Body weight and composition in users of levonorgestrel-releasing intrauterine system

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Background: There is little information about body weight and body composition (BC) among users of the levonorgestrel-releasing intrauterine system (LNG-IUS). The aim of this study was to evaluate body weight and BC in LNG-IUS users compared to users of the TCu380A intrauterine device (IUD). Study Design: A prospective study was done with 76 new users of both contraceptive methods. Women were paired by age (+/- 2 years) and body mass index (BMI, kg/m(2), +/- 2). Body weight and BC (% lean mass and % fat mass) were evaluated by a trained professional at baseline and at 1 year of contraceptive use. The BC measurements were obtained using Lunar DXA equipment. Weight and BC were evaluated in each woman at baseline and at 12 months and analyzed as the mean change within each woman. Then, the changes in weight and BC for each woman were calculated and then compared between LNG-IUS and TCu380A IUD users (paired data for each woman). The central-to-peripheral fat ratio was calculated by dividing trunk fat by the upper and lower limb fat. Results: There were no significant differences at time of IUD insertion between LNG-IUS and TCu380A IUD users regarding age (mean +/- SD) (34.4 +/- 7.5 vs. 33.9 +/- 8.0 years), BMI (25.3 +/- 4.1 vs. 25.9 +/- 4.1) and number of pregnancies (1.9 +/- 0.2 vs. 1.7 +/- 0.2), respectively. Mean body weight gain of 2.9 kg was observed among LNG-IUS users at 12 months (p=.0012), whereas the body weight of TCu380A IUD users only increased by 1.4 kg (p=.067). There was no significant difference in body weight change between the two groups of users at 12 months. The variation in the central-to-peripheral fat ratio was the same between the two groups (-1.6% vs. -0.2%; p=.364). LNG-IUS users showed a 2.5% gain in fat mass (p=.0009) and a 1.4% loss of lean mass, whereas TCu380A IUD users showed a loss of 1.3% of fat mass (p=.159) and gain of 1.0% of lean mass (p=.120). TCu380A IUD users gained more lean mass than LNG-IUS users (p=.0270), although there was no significant difference between the two groups after 12 months of use. Conclusions: Although an increase in mean fat mass among LNG-IUS users at 12 months of use was observed, it should be noted that an increase of body weight was also observed in both groups after 1 year of insertion of the device. However, a study with a larger number of women and long-term evaluation is necessary to evaluate these body changes. (C) 2012 Elsevier Inc. All rights reserved.864350353Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAPESP [2009/15595-4]CNPq [573747/2008-3

Body Weight And Body Composition Of Depot Medroxyprogesterone Acetate Users

Objectives Weight gain is a concern with the contraceptive depot-medroxyprogesterone acetate (DMPA); however, this issue remains controversial. The objective of this study was to compare body weight (BW) and body composition (BC) in DMPA and copper intrauterine device (IUD) users at baseline and after one year of use. Study Design We enrolled new DMPA users and age and weight matched new IUD users into this prospective study. Weight and height were measured, BC (fat and lean mass) was evaluated using dual-energy X-ray absorptiometry, and physical activity was assessed at baseline and at 12 months. Student's paired t test and the Wilcoxon paired test for matched samples were used. Results Ninety-seven women were enrolled for the study; 26 matched pairs continued using the initial method for at least one year, and completed the baseline and 12 month assessments. An increase of 1.9 kg occurred in BW (p=.02) in DMPA users at 12 months of use, resulting from an increase in fat mass of 1.6 kg (p=.03). Weight remained stable in IUD users; however, there was an increase in lean mass at 12 months of use (p=.001). The number of women practicing