Metabolic Disorders in Menopause and their Correction (
DOI:
https://doi.org/10.12970/2310-9971.2016.04.01.3Keywords:
Dietary management, lipid disorders, metabolic syndrome, obesity, physical exercise, postmenopause, type 2 diabetes mellitus.Abstract
Menopause represents a complex period in the women’s life. Several disorders of nutrition and metabolism are accompanying it. The information on this topic is increasing. The carbohydrate disturbances include impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM), but not only. The estrogen deficiency could be an essential contributor to the process of diabetogenesis. Other significant factors for the risk of T2DM are: ageing, obesity (with increasing incidence after menopause), lowering of physical activity, smoking, drinking, some drugs a.s.o. Unfortunately, there are in the scientific literature a number of controversies regarding the relation menopause – diabetes. For instance, an important American study (Diabetes Prevention Program) pointed out that natural menopause did not associate with an increased risk of diabetes and did not influence the answer to the preventive strategy. On the other hand, a large European trial (EPIC – InterAct Study) concluded that early menopause has produced a higher risk for T2DM. Referring to the control of diabetes in the menopause period, many studies emphasize on diet and improving lifestyle, with a major role of physical activity. It is interesting that metformin use in postmenopausal women with diabetes was associated with a lower incidence of invasive breast cancer. Hormone Replacement Therapy (HRT), proposed for the correction of menopause, seems not to be adequate for the women with T2DM. The increase in abdominal and, more particularly, visceral fat accumulation, is associated in menopause with a higher risk of developing an atherogenic lipid profile and an insulin-resistant state. Elevation of total cholesterol, LDL-cholesterol, triglycerides and lipoprotein (a) levels and lowering of HDL-cholesterol levels are observed in the menopause. There is an association between postmenopausal status and a substantial risk of the metabolic syndrome. The cardiovascular risk is also significantly modified. These disorders have a major impact on the quality and duration of life. Their control is in increasing attention of the medical staff.References
[1] Gorodeski GI, Utian WH. Epidemiology and risk factors of cardiovascular disease in postmenopausal women. In: Lobo RA, Ed. Treatment of the Postmenopausal Women. New York: Reaven Press, 1994; pp. 199-221.
[2] Szekacs B, Vajo Z, Varhiro S, et al. Postmenopausal hormone replacement improves proteinuria and impaired creatinine clearance in type 2 diabetes mellitus and hypertension. Brit J Obst Gynaec 2000; 107: 1017-1021. http://dx.doi.org/10.1111/j.1471-0528.2000.tb10406.x
[3] Wylie-Rosett J. Menopause, micronutrients, and hormone therapy. Am J Clin Nutr 2005; 81(Suppl): 1223S-31S.
[4] Carr MC. The Emergence of the Metabolic Syndrome with Menopause. J Clin Endocr Metab 2003; 88: 2404-2411. http://dx.doi.org/10.1210/jc.2003-030242
[5] Bringer HG, Dudley EC, Robertson DM, Dennenstein L. Hormonal changes in the menopause transition. Recent Prog Horm Res 2002; 57: 257-275. http://dx.doi.org/10.1210/rp.57.1.257
[6] Revis J, Keene S. Type II Diabetes in American Women over 40: Obesity and Menopause. The Internet Journal of Health 2006; 6(1).
