Reproductive Factors and Change in Weight/BMI During the Menopausal Transition Öffentlichkeit
Zhao, Jingxuan (2017)
Abstract
During the transition from peri-menopausal to post-menopausal, many women experience gains in weight and obesity. The reproductive period may be a critical time where changes in energy balance, maternal insulin resistance, and increased fat deposition in myocardial tissue occurs - influencing adult weight change. This study examined the association between reproductive characteristics (early menarche, age at first birth, parity, and lactation), and weight gain during the menopausal transition, overall, and in strata of race/ethnic groups.
We used the data from Study of Women's Health Across the Nation (SWAN), which included 1560. The outcomes of interest were the absolute changes in body mass index (BMI) and weight between baseline visit and visit 10. Weight and height were measured by study personnel. The exposures of interests, assessed via interviewer administered questionnaire, included menarche age, age at first birth, parity, lactation. Multiple linear regressions were conducted to evaluate the relation between change in obesity status and reproductive factors.
Women with a menarche age of 12 or 13 were less likely to experience gains in BMI compared with earlier menarche group (age 11) in all race/ethnicity groups (ß= -0.49, 95% CI: [-0.97, -0.01] and ß= -0.5, 95% CI: [-1.00, -0.05] for BMI and weight change, respectively). Women with 1 or 2 children had less gain in weight compared with women with no children (ß= -1.59, 95% CI: [-3.16, -0.02] and ß= -1.47, 95% CI: [-2.80, -0.14], respectively). We observed heterogeneity for the association between menarche age and BMI/weight change, parity and BMI/weight change, as well as lactation and BMI/weight change by race/ethnicity, with Chinese or Chinese American women more likely to experience gains in BMI or weight.
This study indicated that early menarche and null-parity were risk factors for weight gain and BMI increase during menopausal transition, particularly among Japanese or Japanese American women for parity and among African American for early menarche.
Table of Contents
Table of Contents
CHAPTER 1. INTRODUCTION AND BACKGROUND. 1
1.1 Obesity. 1
1.1.1 Obesity in the United States. 1
1.1.2 Obesity and mortality. 2
1.1.3 Obesity and chronic disease. 2
1.2 BMI, weight gain and the menopausal transition. 4
1.3 Risk factors for weight gain during menopausal transition. 5
1.3.1 Psychological condition and weight gain during the menopausal transition. 5
1.3.2 Life style and weight gain during the menopausal transition. 5
1.4 Limitation for previous studies. 8
1.4.1 Lactation: A candidate risk factor for weight gain during menopausal transition. 8
1.4.2 Birth weight, childhood obesity and weight gain during menopausal transition. 9
1.4.3 Race/Ethnicity: A potential effect measure modifier 9
1.5 Significance of thesis. 9
1.6 Specific Aims and Hypothesis. 11
CHAPTER 2 REPRODUCTIVE FACTORS AND CHANGE IN WEIGHT/BMI DURING MENOPAUSAL TRANSITION. 12
2.1 Introduction. 13
2.2 Methods. 14
2.2.1 Population. 14
2.2.2 Outcome assessment. 15
2.2.4 Covariate assessment. 16
2.2.5 Statistical methods. 17
2.3 Results. 17
2.3.1 Menarche age. 18
2.3.2 Parity. 19
2.3.3 Age at first birth. 20
2.3.4 Lactation. 20
2.4 Discussion. 20
CHAPTER 3. FUTURE DIRECTIONS. 28
3.1 Conclusion. 28
3.2 Public Health Implications. 28
3.3 Future Directions. 29
References. 31
Appendix 1. DAG and Pathways. 35
Appendix 2. Backward Elimination for Model Selection. 51
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