Obesity has become an international public health concern. In the United States, the rates of overweight and obesity have escalated dramatically in the last several decades. The health implications of obesity stem from its relationship with the development and progression of several health complications and diseases. Cardiovascular disease, which is the number one killer of women and men, is strongly influenced by obesity. The exact biological relationship between these two conditions is difficult to understand because several overlapping physiological systems and processes influence their development. One important component that affects obesity and cardiovascular disease is the sex of the individual. Although this basic biological variable is an obvious area for scientific study, research analyzing the influence of sex on obesity and cardiovascular disease is gravely lacking. The Society for Women's Health Research convened a workshop of obesity and cardiovascular disease experts in November 2005 to identify the gaps in scientific knowledge and crucial next steps in research related to sex differences in obesity and cardiovascular disease. This meeting report describes the workshop attendees’ recommendations in detail.
RexrodeKM, CareyVJ, HennekensCH. Abdominal adiposity and coronary heart disease in women. JAMA1998;280:1843–8.
8.
MayesJS, WatsonGH.Direct effects of sex steroid hormones on adipose tissues and obesity. Obes Rev2004;5:197–216.
9.
LemieuxS, Prud'hommeD, BouchardC. Sex differences in the relation of visceral adipose tissue accumulation to total body fatness. Am J Clin Nutr1993;58:463–7.
10.
FreedlandES.Role of a critical visceral adipose tissue threshold (CVATT) in metabolic syndrome: implications for controlling dietary carbohydrates: a review. Nutr Metab (Lond)2004;1:12.
11.
NeelsJG, ThinnesT, LoskutoffDJ.Angiogenesis in an in vivo model of adipose tissue development. Faseb J2004;18:983–5.
12.
Caulin-GlaserT, WatsonCA, PardiR. Effects of 17beta-estradiol on cytokine-induced endothelial cell adhesion molecule expression. J Clin Invest1996;98:36–42.
13.
RissanenP, Franssila-KallunkiA, RissanenA.Cardiac parasympathetic activity is increased by weight loss in healthy obese women. Obes Res2001;9:637–43.
14.
Yki-JarvinenH.Ectopic fat accumulation: an important cause of insulin resistance in humans. J R Soc Med2002;95Suppl 42:39–45.
15.
RyanAS, NicklasBJ, BermanDM.Racial differences in insulin resistance and mid-thigh fat deposition in postmenopausal women. Obes Res2002;10:336–44.
16.
BergAH, SchererPE.Adipose tissue, inflammation, and cardiovascular disease. Circ Res2005;96:939–49.
17.
GuoSS, ChumleaWC.Tracking of body mass index in children in relation to overweight in adulthood. Am J Clin Nutr1999;70145S–8S.
18.
WhitakerRC, DietzWH.Role of the prenatal environment in the development of obesity. J Pediatr1998;132:768–76.
19.
BarkerDJ.Fetal origins of coronary heart disease. BMJ1995;311:171–4.
20.
Centers for Disease Control and Prevention, US Department of Health and Human Services. Diabetes & women's health across the life stages. Available at: http://www.cdc.gov/diabetes/pubs/women/ (Accessed May 24, 2006).
21.
KuzawaCW, AdairLS.A supply-demand model of fetal energy sufficiency predicts lipid profiles in male but not female Filipino adolescents. Eur J Clin Nutr2004;58:438–48.
22.
ZambranoE, Martinez-SamayoaPM, BautistaCJ. Sex differences in transgenerational alterations of growth and metabolism in progeny (F2) of female offspring (F1) of rats fed a low protein diet during pregnancy and lactation. J Physiol2005;566(Pt 1):225–36.
23.
HeindelJJ.Endocrine disruptors and the obesity epidemic. Toxicol Sci2003;76:247–9.
24.
DietzWH.Critical periods in childhood for the development of obesity. Am J Clin Nutr1994;59:955–9.
25.
WhitakerRC, PepeMS, WrightJA. Early adiposity rebound and the risk of adult obesity. Pediatrics1998;101:E5.
26.
