Is Waist-Circumference Related to Anxiety Levels in Peri and Postmenopausal Women?

Main Article Content

Monica Flores-Ramos
Leticia Gracia-Medrano
Roberto Silvestri-Tomassoni
Martín Armando Burrola-Suárez
Rodrigo Guiza-Zayas

Abstract

Introduction: depression, anxiety, and the menopausal status seem to play an important role on the etiology of obesity, overweight and increased waist circumference; variables which could be important predictors of cardiometabolic risk. Given this association, it is our aim to evaluate the relationship between waist circumference and anxiety scores in a group of peri and postmenopausal women.


Method: we evaluated 329 participants with a mean age of 52.4 years; 20.06% perimenopausal and 79.9% postmenopausal. We performed an evaluation of both reproductive status, using the classification of the Stages of Reproductive Aging Workshop, and anxiety, using the State and Trait Anxiety Inventory as well as anthropometric measures. Statistical analysis involved descriptive analysis using chi-square and t-test. Bivariate correlations explored variables related to waist circumference; and finally, a logistic model examined the association between waist circumference and anxiety.


Results: we observed a significant correlation between waist circumference and state anxiety and trait anxiety. We did not observe a correlation between anxiety and menopausal status, hormone replacement therapy and age. For every one-point increase in the anxiety-state score in the STAI evaluation, the risk of having a waist > 88 cm, increased by 4%.


Discussion and Conclusions: findings suggest that high levels of anxiety during menopausal transition are related to a greater circumference of the waist. Prospective studies with a larger sample could clarify the nature of this association.

Keywords:
anxiety ,  menopause ,  obesity ,  perimenopause
Published: Jun 26, 2024

Article Details

How to Cite
Flores-Ramos, M., Gracia-Medrano, L., Silvestri-Tomassoni, R., Burrola-Suárez, M. A., & Guiza-Zayas, R. (2024). Is Waist-Circumference Related to Anxiety Levels in Peri and Postmenopausal Women?. Revista Internacional De Investigación En Adicciones, 10(1), 38–47. https://doi.org/10.28931/riiad.2024.1.05
Section
Original Articles

References

Akaike, H. (1998). Information Theory and an Extension of the Maximum Likelihood Principle. In E. Parzen, K. Tanabe, & G. Kitagawa (Eds.). Selected Papers of Hirotugu Akaike (pp. 199-213). New York, NY: Springer Series in Statistics. https://doi.org/10.1007/978-1-4612-1694-0_15

Arias-Galicia, L. F. (1990). Investigaciones sobre el IDARE en cuatro países latinoamericanos: Argentina, Ecuador, México y Perú. Revista Intercontinental de Psicología y Educación, 3(1-2), 49-85.

Asociación Mexicana de Agencias de Inteligencia de Mercado y Opinión, A.C. [AMAI]. (2016). Niveles socioeconómicos 2016. Retrieved from https://www.amai.org/NSE/index.php?queVeo=2016

Avila, C., Holloway, A. C., Hahn, M. K., Morrison, K. M., Restivo, M., Anglin, R., & Taylor, V. H. (2015). An Overview of Links Between Obesity and Mental Health. Current Obesity Reports, 4(3), 303-310. https://doi.org/10.1007/s13679-015-0164-9

Blümel, J. E., Chedraui, P., Aedo, S., Fica, J., Mezones-Holguín, E., Barón, G., Bencosme, A., Benítez, Z., Bravo, L. M., Calle, A., Flores, D., Espinoza, M. T., Gómez, G., Hernández-Bueno, J. A., Laribezcoa, F., Martino, M., Lima, S., Monterrosa, A., Mostajo, D., ... Zúñiga, M. C. (2015). Obesity and its relation to depressive symptoms and sedentary lifestyle in middle-aged women. Maturitas, 80(1), 100-105. https://doi.org/10.1016/j.maturitas.2014.10.007

Blümel, J. E., Legorreta, D., Chedraui, P., Ayala, F., Bencosme, A., Danckers, L., Lange, D., Espinoza, M. T., Gomez, G., Grandia, E., Izaguirre, H., Manriquez, V., Martino, M., Navarro, D., Ojeda, E., Onatra, W., Pozzo, E., Prada, M., Royer, M., ... Zuñiga, C. (2012). Optimal waist circumference cutoff value for defining the metabolic syndrome in postmenopausal Latin American women. Menopause, 19(4), 433-437. https://doi.org/10.1097/gme.0b013e318231fc79

