Sedentary Lifestyle and High-Carbohydrate Intake are Associated with Low-Grade Chronic Inflammation in Post-Menopause: A Cross-sectional StudySedentarismo e alto consumo de carboidratos associados à inflamação crônica de baixo grau na pós-menopausa: um estudo transversal
17 April 2016
12 May 2016
15 July 2016 (eFirst)
Introduction Cardiovascular disease (CVD) is the leading cause of death in post menopausal women, and inflammation is involved in the atherosclerosis process.
Purpose to assess whether dietary pattern, metabolic profile, body composition and physical activity are associated with low-grade chronic inflammation according to high-sensitivity C-reactive protein (hs-CRP) levels in postmenopausal women.
Methods ninety-five postmenopausal participants, with no evidence of clinical disease, underwent anthropometric, metabolic and hormonal assessments. Usual dietary intake was assessed with a validated food frequency questionnaire, habitual physical activity was measured with a digital pedometer, and body composition was estimated by bioelectrical impedance analysis. Patients with hs-CRP ≥10 mg/L or using hormone therapy in the last three months before the study were excluded from the analysis. Participants were stratified according to hs-CRP lower or ≥3 mg/L. Sedentary lifestyle was defined as walking fewer than 6 thousand steps a day. Two-tailed Student's t-test, Wilcoxon–Mann–Whitney U or Chi-square (χ2) test were used to compare differences between groups. A logistic regression model was used to estimate the odds ratio of variables for high hs-CRP.
Results participants with hs-CRP ≥3 mg/L had higher body mass index (BMI), body fat percentage, waist circumference (WC), triglycerides, glucose, and homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.01 for all variables) than women with hs-CRP <3 mg/L. Also, women with hs-CRP ≥3 mg/L had a higher glycemic load diet and lower protein intake. Prevalence of sedentary lifestyle (p < 0.01) and metabolic syndrome (p < 0.01) was higher in women with hs-CRP ≥3 mg/L. After adjustment for age and time since menopause, the odds ratio for hs-CRP ≥3 mg/L was higher for sedentary lifestyle (4.7, 95% confidence interval [95%CI] 1.4–15.5) and carbohydrate intake (2.9, 95%CI 1.1–7.7).
Conclusions sedentary lifestyle and high-carbohydrate intake were associated with low-grade chronic inflammation and cardiovascular risk in postmenopause.
Introdução A doença cardiovascular é a principal causa de morte em mulheres na pós-menpausa e inflamação está envolvida com o processo de aterosclerose.
Objetivo avaliar se o padrão alimentar, o perfil metabólico, a composição corporal e a atividade física estão associados à inflamação crônica de baixo grau, de acordo com os níveis de proteína C-reativa (PCR-us), em mulheres na pós-menopausa.
Métodos noventa e cinco participantes pós-menopáusicas foram submetidas a avaliações antropométrica, metabólica e hormonal. A ingestão alimentar foi avaliada por meio de questionário de frequência alimentar, a atividade física habitual, com pedômetro digital, e a composição corporal, por bioimpedância elétrica. Pacientes com PCR-us ≥10 mg/L ou em uso de terapia hormonal nos últimos três meses antes do estudo foram excluídas. As participantes foram estratificadas de acordo PCR-us inferior ou ≥3 mg/L. Pacientes com menos de 6 mil passos/dia foram consideradas sedentárias. Para análise estatística foram utilizados teste t de Student, Wilcoxon–Mann–Whitney U ou Qui-quadrado (χ2), além de modelo de regressão logística para estimar a razão de chances para PCR-us elevada.
Resultados participantes com PCR-us ≥3 mg/L apresentaram maior índice de massa corporal (IMC), percentual de gordura corporal, circunferência da cintura, triglicerídeos, glicose e índice de insulino-resistência (HOMA-IR) (p = 0,01) comparadas às mulheres com PCR-us <3 mg/L. O grupo PCR-us ≥3 mg/L apresentou uma dieta com maior carga glicêmica e menor ingestão de proteínas. A prevalência de sedentarismo e síndrome metabólica foi maior em mulheres com PCR-us ≥3 mg/L (p < 0,01). Após ajuste para idade e tempo de menopausa, a razão de chances para PCR-us ≥3 mg/L foi maior nas sedentárias (4,7, intervalo de confiança de 95% [95%CI] 1,4–15,5) e com maior ingestão de carboidratos (2,9, 95%CI 1.1–7,7).
