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Body mass index distribution in climacteric women
359
Muturit~, 9 (1988) 359-366 Elsevier Bcientiftc Publishers Ireland Ltd.
Body mass index distribution in climacteric women D. de Aloysiol,
A.S.
Villecco2, A.G. Fabiani’, M. Maulonir, L. Miliff? and F. Bottiglion?
P. Altierir,
lDelxutment of Obstetnks and Gynecology anti 21nMute of Medicine, Clinic II, Bologna University, Italy (Received 21 May 1987; revision received 1 8eptember 1987; accepted 20 November 1987)
Body Mass Index (BMI) was calculated in 2481 climacteric women selected from among the outpatients attending the Menopause Clinic at Bologna University in absence of hormonal replacement therapy and diseases that could cause weight gain. Analysis of variance of the W/Hz (wei8hVhei8ht squared) distribution in different age and climacteric situations demonstrates that the pm-menopause is a weight-gain inducing state and that ageing seems to cause a progressive increase in W/H*. (Key words: Overweight, obesity, Climacteric)
Introduetloa Menopause and overweight/obesity seem to have common consequences and to potentiate each other. However, no in-depth study to establish the relationship between the climacteric and overweight/obesity has been conducted to date [l41. In a previous investigation carried out by our group [5] the mean body mass index (BMI) in climacteric women (25.6 f 4.0 S.D.) was found to be significantly higher than the ideal value and the menopause seemed to be a weight-gain inducing cofactor. Sabjeets and methods
Weight/height
squared (W/H3
was calculated
in 2481 women selected from
C~pondence to: D. de Aloysio. Department of Obstetrics and Gynecology; Bologna University Via Massarenti 13, 40138 Bologna. Italy. 0378-5122/88/803.50 0 1988 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
360
among 4,150 outpatients (aged up to 65 yr) who attended the Menopause Clinic at Bologna University between 1976 and 1986. The selection criteria were as follows: (1) No hormonal replacement therapy during the previous 6 mth and no other drug treatment during the previous 3 mth. (2) Absence of diseases that could cause weight gain. W/H2 was calculated in relation to the following situations and factors: -history of natural menopause (from late fertile age to advanced natural post-menopause); -history of surgical menopause (from late fertile age to advanced surgical post-menopause); -transition from late fertile age to ‘pre-menopause (women aged 43-50 yr in both groups); -transition from pre-menopause to recent natural post-menopause (women aged 47-51 yr in both groups); -transition from late fertile age to recent surgical post-menopause (women aged 40-45 yr in both groups); - age at which natural or surgical menopause occurred; -time elapsed since natural or surgical menopause; - presence or absence of uterus in natural and surgical menopause; - ageing in each climacteric situation. The late fertile age group comprised women aged 40-50 yr with both regular and irregular cycles and women aged 45-50 yr with regular cycles (in our experience only 10% of these women undergo menopause within the following 12 mth). The pre-menopause group comprised women aged 40-45 yr with at least 6 mth of amenorrhoea whose plasma levels of oestradiol and gonadotrophins were
TABLE I HISTORY OF NATURAL MENOPAUSE Late fertile age z? f S.D. Age (yr) 46 f 3 W/H’
F=
Natural post-menopause 6-36 mth f f S.D.
37-% mth z? + S.D.
>%mth x f S.D.
49 f 3
51 + 4
54 f 4
58 f 4
25.25 f 3.74 25.97 zt 4.00 25.67 zt 3.78 n = 469
F-distribution.
Analysis of variance
Premenopause zi? f S.D.
n = 628
n = 629
F: 601.86 PC O.ocKlol 25.90 f 3.91 26.69 f 4.39 F: 4.46 P< 0.002 n = 336 n = 126
361
not indicative of ovarian failure, women aged 46-50 yr with irregularcycles and women aged over 50 yr with both regular and irregularcycles (in our experience more than 85% of these women undergo menopause within the following 12 mth).
