Summary
Women experience numerous metabolic changes during the menopausal transition, however postprandial metabolic changes and their mediating factors are poorly understood. Bermingham et al. [1] recently published the results of the PREDICT 1 UK cohort consisting of 1,002 participants (pre- n=366, peri- n=55, and postmenopausal women, n=206) to whom they assessed anthropometrics, diet and gut microbiome data as well as fasting and postprandial cardiometabolic blood measurements. Differences between menopausal groups were assessed in the cohort and in an age-matched subgroup, after adjusting for age, body mass index (BMI), menopause hormone therapy use (MHT), and smoking status. The authors found that postmenopausal women had significantly higher fasting blood measures (glucose, HbA1c and inflammation (GlycA), 6%, 5% and 4% respectively), sugar intakes (12%) and poorer sleep (12%) compared to premenopausal ones. Postprandial metabolic responses for glucose and insulin 2 hours incremental area under the curve (2h iAUC) were higher (42% and 4% respectively) and continuous glucose monitoring (CGM) measures were unfavourable when comparing post- versus premenopausal women. MHT was associated with favourable visceral fat, fasting (glucose and insulin) and postprandial (triglyceride) measures. The authors conclude that their results support the importance of monitoring and modifying cardiovascular risk factors in women since the menopause transition in order to reduce morbidity and mortality associated with estrogen decline.
Commentary
Several observational studies have shown changes in BMI, visceral fat, cardiometabolic risk and inflammatory markers after menopause [2-4]. Changes in gut microbiome relating to estrogen levels and menopausal status have also been reported [5]. Metabolic changes in mid-aged women have been associated more with aging, environmental factors, and lifestyle changes than with menopause itself [6]. In the current commented study, the authors demonstrate that the postmenopause status is associated with unfavourable changes not only in body composition, as previously described [6,7], but also in fasting and postprandial blood profiles (including inflammation and postprandial glycemia), diet, sleep and gut microbiome. Also, using an age-matched design, they demonstrated a role of menopause independent from age and observed poorer sleep and diet, as well as higher postprandial glycemic measures in postmenopausal women. In addition, worse postprandial glucose and insulin response (2h iAUC) and unfavourable glycemic variability and time in range measured by CGM in free-living days, were also documented in the postmenopausal group. All these results are very important because of the well-known association between glycemic variability and metabolic effects, including oxidative stress, inflammation, and increased cardiovascular and diabetes risk [8]. An association between modifiable risk factors over metabolic changes in menopause, was observed; finding a mediating effect of diet and a gut bacterial species and visceral fat, glycemia, and inflammation, according to menopause status.
The authors have also demonstrated a protective association of MHT use with visceral fat, and glucose and triglycerides blood measures. The results of this publication underline the need for a comprehensive approach to the unfavourable metabolic changes that occur in women since the menopausal transition. Modifiable factors, such as diet, microbiome, physical activity, and use of MHT, in appropriate candidates, are very useful tools in the management of menopause patients, in order to reduce their lifetime cardiovascular and diabetic risks.
Prof. Sonia Cerdas Pérez, MD
University of Costa Rica, Hospital Cima San José, San José, Costa Rica
President of the Menopause and Osteoporosis Costa Rican Society (ACCMYO)
References
- Bermingham KM, Linenberg I, Hall WL, et al. Menopause is associated with postprandial metabolism, metabolic health and lifestyle: The ZOE PREDICT study. 2022;85:104303.
https://pubmed.ncbi.nlm.nih.gov/36270905/ - Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: signs, symptoms, and management options. J Clin Endocrinol Metab. 2021;106(1):1–15.
https://pubmed.ncbi.nlm.nih.gov/33095879/ - Toth MJ, Tchernof A, Sites CK, Poehlman ET. Effect of menopausal status on body composition and abdominal fat distribution. Int J Obes Relat Metab Disord. 2000;24(2):226-31.
https://pubmed.ncbi.nlm.nih.gov/10702775/ - Pu D, Tan R, Yu Q, Wu J. Metabolic syndrome in menopause and associated factors: a meta-analysis. 2017;20(6):583-591.
https://pubmed.ncbi.nlm.nih.gov/29064321/ - Becker SL, Manson JE. Menopause, the gut microbiome, and weight gain: correlation or causation? 2020;28(3):327-331.
https://pubmed.ncbi.nlm.nih.gov/33235036/ - Davis SR, Castelo-Branco C, Chedraui P, et al.; Writing Group of the International Menopause Society for World Menopause Day 2012. Understanding weight gain at menopause. 2012;15(5):419-29.
https://pubmed.ncbi.nlm.nih.gov/22978257/ - Genazzani AR, Monteleone P, Giannini A, Simoncini T. Hormone therapy in the postmenopausal years: considering benefits and risks in clinical practice. Hum Reprod Update. 2021;27(6):1115-1150.
https://pubmed.ncbi.nlm.nih.gov/34432008/ - Zhang L, Li F, Liu HH, et al. Glycaemic variability and risk of adverse cardiovascular events in acute coronary syndrome. Diab Vasc Dis Res. 2022;19(6):14791641221137736.
https://pubmed.ncbi.nlm.nih.gov/36341514/
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