Brown Adipose Tissue Activity and Childhood Exposure to Cold Are Associated With Hot Flashes at Menopause.

OBJECTIVE: Hot flashes (HFs) are experienced as sudden sensations of heat. We hypothesized that brown adipose tissue (BAT) activation could increase the likelihood of HFs in winter. The aim of this study was to test whether women with more BAT activity were more likely to experience self-reported or biometrically measured HFs. METHODS: Women aged 45-55 years (n = 270) participated in face-to-face interviews and anthropometric and ambulatory measures. Level of BAT activity was estimated from the difference in supraclavicular skin temperature measured by infrared thermography before and after cooling. Logistic regressions were applied to examine whether bothersome HFs (yes/no) during the past 2 weeks were associated with BAT activity, adjusting for menopausal status, childhood exposure to cold, waist/hip ratio, and self-reported health. Linear regressions were used to examine the frequency of self-reported and biometrically measured HFs during the study period and BAT activity, adjusting for potential confounders. RESULTS: Menopausal status, childhood exposure to cold, waist-to-hip ratio (WHR), and self-reported health were associated with both BAT activity and HFs. After adjusting for potential confounders, an increase in BAT activity almost tripled the likelihood of bothersome HFs (OR 2.84, 95% CI 1.26-6.43). In linear regressions, BAT activity was not associated with frequency of subjective or objective HFs during the study period, but childhood exposure to cold was associated with subjective HF report (ß = 0.163, p = 0.010). CONCLUSION: To our knowledge, this is the first study of BAT activation and HFs. Our results support a role for BAT activity in HF experience. Therefore, we encourage further examination of the role of BAT, as well as childhood exposure to cold, in HFs.

Hand grip strength, standing balance, and rapid foot tapping in relation to the menopausal transition in Campeche, Mexico.

OBJECTIVES: This cross-sectional study investigated menopause status in relation to hand grip strength, standing balance, and rapid foot tapping. A secondary aim was to examine the relationship between physical performance and urban/rural residence with a focus on habitual daily tasks. METHODS: Maya and non-Maya women (40-60 years) were drawn from urban and rural sites in Campeche, Mexico (n = 543). Demographic, reproductive, and lifestyle information was collected in face-to-face interviews along with anthropometric and physical function measures. Linear regression was used to evaluate menopause status in relation to strength, balance, and foot tapping speed while adjusting for residence, ethnicity, and other variables. RESULTS: Hand grip strength was 22.5, 21.6, and 20.0 kg in pre-, peri-, and postmenopausal women, respectively, but menopause status was not significantly related to grip strength in models adjusted for age. Grip strength was negatively associated with age and socioeconomic index, and positively associated with height and weight, self-reported health, and hours/week spent grinding corn/making tortillas. Postural stability was 9.4, 6.9, and 5.6 s across menopause categories; and menopause status remained significant in adjusted models. The number of foot taps in 10 s was 35.7, 33.4, and 33.9 taps in pre-, peri-, and postmenopausal women. Parity was negatively associated with foot tapping in adjusted models. CONCLUSIONS: While age is a key predictor of physical function in women aged 40-60 years, menopausal status appears to have additional influences on postural control beyond age alone. Hours spent grinding corn/making tortillas were significantly associated with grip strength among rural women.

Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies.

