Adverse Changes in Body Composition During the Menopausal Transition and Relation to Cardiovascular Risk: A Contemporary Review

Exploring the link between age at menarche, anthropometry and body fat composition with type II diabetes in a Singapore multi-ethnic cohort

BACKGROUND

Early menarche is associated with lifelong health implications, including heightened risks for obesity, type 2 diabetes (T2D), cardiovascular disease, and overall mortality. This study explored the associations that link early menarche, major adiposity indices, and T2D in a group of multi-ethnic Asian women.

METHODS

A prospective, hospital-based study was conducted in Singapore. Two thousand seven hundred fifteen women were recruited from 2014 to 2016 (45-69 years old) and 1201 women were followed up from 2021 to 2023. At baseline, age at menarche (AAM) was divided into sub-categories: < 12 (early AAM), 12-13, 14-15 (reference), > 15 years. Major adiposity indices and glycemic profiles were assessed, including fat mass index (FMI), visceral adipose tissue (VAT), and HOMA-IR (homeostatic model assessment for insulin resistance). At the 6.6-year follow-up, T2D was assessed. One-way ANOVA and chi-square were performed for continuous and categorical variables, respectively. Multivariable regression analysis was performed to determine the association between AAM and primary outcomes, including adiposity measurements (FMI, VAT) and metabolic assessments (HOMA-IR) at baseline. Modified Poisson regression was performed to assess relative risk (RR) between AAM and T2D at follow-up. Serial mediation analysis was performed to determine potential mediators underlying the link between AAM and T2D. All analyses accounted for major confounders including age, ethnicity, and education.

RESULTS

Women with early AAM had significantly greater values in adiposity assessments, including increments in FMI (10.9 vs 10.3, p < 0.001), VAT (134 vs 113 cm2, p = 0.05) and HOMA-IR (1.20 vs 1.03, p = 0.08) at baseline. Early AAM (< 12 vs. 14-15 years) was associated with a 60% increased risk of developing T2D (RR 1.60 (95%CI: 1.04, 2.45)). Serial mediation analysis suggested a significant pathway underlying early AAM and T2D, which was firstly mediated by FMI, followed by VAT and lastly by HOMA-IR (p < 0.05).

CONCLUSIONS

Our study provided valuable insight into the pathophysiology of T2D development amongst mid-life women with early AAM. The findings could potentially indicate strategies to target FMI and VAT among Asian women in the menopausal phase with early AAM, to prevent the development of T2D.

The influence of HIV on body composition and its relationship with physical function in mid-life women: a cross-sectional study from Zimbabwe

OBJECTIVE

Menopause-related changes in body composition and physical function are unclear in Southern Africa, particularly in the context of a generalized HIV epidemic with high antiretroviral therapy (ART) coverage.

METHOD

A total of 263 Zimbabwean women (53% women living with HIV [WLH]) aged 40-60 years provided data on menopause, ART use, anthropometry, body composition (appendicular lean mass [ALM], muscle area, fat mass), handgrip strength (HGS) and gait speed. Linear regression determined relationships between body composition and physical function, unadjusted and age-menopause-adjusted, stratified by HIV status. Univariate logistic regression investigated associations between body composition and self-reported falls.

RESULTS

WLH (96% ART established) were a median (interquartile range) 10.4 (6.4-14.5) years since diagnosis, with lower weight, body mass index, ALM, fat mass and HGS than women living without HIV (WLWOH). With menopause transition, WLH lost weight, ALM, gynoid mass and muscle area (all p-trend <0.05); however, WLWOH did not. Both WLH and WLWOH lost HGS (p-trend <0.05). ALM was positively associated with HGS in all women. In WLH, greater percentage body fat, particularly gynoid fat, was associated with increased odds of falls (1.69 [1.00-2.89], p = 0.049 and 1.72 [1.08-2.75], p = 0.023, respectively).

CONCLUSION

Women living with HIV were more likely to experience adverse changes in body composition through menopause; fat mass gains were associated with risk of falls.

Prevalence and Determinants of Metabolic Syndrome Among Adults (18-60 Years) in Urban and Rural South India: A Community-Based Cross-Sectional Study

Background Metabolic syndrome (MetS) constitutes a multifaceted clinical condition characterised by a constellation of metabolic risk factors including central obesity, atherogenic dyslipidemia, elevated blood pressure, and impaired glucose metabolism, which synergistically elevate the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Rapid shifts in lifestyle have notably elevated the incidence of MetS in India, particularly in urban regions. Yet, sparse comparative data is available regarding the urban-rural differences in MetS prevalence within Tamil Nadu. Thus, this research sought to assess the prevalence of MetS and to identify associated risk factors among adults residing in urban and rural locales of Tamil Nadu. Methods Employing a multistage random sampling approach, this community-centric cross-sectional study encompassed 1,000 adults, evenly divided between urban (n=500) and rural (n=500) settings. Data were gathered through structured face-to-face interviews, anthropometric assessments, and biochemical analyses. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines were utilised to define MetS. Analytical methods included descriptive statistics, chi-square tests, independent samples t-tests, and multivariate logistic regression modelling to pinpoint the critical determinants of MetS. Results The cumulative prevalence of MetS was 31.6% (95% confidence interval (CI): 28.7%-34.6%; 316 participants), with a higher prevalence in urban areas at 34.8% (95% CI: 31.9%-37.8%; 174 participants) compared to 28.4% in rural areas (95% CI: 25.6%-31.3%; 142 participants). The study identified significant predictors of MetS, such as age 40 years or above (adjusted odds ratio (AOR): 2.2, p<0.01), female sex (AOR: 2.8, p<0.01), tobacco smoking (AOR: 2.7, p<0.01), sedentary lifestyle (AOR: 2.7, p=0.02), minimal fruit intake (AOR: 4.4, p=0.01), habitual consumption of fried foods (AOR: 5.3, p=0.01), existing diabetes mellitus (AOR: 3.2, p=0.02), and obesity (AOR: 2.3, p=0.03). Conclusion Urban populations exhibited a higher MetS prevalence, likely attributed to modifiable dietary patterns and lifestyle choices. Regular screening initiatives, lifestyle adjustments, and targeted nutritional interventions emerge as vital preventive and therapeutic measures. Public health strategies should emphasise early detection and encourage behavioural modifications, specifically targeting at-risk populations.

