Oral Contraceptives and Fat Patterning in Young Adult Women

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1 Iowa State University From the SelectedWorks of Ruth E. Litchfield February 11, 1988 Oral Contraceptives and Fat Patterning in Young Adult Women Ruth E. Litchfield, Iowa State University Katharine K. Grunewald Available at:

2 Oral Contraceptives and Fat Patterning in Young Adult Women Author(s): RUTH E. LITCHFIELD and KATHARINE K. GRUNEWALD Source: Human Biology, Vol. 60, No. 5 (OCTOBER 1988), pp Published by: Wayne State University Press Stable URL: Accessed: 24/09/ :35 Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at. JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. Wayne State University Press is collaborating with JSTOR to digitize, preserve and extend access to Human Biology.

3 Oral Contraceptives and Fat Patterning in Young Adult Women1 BY RUTH E. LITCHFIELD2 AND KATHARINE K. GRUNEWALD3 Abstract. Ninety white nulliparous young women (18-26 years of age) participated in a double-blind study designed to compare fat patterning and other physical measurements in oral contraceptive (OCA) users and nonusers. Oral contraceptive users (N = 30) and non-users (N = 60) were matched on a 1:2 basis for height and weight. The OCA users and nonusers had similar circumference and skinfold measurements, except that OCA users had larger axilla skinfold measurements. Progestational activity of the oral contraceptives was not associated with any measurements taken. However, estrogenic activity was positively correlated with measured body weight, body mass index, and arm and thigh circumferences. Because our study was cross-sectional, our data are preliminary and do not necessarily prove a cause-and-effect relationship. However they suggest a need for continued investigation this area. Fat patterning is an individual characteristic affected by several factors. Adult men tend to have a centralized (android) fat distribution whereas women have a more peripheral (gynoid) distribution (Vague 1956; Sjöström et al. 1972; Krotkiewski et al. 1983). Age and weight are positively correlated with waist/hip ratio (Lanska et al. 1985). Genetic influences are suggested by similarities between identical twins (Borjeson 1976) and mothers and their daughters (Vague 1947), as well as differences between children of different races (Robson et al. 1971). Weight loss does not seem to influence fat distribution in women (Ashwell et al. 1978). The objective of our study was to study fat distribution in young women who used or did not use oral contraceptives. A study of fat distribution in oral contraceptive (OCA) users is important because they have a greaterisk than non-users for hypertension (Wilson et al. 1984), glucose intolerance (Spellacy et al. 1981), and increased levels of serum triglycerides (Knopp et al. 1981). These disorders are more common in individuals having a centralized fat dis- Presented in part at the 71st Annual Meeting of the Federation of American Societies for Experimental Biology, held in Washington, D.C., April, Gutensohn Osteopathic Health and Wellness Clinic, 700 West Jefferson, Kirksville, MO Author to whom all correspondence should be addressed. Department of Foods and Nutrition, Kansas State University, Manhattan, KS Human Biology, October 1988, Vol. 60, No. 5, pp Wayne State University Press, 1988

4 794 / R.E. LITCHFIELD AND K.K. GRUNEWALD tribution (Weinsier et al. 1985; Feldman et al. 1969; Hartz et al. 1984; Albrink and Meigs 1964). In this cross-sectional study, fat distribution of OCA users is compared to that of non-users matched for height and weight. We also examined the relationship between the physical measurements of the OCA users and the hormonal potencies of the contraceptives. Materials and Methods Subjects. The subjects were a sub-population of 90 nulliparous white female college studentselected from two undergraduate introductory courses (Basic Nutrition and Concepts of Personal Health) at Kansas State University, Manhattan. All subjects were years of age without any reported physical disorder known to affect appetite or body weight. Oral contraceptive (OCA) users (N = 30), identified in a self-administered questionnaire, had been using the same brand of oral contraceptive for an average 17.7 months (range 3-36) and had not used another brand previously. Characteristics of the oral contraceptives are shown in Table 1. Each OCA user was matched to two non-users, based on weight (within 4.6 kg) and height (within 5.1 cm). Matching of subjects was done because we found in preliminary studies that OCA users tended to weigh less than nonusers. The non-users in our study had never taken oral contraceptives. Women in both groups began menstruating an average age of 13.0 years, and 3.3% of both groups were smokers. This study was conducted in accordance with the policies established by the Subcommittee on Research Involving Human Subjects, Kansas State University, Manhattan, Kansas. Prior to the study, the participants signed a consent form in which the procedures, risks, and benefits were explained. The study was conducted between 3 February and 4 March Anthropometric measurements. Each subject's height (without shoes) was measured to the nearest cm. A Detecto sliding- weight balance (Detecto Scales, Inc., Brooklyn, NY) was used to measure body weights of the women (in light clothing) to the nearest 0.1 kg. Seven skinfold measurements were taken in triplicate on the subjects' right side by an experienced examiner using a Lange skinfold caliper (Cambridge Scientific Industries, Cambridge, MD). The skinfold measurements taken were those at the triceps, subscapula, axilla, chest, suprailiac, abdomen, and thigh, as described by Pollock et al. (1984). Circumference measurements were also taken. Subjects were measured in the upright position in front of a fiill-length mirror. All circumference measure-

