Body weight and fat mass across the menopausal transition: hormonal modulators

Abstract

Background

The role of the menopause in weight gain is an understudied yet important field, given the rising prevalence of obesity and its associated risk of disease.

Objective

To review the current evidence regarding the impact of the menopausal transition on changes in body composition and fat accrual in women and the hormonal mechanisms underlying the process.

Methods

A critical appraisal of the current literature by experts in the field.

Results

Menopause is associated with an overall increase in fat mass, which tends to accumulate around the waist. There is also a decrease in lean mass, particularly evident in the lower limbs. Reduced energy expenditure (EE) has been confirmed in parallel with increased food intake, the latter being more evident in experimental models. A prominent role has been found for the estrogen receptor (ER) alpha isoform in fat accrual. Human studies suggest a role for androgens in central fat accumulation and type 2 diabetes. FSH is a key factor in the process of fat accumulation, but only in rodents. Clinical studies suggest that these endocrine alterations are insufficient to explain the observed changes.

Conclusions

The menopausal transition is associated with an increase in adiposity, which accumulates preferentially in the abdominal area. Hypoestrogenism and the imbalance of the androgen/estrogen ratio are strong candidates to explain the phenomenon, although other hormonal factors probably also play a role. The impact on risk of disease is still insufficiently known, although an association with risk factors, such as an unfavorable lipid profile or insulin resistance seems likely.

绝经过渡期的体重和脂肪量：激素调节剂 摘要

背景：鉴于肥胖率及其相关疾病风险的上升, 绝经期在体重增加中的作用是一个尚未得到充分研究但很重要的领域。

目的：回顾有关绝经过渡期对女性身体成分和脂肪累积变化的影响及其激素机制的最新证据。

方法：由该领域的专家对现有文献进行严格评估。

结果：绝经期与脂肪量的总体增加有关, 脂肪倾向于在腰部聚集。瘦肉量也有所减少, 尤其是下肢。能量消耗（energy expenditure, EE）的减少与食物摄入的增加平行, 后者在实验模型中更为明显。雌激素受体（estrogen receptor, ER）α亚型在脂肪积累中起着重要作用。人类研究表明雄激素在中枢脂肪堆积和2型糖尿病中起作用。FSH是脂肪积累过程中的一个关键因素, 但仅限于啮齿类动物。临床研究表明, 这些内分泌改变不足以解释观察到的变化。

结论：绝经过渡期与肥胖症增加有关, 脂肪优先在腹部累积。雌激素水平低下和雄激素/雌激素比例失衡是解释这一现象的可能因素, 其他激素也可能起作用。对疾病风险的影响尚不清楚, 尽管可能与危险因素有关, 如不利的血脂状况或胰岛素抵抗。

Keywords:

• Menopause
• fat
• obesity
• androgens
• estrogens
• FSH
• SHBG

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This research received funding from Grant number 664367 FOCUS, from the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) of the European Commission, under the European Union Health Programme (2014–2020). Peter Chedraui is supported by the Sistema de Investigación y Desarrollo (SINDE) and the Vice-Rectorado de Investigación & Postgrado (VRIP) of the Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador, through grant No. SIU # 554-56: ‘Evaluación de resultantes vinculadas a la salud de la mujer en etapa reproductiva y no reproductiva: Proyecto Omega III’.