Abdominal Obesity and Metabolic Alterations in the Menopausal Transition

Abstract

The prevalence of overweight and obesity is strikingly increasing worldwide. Obesity is a major risk factor for non–insulin-dependent diabetes mellitus, cardiovascular diseases, and cancer, and is also associated with various psychosocial consequences. Menopausal transition is associated with unfavorable changes in body composition and abdominal fat deposition, which is accompanied by an increment of insulin resistance/hyperinsulinemia, a decrease in sex hormone-binding globulin levels and, consequently, an increase in free testosterone and greater androgenicity. Central body fat also correlates with deleterious changes in adipokines and inflammation markers like leptin, C-reactive protein, and adiponectin. In addition, the greater deposition of visceral fat in the menopausal transition contributes to the development of an atherogenic lipoprotein profile, which includes high triglyceride and low high-density lipoprotein (HDL) cholesterol concentrations, as well as an increment of small dense low-density lipoprotein (LDL) subfraction, intermediate density lipoproteins (IDL), apolipoprotein (apo) B/apo A-I ratio and lipoprotein(a).