TABLE II TRANSITION FROM LATE FERTILE AGE TO PRE-MENOPAUSE 43-50
W/H’
yr
Late fertile age 1 f S.D.
Pre-menopause z f S.D.
25.29 f 3.76 II = 427
25.81 f 3.56 n = 398
Analysis of VariiUlCe
F: 3.43 P<
0.05
F = F-distribution.
TABLE III TRANSITION FROM PRE-MENOPAUSE 47-51
W/H’
TO RECENT NATURAL POST-MENOPAUSE
yr
Prc-menopause d f S.D.
Natural Post-menopause 6-36 mth 2 f S.D.
25.70 f 4.02 n = 360
25.47 f 3.71 n = 261
Analysis of variance NS
TABLE IV HISTORY OF SURGICAL MENOPAUSE Late
Surgical post-menopause
fertile age
Age (yr) W/H’
46.00 f 3 25.25 t 3.74 n=469
F = F-distribution.
2-36 mth f f S.D.
37--96 mth R t S.D.
>%mth 2 f S.D.
Analysis of variance
46.00 f 5 25.45 f 3.30 n = 138
49.00 f 5 25.26 f 3.02 n f 75
53.00 k 6 26.46 f 4.32 n = 80
F: 24.76 P< O.oowl NS
362 TABLE V TRANSITION FROM LATE FERTILE AGE TO RECENT SURGICAL POST-MENOPAUSE 40-45 yr
W/H’
Analysis of
Late fertile age 1 f S.D.
Surgical post-menopause 2-36 mth 1 f S.D.
25.07 f 3.70 n = 153
n = 43
25.33 f 3.25
VarianCe
NS
History of natural menopause There were significant changes in the mean W/H2 values in women with a history of natural menopause (Table I). When groups of women of the same age were compared, the mean W/H2 value was significantly higher in the premenopause group than in the late fertile age group (Table II). However, the mean W/H2 value in recent natural post-menopause subjects (6-36 mth) was not
TABLE VI AGE AT WHICH NATURAL OR SURGICAL MENOPAUSE OCCURRED Natural post-menopause <45yr X f S.D.
Natural post-menopause 45-53 yr X f S.D.
Post-menopausal months
45.00 f 37
43.00 f 37
63.00 f 58
W/H*
24.84 f 3.54
25.64 zt 3.74
26.73 f 4.21
n = 45
n = 759
n = 245
SlUgiCA post-menopause <38yr X k S.D.
surgical post-menopause >38 yr X f S.D.
Analysis of variance
111.00 f 75 24.82 f 3.80 n = 35
67.00 f 75 25.93 f 3.77 n = 262
F: 12.02 P< 0.001 NS
Post-menopausal months W/H’ F=
F-distribution.
Natural post-menopause >53yr 1 f S.D.
Analysis of variance F: 25.07 PC O.oowl F: 9.05 P< o.ooo2
363 TABLE VII TIME ELAPSED SINCE NATURAL OR SURGICAL MENOPAUSE
Age w Post-menopausal
months
scattergram Post-menopausal Across W/H’ F=
months
Natural post-menopause
surgical post-menopause
53 f
49 f
4 (S.D.)
6 (S.D.)
48 f 45 (S.D.)
71 f 74 (S.D.)
Plotted values
Plotted values
1056 6-420 r=0.08466 SC 0.003
288 2-375 r = 0.16612 s < 0.003
F: 210.27 P< O.ooool F: 50.33 P< o.oooo1
F-distribution.
TABLE VIII PRESENCE OR ABSENCE OF UTERUS IN NATURAL AND SURGICAL POST-MENOPAUSE
Post-menopausal W/Hz
months
Age OrT) Post-menopausal W/H*
Natural post-menopause E f S.D.
Natural post-menopause in hysterectomized women 2 f S.D.
Analysis of variance
53.00 f
51.00 f
F: 13.43 P< o.ooo4
F = F-distribution.
