Abstract 4342694: Body Composition and Physical Activity Predictors of Vascular Health in Premenopausal and Postmenopausal Asian Women: A Comparative Analysis

Visceral adipose tissue (VAT) is increased in the postmenopausal state, which may contribute to an increase in cardiovascular diseases. This study was undertaken to investigate whether there is a difference in the change of VAT during a weight reduction program between premenopausal and postmenopausal obese women. This study was a longitudinal clinical intervention of a weight reduction program, including lifestyle modification and adjuvant pharmacotherapy, for 12 weeks in 21 premenopausal and 19 postmenopausal obese women. Weight, height, body fat percentage, and waist and hip circumferences were measured. Visceral, subcutaneous, and total adipose tissue of the abdomen were determined by CT scan at the level of L4-L5 before and after weight reduction. The percent changes in VAT and the visceral-to-subcutaneous adipose tissue ratio, as well as waist circumference and waist-to-hip ratio, in the postmenopausal women were significantly less than those in the premenopausal women, whereas the percent changes in hip circumference, fat mass, total adipose tissue, and subcutaneous adipose tissue were similar in the two groups. The association between percent changes of VAT and the percent change of waist circumference is stronger in postmenopausal than in premenopausal women. The postmenopausal women lost less VAT compared with the premenopausal women during the weight reduction program. This may make it more difficult for postmenopausal women to overcome the increased risk of cardiovascular diseases compared with premenopausal women.

Mammographic density is a measurable and modifiable biomarker that is strongly and independently associated with breast cancer risk. Paradoxically, although Asian women have lower risk of breast cancer, studies of minority Asian women in predominantly Caucasian populations have found that Asian women have higher percent density. In this cross-sectional study, we compared the distribution of mammographic density for a matched cohort of Asian women from Malaysia and Caucasian women from Sweden, and determined if variations in mammographic density could be attributed to population differences in breast cancer risk factors. Volumetric mammographic density was compared for 1501 Malaysian and 4501 Swedish healthy women, matched on age and body mass index. We used multivariable log-linear regression to determine the risk factors associated with mammographic density and mediation analysis to identify factors that account for differences in mammographic density between the two cohorts. Compared to Caucasian women, percent density was 2.0% higher among Asian women (p<0.001), and dense volume was 5.7cm3 higher among pre-menopausal Asian women (p<0.001). Dense volume was 3.0cm3 lower among post-menopausal Asian women (p=0.009) compared to post-menopausal Caucasian women, and this difference was attributed to population differences in height, weight, and parity (p<0.001). Our analysis suggests that among post-menopausal women, population differences in mammographic density and risk to breast cancer may be accounted for by height, weight, and parity. Given that pre-menopausal Asian and Caucasian women have similar population risk to breast cancer but different dense volume, development of more appropriate biomarkers of risk in pre-menopausal women is required.

