Clustering of cardiometabolic risk factors in Asian Indian women: Santiniketan women study

A review of menopause nomenclature

Menopause nomenclature varies in the scholarly literature making synthesis and interpretation of research findings difficult. Therefore, the present study aimed to review and discuss critical developments in menopause nomenclature; determine the level of heterogeneity amongst menopause definitions and compare them with the Stages of Reproductive Aging Workshop criteria. Definitions/criteria used to characterise premenopausal and postmenopausal status were extracted from 210 studies and 128 of these studies were included in the final analyses. The main findings were that 39.84% of included studies were consistent with STRAW classification of premenopause, whereas 70.31% were consistent with STRAW classification of postmenopause. Surprisingly, major inconsistencies relating to premenopause definition were due to a total lack of reporting of any definitions/criteria for premenopause (39.84% of studies). In contrast, only 20.31% did not report definitions/criteria for postmenopause. The present findings indicate that there is a significant amount of heterogeneity associated with the definition of premenopause, compared with postmenopause. We propose three key suggestions/recommendations, which can be distilled from these findings. Firstly, premenopause should be transparently operationalised and reported. Secondly, as a minimum requirement, regular menstruation should be defined as the number of menstrual cycles in a period of at least 3 months. Finally, the utility of introducing normative age-ranges as supplementary criterion for defining stages of reproductive ageing should be considered. The use of consistent terminology in research will enhance our capacity to compare results from different studies and more effectively investigate issues related to women's health and ageing.

Factor analyses of metabolic syndrome: A systematic review with special reference to Asian Indians

BACKGROUND

Metabolic syndrome is the constellation of cardiovascular disease risk factors and a growing public health issue affecting more than 20% of world population. Factor analysis is a powerful mathematical tool in exploring the underlying factors of any chronic diseases. Although it is most often criticized for its contrasting results for a common expression differently interpreted by the researchers yet fit the original data equally well.

OBJECTIVE

The present study aims to find out the underlying physiological domains for the phenotypic attribution of metabolic syndrome as documented in several studies.

METHODOLOGY

Literature search was done using Google Scholar, PUBMED, Research Gate and manual searching to identify relevant studies of the selected topic.

CONCLUSION

More than one physiological domain has been explored for the expression of metabolic syndrome explored in different studies. A reason for this disparity may be because most of explored factors are just mathematically significant but not biologically. Another reason may be the varied factor load concern. Therefore, a fixed factor load value is needed to be restricted for all studies across world.

Fat mass changes during menopause: a metaanalysis

OBJECTIVE

Data: Fat mass has been shown to increase in aging women; however, the extent to which menopausal status mediates these changes remains unclear. The purpose of this review was to determine (1) how fat mass differs in quantity and distribution between premenopausal and postmenopausal women, (2) whether and how age and/or menopausal status moderates any observed differences, and (3) which type of fat mass measure is best suited to the detection of differences in fat mass between groups.

STUDY

This review with metaanalyses is reported according to Metaanalysis of Observational Studies in Epidemiology guidelines.

STUDY APPRAISAL AND SYNTHESIS METHODS

Studies (published up to May 2018) were identified via PubMed to provide fat mass measures in premenopausal and postmenopausal women. We included 201 cross-sectional studies in the metaanalysis, which provided a combined sample size of 1,049,919 individuals and consisted of 478,734 premenopausal women and 571,185 postmenopausal women. Eleven longitudinal studies were included in the metaanalyses, which provided a combined sample size of 2472 women who were premenopausal at baseline and postmenopausal at follow up.

RESULTS

The main findings of this review were that fat mass significantly increased between premenopausal and postmenopausal women across most measures, which included body mass index (1.14 kg/m²; 95% confidence interval, 0.95-1.32 kg/m²), bodyweight (1 kg; 95% confidence interval, 0.44-1.57 kg), body fat percentage (2.88%; 95% confidence interval, 2.13-3.63%), waist circumference (4.63 cm; 95% confidence interval, 3.90-5.35 cm), hip circumference (2.01 cm; 95% confidence interval, 1.36-2.65 cm), waist-hip ratio (0.04; 95% confidence interval, 0.03-0.05), visceral fat (26.90 cm²; 95% confidence interval, 13.12-40.68), and trunk fat percentage (5.49%; 95% confidence interval, 3.91-7.06 cm²). The exception was total leg fat percentage, which significantly decreased (-3.19%; 95% confidence interval, -5.98 to -0.41%). No interactive effects were observed between menopausal status and age across all fat mass measures.

