Soy protein and isoflavone effects on vasomotor symptoms in peri- and postmenopausal women: the Soy Estrogen Alternative Study Effect of the insulin sensitizer pioglitazone on insulin resistance, hyperandrogenism, and ovulatory dysfunction in women with polycystic ovary syndrome. Managing menopause. Clinical and biochemical characterization of women with polycystic ovary syndrome in North Rhine-Westphalia. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Impact of obstructive sleep apnea on insulin resistance and glucose tolerance in women with polycystic ovary syndrome. The association of endogenous sex hormones, adiposity, and insulin resistance with incident diabetes in postmenopausal women. Effect of vitamin D supplementation on glycemic control in patients with type 2 diabetes: a systematic review of interventional studies Hypothalamic arousal, insulin resistance and Type 2 diabetes mellitus. Objectively Measured Moderate- and Vigorous-Intensity Physical Activity but Not Sedentary Time Predicts Insulin Resistance in High-Risk Individuals Dietary factors and vasomotor symptoms in breast cancer survivors: the WHEL Study Baseline Serum 25-Hydroxy Vitamin D Is Predictive of Future Glycemic Status and Insulin Resistance Ethnicity and vasomotor symptoms in postmenopausal women. A rationale and method for high-intensity progressive resistance training with children and adolescents. Beneficial effects of soy phytoestrogen intake in postmenopausal women with type 2 diabetes. Effect of trans-fatty acid intake on insulin sensitivity and intramuscular lipids--a randomized trial in overweight postmenopausal women. Effect of moderate-dose vitamin D supplementation on insulin sensitivity in vitamin D-deficient non-Western immigrants in the Netherlands: a randomized placebo-controlled trial. Chronic Ingestion of Flavan-3-ols and Isoflavones Improves Insulin Sensitivity and Lipoprotein Status and Attenuates Estimated 10-Year CVD Risk in Medicated Postmenopausal Women With Type 2 Diabetes A whole-grain diet reduces peripheral insulin resistance and improves glucose kinetics in obese adults: A randomized-controlled trial. Endogenous sex hormones and the development of type 2 diabetes in older men and women: the Rancho Bernardo study. Postmenopausal hormone therapy, type 2 diabetes mellitus, and brain volumes Improved endothelial function with metformin in type 2 diabetes mellitus. Vasomotor symptoms and quality of life in previously sedentary postmenopausal women randomised to physical activity or estrogen therapy.
Objective To investigate the efficacy of dietary soy proteins containing differing amounts of isoflavones on the number and severity of  vasomotor symptoms ( hot flashes and night sweats ) in peri- and postmenopausal women . Design A double-masked , r and omized , controlled , clinical trial was conducted . A total of 241 community-dwelling women reporting vasomotor symptoms at baseline were r and omized into one of three groups . In all groups , participants consumed a daily supplement containing 25 g of soy protein and were r and omly assigned to one of three groups : ( a ) isoflavone extracted soy protein ( control ) , ( b ) soy protein with a medium dose of isoflavones ( 42 mg/day ) , or ( c ) soy protein with a higher dose of isoflavones ( 58 mg/day ) . The primary outcome measure in this trial was change in reported vasomotor symptoms . Results A reduction in the number and severity of vasomotor symptoms was observed in all three treatment groups . No significant differences in the number and severity of vasomotor symptoms were observed among the high isoflavone , middle isoflavone , or control groups . The lack of a between-treatment group effect was observed even after stratified by number of baseline symptoms and use of traditional hormone replacement therapy . Conclusions These data suggest that soy protein containing 42 or 58 mg of isoflavones is no more effective than isoflavone-extracted soy protein for improving the number and severity of vasomotor symptoms in peri- and postmenopausal women Polycystic ovary syndrome ( PCOS ) is characterized by hyper and rogenism , chronic anovulation , and insulin resistance ; long-term consequences include diabetes mellitus type 2 . The aim of this r and omized , double-blind , controlled trial was to investigate whether the thiazolidinedione derivative pioglitazone diminishes insulin resistance and hyper and rogenism and enhances ovulation rates in women with PCOS . Forty premenopausal women with PCOS were r and omly allocated to treatment with either pioglitazone ( 30 mg/d ) or placebo for periods of 3 months . Administration of pioglitazone result ed in a remarkable decline in both fasting serum insulin levels ( P < 0.02 ) and the area under the insulin response curve after an oral glucose load ( P < 0.02 ) . This represented an increase in insulin sensitivity and a decrease in insulin secretion ( P < 0.05 ) . Furthermore , pioglitazone increased serum SHBG ( P < 0.05 ) , result ing in a significant decrease in the free and rogen index ( P < 0.05 compared with placebo ) . Treatment with pioglitazone was also associated with higher ovulation rates ( P < 0.02 ) . Thus , pioglitazone significantly improved insulin sensitivity , hyper and rogenism , and ovulation rates in women with PCOS , thereby providing both metabolic and reproductive benefits OBJECTIVE To provide up date d guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease , breast cancer , urogynaecology , and sexuality . OUTCOMES Lifestyle interventions , prescription medications , and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms . Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are review ed . Approaches to the identification and evaluation of women at high risk of osteoporosis , along with options for prevention and treatment , are presented in the companion osteoporosis guideline . EVIDENCE Published literature was retrieved through search es of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary ( e.g. , hormone therapy , menopause , cardiovascular diseases , and sexual function ) and key words ( e.g. , hormone therapy , perimenopause , heart disease , and sexuality ) . Results were restricted to clinical practice guidelines , systematic review s , r and omized control trials/controlled clinical trials , and observational studies . Results were limited to publication date s of 2009 onwards and to material in English or French . Search es were up date d on a regular basis and incorporated in the guideline until January 5 , 2013 . Grey ( unpublished ) literature was identified through search ing the websites of health technology assessment and health technology assessment -related agencies , national and international medical specialty societies , and clinical practice guideline collection Polycystic ovary syndrome ( PCOS ) , defined as the combination of oligoanovulation and hyper and rogenism , affects more than 5 % of women of reproductive age . Insulin resistance and hyperinsulinemia appear to play an important role in its pathogenesis . Here , we will present a characterization of a PCOS cohort from North Rhine-Westphalia in Germany . Clinical features , family history as well as endocrine and metabolic parameters were prospect ively recorded from 200 successive patients . All patients were evaluated for insulin resistance and beta-cell-function by oral glucose tolerance test .  Patient data were compared with those of 98 age-matched control women . PCOS patients showed significantly higher BMI , body fat mass and and rogen levels as well as impaired glucose and insulin metabolism . A positive family history of PCOS and diabetes was more frequent in PCOS patients . Insulin resistance ( 71 % ) was the most common metabolic abnormality in PCOS patients followed by obesity ( 52 % ) and dyslipidemia ( 46.3 % ) , with an incidence of 31.5 % for the metabolic syndrome . C-reactive protein and other cardiovascular risk factors were frequently elevated even in young PCOS patients . While the clinical characteristics and endocrine parameters of this German PCOS cohort were heterogeneous , they were comparable to those from other Caucasian population OBJECTIVE The purpose of this study was to evaluate whether a combined resistance and aerobic training program would improve insulin sensitivity compared with aerobic training alone in postmenopausal women with type 2 diabetes . A second objective was to relate the improved insulin sensitivity to changes in abdominal adipose tissue ( AT ) and thigh muscle density . RESEARCH DESIGN AND METHODS A total of 28 obese postmenopausal women with type 2 diabetes were r and omly assigned to one of three 16-week treatments : control , aerobic only training ( Ae only ) , or aerobic plus resistance training ( Ae+RT ) . Pre- and posttreatment outcome measures included glucose disposal by hyperinsulinemic-euglycemic clamp and computed tomography scans of abdominal AT and mid-thigh skeletal muscle . RESULTS Glucose infusion rates increased significantly ( P < 0.05 ) in the Ae+RT group . Both exercise groups had reduced abdominal subcutaneous and visceral AT and increased muscle density . The Ae+RT training group exhibited a significantly greater increase in muscle density than the Ae only group . Improved glucose disposal was independently associated with changes in subcutaneous AT , visceral AT , and muscle density . Muscle density retained a relationship with glucose disposal after controlling for abdominal AT . CONCLUSIONS Adding resistance training to aerobic training enhanced glucose disposal in postmenopausal women with type 2 diabetes . The improved insulin sensitivity is related to loss of abdominal subcutaneous and visceral AT and to increased muscle density CONTEXT Insulin resistance , impaired glucose tolerance , and type 2 diabetes are common in women with polycystic ovary syndrome ( PCOS ) .  Obstructive sleep apnea ( OSA ) has been linked to metabolic dysfunction . We studied women with and without PCOS to determine the extent to which OSA is responsible for insulin resistance and glucose intolerance in PCOS . METHODS In a prospect i ve design , 52 women with PCOS and 21 women without PCOS of similar age and body mass index had an overnight polysomnogram and a 75-g oral glucose tolerance test . RESULTS Twenty-nine women ( 56 % ) with PCOS had OSA compared with four controls ( 19 % ) ( adjusted odds ratio 7.1 ; 95 % confidence interval , 1.7 - 45.7 ; P = 0.01 ) . PCOS women with OSA were more insulin resistant than those without OSA [ homeostasis model assessment ( HOMA ) index 5.7 + /- 0.4 vs. 3.5 + /- 0.4 ; P = 0.006 ] after controlling for age , body mass index , and ethnicity . Impaired glucose tolerance was found in 16 of 29 ( 55 % ) PCOS women with OSA and only six of 23 ( 26 % ) of those without OSA ( unadjusted P = 0.049 ) . Insulin resistance and glucose intolerance were highly correlated with the presence and severity of OSA . Among PCOS women with normal glucose tolerance , the presence of OSA was associated with a nearly 2-fold higher fasting insulin level and HOMA index . The severity of OSA was a highly significant predictor of the fasting concentrations of