Menopause, race and weight gain

November 8, 2019
Bob Kronemyer

Freelance writer for Contemporary OB/GYN

Research from the American Journal of Obstetrics & Gynecology indicates that menopausal white women gain significantly more abdominal fat than black women, potentially increasing their risk of type 2 diabetes and CVD.

During menopause transition, white women gained significantly more abdominal fat than black women, which also coincided with increased cardiometabolic risk for white women, according to an analysis of a prospective, observational cohort study in the American Journal of Obstetrics & Gynecology (AJOG).

“There is substantial evidence that increases in abdominal fat occur during the menopause transition, and that these increases predispose women to increased risk for developing type 2 diabetes and cardiovascular disease,” said first author Kara Marlatt, PhD, MPH, a postdoctoral fellow in women’s health at the Pennington Biomedical Research Center in Baton Rouge, Louisiana.

Methods
Much less is known, however, about how women of different races are impacted by these gains in abdominal fat. “If women of different races have similar increases in abdominal fat, but one race has a much greater increase in cardiometabolic risk, then we as scientists and physicians may need to consider more tailored treatments for women of different races that are going through menopause,” Dr. Marlatt told Contemporary OB/GYN

To investigate this, Dr. Marlatt and her colleagues used data from the Healthy Transition study, which consisted of 161 women, 43 years and older with a body mass index (BMI) between 20 and 40 kg/m2, who had not yet transitioned through menopause. All study women were enrolled at the Pennington Biomedical Research Center.

Women were seen annually between 1998 and 2006 for measurements of body composition by dual-energy X-ray absorptiometry, abdominal adipose tissue distribution by computed tomograph, as well as evaluation of sex steroid horomones. Cardiometabolic risk factors, including fasting glucose, insulin, and lipids, were also assessed yearly.

Results
A total of 94 women (25 black, 69 white) who participated in the Healthy Transitions study actually transitioned through menopause and were included in the secondary analysis. At enrollment, black women weighed more than white women: 77.8 kg vs. 70.8 kg, respectively.

“However, white women gained significantly more weight through the years, approximately 3 kg,” Dr. Marlatt said. “And this weight gain was primarily due to increases in abdominal fat of around 19%.”

White women also had greater fluctuations in their hormones and had greater increases in total cholesterol and LDL-cholesterol.

Conclusions
“Our findings were somewhat surprising,” Dr. Marlatt said. “Instead of black and white women gaining similar amounts of weight and abdominal fat during menopause, white women simply caught up to the same level of abdominal fat as the black women in our study,” Dr. Marlatt said. “This could be due to greater fluctuations in their hormones, as well as possible differences in their diet, physical activity level or genetics.”

The study supports increased attention to race differences in how abdominal fat status (or obesity status) before menopause may affect both hormonal changes and changes in abdominal fat across menopause, according to Dr. Marlatt.

“We think there is a potential opportunity for physicians to consider more comprehensive risk profiling of women during the menopause transition as part of their routine clinic visits,” she said. The authors also recommend more aggressive treatment approaches to reduce abdominal fat in the years leading up to menopause.

“We believe that reducing abdominal fat in women before menopause onset may be more advantageous and lead to more successful weight control than waiting until the postmenopausal years,” Dr. Marlatt said.

Future studies by the investigators will focus on comprehensive lifestyle approaches, including diet and exercise, to reduce abdominal fat before menopause onset, with careful consideration of how hormonal changes may impact their findings.

Disclosures:

Dr. Marlatt reports no relevant financial disclosures.