BACKGROUND: Cigarette smoking is associated with earlier menopause, but the impact of being a former smoker and any dose-response relationships on the degree of smoking and age at menopause have been less clear. If the toxic impact of cigarette smoking on ovarian function is irreversible, we hypothesized that even former smokers might experience earlier menopause, and variations in intensity, duration, cumulative dose, and age at start/quit of smoking might have varying impacts on the risk of experiencing earlier menopause. METHODS AND FINDINGS: A total of 207,231 and 27,580 postmenopausal women were included in the cross-sectional and prospective analyses, respectively. They were from 17 studies in 7 countries (Australia, Denmark, France, Japan, Sweden, United Kingdom, United States) that contributed data to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). Information on smoking status, cigarettes smoked per day (intensity), smoking duration, pack-years (cumulative dose), age started, and years since quitting smoking was collected at baseline. We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRRs) and 95% confidence intervals (CIs) for the associations between each smoking measure and categorised age at menopause (<40 (premature), 40-44 (early), 45-49, 50-51 (reference), and ≥52 years). The association with current and former smokers was analysed separately. Sensitivity analyses and two-step meta-analyses were also conducted to test the results. The Bayesian information criterion (BIC) was used to compare the fit of the models of smoking measures. Overall, 1.9% and 7.3% of women experienced premature and early menopause, respectively. Compared with never smokers, current smokers had around twice the risk of experiencing premature (RRR 2.05; 95% CI 1.73-2.44) (p < 0.001) and early menopause (1.80; 1.66-1.95) (p < 0.001). The corresponding RRRs in former smokers were attenuated to 1.13 (1.04-1.23; p = 0.006) and 1.15 (1.05-1.27; p = 0.005). In both current and former smokers, dose-response relationships were observed, i.e., higher intensity, longer duration, higher cumulative dose, earlier age at start smoking, and shorter time since quitting smoking were significantly associated with higher risk of premature and early menopause, as well as earlier menopause at 45-49 years. Duration of smoking was a strong predictor of age at natural menopause. Among current smokers with duration of 15-20 years, the risk was markedly higher for premature (15.58; 11.29-19.86; p < 0.001) and early (6.55; 5.04-8.52; p < 0.001) menopause. Also, current smokers with 11-15 pack-years had over 4-fold (4.35; 2.78-5.92; p < 0.001) and 3-fold (3.01; 2.15-4.21; p < 0.001) risk of premature and early menopause, respectively. Smokers who had quit smoking for more than 10 years had similar risk as never smokers (1.04; 0.98-1.10; p = 0.176). A limitation of the study is the measurement errors that may have arisen due to recall bias. CONCLUSIONS: The probability of earlier menopause is positively associated with intensity, duration, cumulative dose, and earlier initiation of smoking. Smoking duration is a much stronger predictor of premature and early menopause than others. Our findings highlight the clear benefits for women of early smoking cessation to lower their excess risk of earlier menopause.

Variation in levels of AMH among Maya and non-Maya women in Campeche, Mexico.

OBJECTIVES: The purpose of this study was to examine anti-Müllerian hormone (AMH) levels among women of Maya and non-Maya ancestry in the city of Campeche, Mexico. Levels of AMH can potentially predict age at menopause. Previous studies have indicated an early mean age at menopause among the Maya. MATERIALS AND METHODS: Women aged 40-60 (n = 97) participated in semistructured interviews, anthropometric measures, and blood samples. Maya/non-Maya ethnicity was determined by the last names, languages spoken, and birthplace of the woman, her parents, and her grandparents. AMH values were categorized as detectable (0.05-4.19 ng/mL) and undetectable (<0.05 ng/mL). Logistic regressions calculated odds ratios (OR) for undetectable AMH. RESULTS: Women were categorized as Maya (n = 44), not Maya (n = 39), or not able to be clearly defined (n = 14). In bivariate comparisons, women with detectable levels of AMH were younger, more likely to be pre-menopausal, and not Maya. Age, menopausal status, and ethnicity remained significant in a logistic regression models after controlling for age at menarche. Maya women were more than five times as likely to have nondetectable AMH levels as non-Maya women. DISCUSSION: Increasing age and progression through the menopausal transition were both associated with declining levels of AMH. The association between Maya ethnicity and a lower likelihood of detecting AMH is consistent with the early ages at menopause reported in previous studies. We considered a rapid life history model as an explanatory framework, and suggest, from an ecological perspective, that future research should consider measures of developmental stress that may compromise ovarian reserves.

