Study Shows That Post-Menopausal Women Have Difficulty With Long-Term Weight Loss

Dr. Enrique Jacome

Postmenopausal women naturally consume much less energy than when they were younger, the strategies and behaviors they followed earlier in life are simply not sustainable or effective in the long-term any more, researchers from the University of Pittsburgh Department of Health and Physical Activity, reported in the Journal of the Academy of Nutrition and Dietetics. The authors added that several factors work against postmenopausal women when they try to lose weight over the long term.

Several studies have looked at postmenopausal body weight control and diets. A team of researchers from the University of Illinois said that postmenopausal dieting women should eat plenty of protein so that they do not lose too much muscle. Another study warned thathigh-protein diets may encourage bone density loss in postmenopausal women.

Even for younger females and men of all ages, dropping the pounds initially during a diet is usually achievable, but keeping the weight off over the long term is challenging. For postmenopausal women, the authors say, it is much harder.

Postmenopausal women are at a higher risk of developing certain diseases and conditions - those who are overweight have an even higher risk. Overweight postmenopausal women who manage to lose weight, have much better health outcomes. A study carried out by researchers from the Prevention Center at the Fred Hutchinson Cancer Research Center in Seattle, Washington, found that those who lost at least 5% of their bodyweight had noticeable reductions in markers of inflammation.

The researchers found that behaviors which are linked to weight loss initially during a diet and exercise drive, just simply do not work after a while for post-menopausal females. They believe that interventions which target these behaviors could help older women achieve positive long-term outcomes, especially obese women.

Lead researcher Bethany Barone Gibbs, PhD, explained that several factors make weight loss much harder for post-menopausal women:

"Not only does motivation decrease after you start losing weight, there are physiological changes, including a decreased resting metabolic rate. Appetite-related hormones increase. Researchers studying the brain are now finding that you have enhanced rewards and increased motivation to eat when you've lost weight."

If you add them all up, greater appetite, a lower resting metabolic rate, etc., it is very difficult for post-menopausal women to lose weight and to keep it off.

Traditionally, treatments, particularly behavioral ones for obesity, have over-concentrated on keeping the calories down - an approach which may sound good in theory, but has very disappointing long-term results. Dr. Gibbs and team set out to find out what impact certain alterations in eating behaviors and selected foods might have on weight loss after six and 48 months. They focused just on post-menopausal women who were overweight.

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Study Shows Working Moms Enjoy Better Physical & Mental Health

Dr. Enrique Jacome

Moms who work full-time are healthier at age 40 than moms who stay at home, work part time, or moms who find themselves repeatedly out of work. This was the result of a study reported on Monday, the last day of the Annual Meeting of the American Sociological Association in Denver, Colorado.

Co-author Adrianne Frech, Assistant Sociology Professor at the University of Akron in Ohio, told the press, work is good for both physical and mental health, for many reasons: "It gives women a sense of purpose, self-efficacy, control and autonomy." "They have a place where they are an expert on something, and they're paid a wage," she added.

However, Frech and co-author Sarah Damaske of Pennsylvania State University, said rather than stir up the going-out-to-work versus stay-at-home debate, their research highlights a recently identified group, whom they label the persistently unemployed.

 
They say this group of mothers deserves more attention because they appear to be the least healthy at around age 40. Persistently unemployed mothers are in and out of the workforce, often not by their own choice. They repeatedly experience the highs and lows of finding rewarding work, only to lose it and have to start all over again. This becomes a health risk because of the stress caused by work instability.

"Struggling to hold onto a job or being in constant job search mode wears on their health, especially mentally, but also physically," said Frech. "Women with interrupted employment face more job-related barriers than other women, or cumulative disadvantages over time," she added.

For their study, Frech and Damaske analyzed longitudinal data on 2,540 women who became mothers between 1978 and 1995. After adjusting for other factors that could influence the findings, such as prior health, employment before pregnancy, race/ethnicity, single motherhood, cognitive ability, and age at first birth, they found the choices women make early in their professional lives can influence their health later on.

Women who go back to full time work shortly after having children reported better health, both physical and mental. They have more mobility, less tendency to depression, and have more energy, at age 40.