Sex and age differences in sleep disorders: insights from a diverse cohort referred to a sleep center

Sleep health is influenced by sex, gender, and age, with various sleep disorders exhibiting different prevalence rates and clinical presentations among different demographic groups. This retrospective study investigated sex and age differences in a diverse cohort of patients referred to an Italian sleep center for comprehensive sleep evaluations over a four-year period. Medical records of 909 consecutive patients who underwent overnight video-polysomnography between January 2014 and December 2017 were reviewed. Socio-demographic, anthropometric, clinical, and sleep-related data were extracted and compared between male and female patients across different age groups. Our analyses revealed disparities in the access to sleep evaluations, socio-demographic characteristics and lifestyle habits between males and females across age groups. Comorbidities varied, with cardiovascular diseases more prevalent in males, while thyroid disorders, rheumatologic conditions, and psychiatric disorders more common in females. Female patients also reported higher rates of psychotropic medications use at admission. Males had higher rates of obstructive sleep apnea, while females, particularly in middle and older age groups, exhibited more insomnia disorder and restless legs syndrome. Notably, the co-occurrence of multiple sleep disorders was observed, particularly among older individuals and female patients. Our findings emphasize the importance of considering sex and age differences in diagnosing and managing sleep disorders. Tailored approaches are necessary to optimize sleep health and overall well-being, particularly in aging populations, where sleep disturbances often coexist with other chronic conditions. Further research is warranted to elucidate the complex interplay between sex, gender, and age to promote sleep equity and improve patient care.

Dark Chocolate Elevates Resting Energy Expenditure in Postmenopausal Women

Several recent reports have indicated positive health benefits of consuming (-)-epicatechin-rich cocoa products. Postmenopausal women are predisposed to reduced metabolism due to decreased levels and activity of the sex hormones estrogen, progesterone, and estradiol. The purpose of this study was to investigate the influence of dark chocolate consumption on resting and exercise metabolism in postmenopausal women. Using a randomized, double-blind design, 26 postmenopausal participants were assigned to a 30-day supplementation with 20-g per day of 72% dark chocolate (DC) or calorically matched white chocolate (WC). Before supplementation, participants underwent two control trials for assessments (PRE1, PRE2) of resting energy expenditure (REE) and exercise energy expenditure (EEE). Following the PRE2 assessment, participants were randomized and supplemented for 30 days, after which they repeated the assessments for REE and EEE. PRE1 and PRE2 REE and EEE were not significantly different within or between groups (REE: PRE1 DC 1215± 170, WC 1127 ± 174, p=0.662; PRE2 DC 1211 ± 174, WC 1145 ± 165 kcal/d, p=0.720; EEE: PRE1 DC 3.67 ± 0.72, WC 3.40 ± 0.81, p=0.665; PRE2 DC 3.41 ± 0.88, WC 3.39 ± 0.73kcal/min, p=0.373). Post-supplementation REE was significantly increased by 3.2% in the DC group (Pre-Post change: DC 38.6 ± 49, WC -15 ± 31.2 kcal per day, p =0.039, Cohen's d= 0.724 [95% CI: 0.078, 1.513]). These results indicate that DC supplementation in postmenopausal women was associated with a significant 3.2% increase in REE with no significant influence on EEE.

The link between sarcopenic obesity and Alzheimer's disease: a brain-derived neurotrophic factor point of view

Age-related diseases are becoming more prominent as the lifespan of the global population rises. Many of these diseases coincide with each other and can even influence the onset of additional comorbidities. Sarcopenic obesity is described as age-related loss of muscle mass that concurs with excessive weight gain and tends to increase the risk of comorbidity development, including Alzheimer's disease (AD). Though the exact link between sarcopenic obesity and AD is not known, this review explores the possibility that reduced levels of brain-derived neurotrophic factor (BDNF) throughout the body may serve as the underlying commonality. In AD, reductions in BDNF signalling through its receptor promote the activation of glycogen synthase kinase 3 beta (GSK3β), which subsequently increases the production of amyloid beta (Aβ) peptides and neurofibrillary tangles (NFTs). In the skeletal muscle, lower BDNF concentrations are linked to impaired muscle fibre repair and regeneration, increasing the likelihood of sarcopenia. Furthermore, the absence of BDNF impairs mitochondrial function, leading to insulin resistance and increased adiposity. BDNF concentration has a negative relationship with obesogenic markers in adipose tissue, and as such, lower concentrations of BDNF lead to weight gain. Collectively, current literature suggests that BDNF attenuates AD pathology while improving skeletal muscle mitochondrial function, whole-body insulin resistance and facilitating adipocyte browning. Therefore, BDNF may be a viable target for multiple age-related diseases, but more research is required to substantiate this claim, with a particular focus on examining any potential influence of biological sex, as women are at a higher risk for both AD and sarcopenic obesity.

