Total and regional body adiposity increases during menopause-evidence from a follow-up study

How does biological age acceleration mediate the associations of obesity with cardiovascular disease? Evidence from international multi-cohort studies

BACKGROUND

Recent basic biological research found that obesity accelerates biological aging and increases cardiovascular disease (CVD) risk. However, there is still a lack of real-world population evidence. This study aimed to explore the potential mediation roles of biological age acceleration in the associations between different dimensions of obesity characterization and incident CVD.

METHODS

This international multi-cohort study included participants aged over 45 years with 3 waves longitudinal data from China Health and Retirement Longitudinal Study (CHARLS). China Health and Nutrition Survey (CHNS) was used to develop Klemera-Doubal method-biological age (KDM-BA), and the validation analysis was performed in UK Biobank (UKB) and Hongguang Elderly Health Examination Cohort (HEHEC). Obesity indices including body mass index (BMI), waist circumference (WC), waist height ratio (WtHR), body roundness index (BRI) for body shape; Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP) for visceral fat accumulation; triglyceride-glucose index (TyG) and its derivatives (TyG-BMI, TyG-WC, TyG-WtHR) for metabolic function were used to measure obesity across different dimensions. Biological age acceleration was evaluated by the classic KDM-BA acceleration (KDM-BAacc). Causal mediation analyses assessed the role of biological age acceleration in mediating obesity and incident CVD.

RESULTS

In CHARLS, the median follow-up period was 9.00 years, with a baseline age of 58 (52, 65) years. Obesity, KDM-BAacc, and CVD were all significantly associated with each other. For each 1-year increase in KDM-BAacc, the risk of incident stroke, heart disease and CVD increased by 68% (OR 1.68, 95% CI 1.35-2.09), 35% (OR 1.35, 95% CI 1.15-1.59), and 44% (OR 1.44, 95% CI 1.25-1.65), respectively. KDM-BAacc mediated the associations between BMI, WC, WtHR, BRI, CVAI, LAP, TyG-BMI, TyG-WC, TyG-WtHR, with CVD, with the mediation proportions ranging from 10.03 to 25.46%. However, the mediating effect was significant mostly in middle-aged individuals aged 45-65 years. Furthermore, sex differences existed in the mediation mechanisms. Biological age acceleration strongly mediated body shape indices and incident CVD in males, whereas in females, it predominantly mediated visceral fat accumulation and metabolic function dimensions with incident CVD. Similar main results were found in UKB and HEHEC.

CONCLUSIONS

Biological age acceleration partially mediates the relationship between obesity and incident CVD. This temporal evidence firstly validated the mediation pathway based on international cohorts, emphasizing the importance of addressing biological aging processes in population aged 45-65 years while providing sex-specific obesity intervention strategies to prevent CVD.

Physiological alterations around the menopause transition-A 2-year follow-up in PRE, PERI, and POST menopause females

INTRODUCTION

The menopause transition is a critical period marked by significant physiological adaptations. Data on the dynamic changes in body composition and metabolism during this transition are limited. The purpose was to determine body composition and metabolic changes over a 2-year follow-up in a cross-sectional sample of premenopausal (PRE), perimenopausal (PERI), and postmenopausal (POST) females.

METHODS

Twenty-three females who previously participated in a cross-sectional study returned for a 2-year follow-up visit were classified as PRE, PERI, or POST based on menstrual history and a Menopause Health Questionnaire. Muscle size [muscle cross-sectional area (mCSA)] and muscle quality [echo intensity, (EI)] were evaluated in the vastus lateralis with ultrasound. Bone mass and body composition were assessed using dual-energy X-ray absorptiometry, and metabolic flexibility through submax exercise with indirect calorimetry.

RESULTS

At the 2-year follow-up, POST females had an increase in EI (change: 26.93 ± 12.82 a.u., group×time p-adjusted = 0.001) with no change in mCSA (change: -2.03 ± 2.40 cm², group×time p = 0.980). PERI compared to PRE females had lower total bone mass (group×time p-adjusted = 0.029) with an even lower bone mass in POST compared to PERI females (group×time p-adjusted = 0.023). No differences in metabolic flexibility at any exercise intensity were observed between groups over time (group×time p = ≥ 0.05).

CONCLUSION

This study highlights a decline in muscle quality and total bone mass despite stable muscle size, emphasizing the need for targeted exercise and nutrition interventions to support muscle and bone health in females around the menopause transition.

The acute exercise response of peripheral blood mononuclear cells and their bioenergetic function in women with high and low systemic estradiol levels

Decrease in the systemic estradiol (E2) levels caused by menopause has been associated with an increased risk for cardiovascular disease. We have previously shown that E2 level is associated with the systemic response to an acute bout of endurance exercise. However, the association of systemic E2 level with peripheral blood mononuclear cell (PBMC) bioenergetic function has not been investigated. We examined the associations of systemic E2 level (HIGH and LOW E2 groups) on WBC count and PBMC bioenergetic function before and after an acute bout of endurance exercise (time points PRE, POST and 1 h POST exercise). Exercise stimulus was a maximal incremental bicycle ergometer test. We show that an acute bout of exercise induced a transient increase in WBC count in both HIGH and LOW E2 study groups (p < 0.001). We also observed an increase in the percentage of neutrophils and a decrease in the percentage of lymphocytes in response to exercise (p < 0.001). An acute bout of exercise was also associated with a transient increase in PBMC maximal electron transfer capacity and spare capacity (p < 0.001). No statistically significant associations were observed between systemic E2 level and PBMC bioenergetic function at the basal state or in the responses to acute exercise.

Relationship between night eating syndrome, eating disorders, and menopausal symptoms in climacteric women: a pilot study

OBJECTIVE

The aim of this study was to examine the relationship between night eating syndrome, eating disorders, and menopausal symptoms in climacteric women.

