Relationship Between Insulin Sensitivity and Menstrual Cycle Is Modified by BMI, Fitness, and Physical Activity in NHANES

Abstract

Context There is evidence demonstrating variation in insulin sensitivity across the menstrual cycle. However, to date, research has yielded inconsistent results. Objective This study investigated variation in insulin sensitivity across the menstrual cycle and associations with BMI, physical activity and cardiorespiratory fitness. Design Data from 1906 premenopausal women in NHANES cycles 1999-2006 were analysed. Main outcome measures Menstrual cycle day was assessed using questionnaire responses recording days since last period. Rhythmic variation of plasma glucose, triglyceride and insulin, homeostatic model of insulin resistance (HOMA-IR) and adipose tissue insulin resistance index (ADIPO-IR) across the menstrual cycle were analysed using cosinor rhythmometry. Participants were assigned low or high categories of BMI, physical activity and cardiorespiratory fitness and category membership included in cosinor models as covariates. Results Rhythmicity was demonstrated by a significant cosine fit for glucose (p= 0.014) but not triglyceride (p= 0.369), insulin (p= 0.470), HOMA-IR (p=0.461) and ADIPO-IR (p= 0.335). When covariates were included, rhythmicity was observed when adjusting for: 1. BMI: glucose (p< 0.001), triglyceride (p< 0.001), insulin (p< 0.001), HOMA-IR (p< 0.001) and ADIPO-IR (p< 0.001); 2. Physical activity: glucose (p< 0.001), triglyceride (p= 0.006) and ADIPO-IR (p= 0.038); 3. Cardiorespiratory fitness: triglyceride (p= 0.041), insulin (p= 0.002), HOMA-IR (p= 0.004) and ADIPO-IR (p= 0.004). Triglyceride amplitude, but not acrophase, was greater in the high physical activity category compared to low (p=0.018). Conclusions Rhythmicity in insulin sensitivity and associated metabolites across the menstrual cycle are modified by BMI, physical activity and cardiorespiratory fitness.

Sex differences in central insulin action: Effect of intranasal insulin on neural food cue reactivity in adults with normal weight and overweight

“…Hence, the nutritional state could additionally modulate the brain’s response to food cues [ 35 , 42 , 51 , 55 – 57 ], though, the detailed underlying mechanisms remain unclear. Furthermore, hormonal fluctuations during the menstrual cycle have shown to influence peripheral and central insulin sensitivity [ 58 , 59 ]. Hence, further studies are needed to evaluate the complex interplay of sex hormones and nutritional state on the brain response to physiological and environmental cues.…”

“…In our current study, we could not analyze the impact of menstrual cycle or contraceptive medication as the sample size was not large enough for further stratified analyses. Nonetheless, it is known that peripheral insulin sensitivity changes throughout the cycle [ 58 ] and also eating behavior and preferences may change [ 18 ] and should therefore be addressed in further experiments. Furthermore, peripheral insulin sensitivity was not assessed through hyperinsulinemic-euglycemic clamp but estimated with the widely-used Matsuda index from repeated insulin and glucose measurements during an oGTT [ 65 ].…”

Changes in adipose tissue microRNA expression across the menstrual cycle in regularly menstruating females: a pilot study

“…This study recruited young, healthy, regularly menstruating women and as such findings must be extrapolated to a broader population with caution. Elevated adiposity and insulin resistance are associated with greater perturbations in ovarian hormone concentrations and metabolic control across the menstrual cycle (5,6,63,64).…”

“…Cyclical fluctuations in hormonal profiles between menstrual cycle phases are associated with variable metabolic control in regularly menstruating women. Studies report elevated glucose and insulin during the luteal phase, alongside reduced triglyceride and cholesterol (5)(6)(7)(8). Correspondingly, glycemic control, lipid control, insulin resistance and energy expenditure differ between menstrual cycle phases (6,7,9,10).…”

Association between waist-hip ratio and subclinical myocardial injury in the general population: Insights from the NHANES

“…Previous studies have shown that adipose factors mainly from adipose tissue were associated with a variety of metabolic-related diseases, abdominal fat mainly produced harmful adipokines that led to worse clinical outcomes, while hip fat was the opposite (35-37). In addition, excessive abdominal fat can directly or indirectly cause sympathetic hyperactivity and abnormal secretion of adipose factors including adiponectin and leptin, which in turn leads to the occurrence and development of dyslipidemia, prethrombotic state (such as platelet activation), insulin resistance and chronic inflammation, which are the several established independent risk factors of CVD (19,(38)(39)(40). Therefore, the higher the WHR, the higher the risk of CVD, which may be mediated by abnormal fat distribution and adipokine dysfunction.…”