CONCLUSION

The change in fat mass quantity between premenopausal and postmenopausal women was attributable predominantly to increasing age; menopause had no significant additional influence. However, the decrease in total leg fat percentage and increase in measures of central fat are indicative of a possible change in fat mass distribution after menopause. These changes are likely to, at least in part, be due to hormonal shifts that occur during midlife when women have a higher androgen (ie, testosterone) to estradiol ratio after menopause, which has been linked to enhanced central adiposity deposition. Evidently, these findings suggest attention should be paid to the accumulation of central fat after menopause, whereas increases in total fat mass should be monitored consistently across the lifespan.

Relationship between moderate-to-vigorous physical activity, abdominal fat and immunometabolic markers in postmenopausal women

OBJECTS

To assess the burden of levels of physical activity, non-esterified fatty acids (NEFA), triacylglycerol and abdominal fat on the immunometabolic profile of postmenopausal women.

STUDY DESIGN

Forty-nine postmenopausal women [mean age 59.43 (standard deviation 5.61) years] who did not undertake regular physical exercise participated in this study. Body composition was assessed using dual-energy X-ray absorptiometry, and levels of NEFA, tumour necrosis factor-α, adiponectin, insulin and triacylglycerol were assessed using fasting blood samples. The level of physical activity was assessed using an accelerometer (Actigraph GTX3x), and reported as counts/min, time spent undertaking sedentary activities and time spent undertaking moderate-to-vigorous physical activity (MVPA). The following conditions were considered to be risk factors: (i) sedentary lifestyle (<150min of MVPA per week); (ii) high level (above median) of abdominal fat; and (iii) hypertriacylglycerolaemia (<150mg/dl of triacylglycerol).

RESULTS

In comparison with active women, sedentary women had higher levels of body fat (%) (p=0.041) and NEFA (p=0.064). Women with higher levels of abdominal fat had impaired insulin resistance (HOMA-IR) (p=0.016) and spent more time undertaking sedentary activities (p=0.043). Moreover, the women with two risk factors or more had high levels of NEFA and HOMA-IR (p<0.05), as well as an eight-fold higher risk of a high level of NEFA, independent of age (p<0.05). No significant relationship was found between levels of physical activity, abdominal fat, tumour necrosis factor-α and adiponectin (p>0.05).

CONCLUSION

Postmenopausal women with a combination of hypertriacylglycerolaemia, a high level of abdominal fat and a sedentary lifestyle are more likely to have metabolic disturbances.

Effects of endurance exercise training on risk components for metabolic syndrome, interleukin-6, and the exercise capacity of postmenopausal women

We conducted this study to investigate how an exercise program affects the risk components of metabolic syndrome (MS), serum interleukin (IL)-6 levels, and exercise capacity in postmenopausal women. A randomized clinical trial design was used. Women in an exercise group participated in a treadmill-exercise program for 12 weeks, whereas women in a control group maintained their customary lifestyle. Data on variables were collected at baseline and after 12 weeks of the study, which was completed by 46 women (mean age, 56.0 ± 7.0 y). Our results indicate endurance exercise exerted significant beneficial effects on waist circumference, serum high-density lipoprotein cholesterol (HDL-C) and IL-6 levels, and exercise capacity (all P < 0.05). The beneficial effects on IL-6 and exercise capacity were correlated with improvements in HDL-C levels (r = -0.33, P = 0.03 and r = 0.31, P = 0.04, respectively). Our results suggest that health-care providers can incorporate an exercise program in treatments to improve the health of postmenopausal women.

Association of television viewing time with central obesity status in rural Asian Indian women: Santiniketan women study

OBJECTIVES

The present community based cross-sectional study aimed to investigate anthropometric and body composition measures, and blood pressure characteristics by TV viewing times in rural women of Asian Indian Origin.

METHODS

A total of 343 apparently healthy rural Asian Indian women living in and around Santiniketan, West Bengal, India and aged between 25 and 65 years took part in the study. Anthropometric measures namely body mass index (BMI), percentages of body fat (PBF), basal metabolic rate (BMR), and intra-abdominal visceral fat (IVF) were measured using an Omron body fat analyzer. Fat mass (FM), fat free mass (FFM), arm muscle area (AMA), arm fat area (AFA), and arm muscle circumference (AMC) were calculated using standard techniques. Each individual was also asked how many minutes/day they spend watching TV.

