Ana M. Fernández-Alonso

Vitamin D and aging: beyond calcium and bone metabolism.

BACKGROUND Low serum 25-hydroxyvitamin D (25[OH]D) levels are common and may be associated with morbidity and mortality (and indeed with frailty more generally). This association is not restricted to the links between vitamin D and calcium and bone metabolism. OBJECTIVE To review the influences of vitamin D on the aging process other than those related to bone and calcium. Its effect on mortality is also assessed. METHODS The PubMed database was searched for English-language articles relating to vitamin D, using the following MeSH terms: vitamin D, mortality, cardiovascular diseases, and frailty. In addition, searches were carried out with Google. RESULTS Although some of the reported results have proved controversial, overall the evidence seems to support an association between low serum 25[OH]D levels and mortality rates (all-cause and cardiovascular). Frailty is a condition frequently associated with low serum 25[OH]D levels. CONCLUSION The aging process and mortality are associated with low vitamin D levels. Prospective controlled trials are warranted to determine whether vitamin D supplements can increase longevity and reduce the incidence of certain conditions.

First-trimester maternal serum 25-hydroxyvitamin D3 status and pregnancy outcome

To determine the pregnancy outcome as a function of the first‐trimester serum 25‐hydroxyvitamin D3 [25(OH)D] status and to compare the 25(OH)D levels in the first and third trimesters.

Obesity is related to increased menopausal symptoms among Spanish women.

Objective. To assess the metabolic syndrome (METS) and its components in postmenopausal women using updated diagnostic criteria and explore their relation to menopausal symptom severity. Method. Medical records of the first visit of 574 postmenopausal Caucasian Spanish women attending a menopause clinic were retrospectively reviewed. Recorded information included general demographic data, type of menopause, menopausal symptom intensity (Kupperman index) and baseline hormonal and metabolic parameters. METS was established if three or more of the following criteria were met: body mass index (BMI) >28.8 kg/m2, fasting glycaemia >100 mg/dL, high-density lipoprotein cholesterol (HDL-C) <50 mg/dL, triglycerides ≥150 mg/dL and blood pressure ≥130/85 mmHg. Results Mean ± SD age of the whole cohort was 49.9 ± 6.1 years, 66% had natural menopause and 38.9% were obese. In all, 23.1% met diagnostic criteria for METS who were significantly older and displayed higher rates of being married, obesity and abnormal glucose, triglyceride, HDL-C, low-density lipoprotein cholesterol and blood pressure values, when compared with those without the syndrome. The mean Kupperman index score for the whole sample was 26.4 ± 10.6, with 73.8% displaying moderate to severe scores (20 or more). Logistic regression analysis determined that obesity and marriage status were independent risk factors related to more severe menopausal symptoms (Kupperman index scores of 20 or more). Conclusion. Although METS was observed in a lower frequency than previous reports, obesity was associated with more severe menopausal symptoms among postmenopausal Spanish women.

Assessment of sexual function and related factors in mid-aged sexually active Spanish women with the six-item Female Sex Function Index.

ObjectiveThe aim of this study was to assess sexual function and related factors (menopause-related quality of life and mood included) in mid-aged Spanish women. MethodsThis was a cross-sectional study in which 179 sexually active women (40-65 y old) completed the six-item Female Sexual Function Index (FSFI-6), the Menopause Rating Scale (MRS), the Hospital Anxiety and Depression Scale (HADS), and a sociodemographic questionnaire containing personal and partner data. ResultsMedian age was 51 years; 55.3% of the women were naturally postmenopausal, 47.5% had increased body mass index, and 6.7% had hypertension. Currently, 4.5% and 19.6% of the women used hormone therapy and psychotropic drugs, respectively. A total of 87.7% had a stable partner; 1.3% of partners abused alcohol and 8.3% had erectile dysfunction. Of the surveyed women, 36.9% displayed total FSFI-6 scores of 19 or less (lower sexual function); 40.2%, mood morbidity (total HADS scores ≥11); and 23.5%, impaired quality of life (severe total MRS scores ≥17). Cronbach &agr; for the FSFI-6 was 0.91. Total FSFI-6 scores positively correlated with female and partner education and inversely with female age and scores on the MRS and the HADS (total and subscale values). Multiple linear regression analysis found that total FSFI-6 scores positively correlated with partner educational level and inversely (worse sexual function) with female age, partner issues (alcohol abuse and erectile dysfunction), and total HADS and urogenital and somatic MRS scores. ConclusionsIn this mid-aged Spanish sample, as assessed with a short and consistent tool, lower sexual function was related to menopausal and mood symptoms and several women and partner factors. Further research using this instrument is warranted.

