Correlation between age at natural menopause and postmenopausal obesity: a population-based cross-sectional study in Guangzhou city
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摘要:
目的 分析女性自然绝经年龄提前或推迟与绝经后肥胖的相关性,为绝经后女性健康保健提供参考。 方法 从2017年11月 — 2020年1月广州中老年人慢性病前瞻性队列研究基线调查中选取5 646名 ≥ 50岁广州自然绝经女性为研究对象,收集基线的一般人口特征指标和女性生理数据,检测肥胖相关指标;对基线横断面数据采用SPSS 25.0版的广义线性模型、多因素logistic回归模型和STATA 16.0版的限制性立方样条分析模型进行数据分析。 结果 5 646名研究对象平均年龄(60.0 ± 5.8)岁,平均绝经年龄(50.3 ± 3.1)岁;自然绝经年龄与肥胖呈近“U”型关联;调整相关混杂因素后,与自然绝经年龄正常者相比,绝经年龄提前增加以腰围(OR = 1.32,95 % CI = 1.03~1.69)、腰臀比(OR = 1.32,95 % CI = 1.06~1.64)判定的中心性肥胖风险和以体质指数(BMI)(OR = 1.39,95 % CI = 1.13~1.71)判定的超重肥胖风险;绝经年龄推迟者增加以腰围(OR = 1.34,95 % CI = 1.11~1.63)、腰臀比(OR = 1.41,95 % CI = 1.19~1.68)判定的中心性肥胖风险和以BMI(OR = 1.49,95 % CI = 1.26~1.76)判定的超重肥胖风险。 结论 自然绝经年龄提前或推迟均与绝经后肥胖的患病风险增加相关。建议自然绝经年龄提前或推迟的中老年女性多注意强肌训练和平衡饮食,适当控制以提供能量为主的食物摄入。 Abstract:Objective To analyze the correlation between early or late age at natural menopause and obesity among postmenopausal women, and to provide reference for health care of postmenopausal women. Methods From November 2017 through January 2020, totally 5 646 natural menopausal women aged ≥ 50 years were recruited from the voluntary participants of a prospective cohort study on chronic diseases in middle-aged and elderly residents of Guangzhou city. The women's information on demographic characteristics and physical indicators (including body mass index [BMI], waist circumference [WC], and waist-hip ratio [WHR]) were collected from the baseline survey of the cohort study. Generalized linear model, multivariate logistic regression model and restricted cubic spline analysis model were adopted in data analysis using SPSS 25.0 and STATA 16.0. Results For all the women aged 60.0 ± 5.8 years, the mean age at menopause was 50.3 ± 3.1 years and the age at natural menopause was u-shaped associated with obesity. After adjusting for possible confounders, the results of multivariate logistic regression analysis showed that compared with the women with a normal age at natural menopause (46 – 53 years), the women with an early age at natural menopause (< 46) were more likely to have an increased risk of central obesity determined by WC (odds ratio [OR] = 1.32, 95% confidence interval [95% CI]: 1.03 – 1.69) or WHR (OR = 1.32, 95% CI: 1.06 – 1.64) and overweight/obesity determined by BMI (OR = 1.39, 95% CI: 1.13 – 1.71); while, the women with a late age at natural menopause (> 53) were also more likely to have an increased the risk of central obesity determined by WC ( OR = 1.34, 95% CI: 1.11 – 1.63) or WHR (OR = 1.41, 95% CI: 1.19 – 1.68) and overweight/obesity determined by BMI (OR = 1.49, 95% CI: 1.26 – 1.76). Conclusion Early or late age at natural menopause are associated with an increased risk of postmenopausal obesity for middle-aged and elderly women. The results suggest that the women with early or late age at natural menopause should pay more attention to muscle training and balanced diet and appropriately control the intake of food mainly providing energy. -
