Perimenopause may be the best time for lifestyle changes to prevent the shift in body composition and metabolism related to menopause, according to findings from a cross-sectional study published in Menopause.1 But what diet is best during this transition and how can women prevent weight gain in menopause when the odds are stacked against them?

In the study, Gould et al compared body composition, fat distribution, and metabolism in 72 women aged 35 to 60 years: 24 were premenopausal, 24 were perimenopausal, and 24 were postmenopausal. Physical activity level and diet were similar between the subgroups as was the distribution of women with obesity or overweight. Researchers evaluated the participant’s body composition using a 4-compartment model, fat distribution via dual-energy x-ray absorptiometry-derived ratio of android (mid-section) to gynoid (hips and thighs) fat, metabolic measures using indirect calorimetry, and lifestyle factors using surveys.

Body fat percentage and android to gynoid ratio were significantly lower in premenopausal women vs perimenopausal women (Table 1). While resting energy expenditure was similar between the groups, fat oxidation during moderate-intensity exercise was significantly greater in premenopausal vs postmenopausal women. The findings suggest that “perimenopause incites metabolic inflexibility that is sustained into postmenopause,” the study authors explained.

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Table 1. Differences in Body Fat and Fat Distribution by Menopausal Status

 PremenopausalPerimenopausalPostmenopausalPremenopausal vs Perimenopausal
Fat (%)27.89±8.2036.60±8.0035.43±7.00-10.29±2.73; P =.026
Android:gynoid ratio0.83±0.210.99±0.130.94±0.15-0.16±0.05; P =.031
Table adapted from Gould et al.1

The researchers called for future studies to investigate whether sustainable nutrition and exercise modifications can prevent the menopause-related shifts in body composition and metabolism.

What Diet Is Best for Women During Menopause?

Previous evidence suggests that a higher protein, lower carbohydrate diet may help retain lean mass during the menopause transition, Gould and colleagues noted.  

In the Women’s Health Initiative Observational Study, postmenopausal women (n=88 805) with the greatest level of adherence to a reduced-carbohydrate diet had the lowest risk for weight gain compared with those following a Mediterranean-style diet or Dietary Guidelines for Americans diet (Table 2).2 A low-fat diet was linked to the greatest risk of weight gain.

Table 2. Risk for Weight Gain Among Women in Menopause by Dietary Patternsa,2

DietAdjusted OR for Weight Gain (95% CI)
Low-fat diet1.43 (1.33-1.54)
DGA1.24 (1.15-1.33)
Mediterranean-style diet0.95 (0.88-1.03)
Reduced-carbohydrate diet0.71 (0.66-0.76)
OR, odds ratio; DGA, US Department of Agriculture’s Dietary Guidelines for Americans
aRates are for women in this highest quintile for adherence to the dietary pattern

Women adhering to a reduced-carbohydrate diet typically consumed 43% of total energy from protein, 39% from carbohydrates, and 18% from fat.

“If women don’t have good quality protein every day, the decrease in muscle mass that occurs as estrogen levels drop is accelerated,” commented Zhaoping Li, MD, PhD, Director of the Center for Human Nutrition and Chief of the Division of Clinical Nutrition at David Geffen School of Medicine at UCLA.

However, approximately 50% of women aged 51 to 60 years do not get the minimum recommended dietary allowance (RDA) of approximately 0.8 grams of protein per kg of body weight for sedentary adults, according to National Health and Nutrition Examination Surveys data.3

Dr Li said that primary care clinicians can help women take an active role in their health by providing education on diet and exercise strategies to prevent weight gain in midlife. “The important thing is to not deliver passive messages,” she said. “I am often very frustrated with primary care clinicians, including my own, who say that the weight gain is a fact of menopause. The message should be ‘yes, this is a physiological process, but it is a time for us to refocus on how we take care of our body. There are many things we can do about it.’ ” Read more on Dr Li’s advice on counseling women during the menopause transition here.

Dr Li emphasized that a one-size-fits all diet for women during perimenopause and menopause is not realistic and that as many as 50% of women may not respond to a low-carbohydrate, high-protein diet. These women may need to use different strategies such as intermittent fasting, reducing stress levels, improving sleep, and working more resistance training into their day.  

“We are learning more and more about individual differences in metabolism as we age,” Dr Li said. “That is why the National Institutes of Health launched the Nutrition for Precision Health study that will develop algorithms to predict individual responses to food and dietary routines. In another 5 or 10 years, we will have more knowledge on how to individualize management.”

NP-Led Diet Coaching Increases Protein Intake Among Women

Virtual diet coaching by a nurse practitioner (NP) plus protein prescription and nutrition education led to increased daily protein intake among middle-aged women in a recent study by Jackson et al published in Nutrition.4 Women aged 45 to 64 years (n=53) were randomly assigned to receive 10 weeks of diet coaching or no coaching; all participants received a protein prescription and nutritional education. The per-meal protein prescription goal was ≥0.4 g protein/kg body weight, and the 3-meal protein prescription goal was ≥1.2 g protein/kg body weight.

Protein intake increased in both groups; however, more patients achieved daily protein intake goals and had a more even distribution of protein means in coached group. At 12 weeks, a significantly greater proportion of the coached group met the 3-meal protein prescription, suggesting that they sustained behavior change, compared with the noncoached group (76% vs 53%; P =.04; Figure).

Figure. Percentage of participants meeting the 3-meal protein prescription. Source: Jackson et al.4

“Diet coaching should be considered in conjunction with nutrition education and a protein prescription to assist individuals in sustaining behavior change,” Jackson et al concluded.


1. Gould LM, Gordon AN, Cabre HE, Hoyle AT, Ryan ED, Hackney AC, Smith-Ryan AE. Metabolic effects of menopause: a cross-sectional characterization of body composition and exercise metabolism. Menopause. 2022 Feb 28. doi: 10.1097/GME.0000000000001932

2. Ford C, Chang S, Vitolins MZ, et al. Evaluation of diet pattern and weight gain in postmenopausal women enrolled in the Women’s Health Initiative Observational Study. Br J Nutr. 2017;117(8):1189-1197. doi:10.1017/S0007114517000952

3. Krok-Schoen JL, Archdeacon Price A, Luo M, et al. Low dietary protein intakes and associated dietary patterns and functional limitations in an aging population: a NHANES analysis. J Nutr Health Aging. 2019;23(4):338-347. doi:10.1007/s12603-019-1174-1

4. Jackson KL, Gropper SS, Hunt D, D’Avolio D, Newman D. Effectiveness of a per-meal protein prescription and nutrition education with versus without diet coaching on dietary protein intake and muscle health in middle-aged women. Nutrients. 2022;14(2):375. doi:10.3390/nu14020375

This article originally appeared on Clinical Advisor