Modificación de la composición corporal con la terapia hormonal parenteral y oral en la menopausia / Changes in body composition with the use of parenteral and oral hormone therapy in the menopause

Resumen Antecedentes: La menopausia se relaciona con cambios en la composición corporal que el uso de terapia hormonal (TH) puede revertir. Objetivo: Determinar el efecto de la TH parenteral y oral sobre la composición corporal en la menopausia. Material y métodos: Se realizó un estudio retrolectivo que incluyó a 86 mujeres de 45 a 55 años, con FSH > 20 Ul/ml, antecedente de histerectomía y sintomatología vasomotora, a las cuales se les administró TH por vía oral (44 pacientes) o parenteral (42 pacientes) durante seis meses. Se les realizó impedancia bioeléctrica antes y después del tratamiento. Resultados: La TH por vía oral se asoció con una disminución de diferentes parámetros de la composición corporal entre los que destaca la disminución de la grasa visceral (p < 0.05). La TH parenteral no mostró modificación en la composición corporal. Conclusión: La TH por vía oral modifica de manera positiva la composición corporal, lo cual puede contribuir a regular el estado metabólico.

Abstract Background: Menopause is associated with changes in body composition that the use of hormone therapy (HT) can reverse. Objective: To determine the effect of parenteral and oral HT on body composition in menopause. Material and methods: A retrolective study was carried out in 86 women aged 45 to 55 years old, with FSH > 20 Ul/ml, a history of hysterectomy and vasomotor symptoms. The participants received oral HT (44 patients) or parenteral (42 patients) for six months. Bioelectrical impedance was performed before and after treatment. Results: Oral HT was associated with a decrease in different parameters of body composition, among which the decrease in visceral fat stands out (p < 0.05). Parenteral HT did not show changes in body composition. Conclusion: Oral HT positively modifies body composition, which can help regulate the metabolic state.

Obesidad materna como factor de riesgo de obesidad infantil / Maternal obesity as a risk factor for childhood obesity

Introducción: diversos factores ambientales se han relacionado con el incremento en la frecuencia de obesidad infantil en los últimos años. Objetivo: determinar los factores maternos, socioeconómicos y de estilo de vida asociados al sobrepeso/obesidad en niños de 5 a 10 años. Metodología: se realizó un estudio transversal analítico en 153 niños de ambos sexos a los que se les midió peso, talla, índice de masa corporal, presión arterial, glucosa capilar y la presencia de acantosis nigricans. Se compararon los factores entre niños eutróficos y niños con sobrepeso/obesidad a través de Chi cuadrada o t de Student y se realizó una regresión logística para determinar los factores asociados al sobrepeso/obesidad del niño. Resultados: el 30.7% de los niños presentó sobrepeso/obesidad, en ellos se encontró mayor frecuencia de acantosis nigricans y mayores cifras de presión arterial sistólica. El predictor de obesidad infantil fue la obesidad materna, el riesgo de obesidad entre niños de madre con obesidad fue OR: 1.261 (IC95%: 1.047-1.518). Conclusiones: la obesidad materna incrementa el riesgo de obesidad infantil.

Introduction: Several environmental factors have been related to the increase in the frequency of childhood obesity in recent years. Objective: To determine maternal, socioeconomic and lifestyle factors associated with overweight/obesity in children 5 to 10 years oíd. Methods: A cross-sectional analytical study was performed with 153 children of both sexes, measuring weight, height, body mass índex, blood pressure, casual capillary glucose and the presence of acantosis nigricans. Factors were compared between eutrophic children and those with overweight/obesity through Chi-square test or Student's t test, and logistic regression was performed to determine the factors associated with the child's overweight/obesity. Results: 30.7% of the children presented overweight/obesity. In them acantosis nigrica higher systolic blood pressure were found more frequently. The predictor of childhood was maternal obesity; the risk of obesity among children with mothers with obesity it \a 1.261 (95%CI: 1.047-1.518). Condusions: Maternal obesity increases the risk of childhood obesity.