[7] Kim C, Edelstein SL, Crandall JP, et al. Menopause and risk of diabetes in the Diabetes Prevention Program. Menopause 2011; 18(8): 857-868. http://dx.doi.org/10.1097/gme.0b013e31820f62d0
[8] Brand JS, van der Schouw YT, Onland-Moret NC, et al. Age at Menopause, Reproductive Life Span, and Type 2 Diabetes Risk. Results from The EPIC-InterAct study. Diabetes Care 2013; 36: 1012-1019. http://dx.doi.org/10.2337/dc12-1020
[9] Brand JS, Onland-Moret NC, Eijkemans MJC, et al. Diabetes and Onset of Natural Menopause. Results From the European Prospective Investigation Into Cancer and Nutrition. Hum Reprod 2015; 30(6): 1491-1498. http://dx.doi.org/10.1093/humrep/dev054
[10] Herber-Gast G-CM, Mishra GD. Early Severe Vasomotor Menopausal Symptoms Are Associated With Diabetes. Menopause 2014; 21(8): 855-860. http://dx.doi.org/10.1097/GME.0000000000000171
[11] Heianza Y, Arase Y, Kodama S, et al. Effect of Postmenopausal Status and Age of Menopause on Type 2 Diabetes and Prediabetes in Japanese Individuals: Toranomon Hospital Health Management Center Study 17 (TOPICS 17). Diabetes Care 2013; 36: 4007-4014. http://dx.doi.org/10.2337/dc13-1048
[12] Liu S, Tinker L, Song Y, et al. A Prospective Study of Inflammatory Cytokines and Diabetes Mellitus in a Multiethnic Cohort of Postmenopausal Women. Arch Intern Med 2007; 167(15): 1616-1685. http://dx.doi.org/10.1001/archinte.167.15.1676
[13] Chao C, Yiqing S, Cook N, et al. The Lack of Utility of Circulating Biomarkers of Inflammation and Endothelial Dysfunction for Type 2 Diabetes Risk Reduction Among Postmenopausal Women. Arch Intern Med 2010; 170(17): 1557-1565. http://dx.doi.org/10.1001/archinternmed.2010.312
[14] Tinker LF, Bonds DE, Margolis LK, et al. Low-Fat Dietary Pattern and Risk of Treated Diabetes Mellitus in Postmenopausal Women. The Women’s Health Initiative Randomized Controlled Dietary Modification Trial. Arch Intern Med 2008; 168(14): 1500-1511. http://dx.doi.org/10.1001/archinte.168.14.1500
[15] Davies MJ, Baer DJ, Judd JT, et al. Effects of Moderate Alcohol Intake on Fasting Insulin and Glucose Concentrations and Insulin Sensitivity in Postmenopausal Women. A Randomized Controlled Trial. JAMA 2002; 287: 2559-2562. http://dx.doi.org/10.1001/jama.287.19.2559
[16] Pereira MA, Parker ED, Folsom AR. Coffee Consumption and Risk of Type 2 Diabetes Mellitus. An 11-Year Prospective Study of 28812 Postmenopausal Women. Arch Intern Med 2006; 166: 1311-1316. http://dx.doi.org/10.1001/archinte.166.12.1311
[17] Chandalia M, Garg A, Lutjohann D, et al. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. NEJM 2000; 342: 1392-1398. http://dx.doi.org/10.1056/NEJM200005113421903
[18] Cassidy A, Albertazzi P, Nielsen IL, et al. Critical review of healthy effects of soybean phyto-oestrogens in postmenopausal women. Proceedings of the Nutrition Society 2006; 65: 76-92. http://dx.doi.org/10.1079/PNS2005476
[19] Chlebowski RT, McTiernan A, Wactawski-Wende J, et al. Diabetes, Metformin, and Breast Cancer in Postmenopausal Women. J Clin Oncol 2012. http://dx.doi.org/10.1200/JCO.2011.39.7505
[20] Andersson B, Mattsson L, Hahn L, et al. Estrogen Replacement Therapy Decreases Hyperandrogenicity and Improves Glucose Homeostasis and Plasma Lipids in Postmenopausal Women with Noninsulin-Dependent Diabetes Mellitus. J Clin Endocrinol Metab 1997; 82: 638- 643. http://dx.doi.org/10.1210/jc.82.2.638
[21] Remuzzi G. Abnormal protein traffic through the glomerular barrier induces proximal tubular cell dysfunction and causes renal injury. Curr Opin Nephrol Hypertens 1995; 4: 339-342. http://dx.doi.org/10.1097/00041552-199507000-00009
[22] Culver AL, Ockene IS, Balasubramanian R, et al. Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women’s Health Initiative. Arch Intern Med 2012; 172(2): 144-152. http://dx.doi.org/10.1001/archinternmed.2011.625
[23] Luo J, Rossouw J, Tong E, et al. Smoking Cessation, Weight Gain, and Risk of Type 2 Diabetes Mellitus Among Postmenopausal Women (Research Letter). Arch Intern Med 2012; 172(5): 438-439. http://dx.doi.org/10.1001/archinternmed.2012.24
[24] Luo J, Rossouw J, Margolis KL. Smoking Cessation, Weight Change, and Coronary Heart Disease Among Postmenopausal Women With and Without Diabetes (Research Letter). JAMA 2013; 310(1): 94. http://dx.doi.org/10.1001/jama.2013.6871
[25] Lizcano F, Guzmàn G. Estrogen Deficiency and the Origin of Obesity during Menopause. BioMed Research International 2014; article ID 757461, 11. http://dx.doi.org/10.1155/2014/757461
[26] Björntorp P. The regulation of adipose tissue distribution in humans. Int J Obesity 1996; 20: 291-302.