Physical activity level and body composition in a multiethnic sample of school children in Hawaii.

BACKGROUND: Obesity, particularly in Native Hawaiians, is an important health risk. A possible contributing factor to obesity is reduced physical activity levels. AIM: This study investigates the relationship between measured levels of physical activity and body composition in two grade cohorts of school children of Native Hawaiian/Pacific Islander (NHPI) and non-NHPI ethnicity. METHODS: A sample of 105 Kindergarteners and third graders were measured for adiposity, physical fitness, and physical activity levels. Ethnicity was determined from genealogical surveys. BMI, waist circumference (WC) and body fat percentage derived from air displacement plethysmography were used to evaluate adiposity. Maximal oxygen consumption (VO2max/kg) was estimated and total energy expenditure (TEE), physical activity level (PAL) and percentage of time inactive (PTI) were determined using the Flex-heart rate method. RESULTS: VO2max, but not TEE, PAL or PTI, was significantly correlated with BMI in Kindergarteners; while VO2max and PAL were negatively correlated with BMI, PAL was significantly negatively correlated with WC and PTI was positively correlated with fat percentage among third graders. There were no significant ethnic differences in VO2max, TEE, PAL or PTI. CONCLUSIONS: PAL and PTI are moderately related to adiposity measures, and there are no ethnic differences in physical activity or fitness measures in this sample.

Voices from the Hilo Women's Health Study: talking story about menopause.

Our purpose in conducting this qualitative study was to examine how a multiethnic sample of women living in Hilo, Hawai'i, describe menopause. Interviews were conducted with 185 pre-, peri-, and post-menopausal women aged 45 to 55. We found that pre-menopausal women felt anxious compared with peri- and post-menopausal women's more affirmative attitudes of increasing confidence and freedom in this new cycle of life. A dominant theme was the construction of a post-menstrual identity. Peri-and post-menopausal women's attitudes were not biomedically oriented. Local culture and the island lifestyle may provide a positive atmosphere for women going through menopause.

The influence of habitual physical activity and sedentary behavior on objective and subjective hot flashes at midlife.

OBJECTIVE: The purpose of this study was to evaluate relationships between physical activity, sedentary time, and hot flashes during both waking and sleeping periods using concurrent objective and subjective measures of hot flashes in midlife women. METHODS: Women aged 45 to 55 years (n = 196) provided self-reported data on physical activity and underwent 24 hours of hot flash monitoring using sternal skin conductance. Participants used event marking and logs to indicate when hot flashes were perceived. Wake and sleep periods were defined by actigraphy. Mean ambient temperature and humidity were recorded during the study period. Generalized linear regression modeling was used to evaluate the effect of physical activity types and sedentary time on hot flash outcomes. Isotemporal substitution modeling was used to study the effect of replacing sedentary time with activity variables on hot flash frequency. RESULTS: Modeled results indicated that increasing sitting by 1 hour was associated with a 7% increase in the rate of objectively measured but not subjectively reported hot flashes during sleep. Replacing 1 hour of sitting with 1 hour of vigorous activity was associated with a 100% increase in subjectively reported but not objectively measured waking hot flashes. There was little evidence for an effect of temperature or humidity on any hot flash outcome. CONCLUSIONS: These data provide support for relations between sedentary time, physical activity, and hot flashes and highlight the importance of using objective and subjective assessments to better understand the 24-hour hot flash experience.

Acute increases in physical activity and temperature are associated with hot flash experience in midlife women.

