9/28/2018 Background CHANGES IN: • Reproductive hormones MENOPAUSE • Energy expenditure TRANSITION • Abdominal adiposity • Physical activity “Caucasian women have greater gains in subcutaneous RACE abdominal adiposity in the years leading up to menopause compared to African-American women” • Health statistics for AA are worse compared to Caucasians Kara L. Marlatt, PhD, MPH • Understanding the deleterious impact of menopause on On behalf of Robbie Beyl, Jennifer Lovejoy, Steve Smith, and Leanne Redman metabolic health among women of different races is of great public health significance. NAMS Presentation – October 4, 2018 Question ‘Healthy Transitions’ Study Menopause Effect on Obesity, Energy Balance, and Insulin Are there race-specific differences in abdominal [R01: Jennifer Lovejoy, PhD (1997-2006) at Pennington] adiposity, reproductive hormones, and physical activity during the menopause transition? Objective: To examine the impact of menopause on changes in body composition, fat distribution, and cardiometabolic risk factors in AA and Caucasian women. Racial differences in the changes in: MAIN STUDY Enrolled: 156 women (103 C, 53 AA) • Abdominal adiposity (SAT, dSAT, sSAT, VAT, TAT) (4 YEARS) Transitioned: 51 women • Reproductive hormones (estradiol, FSH, SHBG) Inclusion Criteria: • No race differences in changes in • 43 years or older body composition or hormone levels. • Physical activity (TriTrac accelerometer) • Premenopausal (≥5 cycles in last 6 months plus FSH<30 mIU/mL) • Not taking HRT EXTENSION STUDY (+ 3 YEARS) 1
9/28/2018 Complete Longitudinal Analysis Characteristics of Women at through 7 years Menopause Onset (Year 0) • N=94 health women (25 AA, 69 Caucasian) transitioned through menopause (indicated as Year 0) • Menopause defined as absence of menstruation for 1- y and FSH>30 mIU/mL • Annual assessments: 1. Body composition (percent fat, fat mass) by DXA 2. Abdominal fat distribution by CT • Abdominal subcutaneous adipose tissue (SAT) • Deep SAT (dSAT), superficial SAT (sSAT) • Visceral adipose tissue (VAT) 3. Fasting blood collection • Reproductive hormone levels 4. Physical Activity (by accelerometry; TriTrac-R3D) Caucasians, but not AAs, had increased Caucasians, but not AAs, had increased body fat leading up to menopause SAT leading up to menopause WEIGHT % BODY FAT ABDOMINAL SUBCUTANEOUS VISCERAL ADIPOSE TISSUE ADIPOSE TISSUE (SAT) (VAT) Outlier? 2
9/28/2018 Are these changes mediated by Same for Deep SAT hormones or physical activity? ? %fat X MENOPAUSE Estradiol SAT (dSAT, sSAT) FSH TRANSITION VAT TAT ? Physical Activity ? • Key hormones were not associated with the observed race differences in abdominal adiposity. • Physical activity difficult to interpret, but activity levels were negatively associated with abdominal adiposity overall (but not between races). • Menopause symptoms were positively associated with abdominal adiposity overall (but not between races). Changes in FSH and E2 did not Conclusions explain race differences in adiposity • Caucasian women had significant increases FOLLICLE-STIMULATING ESTRADIOL HORMONE (FSH) in abdominal adiposity compared to AA in the 2-6 years before menopause. • Reproductive hormones were not associated with these race differences. • Greater physical activity was associated with less abdominal adiposity gains. • Greater abdominal adiposity was associated However, these changes in hormones were not associated with the observed with more menopause symptoms. racial differences in abdominal adiposity. 3
9/28/2018 Conclusions Limitations • No race differences in body composition were • Sample size was not equal between race observed at menopause onset which suggests that • Longitudinal studies missing data AA women had a worse premenopause body • Physical activity levels only gathered during adiposity profile yet maintained adiposity levels Main Study (first 4 years) throughout the menopause transition while Caucasian women caught up in body adiposity. • The menopause transition may impact Caucasian women more than AA women in terms of adipose tissue deposition. Thank you! Mentors Other Important People Eric Ravussin / Leanne Redman Jackie Stephens Carrie Elks Ursula White Healthy Transitions Team QUESTIONS? Jennifer Lovejoy (Arivale, Inc.) Collaborators Steve Smith (TRI) Wendy Kohrt (UC-Denver) Nanette Santoro (UC-Denver) REWH Lab (Redman) Katherine Guthrie (Fred Hutch) Anne Gilmore Nick Broskey Grant Funding Jasper Most T32-DK064584 [Obesity: From Genes to Man] Dorien Reijnders-Most U54-GM104940 [LA CaTS Pilot Grant (Round 7)] Abby Altazan P30-DK056336 [Trans-NORC Complementary Pilot] Caitlin Hebert 4
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