Frech and Damaske suggest if women are able to make good choices before they have their first child, they are more likely to enjoy better health later on. "Examples of good choices could be delaying your first birth until you're married and done with your education, or not waiting a long time before returning to the workforce," said Frech.

Frech suggests working full time brings many benefits that part time workers rarely see: not only is the pay higher, but the chances of promotion are better, there is more job security and more fringe benefits. In contrast, mothers who stay at home may find themselves socially isolated and financially dependent.

Work makes you healthier and gives you the opportunity to save a nest egg, says Frech. "Also, should a divorce happen, it is harder to enter the workforce if you don't have a solid work history. Don't give up on work and education," she adds.

Frech also suggests society benefits when single mothers are offered child care and transportation, because this results in better job prospects for them.

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Study Shows Exercise Can Protect Premenopausal Women's Bones

Dr. Enrique Jacome

According to new research, premenopausal women who engage in physical activity can significantly reduce a known inhibitor of bone formation called sclerostin. 

The study, which will be published in the October issue of Endocrine Society'sJournal of Clinical Endocrinology and Metabolism (JCEM), also found that physical activity improved IGF-1 levels, which have a positive impact on bone formation.

Sclerostin is a glycoprotein produced primarily by osteocytes, the most abundant cells found in the human bone. Once released, sclerostin migrates to the bone surface where it triggers the production of cells that help bones develop.

Mohammed-Salleh M. Ardawi, Ph.D., FRCPath, professor at the Center of Excellence for Osteoporosis Research and Faculty of Medicine at King Abdulaziz University in Saudi Arabia, explained: 

"Physical activity is good for bone health and results in lowering sclerostin, a known inhibitor of bone formation and enhancing IGF-1 levels, a positive effector on bone health. We also found physical activity training that enhances mechanical loading in combination with anabolic therapeutic agents will had added positive effect on bone health, particularly bone formation."

The team examined 1,235 premenopausal women for the study. They followed 58 women during an 8-week course of physical activity training and compared them with 62 women who acted as controls.

All study participants underwent a medical examination and had their measurements taken for bone mineral density, bone turnover markers, serum sclerostin and IGF-1.

The team found that women who engaged in 2+ hours of physical activity per week had considerably lower levels of serum sclerostin than those who had less than 2 hours of physical activity per week. However, those who regularly exercised had higher IGF-1 levels.

Ardawi said:

"Physical activity training is conceptually simple, inexpensive, and can serve practical purposes including reducing the risk of low bone mass, osteoporosis, and consequently fractures. Our study found that even minor changes in physical activity were associated with clear effects on serum levels of sclerostin, IGF-1 and bone turnover markers."

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Hospital Creates Guidelines To Help Identify Mothers At Risk Of Postpartum Depression

Dr. Enrique Jacome

Although 13 percent of new mothers experience postpartum depression (PPD) in the first year after childbirth, few women recognize the symptoms and seldom discuss their feelings with a health care provider. University of Louisville Hospital (ULH) hopes to change this statistic through a new policy to guide hospital-based perinatal nurses in caring for women with risk of PPD. 

M. Cynthia Logsdon, PhD, APRN, FAAN, professor, University of Louisville School of Nursing, and associate chief of nursing research, University of Louisville Hospital and the James Graham Brown Cancer Center, and her team created evidence-based practice guidelines using research recently published on-line in The American Journal of Maternal Child Nursing. 

"The hospital policies and procedures are designed to provide perinatal nurses the tools they need to prepare new mothers so they are able to self-monitor for symptoms of depression and know what steps to take if they experience symptoms," Logsdon said. 

According to Logsdon, most hospitals lack comprehensive perinatal patient PPD assessment, education and referral policies. Although professional organizations such as the Registered Nurses' Association of Ontario previously published a best practices guideline, the recommendations did not focus on the first few days following childbirth or nursing care while the new mother was hospitalized. 

"Our recommendations for nursing practice of hospital-based perinatal nurses go beyond previous published guidelines," Logsdon said. 