Alpha estrogen receptor polymorphisms and their association with breast density. / Polimorfismos del receptor de estrógenos alfa y su asociación con la densidad mamaria.

BACKGROUND: In the development of breast cancer (BC), estrogen exposure and the increase in breast density (BD) are two determinant factors for BC risk. OBJECTIVE: To identify the relationship between the XbaI and PvuII polymorphisms in the estrogen receptor (ER-alpha) with BD. MATERIAL AND METHODS: Cross-sectional study which included 225 women, aged 40-65 years, without evident cancer data, who underwent routine mammography for early BC diagnosis in a radiology department. Two groups were formed: women with increased and with normal BD. Participants were genotyped for the XbaI and PvuII polymorphisms. RESULTS: 19.1% had normal weight, 37.7% overweight, and 43.2% were obese women. In relation to high-risk patterns, 105 women had increased BD and 120 had normal BD (53.3%). The frequency of women with increased BD was also lower in postmenopausal women. Regarding the type of BD, there was no statistically significant difference between frequencies of PvuII and XbaI genotypes. Logistic regression showed that only age and body mass index (BMI) were associated with BD. CONCLUSION: PvuII and XbaI ER-alpha genotypes were similar among women with dense and non-dense breasts; differently, other factors were associated with BD (age, BMI and menopausal status). Therefore, emphasis should be placed on clinical practice in the relationship between BMI and BD.

INTRODUCCIÓN: En el desarrollo de cáncer de mama (CaMa), la exposición estrogénica y el aumento de la densidad mamaria (DM) son dos factores determinantes de riesgo. OBJETIVO: Identificar la asociación entre los polimorfismos XbaI y PvuII del receptor de estrógenos (ER-alfa) con la DM. MATERIAL Y MÉTODOS: Estudio transversal que incluyó 225 pacientes de 40-65 años, sin datos evidentes de cáncer, que se realizaron mastografía de rutina en un departamento de radiología para diagnóstico precoz de CaMa. Se clasificaron en dos grupos: con presencia o ausencia de DM aumentada. Se les tomó muestra sanguínea para extraer DNA y determinar los polimorfismos XbaI y PvuII del gen ER-alfa. RESULTADOS: 19.1% tuvo peso normal, 37.7% sobrepeso y el 43.2% obesidad. En relación con la DM, 105 tuvieron mama densa (46.7%) y 120 mama no densa (53.3%). La frecuencia de mujeres con mama densa fue inferior en las mujeres posmenopáusicas. En cuanto al tipo de DM, no hubo diferencia significativa entre las frecuencias en los genotipos de PvuII y XbaI. La regresión logística mostró que solo la edad y el índice de masa corporal (IMC) fueron factores determinantes de la DM. CONCLUSIONES: Los genotipos PvuII y XbaI del ER-alfa fueron similares entre las mujeres con mama densa y no densa; en contraste, otros factores se relacionaron con la DM (edad, IMC y estado menopáusico). Por ende, en la práctica clínica se debe enfatizar la relación del IMC con la DM, pues esta representa un factor de riesgo de CaMa.

Coronavirus disease 2019 and pregnancy. / Enfermedad por coronavirus 2019 y embarazo.

Historically, viral respiratory infections in pregnant women have shown an increase in the risk of morbidity and mortality. With regards to COVID-19, information is limited and a greater risk of severe morbidity or mortality has not been shown, when compared to general population; however, pregnant women with comorbidities such as obesity, type 2 diabetes mellitus and hypertension have shown a greater severity of the disease, consistent with the general population with these comorbidities. The risk of vertical transmission appears to be low: it has not been demonstrated in any case during the current outbreak of COVID-19 in China, nor in previous epidemics of similar coronaviruses (SARS-CoV and MERS-CoV). Existing studies have not demonstrated the presence of the virus in genital fluid, amniotic fluid or maternal milk. Described cases of infection in newborns probably come from horizontal transmission, which suggests breastfeeding with respiratory hygiene measures. Given that COVID-19 is a new disease that has extended around the world and that current knowledge is still insufficient, it is mandatory the continued accumulation of data to discover in depth the action mechanisms of SARS-CoV-2 virus, responsible for the disease, and constant update of means of prevention and handling of the disease.

