POSTMENOPAUSAL HORMONE THERAPY AND INTRA ABDOMINAL FAT

背景：与绝经相关的激素和代谢变化 可能增加心血管疾病（CVD）的风险。数据表明 绝经后时期与总的增加有关， 中央（“android”）体脂肪;动脉粥样硬化成分增加 血脂谱;和葡萄糖耐量恶化-所有 CVD的危险因素脂质和葡萄糖代谢的变化可能是 继发于中央脂肪堆积，尤其是腹内脂肪堆积 脂肪（IAF），与血脂异常和胰岛素相关的隔室 阻力激素替代治疗对血脂有积极影响 在绝经后妇女中，可能会影响局部脂肪沉积。 然而，激素治疗的有益效果在多大程度上对 疾病风险因素是由脂肪分布的变化介导的， 知道的很少有研究检查激素替代的影响 身体成分和脂肪分布的治疗，没有人检查过 外源性激素对IAF的影响， 与疾病的上升密切相关。 目的：验证激素替代疗法（HRT， 联合雌激素-孕激素）减少绝经后妇女的疾病 限制IAF沉积的风险。拟议的研究将审查 HRT对总体、局部和腹内脂肪沉积的影响，以及 肥胖、血脂谱和 葡萄糖代谢 设计：140例绝经后早期妇女的纵向队列研究 使用或不使用HRT。基线评估（在第一年内） 激素使用）和一个为期两年的后续评估。 将采用双能X线吸收法评估全身脂肪， 氢密度测定法和氘稀释法;和局部肥胖（大腿， 腹部、腹内）将用计算机断层扫描定量。 循环中总胆固醇水平，高密度和低密度 将测定脂蛋白胆固醇和甘油三酯。胰岛素 将用甲苯磺丁脲评估敏感性和葡萄糖耐量， 改良的频繁采样静脉葡萄糖耐量试验， 最小化建模 意义：HRT可降低绝经后心血管疾病的风险和发生率 妇女这项研究将确定HRT是否通过以下方式降低疾病风险： 影响脂肪分布和降低IAF。

Background: Hormonal and metabolic changes associated with the menopause may confer increased risk for cardiovascular disease (CVD). Data indicate that the postmenopausal period is associated with increases in total and central ("android") body fat; increases in the atherogenic components of the blood lipid profile; and deterioration of glucose tolerance - all risk factors for CVD. Changes in lipid and glucose metabolism may be secondary to accumulation of central fat, particularly intra-abdominal fat (IAF), the compartment associated with dyslipidemia and insulin resistance. Hormone replacement therapy has positive effects on the lipid profile in postmenopausal women, and may affect regional fat deposition. However the extent to which the beneficial effects of hormone therapy on disease risk factors are mediated by changes in fat distribution is not known. Few studies have examined the effects of hormone replacement therapy on body composition and fat distribution, and none have examined the effect of exogenous hormones on IAF, the adipose compartment most closely associated with disease rise. Objective: To test the hypothesis that hormone replacement therapy (HRT, combined estrogen-progestin) in postmenopausal women decreases disease risk by limiting IAF deposition. The proposed research will examine the effect of HRT on total, regional, and intra-abdominal fat deposition, and on the relationships between adiposity, the plasma lipid profile, and glucose metabolism. Design: Longitudinal cohort study of 140 early post:menopausal women using or not using HRT. A baseline assessment (within the first year of hormone use) and one two-year follow-up assessment will be conducted. Total body fat will be assessed with dual-energy X-ray absorptiometry, hydrodensitometry, and deuterium dilution; and regional adiposity (thigh, abdominal, intra-abdominal) will be quantified with computed tomography. Circulating levels of total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides will be determined. Insulin sensitivity and glucose tolerance will be assessed with the tolbutamide- modified, frequently-sampled, intravenous, glucose tolerance test and minimal modeling. Significance: HRT reduces risk and incidence of CVD in postmenopausal women. This study will determine if HRT reduces disease risk by influencing fat distribution and decreasing IAF.