Browning, L. M., Hsieh, S. D., & Ashwell, M. (2010). A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value. Nutrition Research Reviews, 23(2), 247-269. https://doi.org/10.1017/S0954422410000144

Clegg, D. J. (2012). Minireview: The Year in Review of Estrogen Regulation of Metabolism. Molecular Endocrinology, 26(12), 1957-1960. https://doi.org/10.1210/me.2012-1284

Cohen, L. S., Soares, C. N., Vitonis, A. F., Otto, M. W., & Harlow, B. L. (2006). Risk for New Onset of Depression During the Menopausal Transition: The Harvard Study of Moods and Cycles. Archives of General Psychiatry, 63(4), 385-390. https://doi.org/10.1001/archpsyc.63.4.385

Dallman, M. F. (2010). Stress-induced obesity and the emotional nervous system. Trends in Endocrinology and Metabolism, 21(3), 159-165. https://doi.org/10.1016/j.tem.2009.10.004

Epel, E., Jimenez, S., Brownell, K., Stroud, L., Stoney, C., & Niaura, R. (2004). Are Stress Eaters at Risk for the Metabolic Syndrome? Annals of the New York Academy of Sciences, 1032(1), 208-210. https://doi.org/10.1196/annals.1314.022

Flegal, K. M., Kit, B. K., Orpana, H., & Graubard, B. I. (2013). Association of All-Cause Mortality with Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-analysis. JAMA, 309(1), 71-82. https://doi.org/10.1001/jama.2012.113905

Freedman, D. S., & Ford, E. S. (2015). Are the recent secular increases in the waist circumference of adults independent of changes in BMI? The American Journal of Clinical Nutrition, 101(3), 425-431. https://doi.org/10.3945/ajcn.114.094672

Freeman, E. W., Sammel, M. D., Lin, H., Gracia, C. R., Kapoor, S., & Ferdousi, T. (2005). The role of anxiety and hormonal changes in menopausal hot flashes. Menopause, 12(3), 258-266. https://doi.org/10.1097/01.gme.0000142440.49698.b7

Fulton, S., Décarie-Spain, L., Fioramonti, X., Guiard, B., & Nakajima, S. (2022). The menace of obesity to depression and anxiety prevalence. Trends in Endocrinology and Metabolism, 33(1), 18-35. https://doi.org/10.1016/j.tem.2021.10.005

Gariepy, G., Nitka, D., & Schmitz, N. (2010). The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. International Journal of Obesity, 34(3), 407-419. https://doi.org/10.1038/ijo.2009.252

Gold, E. B., Colvin, A., Avis, N., Bromberger, J., Greendale, G. A., Powell, L., Sternfeld, B., & Matthews, K. (2006). Longitudinal Analysis of the Association between Vasomotor Symptoms and Race/Ethnicity across the Menopausal Transition: Study of Women’s Health across the Nation. American Journal of Public Health, 96(7), 1226-1235. https://doi.org/10.2105/AJPH.2005.066936

Greendale, G. A., Sternfeld, B., Huang, M., Han, W., Karvonen-Gutierrez, C., Ruppert, K., Cauley, J. A., Finkelstein, J. S., Jiang, S.-F., & Karlamangla, A. S. (2019). Changes in body composition and weight during the menopause transition. JCI Insight, 4(5), e124865.https://doi.org/10.1172/jci.insight.124865

Guedes, E. P., Madeira, E., Mafort, T. T., Madeira, M., Moreira, R. O., Mendonça, L. M., Godoy-Matos, A. F., Lopes, A. J., & Farias, M. L. F. (2013). Body composition and depressive/anxiety symptoms in overweight and obese individuals with metabolic syndrome. Diabetology & Metabolic Syndrome, 5(1). https://doi.org/10.1186/1758-5996-5-82

Hiles, S. A., Révész, D., Lamers, F., Giltay, E., & Penninx, B. W. J. H. (2016). Bidirectional Prospective Associations of Metabolic Syndrome Components with Depression, Anxiety, and Antidepressant Use. Depression and Anxiety, 33(8), 754-764. https://doi.org/10.1002/da.22512

Ho, R. C. M., Niti, M., Kua, E. H., & Ng, T.-P. (2008). Body mass index, waist circumference, waist-hip ratio and depressive symptoms in Chinese elderly: a population-based study. International Journal of Geriatric Psychiatry, 23(4), 401-408. https://doi.org/10.1002/gps.1893