Logsdon and her team, Diane Eckert, BSN, RN, clinical manager, mother-baby unit, ULH, and Roselyn Tomasulo, RN, MSN, perinatal educator, collaborated with internationally-known researchers in the field to draft the article, Identification of Mothers at Risk for Postpartum Depression by Hospital Based Perinatal Nurses. A task force of clinical nurses was consulted to determine how to improve nursing practice at ULH. Implementation included identifying at-risk patients and referral sources; physician and staff education was another component. 

"When many nurses enter the profession, they don't fully understand their critical role as patient educators," Tomasulo said. "We are helping our perinatal nurses feel more competent in their roles by offering inter-hospital on-line education and staff training." 

During the obstetric patient admission process, ULH perinatal nurses now assess new mothers for PPD and suicide risk factors: low-income status, lack of social support and previous history of depression. If a patient is at risk, it is reported to the obstetrical physician. The evening before hospital discharge, all new mothers fill out a questionnaire that utilizes the Edinburgh Postnatal Depression Scale (EPDS). Mothers are asked questions such as whether they feel anxious or worried for no particular reason and whether they feel sad or miserable. The higher the score, the greater the risk for PPD. 

The physician, social services worker and oncoming shift nurse are then informed. The nurse who administered the EPDS reviews the results of the depression screening with the patient and her support person. Patients also are informed about depression symptoms and what to do if they begin to feel hopeless. 

New mothers go home with a list of community resources and physician referrals, so names and numbers are at their finger-tips in case they need to seek help. They're asked to retake the EPDS questionnaire about a week later after leaving the hospital to see if they're experiencing PPD symptoms. 
"We hope our work will be seen as a model of good policy and can be considered by other hospitals and professional organizations," Logsdon said. 

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Women Who Give Birth After Age 30 Have A Lower Risk Of Endometrial Cancer

Dr. Enrique Jacome

Women who last give birth at age 40 or older have a 44 percent decreased risk of endometrial cancer when compared to women who have their last birth under the age of 25, according to strong evidence in a new, international study led by a researcher at the Keck School of Medicine of USC. 
Endometrial cancer strikes the endometrium, the tissue lining the uterus (womb), and is the most common gynecological cancer in the United States. 

Veronica "Wendy" Setiawan, Ph.D., assistant professor of preventive medicine at the Keck School, was the principal investigator of the study, "Age at Last Birth in Relation to Risk of Endometrial Cancer: Pooled Analysis in the Epidemiology of Endometrial Cancer Consortium," which found that risk begins to decrease after age 30 by approximately 13 percentage points for each five-year delay in last births. Compared to women who last give birth before age 25, those who have their last child between age 30 and 34 reduce their risk by 17 percent and those between age 35 and 39 reduce their risk by 32 percent. 

"While childbearing at an older age previously has been associated with a lower risk of endometrial cancer, the size of this study definitively shows that late age at last birth is a significant protective factor after taking into account other factors known to influence the disease - body weight, number of kids and oral contraceptive use," Setiawan said. 

The study, believed to be the largest of its kind, examined pooled data from four cohort studies and 13 case-control studies. Funded by the National Cancer Institute, the research examined a total of 8,671 cases of endometrial cancer and 16,562 control subjects, all derived from studies in the Epidemiology of Endometrial Cancer Consortium. Results are now available online in theAmerican Journal of Epidemiology. 

"We found that the lower risk of endometrial cancer continued for older mothers across different age-at-diagnosis groups, including under 50, 50-59, 60-69, and over 70 - which shows that the protection persists for many years," Setiawan said. "Protection also did not vary by the two types of the disease: the more common Type 1, which we think is related to estrogen exposure; and the more rare, but more aggressive and deadly, Type 2, which have been thought to develop independent of hormones." 

Setiawan noted that endometrial cancer is the fourth most common cancer diagnosed among American women. The American Cancer Society estimates that in 2012 about 47,130 new cases of cancer of the uterine body will be diagnosed, and about 8,010 women will die from such cancers. The vast majority of those cases are endometrial cancer. 

