A Longitudinal Study of the Menopause and Fat Patterning

描述（由申请人提供）：人们曾经认为， 绝经相关的冠状动脉风险与全身脂肪增加有关， 但最近的研究表明，它不是总脂肪本身，而是 脂肪的位置，这是一个关键的风险因素。中心性肥胖指数， 特别是腹内脂肪（IAF），有：（1）预测冠状动脉事件 优于总脂肪指数;（2）与葡萄糖改变相关， 脂质代谢和血压升高;（3）与 绝经状态的变化。这就产生了一个假设， 绝经期相关的性激素变化加速了IAF的积累， 这反过来又与不利的心血管风险有关。现有研究 这个假设的主要局限性在于它们很小， 横截面和主要是高加索人，只集中在比较前和 绝经后状态，并对重要协变量进行最小控制 年龄和总脂肪。这是一个自然历史的研究， IAF的积累，因为妇女穿越更年期。将于 868名女性（419名非裔美国人; 449名白人）的完整birthorax队列 他们正在参与一项更大规模的研究， 过渡这是一个基于人群的队列， 现有的人口普查参与率为72%， 非裔美国人和高加索人的社会经济地位分布 亚组，辍学率仅为1%/年。作为更大的 在这项研究中，这个队列每年进行一次检查，其中各种心血管， 荷尔蒙和生活方式因素被追踪。对于本研究，2项临床试验 将在536名妇女的第四次或第五次年度考试中加入电池 由于没有做过子宫切除术而预期有资格的人，或 开始接受激素治疗这2项检查将是用于评估的CT扫描 的IAF，和DEXA扫描评估全身脂肪。这些测试将 在未来三年内每年重复一次。在研究结束时， 据预测，462个绝经状态的转变将发生在 地方随机效应模型将用于估计 IAF的水平和速率，从一个绝经状态到另一个。

DESCRIPTION (provided by applicant): It was once believed that menopause-related coronary risk was associated with a gain in total body fat, but recent research has suggested that it is not total fat per se, but the location of that fat, that is a key risk factor. Indices of central adiposity, particularly intra-abdominal fat (IAF), have: (1) predicted coronary events better than indices of total fat; (2) been associated with altered glucose and lipid metabolism and elevated blood pressure; and (3) been associated with changes in menopausal status. This gives rise to the hypothesis that menopause-related changes in sex hormones accelerate the accumulation of IAF, which in turn is associated with adverse cardiovascular risk. Existing studies of this hypothesis share major limitations in that they are small, cross-sectional and primarily Caucasian, focus only on comparisons of pre-and post-menopausal status, and have minimal controls for the important covariates of age and total fat. This is a study of the natural history of the accumulation of IAF as women transverse the menopause. It will be conducted on an intact biracial cohort of 868 women (419 African Americans; 449 Caucasians) who are participating in a larger study of women undergoing the menopausal transition. This is a population-based cohort that was randomly selected from an existing census with a 72 percent participation rate, approximately equal distribution of socioeconomic status within the African American and Caucasian subgroups, and a dropout rate of only 1 percent/year. As part of the larger study, this cohort undergoes annual exams in which a variety of cardiovascular, hormonal, and lifestyle factors are tracked. For this study, 2 clinical tests will be added to the battery at the 4th or 5th annual exam for the 536 women who are expected to be eligible by virtue of not having had a hysterectomy or begun taking hormone therapy. The 2 tests will be a CT scan for the assessment of IAF, and a DEXA scan for the assessment of total body fat. These tests will be repeated on an annual basis for the next 3 years. By the end of the study, it is projected that 462 transitions in menopausal status will have taken place. Random effects models will be used to estimate longitudinal changes in level and rate of IAF as one moves from one menopausal status to another.