METHODS

In this descriptive study, 90 climacteric women who met the inclusion criteria volunteered to participated. The data for the participants were collected via a face-to-face interview method using a sociodemographic and menopause questionnaire, the Eating Disorder Examination Questionnaire, the Night Eating Questionnaire, and the Menopause Rating Scale, and their anthropometric measurements were recorded.

RESULTS

Among all participants, 51.1% had night eating syndrome. However, the night eating syndrome ( P  = 0.790) and eating disorders ( P  = 0.634) of the participants did not differ significantly according to the climacteric periods. Menopausal symptoms were found to be higher in perimenopausal and postmenopausal women than in premenopausal women ( P  = 0.001). There were significant positive correlations between eating disorders and both night eating ( r  = 0.253 and P  < 0.05) and menopausal symptoms ( r  = 0.291 and P  < 0.001). There was no relationship between menopausal symptoms and night eating habits ( r  = 0.141 and P  > 0.05).

CONCLUSIONS

Eating disorders were found to be associated with night eating and menopausal symptom severity in climacteric women. There is a need for multidisciplinary studies to measure the risk of occurrence and recurrence of menopausal symptoms and the association with eating disorders experienced by women.

Mineralocorticoid and estrogen receptors as sex-dependent modulators of vascular health in aging and obesity

Cardiovascular disease (CVD) is the leading cause of death in both men and women, but there are sex differences in the timing and mechanisms of disease development. Sex differences particularly influence the development of CVD in the presence of aging and obesity, 2 major risk factors of CVD. The mineralocorticoid and estrogen receptors have been identified as important regulators of vascular function in healthy and disease states. Recent evidence has highlighted interactions between these receptors in the vasculature, and innovations in global and cell-specific knockout mouse models have substantially advanced our understanding of sex-dependent roles of these receptors in vascular health and disease. This review summarizes recent advances in the sex-dependent roles of the mineralocorticoid and estrogen receptors in arterial stiffness and vasomotor dysfunction, 2 early markers of CVD development. These vascular outcomes are examined in the context of aging and obesity, 2 of the most prevalent CVD risk factors. SIGNIFICANCE STATEMENT: Cardiovascular disease (CVD) is the leading cause of death globally for women and men, but there are sex differences in the timing of CVD development across the lifespan and in mechanisms driving disease. This review summarizes sex-specific roles of mineralocorticoid and estrogen receptors in arterial stiffness and vasomotor dysfunction during aging and obesity. Understanding sex-specific mechanisms of CVD is critical to developing precision medicine strategies to prevent and treat CVD in women and men.

Sex differences in body mass index and waist circumference trajectories and dementia risk: the HUNT4 70+ study

We examined associations between body mass index (BMI), waist circumference (WC), and dementia risk, and differences in BMI and WC trajectories before dementia diagnosis. We included 9,739 participants (54% women) aged 70+ from the Trøndelag Health Study (HUNT4 70+). BMI was measured four times (1984-2019) and WC three times (1995-2019). Dementia diagnoses were clinically assessed at HUNT4 70+ . Women and men with dementia had higher midlife BMI and WC than those without dementia. These differences diminished closer to diagnosis, especially in women. Midlife obesity in both sexes and midlife overweight, high WC, and overweight/obesity with high WC in men were linked to higher dementia risk. Lower dementia risk was observed with late-life overweight for both sexes, late-life high WC in women, late-life overweight/obesity with normal WC in men or high WC in women. Adiposity measures and their changes influence dementia risk differently in women and men.

Broadening the Healthy Aging Paradigm: Inclusion of Gestation, Development, and Reproductive Health

The prevailing focus of lifespan health research has predominantly centered on "healthy aging". This oversight may hinder the understanding of health across the lifespan, as disorders in earlier stages can substantially impact overall health and longevity. Aging, conceptually, begins at gestation. The trajectory of an individual's health is influenced from the earliest stages of life, where adverse conditions can set a foundation for lifelong health challenges. For example, suboptimal conditions during gestation leading to premature birth can predispose individuals to various health issues later in life. Additionally, precocious puberty defined as the onset of sexual maturity before eight years of age or early menopause-occurring before 50 years of age requires medical intervention and is indicative of atypical aging processes. To address these critical gaps in lifespan health research, the expansion of medical lexicons and research categorizations is advocated to include "healthy gestation," "healthy development," and "healthy reproduction" alongside "healthy aging." This broader terminology will enable a more comprehensive investigation of disorders at all life stages. An integrative approach underscores the interconnectedness of all life stages and the continuous nature of aging, advocating for a seamless continuum in health research and interventions from gestation through late adulthood.

Association Between a Body Shape Index and Body Roundness Index with Prevalence of Psoriasis: A Cross-Sectional Population-Based Study

Background

Previous studies have suggested an intimate association between obesity and psoriasis. This study aimed to evaluate and compare the association between traditional and novel obesity biomarkers - waist circumference (WC), body mass index (BMI), a body shape index (ABSI), and body roundness index (BRI) - and the risk of psoriasis.

Methods

This cross-sectional study utilized data from the 2003-2006 and 2011-2014 National Health and Nutrition Examination Survey. The association between obesity biomarkers and psoriasis risk was evaluated using multivariate logistic regression and smoothed curve fitting. The diagnostic performance of various biomarkers for identifying psoriasis were calculated and compared using receiver-operating characteristic curves.

