binding to relevant human antigens. The MS-Hu6 showed the same level of "humanness" as human IgG1 in silico and was non-immunogenic in ELISpot assays for IL-2 and IFN-γ in human peripheral blood mononuclear cell cultures. We conclude that MS-Hu6 is efficacious, durable, and manufacturable, and is therefore poised for future human testing.

Prevalence of sleep disturbances: Sleep disordered breathing, short sleep duration, and non-restorative sleep

Recently, interest in sleep disturbances, such as sleep disordered breathing (SDB), short sleep duration, and non-restorative sleep (NRS), has been increasing. The potentially large public health implications of sleep disturbances indicate a need to determine their prevalence in a general population. This review describes the characteristics of population-based sleep cohorts from past to present. Unavoidable methodological and baseline characteristic heterogeneity was found between studies. The prevalence of SDB (apnea hypopnea index (AHI), respiratory disturbance index (RDI), or oxygen desaturation index (ODI) ≥5/h) was 24.0-83.8% in men and 9.0-76.6% in women, and that of moderate-to-severe SDB (AHI, RDI, or ODI ≥15/h) was 7.2-67.2% in men and 4.0-50.9% in women. Additionally, the prevalence of SDB in post-menopausal women was 3-6 times higher than in pre-menopausal women. The prevalence of subjective short sleep duration (<6 h) was 7.5-9.6%, while that of objective short sleep duration (<6 h) was 22.1-53.3%. The prevalence of NRS was 19.2-31.0% in men and 26.3-42.1% in women, as determined from studies using a yes-no questionnaire, while a multi-national survey using a telephone-based expert system showed a wide range of prevalence between countries, from 2.4% to 16.1%. An association between SDB, short sleep duration, and NRS has recently been suggested. To gain a better understanding of the burden of sleep disturbances, a consensus on the definition of several sleep disturbances is needed, as methodological heterogeneity exists, including SDB scoring rules, subjective versus objective data collection for short sleep duration, and the definition of NRS itself.

Ovarian hormones and obesity

BACKGROUND

Obesity is caused by an imbalance between energy intake, i.e. eating and energy expenditure (EE). Severe obesity is more prevalent in women than men worldwide, and obesity pathophysiology and the resultant obesity-related disease risks differ in women and men. The underlying mechanisms are largely unknown. Pre-clinical and clinical research indicate that ovarian hormones may play a major role.

OBJECTIVE AND RATIONALE

We systematically reviewed the clinical and pre-clinical literature on the effects of ovarian hormones on the physiology of adipose tissue (AT) and the regulation of AT mass by energy intake and EE.

SEARCH METHODS

Articles in English indexed in PubMed through January 2016 were searched using keywords related to: (i) reproductive hormones, (ii) weight regulation and (iii) central nervous system. We sought to identify emerging research foci with clinical translational potential rather than to provide a comprehensive review.

OUTCOMES

We find that estrogens play a leading role in the causes and consequences of female obesity. With respect to adiposity, estrogens synergize with AT genes to increase gluteofemoral subcutaneous AT mass and decrease central AT mass in reproductive-age women, which leads to protective cardiometabolic effects. Loss of estrogens after menopause, independent of aging, increases total AT mass and decreases lean body mass, so that there is little net effect on body weight. Menopause also partially reverses women's protective AT distribution. These effects can be counteracted by estrogen treatment. With respect to eating, increasing estrogen levels progressively decrease eating during the follicular and peri-ovulatory phases of the menstrual cycle. Progestin levels are associated with eating during the luteal phase, but there does not appear to be a causal relationship. Progestins may increase binge eating and eating stimulated by negative emotional states during the luteal phase. Pre-clinical research indicates that one mechanism for the pre-ovulatory decrease in eating is a central action of estrogens to increase the satiating potency of the gastrointestinal hormone cholecystokinin. Another mechanism involves a decrease in the preference for sweet foods during the follicular phase. Genetic defects in brain α-melanocycte-stimulating hormone-melanocortin receptor (melanocortin 4 receptor, MC4R) signaling lead to a syndrome of overeating and obesity that is particularly pronounced in women and in female animals. The syndrome appears around puberty in mice with genetic deletions of MC4R, suggesting a role of ovarian hormones. Emerging functional brain-imaging data indicates that fluctuations in ovarian hormones affect eating by influencing striatal dopaminergic processing of flavor hedonics and lateral prefrontal cortex processing of cognitive inhibitory controls of eating. There is a dearth of research on the neuroendocrine control of eating after menopause. There is also comparatively little research on the effects of ovarian hormones on EE, although changes in ovarian hormone levels during the menstrual cycle do affect resting EE.

