Abdominal adiposity, including visceral and subcutaneous abdominal adipose tissue (VAT and SAT), is recognized as a strong risk factor for cardiometabolic disease, cancer, and mortality.
The primary aim of this analysis is to describe longitudinal patterns of change in abdominal adipose tissue in postmenopausal women, overall and stratified by age, race/ethnicity, and years since menopause.
The data are from six years of follow up on 10,184 postmenopausal women (7828 non-Hispanic White women, 1423 non-Hispanic Black women, and 703 Hispanic women) who participated in the Women’s Health Initiative (WHI). The WHI is a large prospective cohort study of postmenopausal women across the United States. All participants in this analysis had DXA scans in the 1990s as part of the WHI protocol. Hologic APEX software was used to re-analyze archived DXA scans and obtain measures of abdominal adipose tissue. Analyses examined differences in abdominal adipose tissue, overall adiposity, and anthropometric variables.
There were important differences in VAT and SAT by age and race/ethnicity. In women <60 years, VAT increased over the follow-up period, while in women ≥70 years, VAT decreased. Non-Hispanic Black women had the highest levels of SAT. Hispanic women had the highest VAT levels. Women more than ten years since menopause had less SAT and more VAT than women less than ten years since menopause, resulting in a higher VAT/SAT ratio. There was a moderate to strong correlation between measures of abdominal adipose tissue and anthropometric measurements of body size. Still, there were substantial differences in the quantity of VAT and SAT within BMI and waist circumference categories.
These results demonstrate differences in VAT and SAT according to age, race/ethnicity, time since menopause, and compared to standard measures of body composition in a large and diverse cohort of postmenopausal women.
This is a preview of subscription content, access via your institution
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Get just this article for as long as you need it
Prices may be subject to local taxes which are calculated during checkout
The datasets generated during and/or analysed during the current study are available in the Biolincc repository, https://biolincc.nhlbi.nih.gov/home/.
Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–41.
Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309:71–82.
Chaput JP, Doucet E, Tremblay A. Obesity: a disease or a biological adaptation? An update. Obes Rev. 2012;13:681–91.
Despres JP, Tchernof A. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93:359–404.
Britton KA, Fox CS. Ectopic fat depots and cardiovascular disease. Circulation. 2011;124:e837–e41.
Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol. 2020;16:177–89.
Cerhan JR, Moore SC, Jacobs EJ, Kitahara CM, Rosenberg PS, Adami H-O, et al. A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clinic Proc. 2014;89:335–45.
Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation. 2008;117:1658–67.
Abraham TM, Pedley A, Massaro JM, Hoffmann U, Fox CS. Association between visceral and subcutaneous adipose depots and incident cardiovascular disease risk factors. Circulation. 2015;132:1639–47.
Britton KA, Massaro JM, Murabito JM, Kreger BE, Hoffmann U, Fox CS. Body fat distribution, incident cardiovascular disease, cancer, and all-cause mortality. J Am Coll Cardiol. 2013;62:921–5.
Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39–48.
Porter SA, Massaro JM, Hoffmann U, Vasan RS, O’Donnel CJ, Fox CS. Abdominal subcutaneous adipose tissue: a protective fat depot? Diabetes Care. 2009;32:1068–75.
Liu J, Fox CS, Hickson DA, May WD, Hairston KG, Carr JJ, et al. Impact of abdominal visceral and subcutaneous adipose tissue on cardiometabolic risk factors: the Jackson Heart Study. J Clin Endocrinol Metab. 2010;95:5419–26.
Shah RV, Murthy VL, Abbasi SA, Blankstein R, Kwong RY, Goldfine AB, et al. Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA Study. JACC Cardiovasc Imaging. 2014;7:1221–35.
Lalia AZ, Dasari S, Johnson ML, Robinson MM, Konopka AR, Distelmaier K. et al. Predictors of whole-body insulin sensitivity across ages and adiposity in adult humans. J Clin Endocrinol Metab. 2015;28:jc20152892.
Tchkonia T, Giorgadze N, Pirtskhalava T, et al. Fat depot origin affects adipogenesis in primary cultured and cloned human preadipocytes. Am J Physiol Regul Integr Comp Physiol. 2002;282:1286–96.
Bosch TA, Steinberger J, Sinaiko AR, Moran A, Jacobs DR Jr., Kelly AS, et al. Identification of sex-specific thresholds for accumulation of visceral adipose tissue in adults. Obesity. 2015;23:375–82.
Lovejoy JC, Champagne CM, de Jonge L, Xie H, Smith SR. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes. 2008;32:949–58.
Sowers M, Zheng H, Tomey K, Karvonen-Gutierrez C, Jannausch M, Li X. et al. Changes in body composition in women over six years at midlife: ovarian and chronological aging. J Clin Endocrinol Metab. 2007;92:895–901.
Janssen I, Powell LH, Kazlauskaite R, Dugan SA. Testosterone and visceral fat in midlife women: The Study of Women’s Health Across the Nation (SWAN) Fat Patterning Study. Obesity. 2010;18:604–10.
Marlatt KL, Redman LM, Beyl RA, Smith SR, Champagne CM, Yi F, et al. Racial differences in body composition and cardiometabolic risk during the menopause transition: a prospective, observational cohort study. Am J Obstet Gynecol. 2020;222:365.e1–365.e18.
Greendale GA, Han W, Finkelstein JS, Burnett-Bowie S-AM, Huang M, Martin D, et al. Changes in regional fat distribution and anthropometric measures across the menopause transition. J Clin Endocrinol Metab. 2021;106:2520–34.
