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Bakgrund: Osteoporos är en dold folksjukdom. Förekomst av osteoporos är åldersberoende och ökar hos kvinnor från 50-årsåldern. Osteoporos resulterar i minskad bentäthet vilket gör skelettet skört och ökar risken för frakturer. Syfte: Att belysa kvinnors upplevelser av att leva med osteoporos med fokus på kvinnor över 50 år. Metod: Metoden som användes var en allmän litteraturstudie som utgick från åtta vetenskapliga artiklar av kvalitativ metod. Resultatartiklarna analyserades med en innehållsanalys. Dataenheterna som identifierades i resultatartiklarna kategoriserades och bildade resultatets två huvudkategorier och sex underkategorier. Resultat: Resultatet delades in i två huvudkategorier: Upplevelser av begränsningar och Upplevelser av möjligheter. Första huvudkategorin visade att kvinnorna kunde uppleva begränsningar i form av smärta, rädsla och en känsla av att inte bli tagen på allvar. Andra huvudkategorin visade de upplevelser kvinnorna hade av att upprätthålla det dagliga livet med sjukdomen med stöd av kunskap, behandlingar och självständighet. Konklusion: Större förståelse och kunskap från hälso- och sjukvårdspersonal behövs för att bemöta kvinnor med osteoporos på bästa sätt. Alternativa åtgärder som användning av en vårdkoordinator bör övervägas för att underlätta för hälso- och sjukvårdspersonal och för att kunna ge kvinnor med osteoporos det stöd som krävs. Ytterligare forskning behövs om osteoporos hos kvinnor. / Background: Osteoporosis is a hidden public disease. The incidence of osteoporosis is age-dependent and increases in women from the age of 50. Osteoporosis reduces the bone density resulting in a fragile bone structure and increases the risk for bone fractures. Purpose: To describe women’s experiences of living with osteoporosis with a focus on women over 50 years. Method: A general literature study based on eight articles of quantitative method. The resulting articles were analyzed using a content analysis. The identified data units were categorized and formed into two main categories and six subcategories. Results: The result were divided into two main categories: Experiences of limitations and Experiences of opportunities. The result highlighted that women experienced limitations in form of pain, fear and the feeling of not being taken seriously. But also the experiences of maintaining the daily life with the disease and that they could feel supported by knowledge, treatment and independence. Conclusion: A bigger understanding and knowledge from healthcare professionals is needed to treat women with osteoporosis in the best way. Alternative measures such as the use of health care coordinator could be considered to facilitate healthcare professionals and to be able to provide women with osteoporosis with the necessary support. Further research is needed on osteoporosis in women.

No description available.

Background: Reproductive and menstrual factors have been evaluated as surrogates for long-term hormonal exposures in several prospective studies of colorectal cancer, yet findings have been conflicting. Methods: The relation of reproductive and menstrual factors (self-reported via a reproductive history questionnaire) with incident colorectal cancer was investigated among women enrolled in the Women's Health Initiative Observational Study (WHI-OS), a longitudinal cohort of 93 676 postmenopausal women (aged 50-79 years at enrolment) in which 1149 incident cases of colorectal cancer occurred over a median follow-up of 11.9 years. Multivariable Cox proportional hazards models that included established colorectal cancer risk factors were constructed to examine the association of colorectal cancer incidence with reproductive and menstrual factors. Results: Having had two children (vs nulliparous: hazard ratio (HR) = 0.80, 95% confidence interval (CD: 0.64-0.99) was inversely associated with colorectal cancer risk. Compared with never users, ever use of oral contraceptives was associated with lower colorectal cancer risk (HR = 0.74, 95% CI: 0.63-0.86); however, no relationship was observed for duration of oral contraceptives use (4 years vs 1 year: HR = 0.94, 95% CI: 0.67-1.32). None of the remaining reproductive and menstrual factors was associated with colorectal cancer incidence. Conclusions: Parity and prior use of oral contraceptives were associated with lower colorectal cancer risk in this cohort of postmenopausal women.