WIDER IMPLICATIONS

The markedly greater obesity burden in women makes understanding the diverse effects of ovarian hormones on eating, EE and body adiposity urgent research challenges. A variety of research modalities can be used to investigate these effects in women, and most of the mechanisms reviewed are accessible in animal models. Therefore, human and translational research on the roles of ovarian hormones in women's obesity and its causes should be intensified to gain further mechanistic insights that may ultimately be translated into novel anti-obesity therapies and thereby improve women's health.

Is adiposity across life associated with subsequent hysterectomy risk? Findings from the 1946 British birth cohort study

OBJECTIVE

To examine the associations between adiposity at time points from early life onwards and subsequent hysterectomy risk.

DESIGN

Prospective birth cohort study.

SETTING

England, Scotland and Wales.

POPULATION

Women from the Medical Research Council National Survey of Health and Development study, with complete data on hysterectomy status (n= 1790).

METHODS

Survival analysis methods were used to examine the associations between body mass index at time points across life and subsequent hysterectomy rates.

MAIN OUTCOME MEASURE

Self-reported hysterectomy with or without oophorectomy.

RESULTS

From 20 years onwards, those women who were classified as underweight had lower hysterectomy rates, and from 36 years onwards, those women who were overweight had higher hysterectomy rates than those who were normal weight. Women who were obese in adolescence and early adulthood had lower rates of hysterectomy than those who were normal weight, although numbers categorised as obese at these ages were small. Women who were obese in later adulthood had higher subsequent rates of hysterectomy. Greater increases in weight between ages 36 and 53 years were associated with higher rates of hysterectomy in later adulthood. These results were not explained by parity, age at menarche or socio-economic position.

CONCLUSIONS

These results suggest that variation in hysterectomy rates may be partially explained by variation in adiposity, and so with the recent changes in levels of overweight and obesity in populations, there may be increasing demand for gynaecological treatments in the future.

Do the changes in energy balance that occur during pregnancy predispose parous women to obesity?

The aim of this review was to re-assess whether the changes in energy balance that accompany pregnancy predispose parous women to obesity. A number of cross-sectional studies have sought to answer this question by examining the relationship between parity and maternal body weight. However, these studies were unable to control for the large number of sociobehavioural confounders that might be responsible for the apparent effect of parity on body weight. Longitudinal studies that examine changes in maternal body weight before and after regnancy avoid these problems by using each mother as her own control. Nevertheless, these studies have to overcome three methodological constraints: They must obtain an accurate measure of prepregnant body weight, they must give each mother sufficient time to lose any weight retained following delivery, and they must take into account the effect of ageing on maternal weight gain during pregnancy and the follow-up period. More than 90% of the studies reviewed found body weight to be greater after pregnancy than it was before (by 0.2–10.6kg). and previous researchers who have examined the evidence for pregnancy-related weight gains suggest that body weight increases by an average of 04–4.8kg following pregnancy. However, only three of the 71 longitudinal studies examined in the present review complied with the three methodological criteria. These studies concluded that mothers gain, on average, 0.9–3.3kg more weight following pregnancy than nonpregnant controls, and that mean body weight remained 0.4–3.0kg higher, even after controlling for a number of sociobehavioural confounders. This apparently modest increase in mean maternal body weight for women having one or two children conceals the fact that some mothers experience a substantial increase in body weight and become obese following pregnancy. It remains unclear whether these increases are simply the result of changes in energy metabolism during pregnancy and lactation, or whether they are influenced by inherent changes in lifestyle that accompany pregnancy and motherhood. Understanding the relative importance of these alternatives might help to explain the aetiology of maternal obesity.

“Clover was a stout motherly mare approaching middle life, who had never quite got her figure back after her fourth foal”

George Well (1945) Animal Farm. London: Secker and Warburg.

Is there an association between hysterectomy and subsequent adiposity?

Objectives

To examine the associations between hysterectomy and subsequent adiposity and to investigate whether these associations vary by characteristics of hysterectomy and are independent of pre-hysterectomy adiposity and potential confounding factors.

Methods

Using information on women from the 1946 and 1958 British birth cohort studies (N = 1790 and 4552, respectively), collected prospectively across life, regression analyses were used to examine the associations between hysterectomy and subsequent body mass index (BMI) and waist circumference.