Age-specific and sex-specific associations of visceral adipose tissue with metabolic health status and cardiovascular disease risk

BACKGROUND

Visceral adipose tissue (VAT) is known to play a role in the development of metabolic and cardiovascular disease (CVD). However, the age- and sex-specific associations between VAT and these diseases remain unclear.

METHODS

In this cross-sectional study, 1,150 participants (39.5% women; mean age 61.5 years) underwent VAT measurement using dual abdominal bioelectrical impedance analysis (BIA). The four age groups that the participants were divided into were 18-44, 45-59, 60-74, and ≥ 75 years. The relationships between VAT and cardiometabolic outcomes were analyzed by age and sex using multivariable logistic regression.

RESULTS

Significant associations between VAT and metabolic health status were observed in middle-aged (45-59 years; OR = 1.41, 95% CI: 1.04-1.92) and elderly adults (60-74 years; OR = 1.45, 95% CI: 1.10-1.92). VAT demonstrated age-dependent relationships with cardiovascular risk factors, with the strongest associations found in the 60-74 years group for hypertension (OR: 1.55, 95% CI: 1.22-1.98) and low high-density lipoprotein cholesterol (OR: 1.66, 95% CI: 1.33-2.08). Notably, the VAT-CVD association was most pronounced in elderly women (60-74 years; OR: 1.86, 95% CI: 1.14-3.11), while no significant associations were observed in men across all age groups.

CONCLUSIONS

The impact of VAT on metabolic and cardiovascular disease risk varies by age and sex, with particularly strong associations observed in elderly women. This highlights the need for tailored prevention and treatment strategies.

The role of body composition and appetite-regulating hormones in idiopathic central precocious puberty and their changes during GnRH analog therapy

PURPOSE

It was aimed to compare circulating levels of ghrelin, leptin, peptide YY (PYY), and neuropeptide (NPY) between girls with idiopathic central precocious puberty (ICPP) and prepubertal girls, as well as to evaluate alterations in these hormone levels and body composition during leuprolide acetate treatment in girls with ICPP.

METHODS

This prospective study was conducted on girls with isolated premature thelarche (IPT), girls with ICPP, and age-matched prepubertal controls. Anthropometric measurements, body composition analysis and appetite-regulating hormone level measurements were performed in each group and also at the 6th and 12th months of the leuprolide acetate treatment for the girls with ICPP.

RESULTS

Seventy-three girls participated in the study (24 girls with ICPP, 28 with IPT, and 21 prepubertal controls). No significant differences were observed in ghrelin, leptin, PYY, and NPY levels among the three groups. Leuprolide acetate treatment resulted in increased leptin, decreased PYY and NPY levels, and no significant changes in ghrelin. Despite no significant change in body mass index standard deviation score (BMI SDS), body fat percentage increased during treatment.

CONCLUSION

While appetite-regulating hormones do not seem to directly contribute to precocious puberty pathogenesis, puberty blockade was shown to lead to altered levels of these hormones along with changes in body composition.

Palmitoylethanolamide in Postmenopausal Metabolic Syndrome: Current Evidence and Clinical Perspectives

Menopause leads to a decline in estrogen levels, resulting in significant metabolic alterations that increase the risk of developing metabolic syndrome-a cluster of conditions including central obesity, insulin resistance, dyslipidemia, and hypertension. Traditional interventions such as hormone replacement therapy carry potential adverse effects, and lifestyle modifications alone may not suffice for all women. This review explores the potential role of palmitoylethanolamide (PEA), an endogenous fatty acid amide, in managing metabolic syndrome during the postmenopausal period. PEA primarily acts by activating peroxisome proliferator-activated receptor-alpha (PPAR-α), influencing lipid metabolism, energy homeostasis, and inflammation. Evidence indicates that PEA may promote the browning of white adipocytes, enhancing energy expenditure and reducing adiposity. It also improves lipid profiles by boosting fatty acid oxidation and decreasing lipid synthesis, potentially lowering low-density lipoprotein cholesterol and triglyceride levels while increasing high-density lipoprotein cholesterol. Additionally, the anti-inflammatory properties of PEA enhance insulin sensitivity by reducing pro-inflammatory cytokines that interfere with insulin signaling. PEA may aid in weight management by influencing appetite regulation and improving leptin sensitivity. Furthermore, its neuroprotective effects may address the mood disturbances and cognitive decline associated with menopause. Given these multifaceted biological activities and a favorable safety profile, PEA may represent a promising non-pharmacological supplement for managing metabolic syndrome in postmenopausal women. However, further large-scale clinical studies are necessary to establish its efficacy, optimal dosing, and long-term safety. If validated, PEA could become an integral part of strategies to improve metabolic and neuropsychological health outcomes in this population.

