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Correlation between BMI and climateric symptoms in menopausal women
I. Y.. González-Carrilloa, J.. Vázquez-Méndezb, G.. Guerrero-Gonzálezc, O.. Vidal-Gutiérrezd, M.. Cervantes-Florese
a Department of Gynecology and Obstetrics, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
b Department of Gynecology and Obstetrics, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
c Department of Gynecology and Obstetrics, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
d Department of Gynecology and Obstetrics, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
e Department of Gynecology and Obstetrics, "Dr. José Eleuterio González" University Hospital, Universidad Autónoma de Nuevo León, Monterrey, N. L., Mexico
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction </span></p><p class="elsevierStylePara"> Menopause is the natural biological process in which a woman&#39;s menstrual period stops permanently&#46; During climaterium&#44; the progressive disappearance of the ovarian function occurs leading to a gradual decline in estrogen secretions and several associated hormonal alterations giving rise to a series of organic and psychological changes&#46; In healthy women&#44; menopause occurs between the fifth and the sixth decades of life &#40;from ages 47 to 52&#41;&#46;<span class="elsevierStyleSup">1</span> Climateric symptoms worsen in relation to social determinants linked to race&#44; social and cultural entitlements which fall upon their gender&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara"> The manifestations produced as a consequence of the ovarian function ceasing and the subsequent hormonal deficit&#44; are expressed with very unique symptoms known as climateric&#46;<span class="elsevierStyleSup">1-3</span> In order to evaluate climateric symptoms&#44; different scales have been developed&#44; for instance the Kupperman index&#44;<span class="elsevierStyleSup">4</span> the Utian Quality of Life &#40;UQOL&#41; Scale&#44;5 the Greene scale&#44;<span class="elsevierStyleSup">6</span> and the SUMEVA scale&#46;7 Some assess the impact of climateric symptoms in the quality of life&#44; especially the influence on perimenopausal patients&#44; this information being useful in the follow-up of patients who receive hormone replacement treatment &#40;HRT&#41;&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara"> Hypoestrogenism has been related to physiological changes which are&#44; in part&#44; responsible for the weight gain during that period&#46;<span class="elsevierStyleSup">9</span> In Mexico&#44; an overweight prevalence of 72&#37; in adult women has been reported&#46;<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara"> Obesity in connection with vasomotor symptoms is controversial&#46; Previous studies suggest that body fat protects women from vasomotor symptoms due to the aromatization of androgens to estrogens in the adipose tissue&#59; however&#44; other evidence suggests that a greater body mass index &#40;BMI&#41;&#44; and increased body fat in particular&#44; are associated with reports of greater climateric manifestations&#46;<span class="elsevierStyleSup">11&#44;12</span> In this study we assess the hypothesis that there is a correlation between BMI and the severity of climateric symptoms&#44; studying overweight &#40;according to BMI&#41; connection with climaterium&#44; through the Blatt-Kupperman index&#44;<span class="elsevierStyleSup">4</span> with the purpose of determining whether or not obese or overweight patients suffer from more severe climateric symptoms&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Materials and methods </span></p><p class="elsevierStylePara"> An observational&#44; retrospective&#44; descriptive&#44; cross-cohort study was described&#46; We included 431 patients who attended the Menopause Clinic of the &#34;<span class="elsevierStyleItalic">Dr&#46; Jos&#233; Eleuterio Gonz&#225;lez&#34; </span>University Hospital of the <span class="elsevierStyleItalic">Universidad Aut&#243;noma de Nuevo Le&#243;n</span>&#44; in Monterrey&#44; N&#46; L&#46;&#44; Mexico&#44; from November 2008 to December 2011&#46; Patients who had received HRT during the previous 3 months and those who did not comply with the required data were excluded&#46;</p><p class="elsevierStylePara"> We performed a full clinical history check in order to obtain personal data and background information&#44; a physical examination including measurement of height and weight to obtain BMI and a questionnaire on climateric symptoms through the Blatt-Kupperman modified index&#46;<span class="elsevierStyleSup">5</span> The Blatt-Kupperman index is a scale used to determine the severity of climateric symptoms&#59; it assesses 15 symptoms&#44; which are rated by the patients as follows&#58; 0 &#61; none&#44; 1 &#61; mild&#44; 2 &#61; moderate&#44; 3 &#61; severe&#46;</p><p class="elsevierStylePara"> Subsequently&#44; a score was obtained which was categorized as mild &#40;0-20&#41;&#44; moderate &#40;21-35&#41;&#44; or severe &#40;&#62; 35&#41;&#46;<span class="elsevierStyleSup">13</span> The variables included were&#58; age&#44; marital status&#44; occupation&#44; BMI&#44; number of years of