The accelerated bone loss that occurs during menopause and becomes more prone in the postmenopausal period is mediated by the ending of estrogen production. This bone loss can be a threat for women in this period of life concerning to the lead toxicity. Around 95% of the lead accumulated in the body is stored in the bones and may be mobilized to the bloodstream during bone demineralization, posing a potential risk. On the other hand, an adequate calcium supplementation seems to reduce gastrointestinal lead absorption. However, studies carried out in the United States revealed relatively high lead levels in calcium supplements. In the present study, we evaluated the content of lead in calcium supplements available in Brazil. We also investigated the effect of calcium supplementation and bone diseases on blood lead levels, δ-aminolevulinic acid dehydratase (δ-ALAD) activity, δ-ALAD reactivation index and antioxidant enzymes activities in postmenopausal women non-occupationally exposed to lead. Two studies were conducted, one with a cross-sectional design and another with a prospective design. Biochemical parameters were evaluated in both studies. In the prospective study these parameters were evaluated before and after three months of calcium supplementation. A total of 11 calcium-based products were selected and their lead and calcium content were determined by graphite furnace and flame atomic absorption spectrometry, respectively. Blood lead was assessed by inductively coupled plasma mass spectrometry and bone mineral density (BMD) was evaluated at the lumbar spine (BMD L1-L4) and femoral neck (BMD femur) by dual energy X-ray absorptiometry. δ-ALAD activity and antioxidant enzymes activities were determined in whole blood using spectrophotometric methods. δ-ALAD reactivation index was determined by measuring enzyme activity in the presence of 3 mM ZnCl2 and 10 mM DL-dithiothreitol. The lowest lead content per gram of calcium was found in bonemeal (< limit of quantification) and the highest lead content per gram of calcium was found in dolomite (2.3±1.2 μg. g-1 of measured calcium). No differences were observed in δ-ALAD activity or δ-ALAD reactivation index between postmenopausal women with and without bone diseases, both in the cross-sectional and in the prospective study. In the prospective study, three months of calcium supplementation increased blood lead levels in osteopenia (4.6 μg/dL) when compared with control group (3.7 μg/dL) and decreased alkaline phosphatase activity in all groups: control (66.2 vs. 71.9 U/L before the beginning of the treatment) osteopenia (67.1 vs. 71.1 U/L) and osteoporosis (83.9 vs. 86.1 U/L). Catalase (CAT) and superoxide dismutase (SOD) activities were not different between postmenopausal women with and without bone diseases, both in the cross-sectional and in the prospective study. However, gluthatione peroxidase (GPx) activity was significantly higher in osteopenia group (23.32 μmol NADPH/g Hb/min) as compared to control group (18.56 μmol NADPH/g Hb/min) in the cross-sectional study. This finding was interpreted as a defense response to counteract the overproduction of reactive oxygen species in women with osteopenia. Results of the cross-sectional study indicated that bone resorption associated to osteopenia/osteoporosis does not pose a risk of lead toxicity in postmenopausal women exposed to background lead levels. However, results of the prospective suggest that three months of calcium supplementation contributed to a small, but significant increase of blood lead levels in postmenopausal women with bone disease. Although lead levels found in calcium supplements were below the limits established in the United States, it is important to regulate the allowed lead levels in calcium supplements in Brazil through of a specific legislation. A monitoring program of lead levels would also be important, because our results revealed that calcium supplements are a small lead source. Despite being a low lead source, it could cause deleterious effects, mainly in women in the postmenopausal. / A acelerada perda óssea que ocorre durante a menopausa e torna-se mais acentuada no período pós-menopáusico, mediada pelo término na produção de estrogênio, pode constituir