WHAT IS KNOWN ON THE SUBJECT?: Pre- and postmenopausal women (PPW) experience changes in physical, psychological and social health. South-East Asia's female suicide rate is the highest compared with other countries, and the suicide rate of PPW in these countries continues to increase. The most influential factor in Asian women's suicidal ideation is family conflict; specifically, if PPW in South Korea cannot express their anger, it results in a culture-bound syndrome called "Hwa-Byung." However, there is a lack of research on Asian PPW. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study found differences in individual- and community-level factors affecting suicidal ideation between pre- and postmenopausal women. Individual factors that commonly affected suicidal ideation were experiencing violence, stress and depression. Individual factors that affected the suicidal ideation of premenopausal women more than postmenopausal women were religious beliefs, alcohol use and chronic disease. Community level factors affecting suicidal ideation were locational depression and locational counselling for stress in premenopausal women and locational counselling for depression in postmenopausal women. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses could help prevent suicide by developing and applying community-based programmes for PPW, considering the specific socio-economic and cultural context and characteristics of Asian women. Mental health nurses could help PPW participate in programmes by preparing various interventions such as case management, personal counselling, physical activity, home-based mental health services, cognitive behavioural therapy and digital interventions for self-management. Mental health nurses need to prepare various methods such as online, offline, individual and group methods to work effectively in any social situation. ABSTRACT: Introduction Pre- and postmenopausal women (PPW) experience physical and psychological changes with hormonal changes. Among Asian middle-aged women, family and culture affect suicidal ideation, and the suicide rate among this population is increasing. There are few existing research on suicidal ideation among Asian PPW. Aim We examined individual- and community-level factors that predict suicidal ideation among PPW. Method Large-scale panel data from 5,154 South Korean PPW aged 35-64years were used in a series of multilevel logistic regression analyses to examine factors associated with suicidal ideation at individual and community levels. Results Among premenopausal women, religious beliefs, alcohol use, chronic disease, experience of violence, stress and depression were individual-level factors. Locational depression and locational counselling for stress were community-level factors. Among postmenopausal women, experience of violence, stress, depression and perceived health status were individual level factors, and locational counselling for depression was a community level factor. Discussion Suicidal ideation among PPW is affected by both individual and community level factors. Nurses must comprehensively determine what risk factors affect suicidal ideation through various intervention methods-including online, offline, individual and group methods-while considering socio-economic situations. Implications for Practice Mental health nurses should provide targeted biopsychosocial interventions targeting psychosocial and physical problems and promoting the use of community resources to reduce PPW's suicidal ideation.

Postabsorptive resting metabolic rate and thermic effect of food in relation to body composition and adipose tissue distribution

Background Bone mineral density (BMD) is strongly linked to body weight. Overweight exerts mechanical stress on the bone and prevents aging-induced decrease in BMD. Despite the positive association between BMI and BMD and bone mineral content (BMC), the role of fat distribution in BMD remains unclear. The aim of our study is to examine the relation between body composition and regional BMD in premenopausal and postmenopausal obese Egyptian women. Materials and methods This cross-sectional study included 50 obese Egyptian women with a mean age of 52.9±10.9 years and BMI over 30. They were divided into a premenopausal group (n=21) and a postmenopausal group (n=29). Total and regional BMD and body composition were measured by dual-energy X-ray absorptiometry (Lunar). BMD was measured at the hip, lumbar spine, and total body (BMD and BMC). Anthropometric measurements were performed for all participants. Results The premenopausal group had significantly higher total body BMD, BMC, and femur BMD than the postmenopausal group, whereas postmenopausal women had a significantly higher waist to hip ratio and trunk to total fat mass (FM) ratio than premenopausal women. The results of the multiple-regression analysis stepwise method showed that spine BMD, femur BMD, and whole-body BMD had significant correlations with the total lean mass (LM) and the trunk to total FM ratio in the postmenopausal women, whereas the total BMD was significantly correlated with the total LM only in the premenopausal women. Conclusion It can be concluded that lean body mass is a significant determinant of BMD in premenopausal obese women, whereas both body lean and fat mass are significant determinants of regional and total BMD in postmenopausal obese women. The study suggests that LM and FM have an alternative impact on BMD in premenopausal and postmenopausal Egyptian obese women.