[27] Mauriège P, Imbeault P, Prud’homme D, et al. Subcutaneous Adipose Tissue Metabolism at Menopause: Importance of Body Fatness and Regional Fat Distribution. J Clin Endocrinol Metab 2000; 85: 2446-2454. http://dx.doi.org/10.1210/jc.85.7.2446
[28] Ryan AS, Nicklas BJ, Berman DM. Hormone Replacement Therapy, Insulin Sensitivity, and Abdominal Obesity in Postmenopausal Women. Diabetes Care 2002; 25: 127-133. http://dx.doi.org/10.2337/diacare.25.1.127
[29] Mastorakos G, Valsamakis G, Paltoglou G, et al. Management of obesity in menopause: diet, exercise, pharmacotherapy and bariatric surgery. Maturitas 2010; 65: 219-224. http://dx.doi.org/10.1016/j.maturitas.2009.12.003
[30] Brończyk-Puzoń A, Piecha D, Nowak J, et al. Guidelines for dietary management of menopausal women with simple obesity. Prz Menopauzalny 2015; 14(1): 48-52. http://dx.doi.org/10.5114/pm.2015.48678
[31] Huang AJ, Subak LL, Wing R, et al. An Intensive Behavioral Weight Loss Intervention and Hot Flushes in Women. Arch Intern Med 2010; 170(13): 1161-1167. http://dx.doi.org/10.1001/archinternmed.2010.162
[32] van Gemert WAM, van der Palen J, Monninkhof EM, et al. Quality of Life after Diet or Exercise-Induced Weight Loss in Overweight to Obese Postmenopausal Women: The SHAPE2 Randomized Controlled Trial. PLoS ONE 2015; 10(6): e01237520. http://dx.doi.org/10.1371/journal.pone.0127520
[33] Jouyandeh Z, Nayebzadeh F, Qorbani M, Asadi M. Metabolic syndrome and menopause. Journal of Diabetes and Metabolic Disorders 2013; 12: 1. http://dx.doi.org/10.1186/2251-6581-12-1
[34] Stachowiak G, Pertyński T, Pertyńska-Marczewska M. Metabolic disorders in menopause. Prz Menopauzalny 2015; 14(1): 59-64. http://dx.doi.org/10.5114/pm.2015.50000
[35] Gurka JM, Vishnu A, Santen RJ, DeBoer MD. Progression of Metabolic Syndrome Severity During the Menopausal Transition. J Am Heart Assoc 2016; 5: e003609. http://dx.doi.org/10.1161/JAHA.116.003609
[36] Kim HM, Park J, Ryn SY, Kim J. The Effect of Menopause on the Metabolic Syndrome Among Korean Women. The Korean National Health and Nutrition Examination Survey, 2001. Diabetes Care 2007; 30: 701-706. http://dx.doi.org/10.2337/dc06-1400
[37] Janssen I, Powell LH, Crawford S, Lasley B, Sutton-Tyrell K. Menopause and the Metabolic Syndrome. The Study of Women’s Health Across the Nation. Arch Intern Med 2008; 168(14): 1568-1575. http://dx.doi.org/10.1001/archinte.168.14.1568
[38] Magkos F, Mittendorfer B. Gender differences in lipid metabolism and the effect of obesity. Obstet Gynecol Clin North Am 2009; 36: 245-265. vii [PubMed:19501312]. http://dx.doi.org/10.1016/j.ogc.2009.03.001
[39] Wang X, Magkos F, Mittendorfer B. Sex Differences in Lipid and Lipoprotein Metabolism: It’s Not Just About Sex Hormones. J Clin Endocrinol Metab 2011; 96(4): 885-893. http://dx.doi.org/10.1210/jc.2010-2061
[40] Freedman DS, Otvos JD, Jeyarajah EJ, et al. Sex and age differences in liporotein subclasses measured by nuclear magentic resonancy spectroscopy: the Framingham Study. Clin Chem 2004; 50: 1189-1200. http://dx.doi.org/10.1373/clinchem.2004.032763
[41] Jensen J, Nilas L, Christiansen C. Influence of menopause on serum lipids and lipoproteins. Maturitas 1990; 12: 321- 331. http://dx.doi.org/10.1016/0378-5122(90)90012-U
[42] Carr MC, Kim KH, Zambon A, et al. Changes in LDL density across the menopausal transition. J Invest Med 2000; 48: 245-250.