Perceived stress, insomnia and related factors in women around the menopause

BACKGROUND Studies assessing perceived stress and insomnia in mid-aged women are scarce. OBJECTIVE To assess perceived stress, insomnia and related factors in mid-aged Spanish women. METHOD This was a cross sectional study in which 235 women aged 40-65 completed the Menopause Rating Scale (MRS), the Perceived Stress Scale (PSS), the Insomnia Severity Index (ISI), and a general socio-demographic questionnaire containing personal and partner data. Internal consistency of each tool was also computed. RESULTS Median [interquartile range] age of the sample was 52 [9.0] years. A 61.3% were postmenopausal, 49.4% had increased body mass index values, 43.8% were abdominally obese, 11.9% had hypertension, and 74.0% had a partner. In addition, 9.8% used hormone therapy and 12.3% psychotropic drugs. Multiple linear regression analysis found that higher PSS scores (more stress) inversely correlated with female age and positively with MRS psychological and urogenital scores (impaired quality of life in these domains), total higher ISI scores (more insomnia) and partner premature ejaculation. Higher ISI scores positively correlated with PSS and MRS somatic scores and partner unfaithfulness, and inversely with female hip circumference. CONCLUSION In this mid-aged Spanish sample perceived stress and insomnia were significantly correlated and related to various female and partner issues.

Life satisfaction, loneliness and related factors during female midlife

BACKGROUND Studies assessing life satisfaction and feelings of loneliness in mid-aged women are scarce. OBJECTIVE To assess loneliness, life satisfaction and related factors in mid-aged Spanish women. METHOD This was a cross sectional study in which 182 women aged 40 to 65 completed the menopause rating scale (MRS), the University of California at Los Angeles loneliness scale (UCLA-LS), the life satisfaction index A (LSI-A), and a general socio-demographic questionnaire containing personal/partner data. Internal consistency of each tool was also computed. RESULTS Median [interquartile range] age of the sample was 51 [9.0] years. A 55.5% were postmenopausal, 47.3% had increased body mass index (BMI) values, 57.7% were abdominally obese, 1.6% had hypertension and 86.3% had a stable partner. In addition, 4.9% used hormone therapy and 19.2% psychotropic drugs. Multiple linear regression analysis found that higher UCLA-LS scores (more loneliness) correlated with MRS psychological scores, partner alcohol abuse, living in urban areas, lower LSI-A scores (less life satisfaction) and not having a stable partner. Lower LSI-A scores (worse life satisfaction) correlated with severe female economical problems, BMI values and UCLA-LS and MRS psychological scores. CONCLUSION Loneliness and life satisfaction in this mid-aged female sample was influenced by personal and partner issues which seem to play a much more relevant role than biological aspects. More research is warranted in this regard.

First trimester serum 25-hydroxyvitamin D status and factors related to lower levels in gravids living in the Spanish Mediterranean coast.

Objective: To assess first trimester serum 25-hydroxyvitamin D [25(OH)D] status and factors related to deficient levels in pregnant Spanish women. Methods: This cross-sectional study was carried out among 502 gravids (11 to 14 weeks) living in the Spanish Mediterranean sea coast (near Almería at latitude 36° N, longitude 2° W) to whom serum 25(OH)D levels were measured by electrochemiluminescence immunoassay. Logistic and multiple linear regression analysis were performed to assess the influence of ethnicity, immigration status, season of the year at blood sampling, body mass index (BMI), parity and smoking habit over 25(OH)D levels. Results: The median (interquartile range, IQR) serum 25(OH)D levels for the entire sample was 27.4 ng/mL (IQR = 20.9-32.8). Only 35.9% of participants had adequate serum 25(OH)D levels (≥30 ng/mL) whereas in 41.4% and 22.7% these levels were found to be insufficient (20-29.9 ng/mL) and deficient (<20 ng/mL), respectively. Vitamin D status was found to be significantly lower in Arab women as compared to Caucasian women. 25(OH)D levels were positively correlated with gestational age at sampling and inversely with BMI values (univariate analysis). Logistic regression analysis determined that non-Caucasian ethnicity, season at sampling (autumn/winter), and nulliparity were factors related to deficient 25(OH)D levels. Multiple linear regression found a similar model yet also including maternal weight inversely correlating with 25(OH)D levels. Conclusion: Despite living in one of the sunniest, warmest, and driest climates of Europe, gravids displayed a high prevalence of first trimester insufficient/deficient serum 25(OH)D levels related to season at sampling, nulliparity, maternal weight, and non-Caucasian ethnicity.

