title: Abdominal adiposity and hot flashes among midlife women.
abstract: OBJECTIVE
  Two competing hypotheses suggest how adiposity may affect menopausal hot flashes. The "thin hypothesis" asserts that aromatization of androgens to estrogens in body fat should be associated with decreased hot flashes. Conversely, thermoregulatory models argue that body fat should be associated with increased hot flashes. The study objective was to examine associations between abdominal adiposity and hot flashes, including the role of reproductive hormones in these associations.
  
  
  METHODS
  The Study of Women's Health Across the Nation Heart Study (2001-2003) is an ancillary study to the Study of Women's Health Across the Nation, a community-based cohort study. Participants were 461 women (35% African American, 65% white) ages 45 to 58 years with an intact uterus and at least one ovary. Measures included a computed tomography scan to assess abdominal adiposity; reported hot flashes over the previous 2 weeks; and a blood sample for measurement of follicle-stimulating hormone, estradiol, and sex hormone-binding globulin-adjusted estradiol (free estradiol index). Associations were evaluated within multivariable logistic and linear regression models.
  
  
  RESULTS
  Every 1-SD increase in total (odds ratio [OR]=1.28; 95% CI: 1.06-1.55) and subcutaneous (OR=1.30; 95% CI: 1.07-1.58) abdominal adiposity was associated with increased odds of hot flashes in age- and site-adjusted models. Visceral adiposity was not associated with hot flashes. Associations were not reduced when models included reproductive hormone concentrations.
  
  
  CONCLUSIONS
  Increased abdominal adiposity, particularly subcutaneous adiposity, is associated with increased odds of hot flashes, favoring thermoregulatory models of hot flashes. Body fat may not protect women from hot flashes as once thought.
authors.affiliation: From the 1Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15217, USA. thurstonrc@upmc.edu
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Thurston
authors.forename: MaryFran R
authors.initials: MR
authors.lastname: Sowers
authors.forename: Kim
authors.initials: K
authors.lastname: Sutton-Tyrrell
authors.forename: Susan A
authors.initials: SA
authors.lastname: Everson-Rose
authors.forename: Tené T
authors.initials: TT
authors.lastname: Lewis
authors.forename: Daniel
authors.initials: D
authors.lastname: Edmundowicz
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
mesh_terms: D050154:Adiposity / Q000502:physiology*; D001741:Black or African American; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D019584:Hot Flashes / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D050152:Intra-Abdominal Fat / Q000503:physiopathology*; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D016017:Odds Ratio; D047648:Perimenopause / Q000502:physiology*; D017698:Postmenopause / Q000502:physiology*; D050151:Subcutaneous Fat / Q000503:physiopathology*; D044465:White People