Results

In unadjusted analyses there was a difference of 1.18 kg/m² (95% CI: 0.64, 1.74) in mean BMI and of 2.72 cm (1.45, 3.99) in waist circumference at age 44–45 years between women who had undergone hysterectomy and those who had not in the 1958 cohort, and differences of 0.76 kg/m² (−0.05, 1.57) and 0.34 cm (−1.58, 2.26) at age 43 years and 0.81 kg/m² (0.14, 1.49) and 1.45 cm (−0.15, 3.05) at age 53 years in the 1946 cohort. These differences attenuated and were no longer significant after adjustment for pre-hysterectomy BMI and confounders. There was no strong evidence of variation in associations by oophorectomy status, timing, route of or reason for procedure.

Conclusions

This study demonstrates that British women who had previously undergone hysterectomy had higher BMI and waist circumference in middle-age than others. These differences appear to be accounted for by the higher BMI in earlier adulthood and increased levels of risk factors associated with both adiposity and hysterectomy risk among women who had undergone hysterectomy. This suggests that women are unlikely to gain weight as a direct result of hysterectomy.

Change in women's body mass index and waist circumference, 1997 to 2002: The Nepean Study

OBJECTIVE

To investigate characteristics associated with body mass index (BMI) and waist circumference stability over a five-year period in women with school-age children.

METHODS

Women with 7-8 year-old children from western Sydney, Australia, had anthropometric measures taken in 1996/97 (n=436) and five years later (n=327). Socio-demographic characteristics examined at baseline included age, socioeconomic status, smoking, and number of children.

RESULTS

Over five years, less than half of the women maintained a stable BMI (38.8%) or waist circumference (31.5%), with the majority gaining in both indicators of adiposity. BMI and socio-demographic characteristics were not predictive of BMI or waist circumference stability or decrease.

CONCLUSIONS AND IMPLICATIONS

Total and abdominal adiposity increased in these Australian women who have children. The results support the need to develop effective weight gain prevention initiatives.

Strength training and adiposity in premenopausal women: strong, healthy, and empowered study

BACKGROUND

American women aged 25-44 y gain 0.5-1 kg yearly, most of which is fat. Because few midlife women participate in strength training, this mode of activity may be a novel intervention for preventing age-associated fat increases in this population.

OBJECTIVES

The primary aim was to assess the efficacy of twice-weekly strength training to avoid increases in percentage body fat and intraabdominal fat.

DESIGN

A randomized controlled trial was conducted in an ethnically diverse sample of 164 overweight and obese [body mass index (in kg/m2): 25-35] women aged 25-44 y. The treatment group did twice-weekly strength training for 2 y. The standard care comparison group was given brochures recommending aerobic exercise. Assessments at baseline, 1, and 2 y included intraabdominal fat by computed tomography scan and body fat and fat-free mass by dual-energy X-ray absorptiometry.

RESULTS

During 2 y, percentage body fat changes were -3.68 +/- 0.99% for the treatment group and -0.14 +/- 1.04% for the control group, P = 0.01. Two-year intraabdominal fat changes were 7.05 +/- 5.07% for the treatment group and 21.36 +/- 5.34% for the control group, P = 0.05.

CONCLUSION

This study suggests that strength training is an efficacious intervention for preventing percentage body fat increases and attenuating intraabdominal fat increases in overweight and obese premenopausal women. This is relevant to public health efforts for obesity prevention because most weight gain can be assumed to be fat, including abdominal fat.

Randomized controlled trial of the effect of hysterectomy or LNG-IUS use on bone mineral density: a five-year follow-up

A 72-year-old female with scirrhous-type advanced gastric cancer was treated with TS-1/CDDP as neoadjuvant chemotherapy. TS-1 (80 mg/m(2)/day) was orally administered for 3 weeks and CDDP (60 mg/m(2)) was administered by intravenous drip on day 8. Partial response (PR) was obtained after the first course, and total gastrectomy was performed. The histological diagnosis revealed complete disappearance of cancer cells in the stomach and a few regional lymph node metastases (3/67). The patient has now been in good health without a recurrence for 1 year and 9 months after surgery.