Estrogens protect healthy women from cardiovascular disease. However, epidemiological data suggest that women with diabetes are denied the cardioprotection associated with estrogens. Whether or not hormonal replacement therapy (HRT) confers cardiovascular benefits in postmenopausal women with diabetes is not known. The aim of this study was to examine the effects of HRT on the microvascular reactivity and endothelial function of individuals with and without diabetes. We studied the following groups of individuals: premenopausal healthy women [n = 28, age 41 +/- 8 yr (mean +/- SD)], premenopausal women with type 2 diabetes (n = 16, age 43 +/- 6 yr); postmenopausal healthy women (n = 12, age 57 +/- 4 yr), postmenopausal women with diabetes (n = 17, age 62 +/- 5 yr); postmenopausal healthy women on HRT (n = 13, age 51 +/- 5 yr), postmenopausal women with diabetes on HRT (n = 11, age 57 +/- 7 yr). We used laser Doppler flowmetry to measure forearm cutaneous vasodilatation in response to iontophoresis of 1% acetylcholine (endothelium dependent) and 1% sodium nitroprusside (endothelium independent). The endothelium-dependent vasodilation was significantly higher in premenopausal healthy women (180 +/- 67%; increase over baseline) compared to premenopausal diabetic women (87 +/- 41%; P < 0.001). endothelium-dependent vasodilation was also higher in postmenopausal healthy women on HRT (143 +/- 52) compared with postmenopausal diabetic women on HRT (86 +/- 61), postmenopausal healthy women without HRT (104 +/- 43), and postmenopausal diabetic women without HRT (74 +/- 28; P < 0.001). A similar pattern of responses was observed in the endothelium-independent vasodilation (premenopausal healthy women, 126 +/- 56; premenopausal diabetic women, 88 +/- 26; postmenopausal healthy women on HRT, 121 +/- 37; postmenopausal diabetic women on HRT, 88 +/- 41; postmenopausal healthy women without HRT, 84 +/- 36; and postmenopausal diabetic women without HRT, 73 +/- 36; P < 0.001). Soluble intercellular adhesion molecule (sICAM) was also measured among all the women with diabetes. Premenopausal women with diabetes (248.9 +/- 56 ng/ml) and postmenopausal women with diabetes on HRT (257.7 +/- 49 ng/ml) had lower sICAM levels compared with the postmenopausal diabetic women without HRT (346.4 +/- 149 ng/ml; P < 0.05). We conclude that menopausal status and type 2 diabetes are associated with impaired microvascular reactivity. HRT substantially improves microvascular reactivity in postmenopausal healthy women. In contrast, the effect of HRT on the microvascular reactivity of postmenopausal diabetic women is less apparent. However, the use of HRT among women with diabetes is associated with lower sICAM levels, suggesting an attenuation in endothelial activation.

Effects of high-intensity training on cardiovascular risk factors in premenopausal and postmenopausal women

Khan and colleagues' (1) recently reported results from their phase II placebo-controlled randomized trial of the effects of soy (mixed isoflavone compound) on breast cell proliferation (Ki67), and nipple aspirate fluid (NAF) steroid levels are difficult to understand.They studied healthy, high-risk women: 49 in the soy group (28 premenopausal, 21 postmenopausal) and 49 in the placebo group (25 premenopausal, 24 postmenopausal). Baseline and on-treatment NAF were obtained from 26 women in the soy group and from 20 women in the placebo group. The median baseline NAF estradiol levels (Supplementary Table S1) were considerably higher in postmenopausal (276.5 pg/mL) than in premenopausal (116.4 pg/mL) women in the soy group, whereas these levels were similar in postmenopausal (110.8 pg/mL) and premenopausal (104.2 pg/mL) women in the placebo group. This difference between the soy and placebo postmenopausal groups is of concern because it would appear to show a failure of randomization between the 2 groups.In addition, it should be noted that these NAF estradiol results—higher levels in postmenopausal women in the soy group and no difference in levels between postmenopausal and premenopausal levels in the placebo group—are not compatible with the results of their previous studies. The study by Khan and colleagues (1) aimed at collecting the premenopausal NAF samples in the mid-luteal phase of the cycle and this was achieved in a high proportion of the women. In their most recent previous study (2), geometric mean NAF estradiol levels were considerably higher in premenopausal women in the luteal phase of the menstrual cycle (2,130 pg/mL) than in postmenopausal women (1,213 pg/mL). (Note: although the units are given as pg/mL in this 2010 report, this is likely to be a typographical error and the values should be reduced by a factor of 10.) Similarly, in another earlier study (3), they found a geometric mean NAF estradiol level of 86 pg/mL (316 pmol/L; Table 1 of ref. 3) in premenopausal women compared with 33 pg/mL (120 pmol/L; Table 1 of ref. 3) in postmenopausal women.The plasma genistein and NAF genistein levels also appear incongruous. In the soy group at 6 months, the median plasma genistein levels were 156 ng/mL in postmenopausal women and 205 ng/mL in premenopausal women. This was not reflected in the median NAF genistein levels, which were 88.25 ng/mL in postmenopausal women and 35.20 ng/mL in premenopausal women.In the soy group, the median Ki67 labeling index increased from 1.71% at entry to 2.18% at 6 months (P = 0.04) in premenopausal women and to a lesser extent in postmenopausal women (0.63% at entry to 0.77% at 6 months, P = 0.56). The corresponding levels remained unchanged in the placebo group for both premenopausal (1.90%–1.94%, p = 0.56) and postmenopausal (0.70%–0.63%, P = 0.22) women (see Table 3). Table 3 also shows that the Ki67 labeling index for premenopausal and postmenopausal women combined in the soy group was 1.17% at entry and 1.09% at 6 months. It is unclear how the overall 6-month soy group results can be lower when the values at 6 months were higher in both premenopausal and postmenopausal women. Furthermore, in their discussion (paragraph 2), the authors state that there was “a median decrease (of Ki67) of 0.13% in the postmenopausal-treated group, whereas in premenopausal women, it increased by 0.19%.” This statement does not agree with the results presented in Table 3.Finally, it should be noted that the Ki67 results of the soy group were both obtained in the luteal phase of the cycle in 25 of the 28 women in the group (89%) whereas this was only obtained in 18 of the 25 women (72%) in the placebo group. Because Ki67 is increased in the luteal phase of the cycle, this also raises concerns about the legitimacy of comparing the soy and placebo group Ki67 results.The data reported in the article are potentially very important because the use of soy isoflavone supplements has become common place and an increasing number of food products contain soy ingredients. However, we contend that our questions raise concerns about the results presented from this study.See the Response, p. 986No potential conflicts of interest were disclosed.

