The association of menopausal status with body composition and anthropometric indices

Summary

Menopause induces various health problems and is associated with obesity, but the association between menopausal status and obesity is unclear due to several confounding factors, such as aging and reduced physical activity. Bearing this in mind, recently Lee et al. [1] in a cross-sectional study aimed to examine the association of menopausal status with anthropometric indices and body composition indices in 734 South Korean women (297 postmenopausal and 437 premenopausal) using binary logistic regression analysis. They found that height, body mass index, waist-to-height ratio, waist-to-hip ratio, and neck, armpit, chest, rib, waist, iliac, and hip circumferences were associated with menopausal status in the crude analysis, but not in the adjusted models. Among the body composition indices, menopausal status was strongly associated with total body water, skeletal muscle mass, body fat mass, and body fat percentage in the crude analysis; however, only total body water and skeletal muscle mass remained significant in the adjusted models. The authors conclude that most of the anthropometric indices and body composition indices were not associated with menopausal status, but total body water and skeletal muscle mass were significantly lower in postmenopausal women as compared to premenopausal ones.

Commentary

Worldwide, cardiovascular disease (CVD) is the leading cause of mortality. In 2019, approximately 17.9 million people died from CVD, which corresponds to 32% of all global deaths. Although men are at higher risk for CVD, after the menopause, due to estrogen deficiency, women are prone to have higher rates of CVD [2]. During the menopausal transition, due to a decline in ovarian function and estrogen secretion, women are subject to bio-psycho and social changes that can impair their quality of life. But more importantly, after menopause, CVD risk increases significantly, partly due to estrogen deprivation, that exerts lipid profile and metabolic disturbances, psychological stress, and central adiposity increase. In fact, an increase in weight and other factors such as sedentary lifestyle, dietary habits, among others, negatively impact metabolic parameters, making women more susceptible to CVD events [3].

For some time, many studies have examined the association between menopausal status and obesity or adiposity; however, such association remains controversial. Indeed, some studies argue that changes in mentioned indices are due to aging and a reduction in physical activity and not to menopause onset or the transition. Bearing this in mind, Lee and collaborators focused their study on changes in anthropometric indices and also body composition indices between pre- and postmenopausal women from Korea in order to determine any association. Interestingly, using logistic regression analysis, the adjusted model did not find any association with anthropometric indices and menopausal status; yet only a significant relation between menopausal status and decreased total body water and skeletal muscle mass. The clinical implication of their findings is that after menopause, it is important to consider a decrease in skeletal muscle mass and total body water rather than an increase in obesity or fat mass in any particular region of the body. This is interesting as it places sarco-obesity in perspective and its link to future risk of falls and fractures.

The authors correctly state the limitations of their study, for instance, not considering for analysis women defined as perimenopausal, they just categorized women as pre- and postmenopausal ones. Another drawback is the cross-sectional design that does not allow determining cause-effect relationship. Despite mentioned limitations, as a strength one can mention finding the association with decreased skeletal mass in postmenopausal women. In this sense there is a need for more research that can determine the importance of decreased estrogen and lower skeletal muscle mass, and then its link to falls and fractures.

Take home key points

• The association between menopausal status and obesity or increased adiposity remains controversial; hence, there is a need for more prospective longitudinal studies.
• There is a need to increase awareness of the association of skeletal muscle mass and menopausal status, in this case lower among postmenopausal women, in order to promote campaigns to incentive an increase of physical activity and improvement of dietary habits in this at-risk population.

Peter Chedraui, MD, PhD
Research Professor, School of Postgraduate in Health
Universidad Espíritu Santo, Samborondón, Ecuador

References

1. 1. 1. Lee BJ, Kim JU, Lee S. Association of menopausal status with body composition and anthropometric indices in Korean women. PLoS One. 2024 May 20;19(5):e0298212.
         https://pubmed.ncbi.nlm.nih.gov/38768131/
      2. Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, et al. Sex and gender: modifiers of health, disease, and medicine. Lancet. 2020;396(10250):565-582.
         https://pubmed.ncbi.nlm.nih.gov/32828189/
      3. Moccia P, Belda-Montesinos R, Monllor-Tormos A, Chedraui P, Cano A. Body weight and fat mass across the menopausal transition: hormonal modulators. Gynecol Endocrinol. 2022;38(2):99-104.
         https://pubmed.ncbi.nlm.nih.gov/34898344/

If you would like to add a comment or contribute to a discussion based on this issue, please contact Menopause Live Editor, Peter Chedraui, at  peter.chedraui@cu.ucsg.edu.ec.