Dietary fibers and glycemic load, obesity, and plasma adiponectin levels in women with type 2 diabetes

OBJECTIVE: The purpose of this study was to examine the associations of dietary fibers and glycemic load with plasma adiponectin in diabetic women and investigate the modification effect of obesity. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional analysis in 902 women with type 2 diabetes from the Nurses' Health Study. Dietary information was obtained using semiquantitative food frequency questionnaires. RESULTS: After adjustment for age, smoking, alcohol consumption, physical activity, aspirin use, HbA(1c), history of hypertension and hypercholesterolemia, and postmenopausal hormone use, intakes of cereal fiber and fruit fiber (P for trend = 0.002 and 0.036, respectively) were significantly associated with an increasing trend of plasma adiponectin concentrations. Further adjustment for BMI did not appreciably change the associations for cereal fiber but attenuated the associations for fruit fiber. Adiponectin concentrations were 24% higher in the highest compared with the lowest quintile of cereal fiber. Dietary glycemic load and glycemic index were significantly associated with lower plasma adiponectin levels, after adjustment for BMI and other covariates (P for trend = 0.01 and 0.03, respectively). The percent differences in adiponectin concentration between the highest and the lowest quintiles of dietary glycemic load and glycemic index were 17 and 18%, respectively. The associations between dietary factors and plasma adiponectin were consistent across lean (BMI <25 kg/m(2)), overweight (25 or=30 kg/m(2)). CONCLUSIONS: Our data indicate that dietary cereal fiber and glycemic load/index are associated with the circulating adiponectin concentration. Such associations were not modified by obesity status.     

Headache prevention outcome and body mass index

A population-based longitudinal study suggests that obesity is a strong risk factor for the development of headaches on 15 or more days per month. Little is know about the influence of weight on the response to headache preventive treatment. Herein we prospectively assessed the influence of the baseline body mass index (BMI) on the response to headache preventive treatment. We included adults with episodic or chronic migraine (ICHD-2), or transformed migraine (Silberstein and Lipton criteria) that sought care in a headache clinic. BMI was assessed in the first visit. Baseline information included headache frequency, number of days with severe headache (prospectively obtained over 1 month), and headache-related disability (HIT-6). The same information was obtained after 3 months of preventive treatment. Subjects were categorized based on BMI in: normal weight (/=30). We contrasted the headache end-points using anova with post-test and Kruskal-Wallis with post-test. We used logistic regression to model BMI and headache parameters adjusting for covariates. Our sample consisted of 176 subjects (79.5% women, mean of 44.4 years). At baseline 40.9% had normal weight, 29.5% were overweight and 27.3% were obese. No significant differences were observed in the number of headache days at baseline. After treatment, frequency declined in the entire population, but no significant differences were found by BMI group. Regarding the number of days with severe pain per month, there were also no significant differences at baseline (normal = 6.1, overweight = 6.5, obese = 6.7), and improvement overall (P = 0.01). However, changes were greater in the obese (reduction in 2.7 days with treatment) and overweight (3.9) vs. normal (1.5, P < 0.01). Finally, HIT scores at baseline did not differ by BMI group (normal weight = 63.8, overweight = 64.1, obese = 63.6). However, compared with the normal weighted group, change in HIT scores (follow-up baseline) were greater in the obese (6.4 vs. 3.5, P < 0.05) and overweight groups (6.8 vs. 3.5, P < 0.05). In the logistic regression model, BMI did not account for changes in disability, headache frequency, or in the number of days with severe headache per month, after adjusting for covariates. Contrary to what we hypothesized, obesity at baseline does not seem to be related to follow-up refractoriness to preventive treatment.     