uma ameaça para mulheres nessa fase da vida, no que diz respeito à toxicidade do chumbo. Aproximadamente 95% do chumbo acumulado no organismo está depositado nos ossos e com a desmineralização óssea o metal passa para a corrente sanguínea, constituindo um risco potencial. Por outro lado, uma adequada suplementação de cálcio parece reduzir a absorção gastrintestinal de chumbo. No entanto, estudos realizados nos Estados Unidos revelaram níveis relativamente elevados de chumbo em suplementos de cálcio. No presente estudo, nós avaliamos o conteúdo de chumbo nos suplementos de cálcio disponíveis no Brasil. Investigamos também os efeitos da suplementação de cálcio e da doença óssea sobre os níveis sanguíneos de chumbo, a atividade da enzima δ-aminolevulinato desidratase (δ-ALAD), índice de reativação da δ-ALAD e a atividade de enzimas antioxidantes em mulheres pós-menopáusicas não expostas ocupacionalmente ao chumbo. Foi realizado um estudo transversal e outro prospectivo, onde em ambos os estudos foram avaliados os parâmetros bioquímicos; sendo que no estudo prospectivo esses parâmetros foram avaliados antes e após três meses de suplementação de cálcio. Um total de 11 produtos à base de cálcio foram selecionados e o conteúdo de chumbo e cálcio foi determinado por espectrometria de absorção atômica com forno de grafite e de chama, respectivamente. Os níveis de chumbo sanguíneo foram medidos por espectrometria de massa com plasma acoplado indutivamente e a densidade mineral óssea (DMO) foi determinada na lombar (DMO L1-L4) e no colo do fêmur (DMO fêmur) por absorciometria de duplo feixe de raios-X. A atividade da δ-ALAD e das enzimas antioxidantes foram determinados em sangue total usando métodos espectrofotométricos. O índice de reativação da δ-ALAD foi determinado pela medida da atividade da enzima em presença de 3 mM de ZnCl2 e 10 mM de DL-ditiotreitol. A menor quantidade de chumbo por grama de cálcio foi encontrada nos suplementos de cálcio à base de ossos (< que o limite de detecção) e a maior quantidade de chumbo por grama de cálcio foi encontrada na dolomita (2,3±1,2 μg.g-1 de cálcio medido). Nenhuma diferença foi observada na atividade da δ-ALAD ou no índice de reativação da δ-ALAD entre as mulheres pós-menopáusicas com e sem doença óssea, em ambos os estudos, transversal e prospectivo. No estudo prospectivo, três meses de suplementação de cálcio aumentou os níveis de chumbo sanguíneo no grupo com osteopenia (4,6 μg/dL) quando comparado ao grupo controle (3,7 μg/dL) e diminuiu a atividade da fosfatase alcalina em todos os grupos: controle (66,2 vs. 71,9 U/L antes do início do tratamento) osteopenia (67,1 vs. 71,1 U/L) e osteoporose (83,9 vs. 86,1 U/L). A atividade da catalase (CAT) e da superóxido dismutase (SOD) não foram diferentes entre as mulheres pós-menopáusicas com e sem doença óssea, em ambos os estudos, transversal e prospectivo. No entanto, a atividade da glutationa peroxidase (GPx) foi significativamente maior no grupo osteopenia (23,32 μmol NADPH/g Hb/min) quando comparado ao grupo controle (18,56 μmol NADPH/g Hb/min) no estudo transversal. Esse resultado foi interpretado como uma resposta defensiva contra a produção excessiva de espécies reativas de oxigênio nas mulheres com osteopenia. Os resultados do estudo transversal indicaram que a reabsorção óssea associada com osteopenia/osteoporose não representa um risco de toxicidade do chumbo em mulheres na pós-menopausa expostas a baixos níveis de chumbo. No entanto, os resultados do estudo prospectivo sugerem que três meses de suplementação de cálcio contribuíram para um pequeno, mas significativo aumento nos níveis sanguíneos de chumbo em mulheres na pós-menopausa com doença óssea. Embora os níveis de chumbo encontrados nos suplementos de cálcio tenham ficado abaixo dos limites estabelecidos nos Estados Unidos, faz-se necessário a regulamentação, através de uma legislação específica, dos níveis permitidos de chumbo em suplementos de cálcio no Brasil. Também seria importante um programa de monitoramento de tais níveis, pois através dos nossos resultados constatamos que os suplementos de cálcio atuam como uma pequena fonte de chumbo, mas que poderá vir a causar efeitos deletérios, principalmente em mulheres na pós-menopausa.