6
47.00 f 43 25.85 f 3.89 n = 1038
70.00 t 49 24.98 f 2.64 n = 63
F: 8.31 P< 0.005 NS
SUrgicd post-menopause in hysterectomized women x’ * S.D.
surgical post-menopause 2 f S.D.
Analysis of variance
49.00 f months
4
5
63.00 f 64 25.76 f 3.61 n = 247
49.00 f 148.00 f 25.81 f n = 37
10 112 5.04
NS F: 49.20 P< O.ooool NS
W/H*
W/H’
SITUATIONS
r = 0.27108 s< 0.001
Scattergram related to age (yr) (min-max: 37-51)
Surgical post-menopause 2-36 mth Plotted values
138
r = 0.13634 s< o.Ow4
75
Surgical post-menopause 37-% mth Plotted values
336
Natural pest-menopause 37-% mth Plotted values
Scattergram related to age 01-) (min-max: 36-59)
Natural post-menopause 6-36 mth Plotted values
629
NS
469
Scattergram related to age (yr) (min-max: 40-50)
W/Hz
Late fertile age Plotted values
AGE IN DIFFERENT CLIMACTERIC
TABLE IX
r = 0.33597 s< 0.002
Scattergram related to age (yr) (min-max: 37-54)
r = 0.09638 s< 0.04
Scattergram related to age (yr) (mm-max: 39-62)
628
Pre-menopause Plotted values
r = 0.19381 s< 0.05
Scattergram related to age (yr) (min-max: 35-62)
Surgical post-menopause >%mth Plotted values 79
NS
Scattergram related to age (yr) (min-max: 45-65) 125
Natural post-menopause >% mth Plotted values
r = 0.18326 s< o.OtM1
Scattergram related to age (yr) (min-max: 40-56)
E
365
significantly different from the premenopausal value (Table III). Women thus have a tendency to gain weight during the pre-menopause.
History of surgical menopause There were no significant changes in the mean W/H2 values in women with a history of surgical menopause (Table IV). When groups of women of the same age were compared, the mean W/H2 value in recent surgical post-menopause subjects (2-36 mth) was not significantly different from the value in late fertile age (Table V).
Age at which menopause occurred It was found that the mean W/H2 value increased with advancing age at natural menopause. However, the age at which surgical menopause occurred did not significantly affect the mean W/H2 value (Table VI).
Time elapsed since menopause It was observed that the mean W/H2 value slowly increased as time elapsed after the occurrence of both natural and surgical menopause (Table VII).
Presence or absence of uterus in the post-menopause The presence of a uterus in either natural or surgical post-menopausal did not modify the mean W/H2 value (Table VIII).
women
Ageing When women in the same climacteric situations were compared, the mean W/ HZ value was found to increase slowly with age, except in the case of the late fertile age and advanced natural post-menopause (> 96 mth) groups (Table IX). conclusions
Our data indicate that the pre-menopause is a weight-gain inducing state. For this reason the BMI shows significant changes in women who experience a natural menopause, but not in those whose menopause is surgically induced, since the latter do not have a pre-menopause. Ageing seems to bring about a progressive increase in body mass index. References 1 Montegriffo VME. A survey of the incidence of obesity in the United Kingdom. Postgrad. Med J 1971; 47: (suppl.). 418-422. 2 Muller F, Paul I. Brasch C. The incidence of obesity in the German Democratic Republic., Z Gesamte IM h-led 1970; 25: 1001-1009. 3 Sivcrstone JT, Gordon RP. Stunkard AJ. Social factors in obesity in London. Practitioner 1%9; 202: 682-688.
366 4
De Aloysio D, Bottiglioni F, Mauloni M. Aspetti sintomatologici de1 climaterio femminile. In: Atti de1 63O Congresso Nazionale della S.I.G.O., Monduzzi Press, 1983; 21-81. 5 De Aloysio D. Vikcco AS, De Liberali E, Fabiani AG, Ferrari 0, Di Paolo E. Obesity and menopause. In: Lenzi S, Descovich GC, eds. Atherosclerosis and cardiovascular diseases. Compositori Press, 1980; 697-704.