Body mass index and migraine: a survey of the Chinese adult population

The objective of this study is to evaluate the association between body mass index (BMI) and migraine in general population Chinese cohort. This was a cross-sectional secondary analysis from a general population Chinese cohort of men and women of reproductive and post-reproductive age ranging between 18 and 65 years. Migraine was defined utilizing ICHD criteria. Body mass indices were calculated using measured height and weight and categorized based on the World Health Organizations criteria. The 1-year period prevalence of migraine was 9.3 %. No association was identified between migraine and those with a BMI < 30.0. Compared to those with normal BMI (18.5–23.0), those with BMI ≥ 30 (morbid obesity) had a greater prevalence of migraine (8.6 vs. 13.8 %, p = 0.000). Multivariate-adjusted odds ratio demonstrated that those with morbid obesity had a greater than twofold increased odds of migraine [OR 2.10 (1.39–3.12)] as compared to those with a BMI between 18.5 and 23.0. No association was found between obesity and migraine severity, frequency, or disability. Morbid obesity was associated with twofold increased odds of migraine in this Chinese men and women cohort of predominantly reproductive age.     

Polymorphism of angiotensin-converting enzyme gene and BMI in obese Korean women

BACKGROUND: The renin-angiotensin system (RAS) plays a role in the pathogenesis of metabolic diseases. This system was recently found to be completely expressed in human adipose tissue. Especially angiotensin II, the active component of RAS, may affect adipogenesis and adipocyte metabolism. We examined whether obese and non-obese subjects differ from angiotensin-converting enzyme (ACE) genotype distribution, and whether the ACE genotypes affect the anthropometric parameters or the degrees of body mass index (BMI). METHODS: The study included 155 obese healthy women (BMI > or = 25 kg/m(2), range 25-54.7, age range 15-40 years), 82 non-obese women (BMI < 25 kg/m(2), range 15-40 years), and 613 random controls. Total fat mass and percent body fat (PBF) were determined by dual-energy X-ray absorptiometry (DEXA). Genomic DNA was extracted and used for polymerase chain reaction (PCR)-based genotyping of ACE. RESULTS: Age, percent body fat, waist-to-hip ratio (WHR), body mass index, and cholesterol concentrations did not differ from ACE genotype. No differences were observed for allelic and genotype frequencies between obese women (BMI > or = 25) and 82 non-obese women or 613 random controls. In addition, no association of ACE polymorphism was observed with BMI for genotype in obese women. CONCLUSIONS: ACE polymorphism is not a significant factor for BMI and does not contribute to the odds of obesity in obese healthy women from Korea.     

Relationship of serum interleukin-6 and tumor necrosis factor alpha levels with abdominal fat distribution evaluated by ultrasonography in overweight or obese postmenopausal women.

BACKGROUND: The objective of this study was to measure associations of circulating interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) levels with anthropometric and abdominal fat distribution in overweight or obese postmenopausal women. METHODS: One hundred eight overweight or obese postmenopausal were evaluated. Demographic and anthropometric measurements were done. Serum IL-6, TNF-alpha, glucose, and insulin levels were measured. Insulin resistance was calculated by using homeostasis model assessment-insulin resistance (HOMA-IR). The assessment of abdominal fat distribution was performed by ultrasonography. Statistical analysis was made with Pearson and partial correlation analysis. RESULTS: There was a positive correlation between serum IL-6 and TNF-alpha (r = .19; p = .047). IL-6 was positively correlated with body mass index (BMI) (r = .43; p = .0001), waist circumference (r = .41; p = .0001), and visceral fat layer (r = .33; p = .0001) measurements and HOMA-IR index (r = .31, p = .001). A positive relationship between HOMA-IR and visceral fat layer thickness was observed (r = .320; p = .0001). TNF-alpha was positively associated with BMI but not with any measures of central obesity. When adjustment for BMI was performed, there were no significant relationships between the studied parameters. CONCLUSIONS: There are no significant correlations between abdominal fat distributions measured by ultrasonography and circulating IL-6 and TNF-alpha levels. BMI may have a stronger association with circulating inflammatory cytokine concentrations than with different measures of central obesity in overweight or obese postmenopausal women.     

Association Between Obesity and Migraine in Women

Purpose of Review

Migraine is a common and highly disabling condition that is particularly prevalent among women and especially women of reproductive age. The tremendous rise in adiposity in the Western world has led to an epidemic of obesity in women. The particular effects of obesity on women with migraine of various ages are the focus of this review.

Recent Findings

Conflicting findings from various studies with different approaches and populations have made challenging definitive conclusions about associations between migraine and obesity. While the association between obesity and migraine frequency has been consistently demonstrated and obesity is considered a risk factor for progression from episodic to chronic migraine, the association between obesity and migraine prevalence is still somewhat debated and appears to be dependent on gender and age, with the most consistent effects observed in women younger than 55 years of age.