Fragility fractures caused by loss of bone mass due to postmenopausal osteoporosis represent a growing morbidity worldwide. Bisphosphonates are first-line medications for fracture treatment and prevention. In the first phase, we updated a Cochrane systematic review of randomized controlled trials on alendronate, assessing its efficacy for five types of fracture prevention, quality of life, and various safety outcomes. In the second phase, we combined indirect and direct evidence to perform a network meta-analysis including alendronate and nine other bisphosphonates evaluating the comparative efficacy and safety of these treatments. Overall, 58 studies were included in the review and 83 studies in the network. Most evidence was of moderate to high quality. Alendronate and zoledronic acid were effective for preventing the most types of fractures, while off-label and unapproved bisphosphonates showed poor efficacy. More evidence is required to evaluate long-term treatment and rare adverse events.

Orientador: Lúcia Costa-Paiva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-07T13:26:46Z (GMT). No. of bitstreams: 1 Gomes_DeboraAlessandradeCastro_M.pdf: 1338368 bytes, checksum: cc6c228fa56317429a0a9698e1c05cdf (MD5) Previous issue date: 2010 / Resumo: A osteoporose é uma desordem esquelética caracterizada pela baixa massa óssea e deterioração da arquitetura óssea, que pode progredir por décadas de forma assintomática ou manifestar-se através de fraturas ósseas, acometendo principalmente mulheres na pós-menopausa. O tratamento envolve uso de bisfosfonatos, raloxifeno, associados à dieta, cálcio, vitamina D e atividade física. Estudos mostraram que o conhecimento e a aderência a esses tratamentos foram baixos, o que pode interferir com a resposta terapêutica. Objetivo: Avaliar em mulheres na pós-menopausa com osteoporose ou osteopenia o conhecimento sobre a doença e a habilidade de seguir o tratamento aos diferentes medicamentos prescritos. Sujeitos e métodos: Foi realizado um estudo de corte transversal com 232 mulheres na pós menopausa com diagnóstico densitométrico de osteopenia ou osteoporose em uso de tratamento medicamentoso, acompanhadas no Ambulatório de Menopausa Hospital da Mulher Professor José Aristodemo Pinotti, no Caism/Unicamp. O conhecimento sobre osteoporose foi avaliado através da aplicação do questionário OPQ (Osteoporosis Questionary) contendo 20 questões sobre informações gerais sobre a doença, fatores de risco, conseqüências e tratamento. A habilidade de seguir o tratamento foi avaliada através do questionário MedTake, onde foi analisado a habilidade de seguir o tratamento em relação ao regime prescrito, dose, indicações e modo de ingestão da medicação. Análise - estatística: foi realizada através de medidas de frequência, médias e desvio padrão, teste qui-quadrado e t de Student. Para analisar os fatores associados ao conhecimento e a habilidade de seguir o tratamento foi utilizada a análise de regressão múltipla realizada pelo programa SAS, versão 9.1. Resultados: A média de idade das mulheres foi de 61,6 anos (+ 8,2 anos) e o tempo médio de menopausa foi 16,8 anos (+7,9). O escore médio de conhecimento obtido através do OPQ foi de 3,78, sendo que a média de respostas corretas foi de 9,8, respostas incorretas 6,0 e não sabia responder 4,1. Na análise bivariada as variáveis que se mostraram associadas ao escore de conhecimento foram: a maior escolaridade (p<0,01), tempo de leitura (p<0,02), maior nível de renda p<0,03) modo de aquisição da medicação (p<0,02) e ausência de comorbidades (p<0,04). Na análise de regressão múltipla os fatores que permaneceram associados ao maior conhecimento foram o maior nível de escolaridade, maior escore de renda e a ausência de comorbidades. A habilidade de seguir o tratamento avaliada pelo MedTake foi abaixo de 80% para a maioria das mulheres, não havendo