BACKGROUND:Elevated abdominal adipose tissue at time of diagnosis is associated with breast cancer mortality. We sought to understand the association between abdominal adipose tissue (subcutaneous, SAT and visceral, VAT) assessed via dual-energy X-ray absorptiometry (DXA) and breast cancer mortality in the prevention setting. METHODS:Women enrolled in the Women's Health Initiative study with baseline whole-body DXA scans were included in the study (n = 9767). Causes of death were adjudicated up to 27 years of follow-up. Competing risk models were used to examine independent associations between baseline VAT, SAT, per 100 cm2, and breast cancer-specific deaths; findings were reported as sub-hazard ratios (SHR) and confidence intervals (CI). Time-varying analyses additionally included DXA at years 3 and 6. Covariates included demographic, lifestyle, and tumor factors. RESULTS:Baseline VAT and SAT ranged from undetectable to 616.25 cm2 and 55.26-952.46 cm2, respectively. There were 738 incident breast cancer cases post-enrollment, and 87 breast cancer-related deaths. Median age at diagnosis was 62 years. In adjusted models, higher baseline VAT and SAT were significantly associated with higher risk breast cancer mortality (49% and 40%, respectively); time-varying models were similar. CONCLUSIONS:Higher VAT and SAT were similarly associated with breast cancer mortality in this group of postmenopausal women.

Postmenopausal women tend to experience significant changes in body composition, particularly abdominal adipose tissue (AAT) deposition patterns, which are hypothesized to be critical factors influencing future chronic disease risk. The level of protein intake to maintain or achieve a more favorable body composition for health in postmenopausal women is a central, largely unanswered question relating to the appropriateness of current dietary guideline recommendations for sufficient protein intake (set at 0.8 g/kg/day). To estimate the hypothetical effect of a range of protein intake levels on 3-year mean changes in body composition measures in postmenopausal women. We analyzed data from 3789 postmenopausal women aged 50–79 enrolled in the Women’s Health Initiative (WHI) to emulate a 3-year target trial of adhering to increasing levels of protein intake: ≥0.8 g/kg/d, ≥1.0 g/kg/d, ≥1.2 g/kg/d, and ≥1.5 g/kg/d. All participants had repeated Dual X-Ray Absorptiometry (DXA) scans with derived abdominal visceral (VAT) and subcutaneous adipose tissue (SAT). The measured differences in average levels of VAT, SAT, and other body composition measures determined at end of follow-up were estimated with the parametric-g formula. Over 3 years, hypothetical interventions of increasing levels of dietary protein intake are estimated to have dose-dependent reductions in abdominal VAT, SAT, and overall body fat, and increases in lean soft tissue, with potential benefits observed at ≥1.2 g/kg/day and the greatest estimated benefit at ≥1.5 g/kg/day of dietary protein. Compared to no intervention, if all participants hypothetically adhered to a total daily protein intake of ≥1.5 g/kg/day over 3 years, they would be estimated to have lower levels of VAT (−13.1 cm2, 95% Confidence Interval [CI] −18.9, −7.3), SAT (−25.3 cm2, 95% CI −39.7, −11.0), total body fat % (−1.0%, 95% CI −1.7, −0.3), body weight (−2.5 kg, 95% CI −3.7, −1.2) and greater lean soft tissue % (0.9%, 95% CI 0.3, 1.6) over 3 years. This hypothetical emulated intervention suggests that postmenopausal women who maintain a hypothetical total protein intake of at least 1.2 g/kg/day could experience beneficial changes in abdominal VAT, SAT, and overall body composition over three years, with even greater estimated benefits observed at an intake of 1.5 g/kg/day. These findings suggest that protein intake higher than guideline recommendations may better support healthier body composition and lower chronic disease risk in postmenopausal women.

In this manuscript, we present the results of a series of workshops convened in conjunction with the 2023 Society for Epidemiologic Research annual meeting. The overall objective of the workshops was to develop a set of core competencies for PhD students in epidemiology. The topics presented in the list of competencies are organized using a framework similar to many graduate programs in epidemiology, proceeding from basic to advanced topics. Given the breadth of substantive topics in the fields of epidemiology and public health, this list of competencies focuses on methodologic topics that are relevant to all students, regardless of research interest. The final topic lists were developed based on discussions including a large and diverse group of epidemiologists with different areas of expertise. By creating this resource, we aim to facilitate training of future generations of epidemiologists.