Conclusões Sedentarismo e alta ingestão de carboidratos foram associados com inflamação crônica de baixo grau e risco cardiovascular em mulheres na pós-menopausa.
- 1 Mozaffarian D, Benjamin EJ, Go AS , et al; Writing Group Members; American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics – 2016 update: a report from the American Heart Association. Circulation 2016; 133 (4) 447-454
- 2 Jones R, Hardy R, Sattar N , et al; NSHD Scientific and Data Collection Teams. Novel coronary heart disease risk factors at 60-64 years and life course socioeconomic position: the 1946 British birth cohort. Atherosclerosis 2015; 238 (1) 70-76
- 3 Golia E, Limongelli G, Natale F , et al. Inflammation and cardiovascular disease: from pathogenesis to therapeutic target. Curr Atheroscler Rep 2014; 16 (9) 435
- 4 Steyers III CM, Miller Jr FJ. Endothelial dysfunction in chronic inflammatory diseases. Int J Mol Sci 2014; 15 (7) 11324-11349
- 5 Stoner L, Lucero AA, Palmer BR, Jones LM, Young JM, Faulkner J. Inflammatory biomarkers for predicting cardiovascular disease. Clin Biochem 2013; 46 (15) 1353-1371
- 6 Piché ME, Lemieux S, Weisnagel SJ, Corneau L, Nadeau A, Bergeron J. Relation of high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and fibrinogen to abdominal adipose tissue, blood pressure, and cholesterol and triglyceride levels in healthy postmenopausal women. Am J Cardiol 2005; 96 (1) 92-97
- 7 Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 2000; 343 (1) 16-22
- 8 Huffman KM, Orenduff MC, Samsa GP, Houmard JA, Kraus WE, Bales CW. Dietary carbohydrate intake and high-sensitivity C-reactive protein in at-risk women and men. Am Heart J 2007; 154 (5) 962-968
- 9 Fan J, Song Y, Wang Y, Hui R, Zhang W. Dietary glycemic index, glycemic load, and risk of coronary heart disease, stroke, and stroke mortality: a systematic review with meta-analysis. PLoS ONE 2012; 7 (12) e52182
- 10 Silva TR, Franz R, Maturana MA, Spritzer PM. Associations between body composition and lifestyle factors with bone mineral density according to time since menopause in women from Southern Brazil: a cross-sectional study. BMC Endocr Disord 2015; 15: 71
- 11 Donato GB, Fuchs SC, Oppermann K, Bastos C, Spritzer PM. Association between menopause status and central adiposity measured at different cutoffs of waist circumference and waist-to-hip ratio. Menopause 2006; 13 (2) 280-285
- 12 Toscani M, Migliavacca R, Sisson de Castro JA, Spritzer PM. Estimation of truncal adiposity using waist circumference or the sum of trunk skinfolds: a pilot study for insulin resistance screening in hirsute patients with or without polycystic ovary syndrome. Metabolism 2007; 56 (7) 992-997
- 13 Alberti KG, Eckel RH, Grundy SM , et al; International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120 (16) 1640-1645
- 14 Maturana MA, Moreira RM, Spritzer PM. Lipid accumulation product (LAP) is related to androgenicity and cardiovascular risk factors in postmenopausal women. Maturitas 2011; 70 (4) 395-399
- 15 Wiltgen D, Benedetto IG, Mastella LS, Spritzer PM. Lipid accumulation product index: a reliable marker of cardiovascular risk in polycystic ovary syndrome. Hum Reprod 2009; 24 (7) 1726-1731
- 16 Zanolla AF, Olinto MT, Henn RL, Wahrlich V, Anjos LA. [Assessment of reproducibility and validity of a food frequency questionnaire in a sample of adults living in Porto Alegre, Rio Grande do Sul State, Brazil]. Cad Saude Publica 2009; 25 (4) 840-848 Portuguese