Muturit~, 9 (1988) 359-366 Elsevier Bcientiftc Publishers Ireland Ltd.
Body mass index distribution in climacteric women D. de Aloysiol,
A.S.
Villecco2, A.G. Fabiani’, M. Maulonir, L. Miliff? and F. Bottiglion?
P. Altierir,
lDelxutment of Obstetnks and Gynecology anti 21nMute of Medicine, Clinic II, Bologna University, Italy (Received 21 May 1987; revision received 1 8eptember 1987; accepted 20 November 1987)
Body Mass Index (BMI) was calculated in 2481 climacteric women selected from among the outpatients attending the Menopause Clinic at Bologna University in absence of hormonal replacement therapy and diseases that could cause weight gain. Analysis of variance of the W/Hz (wei8hVhei8ht squared) distribution in different age and climacteric situations demonstrates that the pm-menopause is a weight-gain inducing state and that ageing seems to cause a progressive increase in W/H*. (Key words: Overweight, obesity, Climacteric)
Introduetloa Menopause and overweight/obesity seem to have common consequences and to potentiate each other. However, no in-depth study to establish the relationship between the climacteric and overweight/obesity has been conducted to date [l41. In a previous investigation carried out by our group [5] the mean body mass index (BMI) in climacteric women (25.6 f 4.0 S.D.) was found to be significantly higher than the ideal value and the menopause seemed to be a weight-gain inducing cofactor. Sabjeets and methods
Weight/height
squared (W/H3
was calculated
in 2481 women selected from
C~pondence to: D. de Aloysio. Department of Obstetrics and Gynecology; Bologna University Via Massarenti 13, 40138 Bologna. Italy. 0378-5122/88/803.50 0 1988 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
360
among 4,150 outpatients (aged up to 65 yr) who attended the Menopause Clinic at Bologna University between 1976 and 1986. The selection criteria were as follows: (1) No hormonal replacement therapy during the previous 6 mth and no other drug treatment during the previous 3 mth. (2) Absence of diseases that could cause weight gain. W/H2 was calculated in relation to the following situations and factors: -history of natural menopause (from late fertile age to advanced natural post-menopause); -history of surgical menopause (from late fertile age to advanced surgical post-menopause); -transition from late fertile age to ‘pre-menopause (women aged 43-50 yr in both groups); -transition from pre-menopause to recent natural post-menopause (women aged 47-51 yr in both groups); -transition from late fertile age to recent surgical post-menopause (women aged 40-45 yr in both groups); - age at which natural or surgical menopause occurred; -time elapsed since natural or surgical menopause; - presence or absence of uterus in natural and surgical menopause; - ageing in each climacteric situation. The late fertile age group comprised women aged 40-50 yr with both regular and irregular cycles and women aged 45-50 yr with regular cycles (in our experience only 10% of these women undergo menopause within the following 12 mth). The pre-menopause group comprised women aged 40-45 yr with at least 6 mth of amenorrhoea whose plasma levels of oestradiol and gonadotrophins were
TABLE I HISTORY OF NATURAL MENOPAUSE Late fertile age z? f S.D. Age (yr) 46 f 3 W/H’
F=
Natural post-menopause 6-36 mth f f S.D.
37-% mth z? + S.D.
>%mth x f S.D.
49 f 3
51 + 4
54 f 4
58 f 4
25.25 f 3.74 25.97 zt 4.00 25.67 zt 3.78 n = 469
F-distribution.
Analysis of variance
Premenopause zi? f S.D.
n = 628
n = 629
F: 601.86 PC O.ocKlol 25.90 f 3.91 26.69 f 4.39 F: 4.46 P< 0.002 n = 336 n = 126
361
not indicative of ovarian failure, women aged 46-50 yr with irregularcycles and women aged over 50 yr with both regular and irregularcycles (in our experience more than 85% of these women undergo menopause within the following 12 mth).
