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Title: Evaluation of diet pattern and weight gain in postmenopausal women enrolled in the Women’s Health Initiative Observational Study

Author
item FORD, CHRISTOPHER - Emory University
item CHANG, SHINE - Md Anderson Cancer Center
item VITOLINS, MARA - Wake Forest School Of Medicine
item FENTON, JENNIFER - Michigan State University
item HOWARD, BARBARA - Medstar Research Institute
item RHEE, JINNIE - Stanford School Of Medicine
item STEFANIK, MARCIA - Stanford School Of Medicine
item CHEN, BERTHA - Stanford School Of Medicine
item SNETSELAAR, LINDA - University Of Iowa
item URRUTIA, RACHEL - University Of North Carolina
item FRAZIER-WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC)

Submitted to: British Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/27/2017
Publication Date: 4/1/2017
Citation: Ford, C., Chang, S., Vitolins, M.Z., Fenton, J.I., Howard, B.V., Rhee, J.J., Stefanik, M., Chen, B., Snetselaar, L., Urrutia, R., Frazier-Wood, A.C. 2017. Evaluation of diet pattern and weight gain in postmenopausal women enrolled in the Women's Health Initiative Observational Study. British Journal of Nutrition. 117(8):1189-1197.

Interpretive Summary: Women are at an increased risk of weight gain after the menopause, which in turn increases their risk of chronic diseases such as diabetes, cancer and cardiovascular disease. Menopause is a time of great biological change, and this may alter the association of diet with body weight, meaning that we can't base our advice to postmenopausal women based on that for pre-menopausal women or men. The problem is that little research has examined the post-menopausal period to see what diet during this time best prevents excess weight gain. To address this, we used data from nearly 90,000 postmenopausal women, and examined which types of dietary intake were associated with weight gain over eight years. We compared four well known diet types: (1) a low-fat diet; (2) a reduced-carbohydrate diet; (3) a Mediterranean-style diet; and (4) a diet consistent with the US Department of Agriculture's Dietary Guidelines for Americans (DGA). We found that over time, the reduced-carbohydrate diet was protective against weight gain, whereas the low-fat diet and closer adherence to the DGA increased the risk of weight gain. These findings suggest that in post-menopausal women, a low-fat diet may promote weight gain, whereas a reduced-carbohydrate diet may decrease risk of weight gain. The information from this study will be helpful for developing dietary guidelines tailored to postmenopausal women, and for healthcare practitioners who need to advise this patient group on the best diet for health.

Technical Abstract: It is unclear which of four popular contemporary diet patterns is best for weight maintenance among postmenopausal women. Four dietary patterns were characterised among postmenopausal women aged 49-81 years (mean 63.6 (sd 7.4) years) from the Women's Health Initiative Observational Study: (1) a low-fat diet; (2) a reduced-carbohydrate diet; (3) a Mediterranean-style (Med) diet; and (4) a diet consistent with the US Department of Agriculture's Dietary Guidelines for Americans (DGA). Discrete-time hazards models were used to compare the risk of weight gain (=10 %) among high adherers of each diet pattern. In adjusted models, the reduced-carbohydrate diet was inversely related to weight gain (OR 0.71; 95 % CI 0.66, 0.76), whereas the low-fat (OR 1.43; 95 % CI 1.33, 1.54) and DGA (OR 1.24; 95 % CI 1.15, 1.33) diets were associated with increased risk of weight gain. By baseline weight status, the reduced-carbohydrate diet was inversely related to weight gain among women who were normal weight (OR 0.72; 95 % CI 0.63, 0.81), overweight (OR 0.67; 95 % CI 0.59, 0.76) or obese class I (OR 0.63; 95 % CI 0.53, 0.76) at baseline. The low-fat diet was associated with increased risk of weight gain in women who were normal weight (OR 1.28; 95 % CI 1.13, 1.46), overweight (OR 1.60; 95 % CI 1.40, 1.83), obese class I (OR 1.73; 95 % CI 1.43, 2.09) or obese class II (OR 1.44; 95 % CI 1.08, 1.92) at baseline. These findings suggest that a low-fat diet may promote weight gain, whereas a reduced-carbohydrate diet may decrease risk of postmenopausal weight gain.