Results

Overall, 12,406 participants without psoriasis, 287 with mild psoriasis, and 68 with moderate-severe psoriasis, were included. Compared to the lowest quartile of WC, BMI, and BRI, higher quartiles were associated with significantly higher risks of psoriasis (all P for trend < 0.05). The area under the curve for identifying psoriasis was highest for BRI, which was comparable to WC (0.581 vs 0.575, P=0.34) but significantly higher than that of ABSI (0.581 vs 0.546, P=0.04) and BMI (0.581 vs 0.569, P=0.007). The association between BRI and psoriasis risk was not influenced by participant's age, sex, smoking status, physical activity, hypertension and diabetes status.

Conclusion

BRI is positively associated with risk of psoriasis and outperforms BMI and ABSI in identifying psoriasis. Given the cross-sectional design of this study, future research employing prospectively designed longitudinal studies is necessary to validate our findings.

The Association of Menopausal Age with Sex Hormones and Anthropometric Measures Among Postmenopausal Women in the Multi-Ethnic Study of Atherosclerosis Study

Introduction: We investigated associations of menopausal age category with body mass index (BMI), waist circumference, waist-hip ratio, and waist-height ratio. We also explored the moderating effect of anthropometric measures on associations of menopausal age category with prespecified sex hormones: estradiol, dehydroepiandrosterone (DHEA), sex hormone-binding globulin, bioavailable testosterone, and total testosterone-estradiol (T/E) ratio. Methods: In this cross-sectional study, we included 2,436 postmenopausal women from the Multi-Ethnic Study of Atherosclerosis who had menopausal age, anthropometric, and sex hormone data at baseline. Menopausal age was categorized as <45 years (early menopause), 45-49 years, 50-54 years (referent), and ≥55 years (late menopause). Linear models were used for analysis. Results: The mean (standard deviation) age was 64.7 (9.2) years. After multivariable adjustment, women who experienced late menopause had higher waist circumference (2.28 cm), waist-hip ratio (0.013 units), and waist-height ratio (0.014 units) but not BMI than those in the referent category. The interaction terms between menopausal age category and anthropometric measures were not significant for prespecified sex hormones (all Pinteraction >0.05). When compared with the referent category, T/E ratio was 21% (4.72 - 39.8%) higher among women with late menopause while DHEA levels were 9% (1 - 16%) higher among women who experienced menopause between 45 and 49 years in multivariable adjusted models. Conclusion: Women with late menopause had higher abdominal adiposity but not generalized adiposity when compared with those who experienced menopause between 50 and 54 years of age. Androgenicity was higher among women who experienced menopause between 45 and 49 years of age and those with late menopause, based on DHEA and T/E ratios, respectively.

A mediating role of visceral adipose tissue on the association of health behaviours and metabolic inflammation in menopause: a population-based cross-sectional study

Fat distribution changes with advancing menopause, which predisposes to metabolic inflammation. However, it remains unclear, how health behaviours, including sleeping, eating and physical activity, or their combinations contribute to metabolic inflammation caused by visceral adipose tissue (VAT). The aim of the present study was to examine whether health behaviours are associated with metabolic inflammation and whether VAT mediates these associations in menopausal women. This cross-sectional study consisted of a sample of middle-aged women (n = 124). Health behaviours were assessed by self-report questionnaire with measures of sleeping, eating (Eating Disorder Examination Questionnaire, EDE-Q), and physical activity behaviours. Metabolic inflammation was measured using GlycA, a composite biomarker of inflammation, and bioimpedance device was used to assess VAT. Structural equation modelling was used to examine the direct and indirect associations of health behaviours with inflammation, as well as the moderation effect of health behaviours on VAT and metabolic inflammation. VAT was directly associated with inflammation. Two indirect pathways were found: eating and physical activity behaviours were both inversely associated with inflammation through VAT, whereas sleeping behaviour was not. Physical activity moderated the association between VAT and metabolic inflammation. The association was stronger in those who were physically less active. Furthermore, eating behaviour and physical activity had an interaction on VAT. Physical activity was negatively associated with VAT among women with normal eating behaviour, but the association was less clear among women with features of disordered eating behaviour. It is possible to impede the menopausal shift to adverse visceral adiposity through increased physical activity and further decrease the risk of metabolic inflammation in menopausal women. The present study offers potential hypotheses for future longitudinal research.

Menopausal age, adipokines, and heart failure incidence in postmenopausal women of the Multi-Ethnic Study of Atherosclerosis

OBJECTIVE

The mechanisms through which menopausal age influences heart failure (HF) development are controversial. Adiposity increases after menopause and could affect HF risk by influencing serum adipokine secretion. We investigated the associations of early menopause, and serum adipokines with incident HF in postmenopausal women.

METHODS

We included 746 postmenopausal women from the Multi-Ethnic Study of Atherosclerosis who reported their menopausal age and had data on adipokines and incident HF at the end of follow-up. Multivariable Cox proportional hazards models were used for analysis.

RESULTS

The mean age was 65.1 years. Over a median follow-up period of 17.8 years, 45 HF events occurred. After adjusting for waist circumference, other cardiovascular disease risk factors and myocardial infarction, the hazard ratios (95% confidence intervals) of incident HF attributable to early menopause were 4.50 (1.41-14.3), 4.64 (1.46-14.7), and 5.16 (1.59-16.7) in models that additionally included adiponectin, leptin, and resistin, respectively. In adjusted analyses, adiponectin was independently associated with incident HF 2.20 (1.35-3.57), while leptin and resistin were not. The interaction terms of early menopause with adiponectin, leptin, and resistin for incident HF were not significant ( Pint = 0.08-0.82).

CONCLUSIONS

Early menopause was significantly associated with incident HF. This association did not differ by serum adipokine levels. Only adiponectin was independently associated with incident HF in postmenopausal women when waist circumference, body mass index, and waist-hip ratio were used as the adiposity metric.

