Sex dependent risk factors of obesity
in women
Candice Bolling, PA-S
Advisor, Eileen VanDyke MPS, PA-C
Outline
Introduction
Menstrual cycle phenomenology
Fat ingestion
Post-partum weight retention
Leptin
Conclusion
http://www.meps.ahrq.gov/papers/st37/stat37.pdf
http://www.4woman.gov/pub/steps/Obesity.htm
Outline
Introduction
Menstrual cycle phenomenology
Fat ingestion
Post-partum weight retention
Leptin
Conclusion
www.wisc.edu/ansci_repro/lec/lec/11/menstural.jpg
Outline
Introduction
Menstrual cycle phenomenology
Fat ingestion
Post-partum weight retention
Leptin
Conclusion
Fat Ingestion
More pronounced in mice
– Activational vs.
organizational
– Testosterone increases
feeding
• Frequency
• Meal Size
Outline
Introduction
Menstrual cycle phenomenology
Fat ingestion
Post-partum weight retention
Leptin
Conclusion
Post Partum Weight Retention
Average of .5-2.4 kg retained
Adolescents and African American women
Weight gain
–
–
–
–
Snacking
Decreased exercise
Smoking
Weight prior
Timing important
http://www.womenatthesummit.com/1039amazing.jpg
Weight-for-height category Recommended total weight gain
kg
lb
SOURCE: Institute of Medicine.
Low (BMI 19.8)
12.5–18
28–40
Normal (BMI of 19.8 to
26.0)
11.5–16
25–35
High (BMI 26.0 to 29.0)
7–11.5
15–25
Outline
Introduction
Menstrual cycle phenomenology
Fat ingestion
Post-partum weight retention
Leptin
Conclusion
Leptin
Hormone excreted by
white adipose cells
Females
proportionately higher
Feedback to
hypothalamus
Many other effects
http://www-graphics.stanford.edu/~liyiwei/project/fun/mouse_fat.html
Leptin
Female vs. Male
–
–
–
–
Connected to HPG axis
Feedback system relating energy stores
Estrogen stimulates leptin secretion
Proves adipose tissue is not inert
Leptin
Evolutionary pressures
– Female fat storage
• Energy hoarding
– Males increase fitness by:
strength, agility, and
aggression
http://www.3dchem.com/molecules.asp?ID=154#
Outline
Introduction
Menstrual cycle phenomenology
Fat ingestion
Post-partum weight retention
Leptin
Conclusion
Conclusion
Female specific risk
factors
More work in areas of:
– Eating patterns
• Ovulatory patterns
• Leptin
Resist extrapolation
http://www.saludparalagente.org/graphics/female_symbol.jpg
Bibliography
Ahmed, M, Ong, K, Morrell, D, Cox, L, Drayer, N, Perry, L, et. al. Longitudinal study of leptin concentrations during
puberty: sex differences and relationship to changes in body composition. J Clin Endocrinol Metab. 1999; 84(3): 899905.
America’s health: state health rankings. United Health Foundation. 2004. Accessed October 5, 2005. Available from:
http://www.unitedhealthfoundation.org/shr2004/components/obesity.html.
Casabiell, X, Pineiro, V, Vega, F, De la Crus, L, Dieguez, C, Casanueva, F. Leptin, reproduction, and sex steriods.
Pituitary. 2001; 4: 93-99.
Cholesterol Levels. American Heart Association. 2005. Accessed October 24, 2005. Available from:
http://www.americanheart.org/presenter.jhtml?identifier=987.
Combs, T, Berg, A, Rajala, M, Klebanov, S, Iyengar, P, Jimenez-Chillaron, J, et. al. Sexual differentiation, pregnancy,
calorie restriction, and agin affect the adipocyte-specific secretory protein adiponectin. Diabetes. 2003. 52; 268-276.
Cnop, M, Havel, P, Utzschneider, K, Carr, D, Sinha, M, Boyko, E, et. al. Relationship of adiponectin to body fat
distribution, insulin sensitivity and plasma lipoproteins: evidence for independent roles of age and sex. Diabetologia.