Históricamente, las infecciones respiratorias virales en mujeres embarazadas han mostrado un incremento en el riesgo de morbilidad y mortalidad. En relación con el COVID-19 la información es limitada y no ha mostrado un mayor riesgo de morbilidad severa o mortalidad en comparación con la población en general; sin embargo, las mujeres embarazadas con comorbilidades como obesidad, diabetes mellitus tipo 2 e hipertensión arterial han presentado una mayor severidad de la enfermedad de manera más consistente a lo que ocurre en la población general con esas comorbilidades. El riesgo de transmisión vertical parece bajo: no se ha podido demostrar en ningún caso durante el brote actual de COVID-19 en China, ni tampoco en epidemias previas por otros coronavirus similares (SARS-CoV y MERS-CoV). Los estudios existentes no han evidenciado presencia del virus en fluidos genitales, líquido amniótico, ni tampoco en la leche materna. Los casos descritos de infección en recién nacidos provienen probablemente de transmisión horizontal, por lo que se sugiere la lactancia materna con medidas de higiene respiratoria. Debido a que la enfermedad por coronavirus se ha extendido a nivel mundial y el conocimiento actual es aún insuficiente, es imperativo el cúmulo de evidencia y profundizar en los mecanismos de acción del virus SARS-CoV-2, responsable de la enfermedad, y también que se actualicen constantemente las medidas de prevención y manejo de la enfermedad.

In memory of Dr. Arturo Zárate Treviño, pioneer in the study of gynecological endocrinology in Mexico / In memoriam Dr. Arturo Zárate Treviño, pionero en el estudio de la endocrinología ginecológica en México

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Relationship between bone remodeling and metabolism in the elderly / Relación entre la actividad ósea y el metabolismo en el adulto mayor

Background: Recent studies have shown that osteocalcin (OC) is related to not only bone metabolism but also energy metabolism. The aim of the present study was to investigate whether OC was associated with metabolic factors and bone mineral density (BMD) in elderly men. Methods: A cross-sectional study was done including 122 healthy men aged 60 years or older. Serum glucose, lipids, insulin, adiponectin and OC were measured and BMD was estimated using dual energy X-ray absorptiometry. Results: 42.8% of men had metabolic syndrome (MetS). OC levels were not significantly different between men with and without MetS. OC concentrations were inversely associated with body mass index (BMI) (r = −0.226, p = 0.04), waist circumference (r = −0.261, p = 0.02), glucose (r = −0.245, p = 0.03), insulin (r = −0.235, p = 0.03), and HOMA-IR (r = −0.211, p = 0.04). In addition, OC levels were higher in patients with diminished BMD compared with those with normal BMD. Conclusions: OC levels correlate negatively with BMI, waist circumference, glucose, insulin and HOMA-IR in elderly men, which suggests a connection between bone and energy metabolism.

Introducción: diversos estudios sugieren que la osteocalcina (OC) contribuye no solo a la regulación del metabolismo óseo, sino también al metabolismo energético. El objetivo del trabajo fue evaluar la relación entre la concentración sérica de OC y los parámetros metabólicos y la densidad mineral ósea (DMO) en adultos mayores. Métodos: estudio transversal descriptivo en 122 hombres sanos mayores de 60 años. Se les determinó glucosa, lípidos, insulina, adiponectina y OC. La DMO se analizó por absorciometría de doble fotón. Resultados: el 42.8% de la muestra presentó síndrome metabólico (SM). Los niveles de OC no difirieron entre el grupo de pacientes con y sin SM. Se observó una correlación negativa entre la concentración de OC y el índice de masa corporal (IMC) (r = −0.226, p = 0.04), circunferencia de cintura (r = −0.261, p = 0.02), glucosa (r = −0.245, p = 0.03), insulina (r = −0.235, p = 0.03) y HOMA-IR (r = −0.211, p = 0.04). Los pacientes con DMO disminuida mostraron una concentración significativamente mayor de OC en comparación con aquellos con DMO normal. Conclusiones: la OC se asoció inversamente con el IMC, la obesidad abdominal, la glucosa, la insulina y la resistencia a la insulina en hombres mayores de 60 años. Lo anterior confirma la conexión que existe entre el tejido óseo y el metabolismo.

