association between anthropometric indices and quality of life

8/10/2019 Association Between Anthropometric Indices and Quality of Life

1/4

2013

http://informahealthcare.com/gyeISSN: 0951-3590 (print), 1473-0766 (electronic)

Gynecol Endocrinol, 2013; 29(10): 917920! 2013 Informa UK Ltd. DOI: 10.3109/09513590.2013.819078

MENOPAUSE

Association between anthropometric indices and quality of life

in menopausal women

Masumeh Ghazanfarpour1, Somayeh Abdolahian2, Masoud Zare3, and Soodeh Shahsavari4

1Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran,2Department of Midwifery, Islamic Azad University, Firuzabad, Fars, Iran, 3Community Health Nursing Education, School of University,

Mashhad University of Medical Sciences (MUMS), Mashhad, Iran, and 4Biostatistics department, Faculty of Paramedical Sciences, Shahid Beheshti

University of Medical Sciences, Tehran, Iran

Abstract

Objective: To investigate whether body mass index (BMI), abdominal obesity or fat distributioninfluence the quality of life of postmenopausal women.Methods: Subjects in this cross-sectional

study were 233 postmenopausal women (aged 4570 years) with an intact uterus and ovariesand who were sexually active and not using hormone therapy. Anthropometric measurements

were recorded and subjects were interviewed using a specific health-related quality of life(HR-QoL) instrument, the MENQoL scale.Results: According to BMI values, 31.5% of the womenwere obese, 42.2% were overweight, 25.8% were normal weight and none were underweight.

However, according to the MENQOL scale results, obese women scored significantly higheron symptoms for physical domains. The women with the android pattern of fat distribution

had significantly higher scores in the vasomotor and physical domains (p50.05).Conclusions:Obesity did not affect global HR-QoL in postmenopausal women, but appeared to have an

influence on the psychical domains. Other anthropometric measurements were not associatedwith differences in HR-QoL. Keeping the anthropometric indices in the normal/premenopausal

might improve the quality of life in menopause women.

Keywords

Anthropometric measurements, health-

related quality of life, menopause, obesity

History

Received 14 November 2012Revised 28 May 2013

Accepted 20 June 2013

Published online 29 July 2013

Introduction

In Eastern societies, menopause is considered to be a naturalprocess, and women view this change more positively thanin Western societies [1]. However, many women are unfamiliarwith the effects of menopause, and thus may not complain ofproblems or seek professional attention for menopausal symp-toms. The social status of women increases with age in somesocieties, which can have a positive impact on their level ofnutrition, physical activity, as well as cognitive and emotionalfunctioning. Women in Eastern societies also appear to experi-ence fewer negative climacteric symptoms during midlife.

For example, Asian women gain prestige and power in thefamily and society as they age. However, in developed societies,aging may be associated with loss of beauty, a fear of no longer

feeling loved and wanted, and loneliness [2].

Obesity is a multi-factorial disorder that is related to geneticand metabolic factors, nutritional lifestyle and physical activity,which in turn are conditioned by social, behavioral and culturalfactors [3]. Obesity and being overweight are known risk factorsfor diabetes, high blood pressure, heart disease, gallbladderdisease, stroke and some forms of cancer [4].

The effect of menopause on body fat distribution is unclear,but some studies suggest that menopause is associated with

an accumulation of central fat and, in particular, intra-abdominalfat [5]. Although weight gain during menopause is consideredto be a normal phenomenon, few studies have proved therelationship between menopausal status and weight gain.

The relationship between obesity and health-related qualityof life (HR-QoL) has been widely investigated. Quality of life(QoL) has been defined by the World Health Organization as theindividuals perceptions of their position in life in the contextof the cultural and value systems in which they live and inrelation to their goals, expectations, standards and concerns [6].Obesity has been associated with compromised HR-QoL andpsychological well-being [7]. The prevalence of obesity andobesity-linked illnesses is increasing, particularly in the urbanenvironment [8]. Therefore, poor physical functioning andreduced QoL attributable to being overweight are important interms of public health, and should be addressed by preventivemeasures and interventions to promote healthy living [7]. Most

general population studies conclude that QoL in many personswith obesity is suboptimal [9]. The association between obesityand HR-QoL is stronger in women than in men, in both physicaland mental or psychosocial dimensions [3].

