The association between reproductive history and abdominal adipose tissue among postmenopausal women: results from the Women’s Health Initiative
Authors: Banack Hailey R , Cook Claire E , Grandi Sonia M , Scime Natalie V , Andary Rana , Follis Shawna , Allison Matthew , Manson JoAnn E , Jung Su Yong , Wild Robert A , Farland Leslie V , Shadyab Aladdin H , Bea Jennifer W , Odegaard Andrew O 
Published: June 2024

Abstract

STUDY QUESTION
What is the association between reproductive health history (e.g. age at menarche, menopause, reproductive lifespan) with abdominal adiposity in postmenopausal women?

SUMMARY ANSWER
Higher visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) tissue levels were observed among women with earlier menarche, earlier menopause, and greater parity.

WHAT IS KNOWN ALREADY
Postmenopausal women are predisposed to accumulation of VAT and SAT. Reproductive health variables are known predictors of overall obesity status in women, defined by BMI.

STUDY DESIGN, SIZE, DURATION
This study is a secondary analysis of data collected from the baseline visit of the Women’s Health Initiative (WHI). The WHI is a large prospective study of postmenopausal women, including both a randomized trial and observational study. There were 10 184 women included in this analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS
Data were collected from a reproductive health history questionnaire, dual-energy x-ray absorptiometry scans, and anthropometric measures at WHI baseline. Reproductive history was measured via self-report, and included age at menarche, variables related to pregnancy, and age at menopause. Reproductive lifespan was calculated as age at menopause minus age at menarche. Statistical analyses included descriptive analyses and multivariable linear regression models to examine the association between reproductive history with VAT, SAT, total body fat, and BMI.

MAIN RESULTS AND THE ROLE OF CHANCE
Women who reported early menarche (&lt;10 years) or early menopause (&lt;40 years) had the highest levels of VAT. Adjusted multivariable linear regression results demonstrate women who experienced menarche &gt;15 years had 23 cm2 less VAT (95% CI: −31.4, −14.4) and 47 cm2 less SAT (95% CI: −61.8, −33.4) than women who experienced menarche at age 10 years or earlier. A similar pattern was observed for age at menopause: compared to women who experienced menopause &lt;40 years, menopause at 50–55 years was associated with 19.3 cm2 (95% CI: −25.4, −13.3) less VAT and 27.4 cm2 (−29.6, 10.3) less SAT. High parity (&gt;3 pregnancies) was also associated with VAT and SAT. For example, adjusted beta coefficients for VAT were 8.36 (4.33, 12.4) and 17.9 (12.6, 23.2) comparing three to four pregnancies with the referent, one to two pregnancies.

LIMITATIONS, REASONS FOR CAUTION
The WHI reproductive health history questionnaire may be subject to poor recall owing to a long look-back window. Residual confounding may be present given lack of data on early life characteristics, such as maternal and pre-menarche characteristics.

WIDER IMPLICATIONS OF THE FINDINGS
This study contributes to our understanding of reproductive lifespan, including menarche and menopause, as an important predictor of late-life adiposity in women. Reproductive health has also been recognized as a sentinel marker for chronic disease in late life. Given established links between adiposity and cardiometabolic outcomes, this research has implications for future research, clinical practice, and public health policy that makes use of reproductive health history as an opportunity for chronic disease prevention.

STUDY FUNDING/COMPETING INTEREST(S)
HRB and AOO are supported by the National Institute of Health National Institute of Aging (R01AG055018-04). JWB reports royalties from ‘ACSM’S Body Composition Assessment Book’ and consulting fees from the WHI. The remaining authors have no competing interests to declare.

TRIAL REGISTRATION NUMBER
N/A.