Longitudinal Analysis of Skeletal Muscle and Cardiometabolic Risk During the Menopause Transition

We assessed longitudinal changes in body composition and cardiometabolic risk in those with normal-weight and overweight/obese women across the menopausal transition. We examined a 10-year longitudinal analysis of 81 healthy women in the prospective Healthy Transitions cohort. Body composition measures were obtained via dual-energy X-ray absorptiometry. Skeletal muscle was estimated using a validated prediction model: 1.12 × appendicular lean mass- 0.63. Serum sex steroid hormones and cardiometabolic factors were quantified in fasting blood. Participants were stratified by BMI into normal weight (n=41) and overweight/obesity (n=40) groups. Changes within and between BMI groups across the menopause transition were assessed with linear mixed models. At menopause onset, compared to those with normal weight, participants with overweight/obesity had lower sex hormone-binding globulin (-30.9±10.3 nmol/L; p=0.01), greater percent body fat (13.1±1.3%; p<0.001), greater skeletal muscle mass (2.5±0.6 kg; p<0.001), and worse cardiometabolic risk factors (p<0.001). In the 5 years before menopause, participants with overweight/obesity gained skeletal muscle (+1.2 kg) and fat mass (+3.5 kg), while participants with normal weight increased percent body fat (+1.5%) only. At menopause onset, women with overweight/obesity exhibit distinct alterations in body composition, hormonal profiles, and cardiometabolic risk that exist in the years preceding menopause, highlighting the importance of early, targeted interventions to mitigate adverse health trajectories during the menopause transition.