BMI partially mediates link between age at menopause and glucose levels in women
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Women with an older age at menopause onset have an increased risk for developing type 2 diabetes, and BMI partially mediates the link between age at menopause and blood glucose levels, according to study findings published in Menopause.
“Consistent with previous studies, our study confirmed that the risk of type 2 diabetes in women with later menopause ( 54 years) was higher than that in women with menopause aged 44 to 53 years,” Kun Wang, PhD, director of the department of endocrinology at the Affiliated Jiangning Hospital of Nanjing Medical University in China, and colleagues wrote. “Postmenopausal women with a later age of menopause had higher fasting plasma glucose and 2-hour postprandial blood glucose, and lower homeostasis model assessment of beta-cell function than postmenopausal women with an earlier age of menopause. The results were still significant after adjusting for multiple variables.”
Researchers analyzed data from 4,279 women aged 40 years and older who participated in the Risk Evaluation of Cancers in Chinese Diabetic Individuals study. All participants underwent an oral glucose tolerance test to measure FPG, 2-hour postprandial blood glucose and fasting insulin. Height, weight, waist circumference and hip circumference were collected during a physical examination. Obesity was defined as BMI of 28 kg/m2 or higher and overweight as BMI between 24 kg/m2 and 27.9 kg/m2. Age at menopause was self-reported. Women with menopause at age 43 years or younger were placed into an early menopause group and those with menopause at age 54 years or older into a late menopause group. Women with menopause at age 44 to 53 years were considered the reference group in the study.
Of the study cohort, 1,150 had type 2 diabetes. The mean age at menopause was 49.08 years.
After adjusting for age and other covariates, women with later menopause had an increased risk for developing type 2 diabetes compared with the reference group (adjusted OR = 1.401; 95% CI, 1.01-1.945; P = .044). Women with older age at menopause also had an increased risk for overweight or obesity compared with the reference group (aOR = 1.416; 95% CI, 1.028-1.95; P = .015)
Each 1-year increase in age at menopause was associated with increases in FPG (beta = 0.021; 95% CI, 0.004-0.038; P = .014) and 2-hour postprandial blood glucose (beta = 0.048; 95% CI, 0.006-0.09; P = .024), and decrease in HOMA of beta-cell function (beta = –1.154; 95% CI, –2.386 to –0.695; P < .001). Women in the older age at menopause group had an increase in fasting plasma glucose compared with the reference group (beta = 0.211; 95% CI, 0.032-0.391; P = .021), and those in the younger age at menopause group had a higher HOMA of beta-cell function compared with the reference group (beta = 19.145; 95% CI, 6.265-32.026; P = .004).
BMI partially mediated the association between age at menopause and FPG by 5.42% and between age at menopause and 2-hour postprandial blood glucose by 7.69%. BMI suppressed the association between age at menopause and HOMA of beta-cell function by 9.54%.
“Weight gain after menopause may be positively related to insulin secretion abilities,” the researchers wrote. “As noted previously in many studies, with an increased BMI and subsequent insulin resistance, the compensatory secretion of insulin by beta cells also increased significantly. This resulted in hyperinsulinemia and the maintenance of normal glucose.”
According to researchers, several limitations of the study included an inability to verify age at menopause beyond self-reports, the exclusion of women with surgery-related menopause and the possibility that laboratory measurements were affected for women with type 2 diabetes using hypoglycemic agents.
“Prospective studies are required to further explore the female-specific markers of type 2 diabetes and its potential mechanisms,” the researchers wrote.
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