Key words:
- age at natural menopause /
- obesity /
- middle-aged and elderly women
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表 1 一般人口学特征指标中心性肥胖率和超重肥胖率比较
变量 调查人数 中心性肥胖(WC ≥ 85 cm) 中心性肥胖(WHR ≥ 0.85) 超重肥胖(BMI ≥ 24) 人数 % 人数 % 人数 % 年龄(岁) 50~54 1026 118 11.5 315 30.7 351 34.2 55~59 2081 349 16.8 815 39.2 781 37.5 60~64 1598 354 22.2 790 49.4 723 45.2 ≥ 65 941 302 32.1 b 627 66.6 b 428 45.5 b 文化程度 小学及文盲 668 226 33.8 460 68.9 350 52.4 初中 1127 276 24.5 602 53.4 515 45.7 高中 2996 489 16.3 1199 40.0 1134 37.9 大学及以上 855 132 15.4 b 286 33.5 b 284 33.2 b 职业 手工作业 2902 573 19.7 1348 46.5 1203 41.5 非手工作业 1244 252 20.3 567 45.6 454 36.5 其他 1500 298 19.9 632 42.1 d 626 41.7 c 家庭年总收入(万元) < 5 2007 449 22.4 964 48.0 833 41.5 5~6.9 767 124 16.2 305 39.8 307 40.0 7~7.9 1351 251 18.6 579 42.9 544 40.3 ≥ 8 1521 299 19.7 c 699 46.0 b 599 39.4 吸烟 从不 5469 1094 20.0 2476 45.3 2208 40.4 已戒 144 25 17.4 59 41.0 63 43.8 吸烟 33 4 12.1 12 36.4 12 36.4 饮酒 从不 4443 879 19.8 2005 45.1 1788 40.2 已戒 979 183 18.7 405 41.4 408 41.7 饮酒 224 61 27.2 d 137 61.2 b 87 38.8 饮食习惯 没有特别限制 2603 495 19.0 1169 44.9 1002 38.5 多吃肉类 134 30 22.4 64 47.8 59 44.0 多吃蔬菜水果 2531 546 21.6 1173 46.3 1075 42.5 特别饮食 a 378 52 13.8 c 141 37.3 c 147 38.9 d 体力活动 不足 52 9 17.3 27 51.9 20 38.5 适度 1359 254 18.7 598 44.0 556 40.9 活跃 4235 860 20.3 1922 45.4 1707 40.3 初潮年龄(岁) < 13 1149 198 17.2 476 41.4 459 39.9 13~16 3870 780 20.2 1738 44.9 1577 40.7 > 16 627 145 23.1 c 333 53.1 b 247 39.4 自然绝经年龄(岁) < 46 404 101 25.0 212 52.5 194 48.0 46~53 4554 845 18.6 1 960 43.0 1754 38.5 > 53 688 177 25.7 b 375 54.5 b 335 48.7 b 产次 无 301 56 18.6 112 37.2 107 35.5 1个 4114 686 16.7 1667 40.5 1565 38.0 2个 813 227 27.9 482 59.3 392 48.2 ≥ 3个 418 154 36.8 b 286 68.4 b 219 52.4 b 注:a 特别饮食是指素食或接受糖尿病、肾病等饮食治疗;组间比较:b P < 0.001,c P < 0.01,d P < 0.05。 表 2 绝经年龄与绝经后肥胖相关指标的广义线性模型分析
自然绝经年龄(岁) WC(cm) WHR BMI 均数 95 % CI 均数 95 % CI 均数 95 % CI < 46 78.6a 77.8~79.4 0.85 a 0.85~0.86 23.9 a 23.6~24.2 46~53 77.3 77.0~77.5 0.84 0.84~0.85 23.4 23.3~23.5 > 53 78.9 b 78.2~79.5 0.85 b 0.85~0.86 24.0 b 23.8~24.3 F 值 14.055 8.86 13.136 P 值 < 0.001 < 0.001 < 0.001 注:模型调整了年龄、文化程度、家庭年总收入、职业、吸烟、饮酒、体力活动、饮食习惯、初潮年龄和产次;与自然绝经年龄正常(46~53岁)比,a P < 0.01,b P < 0.001。 表 3 绝经年龄对绝经后肥胖相关指标影响多因素logistic回归分析
指标及因素 OR1 值 95 % CI1 OR2 值 95 % CI2 OR3 值 95 % CI3 中心性肥胖(WC) 自然绝经年龄(岁) < 46 1.46 a 1.15~1.85 1.34 c 1.05~1.70 1.32 c 1.03~1.69 > 53 1.52 b 1.26~1.83 1.35 b 1.12~1.63 1.34 a 1.11~1.63 中心性肥胖(WHR) 自然绝经年龄(岁) < 46 1.46 b 1.19~1.79 1.33 a 1.07~1.64 1.32 c 1.06~1.64 > 53 1.59 b 1.35~1.86 1.40 b 1.18~1.65 1.41 b 1.19~1.68 超重肥胖(BMI) 自然绝经年龄(岁) < 46 1.48 b 1.20~1.81 1.42 b 1.16~1.74 1.39 a 1.13~1.71 > 53 1.52 b 1.29~1.78 1.45 b 1.24~1.71 1.49 b 1.26~1.76 注:OR1:模型未调整;OR2:模型调整年龄;OR3:模型调整年龄、文化程度、职业,家庭年总收入、吸烟、饮酒、体力活动、饮食习惯、初潮年龄、产次;参照为自然绝经年龄46~53岁,a P < 0.01;b P < 0.001;c P < 0.05。 -
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