遲發或早發停經會增加第二型糖尿病風險


  【24drs.com】新研究結果指出,在45歲前或55歲後停經的婦女,發生第二型糖尿病的風險比較高(相較於在46-55歲之間停經者,風險比分別是HR 1.04和HR1.08)。
  
  研究結果線上發表於7月27日更年期期刊。
  
  奧勒岡州波特蘭Kaiser Permanente健康研究中心與Erin S LeBlanc醫師等人,檢視了參與「婦女健康研究(WHI)」這項研究的124,379名婦女,該研究由國家健康研究院於1991年起進行,探討停經後婦女的疾病預防。
  
  LeBlanc醫師等人也發現,在相關的年齡調整模式中,生育期最短(少於30年)的女性,發生第二型糖尿病的風險比生育期36-40年者增加37%,同樣的,生育期最長(大於45年)的女性,此一風險比中等生育期女性高23%。
  
  LeBlanc醫師表示,研究認為,終生的雌激素暴露可能會影響婦女是否發生第二型糖尿病,也可能有一個適當雌激素曝露的「甜蜜點」-發生第二型糖尿病的風險最低。
  
  研究團隊假設,因為內生性雌激素已經顯示對發生糖尿病、心血管疾病與骨質疏鬆有保護效果,生育期最短者對於糖尿病的保護最少。
  
  雌激素有助於保持胰島素分泌和穩定的血糖值;雌激素低對於體脂肪分佈和脂肪累積則是有負面影響,此二者皆為第二型糖尿病的重要風險因素。
  
  令人驚訝的是,資料顯示,生育期最長者的第二型糖尿病風險也比較高,LeBlanc醫師表示,對此,我沒有良好的生物學解釋。
  
  當然,婦女對於停經年齡能做的有限,因為它有很強的遺傳性,但是,風險較高者可以考慮生活型態改變,而醫師們有了這些新訊息,對這些高風險族群可以提供更好的諮商。
  
  LeBlanc醫師表示,對於高風險組,希望這些婦女別認為這是可怕的事,別認為她們注定會發生糖尿病。
  
  我們的研究論點,是提供另一個動機讓提早或延遲停經的婦女採取健康的生活型態,因為我們知道,健康的生活型態可以大幅降低婦女發生糖尿病的風險。
  
  她指出,對於醫師,這是納入有關維持健康體重、均衡飲食與營養飲食、多運動為何重要之諮商的另一個因素。
  
  作者們指出,之前有關此議題之研究,樣本數少且缺乏嚴謹的、前瞻性的第二型糖尿病認定。
  
  此次研究的優勢包括:樣本數夠大、可以更明確地顯示研究對象的生育史、追蹤期長、前瞻性的糖尿病認定。
  
  研究者檢視了其他一些因素,包括之前的懷孕次數、第一次生育的年齡、停經是因為手術還是自然發生、身體質量指數、停經後的荷爾蒙治療,但是,這些因素對於發生第二型糖尿病之風險都沒有統計上的顯著關聯。
  
  開始經期的年齡以及不規律的經期,對於糖尿病風險也沒有統計上的顯著影響。
  
  研究限制包括,婦女們是回憶她們開始月經的年齡,這可能會導致分析錯誤。另外,並非所有參與WHI的婦女都有糖尿病診斷資料,研究者須依賴研究對象有關糖尿病的自我報告。
  
  不過,WHI研究對象自我報告的「已治療糖尿病」,已被證明是足夠精確地讓我們用於這類流行病學研究。
  
  LeBlanc醫師等人的研究結果和之前的一篇歐洲研究(Diabetes Care. 2013;36:1012-1019)結果一致。
  
  作者們寫道,在那篇納入超過8,000名停經後婦女、追蹤11年的巢狀、前瞻性病例世代研究中,生育期每降低一個標準差時,第二型糖尿病風險增加6%。
  
  LeBlanc醫師等人觀察指出,但是,依舊不清楚內生性雌激素如何影響第二型糖尿病,應探討此議題,以瞭解女性如何隨著年齡增加而降低糖尿病風險。
  
  LeBlanc醫師結論指出,未來的研究也可檢視,針對這些風險較高的婦女,是否可以降低糖尿病的發生率。
  
  資料來源: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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