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6 796 / R.E. LITCHFIELD AND K.K. GRUNEWALD ments were taken in the horizontal plane using a thin (6mm) flexible steel metric tape held close to the body but not tight enough to indent the skin. Three chest measurements were taken: high chest (under arms and above the bust), bust (largest part of bust), and low chest (directly under bust). The midarm circumference was taken on the right arm halfway between the shoulder and elbow with the arm relaxed. The hip measurement was taken at the largest circumference around the buttocks. The righthigh was measured just below the gluteal fold. These methods for measurement are suggested in Pollock et al. (1984). The waist measurement was taken at the minimum circumference between the rib cage and iliac crest as described by Ashwell et al. (1982). The waist girth to hip ratio (WHR) was calculated as suggested by Lanska et al. (1985) where WHR = waist circumference/hip circumference. Body mass index was calculated as: BMI = weight/ (height) 2 where weight is reported as kilograms and height is in meters (Keys et al. 1972). Arm muscle diameter was calculated as (c/tt) - S, where c is the upper arm circumference (mm), tt is , and S is the tricepskinfold thickness (mm)(abraham 1983). Data Analysis* The ANOVA was chosen to compare OCA users and nonusers because of the two-groupaired block design of the study (Cochran 1983). The ANOVA F-test procedure analyzes pooled data, so the square root of the mean square error, which is the estimate of standar deviation of experimental error (Ray 1982a) was reported instead of the standar deviation of individual treatments. Additionally, estrogenic and progestational activities of combined oral contraceptives (Dickey 1984) were correlated with other variables using Spearman correlations (Ray 1982b). Sequential oral contraceptives were not used for those correlations because their formulation varies within the menstrual cycle. Results and Discussion In this study, fat distribution of young female OCA users was similar to that of non-users matched for height and weight. Both groups were comparable in their circumference and skinfold measurements, except that the OCA users had larger axilla skinfolds (Table 2). Progestational activity of the combined OCAs was not associated with any of the physical measurements. However, estrogenic activity of the combined OCAs was positively correlated with body weight, body mass index, and arm and thigh circumference measurements. Estrogenic activity was also weakly associated with hip (P<0.06) and low chest (P<0. 10) circumferences, but was not correlated with any of the seven skinfold thickness measurements nor the sum of the skinfold measurements.

7 Oral Contraceptives and Fat Patterning / 797 Table 2. Physical Characterisitics of Oral Contraceptive (OCA) Users and Non^Users Correlation with Comparison of OCA Users Hormonal Activities b and Non-Users a Estrogenic Progestational Non-Users OCA Users Activity Activity Measurement (N = 60) (N = 30) (N = 22) (N = 22) Height (without shoes) ± ± (cm) Weight (in light clothing) 59.9 ± ± ** (kg) Skinfold (mm) Triceps 18.2 ± ± Chest 13.6 ± ± Axilla 10.3 ± ± 3.3* Subscapular 13.0 ± ± Abdomen 21.0 ± ± Suprailiac 11.1 ± ± Thigh 25.6 ± ± Circumference (cm) Arm 26.8 ± ± ** High chest 84.2 ± ± Bust 88.2 ± ± Low chest 75.5 ± ± Waist 68.8 ± ± Hip 98.3 ± ± Thigh 57.3 ± ± * * 0.07 Calculated measurements Sum of 7 skinfolds (mm) ± ± Body mass index (BMI) 22.0 ± ± * * Waist/hip ratio (WHR) 0.70 ± ± Arm muscle diameter 67.2 ± ± (mm) aeach value is mean ± VMSE. bspearman's correlation coefficients for women on combined oral contraceptives. 'Significantly different from non-users, p < 0.05 (F-test). * 'Significant correlation, p < 0.05 (Spearman's test). Other studies have shown that estrogens can be taken up by adipose tissue (Bleau et al. 1974; Longcope et al. 1976), and influence its growth and distribution. Estrogenicompoundstimulate in vitro replication of human adipocyte precursors (Roncari and Van 1978). Men given estrogens for treatment of pros-

