Women in post-menopause with a higher waist-to-hip ratio (WHR) measure, they present worse performance in the cognitive domains in tests of verbal memory, auditory and visual attention, language and executive function. This is what a study recently published in the journal Menopause, conducted by researchers from the United States, concludes.
The research analyzed data from more than 700 women, aged between 42 and 58 years, followed for four years in the Kronos Early Estrogen Prevention Study (KEEPS-Cog) survey. The participants had been natural for three years and were divided into three groups: one received oral estrogen; another, transdermal estradiol; and, in the control group, a placebo was applied. Women with diabetes or high cardiovascular risk were excluded from the analysis.
Cognitive assessment was performed at the beginning of the study and after 18, 36 and 48 months. The main marker analyzed was the waist-hip ratio, which estimates the amount of abdominal fat in relation to the hip measurement. The results indicate that 61.5% of the women evaluated had a waist circumference greater than 80 cm, which indicates metabolic risk. And 28.7% had an index of 0.85 when comparing waist and hip measurements, which indicates the presence of abdominal fat.
“WHR reflects the distribution of body fat, differentiating central from peripheral accumulation. And this is fundamental because visceral fat is associated with greater insulin resistance, low-grade inflammation and increased cardiovascular risk”, explains gynecologist and nutritionist Alessandra Bedin Pochini, from Einstein Hospital Israelita.
Women with this higher measurement at the beginning of the study showed worse results in tests that assessed verbal memory, auditory attention, visual attention and executive function — skills linked to planning, organization and impulse control.
Estrogen plays a decisive role in this dynamic. “During reproductive life, adequate levels of the hormone favor greater deposition of peripheral fat. With the drop in estrogen during menopause, there is a shift towards greater centralization”, details Bedin. In other words, even if you maintain your weight, there may be metabolic worsening.
It modulates, among other things, endothelial function, glucose metabolism, lipid profile and exerts direct effects on the central nervous system, including synaptic plasticity and cerebral blood flow. “When this protective factor decreases with menopause, a more favorable environment is created for metabolic and, secondarily, cognitive changes”, warns the gynecologist.
This is why the waist-to-hip ratio may be a more sensitive marker than the body mass index (BMI) — a calculation that relates weight and height to estimate whether a person is within an appropriate weight range — to capture risks during menopause.
Hormone therapy and lifestyle
The research did not find a harmful effect of hormone therapy with estrogen replacement on women’s cognition, nor did it observe that it could modify the association between higher WHR and worse cognitive performance. “There is still fear that hormone therapy may worsen cognition, which is not confirmed with current schemes and protocols. In this study, there was no sign of cognitive damage”, comments the doctor.
Even so, hormone therapy cannot be used to prevent dementia — it must be indicated according to an individual assessment with a gynecologist. To protect the brain, lifestyle is the main ally.
“The first step is to invest in a less processed diet, adequate in proteins and micronutrients, associated with regular exercise, especially strength training combined with aerobic activity, which helps reduce visceral fat and improves sensitivity to skin diseases”, advises Alessandra Bedin. Maintaining health monitoring is also essential to evaluate, among other things, waist circumference, waist-hip ratio and metabolic markers.
