



















































Article- 01 8


Abstract

Background: Following menopause there are changes in values of lipid profile parameters. 

Abdominal obesity has also been linked to significant metabolic abnormalities including 

changes in lipid parameter values. So, we designed this study to observe the pattern of lipid 

profile parameters in postmenopausal central obese women. Objective: To assess the lipid 

profile status of postmenopausal women with central obesity. Materials and Methods: This 

cross sectional study was carried out in the department of Biochemistry, Bangabandhu Sheikh 

Mujib Medical University, Dhaka, Bangladesh during the period of January 2005 to 

December 2005. Seventy four postmenopausal women with central obesity and age matched 

56 nonobese postmenopausal women were included in the study. Central obesity was defined 

having waist hip ratio more than 0.8. All statistical analyses were done by SPSS 12.0. p values 

<0.05 were considered significant. Results: Statistically no significant difference was 

observed between the central obese women and nonobese women in total cholesterol and 

LDL-cholesterol levels. But HDL-cholesterol was found lower and triacylglycerol was found 

higher in postmenopausal central obese women. Conclusion: Dyslipidaemia is a feature of 

postmenopausal women with central obesity.  

Key words: Central obesity, Postmenopausal, Nonobese

                                                                                     J Enam Med Col 2013; 3(1): 8-12

 

Postmenopausal women have an increased tendency 

for gaining weight. The decline of endogenous 

oestrogen, together with physical inactivity is 

probably the major cause of this phenomenon. 

Postmenopausal overweight and obesity lead to 

increased rates of hypertension, diabetes mellitus, 

coronary heart disease (CHD) and all-cause morta-

lity.1 Following menopause, adverse changes in lipid 

profile occur and the levels of several coagulation 

factors increase.2 

The lipid profile is a group of tests that are often 

done together to determine risk of CHD. It includes 

total cholesterol (TC), HDL-cholesterol, LDL-

cholesterol and triacylglycerol (TAG). It is used to 

guide health care providers in decision making as to 

how a person at risk should be treated. The scenario 

of the lipid profile is considered along with other 

known risk factors of CHD to develop a plan of 

treatment and follow-up.3 

It is well known that in pre-menopausal women the 

incidence of cardiovascular events is lower than in 

men of the same age and after menopause 

cardiovascular morbidity and mortality in women 

become similar to that of man indicating that female 

sex hormones play a relevant protective role upon 

the vasculature. The prevalence of obesity and over-

weight is also higher in postmenopausal women than 

that in men of comparable age.4 

Introduction

 

8

Lipid Profile of Postmenopausal Women with Central Obesity

1.   Assistant Professor, Department of Biochemistry, National Institute of Kidney Diseases and Urology, Dhaka

2.   Professor, Department of Biochemistry, Enam Medical College, Savar, Dhaka

3.   Associate Professor, Department of Biochemistry, Delta Medical College, Dhaka

4.   Associate Professor, Department of Biochemistry, National Institute of Kidney Diseases and Urology, Dhaka

5.   Professor, Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka

Correspondence Monowara Khanam, Email:monowara59@gmail.com

Original Article

Monowara Khanam1, Md. Aminul Haque Khan2, Md. Rezwanur Rahman3, 

Selima Akhter4, Md. Mozammel Hoque5



Obesity is a term commonly used to describe 

individual with increased body fat. It is associated 

with an increased risk of atherosclerosis, diabetes 

mellitus and gall bladder disease. Normal fat content 

of body is considered to be 12–18% of body weight 

in men and 18–25% of body weight in women. 

Obesity is commonly said to be present when body 

fat content is more than 20% and 25% of body 

weight in men and women respectively. A value that 

correlates better with body fat is the body mass index 

(BMI).5 Individuals with BMI between 25 and 29.9 

are overweight, and BMI > 30 are defined as obese.6

There are two major types of fat distribution in adult 

obese.7

1.   Some adults store their fat mainly around the 

hips and thigh, which gives them a pear shape 

known as gynoid distribution; this is a 

characteristic of women.

2.   The second type found in both sexes is the storage 

of fat primarily in the abdomen, producing an 

‘apple’ shape known as android distribution. 

Excess fat located in the central abdominal area of the 

body is called android, ‘apple-shaped’ or upper body 

obesity and is associated with a greater risk for 

hypertension, insulin resistance, diabetes, dyslipi-

daemia and coronary heart disease. Android fat 

distribution is defined by waist to hip ratio (WHR) 

more than 0.8 for women and more than 1 for men.6 

Through the effect of menopausal transition, the 

morbidity and mortality of cardiovascular diseases in 

women are increased. Lack of the oestrogen 

protection is presumed to be the major reason. 