physical activity increased in this group. There was a significant difference between the groups regarding the variation in the percentage of central fat (p=.04). Conclusion Weight gain in the DMPA group after the first year of use resulted from an increase in fat mass. Weight remained stable in the IUD group; however, an increase in lean mass and a reduction in localized abdominal fat mass occurred, possibly because more users were practicing physical activity. Implications statement There was a greater increase in body weight in DMPA users compared to TCu380A IUD users in the first year of use of the contraceptive method. Furthermore, the weight increase in users of DMPA occurred principally as the result of an increase in fat mass. Physical activity probably could increase the lean mass in the users of TCu380A IUD. © 2014 Elsevier Inc.902182187(2003) Nutrition. Controlling the Global Obesity Epidemic, , http://www.who.int/nutrition/topics/obesity/en/, Word Health Organization Geneva [accessed 26 Mar 2013]. Available atLopez, L.M., Edelman, A., Chen, M., Otterness, C., Trussell, J., Helmerhorst, F.M., Progestin-only Contraceptives: Effects on Weight, , http://www.cdc.gov/nchs/data/databriefs/db82.pdf, Cochrane Database of Systematic Reviews 2013, Issue 7. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009-2010. NCHS Data Brief. 201282:1-7 [accessed 4 Oct 2012]Wright, S.M., Aronne, L.J., Causes of obesity (2012) Abdom Imaging, 37, pp. 730-732OPAS. Organização Pan-Americana da Saúde. Doenças crônico-degenerativas e obesidade: estratégia mundial sobre alimentação saudável, atividade física e saúde. Brasília, DF: OPAS2003Bakry, S., Merhi, Z.O., Scalise, T.J., Mahmoud, M.S., Fadiel, A., Naftolin, F., Depot-medroxyprogesterone acetate: An update (2008) Arch Gynecol Obstet, 278, pp. 1-12Westhoff, C., Jain, J.K., Milson, I., Ray, A., Changes in weight with depot medroxyprogesterone acetate subcutaneous injection 104 mg/0,65 ml (2007) Contraception, 75, pp. 261-267Guilbert, E.R., Brown, J.P., Kaunitz, A.M., The use of depot-medroxyprogesterone acetate in contraception and its potential impact on skeletal health (2009) Contraception, 79, pp. 167-177Berenson, A.B., Rahman, M., Changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio associated with injectable and oral contraceptive use (2009) Am J Obstet Gynecol, 200, pp. 329e1-329e8Clark, M.K., Dillon, J.S., Sowers, M., Nichols, S., Weight, fat mass, and central distribution of fat increase when women use depot-medroxyprogesterone acetate for contraception (2005) Int J Obes, 29, pp. 1252-1258Haji Kazemi, E., Nikpoor, S., Haghani, H., Reasons for discontinuation of depot medroxyprogesterone acetate (2004) International Congress Series, 1271, pp. 315-318Haider, S., Darney, P.D., Injectable contraception (2007) Clin Obstet Gynecol, 50, pp. 898-906Le, Y.C., Rahman, M., Berenson, A.B., Early weight gain predicting later weight gain among depot medroxyprogesterone acetate users (2009) Obstet Gynecol, 114 (2 PART 1), pp. 279-284Bahamondes, L., Del Castillo, S., Tabares, G., Arce, X.E., Perrotti, M., Petta, C., Comparison of weight increase in users of depot medroxyprogesterone acetate and copper IUD up to 5 years (2001) Contraception, 64, pp. 223-225Canto De Cetina, T.E., Canto, P., Luna, M.O., Effect of counseling to improve compliance in Mexican women receiving depot-medroxyprogesterone acetate (2001) Contraception, 63 (3), pp. 143-146Friendly, M., (1995) SAS System for Statistical Graphics, Version 1.2, , http://euclid.psych.yorku.ca/SCS/sasmac/, First Edition SAS Institute Inc Cary, NC, USA Available at: http://www.yorku.ca/SCS/sasmac/fpower.htmlPantoja, M., Medeiros, T., Baccarin, M.C., Morais, S.S., Bahamondes, L., Fernandes, A.M., Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive (2010) Contraception, 81, pp. 107-111Hassan, D.F., Petta, C.A., Aldrighi, J.M., Bahamondes, L., Perrotti, M., Weight variation