At present, no studies have been conducted in Iranto determine the relationship (if any) between obesity andHR-QoL in postmenopausal women. Accordingly, this studyaimed to examine the association between anthropometricindices (body mass index [BMI] and fat distribution) andHR-QoL in menopausal women residing in Shiraz, a city insouthwestern Iran.

Address for correspondence: Somayeh Abdolahia, Department ofMidwifery, Islamic Azad University, Firuzabad, Fars, Iran. Tel: +98 2188073782. Fax: +98 21 26131179. E-mail:[email protected].
http://-/?-http://-/?-http://-/?-http://-/?-http://-/?-http://-/?-http://-/?-http://-/?-http://-/?-http://-/?-http://-/?-http://-/?-


2/4

Methods

In this cross-sectional study, the menopause quality of life(MENQoL) scale, a specific QoL questionnaire for postmeno-pausal women was used. First, we compiled a list of all 42 healthcenters in Shiraz, and categorized them into five different areasaccording to socioeconomic status. Then, five health centers wereselected by simple random sampling. Subjects were selected

randomly from each health center using cluster sampling untilan adequate sample size was reached (n 233). The sample size

was calculated to be 233 subjects.Inclusion criteria for the postmenopausal women were:(1) natural menopausal status, (2) intact uterus and ovaries and(3) last menstrual period 1 year ago. Information on healthstatus was obtained from medical history and by physicalexamination (done by one of the investigators, M.G., MScMidwife, Senior Lecturer). Exclusion criteria were: (1) hormonereplacement therapy; (2) neuromuscular or neurophysiologicdiseases, as determined from the medical history; (3) difficultyin understanding and interpreting the questions; (4) hysterectomy;and (5) currently menstruating.

All subjects were explained the study objectives, and theysigned a written informed consent form and a research privacyform prior to study enrollment. The procedures in this study were

approved by the institutional review board and the ethicscommittee of Shiraz University of Medical Sciences [10].BMI was calculated as the weight in kilograms divided by the

square of the height in meters. Subjects were categorized as: under-weight (BMI520 kg/m2), normal weight (BMI 2024.9 kg/m2),overweight (BMI 2529.9 kg/m2) or obese (BMI 30 kg/m2).

Waist circumference was measured with an anthropometrictape placed directly on the narrowest point between the lower ribmargin and the iliac crest, in a plane perpendicular to the longaxis of the body. All measurements were made while the subjectsstood balanced on both feet approximately 20 cm apart, and withboth arms hanging freely at their sides. Weight and height weremeasured by one of the investigators, with the participant wearing

light clothing and no footwear.

Data collection and measurements

Each patient completed a three-part questionnaire. One of authors(M.G., MSc Midwife, Senior Lecturer) was responsible tosupervise the completion of questionnaires and any clarificationswere made by her if needed. The first part contained questions onsociodemographic characteristics such as age, educational level

(illiterate, less than secondary school, completed secondaryschool or university), marital status (single, married, divorcedor widowed) and medical conditions of interest (hypertension,diabetes, respiratory disease, kidney disease and heart diseases).The second part comprised of the Menopause-Specific Quality ofLife questionnaire for women. It consisted of 29 items dividedinto 4 domains: vasomotor (3 items), psychosocial (7 items),physical (16 items) and sexual (3 items). All items followed thesame format, in which the woman was asked whether she hadexperienced the item in the previous month. If so, she was thenasked to rate how much she was bothered by the item on a 7-pointLikert scale ranging from 0 (not at all bothered) to 6 (extremelybothered). Therefore, higher scores meant that the subject had

worse symptoms. The total score of each questionnaire wascalculated for each subject.

This questionnaire was translated into Persian and evaluatedby experts. It was then translated back into English andrechecked. Reliability of the Persian language version was verifiedin a pilot study of 40 women who were not included in the mainstudy. Internal consistency with Chronbachs alpha was estimated

at 0.84.