- 17 Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: 2008. Diabetes Care 2008; 31 (12) 2281-2283
- 18 Colpani V, Oppermann K, Spritzer PM. Association between habitual physical activity and lower cardiovascular risk in premenopausal, perimenopausal, and postmenopausal women: a population-based study. Menopause 2013; 20 (5) 525-531
- 19 Graff SK, Alves BC, Toscani MK, Spritzer PM. Benefits of pedometer-measured habitual physical activity in healthy women. Appl Physiol Nutr Metab 2012; 37 (1) 149-156
- 20 Myers GL, Christenson RH, Cushman M , et al; NACB LMPG Committee Members. National Academy of Clinical Biochemistry Laboratory Medicine Practice guidelines: emerging biomarkers for primary prevention of cardiovascular disease. Clin Chem 2009; 55 (2) 378-384
- 21 Otten JJ, Hellwig JP, Meyers LD. Institute of Medicine. Dietary reference intakes: the essential guide to nutrient requirements. Washington (DC): National Academies Press; 2006
- 22 Fernandes CE, Pinho-Neto JSL, Gebara OCE. [I Brazilian Society for Cardiology and Brazilian Menopause Association Guideline on the Prevention of Cardiovascular Disease in Menopausal Women and the Influence of Hormone Therapy]. Arq Bras Cardiol 2008; 91 (1) (Suppl. 01) 1-23
- 23 National Institutes of Health. Clinical Guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 1998; 6 (Suppl. 02) 51S-209S
- 24 Perry CD, Alekel DL, Ritland LM , et al. Centrally located body fat is related to inflammatory markers in healthy postmenopausal women. Menopause 2008; 15 (4 Pt 1): 619-627
- 25 Bastard JP, Jardel C, Bruckert E , et al. Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of obese women after weight loss. J Clin Endocrinol Metab 2000; 85 (9) 3338-3342
- 26 dos Santos RE, Aldrighi JM, Lanz JR, Ferezin PC, Marone MM. Relationship of body fat distribution by waist circumference, dual-energy X-ray absorptiometry and ultrasonography to insulin resistance by homeostasis model assessment and lipid profile in obese and non-obese postmenopausal women. Gynecol Endocrinol 2005; 21 (5) 295-301
- 27 Franz R, Maturana MA, Magalhães JA, Moraes RS, Spritzer PM. Central adiposity and decreased heart rate variability in postmenopause: a cross-sectional study. Climacteric 2013; 16 (5) 576-583
- 28 Moreto F, de Oliveira EP, Manda RM , et al. Pathological and behavioral risk factors for higher serum C-reactive protein concentrations in free-living adults—a Brazilian community-based study. Inflammation 2013; 36 (1) 15-25
- 29 Mora S, Cook N, Buring JE, Ridker PM, Lee IM. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation 2007; 116 (19) 2110-2118
- 30 Lavoie ME, Rabasa-Lhoret R, Doucet E , et al. Association between physical activity energy expenditure and inflammatory markers in sedentary overweight and obese women. Int J Obes 2010; 34 (9) 1387-1395
- 31 Mora S, Lee IM, Buring JE, Ridker PM. Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. JAMA 2006; 295 (12) 1412-1419
- 32 Buyken AE, Flood V, Empson M , et al. Carbohydrate nutrition and inflammatory disease mortality in older adults. Am J Clin Nutr 2010; 92 (3) 634-643
- 33 Liu S, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr 2002; 75 (3) 492-498
- 34 Neuhouser ML, Schwarz Y, Wang C , et al. A low-glycemic load diet reduces serum C-reactive protein and modestly increases adiponectin in overweight and obese adults. J Nutr 2012; 142 (2) 369-374
- 35 Hu FB. Protein, body weight, and cardiovascular health. Am J Clin Nutr 2005; 82 (1, Suppl) 242S-247S