Relationships of age, menopause and central obesity on cardiovascular disease risk factors in Chinese women C-J Chang 1 , C-H Wu 1 *, W-J Yao 1 , Y-C Yang 1 , J-S Wu 1 and F-H Lu 1 1 Department of Family Medicine and Nuclear Medicine, National Cheng Kung University Hospital, Tainan, Taiwan OBJECTIVE: To evaluate the inter-relationships of age- and menopause- related changes of general obesity and body fat distribution and their independent effects on cardiovascular risk factors. DESIGN: Cross-sectional study. SUBJECTS: One-hundred and thirty-six premenopausal and 193 postmenopausal Chinese women with body mass index (BMI) < 30 kg=m 2 . MEASUREMENTS: Anthropometric surrogates of general obesity (BMI, total body fat percentage) and central obesity (waist-to-hip ratio, centrality index) were measured. Blood pressure, 75 g oral glucose tolerance test, glycosylated hemoglobin A 1c and lipid pro®les were also measured. RESULTS: Signi®cant correlation coef®cients between age, general obesity, central obesity and cardiovascular disease risk factors were noted. Through the menopausal transition, the BMI and total body fat percentage were increased signi®cantly. After adjustments for age and BMI, the postmenopausal women showed higher android fat percentage, centrality index, glycosylated hemoglobin A 1c , serum concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol and atherogenic indices than the premenopausal women. In multiple stepwise regres- sion models, age exerted independent effects on oral glucose tolerance test 2 h plasma glucose level, systolic and diastolic blood pressure, total cholesterol level, and LDL cholesterol. Menopause was an independent variable in relation to the changes of glycosylated hemoglobin A 1c , total and LDL cholesterol levels, triglyceride levels and atherogenic indices. The centrality index was the major independent variable of all the cardiovascular disease risk factors, except total and LDL cholesterol level. However, the variation of total body fat percentage had no independent effect on any cardiovascular disease risk factors. CONCLUSION: Through the aging and menopausal effects, women will increase total body fat content, favoring the central body fat distribution. Age, menopause and central obesity were all independent and signi®cant factors to the cardiovascular disease risk factors in Chinese women. International Journal of Obesity (2000) 24, 1699±1704 Keywords: DEXA; menopause; body fat distribution; cardiovascular disease risk factor Introduction Through the effect of menopausal transition, the morbidity and mortality of cardiovascular diseases in women are increased. 1 When compared with preme- nopausal women, elevated blood pressure, increased glucose intolerance and dyslipidemia are not uncom- mon in postmenopausal women. Lack of the protec- tion of estrogen has been supposed to be the major reason. 2,3 However, several physiological changes which develop during menopause may also in¯uence the risk of cardiovascular disease, such as aging effect, 4 increased body weight or android pattern of body fat distribution, 5 decreasing resting metabolic rate and physical activity 5,6 etc. Among these factors, the android pattern of body fat distribution seems to be the major issue. As we know, the android body fat distribution, glucose intolerance, hyperlipidemia, and hypertension appear to be clustered together in the same subject. 7,8 In addition, gender differences in cardiovascular disease can be explained by the differ- ent patterning of body fat distribution, 9,10 so it is reasonable to hypothesize that the menopause-related changes in cardiovascular disease risk factors might be partly due to the changes of patterning of body fat distribution. According to a recent review, 11 the interrelationsh- ips between age, menopause, body fat distribution and cardiovascular risk factors are rather controversial. The ®rst argument is whether the menopause-related changes in body fat distribution are independent of age and general obesity. Most of the studies using indirect anthropometric methods (waist-to-hip ratio, waist circumference) have failed to con®rm the menopause-related effect on central obesity that was *Correspondence: C-H Wu, Department of Family Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan. E-mail: paulo@mail.ncku.edu.tw Received 26 May 1999; revised 18 July 2000; accepted 26 July 2000 International Journal of Obesity (2000) 24, 1699±1704 ß 2000 Macmillan Publishers Ltd All rights reserved 0307±0565/00 $15.00 www.nature.com/ijo