OBJECTIVE: This study determined the association between acute changes in physical activity, temperature, and humidity and 24-hour subjective and objective hot flash experience. METHODS: Data collection occurred during the cooler months of the year in Western Massachusetts (October-April). Women aged 45-55 across three menopause stages (n = 270) were instrumented with ambulatory monitors to continuously measure hot flashes, physical activity, temperature, and humidity for 24 hours. Objective hot flashes were assessed via sternal skin conductance, and subjective hot flashes were recorded by pressing an event marker and data logging. Physical activity was measured with wrist-worn accelerometers and used to define sleep and wake periods. Logistic multilevel modeling was used to examine the differences in physical activity, humidity, and temperature in the 10 minutes preceding a hot flash versus control windows when no hot flashes occurred. The odds of hot flashes were considered separately for objective and subjective hot flashes as well as for wake and sleep periods. RESULTS: Data from 188 participants were included in the analyses. There was a significantly greater odds of a hot flash following acute increases in physical activity for objective waking hot flashes (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.17-1.47; P < 0.001) and subjective waking hot flashes (OR, 1.16; 95% CI, 1.0-1.33; P = 0.03). Acute increases in the actigraphy signal were associated with significantly higher odds of having an objective (OR, 1.17; 95% CI, 1.03-1.35; P < 0.01) or subjective (OR, 1.72; 95% CI, 1.52-2.01; P < 0.001) sleeping hot flash. Increases in temperature were significantly related to the odds of subjective sleeping hot flashes only (OR, 1.38; 95% CI, 1.15-1.62; P < 0.001). There was no evidence for a relationship between humidity and odds of experiencing any hot flashes. CONCLUSION: These results indicate that acute increases in physical activity increase the odds of hot flashes that are objectively measured and subjectively reported during waking and sleeping periods. Temperature increases were only related to subjectively reported nighttime hot flashes.

Relationships between diurnal changes in blood pressure and catecholamines among Filipino-American and European-American women.

OBJECTIVES: Studies show that diurnal blood pressure (BP) sensitivity to epinephrine (EPI) in African-American women is significantly greater than that of European-American (EA) women. Few if any studies have examined diurnal catecholamine-BP relationships in women of other ethnic groups. The purpose of this study was to compare the effects of diurnal changes in EPI and norepinephrine (NE) on the diurnal changes in BP between Filipino-American (FA) and EA women. METHODS: The subjects included 31 FA and 27 EA nurses and nurses aides and eight FA and 19 EA hotel workers from Hawaii who wore an ambulatory BP monitor and collected timed urine specimens (4 h at work, approx.4 h at home and approx. 8 h overnight) for assay of EPI and NE. Proportional changes in systolic and diastolic BP from sleep to work and sleep to home were examined using ANCOVA models including fixed effect-covariate interactions, with ethnicity as a fixed factor, and BMI and the appropriate proportional change in EPI or NE as covariates. RESULTS: The results show that there was no association between changes in EPI and BP, either overall or by ethnic group; however, overall changes in diastolic BP from sleep to work tended to be smaller among the FAs (P < 0.06). There was also an interactive effect of NE and ethnic group on diastolic BP such that among FAs, as diastolic BP increased, the corresponding NE change decreased (P < 0.039). CONCLUSION: The relationships between diurnal BP and catecholamine variations differ by ethnicity. Further research is needed to better understand the mechanisms behind the differences and to evaluate whether this vascular tonic relationship has been the focus of natural selective processes.

Ambulatory blood pressure and blood lipids in a multiethnic sample of healthy adults.

OBJECTIVES: Elevated blood pressure (BP), elevated serum cholesterol, and aberrant lipoprotein fractions (low levels of high-density lipoprotein (HDL) and high levels of low-density lipoprotein fractions and triglycerides) have all been used as measures that assess the "metabolic syndrome" and more recently in indexes of allostatic load, which are designed to assess the degree of integrated metabolic pathology. While there are ample data regarding the interrelationships of these measures in various pathophysiological settings, there are limited data regarding the interrelationship of ambulatory BP (ABP) and blood lipids in healthy subjects. The present study evaluates ABP-blood lipid relationships in a multiethnic sample of healthy adults. METHODS: The subjects were 37 men (age = 40.9 ± 10.7 years) and 42 women (age = 35.8 ± 10.4 years) who were employed as hotel workers in Hawaii. Each wore an ABP monitor for one midweek workday and had pressures averaged in three daily microenvironments (work, home, and during sleep). They also had fasting blood samples taken for lipid profiling. RESULTS: Multivariate analysis of covariance shows that there was a strong inverse relationship between HDL and both systolic (P < 0.006) and diastolic (P < 0.006) BP, overall and in each microenvironment, but no statistically significant relationships with other lipid measures. CONCLUSION: These results suggest lipids and BP do not act as a group in healthy adults but that higher HDL is associated with lower BP. This latter finding is consistent with research that shows that HDL promotes vasodilation via its effect on endothelial nitric oxide synthase.