Summary

Association between migraine and obesity is most commonly observed in women of reproductive age. The multimodal changes associated with age and hormonal change in women likely play a role in this relationship, as obesity does not appear to be related to migraine in women over 55 years of age. Future studies focusing on the migraine-obesity relationship in women should examine the effects of age, endogenous hormonal state, and exogenous hormones on migraine and obesity.

     

The impact of depression and ghrelin on body weight in migraineurs

Background

Comorbidity of migraine with anxiety and depression may play a role in the link between migraine and obesity. We examined the moderating and mediating roles of ghrelin in the relationship between depression (and anxiety) and body weight in newly diagnosed migraineurs.

Methods

Participants were 63 newly diagnosed migraine patients (using the ICHD-II criteria) and 42 healthy volunteers. Body mass index (BMI) was calculated by measuring height and weight. Ghrelin was assessed at fasting. Depression was assessed with the Hamilton Depression scale, and anxiety with the Hamilton Anxiety scale.

Results

The data did not support the mediating role of ghrelin in the relationship between depression (or anxiety) and BMI for either the migraine or the control group. The interaction between ghrelin and depression as well as anxiety was significant for the migraine group, but not for the control group. Depressed (or anxious) migraineurs had a positive association between ghrelin and BMI, whereas for the non-depressed (or non-anxious) migraineurs this association was negative.

Conclusions

Depression and anxiety moderated the effect of ghrelin on BMI for migraineurs. Management of anxiety and depression might be regarded as part of migraine treatment.     

Genetic and BMI Risks for Predicting Blood Pressure in Three Generations of West African Dogon Women

The study of genetic polymorphisms and body mass index (BMI) among African women in Africa and in the United States contributes to our understanding of the genetic and environmental risk factors for hypertension. African American women have the highest prevalence of hypertension and obesity compared to other ethnic groups in the United States. Using a cross-sectional research design, we examined the effects of genetic and environmental risks of single nucleotide polymorphisms (SNPs) and BMI on blood pressure (BP) among three generations of West African Dogon women (N = 199). We genotyped six SNPs located in the candidate genes known to be related to hypertension. We tested the associations between these SNPs and systolic BP (SBP) and diastolic BP (DBP) with Fisher's exact tests, chi-square tests for independence, and multivariable linear mixed models. The SNP rs8179526 (SLC4A5) was significantly associated with SBP adjusted for age, age(2), and BMI (p = .02). The "C" allele variant of rs8179526 (allele frequency of 0.445) was associated with higher SBP. This SNP did not deviate from the Hardy-Weinberg equilibrium (HWE) with p value of .772. The SNP × BMI interaction effects associated with SBP and DBP were not significant. rs8179526 is located on the SLC4A5 gene on chromosome 2. SLC4A5 encodes a protein that transports sodium and bicarbonate across cell membranes while regulating cellular pH and contains several SNPs linked to elevated BP. Knowledge of the SNP's effect on hypertension among West African women can help health practitioners educate their patients about genetic risks of developing hypertension.     

Leptin and obesity in mother-child pairs

Defects in the leptin gene or the leptin receptor may be a genetic cause of obesity, but little is known about the familial associations of leptin and obesity. This study compared plasma leptin and measures of obesity in a sample of 248 subjects (124 mother-offspring pairs); 34% were African American and 66% were white. Youth were aged 12 to 16 years. Plasma leptin and body mass index (BMI) were higher in mothers than in their offspring and, among the offspring, higher in girls than boys, even after correcting for BMI or body fat. Racial differences in leptin were present in both mothers and youth when adjusting for percentage body fat but disappeared when adjusting for BMI. In univariate analyses of the associations between mothers and offspring, BMI was associated with leptin in all groups but was most strongly associated in white pairs and in mother-son pairs. In multiple regression analyses, when adjusting for BMI, significant predictors of leptin levelfor the boys and girls together were gender, BMI, and pubertal status of the offspring; in girls only BMI was significant (R2 = 0.72), and in boys the significant predictors were their BMI (R2 = 0.66) followed by their pubertal status (R2 = 0.06) and the leptin level of their mothers (R2 = 0.02). When adjusting for body fat, the predictors were the offspring's percentage bodyfat (R2 = 0. 67) and mother's leptin (R2 = 0.03), with similar results in gender-specific analyses. The authors conclude that leptin levels of youth are most closely associated with their degree of obesity or body fat; mother's leptin and, for boys only, pubertal status also play a small role. Although the small association between maternal leptin on leptin in their offspring could be due to either heredity or shared environment, the results of this study suggest that individual obesity and environmental factors are important predictors of leptin levels in children.     