Hays J, Hunt JR, Hubbell FA, Anderson GL, Limacher M, Allen C, et al. The Women’s Health Initiative recruitment methods and results. Ann Epidemiol. 2003;13:S18–77.
The Women’s Health Initiative Study G. Design of the Women’s Health Initiative Clinical Trial and Observational Study. Control Clin Trials. 1998;19:61–109.
Sims ST, Kubo J, Desai M, Bea J, Beasley JM, Manson JE, et al. Changes in physical activity and body composition in postmenopausal women over time. Med Sci Sports Exerc. 2013;45:1486–92.
Chen Z, Bassford T, Green SB, Cauley JA, Jackson RD, LaCroix AZ, et al. Postmenopausal hormone therapy and body composition–a substudy of the estrogen plus progestin trial of the Women’s Health Initiative. Am J Clin Nutr. 2005;82:651–6.
Bea JW, Chen Z, Blew RM, Nicholas JS, Follis S, Bland VL, et al. MRI based validation of abdominal adipose tissue measurements from DXA in postmenopausal women. J Clin Densitom. 2021;25:189–97.
Capers PL, Kinsey AW, Miskell EL, Affuso O. Visual Representation of Body Shape in African-American and European American Women: Clinical Considerations. Clin Med Insights Womens Health. 2016;9:63–70.
Langer RD, White E, Lewis CE, Kotchen JM, Hendrix SL, Trevisan M. The women’s health initiative observational study: baseline characteristics of participants and reliability of baseline measures. Ann Epidemiol. 2003;13:S107–S121.
Szklo M, Nieto J. Epidemiology: Beyond the Basics, 2nd Ed. edn Jones and Bartlett Publishers: Massachusetts 2007.
Carroll JF, Chiapa AL, Rodriquez M, Phelps DR, Cardarelli KM, Vishwanatha JK, et al. Visceral fat, waist circumference, and BMI: impact of race/ethnicity. Obesity. 2008;16:600–7.
Perry AC, Applegate EB, Jackson ML, Deprima S, Goldberg RB, Ross R, et al. Racial differences in visceral adipose tissue but not anthropometric markers of health-related variables. J Appl Physiol. 2000;89:636–43.
Nazare J-A, Smith JD, Borel A-L, Haffner SM, Balkau B, Ross R, et al. Ethnic influences on the relations between abdominal subcutaneous and visceral adiposity, liver fat, and cardiometabolic risk profile: the International Study of Prediction of Intra-Abdominal Adiposity and Its Relationship With Cardiometabolic Risk/Intra-Abdominal Adiposity. Am J Clin Nutr. 2012;96:714–26.
Stevens J, Katz EG, Huxley RR. Associations between gender, age and waist circumference. Eur J Clin Nutr. 2010;64:6–15.
Zamboni M, Turcato E, Santana H, Maggi S, Harris TB, Pietrobelli A, et al. The relationship between body composition and physical performance in older women. J Am Geriatr Soc. 1999;47:1403–8.
Burger HG. The endocrinology of the menopause. J Steroid Biochem Mol Biol. 1999;69:31–5.
Burger H. The menopausal transition–endocrinology. J Sex Med. 2008;5:2266–73.
Zaidi M, Lizneva D, Kim S-M, Sun L, Iqbal J, New MI, et al. FSH, bone mass, body fat, and biological aging. Endocrinology. 2018;159:3503–14.
Sternfeld B, Wang H, Quesenberry CP Jr., Abrams B, Everson-Rose SA, Greendale GA, et al. Physical activity and changes in weight and waist circumference in midlife women: findings from the study of women’s health across the nation. Am J Epidemiol. 2004;160:912–22.
Rillamas-Sun E, LaCroix AZ, Waring ME, Kroenke CH, LaMonte MJ, Vitolins MZ, et al. Obesity and late-age survival without major disease or disability in older women. JAMA Intern. Med. 2014;174:98–106.
Banack HR, Stokes A, Fox MP, Hovey KM, Cespedes Feliciano EM, LeBlanc ES, et al. Stratified probabilistic bias analysis for body mass index-related exposure misclassification in postmenopausal women. Epidemiology. 2018;29:604–13.
Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Am J Clin Nutr. 2005;82:923–34.
The Women’s Health Initiative Program Office: (National Heart, Lung, and Blood Institute, Bethesda, Maryland) Jacques Rossouw, Shari Ludlam, Joan McGowan, Leslie Ford, and Nancy Geller Clinical Coordinating Center: (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kooperberg Investigators and Academic Centers: (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA) JoAnn E. Manson; (MedStar Health Research Institute/Howard University, Washington, DC) Barbara V. Howard; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ) Cynthia A. Thomson; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Iowa, Iowa City/Davenport, IA) Jennifer Robinson; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker; (University of Nevada, Reno, NV) Robert Brunner Women’s Health Initiative Memory Study: (Wake Forest University School of Medicine, Winston-Salem, NC) Mark Espeland. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, 75N92021D00005.
The authors declare no competing interests.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Banack, H.R., Bea, J.W., Chen, Z. et al. Longitudinal patterns of abdominal visceral and subcutaneous adipose tissue, total body composition, and anthropometric measures in postmenopausal women: Results from the Women’s Health Initiative. Int J Obes 47, 288–296 (2023). https://doi.org/10.1038/s41366-023-01266-9