What Are the Risks of Central Adiposity in Women?

February 03, 2006


We know that "pear-shaped" women are at less risk for heart disease than "apple-shaped" women. However, many of my female patients complain of weight shifting to the abdomen in menopause. Does this put them at the same increased risk of heart disease as women who have had central adiposity all of their lives?

Response From the Expert

Patricia (Pat) A. Camillo, PhD 
Associate Professor, Director of Women's Health Program, Seton Hall University College of Nursing, South Orange, New Jersey; Women's Health Nurse Practitioner, Menopause Practitioner, Private Practice, New York, NY; President and CEO, Alluise Publishing Incorporated, New York, NY

It's possible that some of the risks associated with central adiposity might be modified, although certainly not eliminated, during the reproductive years because of the positive effect of estrogen on cholesterol. Whether the risk is greater for women who gain this weight after menopause as opposed to those who have this body type all of their lives is difficult to know since there are so many factors associated with increased cardiac risk, including each person's unique biology and culture.

Central adiposity is such a significant risk factor that its presence definitely puts women at increased risk, regardless of age or menopausal status. This active, metabolic tissue releases fatty acids that then build up in the liver, reducing the effect of insulin on both liver and muscle cells. Muscles use these free fatty acids at the expense of glucose, resulting in elevated serum glucose and increased insulin output. Not only is there an increased risk of insulin-resistant diabetes, but high levels of insulin are also associated with hypertension, increased total cholesterol (low high-density lipoprotein and high low-density lipoprotein), and increased triglyceride levels -- all risk factors for cardiovascular disease.

Studies in rats have demonstrated that those with lower estrogen levels have reduced spontaneous physical activity when compared with rats that have higher endogenous estrogen.[1] Women who exercise regularly may be able to counteract this possible effect and minimize the deposition of abdominal fat. In fact, there are some women who never gain this weight after menopause, including those who use estrogen therapy.[2,3]

The Framingham Study found that weight gain after the young adult years results in additional risk, independent of initial weight.[4] Woman would be well advised to consider central adiposity a significant risk for heart disease that can be modified with diet and exercise.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.