menopause&#44; and modified Blatt-Kupperman index&#46;</p><p class="elsevierStylePara"> With the data obtained we created a database in Microsoft Excel<span class="elsevierStyleSup">&#174;</span>&#44; for subsequent analysis using SPSS<span class="elsevierStyleSup">&#174;</span> v&#46; 14&#46; All the variables were analyzed with traditional descriptive statistics such as statistical average and dispersion measures &#40;standard deviation&#41;&#46; Pearson&#39;s correlation test was used to assess the correlation between BMI and Blatt-Kupperman&#44; as well as a dispersion graph&#46; Using Pearson&#39;s correlation&#44; a value of -1 to 1 was obtained &#40;a value closer to 1 indicates a positive correlation while a value closer to -1 indicates a negative correlation&#59; if the value is close to 0&#44; it implies that there is no lineal relation&#41;&#46; We assessed the correlation between marital status and occupation with the Blatt-Kupperman index through Pearson&#39;s R test&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results </span></p><p class="elsevierStylePara"> A total of 403 patients with an average age of 50&#46;01 &#40;&#177; 7&#46;70&#41; years&#44; with an average of 5&#46;69 &#40;&#177; 5&#46;97&#41; years of menopause were included in the study&#46; The average BMI was 28&#46;98 &#40;&#177; 5&#46;71&#41; kg&#47;m<span class="elsevierStyleSup">2</span>&#46; The average value of the Blatt-Kupperman index was 25&#46;78 &#177; 13&#46;48&#46; Regarding marital status&#44; 334 &#40;83&#37;&#41; of the patients were married&#44; 52 &#40;13&#37;&#41; were single&#44; and 17 &#40;4&#37;&#41; were widows&#46; Three hundred forty-nine patients &#40;87&#37;&#41; were housewives&#44; 42 &#40;10&#37;&#41; were employed outside their homes and 12 patients &#40;3&#37;&#41; were retired&#46;</p><p class="elsevierStylePara"> We found that the symptoms in 113 patients &#40;28&#37;&#41; were rated as severe&#44; in 140 &#40;35&#37;&#41; as moderate&#44; and in 150 &#40;37&#37;&#41; as mild&#44; according to the Blatt-Kupperman index&#46;</p><p class="elsevierStylePara"> Concerning BMI and degree of obesity&#44; 0&#46;3&#37; of the patients were thin&#44; only 20&#46;1&#37; had what is considered to be a normal BMI&#44; 41&#46;0&#37; were overweight&#44; and 37&#46;7&#37; were obese&#46; We evaluated the correlation between BMI and the Blatt-Kupperman index through Pearson&#39;s R test&#44; obtaining a value of 0&#46;053&#59; consequently&#44; we did not find a relationship between these 2 variables&#46;</p><p class="elsevierStylePara"> In order to show a correlation between BMI and the Blatt-Kupperman index&#44; a dispersion graph was created&#59; no correlation was found since we were not able to see an increasing or decreasing tendency of the Blatt-Kupperman index regarding BMI &#40;Fig&#46; 1&#41;&#46;</p><p class="elsevierStylePara"><img alt="Figure 1 Dispersion chart between BMI and the Blatt-Kupperman index&#46;" src="304v16n62-90328365fig1.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 1 </span>Dispersion chart between BMI and the Blatt-Kupperman index&#46;</p><p class="elsevierStylePara"> We evaluated the relationship between marital status and occupation with the Blatt-Kupperman index&#44; through Pearson&#39;s R test&#44; with a value of -0&#46;074 and 0&#46;017 respectively&#59; therefore&#44; no relationship was found between these variables&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion </span></p><p class="elsevierStylePara"> The information regarding the association between BMI and climateric symptoms is controversial&#46; In this study we assessed the correlation between the degree of obesity and the Blatt-Kupperman index&#44; since some authors concur that estrogen production in adipose tissue in overweight and obese patients protects them from suffering climateric symptoms&#44;<span class="elsevierStyleSup">9</span> in contrast with other authors who conclude that a greater BMI and weight gain are associated with reports of greater climateric manifestations&#44; mainly hot flashes&#44; during transition to menopause&#46; These findings concur with a thermoregulatory model of vasomotor symptoms in which body fat acts as an insulator&#44; preventing heat dissipation&#46;<span class="elsevierStyleSup">14</span></p><p class="elsevierStylePara"> Riley et al&#46; found that 30&#37; of 468 perimenopausal and 287 postmenopausal females reported hot flashes&#46; Perimenopausal patients with a BMI &#62; 25 kg&#47;m<span class="elsevierStyleSup">2</span> reported more hot flashes with a relative risk &#40;RR&#41; of 2&#46;00 &#40;RI 95&#37; &#61; 1&#46;28 -3&#46;12&#41;&#46; We did not find an association with hot flashes in postmenopausal patients&#46;<span class="elsevierStyleSup">15</span></p><p class="elsevierStylePara"> Mart&#237;nez P&#233;rez et al&#46; carried out a study with 10&#44;514 women with an average age of 57&#46;9 &#40;&#177; 7&#46;1&#41; years&#44; finding that smoking&#44; use of alcohol&#44; BMI &#62; 25 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; marital status&#44; educational level&#44; and social level were associated with more severe menopausal symptoms for BMI &#40;RR &#61; 3&#46;64&#59; RI 95&#37; &#61; 2&#46;96 - 