Migraine,Migraine Features,and Cardiovascular Disease

(Headache 2010;50:1031‐1040) Background.— Many studies support an association between migraine and cardiovascular disease (CVD). This association appears particularly in migraine with aura and is also modified by additional factors. Objective.— We sought to investigate whether the association between migraine and CVD in addition to aura status is affected by certain migraine features. Methods.— Cohort study among 27,840 women, participating in the Women's Health Study. We had detailed self‐reported information on migraine and migraine features among women with active migraine (migraine during the year prior to baseline). Incident CVD events were confirmed after medical record review. We used Cox proportional hazards models to evaluate the association between migraine and incident CVD. The results have been presented in part before. We ran additional analyses according to migraine features. Results.— At baseline, 5125 (18.4%) women reported history of migraine; 39.7% of the 3610 women with active migraine indicated aura. During a mean of 11.9 years of follow‐up, 708 CVD events occurred. Migraine with aura doubled the risk for CVD, ischemic stroke, and myocardial infarction. With regard to ischemic stroke, this association seemed stronger in the absence than in the presence of migraine features. This was most pronounced in the absence (hazard ratio = 3.27; 95% CI = 1.93‐5.51; P < .0001) than in the presence of nausea/vomiting (hazard ratio = 0.91; 95% CI = 0.43‐1.93; P = .80). In contrast, the association with myocardial infarction did not reveal a certain pattern. Conclusions.— These data suggest that the association between migraine with aura and ischemic stroke may differ by absence or presence of migraine features.     

The effects of gender, age, and body mass index on standing lumbar curvature in persons without current low back pain

Reference values for standing lumbar curvature (SLC) obtained via noninvasive methods are not well established in persons without current low back pain. The effect of gender is considered to have a significant effect on SLC with women having more lumbar lordosis than men. The effect of age and degree of obesity are not considered to have a statistically significant effect on SLC. The purpose of this study was to test the assumption that measurements of SLC in healthy adults obtained by a flexible curve will differ between genders, whereas the SLC will not differ across categories of age and body mass index (BMI). Two hundred thirty-five volunteers (119 men and 116 women) whose ages ranged between 20 and 79 years participated in the study. Subjects were almost exclusively White and from the Midwest. Measurements of the SLC were obtained by a flexible curve. The curve's shape was transferred to poster board, and the value of SLC was quantified by a previously described technique. A three-way analysis of variance (alpha = 0.05) was used to examine the main effects of gender, age, and BMI on SLC. The effect of gender (F1,199 = 21.4, p < 0.0001) and the effect of age (F5,199 = 2.8, p < 0.017) were statistically significant. The effect of BMI (F2,199 = 1.8, p = 0.176) was not significant. Women (mean, 49.5 degrees +/-10.7 degrees ) demonstrated about 6.5 degrees more SLC than their male (mean, 43.0 degrees +/-10.7 degrees ) counterparts. For age, the only significant difference was between the 20 to 29- and 50 to 59-year-old age categories. This study provides physical therapists with typical values of SLC in men and women without current low back pain.     

Impact of Parity on Obesity: A Cross-Sectional Study in Iranian Women

Objective

The aim of the present study was to analyze whether or not parity influenced the prevalence of obesity in both pre- and postmenopausal women.

Subjects and Methods

A cross-sectional study was conducted on characteristics of urban women regarding parity. A total of 1,620 women aged 45-63 years were selected using cluster sampling. A face-to-face household interview was conducted by trained, skillful personnel. A risk factor questionnaire was used to obtain information on reproductive history and sociodemographic factors. Statistical associations between parity and obesity using logistic regression were then investigated.

