Racial differences in body composition and cardiometabolic risk during the menopause transition: a prospective, observational cohort study.

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American journal of obstetrics and gynecology




BACKGROUND: Obesity disproportionately affects more women than men. The loss of ovarian function during the menopause transition coincides with weight gain, increases in abdominal adiposity, and impaired metabolic health. Racial differences in obesity prevalence that results from the menopause transition are not well understood.

OBJECTIVES: To assess longitudinal changes in body composition and cardiometabolic risk among Black and White women during the menopausal transition.

STUDY DESIGN: In a secondary analysis of a prospective, observational cohort study-the Healthy Transitions study-161 women aged 43 years and older with body mass index between 20 and 40 kg/m

RESULTS: Ninety-four women (25 Black, 69 White) transitioned through menopause and were included within the analyses. At menopause onset, Black women weighed more (77.8±3.0 vs. 70.8±1.8 kg), and had higher systolic (125±16 vs. 118±14 mmHg) and diastolic (80±8 vs. 74±7 mmHg) blood pressure compared to White women (all p≤0.05). No other differences in body composition, sex steroid hormones, or cardiometabolic risk factors were observed at menopause onset. Before menopause, White women gained significant weight (+3 kg), total body adiposity (+6% percent body fat, +9% fat mass, +12% trunk fat mass), and abdominal adipose tissue (+19% subcutaneous fat, +15% visceral fat, +19% total adipose tissue) which coincided with significant decreases in estradiol, sex hormone-binding globulin, and estrone sulfate, as well as increases in follicle-stimulating hormone, total cholesterol, and low-density lipoprotein cholesterol. Conversely, Black women had more abdominal adipose tissue before menopause, which was maintained across the menopause transition. Black women also had significant decreases in estrone sulfate and total testosterone, as well as increases in follicle-stimulating hormone before menopause. In the postmenopausal years, abdominal subcutaneous adipose tissue, total adipose tissue, follicle-stimulating hormone, total cholesterol, and low-density and high-density lipoprotein cholesterol increased only in White women.

CONCLUSIONS: White women gained more abdominal adiposity during the menopause transition compared to Black women, which may be due in part to differences in the pattern of sex steroid hormone changes between women of different racial backgrounds. The gains in abdominal adiposity in White women were observed in tandem with increased cardiometabolic risk factors. Future studies should consider comprehensive lifestyle approaches to target these increased gains in abdominal adiposity (i.e., nutrition and physical activity coaching), while also taking into account the potential interactions of race, body adiposity, sex steroid hormones, and their influence on cardiometabolic risk.

Clinical Institute

Women & Children


Obstetrics & Gynecology