glucose and insulin as well as the 2-h glucose concentration and HOMA index . CONCLUSIONS OSA is a highly prevalent and important determinant of insulin resistance , glucose intolerance , and type 2 diabetes in PCOS CONTEXT In postmenopausal women , endogenous bioavailable testosterone ( T ) and estradiol ( E2 ) have been positively associated , and SHBG has been negatively associated , with incident type 2 diabetes ( T2DM ) . Previous studies have not explored possible factors explaining these relationships . OBJECTIVE Our objective was to examine the association of endogenous sex hormones with incident T2DM  in postmenopausal women and possible explanatory factors . DESIGN , SETTING , AND PARTICIPANTS The Multi-Ethnic Study of Atherosclerosis ( MESA ) is a prospect i ve study that included 1612 postmenopausal women aged 45 - 84 yr , followed between the years 2000 - 2006 , who were not taking hormone replacement therapy , had no prevalent cardiovascular disease or diabetes , and had complete ascertainment of sex hormones . MAIN OUTCOME MEASURES T2DM was defined based on fasting glucose and /or treatment for diabetes . RESULTS There were 116 incident cases of diabetes during follow-up . Across higher quartiles of bioavailable T and E2 and lower quartiles of SHBG , we found significantly greater hazards of developing incident T2DM ( all P for trend < or=0.001 ) . After adjustment for body mass index and insulin resistance estimated by homeostasis model assessment of insulin resistance , bioavailable T was no longer associated with incident T2DM . The associations of E2 and SHBG with incident T2DM were partially explained by body mass index and insulin resistance but persisted in fully adjusted models ( both P for trend < 0.02 ) . Dehydroepi and rosterone had no relationship with incident T2DM . CONCLUSIONS Adiposity and insulin resistance explained most of the association of bioavailable T but only partially explained the associations of E2 and SHBG with incident T2DM among postmenopausal women Background Diabetes and vitamin D deficiency are global epidemics . Research ers have long been exploring the role of potentially modifiable factors to manage type 2 diabetes . We conducted a systematic review of prospect i ve studies and r and omized controlled trials that involved vitamin D supplementation and specifically intended to study glycemic outcomes related to type 2 diabetes . Methods Two authors independently search ed Medline and PubMed for longitudinal studies that had assessed the effect of vitamin D supplements on glycemic control , insulin resistance and beta-cell dysfunction in patients with diabetes . Results Seventeen r and omized control trials and seven longitudinal studies with a minimum follow-up of one month were included . Results of the various short-term studies ( follow up ≤ 3 months ) suggested that vitamin D supplementation had a positive impact on glycemic control and metabolic parameters such as insulin resistance and beta cell dysfunction . However , the evidence was weak due to the low method ological quality of the studies . There was no significant effect on HbA1c , beta cell function and insulin resistance in the long-term studies ( follow up > 3 months ) . There existed heterogeneity in the methodology of the studies , inclusion criteria , mode of supplementation of vitamin D and the duration of follow up . Conclusions Current evidence based on r and omized controlled trials and longitudinal studies do not support the notion that vitamin D supplementation can improve hyperglycemia , beta cell secretion or insulin sensitivity in patients with type 2 diabetes . Large-scale trials with proper study design , optimal vitamin D supplementation and longer follow up need to be conducted AIMS Type 2 diabetes mellitus ( DM ) develops when insulin resistance overcomes the capacity of compensatory insulin secretion . Insulin resistance may be induced via psychoneuroendocrine pathways , a possibility which has received little previous attention . METHODS We have used salivary cortisol measurements to monitor the activity of the hypothalamic-pituitary-adrenal ( HPA ) axis , the major controller of hormones involved in the regulation of peripheral insulin sensitivity under everyday conditions . The influence of external challenges , as well as the sensitivity of feedback regulation , were followed in r and omly selected middle-aged population sample s. RESULTS In health there is a rhythmicity of cortisol secretion , with a high plasticity and efficient feedback control . In contrast , a group of subjects were identified with a flat , rigid day curve and poor feedback control , who showed consistent abnormalities in stress-related cortisol secretion , including inhibited secretions of sex steroids and growth hormone ; insulin resistance ; abdominal obesity ; elevated leptin levels ; hyperglycaemia ; dyslipidaemia and hypertension with elevated heart rate . The endocrine abnormalities are probably responsible for the anthropometric and metabolic abnormalities . The circulatory perturbations seem to be induced by a parallel activation of the central sympathetic nervous system suggesting an ' hypothalamic arousal syndrome ' , gradually developing into an independent risk for disease . An associated cluster of environmental factors , including psychosocial and socio-economic stress , traits of depression and anxiety , alcohol consumption and smoking , all factors known to activate hypothalamic centres , has been identified . A polymorphism of the glucocorticoid receptor gene , with 13.7 % homozygotes in the male