diferença significativa entre as usuárias de bisfosfonato diário ou semanal e raloxifeno. Na análise bivariada as variáveis significativamente associados ao MedTake foram a escolaridade (p<0,01), nível de leitura (p<0,02), escore de conhecimento OPQ (p<0,02), tipo de medicamento (p<0,01) e tempo de uso para tratamento da osteoporose (p<0,01), presença de outras doenças associadas (p<0,02) e uso de outras medicações concomitantes (p<0,01). Os fatores associados ao tratamento inadequado foram idade acima de 70 anos OR 5,62 (IC 95% 1,23 a 25,64); ser analfabeta OR 10,14 (IC 95% 2,14 a 48,12); uso de outras medicações OR 0,33 (95% 0,15 a 0,76) e menor tempo de uso do tratamento para osteoporose OR 5,67 (IC 95% 2,27 a 14,16). Conclusão: O conhecimento sobre osteoporose em mulheres na pós-menopausa foi baixo, assim como a habilidade de seguir o tratamento proposto. O nivel educacional foi um forte preditor do conhecimento sobre osteoporose. A habilidade de seguir o tratamento para os diferentes medicamentos para osteoporose foi baixa e esteve associado à maior idade, ser analfabeta, não usar outras medicações e menor tempo de tratamento / Abstract: Osteoporosis is a skeletal disorder characterized by low bone mass and deterioration of bone architecture, which may progress for decades to be asymptomatic or manifested by bone fractures, affecting especially postmenopausal women after menopause. Treatment involves bisphosphonates, raloxifene, linked to diet, calcium, vitamin D and physical activity. Studies showed that knowledge and adherence to these treatments are low, which may interfere with the therapeutic response. Objective: To evaluate the knowledge about osteoporosis and the ability to follow the treatment with different drugs prescribed in postmenopausal women with osteoporosis or osteopenia. Subjects and methods: We conducted a cross-sectional study with 232 postmenopausal women with a densitometric diagnosis of osteopenia or osteoporosis in use of drug treatment followed at the Menopause Clinic at Women's Hospital Professor Jose Aristodemo Pinotti in Caism / Unicamp. The knowledge about osteoporosis was assessed by applying the OPQ questionnaire (Osteoporosis Questionnaire) containing 20 questions on general information about the disease, risk factors, consequences and treatment. The ability to follow the treatment was assessed by MedTake questionnaire, in relation to the prescribed regimen, dose, indication and method of ingestion. Analysis - Statistical: was performed by the measures of frequency, mean and standard deviation, chi-square and t Student. To analyze the factors associated with knowledge and ability to follow the treatment was used multiple regression analysis performed by SAS software, version 9.1. Results: The mean age of women was 61.6 years (+ 8.2 years) and mean duration of menopause was 16.8 years (+7.9). The average knowledge score through the OPQ questionnaire was 3.78, while the average was 9.8 correct answers and incorrect answers 6,0 and 4,1 do not answer. In bivariate analysis the variables that were associated with knowledge scores were: higher education (p <0.01), reading (p<0.02), higher income level, p<0.03), mode of acquisition of medication (p<0.02) and ausence of comorbidities (p<0.04). In multiple regression analysis the factors that remained associated with higher knowledge were the highest level of education, higher scores of income and the absence of comobidities. The ability to follow the treatment, evaluated by MedTake was below 80% for almost women and no significant difference among users of daily or weekly bisphosphonate and raloxifene. In bivariate analysis the variables significantly associated with MedTake were schooling (p <0.01), reading level (p<0,02), OPQ knowledge scores (p<0.02), type of drug (p<0.01) and time of use for treatment of osteoporosis (p<0.01), presence