TABLE II TRANSITION FROM LATE FERTILE AGE TO PRE-MENOPAUSE 43-50
W/H’
yr
Late fertile age 1 f S.D.
Pre-menopause z f S.D.
25.29 f 3.76 II = 427
25.81 f 3.56 n = 398
Analysis of VariiUlCe
F: 3.43 P<
0.05
F = F-distribution.
TABLE III TRANSITION FROM PRE-MENOPAUSE 47-51
W/H’
TO RECENT NATURAL POST-MENOPAUSE
yr
Prc-menopause d f S.D.
Natural Post-menopause 6-36 mth 2 f S.D.
25.70 f 4.02 n = 360
25.47 f 3.71 n = 261
Analysis of variance NS
TABLE IV HISTORY OF SURGICAL MENOPAUSE Late
Surgical post-menopause
fertile age
Age (yr) W/H’
46.00 f 3 25.25 t 3.74 n=469
F = F-distribution.
2-36 mth f f S.D.
37--96 mth R t S.D.
>%mth 2 f S.D.
Analysis of variance
46.00 f 5 25.45 f 3.30 n = 138
49.00 f 5 25.26 f 3.02 n f 75
53.00 k 6 26.46 f 4.32 n = 80
F: 24.76 P< O.oowl NS
362 TABLE V TRANSITION FROM LATE FERTILE AGE TO RECENT SURGICAL POST-MENOPAUSE 40-45 yr
W/H’
Analysis of
Late fertile age 1 f S.D.
Surgical post-menopause 2-36 mth 1 f S.D.
25.07 f 3.70 n = 153
n = 43
25.33 f 3.25
VarianCe
NS
History of natural menopause There were significant changes in the mean W/H2 values in women with a history of natural menopause (Table I). When groups of women of the same age were compared, the mean W/H2 value was significantly higher in the premenopause group than in the late fertile age group (Table II). However, the mean W/H2 value in recent natural post-menopause subjects (6-36 mth) was not
TABLE VI AGE AT WHICH NATURAL OR SURGICAL MENOPAUSE OCCURRED Natural post-menopause <45yr X f S.D.
Natural post-menopause 45-53 yr X f S.D.
Post-menopausal months
45.00 f 37
43.00 f 37
63.00 f 58
W/H*
24.84 f 3.54
25.64 zt 3.74
26.73 f 4.21
n = 45
n = 759
n = 245
SlUgiCA post-menopause <38yr X k S.D.
surgical post-menopause >38 yr X f S.D.
Analysis of variance
111.00 f 75 24.82 f 3.80 n = 35
67.00 f 75 25.93 f 3.77 n = 262
F: 12.02 P< 0.001 NS
Post-menopausal months W/H’ F=
F-distribution.
Natural post-menopause >53yr 1 f S.D.
Analysis of variance F: 25.07 PC O.oowl F: 9.05 P< o.ooo2
363 TABLE VII TIME ELAPSED SINCE NATURAL OR SURGICAL MENOPAUSE
Age w Post-menopausal
months
scattergram Post-menopausal Across W/H’ F=
months
Natural post-menopause
surgical post-menopause
53 f
49 f
4 (S.D.)
6 (S.D.)
48 f 45 (S.D.)
71 f 74 (S.D.)
Plotted values
Plotted values
1056 6-420 r=0.08466 SC 0.003
288 2-375 r = 0.16612 s < 0.003
F: 210.27 P< O.ooool F: 50.33 P< o.oooo1
F-distribution.
TABLE VIII PRESENCE OR ABSENCE OF UTERUS IN NATURAL AND SURGICAL POST-MENOPAUSE
Post-menopausal W/Hz
months
Age OrT) Post-menopausal W/H*
Natural post-menopause E f S.D.
Natural post-menopause in hysterectomized women 2 f S.D.
Analysis of variance
53.00 f
51.00 f
F: 13.43 P< o.ooo4
F = F-distribution.
6
47.00 f 43 25.85 f 3.89 n = 1038
70.00 t 49 24.98 f 2.64 n = 63
F: 8.31 P< 0.005 NS
SUrgicd post-menopause in hysterectomized women x’ * S.D.
surgical post-menopause 2 f S.D.
