Table 1_Estradiol mediates the association of waist-to-hip ratio, but not body fat percentage, with menopause-related symptoms in Chinese women aged 40–60 years.docx

Mediation analyses were performed to evaluate the mediating role of E₂, and stratified analyses by menopausal status were conducted to assess the consistency of these associations.</p>Results<p>After adjustment for potential confounders, higher WHR was independently associated with greater menopause-related symptom severity (β = 12.058, 95% CI: 1.816 to 22.300, P = 0.021), and higher PBF showed a similar association (β = 0.103, 95% CI: 0.011 to 0.196, P = 0.029).

Mediation analyses revealed that E₂ significantly mediated the association between WHR and KMI scores (indirect effect = 2.202, 95% CI: 0.520 to 4.323, P = 0.011; mediation proportion = 17.8%), whereas no significant mediating effect was observed for PBF (indirect effect = 0.008, 95% CI: −0.007 to 0.025, P = 0.296). Stratified analyses suggested that these associations were more evident among premenopausal women, although no significant interaction by menopausal status was observed.</p>Conclusion<p>Both overall and central adiposity were associated with more severe menopause-related symptoms; however, estradiol mediated only the association between central adiposity and symptom severity.

These findings suggest that different adiposity patterns may be associated with menopausal symptoms through distinct biological pathways.</p>