Someone asked about this topic recently. I found the incidence of bone
loss especially pertinent. Arbor permits forwarding, as long as no
changes are made in content. Subscribing instructions are at the end.
-- Kathrynne Holden, MS, RD "Ask the Parkinson Dietitian" http://www.parkinson.org/ Author: "Eat well, stay well with Parkinson's disease" "Guidelines for Medical Nutrition Therapy for Parkinson's disease" http://www.nutritionucanlivewith.com/____________________________________________________
ARBOR CLINICAL NUTRITION UPDATES © ____________________________________________________
This week we continue our series on weight management. We review three studies which look at changes in weight in women around the time of menopause.
Subscribing instructions for those who are receiving this Update indirectly (e.g. through a friend, mailing list etc.) are at the end. If you have any friends or colleagues who you think might like to receive them, please let them know.
Instructions for changing your subscription email address also appear at the end.
We invite you to visit our main Arbor Nutrition Guide for a comprehensive listing of nutritional information available on the Internet.
Kind regards,
Arbor Clinical Nutrition Updates http://arborcom.com
____________________________________________________ NUTRITION RESEARCH REVIEW
Study one: Lifestyle intervention prevents peri-menopausal weight gain ----------------------------------------------------------------- A conventional program of reducing saturated and total fat intake and increasing physical activity is effective in preventing weight gain that might otherwise occur in women at or around menopausal age. These are newly published results from the ongoing US-based Women's Healthy Lifestyle Project.
Subjects: 535 pre-menopausal women of average age 47 years and initial upper normal body weight (average BMI=25).
Method: Random assignment to non-intervention (observation only) or active lifestyle intervention.
Results: After 54 months just over a third of the women had become post-menopausal. There was a slight weight loss (-0.2 lb = 0.09 kg) in the intervention group, compared with an increase (+5.2 lb = 2.36 kg) in the non-intervention group (p<0.001).
There was less of an increase in LDL levels in the non-intervention group (+ 3.5 mg/dL) compared with the non-intervention group (+8.9mg/dL, p =0.009).
Reference: Circulation 2001;103:32-7
Study two: Weight loss increases bone loss ------------------------------------------------------------------ Moderate energy restriction in obese post-menopausal women increases bone loss, according to another American study.
Subjects: 27 obese (mean BMI = 33.0) post-menopausal women (average age 56 years).
Method: 14 women followed a moderate energy restricted diet, and 13 control women maintained normal weight for 6 months.
Results: The women on the energy restricted diet lost 10.2% of their initial weight. They had a 1.2% loss in bone mineral density, with elevated rates of bone resorption and formation (all p<0.05 compared with the control group). The energy controlled subjects had a reduction in fat mass with weight loss which was correlated with decreased serum oestrone (r sq =0.5, p < 0.01) and an increase in serum parathyroid hormone (PTH).
Reference: Am J Clin Nutr 2001;73:347-352
Study three: ...but calcium can partly reverse this ------------------------------------------------------------------------- Subjects: 48 obese women placed on a low calorie diet.
Method: The women were randomised to either no additional management or a calcium supplement (1gm/day) for 3 months.
Results: Both groups had a significant fall in total body bone mineral content. The control (but not the supplemented) group also experienced significant loss in bone mineral content of the lumbar spine. The supplemented group (but not the controls) had a significant decrease in serum PTH.
Reference: J Bone Miner Res 2001;16:141-147
COMMENTS The Women's Healthy Lifestyle Project study confirms what has already been known for a long time - that women in mid-life have a tendency to gain weight. Moreover, the weight they gain is likely to be of central distribution, which has greater negative implications for long term health.
It is not clear whether this susceptibility to weight gain is due to the hormonal changes of menopause, or just to the general process of aging and lifestyle change. A recent study from Chile found a similar amount of weight gain amongst middle aged women over a 5 year period of observation regardless of whether they had become menopausal during that time or not. Nor did the use of hormone replacement therapy make any difference (Menopause 2001;8:239-44. ).
On the other hand, a recent Italian study found that menopausal women given low dose oestrogen/ progesterone replacement therapy had significantly less weight gain than controls (J Obst Gynecol 2001;185:1180-5) .
Whatever the cause of this weight gain may be, the current study is helpful in showing that a straightforward dietary and exercise intervention can be effective in reversing this tendency.
However, as the second and third studies show, there are potential complications. They confirm what has been shown in a number of previous studies - that weight loss in women around menopausal age is associated with increased loss of bone density, but that it may be possible to reverse this to some extent using supplementary calcium.
These results and results from other research suggest that around a gram a day of supplemental calcium will normalise the PTH changes. However, it remains to be seen what the impact will be in long term prevention of osteoporosis.
The fact that only lumbar and not total bone mineral density was improved in the second study is something that is often seen in studies on calcium supplementation and osteoporosis (see for example Med J Aust 2001;175:242-5). Why different parameters of bone density (e.g. forearm, lumbar) show different effects from treatment remains uncertain, as does the clinical significance of these different responses.
What conclusion should the clinician draw? ------------------------------------------------------------------ Weight gain around the time of menopause can be prevented, but you need to be aware of the impact on bone loss. Appropriate counter-measures include making sure the weight loss program includes plenty of weight bearing exercise, and that the woman is consuming plenty of calcium.
____________________________________________________ SUBSCRIBING INSTRUCTIONS
BECOMING A SUBSCRIBER If you would like to receive the Clinical Nutrition Updates in your own name, please send us a request email to <updatD@arborcom.com>. This is a FREE service to health professionals and students.
PLEASE PROVIDE details of: your name, email address, the country where you live, the institution you are associated with (if relevant) and your professional background. The Updates are available in English, Spanish, Portuguese and Japanese.
IF YOU WANT TO CHANGE YOUR SUBSCRIPTION DETAILS This process is automated. So please fulfill the following instructions EXACTLY. If there are any deviations, your request will unfortunately NOT be processed.
- To REQUEST NO ACROBAT format version 1. Send an email to <change@arborcom.com>. 2. In the `Subject:' line, put ONLY the words "NO Acrobat" followed by the email address under which you are subscribed.
- To CANCEL your subscription : 1. Send an email to <change@arborcom.com>. 2. In the `Subject:' line, put ONLY the word "UNSUB" followed by the email address under which you are subscribed.
- To CHANGE EMAIL ADDRESS: 1. Send an email to <change@arborcom.com>. 2. In the `Subject:' line, put ONLY the words "CHANGE EMAIL" 3. In the body of the email, put ONLY Old email address: [your old email address] New email address: [your new email address]
We don't guarantee to process changes immediately, so plan ahead! ____________________________________________________ Disclaimer, terms of use and copyright Use of this email or any attachment to it is your acknowledgement and agreement to the disclaimer and terms of use on our web site at http://arborcom.com/disclaim2.htm. If you do not have access to the web, you can obtain these terms of use by emailing us at <upD@arborcom.com>
© This Update is copyright Arbor Communications PTL 2002
This archive was generated by hypermail 2b29 : Mon Feb 25 2002 - 05:45:39 PST