This study has aimed to evaluate how osteoporosis affects the quality of life in postmenopausal women and to assess the influence of physical exercise on markers for quality of life in osteoporosis patients. The EQ-5D questionnaire was applied for evaluation of the markers: Mobility, Self-care, Usual Activities, Pain/Discomfort and Anxiety/Depression. In collaboration with the University of Bologna, a 6-month exercise trial of women aged 60-75 with osteoporotic vertebral fractures was analyzed. These osteoporosis patients were divided into two groups; an exercise group and a control group. Markers linked to quality of life were compared for the women with osteoporosis with those of an average female Italian population of similar age. Markers for quality of life, specifically: Mobility, Usual Activities, Pain/Discomfort and Anxiety/Depression were significantly lower in the Italian osteoporosis patients than in the average population. Exercise slightly improved Mobility and Usual Activities for the osteoporosis patients, but the results did not reach statistical significance.

<p> This thesis focuses on an examination of cortical and trabecular bone density and geometry at the radius and tibia in postmenopausal women, primarily women with history of breast carcinoma, while also assessing musculoskeletal changes in postmenopausal breast cancer patients after treatment with the Aromatase Inhibitor, Anastrozole. The first sub-study is an investigation of the reproducibility of the pQCT measurement parameters at the radius and tibia in healthy pre-and postmenopausal women. Results indicated that the reproducibility was good at the radius and even better at the tibia for all parameters measured. The second study is an appraisal of the level of osteoporosis knowledge in a cohort of postmenopausal women. The participants were assessed via the Facts on Osteoporosis Quiz, a well validated questionnaire, and the data revealed significantly lower test scores among the breast cancer subjects in comparison with healthy postmenopausal women. In the remaining group of studies, pQCT technology was utilized to describe trabecular and cortical bone at the radius and tibia in postmenopausal women and women with a history of breast carcinoma whom had been prescribed Anastrozole. The following measurement sites were significantly lower in the breast cancer subjects: TOT_DEN and TOT_CNT at the 4% radius; CRT_DEN, TOT_CNT, and CRT_CNT at the 20% radius; TOT_DEN at the 4% tibia; and CRT_DEN at the 38% tibia. With respect to time on Anastrozole, TOT_CNT at the 4% radius (r=-0.36); TOT_CNT (r=-0.33), CRT_CNT (r=-0.34) and CRT_DEN (r=-0.44) at the 20% radius; and CRT_DEN (r=-0.39) and CRT_CNT (r=-0.27) at the 38% tibia were significantly negatively correlated with days on Anastrozole. Furthermore, after two years of Anastrozole treatment in a small cohort of breast cancer subjects, there was a significant decrease in CRT_DEN (p=0.025) at the 20% diaphyseal radius and also at the 38% diaphyseal tibia (p=0.051). Together, the sub-studies that comprise this thesis demonstrate that there are noteworthy deficiencies in osteoporosis knowledge among postmenopausal women, particularly those with a history of breast carcinoma, and yet, these are the same women that have an increased need to understand the preventative and treatment options regarding this disease as they demonstrate reduced bone density at all measurement sites. It also appears that time on Anastrozole primarily affects cortical bone density in these women. In summary, this thesis provides novel details regarding cortical bone in breast cancer subjects and emphasizes the need for a normative database of bone quality parameters at different skeletal sites in order to gain a better understanding of the utility of each skeletal site with regard to fracture risk prediction. </p> / Thesis / Doctor of Philosophy (PhD)

The primary purpose of this research was to examine the effects of HRT in women with acute estrogen deficiency from surgically induced menopause. The secondary purpose was to evaluate how HRT improves symptoms of acute estrogen deficiency and quality of life (QOL) in women using hormone supplementation. Peer reviewed articles published from 2000 to 2017 that were written in the English language with a focus on the use of HRT in women with acute estrogen deficiency after surgical menopause were evaluated for relevance. Evidence suggests the primary reason for decreased use of HRT is the associated risks outweighing the benefits; however, this is not reflected in health care provider's (HCP's) clinical experience. HCP's were more likely to prescribe HRT for themselves or family members if they were experiencing the negative side effects of estrogen deficiency due to surgical menopause, but not to women in their care with similar clinical manifestations of menopause. Additionally, serious risks associated with HRT for acute estrogen deficiency remain incongruent with HRT for women experiencing natural menopause; although risk for breast cancer due to HRT was a universal concern. Risks of HRT related to thromboembolism, stroke and heart disease, were discussed with comparison to the undesirable clinical manifestations of menopause. Results indicate further education and research is needed that explores the risks and benefits for HRT in women with sudden onset of estrogen deficiency from surgical menopause.

