Prevalence and negative effects of obesity on health among women of reproductive age

The article surveys generalized and systematized modern data about prevalence and negative side of obesity among women of reproductive age

The increasing prevalence of obesity is one of the most important public health concerns and it is quickly becoming an epidemic that is contributing to the overall disease burden worldwide [1-3]. According to the World Health Organization, from 1980 the number of people worldwide who are obese has doubled. In 2008 more than 1.4 million adults aged 20 years and older were overweight. Out of this number, more than 200-million men and nearly 300 million women were obese [1]. In connection with these terrible figures WHO declared that obesity has become a global epidemic and was serious threat to the public health

Table 1 - Obesity Classification by body mass index * (WHO, 1997) because of comorbidities such as hypertension, coronary heart disease and diabetes [4].

WHO proposed a classification of obesity by body mass index in 1997. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m²)[3].

Table 1 presents the classification of obesity by BMI and the risk of comorbidities.

Nature of the distribution of adipose tissue is determined by the coefficient of waist circumference / hip circumference (WC/HC).

The value of WC/HC for men> 1.0 and women> 0.85 indicates the type of abdominal obesity. The value of waist circumference also acts as indicator of clinical risk of metabolic complications of obesity. At present, the following classification of obesity. By etiological principle: alimentary and constitutive; hypothalamic; endocrine; iatrogenic. By type of fat deposits: abdominal (android, central); gynoid (gluteal-femoral); mixed [1-4].

In Western Europe, from 10 to 20% of men and 20 to 25% of women are overweight or obese [4]. In the United States overweight has reached 61% of the population, in Russia - 54%, in the UK - 52% and in Germany - 50% [5]. Therefore, obesity is considered as a pandemic, reaching millions of people. It should be noted that in all countries of the world women's obesity is more common than among men [6].

In recent decades have seen a steady increase in the different variants of neuroendocrine abnormalities in women with metabolic disorders, often in the form of obesity [2], [3].

In women, the average mass of adipose tissue normally is 25-30% of total body weight, which is significantly greater than its percentage in men - 15-20%. However, the risk of developing diseases associated with obesity, depends not only on the degree of overweight, but also on the nature of the fat distribution, and the dependence of the fat distribution is expressed even more strongly than the degree of obesity [6].

There is a well-known relationship between the rate of obesity and age. Thus, the prevalence of fat in childhood is minimal - about 10%, in adolescence, it increases to 15-20% ,in reproductive age is 35-50% and in postmenopausal among women goes up to 75% [5].

Weight gain after menopause is noted in more than half of women in older age groups. Weight gain in menopause leads to the formation of menopausal metabolic syndrome (MMS), the main manifestations are abdominal obesity, dyslipidemia, and glucose metabolism. One of the pathogenesis of obesity when MMS is slowing basal metabolic rate (energy expenditure) against deficiency of sex hormones. Thus, the decrease in basal metabolism in postmenopausal women contributes to weight gain of 3-4 kg per year [10]. According to Healthy Women's Study, in the first 3 years after menopause weight increased an average of 2.3 kg and after 8 years - 5.5 kg [11], [12].

Current concepts of obesity suggests that it occurs due to inadequate balance between the supply and waste of energy on the background of eating disorders, genetic predisposition and / or hormonal imbalance characteristic of menopause. It is now known that estrogens control the metabolism of fats and carbohydrates in the body [10]. Estrogens accelerate the process of fat digestion and inhibit the synthesis of lipid fractions, contributing to the development of atherosclerosis. Gradual decline in estrogen levels during perimenopause lead to disorders of lipid metabolism and the development of insulin resistance, which results in a tendency to weight gain in menopause [10-13].

Also now obesity is considered as one of the main causes of functional disorders of the reproductive system in women. This fact has been known since ancient times [2]. The relationship between disorders of the reproductive system and obesity was described in 1934 in a classic article by Stein and Leventhal in the description of polycystic ovary syndrome. Little later, in 1952, Rogers and Mitchell have published data that 43% of women with menstrual disorders and infertility cycle were obese. Later on the role of obesity in the genesis of reproductive dysfunction has been proven in many studies [7-14].

Obesity is one of the most common forms of disorders of lipid metabolism and its rate does not tend to decrease, especially in economically developed countries, where the number of pregnant women with this disease reaches 15,526,9% [10]. As stated earlier, obesity adversely affects the function of various organs and systems of the body, creating conditions for the development of extragenital diseases and reduces resistance to infection [10], [11], that increase the risk of abnormal pregnancy, childbirth, postpartum women and perinatal morbidity and mortality in neonates [10-13]. Thus, obesity can be defined as chronic disease that is closely associated with the development of not only extragenital diseases, but also with the emergence of gynecological diseases, high-risk of menstrual disorders, infertility of pathological changes in the ovaries and endometrium. [9-18].

Obesity has an adverse effect on the generative function: increased risk of pathological course of pregnancy, childbirth and the postpartum period, increases the frequency of birth of children with various disabilities, which leads to increased perinatal morbidity and mortality [9]. Moreover, obesity, the frequency of which has a reliable tendency to increase is negative premorbid background for the development of pregnancy and the course of labor. Therefore, obese women should be referred to the risk of complications during pregnancy, labor and perinatal morbidity [19].

References

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