Dual x-ray absorptiometry, bioelectrical impedance, and near infrared interactance in obese women.

PURPOSE: Whether the evaluation of body composition in obese people using low-cost, simple bedside, two-compartment techniques reflects the data obtained by indirect methods such as dual x-ray absorptiometry (DEXA) remains controversial. The aim of this study was to compare the data obtained by three methods of assessment of body composition (DEXA; bioelectrical impedance, BIA; and near infrared interactance, NII). METHOD: Data on body composition obtained in 53 obese women by these three methods were compared, using the Bland and Altman procedure to test the relative validity. RESULTS: Although the correlation coefficients between DEXA and the two other methods were high, there were some major differences (limits of agreement) between data concerning fat and lean mass. CONCLUSIONS: The present study indicates that these methods cannot be considered as interchangeable and raises some questions on the use of BIA and NII as a single method of evaluation of body composition in clinical research and practice in obese populations.

Weight gain at the time of menopause.

The menopause is associated with changes in body composition: a decline in bone mineral content, a decrease in collagen synthesis, a loss of lean body mass and an increase in total and abdominal fat mass. Oestrogen deficiency seems to play a role in the menopause-related changes in body composition, but life styles (diet, exercise, smoking habits, alcohol consumption) are also involved. The time course of the decrease in lean mass deserves attention since it could justify specific actions, i.e. exercising or hormonal treatment, early during the perimenopausal period. A decrease in fat-free mass may be responsible for a decrease in energy expenditure favouring weight gain if the calorie intake is not reduced.

Menopause, fat and lean distribution in obese women.

OBJECTIVES: Whether menopause per se influences fat distribution independently of the effect of aging remains controversial. The lack of consistency in the menopause related changes in body fat distribution may be the result of differences in the methods for measuring fat distribution or in the characteristics of the women studied. The aim of this cross sectional study in obese women was to compare total body composition and regional fat and lean distribution, in premenopausal, perimenopausal and postmenopausal women. METHODS: Body composition was assessed by dual energy X-ray absorptiometry (DEXA) in premenopausal (n = 26), perimenopausal (n = 24) and postmenopausal (n = 73) obese women with no intercurrent diseases. RESULTS: It was shown that postmenopausal obese (n = 73) women had a higher proportion of total fat mass in the trunk and a lower proportion of total fat and lean mass in the femoral and leg regions than premenopausal women after adjustment for age and total fat mass. In the same analysis, perimenopausal women had a lower proportion of total fat in the leg and femoral regions and of total lean in the femoral region than premenopausal women; they had a regional body composition similar to that of postmenopausal women. CONCLUSION: The present data indicate that in obese women, post menopause and perimenopause are associated with differences in fat and lean distribution, independently of age and total fat.

[Pharmacology of estrogens used in the treatment of menopause]. / Pharmacologie des oestrogènes utilisés pour le traitement de la ménopause.

Numerous compounds with estrogenic activity are available to treat menopause. The main ones are oestradiol, administered by various routes, and equine estrogens which are taken orally. These compounds differ from each other by their chemical structure, metabolism and kinetics; the metabolic impact of these drugs especially on the liver depends on these parameters. All estrogens are potent, active, and capable of treating effectively the short and long term manifestations of menopause. Their metabolic safety according to the route of administration remains opened to discussion.

[Treatments of massive obesity]. / Traitements des obésités massives.

Treatment of massive obesity aims at somatic, psychological and social targets and therefore requires a multidisciplinary team co-ordinated by a physician. Treatment usually begins by taking care of the most worrying somatic and metabolic problems (cardio-respiratory and metabolic disorders) and by correcting the diet. It is then enhanced by a psychological assistance provided by the treating team and, in certain cases, by a psychotherapist. Massive obesity is a chronic, recurrent and severe disease. Its treatment is prolonged and implies numerous constraints (diet, drugs, treatment of a possible sleep apnoea syndrome) which are difficult to tolerate in the long term. This type of management resembles that of other chronic diseases, such as complicated diabetes. From dietetics to the most technical medicine, from the doctor-patient relationship to psychotherapy, the therapeutic methods are numerous, and the burden of using them in a coherent manner falls on the physician.