(P20-067-25) Optimal Dietary Patterns for Mitigating Weight Gain and Obesity During the Menopausal Transition

Objectives: Weight gain during the menopausal transition is common, and consuming a healthy diet is crucial for weight management. We examined and compared prospective associations of several dietary patterns with weight gain and risk of obesity during the menopausal transition.

Methods: Among 55,638 participants in the Nurses’ Health Study II (1989–2019), weight change was self-reported 6 years prior to and after the reported menopausal questionnaire cycle (three cycles pre- and post-menopause). Diet was assessed using validated food frequency questionnaires as cumulative average over 12 years. Fourteen diet quality scores were assessed, including plant-based diet index (PDI), healthy PDI (hPDI), unhealthy PDI (uPDI), Dietary Approaches to Stop Hypertension (DASH), Mediterranean diet (MedDiet), Planetary Health Diet Index (PHDI), low-carbohydrate diet (LCD), vegetable-based LCD (VLCD), healthy LCD (HLCD), animal-based LCD (ALCD), unhealthy LCD (ULCD), empirical dietary inflammation pattern (EDIP), empirical dietary index for hyperinsulinemia (EDIH), and ultra-processed food (UPF). Associations of diet quality with weight change (generalized linear models) and obesity risk (Cox regression) were adjusted for age, race, postmenopausal hormone therapy use, parity, smoking, alcohol, energy intake, physical activity, and baseline body mass index.

Results: articipants with higher healthy diet scores (PDI, DASH, MedDiet, PHDI; quintile 5 vs 1) and lower unhealthy diet scores (i.e., LCD, ALCD, ULCD, EDIP, EDIH, UPF; quintile 1 vs 5) had less weight gain during each two-cycle period of the menopausal transition (range: -0.64– -0.20 kg/year of weight gain). Greater adherence to healthy diets (DASH, MedDiet, PHDI, quintile 5 vs 1) and lower adherence to unhealthy diets (i.e., uPDI, LCD, ALCD, ULCD, EDIP, EDIH, UPF; quintile 1 vs 5) were associated with lower obesity risk (range of HR: 0.47–0.89). The lowest obesity risk was observed with higher PHDI score (quintile 5 vs 1: HR: 0.47, 95% CI: 0.43–0.52) and lower EDIH score (quintile 1 vs 5: HR: 0.54, 95% CI: 0.49–0.59).

Conclusions: Adherence to a Planetary Health Diet and reducing insulinemic potential of the diet may optimize weight management during the menopausal transition.

Funding Sources: The Nurses’ Health Study II was supported by grants (U01 CA176726) from the National Institutes of Health.