8 798 / R.E. LITCHFIELD AND K.K. GRUNEWALD täte carcinoma exhibited an increase in gluteal fat cell weight (Krotkiewski and Björntorp 1978). In a clinical study of transsexuals, testosterone decreased and estrogen increased the size of lower body adipocytes (Vague et al. 1984). Common side effects of oral contraceptives attributed to the estrogenicomponent include an increase in size or fat deposition in breast, hips, or thighs (Dickey 1984; Tatum 1980; Tyrer 1984). The oral contraceptive users in our study, as a group, had similar chest and thigh skinfold measurements when compared to the non-users. None of the skinfold measurements of OCA users were significantly correlated with the hormonal activities of their contraceptives. These data suggesthat the use of oral contraceptives does not influence fat distribution. However lack of an effect might be attributed to the short period of time that our subjects took oral contraceptives; the average useage was 17.7 months (range 3-36). Additionally, our subjects took one of 12 different formulations which makes interpretation difficult. One interesting finding in our study was the positive correlation between estrogenic activity of the combined oral contraceptives and body weight, body mass index, and circumference of arms, thighs, and (less significantly) hips. The meaning of this association is not clear, but seem to suggest a relationship between body shape and the estrogenicomponent of the contraceptives. The metabolism of adipose tissue appears to be influenced by its location in the body. Adipocytes from the gluteal-femoral region are less sensitive to catecholamine- induced lipolysis (Smith et al. 1979) and have a slower turnover of free fatty acids (Pittet et al. 1983) than those from the abdominal area. Lipoprotein lipase in gluteal-femoral adipocytes varies with the menstrual cycle (Rebuffé-Scrive et al. 1985) and is increaseduring lactation (Rebuffé-Scrive et al. 1985). These findingsuggesthat fat tissue in this region is influenced by female sex hormones. The estrogens and progestins used to formulate oral contraceptives vary in their dosage and biological activity. Since their introduction in the latter 1950's, the dosage of both hormones has declined. Consequently it is difficult to compare data among studies. Most researc has focused on weight or fat gain. According to two large surveys (Bradley 1985; McMurray 1985) women cited oral contraceptives as a factor leading to weight gain. However well-controlled studies (Kudzma et al. 1972; Goldzieher et al. 1971) have not supported this view. No study, to our knowledge, has examined fat patterning in oral contraceptives users, and the effects of hormonal potencies have not been assessed. Our study shows that fat distribution of young women who used oral contraceptives was similar to that of weight and height-matched non-users. Additionally, we found that the estrogenic potency of oral contraceptives was associated with greater body weight, body mass index, and larger arm and thigh circumference measurements. Because our study was not longitudinal we cannot

9 Oral Contraceptives and Fat Patterning / 799 conclude that there was a cause-and-effect relationship between oral contraceptives and the physical measurements observed. Our data are therefore preliminary. However the known effects of estrogenicompounds and data from our study suggest need for further investigation. Acknowledgments. We are most grateful to Dr. James Higgins and Mark Sorell, Department of Statistics, Kansas State University, for their assistance in experimental design and data analysis. Received 13 October J 987. Accepted 11 February Literature Cited Abraham, S Obese and overweight adults in the United States. Vital and Health Statistics, Series 11, No. 230, DHHS Pub. No , U.S. Government Printing Office, Washington, D.C. Albrink, M.J. and J.W. Meigs 1964 Interrelationship between skinfold thickness, serum lipids and blood sugar in normal men. Am. J. Clin. Nutr. 15: Ashwell, M., S. Chinn, S. Stalley and J.S. Garrow 1978 Female fat distribution: a photographic and cellularity study. Int. J. Obesity 2: Ashwell, M., S. Chinn, S. Stalley and J.S. Garrow 1982 Female fat distribution: a simple classification based on two circumference measurements. Int. J. Obesity 6: Bleau, G., K.D. Roberts and A. Chapdelaine 1974 The in vitro and in vivo uptake and metabolism of steroids in human adipose tissue. J. Clin. Endocrinol. Metab. 39: Borjeson, M The aetiology of obesity in children. A study of 101 twin pairs. Acta Paediat. Scand. 65: Bradley, P.J Conditions recalled to have been associated with weight gain in adulthood. Appetite 6: Cochran, W.G Planning and analysis of observational studies. New York: Wiley Publishing Inc. Dickey, R.P M anaging contraceptive pill patients, 4th ed. Durant, OK: Creative Infomatics, Inc. Feldman, R., A.J. Sender and A.B. Sieglaub 1969 Difference in diabetic and nondiabetic fat distribution patterns by skinfold measurements. Diabetes 18: Goldzieher, J.W.j L.E. Moses, E. Averkin, C. Scheel and B.Z. Taber 1971 A placebocontrolled double-blind crossover investigation of the side-effects attributed to oral contraceptives. Fértil. Steril. 22: Hartz, A.J., D.C. Rupley and A.A. Rimm 1984 The association of girth measurements with disease in 32,856 women. J. Epidemiol. 119: Keys, A., F. Fidanza, M.J. Karnonen, N. Kimura and H.L. Taylor 1972 Indices of relative weight and obesity. J. Chron. Dis. 25: Knopp, R.H., C.E. Walden, P.W. Wahl, J.J. Hoover, G.R. Warnick, J.J. Albers, J.T. Ogilvie and W.R. Hazzard 1981 Oral contraceptives and postmenopausal estrogen effects in lipoprotein triglyceride and cholesterol in an adult female population: Relationships to estrogen and progestin potency. J. Clin, Endocrinol. Metab. 53:

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