2003; 46: 459-469.
Fahim A, Byron WB, JR, Lamendola C, McLaughlin T, Reaven GM. Relationship between obesity, insulin resistance,
and coronary heart disease risk. J Am Coll Cardiol. 2002; 40 (5): 937-943.
Geary, N. Is the control of fat ingestion sexually differentiated? Physiol Behav. 2004; (83): 659-671.
Gui, Y, Silha, J, Murphy, L. Sexual dimorphism and regulation of resistin, adiponectin, and leptin expression in the
mouse. Obes Res. 2004; 12 (9): 1481-1490.
Health Facts: Sex differences in obesity. Womens’ Health Research. 2005. Accessed October 5, 2005. Available from:
www.womenshealthresearch.gor/hs/facts_obesity.htm.
Hellstrom, L, Wahrenberg, H, Hruska, K, Reynisdottir, S, Arner, P. Mechanisms behind gender differences in
dirculating leptin levels. J Int Med. 2000; 247: 457-462.
Humphrey, LL, Chan, B, Sox, HC. Postmenopausal hormonal replacement therapy. Ann Intern Med. 2003; 688-689.
Bibliography
Kennedy, A, Gettys, T, Watson, P, Wallace, P, Ganaway, E, Pan, Q, Garvey, W. The metabolic significance of leptin in
humans: gender-based differences in relationship to adiposity, insulin sensitivity, and energy expenditure. J Clin
Endocrinol Metab. 1997; 82(4): 1293-1300.
Licinio, J., Negrao, A., Mantzoros, C., Kaklamani, V., Wong, M., Bongiorno, P., et. al. Sex differences in circulating
human leptin pulse amplitude: Clinical Implications. J Clin Endocrinol Metab. 1998; 83(11): 4140-4147.
Lovejoy, JC. The influence of sex hormones on obesity across the remale life span. J Women Health. 1998; 7(10):
1247-1255.
Marroquin, OC, Kip, KE, Kelley, DE, Johnson, BD, Shaw, LJ, Merz, NB, et. al. Metabolic Syndrome modifies the
cardiovascular risk associated with angiographic coronary artery disease in women. Circulation. 2004; 109: 714-721.
Mayes, J, Watson, G. Direct effects of sex steroid hormones on adipose tissues and obesity. Obes Rev. 2004; 5: 197216.
Mercuro, G, Vitale, C, Fini, M, Zoncu, S, Leonardo, F, Rosano, G. Lipid profiles and endothelial function with lowdose hormone replacement therapy in postmenopausal women at risk for coronary artery disease: a randomized trial.
Int J Cardiol. 2003; 89, 257-265.
Modena, MG. Acute Myocardial Infarction- Are Women Different? Int J Clin Pract. 2005; 59(1), 2-5.
Nishizawa, H, Shimomura, I, Kishida, K, Maeda, N, Kuriyama, H, Nagaretani, H, et. al. Androgens decrease plasma
adiponectin, an insulin-sensitizing adipocyte-derived protein. Diabetes. 2002; 51: 2734-2742.
Ostlund, R, Yang, J, Klein, S, Gingerish, R. Relation between plasma leptin concentration and body fat, gender, diet,
age, and metabolic covariates. J Clin Endocrinol and Metab. 1996; 81(11), 3909-3013.
Rosenbaum, M, Leibel, R. Role of gonadal steroids in the sexual dimorphisms in body composition and circulating
concentrations of leptin. J Clin Endocrinol Metab. 1999; 84(6): 1784-1789.
Zieba, D, Amstalden, M, Wiliams, G. Regulatory roles of leptin in reproduction and metabolism: a comparative
review. Domest Anim Endocrinol. 2005; 29: 166-185.
Rossum, E, Nicklas, B, Dennis, K, Berman, D, Goldberg, A. Leptin responses to weight loss in postmenopausal
women: relationship to sex-hormone binding globulin and visceral obesity. Obes Res. 2000; 8(1): 29-35.
Solomon, H. Weight loss: managing the health of the overweight woman. Harvard Medical School. In press May 20,
2002.