RESULTS

Comparison of central obesity status (CNO = waist circumference < 80 cm and CO = waist circumference ≥ 80 cm) by TV viewing times (categories) revealed a significant difference [χ(3)2 14.29] for central obesity status across the groups.

CONCLUSION

Increased leisure-time activity was associated with central obesity status and warrant early intervention to prevent increasing incidences of cardiovascular disease in this population.

Cardiovascular disease risk factors in Asian Indian population: A systematic review

BACKGROUND

Cardiovascular diseases (CVDs) are the number one cause of death globally and are the leading cause of death in India also. Several surveys conducted across the country over the past few decades have shown a rising prevalence of major risk factors for CVD in Asian Indian population. The problem of increasing risk factors for CVD in India is because of lack of surveillance system and lack of proper diagnosis. This study will help to point out the need of research so that some advanced diagnosis system may be developed for proper diagnosis of CVDs and to reduce the growing burden of CVDs in the country.

METHODS

We did a literature search for the period from 1968 to 2012 using PUBMED search to identify all relevant studies of cardiovascular diseases. Besides PUBMED searching, manual searching has also been done. This article provides a review of current understanding of the epidemiology of cardiovascular disease, particularly, coronary heart disease (CHD), stroke and related risk factors in Asian Indian population.

RESULTS

Hypertension and diabetes are highly prevalent among Asian Indian population, which may explain their high rate of stroke and heart attack in India. The increasing rate of CVD may be explained by the high rates of other risk factors including adverse lipid profile. The etiology of cardiovascular diseases (CVD) is multifactorial and no single factor is an absolute cause.

CONCLUSION

The cardiovascular diseases and its risk factors are increasing with a rapid pace in Asian Indian population. Though the prevalence of CVD risk factors is found higher in urban population, yet it is increasing at an alarming rate in rural population also, which is a serious threatening to the nation. Since majority of the Indians live in rural area, CVD may lead to epidemic proportions. We need health promotion programs and reorientation of primary health care to improve CVD detection in earlier stage and its management.

Overweight, obesity and related non-communicable diseases in Asian Indian girls and women

The prevalence of obesity is rising globally and in India. Overweight, obesity and related diseases need to be delineated in Asian Indian women. A literature search was done using key words like 'obesity', 'Asian Indian women', 'body fat distribution', 'type 2 diabetes', 'fertility', 'polycystic ovarian disease', metabolic syndrome', 'cardiovascular disease', 'non-alcoholic fatty liver disease', 'gender', 'sex' and 'prevalence' up to September 2012 in Pubmed and Google Scholar search engines. This review highlights the Asian Indian body composition with regards to obesity and provides a collated perspective of gender-specific prevalence of the co-morbidities. Recent data show that women (range of prevalence of overweight and obesity from different studies 15-61%) have higher prevalence of overweight and obesity as compared with men (range of prevalence of overweight and obesity from different studies 12-54%) in India and that obesity is increasing in the youth. The prevalence of overweight and obesity in both men and women steeply rose in a Punjabi community from Jaipur. Importantly, prevalence of abdominal obesity has been consistently higher in women than in men. The lowest prevalence (6.0%) of type 2 diabetes mellitus in women is reported from South India (rural Andhra Pradesh; 2006) and the highest (14.0%) by the National Urban Diabetes Survey (2001). Although the clustering of cardiovascular disease risk factors was generally high, it increased further in post-menopausal women. There are a number of factors that predispose Indian women to obesity; sedentary behaviour, imbalanced diets, sequential and additive postpartum weight gain and further decrease in physical activity during this period and cultural issues. In view of these data, preventive measures should be specifically targeted to Indian women.

Risk factors for hypertension in a population-based sample of postmenopausal women in Kolkata, West Bengal, India

Hypertension is a major public health problem worldwide. However, limited information is available regarding the risk factors for hypertension in postmenopausal women, particularly in urban populations in developing countries such as India. To investigate whether adiposity measures, serum lipids and lipoproteins as well as fasting plasma glucose can predict the risk of hypertension in a population based sample of postmenopausal women in Kolkata, India, we conducted a cross-sectional study of 415 postmenopausal women (aged 40 to 85), selected by cluster sampling from 12 wards of Kolkata. After multivariate adjustment, apolipoprotein B (apo B) and waist circumference (WC) showed the strongest association with hypertension. The risk of hypertension in the highest tertile compared with the lowest tertile was 2.57 (95% confidence interval = 1.00-6.61) for apo B and 2.55 (95% confidence interval = 1.07-6.06) for WC. Apo B and WC were the strongest risk factors for predicting hypertension among postmenopausal women in Kolkata.