A systematic review and meta-analysis investigating differences in chronic inflammation and adiposity before and after menopause

BACKGROUND

Menopause represents a pivotal physiological transition characterized by hormonal fluctuations and an augmented susceptibility to chronic diseases. The relationship between menopause and heightened disease risk may be attributed in part to alterations in low-grade chronic inflammation and adiposity.

METHODS

Three databases were searched for studies assessing differences in inflammation and body adiposity between pre- and postmenopausal women. Meta-analysis examined the association between menopausal status and key inflammatory biomarkers, including leptin, adiponectin, interleukin-6, tumour necrosis factor-α and c-reactive protein, and indices of body adiposity (fat mass, waist circumference, waist-to-hip-ratio and body mass index). The National Institute of Health Quality Assessment Tool for Observational and Cross-sectional studies was used to evaluate quality of studies, and GRADE-assessed evidence certainty.

RESULTS

Levels of adiponectin and leptin were higher in postmenopausal women than in premenopausal women [(1.30 μg/ml, 95 % CI; 0.56 to 2.03 μg/ml, p = 0.001), (0.88 ng/ml; 95 % CI: 0.22 to 1.52; p = 0.008)]. A trend towards significance was observed for tumour necrosis factor-α (0.59 pg/ml, 95 % CI; -0.07 to 1.26 pg/ml, p = 0.080), with no significant differences in interleukin-6 and c-reactive protein [(0.83 pg/ml, 95 % CI; -0.24 to 1.91 pg/ml, p = 0.128), (0.06 mg/ml, 95 % CI; -0.17 to 0.29, p = 0.606)]. Postmenopausal women had greater waist circumference, waist-to-hip-ratio and body mass index than premenopausal women [(0.74 cm; 95 % CI: 1.02 to 0.47; p ≤0.001), (0.78; 95 % CI: 1.47 to -0.09; p = 0.027), (0.31 kg/m2; 95 % CI: 0.50 to 0.12; p = 0.001)].

CONCLUSIONS

Postmenopausal women had higher adipokine levels and greater adiposity. However, given the low certainty of the available evidence, future prospective cohort studies assessing inflammatory changes over the menopausal transition are warranted to inform future clinical decisions. Protocol registered on the Open Science Framework (OSF-ID: 10.17605/OSF.IO/DY8T6).

A cocktail of histidine, carnosine, cysteine and serine reduces adiposity and improves metabolic health and adipose tissue immunometabolic function in ovariectomized rats

Many women have sought alternative therapies to address menopause. Recently, a multi-ingredient supplement (MIS) containing L-histidine, L-carnosine, L-serine, and L-cysteine has been shown to be effective at ameliorating hepatic steatosis (HS) in ovariectomized (OVX) rats, a postmenopausal oestrogen deficiency model. Considering that HS frequently accompanies obesity, which often occurs during menopause, we aimed to investigate the effects of this MIS for 8 weeks in OVX rats. Twenty OVX rats were orally supplemented with either MIS (OVX-MIS) or vehicle (OVX). Ten OVX rats received vehicle orally along with subcutaneous injections of 17β-oestradiol (OVX-E2), whereas 10 rats underwent a sham operation and received oral and injected vehicles (control group). MIS consumption partly counteracted the fat mass accretion observed in OVX animals, leading to decreased total fat mass, adiposity index and retroperitoneal white adipose tissue (RWAT) adipocyte hypertrophy. OVX-MIS rats also displayed increased lean mass and lean/fat ratio, suggesting a healthier body composition, similar to the results reported for OVX-E2 animals. MIS consumption decreased the circulating levels of the proinflammatory marker CRP, the total cholesterol-to-HDL-cholesterol ratio and the leptin-to-adiponectin ratio, a biomarker of diabetes risk and metabolic syndrome. RWAT transcriptomics indicated that MIS favourably regulated genes involved in adipocyte structure and morphology, cell fate determination and differentiation, glucose/insulin homeostasis, inflammation, response to stress and oxidative phosphorylation, which may be mechanisms underlying the beneficial effects described for OVX-MIS rats. Our results pave the way for using this MIS formulation to improve the body composition and immunometabolic health of menopausal women.

Associations of menopausal status and eating behaviour with subjective measures of sleep

Eating and sleeping behaviour are known to interact with each other, yet research is limited in the context of menopausal women. The aim of this study was to examine whether menopausal status is associated with perceived problems in sleeping. Furthermore, we studied different aspects of eating behaviour as potential risk factors for poor sleep in menopausal women. The present study is exploratory in nature, thus the results should be interpreted as hypothesis-generating. We analysed the sleeping and eating behaviour of 1098 women aged 47-55 years and represented different menopausal statuses with regression analyses. Over 20% of them reported fairly poor or poor perceived sleep quality. A higher number of postmenopausal women reported experiencing at least fairly poor sleep quality compared with the other menopausal groups. However, in regression models controlled for several confounding factors menopausal status was not associated with measures of sleep. Women who reported more snacking-type eating behaviour were more likely to report shorter sleep duration, and more daytime tiredness. Externally cued eating was associated with shorter sleep duration and emotional eating was associated with experiencing daytime tiredness. However, after adjusting for multiple testing, it appears that eating behaviour is associated only with daytime tiredness. Menopausal women with sleeping problems may benefit from nutritional interventions targeting eating behaviour.

Estrogen deficiency reduces maximal running capacity and affects serotonin levels differently in the hippocampus and nucleus accumbens in response to acute exercise

Introduction

Estrogen deficiency is associated with unfavorable changes in body composition and metabolic health. While physical activity ameliorates several of the negative effects, loss of ovarian function is associated with decreased physical activity levels. It has been proposed that the changes in brain neurochemical levels and /or impaired skeletal muscle function may underlie this phenomenon.