Setiawan's research also examined whether the association between age at last birth and endometrial cancer was consistent across race and ethnicity. The protective association was observed in Caucasian and Asian women, but not in the study's small subset of black women, and Setiawan suggested this warrants additional study of larger groups of black women. 

More research is necessary to determine why late age at last birth might protect against endometrial cancer, but Setiawan notes that several potential mechanisms have been suggested by other investigators, including:

• Women capable of becoming pregnant at an older age may possess a healthy endometrium or experience fewer menstrual cycles without ovulation;
• Prolonged exposure to the hormone progesterone during pregnancy may be especially beneficial at older ages, the critical period for endometrial cancer development;
• Premalignant or malignant cells of the uterine cavity's mucosal lining, which are more likely to exist with increasing age, are shed during childbirth.

"This study shows an important protective factor for endometrial cancer, and when the exact mechanism by which it protects women from getting the disease is known, it can help our understanding of how endometrial cancer develops and thus how to prevent it," Setiawan said. 

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15 Tips To Minimize Morning Sickness

Dr. Enrique Jacome

Morning sickness affects over half of all pregnant mothers. It is generally related to an increase in estrogen levels, low blood sugar counts, and a greater susceptibility to some smells. More often, morning sickness will be present in the early hours of the morning and will ease up somewhat as the day goes on.  Even though morning sickness can be extremely unpleasant, it is hardly ever severe enough to cause metabolic derangement. It is more likely to occur during the first three months of a pregnancy and in most cases will settle down by the end of the first trimester. Here are a some tips you can put in to practice to minimize unpleasant morning sickness symptoms:

1. Get plenty of rest. 
   You must ensure you get a good night´s sleep - wear a sleep mask, or even dark glasses, to block out as much light as possible. You might also consider a maternity body pillow that will properly help you support your back and stomach. Sometimes taking naps during the day may help. Avoid moving around straight after eating.
2. Get up slowly
   Don't be in a hurry to get out of bed when you wake up. Take your time.


3. Avoid some types of foods
   Avoid fatty and/or spicy foods. Avoid caffeine as well.


4. Food portion sizes - have small ones.
   It is important to always have some kind of food in your stomach, as this will lower your chances of experiencing nausea - and if you do, most likely symptoms will be milder. If the stomach is empty, the acids have nothing to workon, except for the stomach lining, resulting in worsening nausea. Have some salty crackers, peanut butter snacks, or some other protein snack before you get out of bed in the morning.
   
   At breakfast, cold apple sauce, pears, bananas or any citrus fruit will help you feel satisfied early. Baked potatoes, although, less tasty for many, are highly nutritious. The fruit's potassium may help prevent morning sickness. At night, try eating something high in protein snack/meal before going to bed, as this will help regulate your blood-glucose levels.
5. Computer monitor flicker. 
   The rapid, almost unnoticeable flickering of the computer monitor could cause morning sickness. If you are susceptible to morning sickness due to monitor flicker, try to avoid using a computer completely. If you must, you should adjust the screen by making the fonts bold and larger and changing the background to a soft tan or pink color - this will help reduce eye strain.


6. Physical activity. 
   Some mothers may find it hard to move around if they feel lousy. However, being physically active has been found to improve symptoms in many people.


7. Fluid intake. 
   Being hydrated is crucial for good health, and very important during pregnancy. Some mothers with morning sickness may not feel like consuming their recommended eight glasses of water per day, especially if their stomachs seem not to let them. However, the more dehydrated you are, the more nauseated you will become.
   
   If drinking water is hard, try adding apple cider vinegar and honey. Some mothers say flat Sprite helps, or decaffeinated cola. Sucking ice cubes made from water or fruit juice is also an effective method. The colder the drink, the easier it is to consume.


8. Ginger. 
   For many years, ginger has long been publicized as a stomach soother, and studies have shown that it may help relieve nausea symptoms. Sipping cold ginger ale, or adding a slice of raw ginger to water or tea may help sooth your stomach. Snacks such as gingerbread, or ginger cookies will all effectively help prevent nausea.
9. Keep your mind occupied. 
   It is important to try to take your mind off the nauseous feelings. Finding things to do might not be easy. Reading a book, doing puzzles, watching television, playing cards, or going for short walks around the block will clear your mind and relax you. However, you must also listen to your body, and stop whenever necessary.