Results

A total of 233 postmenopausal women were enrolled into thestudy. Mean age of the subjects was 54 years (range, 4564 years).Regarding marital status, 2.1% of the subjects were single, 74.7%were married and 23.2% were divorced or widowed. Table 1shows the demographic characteristics and medical characteristicsof the subjects.

According to BMI values, 31.5% of the women were obese,42.2% were overweight, 25.8% were normal weight and nonewere underweight (Table 2). Total mean QoL score was 61.38.Obese women scored significantly higher on symptoms forphysical domains.

The types of fat distribution were android in 88% of women(abdominal obesity: waist-to-hip ratio 40.08) and gynoid in

11% of women (waist-to-hip ratio between 0.68 and 0.8). The

correlation between age of women and fat distribution was 0.265(p50.05). Our results showed that women with the androidpattern of fat distribution had significantly higher scores in the

vasomotor (mean 8.55) and physical domains (mean 32.09)(p50.05). Moreover, women in this sample who were consideredilliterate scored significantly higher on symptoms for all domains(p50.05). Differences in marital status were also related tosignificant differences in scores on the vasomotor domain; andmarried women had higher scores for vasomotor symptoms(Tables 2and 3).

Discussion

In our study population, BMI was significantly related to scoreson the physical domain (p40.05). Among the three BMI groups,women with obesity had the highest scores in the physicaldomain. In other words, women who were obese had worsephysical functioning than their normal-weight counterparts. Thisfinding is in agreement with a study of obese and non-obeseSpanish women, which found that obesity did not affect overallHR-QoL in postmenopausal women, but may have an influence

on the physical and sexual domains [5]. However, a study ofIndian women in Australia by Hafiz and colleagues reported nostatistically significant relationship between obesity and symp-

toms in any domain [2]. A survey of women in Spain found thatobese respondents had a self-reported HR-QoL lower than thatof women of normal weight [11].

Women with the android type of fat distribution had signifi-

cantly more severe symptoms in the vasomotor and physical

Table 1. Demographic characteristics and medicalcharacteristics of the sample (233 postmenopausalwomen).

Variable N(%)

Marital statusSingle 5 (2.1)Married 174 (74.7)Divorced or widow 54 (23.2)

Educational levelIlliterate 40 (17.2)Less than secondary school 132 (56.7)Secondary school 44 (18.9)University 15 (6.4)

Chronic diseaseSurgery (9/39) 93HTN 74 (31.8)Diabetes 39 (16.7)Musculoskeletal problems 159 (68.2)Pulmonary disease 18 (7.7)Heart disease 38 (16.3)Kidney disease 17 (7.3)

918 M. Ghazanfarpour et al. Gynecol Endocrinol, 2013; 29(10): 917920


3/4

domains compared to women with the gynoid type. In otherwords, the former subgroup had a lower quality of life. Thisfinding is in agreement with a study of women in the Netherlandsthat showed that large waist circumference and high BMI

are important indicators of physical difficulties with the basicactivities of daily living [12]. In contrast, research in Spainshowed that women with abdominal obesity also scored lower inthe sexuality domain compared to women with non-abdominalobesity [5].

A study by Ayatollahi and colleagues showed that themean age of menopause in women in Shiraz was 48.3 yearswith a median age of 49 years [14]. Also, life expectancy hasincreased dramatically in developing countries such as Iran [15];therefore, it may be concluded that keeping the BMI in the normalrange can improve the quality of life during the menopausalperiod.

At present, no studies have been conducted in Iran to deter-

mine the relationship (if any) between obesity and HR-QoLin postmenopausal women. Additional research with specific,validated HR-QoL instruments and longer follow-up periods

are necessary to confirm our results. Studies on the impact ofmenopause on HR-QoL have focused on issues such as hormonereplacement therapy [8], with most studies showing deteriorationin HR-QoL after menopause [16]. Our results have practical

implications for the health of older women because the results

showed that obesity and the android type of fat distribution wereassociated with a worse functional status.

