دانلود رایگان مقاله انگلیسی رژیم غذایی و سبک زندگی برای داشتن زندگی سالم بعد از تولد: تمرکزی بر دیابت - الزویر 2018

The prevalence of type 2 diabetes mellitus (T2DM) is 5 to 10% in western countries, while a large percentage of patients remains undiagnosed [1]. Menopause represents the end of reproductive life of women and is associated with metabolic changes which predispose to T2DM. One of the most prevalent phenotypical changes noted after menopause is weight gain. The decrease in estrogen concentrations leads to an increase in total body fat, specifically central abdominal fat accumulation. The abdominal obesity results in additional physical and psychological morbidity, initiating a vicious cycle. Excessive energy intake, sedentary lifestyle and stress are environmental factors that are often present during menopause and further contribute in the development of central obesity [2]. In turn, abdominal fat deposition leads to low grade inflammation and insulin resistance, through the action of cytokines and adipokines. Pancreatic β-cells have then to compensate insulin resistance in order to maintain normal glucose levels. Ultimately, only a subgroup of women with central obesity in menopause will demonstrate impaired glucose metabolism and T2DM. The genetic predisposition of β-cell dysfunction seems to constitute a crucial parameter [3].

Interestingly, women with climacteric symptoms present greater risk for development of diabetes [4]. Various animal and human studies have provided evidence that hormone replacement treatment (HRT) can ameliorate the tendency towards central obesity after menopause, with improvement of insulin sensitivity and reduction of the risk for T2DM. In large randomized controlled trials, T2DM incidence was decreased from 12% to 21% in women on HRT, with significant improvement of central adiposity, insulin resistance, lipids levels and inflammation markers [5]. However, HRT cannot be provided forever and there is not enough evidence to support administration of HRT for T2DM prevention [4,6]. Clearly, more research data are required in order to identify those women most likely to gain metabolic benefits from HRT.