10. Wear loose and comfortable clothing. 
    Restrictive or tight clothing may exacerbate the symptoms of morning sickness. Studies have found that pregnant mothers with nausea who switched from tight to loose-fitting clothing reported either reduced symptoms or non at all.


11. Consider using children's vitamins instead of regular pre-natal vitamins. 
    Children's vitamins are usually easier to digest.


12. Sniff fresh scents. 
    Morning sickness is very much smell-associated - the pregnant mother becomes more sensitive to odors. Certain ugly smells, smells you cannot get away from, and potent smells such as perfumes can trigger an episode of unpleasant nausea. The most effective scents, according to self-reports, are lemon extract and/or rosemary.
13. Triggers
    There are several triggers that can bring on an episode of nausea and a general feeling of being unwell due to morning sickness. Most people will soon identify what they are. Avoid them as much as you can, and your frequency of nausea and/or vomiting will reduce, as will severity of symptoms.


14. Acid reflux
    Sometimes, the náusea and vomiting may be due to acid reflux. Taking antacid medication before going to bed may help reduce stomach acid levels, and the subsequent morning vomiting. Check with your doctor before buying any medication during pregnancy.


15. Iron pills or iron-containing multivitamins
    Some pregnant women may become nauseous because of the iron supplements they have been told to take. Talk to your doctor and ask him/her to recommend a slower-release form, or even possible a lower dosage.

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Success Of Fertility Treatment May Approach Natural Birth Rate

Dr. Enrique Jacome

A groundbreaking study of nearly 250,000 U.S. women reveals live birth rates approaching natural fertility can be achieved using assisted reproductive technology, where eggs are removed from a woman's ovaries, combined with sperm and then returned to the woman's body. 

The research, led by Michigan State University's Barbara Luke and published in the New England Journal of Medicine,highlights what factors help or hinder getting pregnant using assisted reproductive technology, or ART. The results indicate that when there are favorable patient and embryo characteristics, live birth rates with ART can approach those of natural fertility.

"This is good news for women who are trying to have a child," said Luke, a researcher in the College of Human Medicine's Department of Obstetrics, Gynecology and Reproductive Biology.

The number of ART treatments has more than doubled in the past 10 years, and live birth rates traditionally have been reported per cycle, or per one course of treatment. While that is easily calculated and is the method used by national registries across the world, Luke's team sought to estimate cumulative success rates with continued treatment.

"Women and families want to know the overall chances they will get pregnant, not necessarily whether they will get pregnant during a specific cycle," Luke said.

Data were obtained from the Society for Assisted Reproductive Technology's Clinic Outcome Reporting System for women undergoing treatment between 2004 and 2009. The system contains data on more than 90 percent of all clinics performing ART treatments in the United States.

The study of 246,740 women revealed 57 percent of women achieved a live birth via ART treatment, and 30 percent of all ART cycles resulted in a live birth. Success rates declined with increasing age for women using their own eggs, especially for those ages 38 years and older, but not for women using donor eggs.

The estimated natural fertility rate of the general population is about 20 percent per month, and estimated rates of conceiving spontaneously are 45 percent, 65 percent and 85 percent after three, six and 12 months, respectively.

The study looked at factors such as patient age, diagnosis, response to treatment, cryopreservation and the stage at which embryos were transferred. Two major factors that influence ART success are favorable patient characteristics (specifically age) and good embryo quality. Among older women, live birth rates can be substantially improved with continued treatment and a change to donor eggs.

"Although the decision to use donor eggs is a very personal one, these analyses provide information regarding the likelihood of a live birth using this option," said Luke.

These results also could guide regulations governing health insurance coverage for infertility treatment. The number of treatment cycles covered by insurance is typically limited to two or three. The findings demonstrate that when using a woman's own eggs, the success rates continue to rise beyond two to three cycles; additionally, the study may help providers and women decide when it is appropriate to change to donor eggs.

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