of other disorders (p<0.02) and use of other concomitant medications (p<0.01). Factors associated with inadequate treatment were age above 70 years OR 5.62 (95% CI 1.23 to 25.64), illiterate OR 10.14 (95% CI 2.14 to 48.12), use of other medications OR 0.33 (95% 0.15 to 0.76) and shorter duration of treatment for osteoporosis OR 5.67 (95% CI 2.27 to 14.16). Conclusion: The knowledge about osteoporosis in postmenopausal women with osteoporosis was low, as well as the ability to follow the treatment for the different drugs for osteoporosis. The educational level was a strong predictor of knowledge about osteoporosis. The ability to follow the treatment for the different drugs for osteoporosis was low and was associated with older age, illiterate, do not use other drugs and less treatment time / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

Introduction Menopause which is defined as a permanent physiological, or natural, cessation of menstrual cycle, plays an important role in the development of ocular surface dryness symptoms and there is an increased prevalence of dry eye in women, especially those aged over 50. Despite the high prevalence of dry eye in post-menopausal women (PMW), very few studies have been undertaken to understand dry eye disease in a group of PMW who are not on Hormone Replacement Therapy (HRT). Studies in the past on PMW have primarily focused on the relationship between HRT and dry eye. Hence, a series of studies were undertaken to understand the clinical aspects of dry eye and their relationship to a variety of tear film components, in a group of PMW with and without symptoms of dry eye. The specific aims of each chapter were as follows: • Chapter 4: To characterize symptoms of dry eye using questionnaires, namely Ocular Surface Disease Index Questionnaire© (OSDI) and the Indiana Dry Eye Questionnaire (DEQ). • Chapter 5: To characterize clinical signs and symptoms in participants who present with and without symptoms of dry eye. • Chapter 6: To compare tear osmolality and ferning patterns in participants with and without dry eye symptoms. • Chapter 7: To investigate the potential relationship between subjective symptoms and clinical signs with tear film lipocalin and lysozyme concentrations in participants with and without dry eye symptoms. • Chapter 8: To optimize a technique for the isolation of total RNA (ribo nucleic acid) and total protein derived from conjunctival epithelial cells collected via conjunctival impression cytology (CIC). • Chapter 9: To quantify the expression of MUC1 (mucin1) and MUC16 (mucin16) mRNA and protein and to investigate the potential relationship between mucin expression and tear film breakup time in a group of participants with and without dry eye symptoms. Methods • Chapter 4: Participants were categorized as being symptomatic or asymptomatic of dry eye based on their response to the OSDI questionnaire. These results were then compared to the DEQ, which has questions related to the frequency of ocular surface symptoms and their diurnal intensity. • Chapter 5: Non invasive tear breakup time (NITBUT) was evaluated using the ALCON Eyemap®. Tear volume was assessed using the Phenol Red Thread (PRT) test and bulbar conjunctival hyperemia was measured using objective (SpectraScan PR650© Spectrophotometer) and subjective (slit lamp) methods. • Chapter 6: Tears were collected via capillary tube. A freezing point depression osmometer was used to measure the osmolality of the tear film. The tear ferning test was performed and evaluated for the quality of ferning, based on the Rolando grading system. • Chapter 7: Tears were collected via capillary tube and an eye wash method. Tear lysozyme and lipocalin concentrations were determined via Western blotting. • Chapter 8: CIC was collected using either Millipore (MP) or Poly Ether Sulfone (PES) membranes. RNA