Arm muscle area is correlated to handgrip strength in postmenopausal women

OBJECTIVE

To analyze the correlation between arm muscle area and handgrip strength among postmenopausal community dwelling low-income women in order to provide an easy anthropometric indicator to assess muscle mass quantity and quality.

METHODS

This was a cross-sectional study involving postmenopausal women (n = 171) from three urban-marginal communities of Guayaquil, Ecuador. Corrected arm muscle area was calculated using the Frisancho formula. Dynapenia was defined as HGS < 16 kg. Spearman's correlation coefficient was calculated at a 5% significance level to test the correlation between corrected arm muscle area and handgrip strength.

RESULTS

Median (interquartile range: IQR) age of the sample was 72.0 years (17.0). The median of corrected arm muscle area was 34.8 cm2 (20.7). The overall prevalence of dynapenia was 57.9% (n = 99). There was a significant decreasing trend with age regarding all anthropometric characteristics and handgrip strength, as well as a higher prevalence of dynapenia with age. For the whole sample, a statistically significant positive correlation was found between corrected arm muscle area and handgrip strength [r = 0.267; p < .001].

There was a significant yet weak positive correlation between corrected arm muscle area and handgrip strength in this postmenopausal sample. There is a need for additional research in this regard.

Assessing the Impact of (Poly)phenol-Rich Foods on Cardiometabolic Risk in Postmenopausal Women: A Dietary Trial

Menopause is a critical stage in a woman's life in which cardiometabolic alterations appear, such as insulin resistance or a predisposition to visceral fat deposits, leading to an increased risk of cardiometabolic diseases (R-CMBs). New strategies to reduce the R-CMBs in postmenopausal women using natural compounds without adverse effects are desirable. In this sense, plant-based diets rich in fruits and vegetables could play a fundamental role due to the high content of bioactive compounds found in these diets, such as (poly)phenols, known for their antioxidant, anti-inflammatory and vasodilator properties. The aim of this research was to carry out a dietary trial to evaluate the effect of the daily intake of different (poly)phenol-rich foods (PP-rich foods) for 2 months on the modulation of the main cardiometabolic risk biomarkers of postmenopausal women. The results showed a slight improvement in blood pressure (BP), lipid profile and oxidative stress, endothelial function and inflammatory biomarkers. These findings suggest that daily consumption of PP-rich foods alleviated the R-CMBs of postmenopausal women by reducing the oxidative stress and, thus, the risk of cardiovascular events; however, the magnitude of the cardioprotective effect of (poly)phenols depends on inter-individual variability.

Visceral and Subcutaneous Abdominal Fat Predict Brain Volume Loss at Midlife in 10,001 Individuals

Abdominal fat is increasingly linked to brain health. A total of 10,001 healthy participants were scanned on 1.5T MRI with a short whole-body MR imaging protocol. Deep learning with FastSurfer segmented 96 brain regions. Separate models segmented visceral and subcutaneous abdominal fat. Regression analyses of abdominal fat types and normalized brain volumes were evaluated, controlling for age and sex. Logistic regression models determined the risk of brain total gray and white matter volume loss from the highest quartile of visceral fat and lowest quartile of these brain volumes. This cohort had an average age of 52.9 ± 13.1 years with 52.8% men and 47.2% women. Segmented visceral abdominal fat predicted lower volumes in multiple regions including: total gray matter volume (r = -.44, p<.001), total white matter volume (r =-.41, p<.001), hippocampus (r = -.39, p< .001), frontal cortex (r = -.42, p<.001), temporal lobes (r = -.44, p<.001), parietal lobes (r = -.39, p<.001), occipital lobes (r =-.37, p<.001). Women showed lower brain volumes than men related to increased visceral fat. Visceral fat predicted increased risk for lower total gray matter (age 20-39: OR = 5.9; age 40-59, OR = 5.4; 60-80, OR = 5.1) and low white matter volume: (age 20-39: OR = 3.78; age 40-59, OR = 4.4; 60-80, OR = 5.1). Higher subcutaneous fat is related to brain volume loss. Elevated visceral and subcutaneous fat predicted lower brain volumes and may represent novel modifiable factors in determining brain health.

Sex-Differences in Response to Treatment with Liraglutide 3.0 mg

Background: Sex differences characterize the prevalence and attitudes toward weight management. Despite limited evidence suggesting greater weight loss in women with anti-obesity pharmacotherapy, sex-specific analysis remains underexplored. This retrospective study aimed to evaluate the sex-specific response to liraglutide 3.0 mg treatment in people with obesity without type 2 diabetes (T2D). Methods: Data were collected from 47 patients (31 women, 16 men) with age > 18 years; BMI ≥ 30 kg/m2; absence of T2D; and exclusion of prior anti-obesity treatment, comorbidities, or bariatric surgery. Only patients who maintained the liraglutide 3.0 mg dose for at least 6 months were included. Results: Both sexes showed significant reductions in weight and BMI at 3 and 6 months. Men achieved greater weight loss (WL), BMI reduction, %WL, WL > 5%, and >10% than women, and they also showed more significant improvements in metabolic parameters (total and LDL cholesterol, Fibrosis-4 Index FIB-4). No significant sex differences were observed in glucose metabolism or renal function. Conclusions: This study showed a greater therapeutic effect of liraglutide 3.0 mg in men. Given men's higher risk of cardiovascular disease (CVD), and underrepresentation in clinical weight loss programs, these findings may increase male engagement and improve their CVD risk.