Previous studies found that the level of education wassignificantly related to the severity of menopausal symptoms

[17,18]. Several studies reported that unemployment and a lowlevel of education were associated with more severe menopausalsymptoms, whereas women with postsecondary educationtended to report less bothersome physical symptoms [19,20].These findings are consistent with our results, where we foundthat women considered illiterate in our sample had significantlyworse symptoms.

Marital status was significantly related to the severity ofvasomotor symptoms (p50.001). In contrast, a study of meno-pausal Indian women in Australia showed that there weresignificant differences in the severity of sexual and physicalsymptoms depending on marital status [11]. This contradictsother research findings, which reported that there was no

significant association between marital status and severity ofsymptoms [19].

Conclusions

Obesity did not affect global HR-QoL in postmenopausalwomen, but appeared to have an influence on the psychical

domains. Other anthropometric measurements were not

Table 3. Correlations between BMI, marital status and educational level with menopause quality of life (MENQoL) scale inmenopausal women.

Total quality of life score Vas omotor Ps ychosocial Physical Sexual

BMI

Normal 57.79 (25.05)* 7.96 (4.84) 18.37 (9.08) 28.33 (13.61) 3.46 (3.35)Overweight 60.48 (33.33) 9.97 (5.90) 17.08 (9.54) 28.97 (18.46) 4.46 (4.09)Obese 62.14 (27.77) 8.39 (5.80) 17.47 (8.72) 32.44 (16.73) 3.83 (3.09)

p Value 0.765 0.288 0.857 0.336 0.47

Marital StatusSingle 34 (22.76) 8.75 (3.94) 10.40 (8.17) 15.60 (12.68) 1 (1.22)Married 61.57 (29.28) 8.77 (5.89) 17.14 (8.87) 30.94 (17.31) 4.72 (3.11)Divorced or Widow 62.79 (25.19) 8.17 (5.58) 18.81 (8.28) 34.5 (14.64) 1.32 (2.36)

p Value 0.092 0.8 0.093 0.041** 0.00**

Education levelIlliterate 69 (26.89) 10.77 (5.74) 19 (9.02) 35.17 (15.01) 4.05 (3.80)Less than secondar y school 65.32 (27.44) 8.86 (5.75) 18.79 (8.51) 33.77 (16.41) 3.90 (3.22)Secondary school 52.14 (28.46) 6.52 (5.49) 14.32 (8.69) 27.33 (17.21) 4.07 (3.25)University 34.07 (20.02) 6.78 (5.29) 10.27 (4.39) 15.27 (11.88) 2.2 (2.14)

p Value 0.00** 0.01** 0.00** 0.00** 0.334

*Mean (Standard deviation).

Table 2. Mean and standard deviation (SD) of menopause quality of life (MENQoL) scale in menopausal women according totheir body mass index (BMI) and type of fat distribution.

MENQoL Vasomotor Psychosocial Physical Sexual Total scoreAnthropometrics Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD)

BMINormal (2024.9 kg/m2) 9 (5.68) 17.55 (9.37) 28.55 (16.63) 4.12 (3.80) 59.22 (30.26)Overweigh (2529.9 kg/m2) 8.22 (5.92) 17.07 (9.05) 29.72 (17.21) 3.87 (3.02) 58.89 (29.4)Obese (30kg/m2 or higher) 8.63 (32.12) 18.01 (8.28) 36.08 (15.45) 3.76 (10.27) 66.49 (24.96)Total 8.59 (33.75) 17.37 (8.79) 31.40 (16.85) 3.87 (3.27) 61.38 (28.39)p Value 0.714 0.796 0.016* 0.822 0.187

Fat distributionGynoid 6.25 (5.82) 15.35 (8.89) 25.2 (16.68) 3.31 (2.45) 50.1 (29.82)Android 8.87 (5.81) 17.84 (8.70) 33.11 (17.07) 3.93 (3.34) 63.75 (28.28)Total 8.55 (5.85) 17.45 (8.74) 32.09 (17.15) 3.84 (3.25) 61.94 (28.68)p Value 0.058 0.229 0.051 0.417 0.044*

*Significant at 0.05 level.