However, several other physiological changes (such as 

aging effect, increased body weight or android pattern 

of body fat distribution, decreasing resting metabolic 

rate and physical activity etc.) which develop during 

menopause may also influence the risk of 

cardiovascular disease. Among these factors the 

android pattern of body fat distribution seems to be 

the major issue. The android body fat distribution, 

glucose intolerance, hyperlipidaemia and hypertension 

appear to be clustered together in the same subject.8 

The metabolic phenotype of postmenopausal women, 

which includes an increased tendency for body fat 

deposition in the abdominal region, suggests that 

insulin resistance may underlie the characteristic 

features of postmenopausal dyslipidaemia. Adverse 

effects of insulin resistance on lipid metabolism, with 

consequent effects on circulating TAG 

concentrations, may be the primary metabolic 

defects that lead to low HDL-cholesterol and 

increased prevalence of small dense LDL which are 

the key features of the atherogenic lipoprotein 

phenotype. Greater tendency for central fat 

deposition after the menopause may be particularly 

relevant to the higher incidence of CHD in 

postmenopausal women. Although central obesity 

has been shown to be a strong risk factor of CHD for 

both men and women, studies in women generally 

produce values for relative risk that are higher than 

those found in men.9 

The possibility that raised TAG is a key feature of 

the lipid disturbance that leading to increased risk of 

CHD after the menopause is supported by the fact 

that raised TAG is more strongly associated with 

CHD risk in women than men.

The Framingham Study10 showed that in women the 

strongest predictor of CHD risk was a TAG level 

greater than 1.7 mmol/L and HDL-cholesterol values 

less than 1.3 mmol/L. In a prospective follow-up 

study (over a 20 years period) on 1462 women a 

strong association between serum TAG 

concentrations and CHD mortality was reported. The 

dominance of TAG as a risk factor in postmenopausal 

women and its link with central obesity and insulin 

resistance is also supported by the observation that 

women with non-insulin-dependent diabetes mellitus 

have a 4-5 fold increase in risk of CHD, compared 

with a 2-3 fold increase in men.9 

Obesity is commonly regarded as an important 

contributor to the development of hyperlipidaemia 

on the basis that cross-sectional studies have 

documented statistically significant, although 

modest, associations between lipid levels and various 

estimates of obesity. Vague et al11 introduced the 

‘masculine differentiation index’ to distinguish 

between ‘android’ and ‘gynoid’ obesity. He found 

that a predominance of fat in the upper body 

(android obesity) was associated with metabolic 

disturbances, while a predominance of fat in the 

lower body (gynoid obesity) was associated only 

with problems such as abdominal pressure and 

locomotor difficulty. Following menopause fat is 

increasingly deposited in the upper body region 

which is associated with low HDL-cholesterol, high 

apolipoprotein-B and high triglycerides.12

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J Enam Med Col  Vol 3  No 1 January 2013



 Lipid parameters Cases (n=74) Controls (n=56) t values p values

      (mg/dL) Mean ± SD Mean ± SD

Total cholesterol 197.1 ± 50.6 184.9 ± 41.2 1.47 > 0.05

Triacylglycerol 149.4 ± 65.6 120.7 ± 46.3 2.91 < 0.01

HDL-cholesterol 29.6 ± 6.3 33.5 ± 7.2 3.32 < 0.01

LDL-cholesterol 137.1 ± 50.1 128.0 ± 41.5 1.10 > 0.05

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J Enam Med Col  Vol 3  No 1 January 2013

Abdominal obesity has been linked to signi-

ficant metabolic abnormalities including 

insulin resistance, hyperinsulinaemia, and 

elevated TAG levels as well as increased 

incidence of hypertension, glucose intole-

rance and diabetes mellitus. Abdominal 

adiposity as measured by waist-hip ratio 

(WHR), is an independent risk factor for 

CHD in men and perhaps also in women.13 

Waist circumference and WHR are 

important indicators of cardiovascular risk 

even after adjustment for BMI. The 

increased visceral fat mass associated with 

increased waist circumference is largely the 

result of overall obesity, whereas in case of 

an increased WHR, the increase in visceral 

fat is due to other factors as well.14 

The prevalence of obesity is increasing 

worldwide. Cardiovascular disease (CVD) 

remains the major cause of death in 

postmenopausal women. Before menopause, 

women are relatively protected from 

ischaemic heart disease and thromboembolism 

by their circulating oestrogen, but this 

protection is lost after menopause.2 

Therefore it is important to study lipid 

profile in postmenopausal women with 

central (abdominal) obesity. So this study 

was designed to observe the pattern of lipid 

profile parameters in the postmenopausal 

central obese women. 

Materials and Methods

This cross sectional study was done in the 

department of Biochemistry, Bangabandhu 

Sheikh Mujib Medical University 

(BSMMU), Dhaka, Bangladesh during the 

period of January 2005 to December 2005. 

Seventy four postmenopausal women with 

central obesity and age matched 56 

nonobese postmenopausal women were 

included in the study. The subjects were 

selected by nonrandom purposive sampling 

from outpatient departments of BSMMU, 

Dhaka, Dhaka Medical College Hospital, 

Dhaka, Bashail and Shakhipur Upazilla 

Health Complexes, Tangail and different 

places of Dhaka City. Permission for the study was taken 

from the concerned authorities. All the subjects included in 

the study were informed of the purpose of the study. Written 

consent was taken after detailed explanation about the study.

Central obesity was defined having WHR >0.8. Postmeno-

pausal women with diabetes mellitus, alcoholism, chronic 

renal failure, nephritis, nephrotic syndrome, myocardial 

infarction, hypertension, and hypothyroidism were excluded 

from the study.

After selection of the subjects, 4 mL of blood specimen was 

collected from each of them in fasting condition with all 

aseptic precautions for estimation of serum TC, TAG and 

HDL-cholesterol levels. LDL-cholesterol level was 

calculated by applying Friedewald’s formula. 

All statistical analyses were done by SPSS 12.0. Unpaired 

Student’s t test was done to compare the values between 

groups. p values <0.05 were considered significant.

Results

The mean age of the postmenopausal women with central 

obesity was 55.80 (40–80) years and that of nonobese 

controls was 57.70 (40–76). Table I shows the comparison of 

serum lipid parameters between postmenopausal centrally 

obese cases and nonobese controls. Statistically there was no 

difference between the two groups in total cholesterol and 

LDL-cholesterol levels. But HDL-cholesterol was 

significantly lower in centrally obese postmenopausal women 

compared to postmenopausal nonobese controls and TAG 

levels were found significantly higher in the centrally obese 

cases compared to controls.

Table I: Comparison of serum lipid parameters between 

postmenopausal centrally obese cases and non-

obese controls



Discussion 

Obesity is a well documented separate risk factor for 

metabolic and vascular disease, which may reduce 

life expectancy for overweight people.15 Menopause 

tends to be associated with an increased risk of 

obesity and a shift to an abdominal fat distribution 

with associated increase in health risk.16 

In this study we have measured serum lipid profile in 

74 cases of postmenopausal central obese women 

and 56 nonobese control postmenopausal women. 

The mean serum HDL-cholesterol level was found to 

be significantly low and mean serum TAG level was 

found to be significantly high in central obese cases 

compared to that of controls. With respect to TC and 

LDL-cholesterol two groups did not differ. This 

finding supports other similar studies.17-19 

Serum TC and LDL-cholesterol of two groups did 

not differ significantly, but the values of TC and 

LDL-cholesterol had trend to increase in central 

obese cases. It may be due to small sample size in 

our study. Carr20 observed that elevated LDL-

cholesterol is not a feature of dyslipidaemia in case 

of postmenopausal women with abdominal obesity. 

Our study is similar with this observation. 

Many longitudinal studies have shown that TAG 

level increases with transition through the 

menopause and the increase in TAG also appears 

early in the postmenopausal period. Poehlman et al21 

found that prospective transition to postmenopause 

was associated with a 16% increase in TAG. It was 

observed in most studies that total HDL-cholesterol 

level falls slightly with menopause, whereas other 

blood lipids had no change.22 Increasing TAG with 

menopause may be related to the fact that TAG 

levels are highly correlated with increasing 

abdominal fat content and insulin resistance.22 

In this study WHR was used as indicator of central 

obesity. In a small study of Swedish men, it was 

observed that a high waist-to-hip ratio after 

adjustment for age and BMI was associated with an 

increased visceral fat area and a decreased thigh 

muscle area.23 

The study done by Seidell et al24 observed that 

larger waist and smaller hip circumferences than 

what was predicted on the basis of BMI and age are 

both independently related (but in opposite direction) 

to risk factors such as low HDL-cholesterol, high 

triacylglycerol and high insulin concentration. 

In this study of central obese cases we have found 

increased TAG, decreased HDL-cholesterol without 

significant differences in TC and LDL-cholesterol.  

Central obesity is associated with a threatening 

combination of metabolic abnormalities that includes 

dyslipidaemia (low HDL-cholesterol and high TAG), 

insulin resistance, glucose intolerance and hyper-

tension which have been referred to metabolic 

syndrome. Individuals with this syndrome have a 

significantly increased risk for developing diabetes 

mellitus and cardiovascular disorders. So increased 

TAG and low HDL-cholesterol are risk factors for 

central obese postmenopausal women.   

From the findings of the present study, it can be 

concluded that dyslipidaemia is a feature of 

postmenopausal women with central obesity. 

However, further prospective studies with large 

sample size should be carried out to evaluate the 

degree of dyslipidaemia of centrally obese 

postmenopausal women. Extensive studies should be 

done on central obesity in men, women and children 

as obesity is a global problem now-a-days. We 

recommend creating awareness regarding metabolic 

complications of central obesity in postmenopausal 

women as well as in general population.

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