Association of gain and loss of weight before and after menopause with risk of postmenopausal breast cancer in the Iowa women's health study

Obesity and adult weight gain are well-established risk factors for postmenopausal breast cancer. Although there are a few studies demonstrating the contribution of adult weight gain to breast cancer risk, whether weight gain during a critical time period is specifically associated with risk, or whether subsequent weight loss among women who have gained weight will reduce the excess risk, is not firmly established. We investigated the association of changes in weight (loss or gain in excess of 5% of body weight) using two risk factor models: (a) age 18 to 30 years and age 30 years to menopause and (b) age 30 years to menopause and after the menopause to the baseline study in 1986 on risk of postmenopausal breast cancer in a prospective cohort of 33,660 postmenopausal women in Iowa. Over 15 years of follow-up, 1,987 cases of breast cancer occurred. Data were analyzed using proportional hazards regression models adjusted for established breast cancer risk factors. The most frequently observed pattern of body weight over time was a consistent increase; these women were observed to have the highest rates of breast cancer and served as the reference category for all comparisons. The lowest-risk groups were (a) women who maintained or lost weight from age 18 to 30 years and then lost weight from age 30 years to menopause [risk ratio (RR), 0.36; 95% confidence interval (95% CI), 0.22-0.60] and (b) women who maintained or lost weight from age 30 years to menopause and then lost weight after the menopause (RR, 0.48; 95% CI, 0.22-0.65). Women who gained weight from age 30 years to menopause but then lost weight after the menopause experienced risk reductions (RR, 0.77; 95% CI, 0.64-0.92) although perhaps slightly smaller in magnitude than women who maintained their weight in both time intervals (RR, 0.63; 95% CI, 0.55-0.73). Women who gained weight from age 18 to 30 years and then lost weight from age 30 years to menopause had comparable risk reductions (RR, 0.61; 95% CI, 0.46-0.8) with women who maintained their weight in both time intervals (RR, 0.73; 95% CI, 0.64-0.84). Women who gained weight during the period from age 30 years to menopause but who had stable weight after menopause had rates similar to the reference group. These data suggest prevention of weight gain between age 18 years and menopause or weight loss and maintenance during these years reduces risk of postmenopausal breast cancer.

Sarcopenia is related to physical functioning and leg strength in middle-aged women

BACKGROUND

In the aging process, loss of muscle is relatively continuous, but the initiation, timing, and amount of muscle loss that relate to functional compromise are poorly described. Also poorly understood is whether strength and functioning in aging are related to the amount of lean mass and its change as well as to the amount of fat mass and its change.

METHODS

The purpose of the study was to ascertain whether 3-year lean and fat mass change predicted functional status in 712 African American and Caucasian women, aged 34-58 years. Fat and lean mass were assessed with bioelectrical impedance. Lower leg strength (torque) was measured with a portable isometric chair, and two indices of physical functioning, walking velocity and double support (both feet touching the surface while walking), were measured with an instrumented gait mat.

RESULTS

Almost 9% of middle-aged women had at least a 6% loss (>2.5 kg) of lean mass over the 3-year observation period. Women who lost at least 2.5 kg of lean mass had slower walking velocity and less leg strength, although women who simultaneously gained more than 2.5 kg of fat mass (at least 7.5%) did not have less leg strength. Age was significantly associated with less velocity, less leg strength, and more time in double support.

CONCLUSIONS

Even in middle-aged women, there is loss of lean mass among almost 1 woman in 10, and this loss of lean mass (sarcopenia) is associated with greater compromise in physical functioning.

Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study

Menopause is considered to be a risk factor for sleep-disordered breathing, but this hypothesis has not been adequately tested. The association of premenopause, perimenopause, and postmenopause with sleep-disordered breathing was investigated with a population-based sample of 589 women enrolled in the Wisconsin Sleep Cohort Study. Menopausal status was determined from menstrual history, gynecologic surgery, hormone replacement therapy, follicle-stimulating hormone, and vasomotor symptoms. Sleep-disordered breathing was indicated by the frequency of apnea and hypopnea events per hour of sleep, measured by in-laboratory polysomnography. Multivariable logistic regression was used to estimate odds ratios for having 5 or more and 15 or more apnea and hypopnea events per hour. Odds ratios (95% confidence interval), adjusted for age, body habitus, smoking, and other potential confounding factors, for 5 or more apnea and hypopnea events per hour were 1.2 (0.7, 2.2) with perimenopause and 2.6 (1.4, 4.8) with postmenopause; odds ratios for 15 or more apnea and hypopnea events per hour were 1.1 (0.5, 2.2) with perimenopause and 3.5 (1.4, 8.8) with postmenopause. The menopausal transition is significantly associated with an increased likelihood of having sleep-disordered breathing, independent of known confounding factors. Evaluation for sleep-disordered breathing should be a priority for menopausal women with complaints of snoring, daytime sleepiness, or unsatisfactory sleep.

