@article{568ad84af1cb4cab80c6118247eabeaf,
title = "Obesity, smoking, and risk of vasomotor menopausal symptoms: a pooled analysis of eight cohort studies",
abstract = "Background: Frequent and severe vasomotor symptoms during menopause are linked with adverse health outcomes. Understanding modifiable lifestyle factors for the risk of vasomotor menopausal symptoms is important to guide preventive strategies. Objective: We investigated the associations between body mass index and smoking, their joint effects with the risk of vasomotor symptoms, and whether the associations differed by menopausal stage. Study Design: The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events pooled data on 21,460 midlife women from 8 studies (median age, 50 years; interquartile range, 49–51 years) for the cross-sectional analysis. Four studies provided data for the prospective analysis (n=11,986). Multinomial logistic regression models with 4 categories of frequency/severity for the outcome of vasomotor symptoms were used to estimate relative risk ratios and 95% confidence intervals that were adjusted for within-study correlation and covariates. Results: At baseline, nearly 60% of the women experienced vasomotor symptoms. One-half of them were overweight (30%) or obese (21%), and 17% were current smokers. Cross-sectional analyses showed that a higher body mass index and smoking more cigarettes with longer duration and earlier initiation were all associated with more frequent or severe vasomotor symptoms. Never smokers who were obese had a 1.5-fold (relative risk ratio, 1.52; 95% confidence interval, 1.35–1.73) higher risk of often/severe vasomotor symptoms, compared with never smokers who were of normal-weight. Smoking strengthened the association because the risk of often/severe vasomotor symptoms was much greater among smokers who were obese (relative risk ratio, 3.02; 95% confidence interval, 2.41–3.78). However, smokers who quit at <40 years of age were at similar levels of risk as never smokers. Prospective analyses showed a similar pattern, but the association attenuated markedly after adjustment for baseline vasomotor symptoms. Furthermore, we found that the association between body mass index and vasomotor symptoms differed by menopausal status. Higher body mass index was associated with increased risk of vasomotor symptoms in pre- and perimenopause but with reduced risk in postmenopause. Conclusion: High body mass index (≥25 kg/m2) and cigarette smoking substantially increased women's risk for experiencing frequent or severe vasomotor symptoms in a dose-response manner, and smoking intensified the effect of obesity. However, the effect of body mass index on the risk of vasomotor symptoms was opposite among postmenopausal women. Maintaining a normal weight before the menopausal transition and quitting smoking at <40 years of age may mitigate the excess risk of vasomotor symptoms in midlife.",
keywords = "hot flushes, night sweats, obesity, overweight, smoking, vasomotor symptoms",
author = "Anderson, {Debra J.} and Chung, {Hsin Fang} and Seib, {Charrlotte A.} and Dobson, {Annette J.} and Diana Kuh and Brunner, {Eric J.} and Crawford, {Sybil L.} and Avis, {Nancy E.} and Gold, {Ellen B.} and Greendale, {Gail A.} and Mitchell, {Ellen S.} and Woods, {Nancy F.} and Toyoko Yoshizawa and Mishra, {Gita D.}",
note = "Funding Information: Supported by the following agencies: Australian National Health and Medical Research Council project grant (APP1027196); the Australian National Health and Medical Research Council Principal Research Fellowship (APP1121844; G.D.M.). The data on which this research is based were drawn from 8 observational studies: the Australian Longitudinal Study on Women's Health (ALSWH) is funded by the Australian Government Department of Health; the Medical Research Council National Survey of Health Development (NSHD) has core funding from the UK Medical Research Council (MC UU 12019/1); the National Child Development Study (NCDS) is funded by the UK Economic and Social Research Council; the Whitehall II study is supported by grants from the Medical Research Council (K013351), the British Heart Foundation (BHF RG/16/11/32334) and the US National Institutes on Aging (R01AG013196, R01AG034454); the Seattle Midlife Women's Health Study (SMWHS) was supported in part by grants from the National Institute of Nursing Research, P50-NU02323, P30-NR04001, and R01-NR0414; the Healthy Ageing of Women Study (HOW) and Japanese Midlife Women's Health Study (JMWHS; also called Australian and Japanese Midlife Women's Health Study) were supported by the Queensland University of Technology Early Career Research Grant and the JSPS Grant-in-aid for Scientific Research; the Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), Department of Health and Human Services (DHHS), through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women's Health (ORWH; Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). Funding Information: Supported by the following agencies: Australian National Health and Medical Research Council project grant ( APP1027196 ); the Australian National Health and Medical Research Council Principal Research Fellowship ( APP1121844 ; G.D.M.). The data on which this research is based were drawn from 8 observational studies: the Australian Longitudinal Study on Women{\textquoteright}s Health (ALSWH) is funded by the Australian Government Department of Health; the Medical Research Council National Survey of Health Development (NSHD) has core funding from the UK Medical Research Council (MC UU 12019/1); the National Child Development Study (NCDS) is funded by the UK Economic and Social Research Council ; the Whitehall II study is supported by grants from the Medical Research Council ( K013351 ), the British Heart Foundation (BHF RG/16/11/32334) and the US National Institutes on Aging ( R01AG013196 , R01AG034454 ); the Seattle Midlife Women{\textquoteright}s Health Study (SMWHS) was supported in part by grants from the National Institute of Nursing Research , P50- NU02323 , P30- NR04001 , and R01- NR0414 ; the Healthy Ageing of Women Study (HOW) and Japanese Midlife Women{\textquoteright}s Health Study (JMWHS; also called Australian and Japanese Midlife Women{\textquoteright}s Health Study) were supported by the Queensland University of Technology Early Career Research Grant and the JSPS Grant-in-aid for Scientific Research; the Study of Women{\textquoteright}s Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), Department of Health and Human Services (DHHS) , through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women{\textquoteright}s Health (ORWH; Grants U01NR004061 ; U01AG012505 , U01AG012535 , U01AG012531 , U01AG012539 , U01AG012546 , U01AG012553 , U01AG012554 , U01AG012495 ). Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",
year = "2020",
month = may,
doi = "10.1016/j.ajog.2019.10.103",
language = "English",
volume = "222",
pages = "478.e1--478.e17",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "5",
}