OBJECTIVE: To correlate body fat distribution evaluated by waist circumference, dual-energy X-ray absorptiometry and ultrasonography to insulin resistance and lipid profile in obese and non-obese postmenopausal women. METHODS: We studied 40 obese and 47 non-obese postmenopausal women, assessing obesity by measuring waist circumference and fat tissue using dual-energy X-ray absorptiometry and ultrasonography, and examining their correlation with metabolic parameters: insulin resistance as determined by the homeostasis model assessment technique (HOMA-IR) and lipid profile including triglycerides (TG), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), very-low-density lipoprotein, lipoprotein(a) (Lp(a)) and apoplipoprotein A-I (Apo A-I). RESULTS: There was no difference in lipid profile between the two groups. Insulin resistance was the metabolic disturbance of highest prevalence in the obese group, evaluated by HOMA-IR (obese: 3.38 +/- 2.2; non-obese: 1.20 +/- 0.7; p < 0.001). Obesity was not a confounding factor in linear regression analyses among HOMA-IR, HDL-C, TG, Lp(a), Apo A-I and the methods used to measure body fat distribution. Waist circumference was the method that best explained HOMA-IR (R(2) = 34.9%, p < 0.001) and TG concentration (R(2) = 10.9%, p = 0.002). HDL-C presented a positive association with subcutaneous fat evaluated by ultrasonography (R(2) = 12.5%, p < 0.001). Obesity was a confounding factor in multiple regression analyses between TC and LDL-C, when related to abdominal fat evaluated by ultrasonography, and resulted in a positive association among the obese and a negative association among the non-obese women. The sensibility of this method was related to the quantity of fat in the visceral region. CONCLUSIONS: Waist circumference showed the highest association with insulin resistance. Fat distribution evaluated by dual-energy X-ray absorptiometry and ultrasound was also associated with insulin resistance, but with lower intensity. The relationship of visceral fat distribution evaluated by ultrasound to TC cholesterol and LDL-C showed opposed results between obese and non-obese menopausal women.