An increase in epicardial fat in women is associated with thrombotic risk. / El incremento de la grasa epicárdica en mujeres se asocia a riesgo trombótico.

INTRODUCTION: A decrease in fibrinolytic activity and an increase in the thickness of the epicardial adipose tissue have been observed in patients with coronary artery disease. The aim of this study was to determine the association between epicardial adipose tissue and fibrinolytic activity by measuring the concentration of plasminogen activator inhibitor-1 (PAI-1). METHODS: A cross-sectional study was conducted on 56 apparently healthy women aged 45 to 60 years. Anthropometric measurements and biochemical determinations were performed on all participants. The fibrinolytic activity was determined by measuring PAI-1 by ELISA. Epicardial thickness was assessed by transthoracic echocardiography. RESULTS: The concentration of PAI-1 was directly associated with the thickness of the epicardial adipose tissue (r=0.475, P=.001), body mass index (BMI), visceral adipose tissue, insulin resistance, glucose, and HDL-cholesterol. The multivariate regression analysis indicated that epicardial fat independently predicts the concentrations of PAI-1. CONCLUSIONS: Women with thicker epicardial adipose tissue have reduced fibrinolytic activity, and consequently greater thrombotic risk.

Menopausal women have hypofibrinolysis even in subclinical stage of atherosclerosis.

BACKGROUND: PAI-1 is the main inhibitor of fibrinolysis. Increase in PAI-1 levels has been associated with the risk of coronary disease; however, there are few studies on the relationship between subclinical atherosclerosis and PAI-1 levels. OBJECTIVE: The aim of this study was to analyze the relationship between PAI-1 level and carotid intima-media thickness in premenopausal and postmenopausal women without apparent cardiovascular disease. MATERIAL AND METHODS: A cross-sectional study was conducted in 142 women aged 45 to 60 years with no history of cardiovascular disease. Anthropometric and laboratory measurements were performed, including PAI-1 levels. All participants underwent a B-Mode ultrasound to measure intima-media thickness. Subclinical atherosclerosis was considered when intima-media thickness was ≥ 0.7 mm and/or an atheromatous plaque was observed. RESULTS: Postmenopausal women had greater intima-media thickness than premenopausal women (0.688 ± 0.129 vs. 0.621 ± 0.113 mm; p < 0.05). Compared to women with normal intima-media thickness, women with subclinical atherosclerosis had higher PAI-1 levels (23.2 ± 13.7 vs. 30.4 ± 20.7 ng/ml; p < 0.05). In all participants, intima-media thickness correlated with PAI-1 (r = 0.302; p = 0.01) and with age (r = 0.358; p = 0001). CONCLUSIONS: An increase in intima-media thickness was observed in postmenopausal women compared with premenopausal women. Asymptomatic women with increased intima-media thickness had higher PAI-1 levels. These findings suggest that fibrinolytic activity is low in the subclinical stage of atherosclerosis.

Epicardial adipose tissue is associated with visceral fat, metabolic syndrome, and insulin resistance in menopausal women.

