Optimal Dietary Patterns for Improving Health-Related Quality of Life During the Menopausal Transition: Two Large Prospective United States Cohort Studies

Background: In aging societies, improving health-related quality of life (HRQoL) is vital, as it not only predicts cardiovascular disease and mortality but also reflects overall wellbeing. Because HRQoL often declines across menopause, a pivotal stage of women’s aging, we prospectively examined and compared 11 dietary patterns with HRQoL change during the transition. Methods: We analyzed 23,129 women from the Nurses’ Health Study (NHS) and NHSII who entered menopause between the first diet and the last of HRQoL assessment (NHS: 1984–2000; NHSII: 1991–2001). HRQoL was measured with the Medical Outcomes Study 36-Item Short Form Health Survey, yielding eight domains summarized as Physical (PCS) and Mental (MCS) Component Scores. Diet was assessed with validated food-frequency questionnaires. We calculated cumulative average scores for 11 dietary pattern indices across assessments prior to outcome assessment and categorized them into quintiles. Generalized linear models with repeated measures estimated mean 4-year changes in HRQoL. Results: During the follow-up, mean (SD) PCS declined [−1.30 (7.41) points/4-years] and MCS improved [1.58 (8.26)]. Healthier dietary patterns [Plant-based Diet Index (PDI), healthy PDI (hPDI), Mediterranean Diet (MedDiet), Dietary Approaches to Stop Hypertension (DASH), Mediterranean–DASH Intervention for Neurodegenerative Delay (MIND), Alternative Healthy Eating Index(AHEI)-2010, Planetary Health Diet Index (PHDI)] were associated with less declines in PCS scores and unhealthy patterns [unhealthy PDI (uPDI), empirical dietary inflammation pattern (EDIP), empirical dietary index for hyperinsulinemia (EDIH), ultra-processed foods (UPF)] were associated with more PCS declines, with the largest magnitudes [Δ, Q5 vs. Q1 (95% CI)] observed for MIND [0.56 (0.38, 0.75)]. Healthier dietary patterns (hPDI, MedDiet, DASH, MIND, AHEI) were associated with greater MCS improvement, and unhealthy patterns (uPDI and UPF) were associated with less MCS improvement, showing the largest magnitudes for DASH [0.46 (0.27, 0.65)]. Associations were similar across eight domains. More vegetables, fruits, fish aligned with better HRQoL change; more fast/fried foods, sweetened drinks or snacks, and red and processed meat aligned with worse. Conclusions: Plant-forward, neuroprotective and blood pressure–lowering patterns, including healthy animal based and less processed foods may optimize physical and mental wellbeing across menopause.