Ultrastructural Characteristics and Synaptic Connectivity of Photoreceptors in the Simplex Retina of Little Skate (Leucoraja erinacea).

The retinas of the vast majority of vertebrate species are termed "duplex," that is, they contain both rod and cone photoreceptor neurons in different ratios. The retina of little skate (Leucoraja erinacea) is a rarity among vertebrates because it contains only a single photoreceptor cell type and is thus "simplex." This unique retina provides us with an important comparative model and an exciting opportunity to study retinal circuitry within the context of a visual system with a single photoreceptor cell type. What is perhaps even more intriguing is the fact that the Leucoraja retina is able use that single photoreceptor cell type to function under both scotopic and photopic ranges of illumination. Although some ultrastructural characteristics of skate photoreceptors have been examined previously, leading to a general description of them as "rods" largely based on outer segment (OS) morphology and rhodopsin expression, a detailed study of the fine anatomy of the entire cell and its synaptic connectivity is still lacking. To address this gap in knowledge, we performed serial block-face electron microscopy imaging and examined the structure of skate photoreceptors and their postsynaptic partners. We find that skate photoreceptors exhibit unusual ultrastructural characteristics that are either common to rods or cones in other vertebrates (e.g., outer segment architecture, synaptic ribbon number, terminal extensions), or are somewhere in between those of a typical vertebrate rod or cone (e.g., number of invaginating contacts, clustering of multiple ribbons over a single synaptic invagination). We suggest that some of the ultrastructural characteristics we observe may play a role in the ability of the skate retina to function across scotopic and photopic ranges of illumination. Our findings have the potential to reveal as yet undescribed principles of vertebrate retinal design.

Prevalence and determinants of headaches in Hawaii: the Hilo Women's Health Study.

BACKGROUND: Headache frequency has been associated with ethnicity, menopause, abdominal obesity and stress. AIM: To examine the prevalence and determinants of headaches in the multi-ethnic community of Hilo, Hawaii. SUBJECTS AND METHODS: A random sample of 1824 women aged 16-100 was recruited by postal survey; 206 women aged 45-55 were recruited for clinical measures. Both studies queried the presence/absence of headaches during the past 2 weeks. The clinical study also examined migraines and tension headaches. Headaches were examined in relation to demographic, reproductive and lifestyle variables, stress, symptoms and anthropometric measures. RESULTS: Headache prevalence was 47%. Japanese women were less likely to report headaches compared to women of European descent, but, after controlling for measures of stress, Japanese women were at a higher risk for headaches. Post-menopausal women were half as likely to report headaches compared with pre-menopausal women. Women with children younger than 18 were 4-times as likely to report migraines compared with women who did not have children younger than 18. CONCLUSION: Standardized measures of daily hassles, life and job satisfaction were not associated with headaches. The relationship between headaches and having young children suggests that the everyday stress of family life is a headache risk. This may be particularly true in Hilo, Hawaii, where the value of family is culturally prioritized.

A comparison of stress, symptoms, physical activity, and adiposity among women at midlife before and during the pandemic.