and protein isolation was performed using two different RNA isolation techniques. Two methods of protein isolation from CIC discs were evaluated. RT-PCR of mRNA for MUC1 and western blotting of lipoxygenase type 2 protein (LOX2) was performed to confirm the collection of intact RNA and total protein respectively. • Chapter 9: Tears were collected via capillary tube and an eye wash method. CIC was collected using MP membrane. Expression of MUC1 and MUC16 mRNA was assessed via real time PCR. Expression of both membrane-bound and soluble MUC1 and MUC16 were quantified via Western blotting. Results • Chapter 4: The OSDI total score and sub scores for the Non Dry Eye (NDE) and Dry Eye (DE) groups were significantly different (NDE =7.43 ± 7.71 vs DE = 24.87 ± 13.89; p<0.001). The DEQ scores showed that the DE group exhibited a higher frequency and intensity of symptoms than the NDE group, which worsened as the day progressed (p<0.001). • Chapter 5: The DE group exhibited a significantly shorter NITBUT (5.3 ± 1.7 vs 7.0 ± 2.7 secs; p=0.0012). Tear volume was significantly lower for the DE group (19.3 ± 5.1mm vs. 16.3 ± 5.6mm; p=0.031). Bulbar hyperemia was significantly higher in the DE group for both objective (u’ = 0.285 ± 0.006 vs. 0.282 ± 0.006; p=0.005) and subjective techniques (48.4 ± 10.0 vs 40.6 ± 10.4; p=0.0011). • Chapter 6: Osmolality values in DE individuals were significantly higher than the NDE (328.1 ± 20.8 vs. 315.1 ± 11.3 mOsm/kg; p = 0.02). There was a significant difference between the DE and NDE participants for the ferning patterns (p = 0.019). No significant correlation between tear osmolality and tear ferning was noted (DE: r = 0.12; p > 0.05, NDE: r = -0.17; p > 0.05). • Chapter 7: No difference in tear lysozyme or lipocalin concentration was found between DE and NDE groups, irrespective of tear collection method. Method of collection significantly influenced absolute concentrations (p<0.008). • Chapter 8: There was no significant difference between the two procedures used to isolate RNA and protein from CIC membranes (p>0.05). Total RNA yield was greater with the MP membrane. The mean yield of protein extracted from MP membrane using the two protein isolation techniques also did not show a significant difference. • Chapter 9: No difference was found in the expression of either MUC1 or MUC16 protein or mRNA expression between symptomatic DE and NDE (p>0.05). Weak correlations were found between the NITBUT values compared with either soluble or membrane bound MUC1 and MUC16 expression. Conclusions • Chapter 4: Questionnaires are useful tools to symptomatically divide participants into dry eyed and non dry eyed candidates. However, the questionnaire used to categorise patients can impact on the outcome variables determined. • Chapter 5: Post-menopausal women with dry eye symptoms demonstrate shorter NITBUT, lower tear volume and increased bulbar conjunctival hyperemia than those who have no symptoms. • Chapter 6: Tear osmolality in DE is higher than in NDE. There is a tendency towards less ferning in persons over 50 years of age, regardless of their symptoms. • Chapter 7: Comparison of clinical data with lipocalin and lysozyme concentrations failed to reveal statistically significant correlations. The concentration of either protein was not associated with tear stability or secretion. • Chapter 8: The total RNA yield was greater with the MP membrane. RNeasy Mini (RN) (Qiagen) method is recommended due to enhanced speed as well as on-column isolation and DNase digestion capabilities. CIC with MP membranes followed by immediate freezing and then extraction and processing facilitates the collection of total protein from human conjunctival cells. • Chapter 9: No difference was found in the expression of either MUC1 or MUC16 protein or mRNA expression between symptomatic PMW and asymptomatic controls.

