Abstract
Chronotype is defined as the behavioral manifestation of circadian rhythms related to the external light–dark cycle. Evening chronotype has been associated with an increased risk of developing cardiometabolic diseases in obesity. Menopause is a lifestage associated with an increased risk of developing cardiometabolic diseases and a change in circadian rhythmicity compared to pre-menopause. However, the prevalence of chronotype categories in menopause and their role in determining menopause-related cardiometabolic risk, mostly in obesity, have not been investigated. Thus, we aimed to investigate the prevalence of chronotype categories in post-menopausal women with obesity and their role in menopause-related cardiometabolic risk. In this cross-sectional study we enrolled 49 pre-menopausal and 74 post-menopausal women with obesity. Anthropometric parameters, lifestyle habits, adherence to the Mediterranean Diet (MD), sleep quality, chronotype and the presence of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) were studied. No significance differences were detected in terms of lifestyle and adherence to the MD between pre- and post-menopausal women. Chronotype was classified as morning in 66 (53.6%), evening in 20 (16.3%) and intermediate in 37 (30.1%) women. In addition, pre-menopausal women with obesity showed a significantly higher chance to have an intermediate chronotype (OR = 2.21, 95% CI 1.28–3.83; p = 0.004), whereas post-menopausal women with obesity showed a trend to have a higher morning chronotype (OR = 1.42, 95% CI 0.98–2.06; p = 0.051), although this did not reach statistical significance. No significant differences were detected in terms of prevalence of evening chronotype between the two groups. However, the evening chronotype had a significantly higher risk to have T2DM compared to the morning (OR = 17.29, 95% CI 2.40–124.27; p = 0.005) and intermediate chronotypes (OR = 30.86, 95% CI 2.05–464.32; p = 0.013) in both pre- and post-menopausal women with obesity. In conclusion, the intermediate chronotype was significantly more prevalent in pre-menopausal women with obesity compared to post-menopausal women. Evening chronotype was associated to T2DM in both pre- and post-menopause. These results support the importance of including the assessment of chronotype in the management of women with obesity in post-menopause.
Highlights
The behavioral manifestation of the internal circadian clock system related to the external light–dark cycle is commonly referred to as the chronotype [1,2]
Given the role of chronotype in determining the risk of developing cardiometabolic diseases, and given the fact that menopause is a lifestage associated with an increased risk of developing cardiometabolic diseases compared to pre-menopause, we aimed to investigate the prevalence of chronotype categories in post-menopausal compared to premenopausal women with obesity and the role of chronotype in determining menopauserelated cardiometabolic diseases
After adjusting the analysis for menopause, Body Mass Index (BMI), smoking, dyslipidemia, and sleep quality (Model 1), the evening chronotype had a significantly higher risk to have type 2 diabetes mellitus (T2DM) in both pre- and post-menopausal women compared to the morning (OR = 17.29, 95% CI 2.40–124.47; p = 0.005) and intermediate chronotypes (OR = 30.86, 95% CI 2.05–464.32; p = 0.013)
Summary
The behavioral manifestation of the internal circadian clock system related to the external light–dark cycle is commonly referred to as the chronotype [1,2]. There are three general categories of chronotypes based on variants of the circadian behavioral phenotype: morning, evening, and intermediate chronotypes [3]. The morning chronotype (defined as “larks”) tends to wake up early and prefers activities earlier in the day, while the evening chronotype (defined as “owls”) generally wakes up later and prefers to perform major activity in the late afternoon or evening. Intermediate chronotype is an intermediate position between the morning and evening chronotypes [3]. The evening chronotype encounters health problems such as psychological disorders and gastrointestinal diseases more often and has a higher mortality rate than the morning chronotype [4,5]. The evening chronotype has been reported to be more prone to develop metabolic diseases such as type 2 diabetes (T2DM) and metabolic syndrome than the morning chronotype [6]
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