Junge, W., El-Samalouti, V., Gerlinger, C., & Schaefers, M. (2009). Effects of menopausal hormone therapy on hemostatic parameters, blood pressure, and body weight: Open-label comparison of randomized treatment with estradiol plus drospirenone versus estradiol plus norethisterone acetate. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 147(2), 195-200. https://doi.org/10.1016/j.ejogrb.2009.09.004

Kannel, W. B., Cupples, L. A., Ramaswami, R., Stokes, J., Kreger, B. E., & Higgins, M. (1991). Regional obesity and risk of cardiovascular disease; the Framingham Study. Journal of Clinical Epidemiology, 44(2), 183-190. https://doi.org/10.1016/0895-4356 (91) 90265-b

Katz, J. R., Taylor, N. F., Goodrick, S., Perry, L., Yudkin, J. S., & Coppack, S. W. (2000). Central obesity, depression and the hypothalamo-pituitary-adrenal axis in men and postmenopausal women. International Journal of Obesity, 24(2), 246-251. https://doi.org/10.1038/sj.ijo.0801122

Khoo, S. K., Coglan, M. J., Wright, G. R., DeVoss, K. N., & Battistutta, D. (1998). Hormone therapy in women in the menopause transition. Randomised, double-blind, placebo-controlled trial of effects on body weight, blood pressure, lipoprotein levels, antithrombin III activity, and the endometrium. The Medical Journal of Australia, 168(5), 216-220. https://www.ncbi.nlm.nih.gov/pubmed/9539899

Ko, S.-H., & Kim, H.-S. (2020). Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients, 12(1), 202. https://doi.org/10.3390/nu12010202

Labad, J., Price, J. F., Strachan, M. W. J., Fowkes, F. G. R., Ding, J., Deary, I. J., Lee, A. J., Frier, B. M., Seckl, J. R., Walker, B. R., & Reynolds, R. M. (2010). Symptoms of depression but not anxiety are associated with central obesity and cardiovascular disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetologia, 53(3), 467-471. https://doi.org/10.1007/s00125-009-1628-9

Lemche, A. V., Chaban, O. S., & Lemche, E. (2016). Trait anxiety but not state anxiety level associates with biomarkers for hypertension in the metabolic syndrome. Psychophysiology, 53(6), 914-920. https://doi.org/10.1111/psyp.12623

Li, C. I., Malone, K. E., Porter, P. L., Lawton, T. J., Voigt, L. F., Cushing-Haugen, K. L., Lin, M. G., Yuan, X., & Daling, J. R. (2008). Relationship between Menopausal Hormone Therapy and Risk of Ductal, Lobular, and Ductal-Lobular Breast Carcinomas. Cancer Epidemiology, Biomarkers & Prevention, 17(1), 43-50. https://doi.org/10.1158/1055-9965.EPI-07-0558

Liu, P., Ma, F., Lou, H., & Zhu, Y. (2014). Utility of obesity indices in screening Chinese postmenopausal women for metabolic syndrome. Menopause, 21(5), 509-514. https://doi.org/10.1097/GME.0b013e3182a170be

Liu, Y., Ma, L., Yang, X., Bie, J., Li, D., Sun, C., Zhang, J., Meng, Y., & Lin, J. (2019). Menopausal Hormone Replacement Therapy and the Risk of Ovarian Cancer: A Meta-Analysis. Frontiers in Endocrinology, 10. https://doi.org/10.3389/fendo.2019.00801

Lobo, R. A. (2011). Risk of venous thromboembolism by route of administration of estrogen. Menopause, 18(5), 469-470. https://doi.org/10.1097/gme.0b013e318211745b

Marlatt, K. L., Pitynski-Miller, D. R., Gavin, K. M., Moreau, K. L., Melanson, E. L., Santoro, N., & Kohrt, W. M. (2022). Body composition and cardiometabolic health across the menopause transition. Obesity, 30(1), 14-27. https://doi.org/10.1002/oby.23289

Milaneschi, Y., Simmons, W. K., van Rossum, E. F. C., & Penninx, B. W. (2019). Depression and obesity: evidence of shared biological mechanisms. Molecular Psychiatry, 24(1), 18-33. https://doi.org/10.1038/s41380-018-0017-5

Mohn, E. S. (2015). Obesity: Prevention and Treatment. Obesity: Epidemiology, Pathophysiology, and Prevention. Second Edition. American Journal of Epidemiology, 181(12), 1018-1019. https://doi.org/10.1093/aje/kwv088

