Metabolic Health, Weight Affect Diabetes Risk in Postmenopausal Women

A study on data from the Women’s Health Initiative found good metabolic health and effective weight management can minimize diabetes risk in postmenopausal women. The study, published in Menopause, the journal of The North American Menopause Society, aimed to determine the relationship between metabolic weight categories with incident diabetes in postmenopausal women aged 50 to 79 years.

Between 1993 and 2998 the Initiative collected data from 161,808 postmenopausal women. In the current study, researchers defined normal weight as a body mass index (BMI) between 3.8 lb/ft² and 5.1 lb/ft² and a waist circumference (WC) of less than 34.6 in. Overweight/obesity was defined as a BMI of 5.1 lb/ft² or greater or WC of at least 34.6 in.

Participants’ metabolic health was determined based on whether they exhibited the following traits: triglycerides of 150mg/dL or greater, systolic blood pressure (BP) of 130 mm Hg or greater or diastolic BP of 85 mm Hg or greater, antihypertensives or diuretics, fasting glucose of 100 mg/dL or greater or diabetes medication, and high-density lipoprotein cholesterol less than 50 mg/dL.

To determine risk of incident diabetes among those considered metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUHNW), metabolically healthy overweight/obese (MHO), and metabolically unhealthy overweight/obese (MUHO), researchers used Cox regression.

Throughout the study, 13.3% of participants developed diabetes. In addition, researchers found “MUHNW and MHO confer an approximate 2-fold increased risk for developing [diabetes], with MUHO associated with more than a 4-fold elevated risk compared with those who are MHNW.”

The results suggest that although postmenopausal women may have a normal weight, being metabolically unhealthy still indicates a significant increased risk of diabetes. “During menopause, fat redistribution occurs in women, increasing insulin resistance and leading to an upward trend in the incidence of [diabetes],” researchers said. A decline in estrogen in menopausal women could lead to increased abdominal fat as well.

People who are MUHNW could have more abdominal fat distribution and dyslipidemia than MHNW individuals. “The relationship between type 2 diabetes and WC may be a better metabolic predictor among the normal weight as compared with overweight or obese people” researchers explained.

Of the women who had incident diabetes, this population also exhibited higher WCs, BMIs, systolic and diastolic BPs, glucose, total cholesterol, triglycerides, insulin, and C-reactive protein levels. The data also showed the MUHO cohort had the highest incidence of diabetes. Previous research found MUHO individuals have increased visceral abdominal fat, which is directly associated with metabolic disease.

“This study provides evidence that being of normal weight yet metabolically unhealthy is associated with increased risk for diabetes. Educating women about the importance of maintaining a healthy weight and controlling cardiometabolic risk factors for diabetes and heart disease is important,” said Stephanie Faubion, MD, director of the North American Menopause Society, in a press release.

According to researchers, the prevalence of diabetes in women aged 40 to 64 years is 17%, while that number increases to 25.2% in women aged 65 and older. “Diabetes increases the risk of heart disease…by about 4 times in women but only about 2 times in men, and women have worse outcomes after a heart attack,” according to the CDC. Women with diabetes also heve higher risks of blindness, kidney disease, and depression.

Advances have been made when it comes to addressing health risks in postmenopausal women. In October 2019, researchers developed a web-based calculator to assist “postmenopausal women in determining risk toward conditions like heart attack, stroke, and various cancers,” according to AJMC.com. “By delineating which risks are and are not associated with their current health status, women and physicians can initiate preventative measures sooner.”

Reference

Hsu ARC, Ames SL, Xie B, et al. Incidence of diabetes according to metabolically healthy or unhealthy normal weight or overweight/obesity in postmenopausal women: the Women’s Health Initiative. Menopause. 2020;27(6). doi: 10.1097/GME.0000000000001512.