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Metabolic syndrome is closely linked to obesity. Menopause may play a critical role in understanding the pathophysiology of metabolic syndrome in women. We investigated the relative contribution of obesity and menopause to the association between serum adiponectin levels and the development of metabolic syndrome.A prospective cohort study was conducted in which a total of 1,219 women without metabolic syndrome were examined at baseline (2005-2008) and followed up (2008-2011). Women were divided according to tertiles of serum adiponectin levels and menopause status, and then stratified into four groups: the nonobese with high adiponectin; the nonobese with low adiponectin; the obese with high adiponectin; and the obese with low adiponectin.During an average 2.5-year follow-up, 44 premenopausal women (9.8%) and 161 postmenopausal women (20.9%) developed metabolic syndrome. The obese group with low serum adiponectin demonstrated an increased risk for developing metabolic syndrome in both premenopausal (odds ratio [OR] 5.92, 95% confidence interval [CI] 2.24-15.66) and postmenopausal women (OR 4.22, 95% CI 2.41-7.36). However, the inverse association between serum adiponectin levels and incidence of metabolic syndrome was observed in premenopausal women with obesity (OR 0.16, 95% CI 0.03-0.81), but not in postmenopausal women with obesity (OR 0.55, 95% CI 0.27-1.14).High serum adiponectin levels showed no inverse association with metabolic syndrome in postmenopausal women with obesity. These findings may suggest a need for closer management of metabolic risk in postmenopausal women.