Analysis of variance
49.00 f months
4
5
63.00 f 64 25.76 f 3.61 n = 247
49.00 f 148.00 f 25.81 f n = 37
10 112 5.04
NS F: 49.20 P< O.ooool NS
W/H*
W/H’
SITUATIONS
r = 0.27108 s< 0.001
Scattergram related to age (yr) (min-max: 37-51)
Surgical post-menopause 2-36 mth Plotted values
138
r = 0.13634 s< o.Ow4
75
Surgical post-menopause 37-% mth Plotted values
336
Natural pest-menopause 37-% mth Plotted values
Scattergram related to age 01-) (min-max: 36-59)
Natural post-menopause 6-36 mth Plotted values
629
NS
469
Scattergram related to age (yr) (min-max: 40-50)
W/Hz
Late fertile age Plotted values
AGE IN DIFFERENT CLIMACTERIC
TABLE IX
r = 0.33597 s< 0.002
Scattergram related to age (yr) (min-max: 37-54)
r = 0.09638 s< 0.04
Scattergram related to age (yr) (mm-max: 39-62)
628
Pre-menopause Plotted values
r = 0.19381 s< 0.05
Scattergram related to age (yr) (min-max: 35-62)
Surgical post-menopause >%mth Plotted values 79
NS
Scattergram related to age (yr) (min-max: 45-65) 125
Natural post-menopause >% mth Plotted values
r = 0.18326 s< o.OtM1
Scattergram related to age (yr) (min-max: 40-56)
E
365
significantly different from the premenopausal value (Table III). Women thus have a tendency to gain weight during the pre-menopause.
History of surgical menopause There were no significant changes in the mean W/H2 values in women with a history of surgical menopause (Table IV). When groups of women of the same age were compared, the mean W/H2 value in recent surgical post-menopause subjects (2-36 mth) was not significantly different from the value in late fertile age (Table V).
Age at which menopause occurred It was found that the mean W/H2 value increased with advancing age at natural menopause. However, the age at which surgical menopause occurred did not significantly affect the mean W/H2 value (Table VI).
Time elapsed since menopause It was observed that the mean W/H2 value slowly increased as time elapsed after the occurrence of both natural and surgical menopause (Table VII).
Presence or absence of uterus in the post-menopause The presence of a uterus in either natural or surgical post-menopausal did not modify the mean W/H2 value (Table VIII).
women
Ageing When women in the same climacteric situations were compared, the mean W/ HZ value was found to increase slowly with age, except in the case of the late fertile age and advanced natural post-menopause (> 96 mth) groups (Table IX). conclusions
Our data indicate that the pre-menopause is a weight-gain inducing state. For this reason the BMI shows significant changes in women who experience a natural menopause, but not in those whose menopause is surgically induced, since the latter do not have a pre-menopause. Ageing seems to bring about a progressive increase in body mass index. References 1 Montegriffo VME. A survey of the incidence of obesity in the United Kingdom. Postgrad. Med J 1971; 47: (suppl.). 418-422. 2 Muller F, Paul I. Brasch C. The incidence of obesity in the German Democratic Republic., Z Gesamte IM h-led 1970; 25: 1001-1009. 3 Sivcrstone JT, Gordon RP. Stunkard AJ. Social factors in obesity in London. Practitioner 1%9; 202: 682-688.
366 4
De Aloysio D, Bottiglioni F, Mauloni M. Aspetti sintomatologici de1 climaterio femminile. In: Atti de1 63O Congresso Nazionale della S.I.G.O., Monduzzi Press, 1983; 21-81. 5 De Aloysio D. Vikcco AS, De Liberali E, Fabiani AG, Ferrari 0, Di Paolo E. Obesity and menopause. In: Lenzi S, Descovich GC, eds. Atherosclerosis and cardiovascular diseases. Compositori Press, 1980; 697-704.