Results

The mean BMI was 29.1 ± 5.1, and 96.8% of the sample population were parous, with a median of 4 births. Of the total women enrolled, 216 (13.3%) had <3 parities, while 1,404 (86.7%) had ≥3 parities. The prevalence of obesity (BMI ≥30) was 38.3%, diagnosed at a mean age of 51.4 ± 5.2 years. After adjustment for a range of potential confounders (age, marital status, employment, education, smoking status, abortion history, savings situation and menopausal status), women with ≥3 parities were at higher risk of being obese (OR 1.74, 95% CI 1.24-2.45; p = 0.001).

Conclusion

A positive association was observed between the number of parities and obesity. The findings of this study suggest that the BMI is associated with high parity in Babolian women. Health policymakers should work with health providers to develop appropriate postpartum weight loss interventions.Key Words: BMI, Pregnancy, Women''s health     

Polymorphism of interleukin-1 receptor antagonist gene and obesity

Background: Cytokines appear to be major regulators of adipose tissue metabolism. Interleukin-1 receptor antagonist (IL-1ra) serum concentrations are increased in human obesity, and are under strong genetic control. We tested the hypothesis that the IL-1ra gene might be a candidate for obesity. Methods: We investigated the frequency of a penta-allelic 86-bp tandem repeat (VNTR) in the intron 2 of IL-1ra gene in 52 lean (body mass index (BMI) <25 kg/m²), 133 overweight (BMI 25–29.9 kg/m²) and 76 obese (BMI ≥30.0 kg/m²) otherwise healthy Korean women. Total fat mass and percent body fat were determined by dual-energy X-ray absorptiometry. Genomic DNA was extracted and used for polymerase chain reaction-based genotyping of IL-1ra. Results: Carriers of the allele 2 did not show a significant difference in physical and clinical characteristics. The genotypic, or allelic distribution did not differ markedly between the three groups. The relative risk of being obese in comparison with lean group tended to be higher in allele 2 carriers, but not significantly. Conclusions: We found no relationship between the IL-1ra polymorphism and BMI in Korean women.     

Body mass index, migraine, migraine frequency and migraine features in women

We evaluated the association of body mass index (BMI) with migraine and migraine specifics in a cross-sectional study of 63 467 women aged ≥ 45 years, of whom 12 613 (19.9%) reported any history of migraine and 9195 had active migraine. Compared with women without migraine and a BMI < 23 kg/m², women with a BMI ≥ 35 kg/m² had adjusted odds ratios (ORs) (95% confidence intervals) of 1.03 (0.95, 1.12) for any history of migraine. Findings were similar for active migraineurs. Women with a BMI of ≥ 35 kg/m² had increased risk for low and high migraine frequency, with the highest estimate for women who reported daily migraine. Compared with women with the lowest associated risk (migraine frequency < 6 times/year; BMI between 27.0 and 29.9 kg/m²), women with a BMI ≥ 35 kg/m² had an OR of daily migraine of 3.11 (1.12, 8.67). Among the women with active migraine, a BMI ≥ 35 kg/m² was associated with increased risk of phonophobia and photophobia and decreased risk of a unilateral pain characteristic and migraine aura. Our data confirm previous findings that the association between BMI with migraine is limited to migraine frequency and specific migraine features.     

The effects of gender,age, and body mass index on standing lumbar curvature in persons without current low back pain

Reference values for standing lumbar curvature (SLC) obtained via noninvasive methods are not well established in persons without current low back pain. The effect of gender is considered to have a significant effect on SLC with women having more lumbar lordosis than men. The effect of age and degree of obesity are not considered to have a statistically significant effect on SLC. The purpose of this study was to test the assumption that measurements of SLC in healthy adults obtained by a flexible curve will differ between genders, whereas the SLC will not differ across categories of age and body mass index (BMI). Two hundred thirty-five volunteers (119 men and 116 women) whose ages ranged between 20 and 79 years participated in the study. Subjects were almost exclusively White and from the Midwest. Measurements of the SLC were obtained by a flexible curve. The curve's shape was transferred to poster board, and the value of SLC was quantified by a previously described technique. A three-way analysis of variance (α = 0.05) was used to examine the main effects of gender, age, and BMI on SLC. The effect of gender (F_1,199 = 21.4, p < 0.0001) and the effect of age (F_5,199 = 2.8, p < 0.017) were statistically significant. The effect of BMI (F_2,199 = 1.8, p = 0.176) was not significant. Women (mean, 49.5°±10.7°) demonstrated about 6.5° more SLC than their male (mean, 43.0°±10.7°) counterparts. For age, the only significant difference was between the 20 to 29- and 50 to 59-year-old age categories. This study provides physical therapists with typical values of SLC in men and women without current low back pain.     