Swedish population , parallels receptor dysfunction , and may be responsible for the associated insulin resistance , central obesity and hypertension . CONCLUSIONS This is the first detailed examination of psychoneuroendocrinological processes in the natural environment on a population basis in relation to somatic health . The results suggest that an hypothalamic arousal syndrome , with parallel activation of the HPA axis and the central sympathetic nervous system , is responsible for development of endocrine abnormalities , insulin resistance , central obesity , dyslipidaemia and hypertension , leading to frank disease , including Type 2 DM . We suggest that this syndrome is probably based on environmental pressures in genetically susceptible individuals OBJECTIVE Low levels of physical activity appear to be associated with insulin resistance . However , the detailed associations of these complex relationships remain elusive . We examined the prospect i ve associations between self-reported TV viewing time , objective ly measured time spent sedentary , at light-intensity activity , and at moderate- and vigorous-intensity physical activity ( MVPA ) with insulin resistance . RESEARCH DESIGN AND METHODS In 192 individuals ( 81 men and 111 women ) with a family history of type 2 diabetes , we measured  physical activity and anthropometric and metabolic variables at baseline and after 1 year of follow-up in the ProActive UK trial . Physical activity  was measured objective ly by accelerometry . Insulin resistance was expressed as fasting insulin and the homeostasis model assessment score ( HOMA-IR ) . RESULTS Baseline MVPA was a significant predictor of fasting insulin at follow-up ( β = −0.004 [ 95 % CI −0.007 to −0.0001 ] , P = 0.022 ) , and the association approached significance for HOMA-IR ( β = −0.003 [ −0.007 to 0.000002 ] , P = 0.052 ) , independent of time spent sedentary , at light-intensity activity , sex , age , smoking status , waist circumference , and self-reported TV viewing . Time spent sedentary and at light-intensity activity were not significantly associated with insulin resistance . The change in MVPA between baseline and follow-up was inversely related to fasting insulin ( β = −0.003 [ −0.007 to −0.0003 ] , P = 0.032 ) and the HOMA-IR score ( β = −0.004 [ −0.008 to −0.001 ] , P = 0.015 ) at follow-up , after adjustment for baseline phenotype in addition to the same confounders as above . CONCLUSIONS These results highlight the importance of promoting moderate-intensity activity such as brisk walking for improving insulin sensitivity and possibly other metabolic risk factors to prevent type 2 diabetes Objective : Vasomotor symptoms (VMS)(hot flashes , night sweats ) are associated with natural or surgically or chemotherapy-induced menopause , the latter occurring frequently in women treated for breast cancer . To manage VMS , some women seek alternatives to menopausal hormone therapy , such as supplements or modified food choices . The objective of the present analyses was to assess associations of VMS occurrence and change in severity of VMS over 12 months with dietary intakes of fiber , fat , and selected soy-containing foods , and use of phytoestrogen or vitamin E supplements in women with recent early stage breast cancer , adjusting for covariates . Design : Using multivariate logistic regression , data were analyzed from 2,198 women with early-stage breast cancer who enrolled 2 to 48 months after diagnosis in the Women 's Healthy Eating and Living r and omized , controlled trial of a high-vegetable , high-fiber , reduced-fat diet .  Results : Being peri- or postmenopausal , using tamoxifen , having low social support or depressive symptoms , and using vitamin E or phytoestrogen supplements were significantly associated cross-sectionally with reporting moderate/severe VMS at enrollment . Increased symptom severity after 12 months was significantly associated with higher body mass index , tamoxifen use , and smoking . Decreased symptom severity at 12 months was significantly associated with high dietary fiber intake ; no decrease was observed in women who were peri- or postmenopausal , using tamoxifen , or had low fat intake or low social support . Conclusions High dietary fiber intakes , premenopausal , and high social support were related to decreased severity of VMS 1 year after study enrollment in women recently treated for breast cancer OBJECTIVE —Accumulating epidemiological evidence suggests that hypovitaminosis D may be associated with type 2 diabetes and related metabolic risks . However , prospect i ve data using the biomarker serum 25-hydroxyvitamin D [ 25(OH)D ] are limited and therefore examined in the present study . RESEARCH DESIGN AND METHODS —A total of 524 r and omly selected nondiabetic men and women , aged 40–69 years at baseline , with measurements for serum 25(OH)D and IGF-1 in the population -based Ely Study , had glycemic status ( oral glucose tolerance ) , lipids , insulin , anthropometry , and blood pressure measured and metabolic syndrome risk ( metabolic syndrome z score ) derived at baseline and at 10 years of follow-up . RESULTS —Age-adjusted baseline mean serum 25(OH)D was greater in men ( 64.5 nmol/l [ 95 % CI 61.2–67.9 ] ) than women ( 57.2 nmol/l [ 54.4,60.0 ] ) and varied with season ( highest late summer ) . Baseline 25(OH)D was associated inversely with 10-year risk of hyperglycemia ( fasting glucose : β = −0.0023 , P = 0.019 ; 2-h glucose : β = −0.0097 , P = 0.006 ) , insulin resistance ( fasting insulin β = −0.1467 , P = 0.010 ; homeostasis model assessment of insulin