A substantial proportion of GH circulates bound to high affinity GH-binding protein (GHBP), which corresponds to the extracellular domain of the GH receptor. Current evidence indicates that nutritional status has an important role in regulating plasma GHBP levels in humans. In the present study the relationship among plasma GHBP levels, body composition [by bioelectrical impedance analysis (BIA) and dual energy x-ray absorptiometry (DEXA)] and serum estradiol (E(2)) was evaluated in premenopausal (n = 92) and postmenopausal (n = 118) healthy women with different body weight [three groups according to body mass index (BMI): normal, 18.5-24.99; overweight, 25-29.99; obese, 30-39.99 kg/m(2)]. Plasma GHBP levels were measured by high pressure liquid chromatography gel filtration. GH and insulin-like growth factor I levels were determined by immunoradiometric assay and RIA, respectively. GHBP levels were significantly higher in premenopausal women with BMI above 25 kg/m(2) (overweight, 3.789 +/- 0.306 nmol/L; obese, 4.372 +/- 0.431 nmol/L) than those observed in postmenopausal women (overweight, 1.425 +/- 0.09 nmol/L; obese, 1.506 +/- 0.177 nmol/L). No significant differences were found between normal weight premenopausal (1.741 +/- 0.104 nmol/L) and postmenopausal (1.524 +/- 0.202 nmol/L) women. In premenopausal women GHBP levels correlated positively with BMI (r = 0.675; P < 0.001), fat mass (FM; r = 0.782; P < 0.001; by BIA; r = 0.776; P < 0.001; by DEXA), truncal fat (TF; r = 0.682; P < 0.001), waist to hip circumference ratio (WHR; r = 0.551; P < 0.001), and E(2) (r = 0.298; P < 0.05), whereas no significant correlation was found in postmenopausal women between GHBP levels and BMI, FM, TF, WHR, or E(2). In normal weight pre- and postmenopausal women GHBP levels did not change between the ages of 20 and 69 yr. No statistically significant correlation was found between GHBP and age for all groups studied. Moreover, in two distinct subgroups of pre- and postmenopausal women, aged 40-49 yr, the direct relationship between GHBP levels and all indexes of adiposity were only observed in premenopausal women [BMI: r = 0.836; P < 0.001; FM: r = 0.745 (BIA) and r = 0.832 (DEXA); P < 0.001; TF: r = 0.782; P < 0.001; WHR: r = 0.551; P < 0.05], but not in postmenopausal women. In conclusion, the present data indicate a strong direct correlation between GHBP and body fat in premenopausal, but not in postmenopausal women, whereas they failed to detect a relationship between GHBP and age. Therefore, these results suggest that endogenous estrogen status may be an important determinant of the changes in GHBP levels in women with different body weights.

