Lovejoy J C, Champagne C M, de Jonge L, Xie H, Smith S R
Department of Molecular Endocrinology, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA.
Int J Obes (Lond). 2008 Jun;32(6):949-58. doi: 10.1038/ijo.2008.25. Epub 2008 Mar 11.
This study assessed longitudinal changes in body composition, fat distribution and energy balance in perimenopausal women. We hypothesized that total fat and abdominal body fat would increase at menopause due to decreased energy expenditure (EE) and declining estrogen, respectively.
Observational, longitudinal study with annual measurements for 4 years.
Healthy women (103 Caucasian; 53 African-American), initially premenopausal. During follow-up, lack of menstruation for 1 year and follicle-stimulating hormone >30 mIU ml(-1) defined a subject as postmenopausal.
Fat and lean mass (dual-energy X-ray absorptiometry), visceral (VAT) and subcutaneous abdominal fat (SAT) (computed tomography), dietary intake (4-day food record), serum sex hormones and physical activity (tri-axial accelerometry). Twenty-four hour EE was measured by whole-room calorimeter in a subset of 34 women at baseline and at year 4.
Body fat and weight increased significantly over time only in those women who became postmenopausal by year 4 (n=51). All women gained SAT over time; however, only those who became postmenopausal had a significant increase in VAT. The postmenopausal group also exhibited a significant decrease in serum estradiol. Physical activity decreased significantly 2 years before menopause and remained low. Dietary energy, protein, carbohydrate and fiber intake were significantly higher 3-4 years before the onset of menopause compared with menopause onset. Twenty-four hour EE and sleeping EE decreased significantly with age; however, the decrease in sleeping EE was 1.5-fold greater in women who became postmenopausal compared with premenopausal controls (-7.9 vs -5.3%). Fat oxidation decreased by 32% in women who became postmenopausal (P<0.05), but did not change in those who remained premenopausal.
Middle-aged women gained SAT with age, whereas menopause per se was associated with an increase in total body fat and VAT. Menopause onset is associated with decreased EE and fat oxidation that can predispose to obesity if lifestyle changes are not made.
本研究评估围绝经期女性身体成分、脂肪分布和能量平衡的纵向变化。我们假设，绝经时总脂肪和腹部体脂会分别因能量消耗（EE）减少和雌激素水平下降而增加。
为期4年的年度测量观察性纵向研究。
健康女性（103名白种人；53名非裔美国人），最初处于绝经前状态。在随访期间，停经1年且促卵泡激素>30 mIU/ml（-1）定义为绝经后。
脂肪和瘦体重（双能X线吸收法）、内脏脂肪（VAT）和腹部皮下脂肪（SAT）（计算机断层扫描）、饮食摄入量（4天食物记录）、血清性激素和身体活动（三轴加速度计）。在34名女性亚组中，于基线和第4年通过全室热量计测量24小时EE。
仅在到第4年进入绝经后的女性（n = 51）中，身体脂肪和体重随时间显著增加。所有女性的SAT随时间增加；然而，只有进入绝经后的女性VAT显著增加。绝经后组血清雌二醇也显著降低。绝经前2年身体活动显著减少并维持在低水平。与绝经时相比，绝经前3 - 4年饮食能量、蛋白质、碳水化合物和纤维摄入量显著更高。24小时EE和睡眠EE随年龄显著降低；然而，绝经后女性睡眠EE的降低幅度比绝经前对照大1.5倍（-7.9%对-5.3%）。绝经后女性脂肪氧化降低32%（P<0.05），而仍处于绝经前的女性则无变化。
中年女性的SAT随年龄增加，而绝经本身与全身脂肪和VAT增加有关。绝经与EE和脂肪氧化减少有关，如果不改变生活方式，可能易导致肥胖。