in a cohort of women using copper IUD for contraception (2003) Contraception, 68, pp. 27-30Buppasiri, P., (2012) Progestin-only Contraceptives: Effects on Weight. The WHO Reproductive Health Library, , World Health Organization GenevaBalasch, J., Sex steroids and bone: Current perspectives (2003) Hum Reprod Update, 9, pp. 207-222Karastergiou, K., Smith, S.R., Greenberg, A.S., Fried, S.K., Sex differences in human adipose tissues - The biology of pear shape (2012) Biol Sex Differ, 3, p. 13Wajchenberg, B.L., Subcutaneous and visceral adipose tissue: Their relation to the metabolic syndrome (2000) Endocr Rev, 21, pp. 697-738Ismail, I., Keating, S.E., Baker, M.K., Johnson, N.A., A systematic review and meta-analysis of the effect of aerobic vs resistance exercise training on visceral fat (2012) Obes Rev, 13, pp. 68-91Irving, B.A., Davis, C.K., Brock, D.W., Effect of exercise training intensity on abdominal visceral fat and body composition (2008) Med Sci Sports Exerc, 40, pp. 1863-1872O'Leary, V.B., Marchetti, C.M., Krishnan, R.K., Stetzer, B.P., Gonzalez, F., Kirwan, J.P., Exercise-induced reversal of insulin resistance in obese elderly is associated with reduced visceral fat (2006) J Appl Physiol, 100, pp. 1584-1589Lopez, L.M., Edelman, A., Chen-Mok, M., Trussell, J., Helmerhorst, F.M., Progestin-only contraceptives: Effects on weight (2011) Cochrane Database Syst Rev, 13 (4). , CD00881

Exploratory Study Of The Effect Of Lifestyle Counselling On Bone Mineral Density And Body Composition In Users Of The Contraceptive Depot- Medroxyprogesterone Acetate

Objectives To compare variations in bone mineral density (BMD) and body composition (BC) in depot-medroxyprogesterone acetate (DMPA) users and nonusers after providing counselling on healthy lifestyle habits. Methods An exploratory study in which women aged 18 to 40 years participated: 29 new DMPA users and 25 new non-hormonal contraceptive users. All participants were advised on healthy lifestyle habits: sun exposure, walking and calcium intake. BMD and BC were assessed at baseline and 12 months later. Statistical analysis included the Mann-Whitney test or Student's t-test followed by multiple linear regression analysis. Results Compared to the controls, DMPA users had lower BMD at vertebrae L1 and L4 after 12 months of use. They also had a mean increase of 2 kg in total fat mass and an increase of 2.2% in body fat compared to the non-hormonal contraceptive users. BMD loss at L1 was less pronounced in DMPA users with a calcium intake ≥ 1 g/day compared to DMPA users with a lower calcium intake. Conclusions DMPA use was apparently associated with lower BMD and an increase in fat mass at 12 months of use. Calcium intake ≥ 1 g/day attenuates BMD loss in DMPA users. Counselling on healthy lifestyle habits failed to achieve its aims. © 2014 The European Society of Contraception and Reproductive Health.194244249Scholes, D., La Croix, A.Z., Ichikawa, L.E., Injectable hormone contraception and bone density: Results from a prospective study (2002) Epidemiology, 13, pp. 581-587Berenson, A.B., Breitkopf, C.R., Grady, J.J., Effects of hormonal contraception on bone mineral density after 24 months of use (2004) Obstet Gynecol, 103, pp. 899-906Cundy, T., Cornish, J., Roberts, H., Spinal bone density in women using depot medroxyprogesterone contraception (1998) Obstet Gynecol, 92, pp. 569-573Scholes, D., La Croix, A.Z., Ott, S.M., Bone mineral density in women using depot medroxyprogesterone acetate for contraception (1999) Obstet Gynecol, 93, pp. 233-238Berenson, A.B., Radecki, C.M., Grady, J.J., A prospective, controlled study of the effects of hormonal contraception on bone mineral density (2001) Obstet Gynecol, 98, pp. 576-582Wetmore, C.M., Ichikawa, L., LaCroix, A.Z., Association between caffeine intake and bone mass among young women: Potential effect modification by depot medroxyprogesterone acetate use (2008) Osteoporos Int, 