Methods

We studied the effect of estrogen deficiency induced via ovariectomy (OVX) in female Wistar rats (n = 64). Rats underwent either sham or OVX surgery and were allocated thereafter into four groups matched for body mass and maximal running capacity: sham/control, sham/max, OVX/control, and OVX/max, of which the max groups had maximal running test before euthanasia to induce acute response to exercise. Metabolism, spontaneous activity, and maximal running capacity were measured before (PRE) and after (POST) the surgeries. Three months following the surgery, rats were euthanized, and blood and tissue samples harvested. Proteins were analyzed from gastrocnemius muscle and retroperitoneal adipose tissue via Western blot. Brain neurochemical markers were measured from nucleus accumbens (NA) and hippocampus (HC) using ultra-high performance liquid chromatography.

Results

OVX had lower basal energy expenditure and higher body mass and retroperitoneal adipose tissue mass compared with sham group (p ≤ 0.005). OVX reduced maximal running capacity by 17% (p = 0.005) with no changes in muscle mass or phosphorylated form of regulatory light chain (pRLC) in gastrocnemius muscle. OVX was associated with lower serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) level in the NA compared with sham (p = 0.007). In response to acute exercise, OVX was associated with low serotonin level in the HC and high level in the NA (p ≤ 0.024).

Discussion

Our results highlight that OVX reduces maximal running capacity and affects the response of brain neurochemical levels to acute exercise in a brain region-specific manner. These results may offer mechanistic insight into why OVX reduces willingness to exercise.

Impact of hormone replacement therapy on all-cause and cancer-specific mortality in colorectal cancer: A systematic review and dose‒response meta-analysis of observational studies

OBJECTIVE

The effect of hormone replacement therapy (HRT) on colorectal cancer (CRC) mortality and all-cause mortality remains unclear. We conducted a systematic review and dose-response meta-analysis to determine the effects of HRT on CRC mortality and all-cause mortality.

METHODS

We searched the electronic databases of PubMed, Embase, and The Cochrane Library for all relevant studies published until January 2024 to investigate the effects of HRT exposure on survival rates for patients with CRC. Two reviewers independently extracted individual study data and evaluated the risk of bias between the studies using the Newcastle‒Ottawa Scale. We performed a two-stage random-effects dose-response meta-analysis to examine a possible nonlinear relationship between the year of HRT use and CRC mortality.

RESULTS

Ten cohort studies with 480,628 individuals were included. HRT was inversely associated with the risk of CRC mortality (hazard ratios (HR) = 0.77, 95% CI (0.68, 0.87), I2 = 69.5%, p < 0.05). The pooled results of seven cohort studies revealed a significant association between HRT and the risk of all-cause mortality (HR = 0.71, 95% CI (0.54, 0.92), I2 = 89.6%, p < 0.05). A linear dose-response analysis (p for nonlinearity = 0.34) showed a 3% decrease in the risk of CRC for each additional year of HRT use; this decrease was significant (HR = 0.97, 95% CI (0.94, 0.99), p < 0.05). An additional linear (p for nonlinearity = 0.88) dose-response analysis showed a nonsignificant decrease in the risk of all-cause mortality for each additional year of HRT use.

CONCLUSIONS

This study suggests that the use of HRT is inversely associated with all-cause and colorectal cancer mortality, thus causing a significant decrease in mortality rates over time. More studies are warranted to confirm this association.

Combined supplementation with hesperidin, phytosterols and curcumin decreases adiposity and improves metabolic health in ovariectomized rats

In recent years many women have looked for alternative therapies to address menopause. Hesperidin, phytosterols and curcumin are bioactive compounds that can ameliorate some cardiovascular risk factors associated with menopause, although there are no data concerning the effects of their combined supplementation. We used ovariectomized (OVX) rats, a postmenopausal model with oestrogen deficiency, to evaluate whether supplementation with a multi-ingredient (MI) including hesperidin, phytosterols and curcumin for 57 days would display beneficial effects against fat mass accretion and metabolic disturbances associated with menopause. Twenty OVX rats were orally supplemented with either MI (OVX-MI) or vehicle (OVX). Furthermore, 10 OVX rats orally received the vehicle along with subcutaneous injections of 17β-oestradiol biweekly (OVX-E2), whereas 10 rats were sham operated and received oral and injected vehicles (control group; SH). MI supplementation partly counteracted the fat mass accretion observed in OVX animals, which was evidenced by decreased total fat mass, adiposity index, the weight of retroperitoneal, inguinal and mesenteric white adipose tissue (MWAT) depots and MWAT adipocyte hypertrophy. These effects were accompanied by a significant decrease in the circulating levels of leptin and the mRNA levels of the fatty acid uptake-related genes Lpl and Cd36 in MWAT. These results were very similar to those observed in OVX-E2 animals. OVX-MI rats also displayed a higher lean body mass, lean/fat mass ratio, adiponectin-to-leptin ratio and insulin sensitivity than their OVX counterparts. Our findings can pave the way for using this MI formulation as an alternative therapy to manage obesity and to improve the cardiometabolic health of menopausal women.

Mechanisms of body fat distribution and gluteal-femoral fat protection against metabolic disorders

Obesity is a major health problem that affects millions of individuals, and it is associated with metabolic diseases including insulin resistance (IR), type 2 diabetes (T2D), and cardiovascular diseases (CVDs). However, Body fat distribution (BFD) rather than crude obesity is now considered as a more accurate factor associated with these diseases. The factors affecting BFD vary, from genetic background, epigenetic factors, ethnicity, aging, hormonal changes, to lifestyle and medication consumptions. The main goal of controlling BFD comes from the fact that fat accumulation in different depots has a different effect on the overall health and metabolic health of individuals. It is well established that fat storage in the abdominal visceral depot is associated with metabolic disorder occurrence, while gluteal-femoral subcutaneous fat depot seems to be protective against these diseases. In this paper, we will summarize the factors affecting fat distribution. Then, we will present evidence connecting gluteal-femoral fat depot with protection against metabolic disorders including IR, T2D, and CVDs. Finally, we will list the suggested mechanisms that lead to this protective effect. The abstract is visualized in Graphical Abstract.