Perceptions of risk factors for breast cancer and attitudes toward mammography among women who are current, ex- and non-smokers

Understanding risk perceptions for breast cancer among women smokers is important because smokers tend to underutilize breast cancer screening. Perceptions of the relative importance of a variety of factors which may increase breast cancer risk and the benefits/barriers of mammography, were examined among women who were current (n = 185), ex- (n = 632) and never (n = 623) smokers. Participants were a subset of women taking part in a project to increase mammography utilization among women aged 50 and over. Current smokers, but not ex-smokers, were significantly less likely than never smokers to agree that health risk behaviors most frequently seen in smokers (e.g., smoking cigarettes, high-fat diet, low intake of fruits and vegetables, physical inactivity, drinking alcohol) may increase risk for breast cancer. Current smokers, but not ex-smokers, perceived more barriers and fewer benefits of mammography, than never smokers.

Physical activity, body fat, and serum C-reactive protein in postmenopausal women with and without hormone replacement

The objective was to determine whether higher physical activity is associated with lower serum C-reactive protein (CRP), independent of oral hormone replacement therapy (HRT) status and body fatness, in 133 postmenopausal women using a cross-sectional exploratory design at a university research laboratory. The subjects were 133 postmenopausal women, age 50-73 years, with no evidence of coronary artery disease or diabetes. The main outcome measures were: serum CRP, physical activity as measured by Stanford 7-day activity recall, body fat (both total and regional) as measured by dual energy X-ray absorptiometry (DXA), and anthropometry (waist and hip circumference). Secondary outcome measures included fasting plasma glucose and insulin as well as fasting serum triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Higher physical activity energy expenditures were significantly associated with lower serum CRP levels (r = -0.18, P = 0.041), independent of oral HRT use, age, smoking behavior, alcohol consumption, aspirin use, and statin use. However, in the complete multivariate model, which included body fat, older ages (P = 0.047), greater trunk fat masses (P < 0.001), any oral HRT use (P < 0.001), and unopposed oral estrogen use (P = 0.012) were the sole independent predictors of higher serum CRP levels. The complete multivariate model accounted for 58% of the variance in serum CRP. We conclude that the association between higher physical activity and lower serum CRP levels is dependent on the lower body fat of the more active women, yet independent of oral HRT use. Future intervention trials should determine whether diet- and exercise-related reductions in body fat may be effective ways to diminish the proinflammatory effects of oral HRT in postmenopausal women.

Longitudinal changes in body composition in older men and women: role of body weight change and physical activity

BACKGROUND

Estimates of body-composition change in older adults are mostly derived from cross-sectional data.

OBJECTIVE

We examined the natural longitudinal patterns of change in fat-free mass (FFM) and fat mass (FM) in older adults and explored the effect of physical activity, weight change, and age on these changes.

DESIGN

The body composition measured by hydrodensitometry and the level of sports and recreational activity (SRA) of 53 men and 78 women with a mean (+/-SD) initial age of 60.7 +/- 7.8 y were examined on 2 occasions separated by a mean (+/-SD) time of 9.4 +/- 1.4 y.

RESULTS

FFM decreased in men (2.0% per decade) but not in women, whereas FM increased similarly in both sexes (7.5% per decade). Levels of SRA decreased more in men than in women over the follow-up period. Baseline age and level of SRA were inversely and independently associated with changes in FM in women only. Neither age nor level of SRA was associated with changes in FFM in men or women. Weight-stable subjects lost FFM. FFM accounted for 19% of body weight in those who gained weight, even in the presence of decreased levels of SRA. Loss of FFM (33% of body weight) was pronounced in those who lost weight, despite median SRA levels >4184 kJ/wk.

CONCLUSIONS

On average, FM increased; however, the increase in women was attenuated with advancing age. The decrease in FFM over the follow-up period was small and masked the wide interindividual variation that was dependent on the magnitude of weight change. The contribution of weight stability, modest weight gains, or lifestyle changes that include regular resistance exercise in attenuating lean-tissue loss with age should be explored.