19, pp. 519-527Berenson, A.B., Rahman, M., Breitkopf, C.R., Effects of depot medroxyprogesterone acetate and 20-microgram oral contraceptives on bone mineral density (2008) Obstet Gynecol, 112, pp. 788-799Clark, M.K., Sowers, M.R., Nichols, S., B one mineral density changes over two years in first-Time users of depot medroxyprogesterone acetate (2004) Fertil Steril, 82, pp. 1580-1586Clark, M.K., Sowers, M., Levy, B., Bone mineral density loss and recovery during 48 months in first-Time users of depot medroxyprogesterone acetate (2006) Fertil Steril, 86, pp. 1466-1474Wanichsetakul, P., Bone mineral density at various anatomic bone sites in women receiving combined oral contraceptives and depo-medroxyprogesterone acetate for contraception (2002) Contraception, 65, pp. 407-410Kaunitz, A.M., Miller, P.D., Rice, V.M., Bone mineral density in women aged 25-35 years receiving depot medroxyprogesterone acetate: Recovery following discontinuation (2006) Contraception, 74, pp. 90-99Albertazzi, P., Bottazzi, M., Steel, S.A., Bone mineral density and depot medroxyprogesterone acetate (2006) Contraception, 73, pp. 577-583Prophylaxis and treatment of osteoporosis (1991) Osteoporos Int, 1, pp. 114-117. , Consensus Development ConferenceWarensjo, E., Byberg, L., Melhus, H., Dietary calcium intake and risk of fracture and osteoporosis: Prospective longitudinal cohort study (2011) BMJ, 24, pp. d1473Michaëlsson, K., Melhus, H., Bellocco, R., Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk (2003) Bone, 32, pp. 694-703Feskanich, D., Willett, W.C., Colditz, G.A., Calcium, vitamin D, milk consumption, and hip fractures: A prospective study among postmenopausal women (2003) Am J Clin Nutr, 77, pp. 504-511Pludowski, P., Holick, M.F., Pilz, S., Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-A review of recent evidence (2013) Autoimmun Rev, 12, pp. 976-989Murad, H.M., Elamin, K.B., Abu Elnour, N.O., The effect of vitamin D on falls: A systematic review and metaanalysis (2011) J Clin Endocrinol Metab, 96, pp. 2997-3006Ahola, R., Korpelainen, R., Vainionpaa, A., Daily impact score in long-Term acceleration measurements of exercise (2010) J Biomech, 43, pp. 1960-1964Berenson, A.B., Rahman, M., Changes in weight, total fat, percent body fat, and central-To-peripheral fat ratio associated with injectable and oral contraceptive use (2009) Am J Obstet Gynecol, 200, p. 329. , e1-8Clark, M.K., Dillon, J.S., Sowers, M., Weight, fat mass, and central distribution of fat increase when women use depot-medroxyprogesterone acetate for contraception (2005) Int J Obes, 29, pp. 1252-1258Frost, H.M., Schonau, E., The muscle-bone unit in children and adolescents (2000) J Pediatr Endocrinol Metab, 13, pp. 571-590Babatunde, O.O., Forsyth, J.J., Association between depot medroxyprogesterone acetate (DMPA), physical activity and bone health (2013) J Bone Miner Metab, 32, pp. 305-31

Body Composition And Weight Gain In New Users Of The Three-monthly Injectable Contraceptive, Depot-medroxyprogesterone Acetate, After 12 Months Of Follow-up

Objectives: To evaluate weight gain and body composition (BC) in new users of depot-medroxyprogesterone acetate (DMPA) as a contraceptive. Methods: This cohort study followed up 20 DMPA users and 20 copper intrauterine device (TCu380A IUD) users, paired for age (±1 year) and body mass index (BMI±1 kg/m2), during 12-months. Healthy, non-obese women aged 18 to 40 years, unaffected by conditions that could influence their body weight, were enrolled. Socio-demographic variables, habits, weight, BMI, BC using dual-energy X-ray absorptiometry, circumferences, skinfold thickness, body fat percentage and waist-to-hip ratio were evaluated. All participants were encouraged to adopt healthy habits. Results: At baseline, median age was 29 and 30.5 years, and mean BMI was 24.8 and 24.5 kg/m2 in the DMPA and IUD groups, respectively. At 12 months, an increase was observed in waist