Body mass index and adult weight gain among reproductive age women with migraine

(Headache 2011;51:559‐569) Objective.— To evaluate the cross‐sectional relationship between migraine and pregravid obesity; and to assess the risk of adult weight gain among women with history of a pediatric diagnosis of migraine. Background.— Obesity, comorbid with pain disorders including migraine, shares common pathophysiological characteristics including systemic inflammation, and derangements in adipose‐tissue derived cytokines. Despite biochemical and epidemiological commonalities, obesity–migraine associations have been inconsistently observed. Methods.— A cohort of 3733 women was interviewed during early pregnancy. We ascertained participants' self‐reported history of physician‐diagnosed migraine and collected self‐reported information about pregravid weight, adult height, and net weight change from age 18 to the 3‐months period before pregnancy. Using pregravid body mass index, we categorized participants as follows: lean (<18.5 kg/m²), normal (18.5‐24.9 kg/m²), overweight (25‐29.9 kg/m²), obese (30‐34.9 kg/m²), severely obese (35‐39.9 kg/m²), and morbidly obese (≥40 kg/m²). Logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results.— After adjusting for confounders, relative to normal weight women, obese women had a 1.48‐fold increased odds of migraine (OR = 1.48; 95% CI 1.12‐1.96). Severely obese (OR = 2.07; 95% CI 1.27‐3.39) and morbidly obese (OR = 2.75; 95% CI 1.60‐4.70) had the highest odds of migraines. Women with a history of diagnosed pediatric migraine had a 1.67‐fold higher odds of gaining ≥10.0 kg above their weight at age 18, as compared with non‐migraineurs (OR = 1.67; 95% CI 1.13‐2.47). Conclusion.— These data support earlier observations of migraine–obesity association among women, and extend the literature to include evidence of adult weight gain among women with a history of pediatric migraine.     

成都地区中老年人群体质量指数及腹型肥胖对糖尿病患病率及空腹血糖水平的影响

目的研究成都地区中老年人群体质量指数(BMI)及腹型肥胖对糖尿病患病率及空腹血糖水平的影响。方法 2007年5月,采用随机抽样方法抽取50～80岁中老年人685人进行心血管危险因素调查,其男394人,女291人,年龄(63.3±0.2)岁。结果成都地区中老年人群的超重和肥胖所占的比例较大(约44.3%),按BMI分组(BMI<24 kg/m2;24 kg/m2≤BMI<28 kg/m2;BMI≥28 kg/m2)的糖尿病患病率分别为14.0%、18.7%及23.3%,组间差异有统计学意义(P=0.031)。男女分别按腹型肥胖标准分组(男性切点=85 cm,女性切点=80 cm),男性糖尿病患病率在非腹型肥胖及腹型肥胖组分别为17.9%及18.7%组间差异无统计学意义(P=0.849),女性糖尿病患病率分别为9.7%及18.4%,组间差异有统计学意义(P=0.034)。整个人群中,空腹血糖无随BMI增加而升高的趋势(P=0.071);女性人群中,空腹血糖随腰围的增加而升高(P=0.001);而在男性人群中无此趋势。在调整相关指标后,logistic回归分析提示BMI对糖尿病患病率独立影响,以BMI正常为参照,超重及肥胖的OR值分别为:1.412[95%CI(0.818,2.437),P=0.215]及2.200[95%CI(1.034,5.178),P=0.046]。在调整相关指标后,腹型肥胖在女性人群中对糖尿病患病率独立影响,以非腹型肥胖为参考,腹型肥胖的OR值为:1.394[95%CI(1.080,3.205),P=0.041],而在男性人群中无此关系。结论成都地区中老年人群超重及肥胖所占的比重较大,BMI可影响糖尿病患病率及空腹血糖水平;腹型肥胖能够影响女性人群糖尿病患病率及空腹血糖水平,但在男性人群中无此关系。     