BACKGROUND: The COVID-19 pandemic presented challenges that disproportionately impacted women. Household roles typically performed by women (such as resource acquisition and caretaking) became more difficult due to financial strain, fear of infection, and limited childcare options among other concerns. This research draws from an on-going study of hot flashes and brown adipose tissue to examine the health-related effects of the COVID-19 pandemic among 162 women aged 45-55 living in western Massachusetts. METHODS: We compared women who participated in the study pre- and early pandemic with women who participated mid-pandemic and later-pandemic (when vaccines became widely available). We collected self-reported symptom frequencies (e.g., aches/stiffness in joints, irritability), and assessments of stress, depression, and physical activity through questionnaires as well as measures of adiposity (BMI and percent body fat). Additionally, we asked open-ended questions about how the pandemic influenced women's health and experience of menopause. Comparisons across pre-/early, mid-, and later pandemic categories were carried out using ANOVA and Chi-square analyses as appropriate. The Levene test for homogeneity of variances was examined prior to each ANOVA. Open-ended questions were analyzed for yes/no responses and general themes. RESULTS: Contrary to our hypothesis that women would suffer negative health-related consequences during the COVID-19 pandemic, we found no significant differences in women's health-related measures or physical activity across the pandemic. However, our analysis of open-ended responses revealed a bi-modal distribution of answers that sheds light on our unexpected findings. While some women reported higher levels of stress and anxiety and lower levels of physical activity, other women reported benefitting from the remote life that the pandemic imposed and described having more time to spend on physical activity or in quality time with their families. CONCLUSIONS: In this cross-sectional comparison of women during the pre-/early, mid-, and later-pandemic, we found no significant differences across means in multiple health-related variables. However, open-ended questions revealed that while some women suffered health-related effects during the pandemic, others experienced conditions that improved their health and well-being. The differential results of this study highlight a need for more nuanced and intersectional research on risk, vulnerabilities, and coping among mid-life women.

Relationship between hot flashes and ambulatory blood pressure: the Hilo women's health study.

OBJECTIVES: To examine ambulatory blood pressure (BP) differences between women who report hot flashes (HFs) and those who do not, and to observe whether an objectively measured HF is associated with transient changes in BP. HFs have been associated with elevated BP, but studies have not examined the relationship between objectively measured HFs and blood pressure during normal daily activities. METHODS: A sample of 202 women in Hilo, Hawaii, aged 45 to 55 years, were asked to fill out a questionnaire that included demographic information and an inventory of symptoms. The women underwent simultaneous 24-hour monitoring of ambulatory BP and HFs, at the same time keeping a diary that included mood and HF reports. RESULTS: No significant difference was present in mean BP between women who reported having an HF during the last 2 weeks and those who did not. When measurements controlled for negative mood reports and posture, there was a highly significant elevation in Z scores of systolic BP when a measured, objective HF occurred within 10 minutes before a BP reading, and a significant elevation of Z scores of diastolic BP when a subjectively reported HF occurred within 10 minutes after a BP reading. CONCLUSIONS: These results suggest that objectively measured HFs precede transient elevations of systolic BP, but it is unclear if there is a causal relationship. These results also suggest that women experience subjective HFs within 10 minutes after a transient increase in diastolic BP. Again, the causal relationship is not understood.

Measures of adiposity in two cohorts of Hawaiian school children.