DOI: 10.3109/09513590.2013.819078 Anthropometric and life quality in menopause women 919


4/4

associated with differences in HR-QoL. Keeping the anthropo-metric indices in the normal/premenopausal might improve the

quality of life in menopause women.

Declaration of interest

The authors report no conflicts of interest and financial relationships forthis study.

References

1. Al- sejari M. Age at natural menopause and menrdopausalsymptoms among Saudi Arabian women in Al-Khobar. Documentnumber: osu1116611916. Available from: http://rave.ohiolink.edu/etdc/view?acc_numosu1116611916.

2. Hafiz I, Liu J, Eden J. A quantitative analysis of the menopauseexperience of Indian women living in Sydney. Aust Nz J Obstet Gyn2007;47:32934.

3. Kolotkin RL, Meter K, Williams GR. Quality of life and obesity.Obes Rev 2001;2:21929.

4. Brown P, Allen AR. Obesity linked to some forms of cancer.W V Med J 2002;98:2712.

5. Llaneza P, Inar rea J, Gonzalez C, et al. Differences in health relatedquality of life in a sample of Spanish menopausal women with andwithout obesity. Maturitas 2007;58:38794.

6. World Health Organization. Quality of life assessment: internationalperspectives. Berlin: Spinger-Verlag; 1994.

7. Laferrere B, Zhu SH, Clarkson JR, et al. Race, menopause, health-related quality of life, and psychological well-being in obesewomen. Obes Res 2002;10:12705.

8. Duda RB, Afua Jumah N, Hill AG, et al. Interest in healthy livingoutweighs presumed cultural norms for obesity for Ghanaianwomen. Health Qual Life Out 2006;4:44.

9. Ucan O, Ovayolu N. Relationship between diabetes mellitus,hypertension and obesity, and health-related quality of life inGaziantep, a central south-eastern city in Turkey. J Clin Nurs 2010;19:251119.

10. Ghaderi E, Ghazanfarpour M, Kaviani M. Evaluation of menopausalwomens attitudes towards menopause in Shiraz. Pak J Med Sci2010;26:698703.

11. Castelo-Branco C, Palacios S, Ferrer-Barriendos J, et al. Impact ofanthropometric parameters on quality of life during menopause.Fertil Steril 2009;92:194752.

12. Han TS, Tijhuis MAR, Lean MEJ, Seidell JC. Quality of life in

relation to overweight and body fat distribution. Am J Public Health1998;88:181420.13. Cuadros J, Llaneza P, Mateu S. Demografa y epidemiologia de la

menopausia en Espana. In: Libro Blanco de la Menopausia enEspana. Emisa Ed. Madrid;2000:1433.

14. Ayatollahi SMT, Ghaem H, Ayatollahi S. Age at natural menopauseand its determinants in shiraz. MJIRC 2005;7:714.

15. Jahanfar Sh, Ramezani Tehrani F, Hashemi SM. Early complicationsof menopause among women in Tehran. J Reprod Infertil 2002;3:73.

16. Bierman AS, Clancy CM. Health disparities among older women:identifying opportunities to improve quality of care and functionalhealth outcomes. J Am Med Women Assoc 2001;56:1559.

17. Dennerstein L, Smith AM, Morse C. Menopausal symptoms inAustralian women. Med J Aust 1993;159:2326.

18. Kirchengast S. Effect of socioeconomic factors on timing of meno-pause and the course of climacteric. Z Gerontol 1992;25:12833.

19. Chim H, Tan BHI, Ang CC, et al. The prevalence of meno-pausal symptoms in a community in Singapore. Maturitas 2002;41:27582.

20. Brzyski RJ, Medrano MA, Hyatt-Santos JM, Ross JS. Quality of lifein low-income menopausal women attending primary care clinics.Fertil Steril 2001;76:449.

920 M. Ghazanfarpour et al. Gynecol Endocrinol, 2013; 29(10): 917920

association between anthropometric indices and quality of life

Documents