Aging and Adiposity-Focus on Biological Females at Midlife and Beyond

Menopause is a physiological phase of life of aging women, and more than 1 billion women worldwide will be in menopause by 2025. The processes of global senescence parallel stages of reproductive aging and occur alongside aging-related changes in the body. Alterations in the endocrine pathways accompany and often predate the physiologic changes of aging, and interactions of these processes are increasingly being recognized as contributory to the progression of senescence. Our goal for this review is to examine, in aging women, the complex interplay between the endocrinology of menopause transition and post-menopause, and the metabolic transition, the hallmark being an increasing tendency towards central adiposity that begins in tandem with reproductive aging and is often exacerbated post menopause. For the purpose of this review, our choice of the terms 'female' and 'woman' refer to genetic females.

Effect of resistance training volume on body adiposity, metabolic risk, and inflammation in postmenopausal and older females: Systematic review and meta-analysis of randomized controlled trials

PURPOSE

This meta-analytical study aimed to explore the effects of resistance training (RT) volume on body adiposity, metabolic risk, and inflammation in postmenopausal and older females.

METHODS

A systematic search was performed for randomized controlled trials in PubMed, Scopus, Web of Science, and SciELO. Randomized controlled trials with postmenopausal and older females that compared RT effects on body adiposity, metabolic risk, and inflammation with a control group (CG) were included. Independent reviewers selected the studies, extracted the data, and performed the risk of bias and certainty of the evidence (Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)) evaluations. Total body and abdominal adiposity, blood lipids, glucose, and C-reactive protein were included for meta-analysis. A random-effects model, standardized mean difference (Hedges' g), and 95% confidence interval (95%CI) were used for meta-analysis.

RESULTS

Twenty randomized controlled trials (overall risk of bias: some concerns; GRADE: low to very low) with overweight/obese postmenopausal and older females were included. RT groups were divided into low-volume RT (LVRT, ∼44 sets/week) and high-volume RT (HVRT, ∼77 sets/week). Both RT groups presented improved body adiposity, metabolic risk, and inflammation when compared to CG. However, HVRT demonstrated higher effect sizes than LVRT for glucose (HVRT = -1.19; 95%CI: -1.63 to -0.74; LVRT = -0.78; 95%CI:-1.15 to -0.41) and C-reactive protein (HVRT = -1.00; 95%CI: -1.32 to -0.67; LVRT = -0.34; 95%CI, -0.63 to -0.04)) when compared to CG.

CONCLUSION

Compared to CG, HVRT protocols elicit greater improvements in metabolic risk and inflammation outcomes than LVRT in overweight/obese postmenopausal and older females.

Effect of moderate beer consumption (with and without ethanol) on cardiovascular health in postmenopausal women

BACKGROUND

The main aim of this 2-year non-randomized parallel controlled clinical pilot trial was to evaluate the long-term effect of a moderate daily intake of beer (with and without alcohol) on cardiovascular health in postmenopausal women. A total of 34 participants were grouped into three study arms: 16 were administered alcoholic beer, 6 consumed non-alcoholic beer, and 12 were in the control group. Changes in glucose metabolism, lipid profile, liver enzymes, anthropometric measurements, body composition, and blood pressure variables were monitored. Data on medical history, diet, and exercise were collected, and gustatory capacities were determined.

RESULTS

Moderate consumption of beer, both alcoholic and non-alcoholic, seemed to have positive effects on biochemical indicators of cardiovascular health in postmenopausal women, with 660 mL day-1 of non-alcoholic beer reducing low-density lipoprotein cholesterol blood levels, and 330 mL day-1 of alcoholic beer increasing high-density lipoprotein cholesterol. The evolution of changes in android and gynoid fat percentage and their ratio differed significantly between study groups, which was attributable to either the interventions or the disparity between groups regarding the time elapsed since menopause onset. Iso-α-acids recognition threshold could be involved in intervention group election, whereas the sensory phenotypes studied were not associated with alcohol drinking frequency.

CONCLUSIONS

Moderate beer consumption was found to improve the lipid profile of postmenopausal women, although their effects in preventing cardiometabolic alterations deserve further research (trial registration number: ISRCTN13825020; https://doi.org/10.1186/ISRCTN13825020). © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Consumption of Ultra-Processed Food and Drink Products in a Greek Christian Orthodox Church Fasting Population

The positive effects of the Mediterranean diet on healthy living are widely known, while the health effects of religious fasting have received increased attention during the last decade. However, no study has focused on the consumption of ultra-processed foods (UPFs) in such populations. Therefore, our aim was to investigate UPF intake and its association with metabolic syndrome (MetS) in a Christian Orthodox church (COC) religious fasting population in Greece. In this cross-sectional study, 400 individuals who follow the Mediterranean diet were included, stratified as COC fasters and non-fasters. Dietary intake data were collected via three 24 h diet recalls and a monthly food frequency questionnaire (FFQ). The NOVA food classification system was used to identify the level of processing and categorize all food items. Fasters consumed significantly less chicken, turkey, and beef and significantly more seafood, fish, snails, soy products, and fresh fruits, in terms of unprocessed or minimally processed foods, as well as significantly more fried potatoes and olives in terms of processed foods when compared with non-fasters. Regarding UPFs, a significantly lower intake of pork sausages, ketchup, and mustard as well as a significantly higher consumption of margarine and tarama dip were recorded in fasters compared with non-fasters. Fasters with MetS more frequently consumed UPFs (such as cheese pastries, biscuits, and cakes) than fasters without MetS (p < 0.05 for all comparisons). Similarly, non-fasters with MetS had an increased intake of UPFs (such as Cypriot bread and Coco Pops breakfast cereals) than non-fasters without MetS. Future research should focus on UPF consumption and its associations with clinical outcomes in such populations, thus providing further data for the potential health effects of COC fasting.