Exploring the Link Between Metabolic Syndrome and Cellulite

Metabolic syndrome (MetS) encompasses a cluster of metabolic abnormalities, including insulin resistance, hypertension, abdominal obesity, and dyslipidemia, increasing cardiovascular disease and type 2 diabetes risks. Cellulite, a cosmetic condition marked by dimpled skin, predominantly affects women and shares risk factors with MetS, such as obesity and hormonal imbalances. This review examines the potential link between MetS and cellulite, focusing on shared pathophysiological pathways and implications for clinical practice and future research. Common factors such as inflammation, hormonal changes, and adipose tissue dysfunction are explored. The review highlights the importance of longitudinal studies to track cellulite progression in MetS patients, biomarker identification for early detection, intervention trials to assess therapeutic efficacy, mechanistic studies to elucidate underlying pathways and the impact of comorbidities on cellulite development. Understanding these relationships can enhance prevention, diagnosis, and treatment strategies for both MetS and cellulite, addressing significant public health and cosmetic concerns.

Cross-sectional and longitudinal associations of Iron biomarkers and cardiovascular risk factors in pre- and postmenopausal women: leveraging repeated measurements to address natural variability

BACKGROUND

The association between iron biomarkers and cardiovascular disease risk factors (CVD-RFs) remains unclear. We aimed to (1) evaluate the cross-sectional and longitudinal associations between iron biomarkers (serum ferritin, transferrin saturation (TSAT), transferrin) and CVD-RFs among women, and (2) explore if these associations were modified by menopausal status.

METHOD

Cross-sectional and longitudinal analyses including 2542 and 1482 women from CoLaus cohort, respectively. Multiple linear regression and multilevel mixed models were used to analyse the associations between Iron biomarkers and CVD-RFs. Variability of outcomes and iron markers between surveys was accessed using intraclass correlation (ICC).

RESULTS

After multivariable adjustment, elevated serum ferritin levels were associated with increased insulin and glucose levels, while higher transferrin levels were linked to elevated glucose, insulin and total cholesterol, and systolic and diastolic blood pressure (p < 0.05). No association was observed between CVD-RFs and TSAT (p > 0.05). Iron biomarkers demonstrated low reliability across reproductive stages but exhibited stronger associations in the perimenopausal group. In longitudinal analysis, we found association only for transferrin with lower glucose levels [β = - 0.59, 95% CI (- 1.10, - 0.08), p = 0.02] and lower diastolic blood pressure [β = - 7.81, 95% CI (- 15.9, - 0.56), p = 0.04].

CONCLUSION

In cross-sectional analysis, transferrin was associated with several CVD-RFs, and the associations did not change according to menopausal status. Conversely, in the longitudinal analyses, changes in transferrin were associated only with lower glucose and diastolic blood pressure levels. These differences might stem from the substantial longitudinal variation of iron biomarkers, underscoring the need for multiple iron measurements in longitudinal analyses.

2023 Obesity Fact Sheet: Prevalence of Obesity and Abdominal Obesity in Adults, Adolescents, and Children in Korea from 2012 to 2021

Background

The 2023 Obesity Fact Sheet aims to present an updated overview of obesity prevalence across all age groups, including children and adolescents.

Methods

This study included individuals aged ≥20 years (n=16,941,423 in 2021) who underwent health checkups provided by the Korean National Health Insurance Service between 2012 and 2021. The prevalence of obesity and abdominal obesity was standardized by age and sex using data from the 2010 population and housing census. For children and adolescents (6 to 18 years) (n=884 in 2021), we used the Korea National Health and Nutrition Examination Survey (2012 to 2021), and obesity was defined by the corresponding sex- and age-specific body mass index percentile of 95th or greater based on the 2017 Korean National Growth Chart for Children and Adolescents.

Results

The overall prevalence of obesity in 2021 is 38.4% (49.2% in men and 27.8% in women), which is a 1.27-fold increase from 30.2% in 2012. The prevalence of obesity has increased across all age groups, particularly among those aged 20, 30, and 80 years. The prevalence of class III obesity substantially increased from 0.35% (men) and 0.42% (women) in 2012 to 1.21% and 0.97% in 2021, with 3.46- and 2.31-fold increases, respectively. This increase was particularly pronounced in young adults. The prevalence of obesity in children and adolescents has surged from 9.7% in 2012 to 19.3% in 2021, with a greater increase among boys.

Conclusion

Our study provides information on the current status of obesity prevalence based on the 2023 Obesity Fact Sheet, emphasizing the urgency of implementing timely strategies to reverse this increasing trend.

Midlife symptoms and household stress are associated with fingernail cortisol

OBJECTIVE

This study investigates menopausal symptoms, household stressors, and ethnopolitical problems in relation to stress markers, including chronic stress measured by fingernail cortisol, perceived stress measured by the Perceived Stress Scale, and acute stress measured by blood pressure.

METHODS

Data from 151 women aged 40 to 55 years were collected from four regions in Nagaland, India, using opportunity sampling. A structured questionnaire was used to collect sociodemographic and lifestyle variables. Symptoms were grouped into emotional instability, vasosomatic symptoms, mood disturbances, and aches and pains using principal component analysis in a previous study, and stress markers included fingernail cortisol, perceived stress, and blood pressure. Community-level, household-level, and midlife symptoms were included to ascertain stressors from different sources.