StyneDM.Physiology of puberty. Horm Res1994;41Suppl 2:3–6.
27.
HeQ, HorlickM, ThorntonJ. Sex and race differences in fat distribution among Asian, African-American, and Caucasian prepubertal children. J Clin Endocrinol Metab2002;87:2164–70.
28.
VeldhuisJD, RoemmichJN, RichmondEJ. Endocrine control of body composition in infancy, childhood, and puberty. Endocr Rev2005;26:114–46.
29.
BerensonGS, SrinivasanSR, BaoW. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med1998;338:1650–6.
30.
LinneY, DyeL, BarkelingB. Long-term weight development in women: a 15-year follow-up of the effects of pregnancy. Obes Res2004;12:1166–78.
31.
BaetenJM, BukusiEA, LambeM.Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health2001;91:436–40.
32.
OwenCG, MartinRM, WhincupPH. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics2005;115:1367–77.
33.
St JeorST, HaymanLL, DanielsSR. Prevention Conference VII: obesity, a worldwide epidemic related to heart disease and stroke: group II: age-dependent risk factors for obesity and comorbidities. Circulation2004;110:e471–5.
34.
DeweyKG.Impact of breastfeeding on maternal nutritional status. Adv Exp Med Biol2004;554:91–100.
35.
KotaniK, TokunagaK, FujiokaS. Sexual dimorphism of age-related changes in whole-body fat distribution in the obese. Int J Obes Relat Metab Disord1994;18:207–2.
36.
WingRR, MatthewsKA, KullerLH. Waist to hip ratio in middle-aged women. Associations with behavioral and psychosocial factors and with changes in cardiovascular risk factors. Arterioscler Thromb1991;11:1250–7.
37.
SitesCK, BrochuM, TchernofA. Relationship between hormone replacement therapy use with body fat distribution and insulin sensitivity in obese postmenopausal women. Metabolism2001;50:835–40.
38.
EspelandMA, StefanickML, Kritz-SilversteinD. Effect of postmenopausal hormone therapy on body weight and waist and hip girths. Postmenopausal Estrogen-Progestin Interventions Study Investigators. J Clin Endocrinol Metab1997;82:1549–56.
39.
EnziG, GasparoM, BiondettiPR. Subcutaneous and visceral fat distribution according to sex, age, and overweight, evaluated by computed tomography. Am J Clin Nutr1986;44:739–46.
40.
FelsonDT, ZhangY, HannanMT. The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum1995;38:1500–5.
41.
GroundsMD.Reasons for the degeneration of ageing skeletal muscle: a central role for IGF-1 signalling. Biogerontology2002;3:19–24.
42.
FukagawaNK, BandiniLG, DietzWH. Effect of age on body water and resting metabolic rate. J Gerontol A Biol Sci Med Sci1996;51M71–3.
43.
KortzingerI, BierwagA, MastM. Dietary underreporting: validity of dietary measurements of energy intake using a 7-day dietary record and a diet history in non-obese subjects. Ann Nutr Metab1997;41:37–44.
44.
LukaskiHC, JohnsonPE, BolonchukWW. Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr1985;41:810–7.
45.
EllisKJ, ShypailoRJ, PrattJA. Accuracy of dual-energy x-ray absorptiometry for body-composition measurements in children. Am J Clin Nutr1994;60:660–5.
46.
ThomasEL, SaeedN, HajnalJV. Magnetic resonance imaging of total body fat. J Appl Physiol1998;85:1778–85.
47.
deGraaf C, BlomWA, SmeetsPA. Biomarkers of satiation and satiety. Am J Clin Nutr2004;79:946–61.
48.
SvensonKL, BogueMA, PetersLL.Invited review: identifying new mouse models of cardiovascular disease: a review of high-throughput screens of mutagenized and inbred strains. J Appl Physiol2003;941650-9; discussion 1673.
49.
ShibataR, SatoK, PimentelDR. Adiponectin protects against myocardial ischemia-reperfusion injury through AMPK- and COX-2-dependent mechanisms. Nat Med2005;11:1096–103.