Objective: To test the effect of substituting plain water (the ideal standard) for habitual artificial sweetened beverage (ASB) intake in people with type 2 diabetes (T2D) on primary measures of diabetes control. Research Design and Methods: The Study Of Drinks with Artificial Sweeteners in People With T2D (SODAS) was conducted at two academic health centers; and was a randomized, two-arm parallel trial with a 2-week run-in period and a 24-week active intervention period. 181 adults with T2D (HbA1c 6.5-8.5%), age 35+ years, who regularly consumed commercial ASB were randomized to receive and consume 24 oz. daily for 24-weeks of either: 1) Commercial ASB of choice (control); or 2) Unflavored, sparkling or still, bottled/canned water of choice in place of ASB. The outcomes measures were collected at baseline, 12, and 24 weeks and include the primary (HbA1c%) and related secondary measures (Fructosamine, fasting glucose and insulin, body weight and continuous glucose monitor metrics). Results: 179 participants provided complete data over 24 weeks. From baseline to 24 weeks, the mean difference in change of HbA1c% was 0.29% (SE 0.12; P value = 0.013) higher in the water arm compared to the ASB arm. There were no significant effects on secondary clinical measures, but data were directionally consistent with the primary results. Conclusion: For people with T2D and HbA1c% < 8.5% who regularly consume ASB, this trial provided no evidence that substituting water would improve glycemic-related clinical care measures over 24 weeks.

AIM:This study uses a target trial emulation framework to estimate how different hypothetical sustained alcohol intake patterns affect 30-year cardiovascular disease risk in young adults. METHODS:This target trial emulation used longitudinal data from the CARDIA study, a multi-site cohort of Black and White young adults aged 18-30 at baseline (1985-1986), followed for 35 years. The exposure of this study consisted of self-reported daily alcohol intake categorized by sex into abstainer, light, moderate, heavy, and very heavy use categories. The emulated intervention compared hypothetical scenarios in which participants maintained consistent levels of alcohol consumption over time (assigned each of the 5 categories above) to estimate their long-term cardiovascular risk. Using the parametric g-formula to account for time-varying confounding and treatment-confounder feedback, we then estimated the 30-year incident risk of the composite cardiovascular outcome. RESULTS:Over 30 years, the overall CVD risk among all participants was 8.7%. Abstaining was associated with a slightly lower risk (8.3%; risk difference [RD] -0.4%; 95% CI, -0.6 to 0.1), while light (8.8%; RD 0.2%; 95% CI, -0.1 to 0.2) and moderate (9.4%; RD 0.7%; 95% CI, -0.1 to 0.9) drinking showed minimal risk differences. Heavy (RD 1.3%; 95% CI, -0.2 to 1.8) and very heavy drinking (RD 1.9%; 95% CI, -0.3 to 2.9) suggested modestly increased risks, though confidence intervals included no effect. CONCLUSION:This hypothetical intervention indicates no meaningful difference in 30-year CVD risk among abstainers, light, or moderate drinkers in young adults. Heavy alcohol intake may modestly raise risk, but estimates are imprecise with a range from no effect to a modest increase. By addressing key biases and leveraging comprehensive longitudinal data, these findings offer valuable insights for clinical and public health guidance.

OBJECTIVE:Obesity is associated with the risk of several cancers, yet conventional anthropometric measures do not distinguish the contributions of different compartments of abdominal adipose tissue. This study examined the relationship between visceral (VAT) and subcutaneous (SAT) abdominal adiposity and the incidence of 13 obesity-related cancers (ObRCs) in postmenopausal women. METHODS:Data from 9950 postmenopausal participants in the Women's Health Initiative (WHI) dual-energy X-ray absorptiometry (DXA) cohort were analyzed. Abdominal VAT and SAT were quantified from DXA scans using validated imaging software. Fine and Gray competing-risks models estimated associations with ObRC incidence over 177,295 person-years of follow-up. RESULTS:Higher abdominal VAT was significantly associated with higher ObRC risk, independently of BMI, waist circumference (WC), and other confounders. Each 100-cm2 increase in VAT corresponded to a 32% higher risk, with a nearly twofold increase for women in the highest VAT quartile. SAT and the VAT/SAT ratio were also significantly associated with risk, though more modestly. Findings were consistent across BMI, WC, age, and race/ethnicity strata and in time-varying models. CONCLUSIONS:Visceral adiposity has a strong, independent association with ObRC risk in postmenopausal women. Incorporating imaging-based body composition measures may improve cancer risk stratification and guide targeted prevention strategies. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT00000611 https://clinicaltrials.gov/study/NCT00000611.