Epidemiology of obstructive sleep apnea: a population health perspective

Population-based epidemiologic studies have uncovered the high prevalence and wide severity spectrum of undiagnosed obstructive sleep apnea, and have consistently found that even mild obstructive sleep apnea is associated with significant morbidity. Evidence from methodologically strong cohort studies indicates that undiagnosed obstructive sleep apnea, with or without symptoms, is independently associated with increased likelihood of hypertension, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. Strategies to decrease the high prevalence and associated morbidity of obstructive sleep apnea are critically needed. The reduction or elimination of risk factors through public health initiatives with clinical support holds promise. Potentially modifiable risk factors considered in this review include overweight and obesity, alcohol, smoking, nasal congestion, and estrogen depletion in menopause. Data suggest that obstructive sleep apnea is associated with all these factors, but at present the only intervention strategy supported with adequate evidence is weight loss. A focus on weight control is especially important given the expanding epidemic of overweight and obesity in the United States. Primary care providers will be central to clinical approaches for addressing the burden and the development of cost-effective case-finding strategies and feasible treatment for mild obstructive sleep apnea warrants high priority.

Body mass index in mid-life women: relative influence of menopause, hormone use, and ethnicity

OBJECTIVE

To assess the relative influence of menopausal status and hormone use on body mass index (BMI) among a multiethnic sample of mid-life women.

DESIGN

Cross-sectional telephone survey conducted at seven sites where each site targeted an ethnic minority group and Caucasians as part of Study of Women's Health Across the Nation (SWAN).

SUBJECTS

A total of 7181 Caucasians, 3949 African-Americans, 1660 Hispanics, 562 Chinese Americans, and 803 Japanese Americans between ages of 40 and 55 y residing in or near Boston, Chicago, Detroit, Los Angeles, Newark, NJ, Oakland, CA, and Pittsburgh, PA.

MEASUREMENTS

Self-reported BMI based on weight in kg divided by height in m(2) menopausal status, physical inactivity, postmenopausal hormone use, ethnicity, and age in years.

RESULTS

Compared to premenopausal women (covariate adjusted M=27.3), women reporting a surgical menopause (M=28.2) or being in the perimenopausal transition (M=27.7 for early and 27.9 for late perimenopause) had higher BMI. Women reporting a natural menopause (M=27.4) did not have a higher BMI than premenopausal women, after adjusting for chronological age and other covariates. Hormone use was associated with lower BMI (M=26.5 vs 27.3). A comparison of effect sizes showed that menopausal status (F=13.1), followed by chronological age (F=24.0), were the least powerful predictors of BMI, whereas the more powerful predictors were physical activity level (F=1377.1) and ethnicity (F=400.5).

CONCLUSIONS

The menopausal transition affects body mass index in mid-life, but the effect is small relative to other influences. Interventions to increase physical activity are highly recommended to prevent increases in adiposity common in mid-life.

[Factors associated with abdominal obesity among childbearing-age women]

OBJECTIVE

To investigate variables potentially associated with abdominal obesity among childbearing-age women.

METHODS

A total of 781 women were studied based on data from the Nutrition and Health Survey conducted in 1996 in the municipality of Rio de Janeiro, Brazil. Abdominal obesity was defined as waist girth (WG) > 80 cm or waist:hips girth ratio (WHR) > 0.85. Statistical analysis involved calculation of central trend measures. Calculating the odds ratio using multivariate logistic regression tested the association between abdominal obesity and BMI, age, parity, and tobacco use.

RESULTS

The highest frequencies of abdominal obesity were observed in women over 35 years of age and those with two or more children (50.7%). OR showed the effect of interaction between parity and age for WG>80 cm when only the effect of these two variables was controlled. Based on the logistic regression models, the study showed that when the population was categorized into women with and without overweight, schooling was the only factor associated with WHR, while the association with age and parity disappeared for WG>80 cm.

CONCLUSIONS

Abdominal obesity in this population group is independent of age and parity when adjusted by relative weight, with overall adiposity and schooling as the greatest determinant. Having more schooling meant having a smaller WHR. It is crucial to implement strategies to prevent the development of obesity in childbearing-age women.