No description available.

Motivation - The burden of cardiovascular diseases (CVD) is increasing in developing countries worldwide, but even more so in sub-Saharan Africa. Due to rapid urbanisation, black populations experience lifestyle changes (e.g. unhealthy diet, increased access to alcohol and tobacco) that predispose them to increased obesity and cardiovascular risk. In this study, attention will be given to cardiovascular alterations, specifically arterial calcification, in lean and overweight/obese women nearing or already experiencing menopause. These include elevated blood pressure, large artery stiffness (indicated by increased central pulse pressure (cPP)) and carotid intima-media thickness (CIMT). Other factors linked to arterial calcification include the level of obesity as well as low bone mineral density. Ectopic calcification plays a significant role in cardiovascular morbidity and mortality, especially in renal failure patients, osteoporotic and elderly women. Factors contributing to the development and progression of arterial calcification include calciotropic hormones and altered bone metabolism, particularly in older postmenopausal women. This is due to the lack of protective effects of oestrogen against vascular alterations and bone loss after menopause. Previous studies have shown that increased bone resorption indicated by elevated levels of c-telopeptide of type I collagen (CTX), parathyroid hormone (PTH), low 25- hydroxycholecalciferol (25(OH)D3) and parathyroid hormone to 25-hydroxycholecalciferol ratio (PTH:25(OH)D3) are independently linked to arterial stiffening, CIMT and vascular calcification. Knowledge on the contribution of altered bone metabolism and associated calciotropic hormones on cardiovascular health in Africans is limited. Previous studies on ectopic calcification in South Africans focused on men and renal failure patients. This study will explore the possible role of altered calcium regulation and bone metabolism in the development of arterial calcification and CVD in older African women. Aim - The aim of this study was to investigate the associations of brachial and central pressures and CIMT with PTH, PTH:25(OH)D3 and CTX, a marker of bone resorption, in lean and overweight/obese African women older than 46 years. Methodology - This sub-study forms part of the Prospective Urban Rural Epidemiology (PURE) study. A total of 434 urban and rural women older than 46 years were included in the study. Women infected with the human immunodeficiency virus (HIV) were excluded from the study. The study was reviewed and approved by the Ethics Committee of the North-West University (Potchefstroom campus) and all participants signed an informed consent form prior to enrolment into the project. Field workers administered demographic, general health and physical activity questionnaires in the participants’ home language. Anthropometric measurements included weight, height and waist circumference, while body mass index (BMI) was calculated in kg/m2. Cardiovascular measurements included brachial and central systolic blood pressure (SBP), brachial diastolic blood pressure (DBP), brachial and central pulse pressure (PP) as well as CIMT and carotid cross-sectional wall area (CSWA). Blood pressure measurements were performed on the right arm with the participant in the sitting position. Blood was drawn after an overnight fasting period. We performed biochemical analyses from serum and plasma samples for follicle stimulating hormone (FSH), PTH, 25(OH)D3, and CTX. HIV testing was performed according to standardised procedures. Since interactions existed for BMI with regards to associations of CIMT and cPP with PTH:25(OH)D3, the study population was divided into the lean (BMI <25 kg/m2) and overweight/obese (BMI ≥25 kg/m2) groups. We performed independent T-tests to compare means and used the chi-square test to compare proportions. Single and multiple regression analyses were performed to investigate the associations of markers of vascular structure and function with CTX and calciotropic hormones. Results - In this study, 90% of the women displayed an FSH concentration exceeding the cut-off value of 35 mIu/mL, indicating a postmenopausal state. When comparing lean and overweight/obese African women, we found that lean women had higher levels of CTX and 25(OH)D3 (both p<0.001), while the overweight/obese group was older (p=0.007) and presented with higher PTH and PTH:25(OH)D3 levels (both p<0.001). Brachial and central pressures did not differ between the groups (p≥0.23), except for DBP being higher in the overweight/obese group (p=0.017). Overweight/obese women had higher CIMT (p<0.001) and CSWA (p=0.001) as compared to their lean counterparts. A larger proportion of lean women smoked (63%) and self-reported on