4&#46;32&#41;&#46;<span class="elsevierStyleSup">16 </span></p><p class="elsevierStylePara"> Thurston et al&#46; Assessed the connection of the adiposity with vasomotor symptoms in the study of Women&#39;s Health across the nation&#44; which included 1&#44;776 women aged 47 to 59 years with an intact uterus and at least 1 ovary&#44; in whom vasomotor symptoms and hormonal serum levels were evaluated&#46; They concluded that a greater percentage of body fat was associated with vasomotor symptoms &#40;RR &#61; 1&#46;27&#59; RI 95&#37; &#61; 1&#46;14 - 1&#46;42&#41;&#46;<span class="elsevierStyleSup">17</span></p><p class="elsevierStylePara"> In this study&#44; no connection between BMI and Blatt-Kupperman index was found&#59; a probable reason for this is the fact that estrogens of peripheral origin do not have the biological action that ovarian estrogen has&#46;</p><p class="elsevierStylePara"> The reason for the inconsistent findings regarding a connection between BMI and climateric symptoms is unknown&#46; Some studies suggest that the inconsistencies may be related to the different endogenous estrogen and other hormones levels in women with different body sizes&#46; Hormonal changes are customary during the transition into menopause&#46; Furthermore&#44; for the formation of estrogens from circulating androgen precursors&#44; the adipose tissue produces hormones such as leptin and tumor necrosis factor&#44; which suppress ovarian production of steroids and have an influence on thermoregulation&#46;<span class="elsevierStyleSup">18 </span></p><p class="elsevierStylePara"> P&#233;rez-P&#233;rez found that women who work in public spaces adapt more easily to hormonal changes in climaterium and menopause&#44; in contrast to those who are housewives who feel misunderstood&#44; rejected&#44; and have a low self-esteem&#46;<span class="elsevierStyleSup">19</span></p><p class="elsevierStylePara"> However&#44; no connection was established between the Blatt-Kupperman index and occupation or marital status in our study&#46; Further studies assessing all risk factors&#44; like health problems&#44; use of alcohol&#44; smoking&#44; role at work&#44; family dynamics&#44; presence of depression&#44; as well as their connection with weight gain or loss in the female in transition to menopause are required&#46;</p><p class="elsevierStylePara"> While the results of this study report that the degree of obesity does not have an impact on climateric symptoms severity&#44; most patients showed some degree of overweight or obesity&#59; hence obese patients should undergo more complete tests&#44; including sociological&#44; physical&#44; and personal history&#44; in order to identify those with a higher risk of presenting symptoms and to develop appropriate preventative strategies&#44; including lifestyle modifications and the establishment of better treatment&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest </span></p><p class="elsevierStylePara"> The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Funding </span></p><p class="elsevierStylePara"> No financial support was provided&#46;</p><hr></hr><p class="elsevierStylePara"> Received&#58; February 2013&#59; <br></br> accepted&#58; november 2013</p><p class="elsevierStylePara"> &#42; Corresponding author&#58; <br></br> Laguna de Catemaco 1359&#44; Las Quintas&#44; Z&#46;P&#46; <br></br> 80060&#44; Culiac&#225;n&#44; Sin&#46;&#44; Mexico&#46; <br></br> Telephone&#58; &#40;667&#41; 715 8045&#46; <span class="elsevierStyleItalic"><br></br> E-mail address</span>&#58; <a href="mailto&#58;isabelyunuen&#64;hotmail&#46;com" class="elsevierStyleCrossRefs">isabelyunuen&#64;hotmail&#46;com</a> &#40;I&#46; Y&#46; Gonz&#225;lez-Carrillo&#41;&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"> <span class="elsevierStyleItalic">Objectives</span>&#58; To determine the association between climateric symptoms and body mass index &#40;BMI&#41;&#46; In addition&#44; to define the age of onset of climateric symptoms and to associate a patient&#39;s occupation and marital status with climateric symptom severity&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Materials and methods</span>&#58; Observational&#44; retrospective and cross-cohort study including 403 patients attending the Menopause Clinic of the University Hospital of the <span class="elsevierStyleItalic">Universidad Aut&#243;noma de Nuevo Le&#243;n</span> from November 2008 to December 2011&#46; Clinical history&#44; physical examination&#44; weight and height&#44; and BMI were evaluated&#46; Climateric symptoms were assessed through the Blatt-Kupperman modified index&#46; Marital status and occupation were also analyzed&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Results</span>&#58; No relation was found between BMI and climateric severity&#44; nor was there any relation between climateric symptoms and marital status or occupation&#46;</p> <p class="elsevierStylePara"> <span class="elsevierStyleItalic">Conclusions</span>&#58; Additional research is needed to assess the influence of climateric risk factors&#46;</p>"
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Article information
ISSN: 16655796
Original language: English
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