and hip circumference in the DMPA users and 8/20 of them had a weight gain ≥5% (mean 4.6 kg) with accumulation of fat centrally. Conclusions There were no differences in weight gain or in BC measurements between the groups; nevertheless 40% of women in the DMPA group had larger weight gain and accumulation of fat centrally. The duration of follow-up may have been insufficient to detect differences between the groups.196432438Fraser, I.S., Weisberg, E., A comprehensive review of injectable contraception with special emphasis on depot medroxyprogesterone acetate (1981) Med J Aust, 1 (1), pp. 3-19Mosher, W.D., Martinez, G.M., Chandra, A., Use of contraception and use of family planning services in the United States: 1982-2002 (2004) Advance Data from Vital and Health Statistics, (350), pp. 1-36. , Hyattsville, MD: National Center for Health StatisticsBakry, S., Merhi, Z.O., Scalise, T.J., Depot-medroxyprogesterone acetate: An update (2008) Arch Gynecol Obstet, 278, pp. 1-12Pelkman, C., Hormones and weight change (2002) J Reprod Med, 47, pp. 791-794Taneepanichskul, S., Reinprayoon, D., Khaosaad, P., Comparative study of weight change between long-term DMPA and IUD acceptors (1998) Contraception, 58, pp. 149-151Clark, M.K., Dillon, J.S., Sowers, M., Weight, fat mass, and central distribution of fat increase when women use depot-medroxyprogesterone acetate for contraception (2005) Int J Obes, 29, pp. 1252-1258Westhoff, C., Jain, J.K., Milsom, I., Changes in weight with depot medroxyprogesterone acetate subcutaneous injection 104 mg/0.65 mL (2007) Contraception, 75, pp. 261-267Berenson, A.B., Rahman, M., Changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio associated with injectable and oral contraceptive use (2009) Am J Obstet Gynecol, 200, pp. 329+e1-8Le, Y.C., Rahman, M., Berenson, A.B., Early weight gain predicting later weight gain among depot medroxyprogesterone acetate users (2009) Obstet Gynecol, 114, pp. 279-284Friendly, M., (1995) SAS System for Statistical Graphics, Version 1.2, 1st Edn., , http://euclid.psych.yorku.ca/SCS/sasmac/, Cary, NC: SAS Institute Inc. Accessed 18 April 2014 from: http://euclid.psych.yorku.ca/SCS/sasmac/fpower.ht(2010) Critério de Classificac¸ão Econômica Brasil The Brazilian Economic Classification Criteria, , http://www.abep.org/novo/Utils/FileGenerate.ashx?id=46, Brazilian Association of Research Companies Accessed 18 April 2014 fromFord, E.S., Kohl, H.W., 3rd, Mokdad, A.H., Sedentary behavior, physical activity, and the metabolic syndrome among U.S. adults (2005) Obes Res, 13, pp. 608-614Lohman, T.G., Roche, A.F., Martorell, R., (1991) Anthropometric Standardization Reference Manual, 1st Edn., , Champaign, IL: Human Kinetics BooksPhysical status: The use and interpretation of anthropometry (1995) Technical Report Series, (854). , http://whqlibdoc.who.int/trs/WHO_TRS_854.pdf?ua=1, Geneva: World Health Organization Accessed 18 April 2014 fromFaulkner, J.A., Physiology of swimming and diving (1968) Exercise Physiology, pp. 415-446. , Falls H, ed. Baltimore: Academic PressAmatayakul, K., Sivasomboon, B., Thanangkul, O., A study of the mechanism of weight gain in medroxyprogesterone acetate users (1980) Contraception, 22, pp. 605-622Vickery, Z., Madden, T., Zhao, Q., Weight change at 12 months in users of three progestin-only contraceptive methods (2013) Contraception, 88, pp. 503-508Pantoja, M., Medeiros, T., Baccarin, M.C., Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive (2010) Contraception, 81, pp. 107-111Bonny, A.E., Ziegler, J., Harvey, R., Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method (2006) Arch Pediatr Adolesc Med, 160, pp. 40-45Bonny, A.E., Lange, H.L., Rogers, L.K., A pilot study of depot medroxyprogesterone acetate pharmacokinetics and weight gain in adolescent females (2014) Contraception, 89, pp. 357-360Haider, S., Darney, P.D., Injectable contraception (2007) Clin Obstet Gynecol, 50, pp. 898-90