Menopause versus aging: The predictor of obesity and metabolic aberrations among menopausal women of Karnataka, South India

Context:

Increased incidences of cardiovascular disorder and metabolic syndrome particularly after menopause have raised curiosity for the underlying factors. However, it is still a debate whether age or menopausal transition is a greater contributor.

Aims:

To elucidate the inter-relationships of age, menopause, and associated obesity and to assess their independent effects on aggravation of cardio metabolic risk factors in postmenopausal women.

Settings and Design:

Four hundred two women aged between 30 and 75 years were recruited in a cross-sectional study from Southern India. Three hundred sixteen participants exempting exclusion criteria, comprising of 169 premenopausal and 147 postmenopausal women were finally included.

Materials and Methods:

Anthropometric measurements such as weight, height, waist circumference (WC), hip circumference (HC), fat percentage, basal metabolic rate (BMR), and blood pressure were taken. Fasting plasma glucose, postprandial glucose, glycated hemoglobin (HbA1c), lipid profile, and C-reactive protein (CRP) were also measured.

Statistical Analysis Used:

Independent t-test, Analysis of covariates (ANCOVA), Pearson's correlation coefficients and multiple stepwise linear regression model analysis were done.

Results:

A significant increase in physical and metabolic factors was observed in postmenopausal women compared to premenopausal women except WC and HbA1c. Contrastingly, high-density lipoprotein cholesterol (HDL) levels and BMR were significantly decreased. After adjusting for BMI and age, the significant differences in the variables through the menopausal transition persisted, including an increase in WC. Significant correlation was observed between age and measures of general obesity such as BMI (P < 0.05) and fat percentage (P < 0.001) but not with central obesity indices. Menopausal status and WC exerted an independent effect on most of the metabolic risk factors (P < 0.001 or P < 0.01). Fat percentage was the predicting variable for CRP, HbA1c, diastolic blood pressure (P < 0.001), and HDL (P < 0.01). But Age showed independent effect only on HbA1c.

Conclusions:

Menopausal transition brings about anomalies in total body composition characterized by an increased body fat mass and central adiposity. This creates a compatible atmosphere for abnormal metabolism and aggravated cardio metabolic risk factors. Thus, menopausal status and associated obesity is the major predictor of metabolic aberrations over age in menopausal women.

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

Introduction:

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

Objective:

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

Methods:

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

Results:

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

Obesity measures, metabolic profiles, blood pressure and intake of dietary fatty acids in rural women of Asian Indian origin: Santiniketan women study

OBJECTIVES

The present cross-sectional study was aimed to investigate obesity measures, metabolic profiles, blood pressure, and intake of dietary fatty acids in rural women of Asian Indian origin.

MATERIALS AND METHODS

A total of 280 healthy rural women aged 25-65 years took part in the study. A random sampling procedure using a local voters' registration list was followed to select the participants. All participants belonged to the Bengalee population and were inhabitants of the Bolpur-Santiniketan area, West Bengal, India. Anthropometric measures, namely, height, weight, circumferences of waist and hip, skinfolds at biceps, triceps, subscapular, and suprailiac regions, etc., were collected using standard techniques. Body mass index (BMI), percentages of body fat (PBFs), basal metabolic rate (BMR), and intra-abdominal visceral fat (IVF) were measured using an Omron body fat analyzer (Omron Corporation, Tokyo, Japan). Fat mass (FM), fat free mass (FFM), waist-hip ratio (WHR), and sum of four skinfolds (SF4) were also taken into consideration. Blood pressure and metabolic and hormonal profiles were measured using standard techniques. The weekly consumption (frequency) of food stuffs was collected using an already validated food frequency schedule.