BACKGROUND: Native Hawaiians have high rates of obesity and obesity-related diseases compared with non-Hawaiians in Hawaii, and the relation between this ethnic disparity in adiposity and socioeconomic status (SES) in children is unclear. AIM: The present study compared measures of adiposity in two cohorts of school children residing in the Hilo area of Hawaii and related these measures to parental reports of ethnicity, household income and parent educational attainment. SUBJECTS AND METHODS: All children in either Kindergarten (mean age 5.6 years) or third grade (mean age 8.7 years) in eight elementary schools in the Hilo area were invited to participate. A total of 125 children had anthropometric, bioelectric impedance and air displacement plethysmography measurements taken and their parents answered questions about household income, parental educational attainment and genealogical background that included ethnicity of ancestors. RESULTS: Boys and girls in both cohorts had stature approximately at the 50(th) percentile (Z-score = 0) of national samples (CDC data). Z-scores of BMI were elevated compared to the CDC reference curves, but were significantly higher in male Native Hawaiian children in the older cohort among whom nearly 50% had a BMI above the 95(th) percentile for age. In the younger cohort, there was no significant ethnic difference in adiposity measures. In the older cohort, Native Hawaiian boys had significantly higher adiposity measures than their classmates. Adiposity in third grade girls was significantly and inversely related to their father's educational attainment. Percentage of Hawaiian ancestry was not significantly related to adiposity measures. CONCLUSIONS: Ethnic disparity in adiposity among Native Hawaiians compared with non-Hawaiian age mates occurs after the age of 6 years, and is confined to males in this sample. For older girls, father's, but not mother's, educational attainment was inversely related to adiposity.

Age at menopause among rural and urban women in the state of Campeche, Mexico.

OBJECTIVE: The purpose of this study was to examine age at natural menopause among women of Maya and non-Maya ancestry living in urban and rural communities in the state of Campeche, Mexico. METHODS: Women ages 40 to 60 (n = 543) participated in semi-structured interviews and anthropometric measures. The last names, languages spoken, and the birthplace of the woman, her parents, and her grandparents were used to determine Maya or non-Maya ethnicity. Recalled age at natural menopause was compared across four communities; analysis of variance was used to compare means and Kaplan-Meier analyses were used to compare medians. Probit analysis was also used to estimate median ages at menopause. Cox regression analyses were applied to identify variables associated with age at menopause. RESULTS: Mean recalled age at natural menopause across all sites was 46.7 years, ranging from 47.8 years in the city of Campeche to 43.9 years in the rural Maya communities in the municipality of Hopelchén. Median ages at menopause across all sites were 50.55 years by probit analysis and 50.5 years by Kaplan-Meier. Variables associated with a later age at menopause included higher socioeconomic status, higher parity, and a later age at menarche. CONCLUSIONS: The early mean recalled age at menopause in southern Hopelchén was consistent with previous studies in the Yucatán peninsula. As expected, probit and Kaplan-Meier analyses demonstrated later ages at menopause. Contrary to our expectations, Maya/non-Maya ethnicity was not associated with age at menopause. Demographic and reproductive factors were more important than ethnicity in explaining variation in age at menopause within the state of Campeche, Mexico.

Relation between C-reactive protein levels and body composition in a multiethnic sample of school children in Hawaii.

OBJECTIVES: Adipose cells secrete proinflammatory cytokines that stimulate hepatic production of C-reactive protein (CRP). CRP levels are associated with adiposity levels in adults, adolescents, and older children but not in young children (age 2-3). This study examined the relation between CRP, adiposity, and cardiovascular and metabolic variables including blood pressure, glucose, and blood lipids in two young cohorts of children, averaging approximately 5.5 and 8.5 years, respectively. METHODS: Children (N = 125) from eight elementary schools in the multiethnic community of Hilo Hawaii were recruited to fill out questionnaires, undergo anthropometrics and air displacement plethysmography, have resting blood pressure measured, and provide a finger stick blood sample for analysis of CRP, glucose, and blood lipids. RESULTS: There were no significant differences between the cohorts in ethnic make up, household income, or parents' educational attainment. No significant relation was found between CRP and either adiposity or cardiovascular/metabolic variables in the younger cohort. However, significant correlations were found between CRP and adiposity measures and blood pressure in the older cohort. There was no marked difference in association of CRP with BMI versus waist circumference or waist-to-hip ratio. In neither cohort was CRP significantly related to glucose or blood lipids. CONCLUSIONS: Both amount of fat mass and time duration for possessing the adipose tissue may be important factors in determining the relation between CRP and both adiposity and blood pressure.

