Download PDF
Horm Metab Res 2002; 34(10): 583-588
DOI: 10.1055/s-2002-35420
Original Clinical
© Georg Thieme Verlag Stuttgart · New York

Effects of Estrogen Replacement Therapy on Abdominal Fat Compartments as Related to Glucose and Lipid Metabolism in Early Postmenopausal Women

I.  Mattiasson 1 , M.  Rendell 1 , C.  Törnquist 2 , S.  Jeppsson 3 , U.  L.  Hulthén 4
  • 1Department of Vascular Diseases Malmö-Lund, Lund University, University Hospital, Malmö, Sweden
  • 2Department of Radiology, Lund University, University Hospital, Malmö, Sweden
  • 3Department of Gynecology, Lund University, University Hospital, Malmö, Sweden
  • 4Department of Endocrinology, Lund University, University Hospital, Malmö, Sweden
Further Information

Publication History

Received: 29 January 2002

Accepted after revision: 3 July 2002

Publication Date:
19 November 2002 (online)

Also available at
    Permissions and Reprints

Abstract

The effects of estrogen replacement therapy on lipid and glucose metabolism as related to abdominal fat distribution were investigated in fifty-one healthy postmenopausal women aged 52-53 years. They were randomized to treatment with either estradiol 2 mg or placebo daily for three months in a double-blind design. Forty-six women continued with estradiol for another nine months in an open design with the addition of medroxyprogesterone for ten days every three months. Intra-abdominal and subcutaneous abdominal fat, and intrapelvic and subcutaneous pelvic fat was estimated by computed tomography before and after one year of estrogen treatment. Euglycemic hyperinsulinemic clamp, oral glucose tolerance test and analyses of blood lipids were performed after 3 and 12 months of treatment. Estrogen replacement therapy decreased body fat mass as well as intra-abdominal and intrapelvic fat, but not the subcutaneous fat compartments. LDL cholesterol decreased and HDL cholesterol increased, whereas triglycerides were not changed by one year of estrogen treatment. Insulin sensitivity and glucose tolerance were not affected by estrogen treatment. In postmenopausal women estrogen treatment for one year decreased intra-abdominal and intrapelvic fat compartments, but this was not related to changes in plasma lipid levels. Insulin sensitivity and plasma triglycerides were not affected by estrogen treatment.

Key words

Intraabdominal Fat - Intrapelvic Fat - Subcutaneous Fat - Insulin Sensitivity - Estradiol - Medroxyprogesteron - Leptin

References

  • 1 Bush T L. The epidemiology of cardiovascular disease in postmenopausal women.  Ann NY Acad Sci. 1990;  592 263-271
    PubMedGoogle Scholar
  • 2 Gordon T, Kanel W B, Hjortland M C, Mc Namara P M. Menopause and coronary heart disease. The Framingham Study.  Ann Intern Med. 1978;  89 157-161
    PubMedGoogle Scholar
  • 3 Barrett-Connor E, Bush T L. Estrogen-replacement and coronary heart disease.  Cardiovasc Clin. 1989;  19 159-172
    PubMedGoogle Scholar
  • 4 Gorodeski G J. Impact of the menopause on the epidemiology and risk factors of coronary artery heart disease in women.  Exp Gerontol. 1994;  29 357-375
    CrossrefPubMedGoogle Scholar
  • 5 Stampfer M J, Colditz G A. Estrogen replacement therapy and coronary artery heart disease: a quantitative assessment of the epidemiologic evidence.  Prev Med. 1991;  20 47-63
    CrossrefPubMedGoogle Scholar
  • 6 Grodstein F. et al . Postmenopausal estrogen and progestin use and the risk of cardiovascular disease.  New Engl J Med. 1996;  15 453-461
    PubMedGoogle Scholar
  • 7 Hulley S, Grady D, Bush T, Furberg C. et al . Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women.  JAMA. 1998;  280 605-613
    CrossrefPubMedGoogle Scholar
  • 8 Jensen J, Vilas L, Christiansen C. Influence of menopause on serum lipids and lipoproteins.  Maturitas. 1990;  12 321-331
    CrossrefPubMedGoogle Scholar
  • 9 Lobo R A. Effects of hormone replacement on lipids and lipoproteins in postmenopausal women.  J Clin Endocrin Metabol. 1991;  73 925-930
    PubMedGoogle Scholar
  • 10 Walsh B W, Schiffs I, Rosner B, Greenberg L. Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins.  N Engl J Med. 1991;  325 1196-1204
    CrossrefPubMedGoogle Scholar
  • 11 The w riting. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women.  JAMA. 1995;  273 199-208
    CrossrefPubMedGoogle Scholar
  • 12 Barrett-Connor E, Bush T L. Estrogen and coronary heart disease in women.  JAMA. 1991;  265 1861-1867
    CrossrefPubMedGoogle Scholar
  • 13 Zamboni M, Armellini F, Milani M P. et al . Body fat distribution in pre- and post-menopausal women: metabolic and anthropometric variables and their inter-relationships.  Int J Obes Relat Metab Disord. 1992;  16 495-504
    PubMedGoogle Scholar
  • 14 Barrett-Connor E, Laakso M. Ischemic heart disease risk in postmenopausal women. Effects of estrogen use on glucose and insulin levels.  Arteriosclerosis. 1990;  10 531-544
    PubMedGoogle Scholar
  • 15 Godsland I F, Gangar K, Walton C, Cust M, Whitehead M J, Wynn V, Stevensson J C. Insulin resistance, secretion and elimination in post-menopausal women receiving oral or transdermal hormone replacement therapy.  Metabolism. 1993;  42 846-853
    CrossrefPubMedGoogle Scholar
  • 16 Lundheim S R, Duffy D M, Kojima T, Vijod M A, Stanczyk F Z, Lobo R A. The route of administration influences the effect of estrogen on insulin sensitivity in postmenopausal women.  Fertil Steril. 1994;  62 1176-1180
    PubMedGoogle Scholar
  • 17 Andersson B, Matsson L A˚, Hahn L, Maringrin P, Lapidus L, Holm G, Bengtsson B-A˚, Björntorp P. Estrogen replacement therapy decreases hyperandrogenicity and improves glucose hemostasis and plasma lipids in postmenopausal women with non-insulin dependent diabetes mellitus.  J Clin Endocrinol Metabol. 1997;  82 638-643
    CrossrefPubMedGoogle Scholar
  • 18 Brussaard H E, Gevers Leuven J A, Frölich M, Kluft C, Kraus H M. Short-term estrogen replacement therapy improves insulin resistance, lipids and fibrinolysis in postmenopausal women with NIDDM.  Diabetologia. 1997;  40 843-849
    CrossrefPubMedGoogle Scholar
  • 19 Lapidus L, Bengtsson C, Larsson B. et al . Distribution of adipose tissue and risk of CVD and death. A 12-year follow-up of participants in the study of women in Göteborg, Sweden.  BMJ. 1984;  289 1257-1261
    PubMedGoogle Scholar
  • 20 Ley C J, Lees B, Stevenson J C. Sex- and menopause-associated changes in body fat distribution.  Am J Clin Nutr. 1992;  55 950-954
    CrossrefPubMedGoogle Scholar
  • 21 Krauss R M, Winston M. Obesity: Impact on cardiovascular disease.  AHA Circulation. 1998;  98 1472-1476
    PubMedGoogle Scholar
  • 22 Björntorp P. The association between obesity, adipose tissue distribution and disease.  Acta Med Scand. 1988;  723 121-124
    PubMedGoogle Scholar
  • 23 Engeli S, Sharma A M. Role of adipose tissue for cardiovascular-renal regulation in health and disease.  Horm Metab Res. 2000;  32 485-499
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Rendell M, Hulthén U L, Törnquist C, Groop L, Mattiasson I. Relationship between abdominal fat compartments and glucose and lipid metabolism in early postmenopausal women.  J Clin Endocrinol Metab. 2001;  86 744-749
    CrossrefPubMedGoogle Scholar
  • 25 Lukasi H C, Bolonchuk V W, Hall C B, Siders W A. Validation of tetrapolar bioelectrical impedance method to assess human body composition.  J Appl Physiol. 1986;  60 1327-1332
    PubMedGoogle Scholar
  • 26 Kvist H, Sjöström L, Tylén U. Adipose tissue volume determinations in women by computed tomography: technical considerations.  Int J Obes. 1986;  10 53-67
    PubMedGoogle Scholar
  • 27 Mattiasson I, Berntorp K, Lindgärde F. Insulin resistance and Na/K-ATPase in hypertension in women: a difference in mechanism depending on level of glucose tolerance.  Clin Sci. 1992;  82 106-111
    PubMedGoogle Scholar
  • 28 A˚strand I. Aerobic work capacity of men and women with special reference to age.  Acta Physiol Scand Suppl. 1960;  169 49-92
    PubMedGoogle Scholar
  • 29 Berntorp K, Eriksson K F, Lindgärde F. The importance of diabetes heredity in lean subjects on insulin secretion, blood lipids and oxygen uptake in pathogenesis of glucose intolerance.  Diabetes Res. 1986;  3 231-236
    PubMedGoogle Scholar
  • 30 Aloia J F, Vaswani A, Russo L, Sheehan M, Flaster E. The influence of menopause and hormonal replacement therapy on body cell mass and body fat mass.  Am J Obstet Gynecol. 1995;  172 896-890
    CrossrefPubMedGoogle Scholar
  • 31 Reubinoff B E, Wurtman J, Rojansky N. et al . Effects of hormone replacement therapy on weight, body composition, fat distribution, and food intake in early postmenopausal women: a prospective study.  Fertil Steril. 1995;  64 963-968
    PubMedGoogle Scholar
  • 32 O’Sullivan A J, Crampton L J, Freund J, Ho K K. The route of estrogen replacement therapy confers divergent effects on substrate oxidation and body composition in postmenopausal women.  J Clin Invest. 1998;  102 1035-1040
    PubMedGoogle Scholar
  • 33 Samaras K, Hayward C S, Sullivan D, Kelly R P, Campbell L V. Effects of postmenopausal hormone replacement therapy on central abdominal fat, glycemic control, lipid metabolism, and vascular factors in type 2 diabetes.  Diabetes Care. 1999;  22 1401-1407
    PubMedGoogle Scholar
  • 34 Kritz-Silverstein D, Barrett-Connor E. Long-term postmenopausal hormone use, obesity, and fat distribution in older women.  JAMA. 1996;  275 46-49
    CrossrefPubMedGoogle Scholar
  • 35 Espeland M A, Stefanick M L, Kritz-Silverstein D. et al . Effect of postmenopausal hormone therapy on body weight and waist and hip girths.  J Clin Enocrinol Metab. 1997;  82 1549-1556
    PubMedGoogle Scholar
  • 36 Samaras K, Hayward C S, Sullivan D, Kelly R P, Campbell L V. Effects of postmenopausal hormone replacement therapy on central abdominal fat, glycemic control, lipid metabolism, and vascular factors in type 2 diabetes.  Diabetes Care. 1999;  22 1401-1407
    PubMedGoogle Scholar
  • 37 Haarbo J, Marslew U, Gotfredsen A, Christiansen C. Postmenopausal hormone replacement therapy prevents central distribution of body fat after menopause.  Metabolism. 1991;  40 1323-1326
    CrossrefPubMedGoogle Scholar
  • 38 Gambacciani M, Ciaponi M, Cappagli . et al . Body weight, body fat distribution and hormonal replacement therapy in early postmenopausal women.  J Clin Endocrinol Metab. 1997;  82 414-417
    CrossrefPubMedGoogle Scholar
  • 39 Iverius P H, Brunzell J D. Relationships between lipoprotein lipase activity and plasma sex steroid levels in obese women.  J Clin Invest. 1988;  82 1106-1112
    PubMedGoogle Scholar
  • 40 Price T M, O’Brien S N, Brenda H W. et al . Estrogen regulation of adipose tissue lipoprotein lipase - Possible mechanisms of body fat distribution.  Am J Obstet Gynecol. 1998;  178 101-107
    PubMedGoogle Scholar
  • 41 Ma˚rin P, Lönn L, Andersson B, Odén B, Olbe L, Bengtsson B A˚, Björntorp P. Assimilation of triglycerides in subcutaneous and intraabdominal adipose tissues in vivo in men: effects of testosterone.  J Clin Endocrinol Metab. 1996;  81 1081-1122
    PubMedGoogle Scholar
  • 42 Kobayashi J, Saito K, Fukamachi I. et al . Pre-heparin plasma lipoprotein lipase mass: correlation with intra-abdominal visceral fat accumulation.  Horm Metab Res. 2001;  33 412-416
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Björntorp P. “Portal” adipose tissue as a generator of risk factors for cardiovascular disease and diabetes.  Arteriosclerosis. 1990;  10 493-496
    PubMedGoogle Scholar
  • 44 Jensen M D, Martin M L, Cryer P E, Roust L R. Effects of estrogen on free fatty acid metabolism in humans.  Am J Physiol. 1994;  266 E914-E920
    PubMedGoogle Scholar
  • 45 O’Sullivan A J, Ho K KY. Comparison of the effects of oral and transdermal estrogen replacement on insulin sensitivity in postmenopausal women.  J Clin Endocrinol Metab. 1995;  80 1783-1788
    CrossrefPubMedGoogle Scholar
  • 46 Van Harmelen V, Reynisdottir S, Eriksson P E. et al . Leptin secretion from subcutaneous and visceral adipose tissue in women.  Diabetes. 1998;  47 913-917
    CrossrefPubMedGoogle Scholar
  • 47 Hube F, Lietz U, Igel M. et al . Difference in leptin mRNA levels between omental and subcutaneous adipose tissue from obese humans.  Horm Metab Res. 1996;  28 690-693
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Masuzaki H, Ogawa Y, Isse N. et al . Human obese gene expression. Adipocyte-specific expression and regional differences in the adipose tissue.  Diabetes. 1995;  44 855-858
    CrossrefPubMedGoogle Scholar
  • 49 Shimizu H, Shimomura Y, Nakanishi Y. et al . Estrogen increases in vivo leptin production in rats and human subjects.  J Endocrinol. 1997;  154 285-292
    CrossrefPubMedGoogle Scholar
  • 50 Elbers J M, de Roo G W, Popp-Snijders C. et al . Effects of administration of 17β-oestradiol on serum leptin levels in healthy postmenopausal women.  Clin Endocrinol. 1999;  51 449-454
    CrossrefPubMedGoogle Scholar
  • 51 Kohrt W M, Landt M, Birge S J. Serum leptin levels are reduced in response to exercise training, but not hormone replacement therapy, in older women.  J Clin Endocrinol Metab. 1996;  81 3980-3985
    CrossrefPubMedGoogle Scholar
  • 52 Haffner S M, Mykkänen L, Stern M. Leptin concentration in women in the San Antonio Heart Study: effect of menopausal status and postmenopausal hormone replacement therapy.  Am J Epidemiol. 1997;  146 581-585
    PubMedGoogle Scholar
  • 53 Castrance V D, Kraemer R R, Franken M A. et al . Serum leptin concentration in women: effect of age, obesity, and estrogen administration.  Fertil Steril. 1998;  70 472-477
    CrossrefPubMedGoogle Scholar
  • 54 Kristensen K, Pedersen S B, Vetsregaard P, Mosekilde L, Richelsen B. Hormone replacement therapy affects body composition and leptin differently in obese and non-obese postmenopausal women.  J Endocrinol. 1999;  163 55-62
    CrossrefPubMedGoogle Scholar
  • 55 Gower B A, Nagy T R, Goran M I, Smith A, Kent E. Leptin in postmenopausal women: influence of hormone therapy, insulin and fat distribution.  J Clin Endocrinol Metab. 2000;  85 1770-1775
    CrossrefPubMedGoogle Scholar
  • 56 Endre T, Mattiasson I, Hulthén U L, Lindgärde F, Berglund G. Insulin resistance is coupled to low physical fitness in normotensive men with a family history of hypertension.  J Hypertension. 1994;  12 81-88
    PubMedGoogle Scholar

Prof. I. Mattiasson

Department of Vascular Diseases, University Hospital

Entrance 41 · 20502 Malmö · Sweden

Fax: + 46-40-338097 ·

Email: ingrid.mattiasson@skane.se