Age But Not Menopausal Status Is Linked to Lower Resting Energy Expenditure

CONTEXT

It remains uncertain whether aging before late adulthood and menopause are associated with fat-free mass and fat mass-adjusted resting energy expenditure (REEadj).

OBJECTIVES

We investigated whether REEadj differs between middle-aged and younger women and between middle-aged women with different menopausal statuses. We repeated the age group comparison between middle-aged mothers and their daughters to partially control for genotype. We also explored whether serum estradiol and FSH concentrations explain REEadj in midlife.

METHODS

We divided 120 women, including 16 mother-daughter pairs, into age groups; group I (n = 26) consisted of participants aged 17 to 21, group II (n = 35) of those aged 22 to 38, and group III (n = 59) of those aged 41 to 58 years. The women in group III were further categorized as pre- or perimenopausal (n = 19), postmenopausal (n = 30), or postmenopausal hormone therapy users (n = 10). REE was assessed using indirect calorimetry, body composition using dual-energy X-ray absorptiometry, and hormones using immunoassays.

RESULTS

The REEadj of group I was 126 kcal/day [95% confidence interval (CI): 93-160] higher than that of group III, and the REEadj of group II was 88 kcal/day (95% CI: 49-127) higher. Furthermore, daughters had a 100 kcal/day (95% CI: 63-138 kcal/day) higher REEadj than their middle-aged mothers (all P < .001). In group III, REEadj was not lower in postmenopausal women and did not vary by sex hormone concentrations.

CONCLUSIONS

We demonstrated that REEadj declines with age in women before late adulthood, also when controlling partially for genetic background, and that menopause may not contribute to this decline.

Role of Body Composition in the Prediction of Skeletal Fragility Induced by Hormone Deprivation Therapies in Cancer Patients

PURPOSE OF REVIEW

This review paper is intended to show that changes in body composition are key in the pathogenesis of bone fragility amongst patients with breast and prostate cancer receiving hormone deprivation therapies (HDTs) and that the mechanism is based on the development of alterations in bone quality rather than in bone quantity.

RECENT FINDINGS

Preclinical and clinical data suggest a tight connection amongst bone, adipose and muscular tissues by means of several soluble mediators, potentially leading to (1) bone resorption and bone quality deterioration in sarcopenic obese subjects, (2) bone mineral deposition in healthy trained subjects. Cancer patients treated with HDTs frequently fall into the first condition, named osteosarcopenic obesity. Current clinical guidelines for the prevention of treatment-induced osteoporosis focus on bone mineral density (BMD) as a main predictive factor for fracture risk; however, the pathophysiology underlying HDT-induced bone fragility differs from that of primary and postmenopausal osteoporosis, suggesting a prevalent role for bone quality alterations. Focusing on available data from clinical trials, in our review we suggest osteosarcopenic obesity as a common target for the prevention and treatment of HDTs-related metabolic and skeletal complications, beyond a BMD-centred approach.

Fat mass, weight and body shape changes at menopause - causes and consequences: a narrative review

In addition to age-related weight gain, menopause adds additional challenges for women with the occurrence of significant metabolic alterations and central and visceral fat redistribution. The changes in body composition then influence risks of cardiovascular disease, metabolic disruption, cancer, fracture, lung disease, sexual dysfunction, mental health disorders and dementia. They may also heighten the severity of vasomotor symptoms. Treatment of these changes requires a flexible long-term strategy. This narrative review explores the pathogenesis of the metabolic changes at menopause and effective management options.

Higher intuitive eating is associated with lower adiposity in midlife women

OBJECTIVE

Intuitive eating (IE) is consistently associated with a lower body mass index, though its relationship with adiposity, specifically abdominal adiposity, is unknown. Given that midlife women often experience increases in adiposity during midlife, our objective was to examine the association between IE and adiposity in midlife women. We also aimed to validate the factor structure of the Intuitive Eating Scale (IES) in a sample of midlife women.

METHOD

We analyzed data from a cross-sectional study of 116 women between 40 and 64 years of age. Participants completed in-person visits and self-reported questionnaires, including the 21-item IES. Adiposity was assessed using dual energy x-ray absorptiometry. Measurements included total body fat percentage and android/gynoid (AG) ratio as a measure of abdominal adiposity.

RESULTS

Confirmatory factor analysis of the IES demonstrated a poor fit to the data. Thus, we conducted an exploratory factor analysis which resulted in a 15-item scale with five items on each subscale, and demonstrated improved fit. Higher intuitive eating was associated with lower total body fat percentage (β = -6.77, p < 0.0001) and lower abdominal adiposity (β = -0.09, p = 0.0005). Higher scores on eating for physical reasons and reliance on internal hunger and satiety cues were associated with lower total body fat and lower abdominal adiposity.

CONCLUSIONS

Our findings suggest that higher intuitive eating is associated with lower total body fat percentage and lower abdominal adiposity. These results may have public health implications to promote intuitive eating in midlife women, a population at risk of weight gain and changes to body fat distribution.