alcohol use (37%) than overweight/obese women (41% and 18%, respectively) (both p<0.001). Forty-one percent of overweight/obese women used antihypertensive medication, opposed to 25% in the lean group (p=0.001). In multivariate regression analyses, an independent positive association existed between CIMT and PTH:25(OH)D3 (R2=0.22; β=0.26; p=0.003) in lean women. In the overweight/obese group independent positive associations were confirmed between brachial SBP and PTH (p=0.013) and CTX (p=0.038), and between DBP and PTH (p=0.030). Brachial PP and central SBP remained positively associated with CTX (p=0.016 and p=0.024, respectively), while cPP was independently associated with PTH:25(OH)D3 (R2=0.20; β=0.17; p=0.017) and CTX (R2=0.20; β=0.17; p=0.025). Conclusion - Our results indicate that in older African women, large artery structure and function are associated with calciotropic hormones and bone resorption, suggesting that altered bone metabolism and associated calciotropic hormones play a role in the development of vascular calcification. The different associations in lean and overweight/obese women suggest different mechanisms at work regarding arterial calcification in states of low and high adiposity. These findings need confirmation in larger prospective and experimental studies. / MSc (Physiology), North-West University, Potchefstroom Campus, 2014

Motivation - The burden of cardiovascular diseases (CVD) is increasing in developing countries worldwide, but even more so in sub-Saharan Africa. Due to rapid urbanisation, black populations experience lifestyle changes (e.g. unhealthy diet, increased access to alcohol and tobacco) that predispose them to increased obesity and cardiovascular risk. In this study, attention will be given to cardiovascular alterations, specifically arterial calcification, in lean and overweight/obese women nearing or already experiencing menopause. These include elevated blood pressure, large artery stiffness (indicated by increased central pulse pressure (cPP)) and carotid intima-media thickness (CIMT). Other factors linked to arterial calcification include the level of obesity as well as low bone mineral density. Ectopic calcification plays a significant role in cardiovascular morbidity and mortality, especially in renal failure patients, osteoporotic and elderly women. Factors contributing to the development and progression of arterial calcification include calciotropic hormones and altered bone metabolism, particularly in older postmenopausal women. This is due to the lack of protective effects of oestrogen against vascular alterations and bone loss after menopause. Previous studies have shown that increased bone resorption indicated by elevated levels of c-telopeptide of type I collagen (CTX), parathyroid hormone (PTH), low 25- hydroxycholecalciferol (25(OH)D3) and parathyroid hormone to 25-hydroxycholecalciferol ratio (PTH:25(OH)D3) are independently linked to arterial stiffening, CIMT and vascular calcification. Knowledge on the contribution of altered bone metabolism and associated calciotropic hormones on cardiovascular health in Africans is limited. Previous studies on ectopic calcification in South Africans focused on men and renal failure patients. This study will explore the possible role of altered calcium regulation and bone metabolism in the development of arterial calcification and CVD in older African women. Aim - The aim of this study was to investigate the associations of brachial and central pressures and CIMT with PTH, PTH:25(OH)D3 and CTX, a marker of bone resorption, in lean and overweight/obese African women older than 46 years. Methodology - This sub-study forms part of the Prospective Urban Rural Epidemiology (PURE) study. A total of 434 urban and rural women older than 46 years were included in the study. Women infected with the human immunodeficiency virus (HIV) were excluded from the study. The study was reviewed and approved by the Ethics Committee of the North-West University (Potchefstroom campus) and all participants signed an informed consent form prior to enrolment into the project. Field workers administered demographic, general health and physical activity questionnaires in the participants’ home language. Anthropometric measurements included weight, height and waist circumference, while body mass index (BMI) was calculated in kg/m2. Cardiovascular measurements included brachial and central systolic blood pressure (SBP), brachial diastolic blood pressure (DBP), brachial and central pulse pressure (PP) as well as CIMT and carotid cross-sectional wall area (CSWA). Blood pressure measurements were performed on the right arm with the participant in the sitting position. Blood was drawn after an overnight fasting period. We performed biochemical analyses from serum and plasma