Testosterone concentrations in women aged 25-50 years: associations with lifestyle, body composition, and ovarian status

While there is substantial evidence of the importance of endogenous and exogenous estrogen in reproductive health and chronic disease, there is little consideration of androgens in women's health. In the Michigan Bone Health Study (1992-1995), the authors examined the correlates of testosterone concentrations in pre- and perimenopausal women (i.e., age, menopausal status, body composition, and lifestyle behaviors) in a population-based longitudinal study including three annual examinations among 611 women aged 25-50 years identified through a census in a midwestern community. Current smokers had the highest testosterone concentrations with decreasing values in former and nonsmokers (p = 0.0001). Body composition measures (body mass index, body fat (%), weight (kg), lean body mass (kg), and fat mass (kg)) were significantly and positively associated with total testosterone concentrations in a dose-response manner. Hysterectomy with oophorectomy was associated with significantly lower testosterone concentrations. Alcohol consumption, physical activity, and dietary macronutrient intake were not associated with testosterone concentrations. This is one of the first studies to examine correlates of serum testosterone concentrations in anticipation of the growing interest in the role of androgens in women's health. The greater circulating levels of testosterone in obese women and smokers suggest that testosterone concentrations should be considered in the natural history of disease conditions where obesity and smoking are risk factors, including cardiovascular disease.

Sarcopenia: current concepts

Sarcopenia, the loss of muscle mass and strength with age, is becoming recognized as a major cause of disability and morbidity in the elderly population. Sarcopenia is part of normal aging and does not require a disease to occur, although muscle wasting is accelerated by chronic diseases. Sarcopenia is thought to have multiple causes, although the relative importance of each is not clear. Neurological, metabolic, hormonal, nutritional, and physical-activity-related changes with age are likely to contribute to the loss of muscle mass. In this review, we discuss current concepts of the pathogenesis, treatment, and prevention of sarcopenia.

Plasma leptin concentrations, basal metabolic rates and respiratory quotients in young and older adults

OBJECTIVE

To-examine the interrelationship of circulating leptin concentrations, basal metabolic rates (BMR) and respiratory quotients (RQ) in young and older adults.

DESIGN

Cross sectional study.

SUBJECTS

Seventy-six Australian men and women, 48 young (< 35 y) and 28 older ( > or = 50 y).

MEASUREMENTS

Fasting plasma leptin concentrations by RIA, BMR and RQ by indirect calorimetry, percentage body fat (BF%), fat mass (FM) and fat-free mass (FFM) from total body water (TBW) based on deuterium dilution, waist and hip circumferences from anthropometry.

RESULTS

Older subjects had significantly higher BF%, FM and waist-to-hip ratio (WHR), but significantly lower FFM and absolute BMR as compared to younger subjects. Absolute leptin concentrations were 60% higher in older subjects but did not achieve statistical significance. There was, however, a significant gender x age group interaction in leptin concentrations. This was reflected in a significant inverse relationship between age group and leptin in women when data was controlled for waist circumference (r = -0.38, P = 0.028), or FM (r = -0.36, P = 0.042). A similar relationship was not observed in men on controlling for BF% or FM. Log transformed plasma leptin was best explained by a model that included BF%, gender, age-group, gender x age-group and WHR r = 0.75, adjusted r2 = 0.56, standard error of estimate (SEE) = 0.73 ng/ml). BMR was best explained by FFM, FM and age group r = 0.94, adjusted r2 = 0.87; SEE = 429 kJ/day). On controlling for BF%, WHR and FFM, leptin was negatively related to RQ only in older men (r = -0.67, P = 0.033). There was no relationship of leptin to BMR in the groups studied.

CONCLUSION

The study demonstrates an age-related modification of the gender bias in leptin, and a gender-specific inverse relationship between leptin and RQ in older people. The decline in leptin and the lack of a relationship between RQ and leptin in older women may indicate an increased risk of weight gain relative to older men.

Lifetime dietary change and its relation to increase in weight in Spanish women

INTRODUCTION

Changes in dietary patterns and a decrease in physical activity have occurred in Western countries. These are factors in the variation in body composition observed in populations, characterized by a progressive accumulation of fat with age and a consequent increase in the risk of suffering from common chronic illnesses such as obesity, cardiovascular disease and cancer.

OBJECTIVE

To investigate weight gain throughout the life-cycle and its relation to modifications in dietary patterns, analyzing the causes of these modifications and their implications for patterns of adult overweight and obesity.

DESIGN

Cross-sectional sample of Spanish women from a socio-economically disadvantaged class.

SUBJECTS

1037 healthy perimenopausal women (age: 45-65 y).

MEASUREMENTS

Juvenile body mass index (BMI), current BMI, food frequency questionnaire, retrospective food habits.

