迟发或早发停经会增加第二型糖尿病风险


  【24drs.com】新研究结果指出,在45岁前或55岁后停经的妇女,发生第二型糖尿病的风险比较高(相较于在46-55岁之间停经者,风险比分别是HR 1.04和HR1.08)。
  
  研究结果在线发表于7月27日更年期期刊。
  
  奥勒冈州波特兰Kaiser Permanente健康研究中心与Erin S LeBlanc医师等人,检视了参与「妇女健康研究(WHI)」这项研究的124,379名妇女,该研究由国家健康研究院于1991年起进行,探讨停经后妇女的疾病预防。
  
  LeBlanc医师等人也发现,在相关的年龄调整模式中,生育期最短(少于30年)的女性,发生第二型糖尿病的风险比生育期36-40年者增加37%,同样的,生育期最长(大于45年)的女性,此一风险比中等生育期女性高23%。
  
  LeBlanc医师表示,研究认为,终生的雌激素暴露可能会影响妇女是否发生第二型糖尿病,也可能有一个适当雌激素曝露的「甜蜜点」-发生第二型糖尿病的风险最低。
  
  研究团队假设,因为内生性雌激素已经显示对发生糖尿病、心血管疾病与骨质疏松有保护效果,生育期最短者对于糖尿病的保护最少。
  
  雌激素有助于保持胰岛素分泌和稳定的血糖值;雌激素低对于体脂肪分布和脂肪累积则是有负面影响,此二者皆为第二型糖尿病的重要风险因素。
  
  令人惊讶的是,资料显示,生育期最长者的第二型糖尿病风险也比较高,LeBlanc医师表示,对此,我没有良好的生物学解释。
  
  当然,妇女对于停经年龄能做的有限,因为它有很强的遗传性,但是,风险较高者可以考虑生活型态改变,而医师们有了这些新讯息,对这些高风险族群可以提供更好的谘商。
  
  LeBlanc医师表示,对于高风险组,希望这些妇女别认为这是可怕的事,别认为她们注定会发生糖尿病。
  
  我们的研究论点,是提供另一个动机让提早或延迟停经的妇女采取健康的生活型态,因为我们知道,健康的生活型态可以大幅降低妇女发生糖尿病的风险。
  
  她指出,对于医师,这是纳入有关维持健康体重、均衡饮食与营养饮食、多运动为何重要之谘商的另一个因素。
  
  作者们指出,之前有关此议题之研究,样本数少且缺乏严谨的、前瞻性的第二型糖尿病认定。
  
  此次研究的优势包括:样本数够大、可以更明确地显示研究对象的生育史、追踪期长、前瞻性的糖尿病认定。
  
  研究者检视了其它一些因素,包括之前的怀孕次数、第一次生育的年龄、停经是因为手术还是自然发生、身体质量指数、停经后的荷尔蒙治疗,但是,这些因素对于发生第二型糖尿病之风险都没有统计上的显著关联。
  
  开始经期的年龄以及不规律的经期,对于糖尿病风险也没有统计上的显著影响。
  
  研究限制包括,妇女们是回忆她们开始月经的年龄,这可能会导致分析错误。另外,并非所有参与WHI的妇女都有糖尿病诊断资料,研究者须依赖研究对象有关糖尿病的自我报告。
  
  不过,WHI研究对象自我报告的「已治疗糖尿病」,已被证明是足够精确地让我们用于这类流行病学研究。
  
  LeBlanc医师等人的研究结果和之前的一篇欧洲研究(Diabetes Care. 2013;36:1012-1019)结果一致。
  
  作者们写道,在那篇纳入超过8,000名停经后妇女、追踪11年的巢状、前瞻性病例世代研究中,生育期每降低一个标准差时,第二型糖尿病风险增加6%。
  
  LeBlanc医师等人观察指出,但是,依旧不清楚内生性雌激素如何影响第二型糖尿病,应探讨此议题,以了解女性如何随著年龄增加而降低糖尿病风险。
  
  LeBlanc医师结论指出,未来的研究也可检视,针对这些风险较高的妇女,是否可以降低糖尿病的发生率。
  
  资料来源:http://www.24drs.com/
  
  Native link:Early or Late Menopause Ups Risk for Type 2 Diabetes

Early or Late Menopause Ups Risk for Type 2 Diabetes

By Marcia Frellick
Medscape Medical News

Women who had their final menstrual period before age 45 or after 55 have a higher risk of developing type 2 diabetes (hazard ratio [HR], 1.04 and HR, 1.08, respectively, compared with those who had their final period between ages 46 and 55), new study results indicate.