samples for follicle stimulating hormone (FSH), PTH, 25(OH)D3, and CTX. HIV testing was performed according to standardised procedures. Since interactions existed for BMI with regards to associations of CIMT and cPP with PTH:25(OH)D3, the study population was divided into the lean (BMI <25 kg/m2) and overweight/obese (BMI ≥25 kg/m2) groups. We performed independent T-tests to compare means and used the chi-square test to compare proportions. Single and multiple regression analyses were performed to investigate the associations of markers of vascular structure and function with CTX and calciotropic hormones. Results - In this study, 90% of the women displayed an FSH concentration exceeding the cut-off value of 35 mIu/mL, indicating a postmenopausal state. When comparing lean and overweight/obese African women, we found that lean women had higher levels of CTX and 25(OH)D3 (both p<0.001), while the overweight/obese group was older (p=0.007) and presented with higher PTH and PTH:25(OH)D3 levels (both p<0.001). Brachial and central pressures did not differ between the groups (p≥0.23), except for DBP being higher in the overweight/obese group (p=0.017). Overweight/obese women had higher CIMT (p<0.001) and CSWA (p=0.001) as compared to their lean counterparts. A larger proportion of lean women smoked (63%) and self-reported on alcohol use (37%) than overweight/obese women (41% and 18%, respectively) (both p<0.001). Forty-one percent of overweight/obese women used antihypertensive medication, opposed to 25% in the lean group (p=0.001). In multivariate regression analyses, an independent positive association existed between CIMT and PTH:25(OH)D3 (R2=0.22; β=0.26; p=0.003) in lean women. In the overweight/obese group independent positive associations were confirmed between brachial SBP and PTH (p=0.013) and CTX (p=0.038), and between DBP and PTH (p=0.030). Brachial PP and central SBP remained positively associated with CTX (p=0.016 and p=0.024, respectively), while cPP was independently associated with PTH:25(OH)D3 (R2=0.20; β=0.17; p=0.017) and CTX (R2=0.20; β=0.17; p=0.025). Conclusion - Our results indicate that in older African women, large artery structure and function are associated with calciotropic hormones and bone resorption, suggesting that altered bone metabolism and associated calciotropic hormones play a role in the development of vascular calcification. The different associations in lean and overweight/obese women suggest different mechanisms at work regarding arterial calcification in states of low and high adiposity. These findings need confirmation in larger prospective and experimental studies. / MSc (Physiology), North-West University, Potchefstroom Campus, 2014

No description available.

Le risque cardiométabolique (RCM) représente l’ensemble de tous les facteurs de risque pour les maladies cardiovasculaires et le diabète de type 2, incluant les facteurs de risque traditionnels et ceux émergents. Les évidences indiquent que la résistance à l’insuline, l’inflammation et le stress oxydant jouent un rôle clé dans le RCM, bien que l’acteur initiateur des altérations métaboliques caractéristiques du RCM reste encore à définir. Les femmes post-ménopausées constituent un sous-groupe important de la population puisque le risque de complications cardiométaboliques augmente après la ménopause. Les facteurs de RCM peuvent être modulés par l’alimentation, l’activité physique et la perte de poids. Alors que l’étude de nutriments / aliments spécifiques a permis de mieux comprendre l’implication de l’alimentation dans le RCM, celle de la qualité de l’alimentation est prometteuse. L’activité physique a des effets bénéfiques sur le RCM bien démontrés chez des personnes actives. Cependant, la relation entre la dépense énergétique et le RCM chez des individus sédentaires a été moins investiguée. De même, peu ou pas de données existent quant à une interaction synergique possible entre l’alimentation et l’activité physique sur le RCM. L’objectif de la présente thèse est d’investiguer les relations entre l’alimentation, l’activité physique, le stress oxydant et le RCM chez des femmes post-ménopausées en surpoids ou obèses, sédentaires et sans autres complications métaboliques. Les résultats montrent que d’une part, chez ces femmes sédentaires, une dépense énergétique active (DÉAP) élevée est associée à un meilleur profil inflammatoire, indépendamment de l’adiposité. D’autre part, il existe une relation synergique entre la qualité alimentaire et la DÉAP associée à un meilleur RCM. Une qualité alimentaire élevée combinée à une DÉAP élevée est associée à un meilleur profil lipidique et lipoprotéique et à une inflammation sub-clinique moindre, indépendamment de l’adiposité. Par ailleurs, dans une étude pilote, seuls des effets indépendants des