[43] Stevenson JC, Crook D, Godsland IF. Influence of age and menopause on serum lipids and liporoteins in healthy women. Atherosclerosis 1993; 98: 83-90. http://dx.doi.org/10.1016/0021-9150(93)90225-J
[44] Chang P-Y, Gold EB, Cauley JA, et al. Triglyceride Levels and Fracture Risk in Midlife Women: Study of Women’s Health Across the Nation (SWAN). J Clin Endocrinol Metab 2016. http://dx.doi.org/10.1210/jc.2016-1366
[45] Vari IS, Balkau B, Kettaneh A, et al. DESIR Study Group Ferritin and transferrin are associated with metabolic syndrome abnormalities and their change over time in general population. Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR). Diabetes Care 2007; 30: 1795-801. http://dx.doi.org/10.2337/dc06-2312
[46] Cho GJ, Shin JH, Yi KW, et al. Serum ferritin levels are associated with metabolic syndrome in postmenopausal women but not in premenopausal women. Menopause 2011; 18: 1120-4. http://dx.doi.org/10.1097/gme.0b013e318217e172
[47] Ju SY, Ha AW. Dietary factors associated with high serum ferritin levels in postmenopausal women with the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V), 2010-2012. Nutrition Research and Practice 2016; 10(1): 81-88. http://dx.doi.org/10.4162/nrp.2016.10.1.81
[48] Wylie-Rosett J. Menopause, micronutrients, and hormone therapy. Am J Clin Nutr 2005; 81(Suppl): 1223S-31S. Available from: ajcn.nutrition.org
[49] van Gemert WA, Lanting CI, Goldbohm RA, et al. The proportion of postmenopausal breast cancer cases in the Netherlands attributable to lifestyle-related risk factors. Breast Cancer Res Treat 2015; 152: 155-162. http://dx.doi.org/10.1007/s10549-015-3447-7
[50] Luzia LA, Aldrighi JM, Damasceno NRT, et al. Fish oil and vitamin E change lipid profiles and anti-LDL-antibodies in two different ethnic groups of women transitioning through menopause. Nutr Hosp 2015; 32(1): 165-174.
[51] Liu Z-m, Ho SC, Xie YJ, et al. Associations between dietary patterns and psychological factors: a cross-sectional study among Chinese postmenopausal women. Menopause 2016. http://dx.doi.org/10.1097/GME.0000000000000701
[52] Blümel JE, Fica J, Chedraui P, et al. Sedentary Lifestyle in Middle-aged Women Is Associated With Severe Menopausal Symptoms and Obesity. Menopause 2016; 23(5): 488-493. http://dx.doi.org/10.1097/GME.0000000000000575
[53] World Health Organization (WHO). Global Recommendations on Physical Activity for Health. WHO, Geneva 2010.
[54] Dabrowska J, Dabrowska-Galas M, Naworska B, Wodarska M, Plinta R. The role of physical activity in preventing obesity in midlife women. Prz Menopauzalny 2015; 14(1): 13-19. http://dx.doi.org/10.5114/pm.2015.49252
[55] Despres JP, Pouliot MC, Moorjani S, et al. Loss of abdominal fat and metabolic response to exercise training in obese women. Am J Physiol 1991; 261: E159-E167.