Obesity and risk of venous thromboembolism among postmenopausal women: differential impact of hormone therapy by route of estrogen administration. The ESTHER Study

BACKGROUND: Oral estrogen use and elevated body mass index (BMI) increase the risk of venous thromboembolism (VTE). Recent data suggest that transdermal estrogen might be safe with respect to thrombotic risk. However, the impact of transdermal estrogen on the association between overweight (25 kg m(-2) < BMI < or = 30 kg m(-2)) or obesity (BMI >30 kg m(-2)) and VTE risk has not been investigated. METHODS: We carried a multicenter case-control study of VTE among postmenopausal women aged 45-70 years, between 1999 and 2005, in France. Case population consisted of women with a first documented idiopathic VTE. We recruited 191 hospital cases matched with 416 hospital controls and 62 outpatient cases matched with 181 community controls. RESULTS: The odds ratio (OR) for VTE was 2.5 [95% confidence interval (CI):1.7-3.7] for overweight and 3.9 (95% CI: 2.2-6.9) for obesity. Oral, not transdermal, estrogen was associated with an increased VTE risk (OR = 4.5; 95% CI: 2.6-7.7 and OR = 1.1; 95% CI: 0.7-1.7, respectively). Compared with non-users with normal weight, the combination of oral estrogen use and overweight or obesity further enhanced VTE risk (OR = 10.2; 95% CI: 3.5-30.2 and OR = 20.6; 95% CI: 4.8-88.1, respectively). However, transdermal users with increased BMI had similar risk as non-users with increased BMI (OR = 2.9; 95% CI: 1.5-5.8 and OR = 2.7; 95% CI: 1.7-4.5 respectively for overweight; OR = 5.4; 95% CI: 2.1-14.1 and OR = 4.0; 95% CI: 2.1-7.8 respectively for obesity). CONCLUSIONS: In contrast to oral estrogen, transdermal estrogen does not confer an additional risk of idiopathic VTE in women with increased BMI. The safety of transdermal estrogen on thrombotic risk has to be confirmed.     

The -256T>C polymorphism in the apolipoprotein A-II gene promoter is associated with body mass index and food intake in the genetics of lipid lowering drugs and diet network study

BACKGROUND: Apolipoprotein A-II (APOA2) plays an ambiguous role in lipid metabolism, obesity, and atherosclerosis. METHODS: We studied the association between a functional APOA2 promoter polymorphism (-265T>C) and plasma lipids (fasting and postprandial), anthropometric variables, and food intake in 514 men and 564 women who participated in the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) study. We obtained fasting and postprandial (after consuming a high-fat meal) measures. We measured lipoprotein particle concentrations by proton nuclear magnetic resonance spectroscopy and estimated dietary intake by use of a validated questionnaire. RESULTS: We observed recessive effects for this polymorphism that were homogeneous by sex. Individuals homozygous for the -265C allele had statistically higher body mass index (BMI) than did carriers of the T allele. Consistently, after multivariate adjustment, the odds ratio for obesity in CC individuals compared with T allele carriers was 1.70 (95% CI 1.02-2.80, P = 0.039). Interestingly, total energy intake in CC individuals was statistically higher [mean (SE) 9371 (497) vs 8456 (413) kJ/d, P = 0.005] than in T allele carriers. Likewise, total fat and protein intakes (expressed in grams per day) were statistically higher in CC individuals (P = 0.002 and P = 0.005, respectively). After adjustment for energy, percentage of carbohydrate intake was statistically lower in CC individuals. These associations remained statistically significant even after adjustment for BMI. We found no associations with fasting lipids and only some associations with HDL subfraction distribution in the postprandial state. CONCLUSIONS: The -265T>C polymorphism is consistently associated with food consumption and obesity, suggesting a new role for APOA2 in regulating dietary intake.