Assessment of sleep quality and correlates in a large cohort of Colombian women around menopause.

ObjectiveThe aim of this study was to determine the relationship between self-reported sleep quality, menopausal symptom intensity, and correlates (including ethnicity) among middle-aged women. MethodsThe present cross-sectional study involved 1,078 Colombian women aged 40 to 59 years who completed the Pittsburgh Sleep Quality Index (PSQI), the Menopause Rating Scale (MRS), and a general questionnaire exploring sociodemographic data. ResultsThe median [interquartile range] age of the whole sample was 49.0 [9.0] years. Among the participants, 45.4% were postmenopausal, 57.2% had increased body mass index values, 13.9% were black, 20.7% had hypertension, 74.1% had a stable partner, and 3.8% used hormone therapy. The prevalence of poor sleep quality was 57.1% (PSQI global score ≥5). Significant correlations between PSQI global scores and MRS total and subscale scores were found. Multiple linear regression analysis found that higher PSQI scores (poorer quality of sleep) correlated with higher MRS psychological and somatic subscale scores (more severe symptoms), smoking habit, and hypertension. Menopause status and black ethnicity were excluded from the final regression model. ConclusionsDespite study limitations, poor sleep quality is highly prevalent in this large middle-aged Colombian female sample and is related to menopausal symptom severity, tobacco use, and presence of hypertension.

Resilience, depressed mood, and menopausal symptoms in postmenopausal women

ObjectiveThis study aims to assess resilience, depressed mood, and menopausal symptoms in postmenopausal women. MethodsIn this cross-sectional study, 169 postmenopausal women aged 48 to 68 years were asked to fill out the Wagnild and Young Resilience Scale (WYRS), the Center for Epidemiologic Studies Depression Scale (CESD-10), the Menopause Rating Scale (MRS), and a questionnaire containing personal and partner sociodemographic data. ResultsThe median [interquartile range] age of participating women was 54 [10.0] years. Among the women, 55.6% had increased body mass index, 76.9% had a partner, 17.8% were current smokers, 14.2% had hypertension, 25.4% used psychotropic drugs, and 13.0% used hormone therapy. Forty-five percent of the women had depressed mood (CESD-10 scores ≥10), and 34.9% had severe menopausal symptoms (total MRS scores ≥17). Less resilience (lower WYRS scores) correlated with depressed mood (higher CESD-10 scores) and severe menopausal symptoms (higher total, psychological, and urogenital MRS scores). Multiple linear regression analysis determined that WYRS scores positively correlated with exercising regularly and inversely correlated with CESD-10 scores (depressed mood). CESD-10 scores positively correlated with somatic and psychological MRS subscale scores and inversely correlated with WYRS scores (less resilience). ConclusionsIn this postmenopausal sample, depressed mood and participation in regular exercise correlate with lower and higher resilience, respectively. Depressed mood is associated with the severity of menopausal symptoms (somatic and psychological).

Quality of life in a large cohort of mid-aged Colombian women assessed using the Cervantes Scale.

ObjectiveThe aim of this study was to assess quality of life (QoL) in a cohort of mid-aged Colombian women using the Cervantes Scale (CS). MethodsIn this cross-sectional study, 1,739 healthy women aged 40 to 59 years were asked to simultaneously fill out the CS and a questionnaire containing general female demographic data. The CS includes four domains: menopause and health (15 items), psychological (9 items), sexuality (4 items), and couple relationship (3 items). In addition, the menopause and health domain includes three subdomains: vasomotor symptoms, health, and aging. The global CS score may range from 0 to 155 (from better to worse QoL). ResultsMultiple linear regression determined that CS scores (global and domains) significantly increased (therefore, worse QoL) with age, menopause status, body mass index, parity, race, and marital and working status. The CS displayed a high internal consistency as Cronbach &agr; values for the global and domain scores were above 0.80. ConclusionsThis is the first study to report QoL assessment using the CS among mid-aged Latin American women from Colombia in whom age, menopause status, body mass index, and other personal factors influenced QoL.