RESULTS

Our results revealed a significant positive association between a composite measure of emotional instability and stress assessed by fingernail cortisol ( β = 0.46, P < 0.001). In addition, there was a positive association between mood disturbances and fingernail cortisol ( β = 0.24, P < 0.05). This relationship persisted after controlling for body mass index, socioeconomic status, and menopausal status. In addition, household problems were positively associated with fingernail cortisol ( β = 0.25, P = 0.01).

CONCLUSIONS

These findings highlight the potential health impacts of the psychosocial stress response associated with domestic stressors such as financial strain and concerns about children and health.

A comprehensive evaluation of predictors of obesity in women during the perimenopausal period: A systematic review and narrative synthesis

INTRODUCTION

Obesity during perimenopausal transition can be attributed to various factors. Identifying these factors is crucial in preventing obesity and developing effective strategies to manage weight during this phase. This review aimed to systematically understand predictors of obesity during menopausal transition.

METHODS

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched databases like PubMed, Wiley Online Library, and Cochrane Reviews. Cohort and cross-sectional studies in English language assessing obesity among menopausal women were included. The methodological quality was assessed using Joanna Briggs Checklist for critical appraisal. Risk of Bias (RoB) was generated using Review Manager 5.4.1 (RevMan). Identified predictors were assessed for overall quality of evidence using adopted Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

This review encompassed 42 studies, (21 cross-sectional and 21 cohort) with sample ranging from 164 to 107,243 across studies. Higher parity( ≥ 3 children) emerged as a strong predictor of obesity across seven studies, with good-quality evidence. Lower physical activity was another predictor, supported by eight studies with good-quality evidence. Sociodemographic factors like lower education(<8 years or < than college degree), socioeconomic background, menopausal transition, and older age at menarche showed associations with weight gain, with moderate-quality evidence. Lifestyle factors (high-fat consumption, sedentariness, active smoking status, and psychological difficulties) also showed moderate-quality evidence.

CONCLUSION

This review underscores the multifaceted factors associated with obesity during the perimenopausal transition. Identifying these factors will be helpful in prevention and management of obesity among these women.

The Importance of Nutrition in Menopause and Perimenopause-A Review

Menopause is associated with an increased prevalence of obesity, metabolic syndrome, cardiovascular diseases, and osteoporosis. These diseases and unfavorable laboratory values, which are characteristic of this period in women, can be significantly improved by eliminating and reducing dietary risk factors. Changing dietary habits during perimenopause is most effectively achieved through nutrition counseling and intervention. To reduce the risk factors of all these diseases, and in the case of an already existing disease, dietary therapy led by a dietitian should be an integral part of the treatment. The following review summarizes the recommendations for a balanced diet and fluid intake, the dietary prevention of cardiovascular diseases, the role of sleep, and the key preventive nutrients in menopause, such as vitamin D, calcium, vitamin C, B vitamins, and protein intake. In summary, during the period of perimenopause and menopause, many lifestyle factors can reduce the risk of developing all the diseases (cardiovascular disease, insulin resistance, type 2 diabetes mellitus, osteoporosis, and tumors) and symptoms characteristic of this period.

Body image disturbance, interoceptive sensibility and the body schema across female adulthood: a pre-registered study

Introduction

Body image disturbance (BID) typically involves explicit negative attitudes toward one's shape and weight and is associated with altered interoceptive sensibility (the subjective perception of internal bodily states). This association is a known risk factor for the development and maintenance of eating disorders. However, while research has centred on younger women with eating disorders, diverse facets of BID appear in women without eating disorders across adulthood. Research shows that in the general population, young women (ages 18-25) with high BID exhibit disturbances in the body schema: an implicit sensorimotor representation of the body in space which includes mental simulation of a movement such as motor imagery. Given that body image is subject to age-related influences, it is important to investigate how age-related variation in BID can influence the body schema beyond young adulthood alone. Here, we examine the relationship between BID, interoceptive sensibility and the body schema across female adulthood.

Methods

Cross-sectional data was collected online from 1,214 women across four age groups: Young adults (18-24), Adults (25-39), Middle-aged adults (40-59), and Older aged adults (60-75). BID was indexed by questionnaires measuring body objectification, state, and trait body dissatisfaction. Interoceptive sensibility (IS) was measured using the MAIA-2 questionnaire. The body schema was evaluated through the Own Body Transformation task: a mental rotation task which assesses the capacity to make an embodied mental transformation.

Results

Analyses revealed that while body objectification and trait body dissatisfaction decreased from young to older adulthood, state body dissatisfaction showed a marked increase. A negative relationship between IS and BID across all age groups was also evidenced. Finally, age, BID and orientation of the presented body were significant predictors of the time taken to make an embodied transformation.

Discussion

These findings highlight the consistent relationship of BID and IS across age groups beyond young adulthood and demonstrate the varying importance of different aspects of BID as individuals age. We also evidence for the first time that disruptions in body image have the potential to impact implicit sensorimotor representations of the body even in women without eating disorders across female adulthood.