The Interplay between Metabolic Syndrome and Religious Fasting in Postmenopausal Women

Religious fasting that involves abstinence from specific food(s) is part of many religions worldwide and has been gaining attention by the research community during the last years. The study aimed to investigate whether the periodic Christian Orthodox fasting mitigates the changes in body composition, dietary intake, and metabolic syndrome (MetS) in postmenopausal women. One hundred and thirty-four postmenopausal women aged 57.3 ± 6.7 years participated in this study. The Christian Orthodox fasting was followed by 68 postmenopausal women since their childhood, whereas 66 postmenopausal women were non-fasters. Data collection involved anthropometric, biochemical, clinical, and dietary information. Postmenopausal women who fasted according to Christian Orthodox Church recommendations had significantly higher mean fat free mass (45 vs. 44 kg, p = 0.002), hip circumference (104 vs. 99 cm, p = 0.001), and diastolic blood pressure (79 vs. 82 mmHg, p = 0.024). No other differences were found with regards to anthropometric data. Fasters also consumed significantly less fat (78 vs. 91 g, p = 0.006), as well as saturated (19 vs. 23 g, p = 0.015), monounsaturated (41 vs. 47 g, p = 0.018), and polyunsaturated fat (8.5 vs. 10 g, p = 0.023), trans fatty acids (0.5 vs. 2.3 g, p = 0.035), and cholesterol (132 vs. 176 g, p = 0.011). In terms of MetS features, non-fasters had more frequently elevated fasting blood glucose (11.8 vs. 24.2%, p = 0.039) and elevated blood pressure (13.2 vs. 36.4%, p = 0.041) compared with fasters. MetS was more common in non-fasters versus fasters with a marginal level of significance (30.3 vs. 23.5%, p = 0.052). Postmenopausal women who follow the Christian Orthodox fasting regime had lower fat intake, and no other difference in nutrient intake, compared with non-fasters. The latter were more likely to have MetS and some of its components. Overall, periodic abstinence from meat, dairy products, and eggs might play a protective role in postmenopausal women with regard to MetS.

Regular Exercise in Drosophila Prevents Age-Related Cardiac Dysfunction Caused by High Fat and Heart-Specific Knockdown of skd

Skuld (skd) is a subunit of the Mediator complex subunit complex. In the heart, skd controls systemic obesity, is involved in systemic energy metabolism, and is closely linked to cardiac function and aging. However, it is unclear whether the effect of cardiac skd on cardiac energy metabolism affects cardiac function. We found that cardiac-specific knockdown of skd showed impaired cardiac function, metabolic impairment, and premature aging. Drosophila was subjected to an exercise and high-fat diet (HFD) intervention to explore the effects of exercise on cardiac skd expression and cardiac function in HFD Drosophila. We found that Hand-Gal4>skd RNAi (KC) Drosophila had impaired cardiac function, metabolic impairment, and premature aging. Regular exercise significantly improved cardiac function and metabolism and delayed aging in HFD KC Drosophila. Thus, our study found that the effect of skd on cardiac energy metabolism in the heart affected cardiac function. Exercise may counteract age-related cardiac dysfunction and metabolic disturbances caused by HFD and heart-specific knockdown of skd. Skd may be a potential therapeutic target for heart disease.

Adipose tissue aging: An update on mechanisms and therapeutic strategies

Aging is a complex biological process characterized by a progressive loss of physiological integrity and increased vulnerability to age-related diseases. Adipose tissue plays central roles in the maintenance of whole-body metabolism homeostasis and has recently attracted significant attention as a biological driver of aging and age-related diseases. Here, we review the most recent advances in our understanding of the molecular and cellular mechanisms underlying age-related decline in adipose tissue function. In particular, we focus on the complex inter-relationship between metabolism, immune, and sympathetic nervous system within adipose tissue during aging. Moreover, we discuss the rejuvenation strategies to delay aging and extend lifespan, including senescent cell ablation (senolytics), dietary intervention, physical exercise, and heterochronic parabiosis. Understanding the pathological mechanisms that underlie adipose tissue aging will be critical for the development of new intervention strategies to slow or reverse aging and age-related diseases.

The negative association of lower body fat mass with cardiometabolic disease risk factors is partially mediated by adiponectin

Gluteofemoral fat correlates negatively with a number of cardiometabolic disease risk factors, but the mechanisms involved in these relationships are unknown. The aim of this study was to test the hypothesis that gluteofemoral fat attenuates the risk of cardiometabolic disease by increasing blood adiponectin levels. This was a cross-sectional study in which arm, leg, gluteofemoral, abdominal s.c. and visceral fat levels were measured by dual-energy X-ray absorptiometry in 648 African females. Fasting serum adiponectin, lipid, insulin and plasma glucose levels and blood pressure were measured. Relationships between variables were analysed using multivariable linear regression and structural equation modelling. Adiponectin correlated positively (β = 0.45, P < 0.0001) with gluteofemoral fat in a multivariable regression model that included age, height, and arm, s.c. and visceral fat levels. In further regression models, there was a negative correlation of gluteofemoral fat with fasting glucose (β = -0.28; P < 0.0001) and triglyceride levels (β = -0.29; P < 0.0001) and insulin resistance (HOMA; β = -0.26; P < 0.0001). Structural equation modelling demonstrated that adiponectin mediated 20.7% (P < 0.01) of the association of gluteofemoral fat with insulin resistance and 16.1% (P < 0.01) of the association with triglyceride levels but only 6.67% (P = 0.31) of the association with glucose levels. These results demonstrate that gluteofemoral and leg fat are positively associated with adiponectin levels and that the negative association of lower body fat with insulin resistance and triglyceride levels may partially be mediated by this adipokine. Further studies are required to determine other factors that mediate the effect of lower body fat on cardiometabolic disease risk factors.