Relationships between menstrual and menopausal attitudes and associated demographic and health characteristics: the Hilo Women's Health Study.

The objective of this study was to examine the relation of menstrual attitudes to menopausal attitudes and the demographic and health characteristics associated with each. This cross-sectional study consisted of a randomly selected sample of 1,824 respondents aged 16 to 100 years in multi-ethnic Hilo, Hawai'i. Women completed questionnaires for demographic and health information, such as age, ethnicity, education, residency in Hawai'i, menopausal status, exercise, and attitudes toward menstruation and menopause. Women more often chose positive terms, such as "natural," to describe menstruation (60.8%) and menopause (59.4%). In bivariate analyses, post-menopausal women were significantly more likely to have positive menstrual and menopausal attitudes than pre-menopausal women. Factor analyses were used to cluster attitudes followed by linear regression to identify demographic characteristics associated with factor scores. Asian-American ethnicity, higher education, reporting more exercise, and growing up outside of Hawai'i were associated with positive menstrual attitudes. Higher education, older age, post-menopausal status, growing up outside of Hawai'i and having hot flashes were associated with positive menopausal attitudes. Bivariate correlation analyses suggested significant associations between factor scores for menstrual and menopausal attitudes. Both negative and positive menstrual attitudes were positively correlated with the anticipation of menopause, although negative attitudes toward menstruation were negatively correlated with menopause as a positive, natural life event. Demographic variables, specifically education and where one grows up, influenced women's attitudes toward menstruation and menopause and should be considered for inclusion in subsequent multi-ethnic studies. Further research is also warranted in assessing the relationship between menstrual and menopausal attitudes.

Association Between Reproductive Life Span and Incident Nonfatal Cardiovascular Disease: A Pooled Analysis of Individual Patient Data From 12 Studies.

Importance: Early menarche and early menopause are associated with increased risk of cardiovascular disease (CVD) in midlife, but little is known about the association between reproductive life span and the risk of CVD. Objective: To investigate the association between the length of reproductive life span and risk of incident CVD events, while also considering the timing of menarche and menopause. Design, Setting, and Participants: Individual-level data were pooled from 12 studies participating in the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events consortium. Women provided complete information on the timing of menarche and menopause, nonfatal CVD events, and covariates. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs, adjusted for covariates. The association between reproductive life span and CVD was adjusted for age at menarche and age at menopause separately. Analysis began March 2018 and ended December 2019. Exposures: Reproductive life span was calculated by subtracting age at menarche from age at menopause and categorized as younger than 30, 30 to 32, 33 to 35, 36 to 38 (reference group), 39 to 41, 42 to 44, and 45 years or older. Main Outcomes and Measures: First nonfatal CVD event, including coronary heart disease and stroke events. Results: A total of 307 855 women were included. Overall, the mean (SD) ages at menarche, menopause, and reproductive life span were 13.0 (1.5) years, 50.2 (4.4) years, and 37.2 (4.6) years, respectively. Pooled analyses showed that women with a very short reproductive life span (<30 years) were at 1.71 (95% CI, 1.58-1.84) times higher risk of incident CVD events than women with a reproductive life span of 36 to 38 years after adjustment for covariates. This association remained unchanged when adjusted for age at menarche but was attenuated to 1.26 (95% CI, 1.09-1.46) when adjusted for age at menopause. There was a significant interaction between reproductive life span and age at menarche associated with CVD risk (P < .001). Women who had both short reproductive life span (<33 years) and early menarche (age ≤11 years) had the highest risk of CVD (hazard ratio, 2.06; 95% CI, 1.76-2.41) compared with those with a reproductive life span of 36 to 38 years and menarche at age 13 years. Conclusions and Relevance: Short reproductive life span was associated with an increased risk of nonfatal CVD events in midlife, and the risk was significantly higher for women with early age at menarche.