Weight excess and inflammation in menopause: pathophysiology of a dangerous liaison and role of lifestyles
Gabriella Pugliese1 – , Annamaria Colao1,2 – , Alessandra Graziottin3 –
1 – Department of Clinical Medicine and Surgery, Endocrinology Section, “Federico II” University of Naples, Naples, Italy
2 – Unesco Chair “Health Education and Sustainable Development”, Federico II University, Naples, Italy
3 – Center for Gynecology and Medical Sexology H. San Raffaele Resnati Milan, Italy; Graziottin Foundation for the treatment of pain in women, ONLUS, Italy
Corresponding Author: Gabriella Pugliese
Weight gain is a common condition in menopause. It recognizes both non- modifiable and modifiable multifactorial etiological mechanisms. The first include: age, climacteric hormonal changes, alteration of hunger and satiety circuits, reduction of energy expenditure and sleep disorders; while among non-modifiable factors: sedentary lifestyle and nutrition, including the ea- ting time (chrononutrition and chronotype). The redistribution of adipo- se tissue, mainly from the subcutaneous site to the visceral site, acts as a real endocrine organ capable of secreting adipokines and proinflammatory cytokines such as TNF-a, IL-1, IL-6 and leptin. This contributes to the meno- pausal chronic low-grade inflammation, that increases the risk of metabolic disorders, cardiovascular events and neurovegetative disorders. Lifestyles interventions are the first line approach to cope with this condition. To date there are no specific dietary and exercise recommendations to be prescribed in overweight/obese women at menopause. The purpose of this review is, first, to analyse the mechanisms that favour weight gain, with focus on the role of sleep disorders and of proinflammatory mediators produced by the adipose tissue; second, to provide practical recommendations focused on li- festyles, useful in the general clinical management of postmenopausal wo- men. The potential role of bowel microbiota and chronotype will be finally briefly discussed.
Keywords: menopause; obesity; inflammation; sleep disorders; adipose tissue; adipokines.
Available in LRIOG Nr.4 – 2021
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Endocrine-metabolic syndrome and nutritional aspects: polycystic ovary syndrome
Luigi Barrea1,2 – , Ludovica Verde3 – , Giovanna Muscogiuri2,3,4 –
1 – Department of Humanities, Pegaso Telematic University, Naples, Italy
2 – Italian Center for the Care and Wellbeing of Patients with Obesity (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, Federico II University, Naples, Italy
3 – Department of Clinical Medicine and Surgery, Endocrinology Unit, Federico II University, Naples, Italy
4 – Unesco Chair “Education for health and sustainable development”, Federico II University, Naples, Italy
Corresponding Author: Luigi Barrea
Polycystic ovary syndrome (PCOS) is the most common endocrine and me- tabolic disorders in women of reproductive age, defined by a combination of signs and clinical or biochemical symptoms of androgen excess and ova- rian dysfunction in the absence of other specific endocrine diagnoses. The aetiology of PCOS is largely unknown, but different evidence suggests that this syndrome might be a complex multifactorial disorder with strong envi- ronmental and epigenetic influences, including lifestyle factors, such as nutri- tion. Specific nutrients per sè or via weight loss improve endocrine features, cardiometabolic risk profile, and reproductive function. Different foods and a change in dietary habits are associated with the reduction of body weight and with improvement PCOS clinical severity. Of interest, beyond obesity se- veral comorbidities, including infertility, metabolic syndrome, impaired glu- cose tolerance, insulin resistance, type 2 diabetes, and increased cardiovascu- lar risk are associated with PCOS. In this context, specific recommendations on macronutrient intake should be provided to patients with obesity and PCOS. In particular, high intake of high glycemic index carbohydrate contributes to weight gain and metabolic alterations, including insulin resistance, dysli- pidemia and metabolic syndrome, and stimulates hunger and carbohydrate craving. The nutritional approach in PCOS must be to reach specific goals including as improving insulin resistance and metabolic disorders that will be possible through an hypocaloric diet reducing the intake of simple and refined carbohydrates with a high glycemic index, limiting of saturated fatty acids (<10% of total energy intake), and attention to possible deficiencies of several micronutrients, including vitamin D, chromium and omega-3. The main aim of this narrative review is to discuss the role of diet as therapeutic treatment in management of women with obesity and PCOS.
Keywords: polycystic ovary syndrome; obesity; nutrition; diet.
Available in LRIOG Nr.4 – 2021
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