Introduction Menopause which is defined as a permanent physiological, or natural, cessation of menstrual cycle, plays an important role in the development of ocular surface dryness symptoms and there is an increased prevalence of dry eye in women, especially those aged over 50. Despite the high prevalence of dry eye in post-menopausal women (PMW), very few studies have been undertaken to understand dry eye disease in a group of PMW who are not on Hormone Replacement Therapy (HRT). Studies in the past on PMW have primarily focused on the relationship between HRT and dry eye. Hence, a series of studies were undertaken to understand the clinical aspects of dry eye and their relationship to a variety of tear film components, in a group of PMW with and without symptoms of dry eye. The specific aims of each chapter were as follows: • Chapter 4: To characterize symptoms of dry eye using questionnaires, namely Ocular Surface Disease Index Questionnaire© (OSDI) and the Indiana Dry Eye Questionnaire (DEQ). • Chapter 5: To characterize clinical signs and symptoms in participants who present with and without symptoms of dry eye. • Chapter 6: To compare tear osmolality and ferning patterns in participants with and without dry eye symptoms. • Chapter 7: To investigate the potential relationship between subjective symptoms and clinical signs with tear film lipocalin and lysozyme concentrations in participants with and without dry eye symptoms. • Chapter 8: To optimize a technique for the isolation of total RNA (ribo nucleic acid) and total protein derived from conjunctival epithelial cells collected via conjunctival impression cytology (CIC). • Chapter 9: To quantify the expression of MUC1 (mucin1) and MUC16 (mucin16) mRNA and protein and to investigate the potential relationship between mucin expression and tear film breakup time in a group of participants with and without dry eye symptoms. Methods • Chapter 4: Participants were categorized as being symptomatic or asymptomatic of dry eye based on their response to the OSDI questionnaire. These results were then compared to the DEQ, which has questions related to the frequency of ocular surface symptoms and their diurnal intensity. • Chapter 5: Non invasive tear breakup time (NITBUT) was evaluated using the ALCON Eyemap®. Tear volume was assessed using the Phenol Red Thread (PRT) test and bulbar conjunctival hyperemia was measured using objective (SpectraScan PR650© Spectrophotometer) and subjective (slit lamp) methods. • Chapter 6: Tears were collected via capillary tube. A freezing point depression osmometer was used to measure the osmolality of the tear film. The tear ferning test was performed and evaluated for the quality of ferning, based on the Rolando grading system. • Chapter 7: Tears were collected via capillary tube and an eye wash method. Tear lysozyme and lipocalin concentrations were determined via Western blotting. • Chapter 8: CIC was collected using either Millipore (MP) or Poly Ether Sulfone (PES) membranes. RNA and protein isolation was performed using two different RNA isolation techniques. Two methods of protein isolation from CIC discs were evaluated. RT-PCR of mRNA for MUC1 and western blotting of lipoxygenase type 2 protein (LOX2) was performed to confirm the collection of intact RNA and total protein respectively. • Chapter 9: Tears were collected via capillary tube and an eye wash method. CIC was collected using MP membrane. Expression of MUC1 and MUC16 mRNA was assessed via real time PCR. Expression of both membrane-bound and soluble MUC1 and MUC16 were quantified via Western blotting. Results • Chapter 4: The OSDI total score and sub scores for the Non Dry Eye (NDE) and Dry Eye (DE) groups were significantly different (NDE =7.43 ± 7.71 vs DE = 24.87 ± 13.89; p<0.001). The DEQ scores showed that the DE group exhibited a higher frequency and intensity of symptoms than the NDE group, which worsened as the day progressed (p<0.001). • Chapter 5: The DE group exhibited a significantly shorter NITBUT (5.3 ± 1.7 vs 7.0 ± 2.7 secs; p=0.0012). Tear volume was significantly lower for the DE group (19.3 ± 5.1mm vs. 16.3 ± 5.6mm; p=0.031). Bulbar hyperemia was significantly higher in the DE group for both objective (u’ = 0.285 ± 0.006 vs. 0.282 ± 0.006; p=0.005) and subjective techniques (48.4 ± 10.0 vs 40.6 ± 10.4; p=0.0011). • Chapter 6: Osmolality values in DE individuals were significantly higher than the NDE (328.1 ± 20.8 vs. 315.1 ± 11.3 mOsm/kg; p = 0.02). There was a significant difference between the DE and NDE participants for the ferning patterns (p = 0.019). No significant correlation between tear osmolality and tear ferning was noted (DE: r = 0.12; p > 0.05, NDE: r = -0.17; p > 0.05). • Chapter 7: No difference in tear lysozyme or lipocalin concentration was found between DE and NDE groups, irrespective of tear collection method. Method of collection significantly influenced absolute concentrations (p<0.008). • Chapter 