Caring for the Breast Cancer Survivor

DXA Measured Visceral Adipose Tissue, Total Fat, Anthropometric Indices and its Association With Cardiometabolic Risk Factors in Mother-Daughter Pairs From India

Widely used breast cancer risk-prediction tools are based on data from Western countries, but risk factors may differ for Asian women. Hence, we aimed to develop a risk assessment tool for breast cancer in Asian women using a nationwide, population-based mammographic screening cohort. Women aged ≥ 40 years who underwent breast cancer screening and general health examination in 2009 were included. Age, body mass index (BMI), breast density, lifestyle and reproductive factors, and comorbidities were used to develop 5-year breast cancer risk-prediction models for premenopausal (n=771,856) and postmenopausal (n=1,108,047) women at baseline. The best-fit risk prediction model was constructed using backward stepwise selection in a Cox proportional hazards model and was transformed into a risk score nomogram. The performance was assessed by discrimination and calibration. In premenopausal women, high BMI, low parity, short breastfeeding period, early age at menarche, high breast density, a history of benign breast masses, and family history of breast cancer contributed to the risk prediction of breast cancer. In postmenopausal women, age, diabetes mellitus, dyslipidemia, late-onset menopause, and hormone replacement therapy use were additional risk predictors of breast cancer. Our risk-prediction model showed a concordant statistic of 0.58 (0.57-0.59) for premenopausal women and 0.64 (0.63-0.65) for postmenopausal women. The calibration plot demonstrated good correlations for both models. Our breast cancer risk-prediction model demonstrated performance comparable to that of Western countries, especially among postmenopausal women. This provides a foundation for implementing risk-based screening recommendations in Asian women.

Association of Visceral and Subcutaneous Fat Mass With Bone Density and Vertebral Fractures in Women With Severe Obesity

The aim of this study was to determine the effect of sex and the menopausal transition on age-related differences in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) among patients with cardiovascular disease. A cross-sectional study of 997 women and 3,409 men with cardiovascular disease was performed. VAT and SAT were measured by ultrasonography. Differences in abdominal fat per decade in premenopausal and postmenopausal women were analyzed with linear regression and compared with men younger and older than the mean menopause age of women. VAT increased gradually across advancing age groups. For postmenopausal women, the 10-year differences in VAT were smaller than those for premenopausal women (0.24 cm [β = 0.24; 95% CI, 0.05 to 0.43] vs 0.71 cm [β = 0.71; 95% CI, 0.29 to 1.12]). There were no differences in SAT (β = -0.12; 95% CI, -0.37 to 0.13) in premenopausal women, and SAT decreased across the age groups of postmenopausal women (-0.36 cm per decade [β = -0.36; 95% CI, -0.47 to -0.26]). Postmenopausal women showed 10-year differences in VAT that were larger than those for men 48 years or older (0.24 cm per decade [β = 0.24; 95% CI, 0.05 to 0.43] vs -0.01 cm per decade [β = -0.01; 95% CI, -0.12 to 0.10]). In addition, 10-year differences in SAT were larger in postmenopausal women than in men 48 years or older (-0.36 cm [β = -0.36; 95% CI, -0.47 to -0.26] vs -0.22 cm [β = -0.22; 95% CI, -0.27 to -0.18]). Menopause is not associated with accelerated fat gain in women with cardiovascular disease. Compared with similar-aged men, postmenopausal women show a steeper increase in VAT and a steeper decrease in SAT. These ongoing changes might add to an unfavorable metabolic profile associated with an increased risk of recurrent cardiovascular events.

ObjectiveThe lower incidence of atherosclerosis in premenopausal women than in men was an established epidemiological observation. However, the incidence of cardiovascular disease in women increased dramatically after postmenopausal years. Compliance...