changements de la qualité alimentaire et de la DÉAP sur les changements dans les facteurs de RCM ont été observés suite à cette diète hypocalorique de 6 mois, indépendamment du changement de l’adiposité encouru. En effet, au-delà de la réduction de l’adiposité et de l’amélioration du profil lipoprotéique induites par l’intervention, l’amélioration de la qualité alimentaire et de la DÉAP est associée, indépendamment l’une de l’autre, à une meilleure pression artérielle et un meilleur profil lipidique. Par ailleurs, une modification du système glutathion, un des systèmes antioxydants les plus communs de l’organisme, est associée à un RCM élevé. Une activité élevée de la glutathion peroxydase est associée à une résistance à l’insuline et à une épaisseur plus importante de l’intima-media de la carotide. Ces relations pourraient être médiées par un stress réducteur. En conclusion, l’adoption d’une saine alimentation et la pratique d’activités physiques doivent être encouragées dans les interventions visant à contrer l’obésité et ses complications, même en absence d’un changement d’adiposité. D’autre part, l’activité de la glutathion peroxydase pourrait être un paramètre impliqué dans le développement de désordres cardiométaboliques sub-cliniques et asymptomatiques chez des femmes obèses. D’autres investigations sont requises pour confirmer ces observations et élucider les mécanismes d’action impliqués. / The cardiometabolic risk represents all risk factors for cardiovascular diseases and type 2 diabetes, including the traditional and the emerging risk factors. Accumulating evidences indicate that insulin resistance, inflammation and oxidative stress are key players in the cardiometabolic risk, although the main cause initiating the metabolic alterations associated with the cardiometabolic risk has to be identified. Postmenopausal women are an important sub-group of the general population because the risk of developing cardiometabolic complications increases after menopause. The cardiometabolic risk factors can be modulated by dietary intake, physical activity and weight loss. Despite the fact that the study of specific nutrients or foods provided a better understanding of the implication of nutrition in the cardiometabolic risk, the relationship between diet quality and cardiometabolic risk has been less studied. Beneficial effects of physical activity on the cardiometabolic risk have been demonstrated in physically active individuals. However, the relationship between energy expenditure and the cardiometabolic risk in sedentary individuals has been less investigated. Similarly, it is unknown whether dietary intake interacts with physical activity in order to have greater beneficial effects on the cardiometabolic risk. The objective of this thesis is to determine the relationships between diet quality, physical activity and oxidative stress on the cardiometabolic risk in sedentary postmenopausal overweight and obese women without cardiometabolic complications. The results showed that, in these sedentary women, physical activity energy expenditure is associated with reduced inflammation, independently of adiposity. Moreover, there is a synergistic relationship between quality and physical activity energy expenditure (PAEE) which is associated with a reduced cardiometabolic risk compared to their separate effects. Indeed, high diet quality combined to high PAEE levels is associated with a better lipid and lipoprotein profile and a lower inflammatory status, independently of adiposity. However, in a pilot study, only independent effects of changes in diet quality and PAEE on the changes in cardiometabolic risk factors was observed following a 6-month hypocaloric diet. Indeed, beyond the reduction of adiposity and improvement of the lipoprotein profile induced by this diet, improved diet quality and increased PAEE are associated with beneficial changes in blood pressure and lipid profile. On the other hand, modification in the glutathione system, which is one of the most common antioxidant systems in the body, is associated with a higher cardiometabolic risk. Greater glutathione peroxidase activity is associated with insulin resistance and greater intima-media thickness of blood vessels. These relationships may be mediated through a reductive stress. In conclusion, a healthy diet and physical activity should be emphasized in interventions aimed to reduce obesity and its related complications, even in absence of change in adiposity. Moreover, glutathione peroxidase activity may be a parameter contributing to the development of sub-clinical but clinically relevant asymptomatic cardiometabolic abnormalities in obese women. Further investigations are needed to confirm these results and to elucidate the underlying mechanisms.

No description available.