Changes in Food Consumption in Postmenopausal Women during the COVID-19 Pandemic: A Longitudinal Study

Studying the dietary habits and symptoms of postmenopausal women during situations such as the COVID-19 pandemic is important to mitigate long-term post-pandemic health problems. We compared the menopausal symptoms and food consumption in postmenopausal women before and during the COVID-19 pandemic. A longitudinal survey was conducted on postmenopausal Brazilian women between 2018 and 2021. The Kupperman-Blatt Menopausal Index, Women's Health Questionnaire, and 24 h food recall were used. Of 274 women, 78 (28.5%) participated in the study during the COVID-19 pandemic. The intensity of the symptoms was lower during the pandemic than during the previous period (p < 0.05). Energy and processed food consumption were lower during the pandemic than before (p = 0.003 and p = 0.003, respectively). Milk and plain yogurt consumption were also lower (p = 0.043), while the consumption of sugar-sweetened beverages and sweet foods was higher (p = 0.007 and p = 0.001, respectively) during the pandemic. There was also a decrease in the consumption of proteins and lipids (p = 0.001 and p = 0.004, respectively). In conclusion, we found that postmenopausal women consumed sweet foods and sugar-sweetened beverages in higher quantities and had a lower consumption of milk and plain yogurt and processed foods during the pandemic than during the pre-pandemic period. Furthermore, decreases in energy and macronutrient consumption were observed.

Investigating the efficacy and feasibility of using a whole-of-diet approach to lower circulating levels of C-reactive protein in postmenopausal women: a mixed methods pilot study

OBJECTIVE

Chronic inflammation is associated with obesity and is an underlying pathophysiology for cardiovascular disease (CVD) development in postmenopausal women. This study aims to determine feasibility and efficacy of an anti-inflammatory dietary intervention to lower levels of C-reactive protein in weight stable postmenopausal women with abdominal obesity.

METHODS

This mixed-methods pilot study used a single arm pre-post design. Thirteen women followed a 4-week anti-inflammatory, dietary intervention, optimizing consumption of healthy fats, low glycemic index wholegrains, and dietary antioxidants. Quantitative outcomes included change in inflammatory and metabolic markers. Focus groups were undertaken and thematically analyzed to explore participants lived experience of following the diet.

RESULTS

There was no significant change in plasma high-sensitivity C-reactive, protein. Despite discouraging weight loss, median (Q1-Q3) body weight decreased by -0.7 (-1.3 to 0 kg, P = 0.02). This was accompanied by reductions in plasma insulin (0.90 [-0.05 to 2.20] mmol/L), Homeostatic Model Assessment of Insulin Resistance (0.29 [-0.03 to 0.59]), and low-density lipoprotein:high-density lipoprotein ratio (0.18 [-0.01 to 0.40]) ( P ≤ 0.023 for all). Thematic analysis revealed that postmenopausal women have a desire to improve meaningful markers of health status that do not focus on weight. Women were highly engaged with learning about emerging and innovative nutrition topics, favoring a detailed and comprehensive nutrition education style that challenged their proficient health literacy and cooking skills.

CONCLUSIONS

Weight-neutral dietary interventions targeting inflammation can improve metabolic markers and may be a viable strategy for CVD risk reduction in postmenopausal women. To determine effects on inflammatory status, a fully powered and longer-term randomized controlled trial is required.

Obesity and menopause

The global obesity pandemic continues to rise, with figures from the World Health Organization showing that 13% of the world's adult population was obese in 2016. Obesity has significant implications, with an increased risk of cardiovascular diseases, diabetes mellitus, metabolic syndrome, and several malignancies. The menopausal transition is associated with increased obesity, a transition from a gynecoid to an android body shape, and increased abdominal and visceral fat, which further worsens the associated cardiometabolic risks. Whether this increased obesity is a consequence of menopause, age, genetics, or environmental factors has long been debated. Increasing life expectancy means women spend a significant part of their lives in the menopause. As such, understanding this complex interplay of obesity and menopause is important to providing the right advice/management. We review the current evidence on obesity and menopause, focusing on the implications of increased obesity during menopause, the impact of menopause on obesity, and the effect of available treatments on associated morbidities.

Ovarian volume partially explains associations of phthalate biomarkers with anti-Müllerian hormone and estradiol in midlife women

BACKGROUND/OBJECTIVES

Women are ubiquitously exposed to endocrine disruptors, including phthalates. Ovarian follicles undergoing folliculogenesis (indirectly measured by ovarian volume) produce anti-Müllerian hormone (AMH) and estradiol (E2). We evaluated associations of phthalates with ovarian volume to assess whether this explained prior positive associations of phthalates with AMH and E2.

METHODS

Women ages 45-54 years (n = 614) had transvaginal ultrasounds of right/left ovaries to calculate mean ovarian volume. Women provided up-to-four urine and blood samples for quantifying AMH (first serum sample), E2 (all serum samples), and nine phthalate metabolites (from pooled urine, representing six parent phthalates). Multivariable linear or logistic regression models (for individual phthalate biomarkers), as well as weighted quantile sum (WQS) regression (for mixture analyses) evaluated associations of phthalate biomarkers with ovarian volume. Using cross-sectional mediation analysis, we assessed whether associations of phthalates with ovarian volume partially explained those of phthalates with AMH or E2.

