Original ArticleChildhood lung function as a determinant of menopause-dependent lung function decline
Introduction
With menopause begins the non-reproductive phase of a woman's life, including crucial changes of the activity of the hypothalamo-pituitary-gonadal axis [1]. The ovaries cease estrogen production and circulating concentrations of follicle stimulating hormone (FSH) and luteinizing hormone (LH) rise [2]. This entails various adverse health effects, such as osteoporosis and increased risk of developing diabetes or cardiovascular diseases [3], [4], [5], [6], [7]. Interestingly, also the naturally occurring age-dependent lung function decline is accelerated after menopause (menopause-dependent lung function decline) [8]. Lung function is a major predictor of longevity and quality of life, which thus gains even more importance as nowadays most women live far beyond the age of menopause [9]. After menopause the total lung function decline thus displays the sum of age-dependent and menopause-dependent lung function decline. Therefore it is pivotal to understand how to preserve good health and quality of life after menopause, for instance through prevention of excess menopause-dependent lung function decline [1, [10], [11], [12]].
Existing research already shows, that deficient lung growth in childhood is associated with negative pulmonary outcomes, even in the absence of a rapid decline during adult life [13], [14], [15]. Threfore, we hypothesize a priori that poor childhood lung function, which is associated with less than optimal lung function achieved [16], may further exacerbate the menopause-dependent lung function decline. Investigation into this research question may help strengthen the focus on modifiable factors during childhood with subsequent improvements in respiratory health during adult life [1, [10], [11], [12]]. Furthermore, and perhaps even more practically, such evidence will provide an impetus to support interventions on preconceptional, early life housing conditions and smoking cessation to halt worsening respiratory health during reproductive aging. Therefore, we assessed differences in menopause-dependent lung function decline between women with poor, regular and high childhood lung function.
Section snippets
Study design and population
The current analysis includes data from women born in 1961, participating in the Tasmanian Longitudinal Health Study (TAHS), for which the detailed methodology has been reported elsewhere [17]. In brief, the TAHS started in 1968 when 8583 Tasmanian children at age seven, were enrolled by their parents. The parents completed a respiratory health questionnaire for their child, who then underwent clinical examination and spirometry. The participants were followed-up regularly and the current
Results
The included 506 women provided a total of 737 observations across the two follow-ups conducted at age 45 years and 50 years. Two hundred eight women contributed with one pulmonary function test and 298 women contributed with two pulmonary function tests. The latent profile analysis estimated 426 observations (57.8%) to be from nonmenopausal women and 311 observations (42.2%) to be from postmenopausal women. Fig. 2 shows the corresponding concentrations, as well as the grouping pattern.
Discussion
To our knowledge, this is the first study investigating menopause-dependent lung function decline in relation to childhood lung function. We observed that the menopause-dependent FVC decline was significantly higher in women within the lowest tertile of childhood lung function, which is a novel finding. The menopause-dependent FEV1 decline showed a similar trend but was marginally significant. The menopause-dependent lung function decline being more pronounced for FVC than for FEV1 points
Conclusions
Lung function decline, characterized by the change in FVC, after menopause is greater among women with poor childhood lung function. Similar patterns were observed for FEV1. Our findings highlight the importance of childhood lung function as a determinant of respiratory health during reproductive aging and are relevant for the quality of life of women worldwide. Screening for low lung function in childhood might support policy-makers to develop holistic strategies to protect the subsequent most
Conflict of interest
The authors declare that they have no conflict of interest.
CRediT authorship contribution statement
Kai Triebner: Conceptualization, Data curation, Formal analysis, Writing – original draft. Dinh Bui: Conceptualization, Data curation, Formal analysis, Writing – original draft. Eugene Haydn Walters: Writing – review & editing, Writing – original draft. Michael J Abramson: Funding acquisition, Writing – review & editing, Writing – original draft. Gayan Bowatte: Data curation, Writing – review & editing, Writing – original draft. Brittany Campbell: Data curation, Writing – review & editing,
Funding
KT has received a postdoctoral fellowship from the University of Bergen. The study was supported by the National Health and Medical Research Council (NHMRC) of Australia, research grant 299901; the University of Melbourne; Clifford Craig Foundation; the Victorian, Queensland and Tasmanian Asthma Foundations; Royal Hobart Hospital; Helen MacPherson Smith Trust; GlaxoSmithKline. JLP, CJL, AJL, EHW and SCD are further funded through the NHMRC of Australia. PD is funded by a Ramón y Cajal fellowship
Ethical approval
This study was approved by the Human Ethics Review Committees at The University of Melbourne (Ethics ID: 1647529).
Provenance and peer review
This article was not commissioned and was externally peer reviewed.
Research data (data sharing and collaboration) (all research papers)
This article has an online data supplement. Otherwise, there are no linked research data sets for this paper. Data will be made available on request.
Acknowledgments
We thank all participants, field workers and coordinators of the TAHS for their efforts as well as Ersilia Bifulco and Sandra Suske from the Core Facility for Metabolomics at the University of Bergen for work done in connection with the hormone measurements. Further, we are very grateful for the travel support, granted by EPINOR.
References (41)
- et al.
A prospective population-based study of menopausal symptoms
Obstet. Gynecol.
(2000) - et al.
Risk factors and early origins of chronic obstructive pulmonary disease
The Lancet
(2015) - et al.
Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study
The Lancet
(2007) WHO Scientific Group On Research on the Menopause in the 1990s (1994: Geneva, Research on the Menopause in the 1990s: Report of a WHO Scientific Group WHO
(1996)- et al.
Menopause and the Perimenopausal transition
- et al.
Assessing osteoporosis risk factors in Spanish menopausal women
Gynecol. Endocrinol.
(2011) The emergence of the metabolic syndrome with menopause
J. Clin. Endocrinol. Metab.
(2003)- et al.
Sex hormones are associated with right ventricular structure and function: the MESA-right ventricle study
Am. J. Respir. Crit. Care Med.
(2011) - et al.
Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study
Am. J. Respir. Crit. Care Med.
(2003) - et al.
Menopause Is Associated with Accelerated Lung Function Decline
Am. J. Respir. Crit. Care Med.
(2017)
Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study
Thorax
Blue journal conference. Aging and susceptibility to lung disease
Am. J. Respir. Crit. Care Med.
The association between childhood asthma and adult chronic obstructive pulmonary disease
Thorax
Childhood lung function predicts adult chronic obstructive pulmonary disease and asthma–chronic obstructive pulmonary disease overlap syndrome
Am. J. Respir. Crit. Care Med.
Cohort profile: the Tasmanian longitudinal health study (TAHS)
Int. J. Epidemiol.
Standardisation of spirometry
Eur. Respir. J.
A sensitive method for estrogen profiling in human serum by liquid chromatography–tandem mass spectrometry., 16th European Congress of Endocrinology
Endocr. Abstr.
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