RESULTS AND CONCLUSIONS

Of these women, 48.8% had changed their dietary habits during their lifetime. A change in diet due to migration or marriage occurred at approximately 20 years of age and was characterized by an increased frequency of consumption of foods rich in protein and complex carbohydrates, while a change due to illness occurred at around 50 years of age and was characterized by a decrease in the consumption of these types of food. The change in dietary behavior due to migration was associated with weight gain. Weight gain was also inversely associated with BMI during youth; women who in their youth had a BMI<18.5 kg/m2 gained an average of 21.4 kg, compared with those with a BMI>27 kg/m2 in their youth, who gained an average of 5.4 kg. International Journal of Obesity (2000)24, 14-19

Wellness in women after 40 years of age: the role of sex hormones and pheromones

In the past twenty years hundreds of peer-reviewed studies have provided a significant body of information to guide the health care of women in the second halves of their lives. The harmonic nature of the fertile reproductive system forms the background against which hormonal replacement therapy can be understood to best serve women. In addition, the 1986 discovery of human pheromones and the subsequent 1998 confirmation of their existence increases certain sexual options for maturing women. Not all hormonal replacement therapies and wellness regimens serve women well. Some regimens have the potential to produce disease, especially over-the-counter remedies like dehydroepiandrosterone and the formulas that contain estrogen. Some regimens profoundly improve the quality of life of many women; some women do not need or want such regimens. All sex hormones affect physiologic systems including the cardiovascular system, bone metabolism, cognitive function, sexual response, and sexual attractiveness. The 7 years before menopause have recently been revealed to be an extremely complex era. During this period, some women increase their estrogen levels to new lifetime highs; others start an unequivocal decline, and still others vary from month to month. Coupled to this variability in estrogen is an equally variable set of changes in progesterone secretion by the ovary as androgen secretion patterns also change. Many women show increases in circulating androgens while many others show deficiencies. Both the adrenal and the ovarian sources of these hormones show age-related changes that alter a woman's capacity to attract sexual attention through both her physical appearance (and condition) and her pheromonal excretions. The complex contributions to the overall health of a woman may not always be understood. Often a hysterectomy can exacerbate--rather than ameliorate--the conditions that led to the surgery. One in 2 American women is offered a hysterectomy, a rate 5 times higher than that of the European countries for which data are available. Ninety percent of hysterectomies are not related to cancer; they are elective procedures. Avoidance of elective hysterectomy helps prevent its side effects: sexual deficits, acceleration of cardiovascular and bone disease, and more rapid aging. No efficacy data exist that suggest that elective hysterectomy works better than the alternative approaches that do not induce these side effects. The health and well-being of women who have already had hysterectomies, with or without ovariectomies, can be improved by a recognition of the cascade of difficulties that must addressed. Estrogen, progesterone, and androgens all tend to be compromised by hysterectomy; all should be considered for replacement. Because hormonal regimens can be prescribed to enhance the quality of life, the review of the available research can allow the medical art to greatly benefit mature women. Not surprisingly, the emerging conclusion reveals that structurally human hormones, prescribed appropriately, almost always best serve the patient.

Bone mineral density and its change in pre-and perimenopausal white women: the Michigan Bone Health Study

There is a need to better understand potential bone mineral density (BMD) loss during the menopausal transition since this period may include the initiation of interventions. The study purpose was to determine if there was BMD loss at the femoral neck, lumbar spine, or total body bone sites in a population-based study of women approaching or transitioning the midlife. The 583 enrollees were 25-45 years of age at the first of four annual measurements from 1992 through 1996. Bone mineral content and bone width were measured using dual-energy X-ray absorptiometry. Considering all enrollees collectively, there was a significant 3-year decline (1%) in BMD at the femoral neck over the 3-year period (p = 0.076). There was no significant annual change in the lumbar spine (p = 0.11), and a significant annual increase in the total body BMD (p = 0.0003). Within subgroups and cross-sectionally, BMD values of the femoral neck were 5% lower in women classified as perimenopausal compared with premenopausal enrollees; BMD was 3% and 1% lower at the lumbar spine and total body site, respectively. Longitudinally, among perimenopausal women, a double oophorectomy was associated with BMD loss in the spine (p = 0.0003), even though 75-85% of these women had a hormone replacement prescription at some time during the study period. In summary, the site with evidence of loss was the femoral neck, specifically among perimenopausal women. There was little evidence of substantial total body or lumbar spine BMD loss in premenopausal women with ovaries who maintained follicle-stimulating hormone levels < 20 mIU/l in the early follicular period. Double oophorectomy, even with hormone replacement, was associated with bone loss.