INTRODUCTION AND OBJECTIVES: Epicardial adipose tissue has been associated with several obesity-related parameters and with insulin resistance. Echocardiographic assessment of this tissue is an easy and reliable marker of cardiometabolic risk. However, there are insufficient studies on the relationship between epicardial fat and insulin resistance during the postmenopausal period, when cardiovascular risk increases in women. The objective of this study was to examine the association between epicardial adipose tissue and visceral adipose tissue, waist circumference, body mass index, and insulin resistance in postmenopausal women. METHODS: A cross sectional study was conducted in 34 postmenopausal women with and without metabolic syndrome. All participants underwent a transthoracic echocardiogram and body composition analysis. RESULTS: A positive correlation was observed between epicardial fat and visceral adipose tissue, body mass index, and waist circumference. The values of these correlations of epicardial fat thickness overlying the aorta-right ventricle were r = 0.505 (P < .003), r = 0.545 (P < .001), and r = 0.515 (P < .003), respectively. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome than in those without this syndrome (mean [standard deviation], 544.2 [122.9] vs 363.6 [162.3] mm(2); P = .03). CONCLUSIONS: Epicardial fat thickness measured by echocardiography was associated with visceral adipose tissue and other obesity parameters. Epicardial adipose tissue was higher in postmenopausal women with metabolic syndrome. Therefore, echocardiographic assessment of epicardial fat may be a simple and reliable marker of cardiovascular risk in postmenopausal women.

Decrease in serum adiponectin levels associated with visceral fat accumulation independent of pubertal stage in children and adolescents.

BACKGROUND AND AIMS: Childhood obesity is an important risk factor for the development of insulin resistance (IR) and its co-morbidities. However, visceral adipose tissue (VAT) rather than obesity appears to have a determining role in the development of IR. Adiponectin is considered a key molecule for protection against metabolic abnormalities related to IR. Several studies have documented that lower adiponectin concentrations are related to VAT, but the results are still controversial. We undertook this study to assess the association between VAT and adiponectin concentrations with respect to body mass index (BMI) and pubertal stage in children and adolescents. METHODS: Eighty five subjects were studied (46 prepubertal and 39 pubertal) and classified according to BMI into obese and normal weight groups. All participants were given a clinical examination. Glucose, insulin, lipid profile and adiponectin were measured. VAT was estimated using helical computed tomography. RESULTS: In the prepubertal group, obese children had lower adiponectin concentrations than nonobese subjects (p <0.001) but not in pubertal group (p = 0.67). When the total population was subclassified according to VAT, those with higher VAT had greater systolic and diastolic blood pressure, triglycerides, post-load glucose, insulin and HOMA-IR (p <0.001) compared to those with less VAT. HDL-C and adiponectin values trends to diminish as VAT increased (p = 0.005 and p = 0.015, respectively). CONCLUSIONS: Adiponectin concentrations are inversely associated with VAT in children. The higher amount of VAT is related to metabolic abnormalities including lower values of adiponectin, which could confer a greater risk of developing type 2 diabetes mellitus and cardiovascular disease.

[Oral or trandsdermanl hormone replacement therapy reduces interleukine-6 levels]. / La terapia estrogénica de reemplazo, oral o transdérmica, reduce las concentraciones de interleucina-6.

OBJECTIVE: To compare the effect of oral and transdermal estrogen replacement therapy (ET) on circulating interleukin-6 (IL-6) in post-menopausal women. PATIENTS AND METHOD: Prospective open trial study in 55 healthy hysterectomized postmenopausal women with a mean age of 52 years. Twenty-seven women received oral conjugated equine estrogens (0.625 mg daily) and the remaining 28 received transdermal estrogen replacement therapy (50 microg/day) during 6 months. At baseline both groups were similar as to age, body weight, and body mass index as well as serum levels of LH, FSH, 17-beta estradiol (E2) and IL-6. RESULTS: Baseline elevated IL-6 levels decreased significantly (p<0.05) after both oral and transdermal estrogen replacement therapy; this decrement showed no difference between the two groups. After the follow-up there were no differences in body weight and body mass index between groups; however, in the oral group there was a trend to increment this parameters. Serum levels of E2 and IL-6 were negatively correlated in the two groups and IL-6 was positively correlated with body mass index in untreated women and this correlation was the same in women with estrogen replacement therapy. CONCLUSIONS: The decrement of IL-6 after estrogen replacement therapy was similar for both routes of administration; in addition IL-6 had a negative correlation with E2 and a positive correlation with body mass index.