Body fat, overweight and obesity in adult menopausal women

Introduction

Menopause signifies the phase during which ovarian activity ceases, leading to the discontinuation of ovulation and impeding fertilization. This transition is accompanied by notable hormonal, physical, and psychological transformation. Numerous women encountering menopausal symptoms undergo a discernible deterioration in their quality of life, particularly those with excess weight, obesity, and exposure to adverse environmental influences.^1,2

The global prevalence of overweight and obesity is widespread. Projections suggest that the prevalence of obesity in women is poised to exceed 20% by 2025.³ Obesity is a comorbidity that increases the risk to many disorders. From a physiological perspective, the adverse ramifications of obesity are intricately linked to dysfunctions within adipose tissue, engendering perturbations in the hormonal milieu, encompassing sexual hormones.⁴

The menopausal transition renders women susceptible to weight gain,⁵ a phenomenon observed irrespective of prior body composition, size, geographical locale, or ethnicity.⁶ Concomitantly, alterations in fat mass distribution arise due to hormonal perturbations, encompassing heightened levels of androgens,⁷ and follicle stimulating hormone (FSH).⁸ Noteworthy is the observation that postmenopausal women harboring a healthy body mass index (BMI) yet exhibiting elevated adiposity in the trunk region and diminished adiposity in the lower extremities, manifest heightened vulnerability to cardiovascular ailments.^9,10 Certain investigations posit that women who maintain a low BMI in the premenopausal phase, engage in regular physical activity, adhere to a healthful diet, and possess higher educational attainment, tend to sustain a favorable distribution of body fat subsequent to menopause.¹⁰ Conversely, multiparity stands recognized as a risk factor for obesity development among postmenopausal women.¹¹ Strategies encompassing hormone replacement therapy administered to premenopausal women with elevated BMI, exhibit a higher risk of venous thromboembolism, notably pronounced within the initial year of treatment.¹²

The assessment of coping strategies concerning the repercussions of menopause necessitates a comprehensive exploration of the determinants linked to heightened body fat accumulation. Such endeavors hold crucial significance in facilitating proficient assistance for menopausal women,¹³ underscoring the imperative nature of elucidating distinct impediments obstructing the assimilation of healthful lifestyle practices among postmenopausal individuals.¹⁴ Hence, the primary objective of this study was to evaluate the determinants linked with the proportion of body fat, overweight, and obesity among a cohort of menopausal adult women aged 40 to 60 years. This investigation was conducted within the premises of a private clinic situated in Lima, Peru.

Methods

Results

In total, 58 women were evaluated, more than half of the women were between 52 and 60 years of age (53.4%), were not housewives (70.2%), and received between 8 and 16 consultations (70.2%). A third of participants consumed tobacco (36.2%), consumed coffee (77.6%), consumed water (91.4%), consumed soft drinks (43.1%), consumed fish (87.7%), consumed chicken (94.7%), consumed beef (80.7%), consumed offal (22.8%), consumed eggs (100%), consumed pork (38.6%), consumed dairy products (96.5%), and were physically active (41.1%). BMI values changed (initial BMI-final BMI), Normal (19%-39.7%), Overweight (39.7%-34.5%), Obesity (41.3%-25.8%) (see Table 1).

Table 2 shows a considerable decrease in weight and body fat when comparing the measurements at the beginning and at the end of the nutritional consultations, a difference that is statistically significant.

The sole variable demonstrating a significant association with the reduction in body fat percentage was the frequency of nutritional consultations falling within the range of 8 to 16 sessions (p<0.05) (Table 3).

Multiple regression analysis shows the variables nutritional consultation and no coffee consumption to be associated with decreased body fat (p<0.05) (Table 4).

Discussion

More than half of the women were between 52 and 60 years of age and the foods with the highest consumption were coffee (77.6%), water (91.4%), fish (87.7%), chicken (94.7%), beef (80.7%), eggs (100%) and dairy products (96.5%). Factors associated with decreased body fat were having between 8 to 16 nutritional consultations (RR:1.78; p<0.001) and no coffee consumption (RR:8.13; p<0.031).

The entry to menopause comes with an imbalance of estrogen and androgens levels leading to impaired energy metabolism. These hormonal changes lead to the increase in adipose tissue that is key to overweight and obesity.¹⁵ In this study 60% of the patients were overweight and obese, the patients were admitted to a feeding regimen, according to the answers given to the clinical nutritionist in charge of the care, and consumption alternatives were offered. Weight gain is common during the menopausal transition process and women who are already obese or overweight tend to gain more weight when they reach and during menopause. Nutritionally, this should be addressed by reducing caloric intake and promoting physical activity and other good lifestyles.¹⁶ Authors such as Ko and Jung (2020) suggest some foods as part of the diets to appropriately and timely address postmenopausal women.¹⁷

Dmitruk et al. (2018) found that the perimenopausal group had higher values of body mass, hip circumference, and most skinfolds. Postmenopausal women presented higher body fat percentage and for the lower lean tissue, soft tissue, and total body water content. The researchers found that the highest proportion of obese women was found in the postmenopausal group, where 40% of them presented visceral obesity. Thus, menopause contributed to changes in the distribution of fat tissue.¹⁸

In this study it was found that women who received between 8 to 16 nutritional consultations had a lower amount of fat mass, which indicates that the advice of a nutrition professional would help to avoid fat accumulation in postmenopausal women. Studies have shown that nutritional consultations followed by adherence to low-calorie diets have also had a large effect on weight loss.^19–21

Our results showed that not consuming coffee (RR=8.13 [95% CI: 1.22-54.31]; p<0.031), is associated with lower body fat among menopausal women. This is in line with previous studies that indicate a link between coffee and obesity²² and other chronic conditions such as vascular problems in menopausal women.²³ The explanatory mechanism by which overweight or obesity is present could be because coffee is a product that contains mainly caffeine and some studies suggest that constant and prolonged caffeine consumption impacts the quantity and quality of sleep.^24,25 Scientific evidence indicates that lack of sleep is a risk factor for several types of metabolic problems, including obesity. The rationale for this is that when individuals get too little sleep, they alter the release of multiple hormones, including cortisol, whose increase causes hyperglycemia and thus insulin activates lipogenesis.²⁶ In this study, the participants may have different frequencies of consumption, amounts of coffee ingested, type of coffee consumed, time of consumption, amount of sugar, among other aspects of eating habits. Therefore, further studies are needed to identify the quantity and time of consumption of caffeine-containing beverages in pre- and post-menopausal women.

As a limitation, we did not identify the specific intervention that each of the participants received, so that the benefit of the diet plan and recommendations provided by the professional nutritionist could alter the results by increasing or decreasing the strength and direction of the association. However, the professional nutritionist followed an institutional protocol for the nutritional management of patients.

Another limitation of the study is that there was no data on the number of calories ingested and intensity of the physical activity performed by each patient. These particularities may modify the strength and direction of the association. Based on our data, we provide indications of the possible positive effect of following a structured diet and performing physical activity.

Conclusions

The abstention from coffee consumption and engagement in nutritional consultations have been found to correlate with a reduction in body fat among menopausal women. The adoption of low-carbohydrate and low-fat dietary regimens may offer efficacy in the context of body fat reduction in pre and postmenopausal women.