Objective: Visceral adipose tissue (VAT) is increased in the postmenopausal state, which may contribute to an increase in cardiovascular diseases. This study was undertaken to investigate whether there is a difference in the change of VAT during a weight reduction program between premenopausal and postmenopausal obese women.
Design: This study was a longitudinal clinical intervention of a weight reduction program, including lifestyle modification and adjuvant pharmacotherapy, for 12 weeks in 21 premenopausal and 19 postmenopausal obese women. Weight, height, body fat percentage, and waist and hip circumferences were measured. Visceral, subcutaneous, and total adipose tissue of the abdomen were determined by CT scan at the level of L4-L5 before and after weight reduction.
Results: The percent changes in VAT and the visceral-to-subcutaneous adipose tissue ratio, as well as waist circumference and waist-to-hip ratio, in the postmenopausal women were significantly less than those in the premenopausal women, whereas the percent changes in hip circumference, fat mass, total adipose tissue, and subcutaneous adipose tissue were similar in the two groups. The association between percent changes of VAT and the percent change of waist circumference is stronger in postmenopausal than in premenopausal women.
Conclusions: The postmenopausal women lost less VAT compared with the premenopausal women during the weight reduction program. This may make it more difficult for postmenopausal women to overcome the increased risk of cardiovascular diseases compared with premenopausal women.
It is now well established that abdominal body fat distribution, that is, increased visceral adipose tissue, is a more important determinant for both metabolic disorders and cardiovascular diseases than obesity per se. 1–3 After menopause, the risk of cardiovascular and metabolic disease increases. 4–7 The etiology of increased cardiovascular risk in postmenopausal women is unclear but may be linked in part with changes in body fat distribution. 8 In this regard, the increase in visceral fat accumulation in menopause 9,10 is shown to be correlated with the risk factors for cardiovascular diseases, including impaired glucose tolerance, dyslipidemia, and hypertension.
Several studies have shown changes in abdominal fat distribution during weight reduction in the obese participants. 11–14 To date, however, there has been only one study 15 evaluating the changes of abdominal fat distribution during weight reduction according to menopausal status. It was shown that postmenopausal women lost less body weight compared with premenopausal women with no significant difference of visceral fat loss between two groups. 15 That study was performed in white women with severe obesity (body mass index [BMI] ≥ 35.0 kg/m2). Asian people are less obese but tend to have a larger amount of visceral fat compared with white people. 16,17 The aim of the present study was to investigate the changes of abdominal fat distribution during a weight reduction program in premenopausal and postmenopausal Asian women with similar values of whole fatness and abdominal fat distribution.
From the 1Department of Family Medicine and the 2Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Received April 11, 2002; revised and accepted September 18, 2002.
Address reprint requests to Hye Soon Park, MD, PhD, Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388–1 Poongnap-dong, Songpa-gu, Seoul, Korea (South), 138–736. E-mail: firstname.lastname@example.org.