Influence of obesity and sarcopenic obesity on plantar pressure of postmenopausal women.

BACKGROUND: Menopause is associated with a decrease in fat-free mass and an increase in fat mass. Sarcopenic obesity is more strongly associated with physical limitations than either obesity or sarcopenia and their effect in plantar pressure is not known. Consequently, the scope of the present study was to examine the effect of obesity and sarcopenic obesity on plantar pressure of postmenopausal women, during walking. METHODS: Body composition and biomechanics parameters of plantar pressure were assessed in 239 postmenopausal women. FINDINGS: Compared to non-obese and non-sarcopenic women, obese postmenopausal women have higher peak pressure in the metatarsal areas 1, 4, 5, midfoot and lateral heel and higher absolute impulses in all metatarsal and heel areas. On the other hand, sarcopenic obese postmenopausal women presented higher peak pressure and absolute impulses under all metatarsal areas, midfoot and heels. When the absolute values of maximal peak pressures and absolute impulses were normalised to body mass, pressure increases were only perceived for midfoot. INTERPRETATION: The pressure increase found in different foot areas of obese and particularly in sarcopenic obese could cause discomfort and pain in the foot. Sarcopenic obese postmenopausal women also present a higher loading during the stance phase comparing with non-sarcopenic non-obese, fact that might limit their basic daily activity tasks, such as walking.

Insulin resistance, obesity and breast cancer risk.

Breast cancer (BC) is one of the most important problems of public health. Among the avoidable risk factors during a woman's life, overweight and obesity are very important ones. Furthermore they are increasing worldwide. The risk of breast cancer is traditionally linked to obesity in postmenopausal women; conversely, it is neutral or even protective in premenopausal women. Since the initiator and promoter factors for BC act over a long time, it seems unlikely that the menopausal transition may have too big an impact on the role of obesity in the magnitude of the risk. We reviewed the literature in an attempt to understand this paradox, with particular attention to the body fat distribution and its impact on insulin resistance. The association of insulin resistance and obesity with BC risk are biologically plausible and consistent. Estradiol (E2) and IGFs act as mitogens in breast cancer cells. They act together and reciprocally. However the clinical and biological methods to assess the impact of insulin resistance are not always accurate. Furthermore insulin resistance is far from being a constant feature in obesity, particularly in premenopausal women; this complicates the analysis and explains the discrepancies in large prospective trials. The most consistent clinical feature to assess risk across epidemiological studies seems to be weight gain during lifetime. Loss of weight is associated with a lower risk for postmenopausal BC compared with weight maintenance. This observation should be an encouragement for women since loss of weight may be an effective strategy for breast cancer risk reduction.

[Should all menopausal women have hormone replacement therapy for the prevention of coronary disease?]. / A prevenção hormonal da doença coronária deverá ser feita a todas as mulheres na menopausa?

A review of the biochemical changes which occur after menopause. Menopause is the onset of a chronic hypoestrogenism. The lack of estrogens which follows either a premature oophorectomy or menopause is a cause of risk factors and diseases at several levels, amongst which, due to its importance, is the cardiovascular system. Estrogens can favorably modify those risk factors and thus contribute to a sharp decrease in cardiovascular morbidity and mortality. For this reason, its use is legitimate for the primary and secondary prevention of coronary disease.

Oral contraceptives and breast cancer.

PIP: Recent studies on oral contraceptives (OCs) suggest that the present rules for prescribing them are acceptable and that the benefits of OC use far outweigh the risks. Researchers seem to agree that women who use OCs before a first full-term pregnancy may have a slightly increased risk of breast cancer, but there is a more general view that it is impossible to establish an OC-breast cancer link and that OCs may even provide a beneficial effect for older women. Good clinical judgement should prevail when weighing risks versus benefits. There may even be benefits of OC and hormone replacement therapy in patients who have had breast and other gynecological cancers. Good medical practice calls for prevention of all diseases and maintenance of health, which is a state of physical, mental, and social well-being. It may, on the other hand, be beneficial to attempt to reduce longterm exposure to estrogens, but some of the benefits of OCs may be lost this way. Hopefully, in the near future, molecular genetics will identify the breast cancer gene, and women will be screened for risks of such longterm therapies.^ieng

[Androgens and sterility]. / Androgénes et stérilité.

The hyperandrogenisms, and in particular those which accompany polycystic ovaries, should always be treated, because the risk of carcinoma of the endometrium and of the breast is increased in these cases. Sterility is inconstant, but can benefit from treatment.

Unilateral streaked ovary syndrome. Slotnick-Goldfarbs syndrome.

A case of unilateral streaked ovary (Slotnick-Goldfarb's syndrome) is reported and documented with hormonal, chromosomal, laparoscopic, and histologic studied. It is postulated that viral oophoritis associated with mumps might explain the coexistence of a streaked ovary of a congenital origin with a hypoplastic ovary, tbat would be the expression of a factor acting in postnatal life.