The findings were published online July 27 in Menopause.

Erin S LeBlanc, MD, MPH, with Kaiser Permanente Center for Health Research, Portland, Oregon, and colleagues examined 124,379 women in the Women's Health Initiative (WHI), a multicenter study launched in 1991 by the National Institutes of Health that looked at preventing disease in postmenopausal women.

Dr LeBlanc and colleagues also found that in related age-adjusted models, women with the shortest reproductive periods (less than 30 years) had a 37% greater risk of developing type 2 diabetes than those with reproductive periods of 36 to 40 years. Likewise, women with the longest reproductive span (more than 45 years) had a 23% higher risk than women with medium-length reproductive years.

Dr LeBlanc told Medscape Medical News the study suggests that lifetime estrogen exposure may play a role in whether a woman develops type 2 diabetes or not and that there may be a "sweet spot" where optimal estrogen exposure meets lowest risk for type 2 diabetes.

The research team had hypothesized that because endogenous estrogen has been known to have protective effects against developing diabetes, cardiovascular disease, and osteoporosis, those with shorter reproductive years would have less protection from diabetes.

Estrogen helps to preserve insulin secretion and stabilize glucose levels. Low estrogen negatively affects body-fat distribution and fat accumulation, important factors in type 2 diabetes risk.

The surprise was that the data showed those with the longest reproductive years also had a higher risk for type 2 diabetes. "I don't have a good biological explanation for that," Dr LeBlanc said.

Results Can Help Target Lifestyle Changes

Of course, there's little women can do about age of menopause, given its strong genetic component, but those in the higher-risk groups can consider lifestyle changes, and clinicians, armed with this new information, can better counsel patients in the higher-risk groups.

"I don't want women thinking this is something terrible and they're doomed to get diabetes" if they are in the higher-risk groups, Dr LeBlanc said.

"The point of our study is to give women who have early menopause or late menopause another motivator for adopting a healthy lifestyle, because we know that a healthy lifestyle can substantially reduce a woman's risk of developing diabetes."

For clinicians, this is another factor to add to the conversation on why it's important to maintain a healthy weight, eat a balanced and nutritious diet, and increase exercise levels, she noted.

The authors add that previous work on this topic has had small sample sizes and lacked rigorous, prospective ascertainment of type 2 diabetes.

Strengths of this study include its large size, ability to more clearly characterize participants' reproductive history, long follow-up, and prospective ascertainment of diabetes.

Other Factors Not Linked to Risk

The researchers examined several other factors, including number of previous pregnancies, age at first birth, whether menopause was surgical or natural, body mass index, and hormone therapy after menopause. But none of these factors had a statistically significant link to risk of developing type 2 diabetes.

Age at which periods started and irregular periods were also not statistically significant in risk for diabetes.

Study limitations included that women were asked to recall their age at start of menstruation, which could have resulted in measurement error. And because medically diagnosed diabetes was not available for all WHI women, the researchers relied on participants' reports of diabetes.

"[H]owever, self-reports of 'treated diabetes' in WHI have been shown to be sufficiently accurate to allow use in epidemiologic studies such as this one," they write.

The findings by Dr LeBlanc, et al, are aligned with those of a previous European study (Diabetes Care. 2013;36:1012-1019).

"In that nested, prospective case-cohort study of more than 8000 postmenopausal women followed for 11 years, there was a 6% increased risk of type 2 diabetes per standard deviation of lower reproductive lifespan in years," the authors write.

But it still remains unknown how endogenous estrogen affects type 2 diabetes risk. Exploring that could lead to answers on how a woman could decrease diabetes risk as she ages, Dr LeBlanc and colleagues observe.

Further research could also test whether targeting women in these identified higher-risk groups could bring down the incidence of diabetes, Dr LeBlanc concluded.

The WHI program is funded by the National Institutes of Health. Dr LeBlanc's institute has received research funding from Amgen, AstraZeneca, Bristol Meyers Squibb, and Merck for unrelated projects. The coauthors had no relevant financial relationships.

For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

Menopause. Published online July 27, 2016.

    
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