resistance [ HOMA-IR ] : β = −0.0059 , P = 0.005 ) , and metabolic syndrome z score ( β = −0.0016 , P = 0.048 ) after adjustment for age , sex , smoking , BMI , season , and baseline value of each metabolic outcome variable . Associations with 2-h glucose , insulin , and HOMA-IR remained significant after further adjustment for IGF-1 , parathyroid hormone , calcium , physical activity , and social class . CONCLUSIONS —This prospect i ve study reports inverse associations between baseline serum 25(OH)D and future glycemia and insulin resistance . These associations are potentially important in underst and ing the etiology of abnormal glucose metabolism and warrant investigation in larger , specifically design ed prospect i ve studies and r and omized controlled trials of supplementation OBJECTIVE To determine if there is a difference in the prevalence of vasomotor symptoms between African American and white postmenopausal women . METHODS We conducted a cross-sectional study to evaluate baseline vasomotor symptoms in postmenopausal women enrolled in a r and omized , placebo-controlled trial of dietary soy supplements .  The Menopause-Specific Quality of Life Question naire ( MENQOL ) vasomotor subscale was used to measure vasomotor symptoms , including hot flashes and night sweats . RESULTS In total , 104 African American and 112 white postmenopausal women ( mean age 56.8 + /- 5.6 years ) were studied . A multiple linear regression analysis , which controlled for differences in body mass index ( BMI ) and dietary fat intake , showed that race and age were significantly and independently associated with vasomotor symptoms , explaining 10 % of the variance ( p < 0.001 ) . Being African American and younger age were associated with increased vasomotor symptoms . CONCLUSIONS The most prevalent postmenopausal symptoms were vasomotor symptoms , which were more bothersome in African American women compared with white women . Factors associated with vasomotor symptoms included race , BMI , and dietary intake of fat calories . Implication s for practice include increasing provider awareness to discuss vasomotor symptoms and the need for treatment in postmenopausal African American women . Further research to increase our underst and ing of racial differences and associated factors that influence the duration and intensity of vasomotor symptoms experienced by postmenopausal women is needed BACKGROUND The rising prevalence of obesity in children and adolescents is implicated in the metabolic abnormalities that track into adulthood . The associated increased incidence of insulin resistance , metabolic syndrome and type 2 diabetes being identified in younger cohorts has given rise to a critical global health issue . Muscular strength is a vital component of metabolic fitness that provides protection from insulin resistance in adults , and we have recently shown this to be true in children as well . Targeting muscular strength deficiencies at an early age may be an effective preventative strategy for metabolic syndrome and type 2 diabetes . PURPOSE There is limited evidence -based best practice for progressive resistance training ( PRT ) , adiposity and metabolic fitness in children and adolescents . The purpose of this paper is to describe the methodology we utilized for implementing a PRT program to avoid publication bias , enable replication of the study and share a novel program that we have found safe and suitable for use with youth . METHODS We conducted the first r and omized controlled trial ( RCT ) prescribing high-intensity PRT to children and adolescents ( 10 - 15 years ) as a community-based primary prevention program to address adiposity and metabolic health . Participants were instructed to complete 2 sets of 8 repetitions of 11 exercises targeting all the major muscle groups twice a week at an RPE of 15 - 18 for 8 weeks . RESULTS Primary outcome was waist circumference ; secondary outcomes included insulin resistance , lipid levels , muscle strength , cardiorespiratory fitness , body composition , self-efficacy , self-concept , habitual physical activity , nutritional and sedentary behavior patterns . CONCLUSION The supervised PRT program that we used with children and adolescents has been described in detail . The efficacy of this modality of exercise for metabolic fitness and other health outcomes is now under investigation OBJECTIVE Phytoestrogen consumption has been shown to reduce risk factors for cardiovascular disease . Type 2 diabetes confers an adverse cardiovascular risk profile particularly in women after menopause . The aim of this study was to determine whether a dietary supplement with soy protein and isoflavones affected insulin resistance , glycemic control , and cardiovascular risk markers in postmenopausal women with type 2 diabetes . RESEARCH DESIGN AND METHODS A total of 32 postmenopausal women with diet-controlled type 2 diabetes completed a r and omized , double blind , cross-over trial of dietary supplementation with phytoestrogens ( soy protein 30 g/day , isoflavones 132 mg/day ) versus placebo ( cellulose 30 g/day ) for 12 weeks , separated by a 2-week washout period . RESULTS Compliance with the dietary supplementation was > 90 % for both treatment phases . When compared with the mean percentage change from baseline seen after 12 weeks of placebo , phytoestrogen supplementation demonstrated significantly lower mean values for fasting insulin ( mean + /- SD 8.09 + /- 21.9 % , P = 0.006 ) , insulin resistance ( 6.47 + /- 27.7 % , P = 0.003 ) , HbA(1c ) ( 0.64 + /- 3.19 % , P = 0.048 ) , total cholesterol ( 4.07 + /- 8.13 % , P = 0.004 ) , LDL cholesterol ( 7.09 + /- 12.7 % , P = 0.001 ) , cholesterol/HDL cholesterol ratio ( 3.89 + /- 11.7 % , P = 0.015 ) , and free thyroxine ( 2.50 + /- 8.47 % , P = 0.004 ) . No significant change occurred in HDL cholesterol , triglycerides , weight , blood pressure , creatinine , dehydroepi and rosterone sulfate , and rostenedione , and the hypothalamic-pituitary-ovarian axis hormones . CONCLUSIONS These results show that dietary supplementation with soy phytoestrogens favorably alters insulin resistance , glycemic control , and serum lipoproteins in postmenopausal women with type 2 diabetes , thereby improving their cardiovascular risk profile Intake of industrially produced trans-fatty acids ( TFA ) has been linked to increased risk of type 2 diabetes mellitus in observational studies . We investigated the causality of this association by examining if a high intake of TFA impairs measures of glucose homeostasis and induces intramuscular lipid deposition in abdominally obese women . In a double-blind , parallel dietary intervention study , 52 healthy but overweight postmenopausal women were r and omized to receive either partially hydrogenated soybean oil ( 15 g/d TFA ) or a control oil ( mainly oleic and palmitic acid ) for 16 weeks . Three markers of glucose homeostasis and 4 markers of lipolysis were derived from glucose , insulin , C-peptide , nonesterified fatty acid , and glycerol concentrations during a 3-hour frequent sampling oral glucose tolerance test . Intramuscular lipids were assessed by magnetic resonance spectroscopy . Forty-nine women completed the  study .  Insulin sensitivity ( assessed by ISI(composite ) ) , β-cell function ( the disposition index ) , and the metabolic clearance rate of insulin were not significantly affected by the dietary intervention . Neither was the ability of insulin to suppress plasma nonesterified fatty acid and glycerol during oral glucose ingestion nor the intramuscular lipid deposition . In conclusion , high TFA intake did not affect glucose metabolism over 16 weeks in postmenopausal overweight women . A study population with a stronger predisposition to insulin resistance and /or a longer duration of exposure may be required for insulin sensitivity to be affected by intake of industrial TFA BACKGROUND Low serum 25-hydroxyvitamin D [ 25(OH)D ] concentrations have been associated with insulin resistance , the metabolic syndrome , and type 2 diabetes . Because many non-Western immigrants in the Netherl and s are vitamin D deficient , obese , and at high risk of diabetes , vitamin D supplementation may contribute to prevent diabetes and insulin resistance . OBJECTIVE We examined the effect of vitamin D supplementation on insulin sensitivity and β cell function in overweight , vitamin D-deficient , non-Western immigrants at high risk of diabetes . DESIGN The study was a 16-wk , r and omized , placebo-controlled trial . A total of 130 non-Western immigrants with prediabetes ( fasting glucose concentration > 5.5 mmol/L or r and om glucose concentration from 7.8 to 11.1 mmol/L ) and vitamin D deficiency ( serum 25[OH]D concentration < 50 nmol/L ) were r and omly assigned after stratification by sex to receive either cholecalciferol ( 1200 IU/d ) or a placebo for 16 wk . All participants received 500 mg Ca/d as calcium carbonate . The primary outcome was the difference in the area under the curve of insulin and glucose after a 75-g oral-glucose-tolerance test after 4 mo of treatment . Secondary outcomes were insulin-sensitivity variables , β cell-function variables , and metabolic syndrome . RESULTS Mean serum 25(OH)D concentrations increased significantly in the vitamin D compared with placebo groups . After 4 mo of therapy , the mean between-group difference was 38 nmol/L ( 95 % CI : 32.1 , 43.9 nmol/L ; P < 0.001 ) . There was no significant effect on insulin sensitivity and β cell function . In a post hoc analysis , when patients with diabetes at baseline were excluded , a significant increase in the insulinogenic index was observed in participants who obtained a 25(OH)D concentration ≥60 nmol/L ( P = 0.040 ) . CONCLUSIONS Vitamin D supplementation in non-Western vitamin D-deficient immigrants with prediabetes did not improve insulin sensitivity or β cell function or change the incidence of metabolic syndrome . However , after the exclusion of diabetic subjects , an improvement in the insulinogenic index was observed in participants who obtained a 25(OH)D concentration ≥60 nmol/L. This trial was registered at trialregister.nl as NTR1827 OBJECTIVE To assess the effect of dietary flavonoids on cardiovascular disease ( CVD ) risk in postmenopausal women with type 2 diabetes on established statin and hypoglycemic therapy . RESEARCH DESIGN AND METHODS Despite being medicated , patients with type 2 diabetes have elevated CVD risk , particularly postmenopausal women . Although dietary flavonoids have been shown to reduce CVD risk factors in healthy participants , no long-term trials have examined the additional benefits of flavonoids to CVD risk in medicated postmenopausal women with type 2 diabetes . We conducted a parallel- design , placebo-controlled trial with type 2 diabetic patients r and omized to consume 27 g/day ( split dose ) flavonoid-enriched chocolate ( containing 850 mg flavan-3-ols [ 90 mg epicatechin ] and 100 mg isoflavones [ aglycone equivalents)]/day ) or matched placebo for 1 year . RESULTS Ninety-three patients completed the trial , and adherence was high ( flavonoid 91.3 % ; placebo 91.6 % ) . Compared with the placebo group , the combined flavonoid intervention result ed in a significant reduction in estimated peripheral insulin resistance ( homeostasis model assessment of insulin resistance [ HOMA-IR ] −0.3 ± 0.2 ; P = 0.004 ) and improvement in insulin sensitivity ( quantitative insulin sensitivity index [ QUICKI ] 0.003 ± 0.00 ; P = 0.04 ) as a result of a significant decrease in insulin levels ( −0.8 ± 0.5 mU/L ; P = 0.02 ) . Significant reductions in total cholesterol : HDL-cholesterol ( HDL-C ) ratio ( −0.2 ± 0.1 ; P = 0.01 ) and LDL-cholesterol ( LDL-C ) ( −0.1 ± 0.1 mmol/L ; P = 0.04 ) were also observed . Estimated 10-year total coronary heart disease risk ( derived from UK Prospect i ve Diabetes Study algorithm ) was attenuated after flavonoid intervention ( flavonoid + 0.1 ± 0.3 vs. placebo 1.1 ± 0.3 ; P = 0.02 ) . No effect on blood pressure , HbA1c , or glucose was observed . CONCLUSIONS One-year intervention with flavan-3-ols and isoflavones improved biomarkers of CVD risk , highlighting the additional benefit of flavonoids to st and ard drug therapy in managing CVD risk in postmenopausal type 2 diabetic patients BACKGROUND Whole-grain intake is associated with lower risk of type 2 diabetes  but the mechanisms are unclear . PURPOSE We tested the hypothesis that a WG diet reduces insulin resistance and improves glucose use in individuals at risk for type 2 diabetes compared with an isocaloric-matched refined-grain diet . METHODS A double-blind , r and omized , controlled , crossover trial of 14 moderately obese adults ( Age , 38 ± 2 y ; BMI , 34.0 ± 1.1 kg/m2 ) . Insulin resistance and glucose metabolism was assessed using an oral glucose tolerance test combined with isotopic tracers of [6,6 - 2H2]-glucose and [U-13C]-glucose , and indirect calorimetry . Peripheral and hepatic insulin resistance was assessed as 1/(rate of disposal/insulin ) , and endogenous glucose rates of appearance ( Ra ) iAUC60 - 240 × insulin iAUC60 - 240 , respectively . Both diets met ADA nutritional guidelines and contained either whole-grain ( 50 g per 1000 kcal ) or equivalent refined-grain . All food was provided for 8 wk . with an 8 - 10 wk . washout period between diets . RESULTS Post-pr and ial glucose tolerance , peripheral insulin sensitivity , and metabolic flexibility ( insulin-stimulated - fasting carbohydrate oxidation ) improvements were greater after whole-grain compared to the refined-grain diet ( P < 0.05 ) . Compared to baseline , body fat ( ~2 kg ) and hepatic Ra insulin resistance was reduced by both diets , while fasting glucose and exogenous glucose-meal were unchanged after both interventions . Changes in peripheral insulin resistance and metabolic flexibility correlated with improved glucose tolerance ( P < 0.05 ) . CONCLUSION Whole-grains reduced diabetes risk and the mechanisms appear to work through reduced post-pr and ial blood glucose and peripheral insulin resistance that were statistically linked to enhanced metabolic flexibility OBJECTIVE To determine the prospect i ve association between endogenous sex hormones and the development of  type 2 diabetes in older men and women . RESEARCH DESIGN AND METHODS A st and ardized medical history was obtained , an oral glucose tolerance test was performed , and plasma sample s for sex hormones and covariates were collected from ambulatory , community-dwelling men and women at baseline from 1984 to 1987 . Approximately 8 years later ( 1992 - 1996 ) , another medical history was obtained , an oral glucose tolerance test was performed , fasting and 2-h insulin levels were measured , and the homeostasis model assessment for insulin resistance ( HOMA-IR ) was evaluated . This report is based on the 294 men and 233 women , aged 55 - 89 years , who completed both visits and who did not have diabetes as determined by history or glucose tolerance test at baseline , as well as women who were postmenopausal and not taking replacement estrogen . RESULTS In age-adjusted correlation analyses , total testosterone was inversely and significantly related to subsequent levels of fasting and postchallenge glucose and insulin in men , whereas bioavailable testosterone and bioavailable estradiol were positively and significantly related to fasting and postchallenge glucose and insulin in women ( all P < 0.05 ) . There was similar significant association with insulin resistance ( HOMA-IR ) in unadjusted and multiply adjusted analyses ( P < 0.05 ) . There were 26 men and 17 women with new ( incident ) diabetes .  The odds for new diabetes were 2.7 ( 95 % CI 1.1 - 6.6 ) for men in the lowest quartile of total testosterone and 2.9 ( 1.1 - 8.4 ) for women in the highest quartile of bioavailable testosterone . CONCLUSIONS Low testosterone levels in men and high testosterone levels in women predict insulin resistance and incident type 2 diabetes in older adults Objective : To examine whether the effect of postmenopausal hormone therapy ( HT ) on brain volumes in women aged 65–79 years differs depending on type 2 diabetes status during postintervention follow-up of a r and omized controlled clinical trial . Methods : The Women 's Health Initiative r and omized clinical trials assigned women to HT ( 0.625 mg/day conjugated equine estrogens with or without 2.5 mg/day medroxyprogesterone acetate ) or placebo for an average of 5.6 years . A total of 1,402 trial participants underwent brain MRI  2.4 years after the trials ; these were repeated in 699 women 4.7 years later . General linear models were used to assess the interaction between diabetes status and HT assignment on brain volumes . Results : Women with diabetes