RESULTS

Most women were non-Hispanic White (68%) and pre-menopausal (67%) with higher urinary phthalate metabolite concentrations than U.S. women. In single-pollutant models, 10% increases in mono(3-carboxypropyl) phthalate (MCPP) and monobenzyl phthalate (MBzP) were associated with 0.44% (95% CI: -0.02%, 0.91%) and 0.62% (95% CI: 0.02%, 1.23%) larger ovarian volumes, respectively. As a cumulative mixture, 10% increases in the phthalate mixture were associated with 2.89% larger ovarian volume (95%CI: 0.27, 5.59) with MCPP (35%) and MBzP (41%) identified as major contributors. Higher ovarian volume due to a 10% increase in MBzP (indirect effect OR: 1.004; 95% CI: 1.00, 1.01) explained 16% of the positive association between MBzP and higher AMH, whereas higher ovarian volume due to a 10% increase in MCPP (indirect effect %Δ: 0.11; 95% CI: -0.01, 0.22) explained 23% of the positive association between MCPP and E2.

CONCLUSION

In this cross-sectional study, phthalates were associated with increased ovarian volume, with implications for midlife hormone production.

Association between Physical Activity, Body Composition, and Metabolic Disorders in Middle-Aged Women of Ksar el Kebir (Morocco)

This study aimed to examine the association between physical activity (PA), body composition, and metabolic disorders in a population of Moroccan women classified by menopausal status. This cross-sectional study comprised 373 peri- and postmenopausal women aged 45-64 years old. PA levels were assessed using the short version of the International Physical Activity Questionnaire (IPAQ-SF). Body composition and metabolic disorders were assessed by measurements of anthropometric and biological parameters: weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), WC/HC ratio, percent body fat, systolic and diastolic blood pressure, fasting blood glucose, and serum lipids (total cholesterol (TC), triglycerides (TG), HDL-C, and LDL-C). Metabolic syndrome (MetS) was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Pearson correlations were used to test for associations. The mean total PA score of perimenopausal women was 1683.51 ± 805.36 MET-min/week, and of postmenopausal women was 1450.81 ± 780.67 MET-min/week. In all participants, peri- and postmenopausal women, PA was significantly and inversely associated with BMI, weight, percent body fat, HC, WC, and number of MetS components (p < 0.01), and with fasting blood glucose, TC, TG, and LDL-C (p < 0.05). The frequencies of metabolic disorders, obesity, abdominal obesity, type 2 diabetes, dyslipidemia, and MetS were significantly lower at moderate and intense levels of PA (p < 0.05), in also all participants. In middle-aged women, particularly those who are peri-menopausal, PA at moderate and intense levels is associated with more favorable body composition and less frequent metabolic disorders. However, in this particular study, PA does not appear to be associated with blood pressure and HDL-C concentrations. Future studies may be needed to further clarify these findings.

Impact of Paraben Exposure on Adiposity-Related Measures: An Updated Literature Review of Population-Based Studies

Parabens are alkyl esters of p-hydroxybenzoic acid that are commonly used in pharmaceutical and cosmetic products. Humans are exposed to parabens when they use these products and through diet. There are growing concerns that paraben exposure can adversely impact human health. The endocrine-disrupting and obesogenic properties of parabens have been observed in animal studies and in vitro, prompting the increase in population-based studies of paraben exposure and adiposity-related endpoints. In this review, we summarize epidemiological studies published between 2017 and 2022 that examined paraben exposure in utero, between birth and adolescence, and in adulthood, in relation to adiposity-related measures. Overall, these studies provide some evidence that suggests that paraben exposure, especially during critical development windows, is associated with adiposity-related measures. However, we have noted several limitations in these studies, including the predominance of cross-sectional studies, inconsistent sample collection procedures, and small sample sizes, which should be addressed in future studies.

Global psychological assessment with the evaluation of life and sleep quality and sexual and cognitive function in a large number of patients with acromegaly: a cross-sectional study

Objective

Acromegaly is associated with somatic disfigurements which impair self-perception of well-being and quality of life. Nowadays, limited data are available on the interplay between hormonal excess and psychological discomfort. The study aimed at investigating the psychological profile, sleep quality, sexual function, cognitive functions, and quality of life in patients with acromegaly.

Methods

In 223 acromegaly patients from 5 referral centres, global psychological profile, sleep quality, sexual function, cognitive function, and quality of life were investigated.

Results

Depression was found in ~30% of patients, and anxiety in two-thirds, together with severe discomfort in body image mainly in women. Obstructive sleep apnoea syndrome risk and sleep disorders were found in >50% of patients and daily sleepiness in ~20%. Sexual dysfunction was reported in most of the patients, with the most severe impairment in women. Cognitive functions were compromised in ~10% of cases. Disease duration and patient's age and gender were the main determinants of these psychopathological conditions. Depression (P = 0.047), somatic-affective mood lowering (P = 0.021), state (P < 0.001) and trait (P = 0.013) anxiety, and body image distortion in body uneasiness test A (P < 0.001) and B (P = 0.006) were significantly worsened in patients <45 years and slightly worsened in those with disease duration less than 2 years. Male (P < 0.001) and female (P < 0.001) sexual function scores were significantly worsened in patients aged >64 years and slightly worsened in those with disease duration for more than 10 years, particularly in presence of cardiometabolic and respiratory complications. Cognitive symptoms were slightly worsened in older patients and in those with long disease duration.

Conclusions

Acromegaly is associated with a relevant impairment of psychological profile persisting despite remission and long-term medical treatment.