8: There was no significant difference between the two procedures used to isolate RNA and protein from CIC membranes (p>0.05). Total RNA yield was greater with the MP membrane. The mean yield of protein extracted from MP membrane using the two protein isolation techniques also did not show a significant difference. • Chapter 9: No difference was found in the expression of either MUC1 or MUC16 protein or mRNA expression between symptomatic DE and NDE (p>0.05). Weak correlations were found between the NITBUT values compared with either soluble or membrane bound MUC1 and MUC16 expression. Conclusions • Chapter 4: Questionnaires are useful tools to symptomatically divide participants into dry eyed and non dry eyed candidates. However, the questionnaire used to categorise patients can impact on the outcome variables determined. • Chapter 5: Post-menopausal women with dry eye symptoms demonstrate shorter NITBUT, lower tear volume and increased bulbar conjunctival hyperemia than those who have no symptoms. • Chapter 6: Tear osmolality in DE is higher than in NDE. There is a tendency towards less ferning in persons over 50 years of age, regardless of their symptoms. • Chapter 7: Comparison of clinical data with lipocalin and lysozyme concentrations failed to reveal statistically significant correlations. The concentration of either protein was not associated with tear stability or secretion. • Chapter 8: The total RNA yield was greater with the MP membrane. RNeasy Mini (RN) (Qiagen) method is recommended due to enhanced speed as well as on-column isolation and DNase digestion capabilities. CIC with MP membranes followed by immediate freezing and then extraction and processing facilitates the collection of total protein from human conjunctival cells. • Chapter 9: No difference was found in the expression of either MUC1 or MUC16 protein or mRNA expression between symptomatic PMW and asymptomatic controls.

Thesis (Ph. D.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains xi, 211 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 171-186).

Background Obesity is increasing worldwide and is a major contributor to morbidity and mortality. Notably, abdominal (central) obesity carries a high risk of obesity-related diseases, while peripheral fat accumulation can act in a protective manner. A redistribution of fat from peripheral to central depots is seen after the menopause and is associated with an increasing prevalence of diabetes and cardiovascular disease. A key mediator may be ectopic fat accumulation in the liver. Our hypothesis was that a Palaeolithic-type diet (PD) consumed ad libitum improves body composition and metabolic risk markers, including liver fat and insulin sensitivity, in obese postmenopausal women. Methods In study I the study subjects (n=10) used a PD during 5 weeks. In study II and III (n=70) the effect of a Palaeolithic-type diet (PD) was compared to a diet according to the Nordic Nutrition Recommendations diet (NNR) during a 2-year randomized clinical trial (RCT). Food records and nitrogen excretion in urine validated food intake. Anthropometric measurements were performed in a standardized manner. Body composition was calculated using Dual Energy X-ray Absorptiometry (DXA). Total energy expenditure was calculated by accelerometry (Actiheart®) in combination with indirect calorimetry. Liver and muscle fat content was estimated by magnet resonance spectroscopy (1H-MRS). Insulin sensitivity was measured either with hyperinsulinemic euglycemic clamps (paper I) or oral glucose tolerance tests (OGTTs) (paper III). Results In study I a significant weight loss, linked to improved lipid and blood pressure levels, was associated with a 49% decrease in liver fat. Concomitantly, hepatic insulin sensitivity improved, while peripheral insulin sensitivity (and muscle fat) was unaltered. In study II/III both groups had a significant and sustained weight loss after 2 years. The PD was more effective than the NNR diet regarding loss of weight and fat mass after 6 months, but not after 24 months. Serum triglyceride levels were significantly lower at 24 months in the PD group. Liver fat decreased throughout the study in both groups. Hepatic insulin sensitivity improved during the first 6 months of the study, while peripheral insulin sensitivity did not change. Hepatic insulin sensitivity was associated with liver fat at baseline, but not during the diet intervention. Energy expenditure did not change in any of the study groups. Conclusion Ad libitum diets can have sustained beneficial effects on weight and body composition in obese postmenopausal women, a PD being more effective on short-term than a diet according to the NNR. This is associated with a reduction in liver fat that may reduce the risk of future diabetes and cardiovascular disease. Further studies are needed in order to explore the association between liver fat and metabolic dysfunction, including insulin sensitivity.