at baseline or during follow-up who had been assigned to HT compared to placebo had mean decrement in total brain volume of −18.6 mL ( 95 % confidence interval [ CI ] −29.6 , −7.6 ) . For women without diabetes , this mean decrement was −0.4 ( 95 % CI −3.8 , 3.0 ) ( interaction p = 0.002 ) . This interaction was evident for total gray matter ( p < 0.001 ) and hippocampal ( p = 0.006 ) volumes . It was not evident for changes in brain volumes over follow-up or for ischemic lesion volumes and was not influenced by diabetes duration or oral medications . Conclusions : For women aged 65 years or older who are at increased risk for brain atrophy due to type 2 diabetes , prescription of postmenopausal HT is associated with lower gray matter ( total and hippocampal ) volumes . Interactions with diabetes and insulin resistance may explain divergent findings on how estrogen influences brain volume among older women OBJECTIVES This study was design ed to assess the effect of metformin on impaired endothelial function in type 2 diabetes mellitus . BACKGROUND Abnormalities in vascular endothelial function are well recognized among patients with type 2 ( insulin-resistant ) diabetes mellitus . Insulin resistance itself may be central to the pathogenesis of endothelial dysfunction . The effects of metformin , an antidiabetic agent that improves insulin sensitivity , on endothelial function have not been reported . METHODS Subjects with diet-treated type 2 diabetes but without the confounding collection of cardiovascular risk factors seen in the metabolic syndrome were treated with metformin 500 mg twice daily ( n = 29 ) or placebo ( n = 15 ) for 12 weeks . Before and after treatment , blood flow responses to intraarterial administration of endothelium-dependent ( acetylcholine ) , endothelium-independent ( sodium nitroprusside ) and nitrate-independent ( verapamil ) vasodilators were measured using forearm plethysmography . Whole-body insulin resistance was assessed on both occasions using the homeostasis model ( HOMA-IR ) . RESULTS Subjects who received metformin demonstrated statistically significant improvement in acetylcholine-stimulated flows compared with those treated with placebo ( p = 0.0027 by 2-way analysis of variance ) , whereas no significant effect was seen on nitroprusside-stimulated ( p = 0.27 ) or verapamil-stimulated ( p = 0.40 ) flows . There was a significant improvement in insulin resistance with metformin ( 32.5 % reduction in HOMA-IR , p = 0.01 ) , and by stepwise multivariate analysis insulin resistance was the sole predictor of endothelium-dependent blood flow following treatment ( r = -0.659 , p = 0.0012 ) . CONCLUSIONS Metformin treatment improved both insulin resistance and endothelial function , with a strong statistical link between these variables . This supports the concept of the central role of insulin resistance in the pathogenesis of endothelial dysfunction in type 2 diabetes mellitus . This has important implication s for the investigation and treatment of vascular disease in patients with type 2 diabetes mellitus OBJECTIVE To assess if regular physical exercise or oral oestradiol therapy decreased vasomotor symptoms and increased quality of life in previously sedentary postmenopausal women . SETTING A prospect i ve , r and omised trial at a University Hospital . METHODS 75 postmenopausal , sedentary women with vasomotor symptoms were r and omised to : exercise three-times weekly over 12 weeks ( 15 women ) , oral oestradiol therapy for 12 weeks ( 15 women ) and 45 women to three other treatment arms . Results from the exercise and oestradiol groups are presented here . The effects on vasomotor symptoms and wellbeing were assessed with logbooks and vali date d question naires . RESULTS Ten women fulfilled 12 weeks of exercise . The number of flushes was rather unchanged in five women and decreased to 28 % ( range 18 - 42 % ) of baseline in the other five women . Five of the ten women continued to exercise another 24 weeks , thus in all 36 weeks . The mean number of flushes decreased by about 50 % in these five women ( from 6.2/24 to 3.2 flushes/24 h at 36 weeks ) . In the same group a score made as the product of reduction in number and severity of flushes decreased by 92 % at 12 weeks , 75 % at 24 weeks and 72 % at 36 weeks compared with baseline . In the estrogen group flushes decreased from 8.4 to 0.8 ( P<0.001 ) after 12 weeks of therapy and remained at this level after 36 weeks . Well-being according to different measurements improved significantly in both groups , albeit more markedly in the estrogen group . CONCLUSIONS Apart from many other health benefits regular physical exercise may decrease vasomotor symptoms and increase quality of life in postmenopausal women , but this has to be further evaluated scientifically . Exercise should be introduced gradually to ensure compliance
Because of the heterogeneity and the limited number of studies , there is no sufficient evidence on the potential role of vasomotor symptoms in metabolic health .
However , both high- quality cohort studies , with large study population s and adjustment for multiple confounding variables showed positive associations between vasomotor symptoms and insulin resistance and type 2 diabetes mellitus .
These findings suggest that there is an association between vasomotor symptoms and metabolic health outcomes .
The objective of this study was to systematic ally review studies describing the association between vasomotor symptoms and metabolic syndrome , type 2 diabetes and insulin resistance in peri- and postmenopausal women .