Moreira, R. O., Marca, K. F., Appolinario, J. C., & Coutinho, W. F. (2007). Increased waist circumference is associated with an increased prevalence of mood disorders and depressive symptoms in obese women. Eating and Weight Disorders, 12(1), 35-40. https://doi.org/10.1007/BF03327770

Muslić, L., & Jokić-Begić, N. (2016). The experience of perimenopausal distress: examining the role of anxiety and anxiety sensitivity. Journal of Psychosomatic Obstetrics and Gynecology, 37(1), 26-33. https://doi.org/10.3109/0167482X.2015.1127348

Nicklas, B. J., Penninx, B. W. J. H., Ryan, A. S., Berman, D. M., Lynch, N. A., & Dennis, K. E. (2003). Visceral Adipose Tissue Cutoffs Associated With Metabolic Risk Factors for Coronary Heart Disease in Women. Diabetes Care, 26(5), 1413-1420. https://doi.org/10.2337/diacare.26.5.1413

Opoku, A. A., Abushama, M., & Konje, J. C. (2023). Obesity and menopause. Best Practice & Research. Clinical Obstetrics & Gynaecology, 88, 102348. https://doi.org/10.1016/j.bpobgyn.2023.102348

Rivenes, A. C., Harvey, S. B., & Mykletun, A. (2009). The relationship between abdominal fat, obesity, and common mental disorders: Results from the HUNT Study. Journal of Psychosomatic Research, 66(4), 269-275. https://doi.org/10.1016/j.jpsychores.2008.07.012

Santoro, N., Roeca, C., Peters, B.A., Neal-Perry, G. (2021). The Menopause transition: signs, symptoms and management options. The Journal of Clinical Endocrinology and Metabolism, 106(1), 1-15. doi: 10.1210/clinem/dgaa764

Scott, K. M., McGee, M. A., Wells, J. E., & Oakley, M. A. (2008). Obesity and mental disorders in the adult general population. Journal of Psychosomatic Research, 64(1), 97-105. https://doi.org/10.1016/j.jpsychores.2007.09.006

Shea, K. L., Gavin, K. M., Melanson, E. L., Gibbons, E., Stavros, A., Wolfe, P., Kittelson, J. M., Vondracek, S. F., Schwartz, R. S., Wierman, M. E., & Kohrt, W. M. (2015). Body composition and bone mineral density after ovarian hormone suppression with or without estradiol treatment. Menopause, 22(10), 1045-1052. https://doi.org/10.1097/GME.0000000000000430

Sjögren, L. L., Mørch, L. S., & Løkkegaard, E. (2016). Hormone replacement therapy and the risk of endometrial cancer: A systematic review. Maturitas, 91, 25-35. https://doi.org/10.1016/j.maturitas.2016.05.013

Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). STAI manual for the State-Trait Anxiety Inventory (“self-evaluation questionnaire”). Consulting Psychologists Press.

Strine, T. W., Mokdad, A. H., Dube, S. R., Balluz, L. S., Gonzalez, O., Berry, J. T., Manderscheid, R., & Kroenke, K. (2008). The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. General Hospital Psychiatry, 30(2), 127-137. https://doi.org/10.1016/j.genhosppsych.2007.12.008

Turley, M., Tobias, M., & Paul, S. (2006). Non-fatal disease burden associated with excess body mass index and waist circumference in New Zealand adults. Australian and New Zealand Journal of Public Health, 30(3), 231-237. https://doi.org/10.1111/j.1467-842x.2006.tb00863.x

Van Pelt, R. E., Gavin, K. M., & Kohrt, W. M. (2015). Regulation of Body Composition and Bioenergetics by Estrogens. Endocrinology and Metabolism Clinics of North America, 44(3), 663-676. https://doi.org/10.1016/j.ecl.2015.05.011

Wassertheil-Smoller, S., Hendrix, S. L., Limacher, M., Heiss, G., Kooperberg, C., Baird, A., Kotchen, T., Curb, J. D., Black, H., Rossouw, J. E., Aragaki, A., Safford, M., Stein, E., Laowattana, S., Mysiw, W. J., & WHI Investigators. (2003). Effect of Estrogen plus Progestin on Stroke in Postmenopausal Women: The Women’s Health Initiative: A Randomized Trial. JAMA, 289(20), 2673-2684. https://doi.org/10.1001/jama.289.20.2673

World Health Organization [WHO]. (2024). Obesity and overweight. Retrieved from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight