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Objective: Although obesity is typically associated with increased cardiovascular risk, a subset of obese individuals display a normal metabolic profile (''metabolically healthy obese,'' MHO) and conversely, a subset of nonobese subjects present with obesity-associated cardiometabolic abnormalities (''metabolically obese nonobese,'' MONO). The aim of this cross-sectional study was to identify the most important body composition determinants of metabolic phenotypes of obesity in nonobese and obese healthy postmenopausal women. Design and Methods: We studied a total of 150 postmenopausal women (age 54 6 7 years, mean 6 1 SD). Based on a cardiometabolic risk score, nonobese (body mass index [BMI] 27) and obese women (BMI > 27) were classified into ''metabolically healthy'' and ''unhealthy'' phenotypes. Total and regional body composition was assessed with dual-energy X-ray absorptiometry (DXA). Results: In both obese and nonobese groups, the ''unhealthy'' phenotypes were characterized by frequent bodyweight fluctuations, higher biochemical markers of insulin resistance, hepatic steatosis and inflammation, and higher anthropometric and DXA-derived indices of central adiposity, compared with ''healthy'' phenotypes. Indices of total adiposity, peripheral fat distribution and lean body mass were not significantly different between ''healthy'' and ''unhealthy'' phenotypes. Despite having increased fat mass, MHO women exhibited comparable cardiometabolic parameters with healthy nonobese, and better glucose and lipid levels than MONO. Two DXA-derived indices, trunk-to-legs and abdominal-to-gluteofemoral fat ratio were the major independent determinants of the ''unhealthy'' phenotypes in our cohort. Conclusions: The ''metabolically obese phenotype'' is associated with bodyweight variability, multiple cardiometabolic abnormalities and an excess of central relative to peripheral fat in postmenopausal women. DXA-derived centrality ratios can discriminate effectively between metabolic subtypes of obesity in menopause.

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Objective: Aim of this study was to investigate the association of total and regional lean body mass (LBM) with cardiometabolic risk factors in healthy obese and nonobese postmenopausal women. Methods: A total of 150 postmenopausal women (age 54 6 7 years, BMI 29.6 6 5.8 kg/m 2 ) underwent a comprehensive assessment of cardiometabolic risk, including metabolic syndrome (MS). Body composition analysis was performed with Dual-energy X-ray Absorptiometry, and multiple heightadjusted indices of total and regional LBM were evaluated. Results: After controlling for age, diet, physical activity, and total fat mass, most indices of total, central, and peripheral LBM displayed significant positive correlations with cardiometabolic risk factors. Most associations were no longer significant after controlling for waist circumference, with the only exception of lean mass in the arms, which remained significantly associated with the presence and severity of MS (number of MS abnormalities), independently of central adiposity. A significant additive interaction was found between lean mass in the arms and waist circumference in increasing the prevalence of MS. Conclusions: LBM is unfavorably associated with cardiometabolic risk factors in healthy postmenopausal women. Whether LBM, especially in arms, is associated with cardiometabolic health independently of central fat distribution in postmenopausal women, merits further investigation.

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