RESULTS

The result showed that the mean age was 41.52 ± 10.95, BMI 23.07 ± 4.34, PBF 31.76 ± 7.06, BMR 1162.34 ± 139.59, WHR 0.83 ± 0.06, systolic blood pressure 118.84 ± 20.35, diastolic blood pressure 77.77 ± 12.12, total cholesterol 185.61 ± 25.19, triglyceride level 135.82 ± 30.39, high-density lipoprotein 48.13 ± 6.13, low-density lipoprotein 109.90 ± 22.53, fasting blood glucose 90.91 ± 7.98, and insulin 11.98 ± 3.42. The result also shows the mean intake of total protein to be 177.01 ± 47.79, total energy 8321.60 ± 1354.86, total fat 210.36 ± 53.57, total PUFA 82.02 ± 49.73, and total MUFA 94.01 ± 16.38. The percentile distribution of the dietary fat intake revealed that the 10th and 95th percentile values of the total protein intake were 125.3 and 261.5, total energy intake were 7491.6 and 10470.2, total fat intake were 178.8 and 273.5, total PUFA intake were 55.5 and 191.7, and of the total MUFA intake were 86.0 and 126.9, respectively.

CONCLUSION

It seems reasonable to argue that dietary management including dietary guidelines across India is essential to retard the growing incidence of cardiovascular diseases in coming years.

Prevalence of cardiovascular disease risk factors in people of Asian Indian origin: Age and sex variation

BACKGROUND

No study has been undertaken on people of Asian Indian origin to investigate the age and sex variation in the prevalence of cardiovascular disease (CVD) risk factors.

OBJECTIVES

To investigate the age and sex variation in the prevalence of CVD risk factors among the people of Asian Indian origin.

MATERIALS AND METHODS

A total of 682 (302 males and 380 females) participants aged 25-85 years took part in the study. The subjects were categorized into 4 groups, namely, Group I (25-34 years), Group II (35-44 years), Group III (45-54 years), and Group IV (55 years and above). Height, weight, and the circumferences of minimum waist (MWC) and maximum hip were collected using standard techniques. Waist-hip ratio (WHR) was then calculated. Percentage of body fat (%BF) and body mass index (BMI) were measured using an Omron body fat analyzer. Left arm systolic (SBP) and diastolic (DBP) blood pressure were taken from each participant with the help of an Omron MI digital electronic blood/pulse monitor. Metabolic profiles, namely, total cholesterol (TC), triglyceride (TG), high (HDL), low (LDL), very low-density lipoprotein (VLDL), and fasting blood glucose (FBG) were also measured using an autoanalyzer.

RESULTS

One-way analysis of variance revealed significant differences for age, BMI, MWC, WHR, SBP, DBP, TC, TG, LDL, VLDL, and TC:HDL and TG:HDL ratios across the groups. It was observed that there were significant sex-specific group differences (male [χ(2) (12)] =29.22, P < 0.01 and female [χ(2) (12)] =56.69, P < 0.001) for obesity, high BP, high TC, high TG, and high FBG. But no significant group-specific sex difference was evident for either of the risk factors, except for Group IV.

CONCLUSION

Age irrespective of sex modulates CVD risk factors and warranted prevention as early as middle age.

Factor analysis of risk variables associated with metabolic syndrome in adult Asian Indians

BACKGROUND

Several studies hinted about the clustering of risk variables of the metabolic syndrome (MS) and suggested that the underlying genetic polymorphisms could be responsible for the increasing incidence of coronary heart disease (CHD) in people of Indian origin. Therefore, identification of the components of the MS along with the genetic factors could be one of the aspects to make an attempt to prevent the increasing incidence of CHD.

MATERIALS AND METHODS

Principal component factor analysis (PCFA) was undertaken to identify the components or factors of the MS among the adult (≥30 years) Asian Indians living in and around Calcutta, India. The study comprised 350 adult Asian Indians. Anthropometric measurements were taken, and lipid profiles, blood pressure and fasting blood glucose were measured for each participant. Two genetic polymorphisms, namely, angiotensin converting enzyme (ACE) gene polymorphism (insertion/deletion [I/D]) or ACE (I/D) and apolipoproteinE (Hha I) were also studied.

RESULTS

PCFA revealed 3 factors that cumulatively explained 65.39% of the observed variance of the MS by measured variables. The 3 factors identified were lipids and lipoprotein (Factor 1), centripetal fat and blood pressure (Factor 2), and ACE (I/D) polymorphism with blood pressure (Factor 3). Moreover, the first 2 factors, that is, lipids, lipoprotein, centripetal fat, and blood pressures cumulatively explained ~46% (45.94%) of the observed variance of MS in this population.

CONCLUSIONS

Since more than 1 factor was identified for the MS phenotype, more than 1 physiogenetic mechanism could be accounted for MS in the Asian Indian population.