BACKGROUND:A 2020 consensus statement proposed body mass index (BMI)-specific waist circumference (WC) thresholds to improve patient care. OBJECTIVE:To determine whether stratifying BMI categories by BMI-specific WC thresholds improves mortality risk prediction. DESIGN:Prospective cohort study. SETTING:Women's Health Initiative multicenter, population-based U.S. study, with enrollment from 1993 to 1998 and follow-up through 2021. PARTICIPANTS:139 213 postmenopausal women aged 50 to 79 years were included in a development cohort (n = 67 774) and 2 external validation cohorts. Validation Cohort 1 had high prevalence of overweight or obesity (n = 48 335), and Validation Cohort 2 included diverse, geographically separate centers (n = 23 104). MEASUREMENTS:Height, weight, and WC measured at enrollment. BMI categories were normal weight (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), obesity-1 (30 to <35 kg/m2), obesity-2 (35 to <40 kg/m2), and obesity-3 (≥40 kg/m2), with further stratification by prespecified WC thresholds (≥80, ≥90, ≥105, ≥115, and ≥115 cm, respectively). Mortality was ascertained annually and was supplemented with serial National Death Index queries. Ten- and 20-year mortality prediction models that included BMI categories were compared to models with BMI categories stratified by WC thresholds using c-statistics and continuous net reclassification improvement (NRI). RESULTS:Over a median of 24 years of follow-up, 69 297 participants died. Multivariable-adjusted mortality risk was consistently greater for BMI categories with large WC than those with normal WC. Compared with women with normal weight and normal WC, women with normal or overweight BMI but large WC (hazard ratios [HRs], 1.17 [95% CI, 1.12 to 1.21] and 1.19 [CI, 1.15 to 1.24], respectively) had risk similar to those with obesity-1 but normal WC (HR, 1.12 [CI, 1.08 to 1.16]). Mortality associated with obesity-1 and large WC (HR, 1.45 [CI, 1.35 to 1.55]) was similar to that with obesity-3 and normal WC (HR, 1.40 [CI, 1.28 to 1.54]). Models with BMI-specific WC thresholds improved discrimination and risk stratification at 10 years for Validation Cohort 1; c-statistics improved by 0.7% (CI, 0.3% to 1.0%) to 61.3% (CI, 60.2% to 62.5%), and continuous NRI was 20.4% (CI, 17.3% to 23.6%). Results were mixed for Validation Cohort 2; risk stratification improved (continuous NRI, 12.3% [CI, 8.5% to 16.0%]), but not discrimination. Results were similar at 20 years. LIMITATION:The study did not include men or younger women. CONCLUSION:Further stratifying BMI categories by WC thresholds modestly improved mortality risk stratification, with larger WC predicting greater mortality, although the degree of improvement varied by cohort. Discrimination did not improve consistently. PRIMARY FUNDING SOURCE:National Heart, Lung, and Blood Institute of the National Institutes of Health.

OBJECTIVE:Postmenopause is characterized by changes in reproductive hormones and body composition. Preclinical evidence suggests that follicle stimulating hormone (FSH) may increase adiposity, but epidemiologic research is limited. This study examined whether postmenopausal FSH and luteinizing hormone (LH) are related to adiposity changes. METHOD:The sample included 675 postmenopausal women enrolled in the Women's Health Initiative (WHI) Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study with dual-energy X-ray absorptiometry measures. Adiposity measures included visceral adipose tissue (VAT), subcutaneous adipose tissue, body mass index, and total and percent body fat. Group-based trajectory models and generalized estimating equation models estimated associations of baseline FSH and LH with 17-year adipose trajectories and longitudinal measures of adiposity, respectively. RESULTS:The study estimated three trajectories for adiposity measures, corresponding to low, medium and high levels of adiposity over time. Higher baseline concentration of FSH and LH was associated with reductions in adiposity measures over time. An increase of 1 mIU/ml in FSH was associated with a 0.55 cm2 reduction in VAT (95% confidence interval [CI]: -0.69, -0.40); and an increase of 1 mIU/ml in LH was associated with a 0.81 cm2 reduction in VAT (95% CI: -1.09, -0.52). CONCLUSION:Higher circulating FSH and LH were associated with lower adipose trajectories and lower adiposity levels in older postmenopausal women, counter to our hypothesis. Future research is needed on the relationship between gonadotropins and adiposity during the postmenopausal period.

BACKGROUND:The association of metformin with mortality has been mixed, and no prior study has determined whether metformin initiation is associated with exceptional longevity, defined as survival to ages 90 and older. METHODS:We performed a new-user, active comparator cohort study using the target trial emulation framework among the Women's Health Initiative cohort to determine whether metformin versus sulfonylurea initiation was associated with exceptional longevity (survival to age 90). We identified participants ≥60 years with incident type 2 diabetes and no history of hypoglycemic agents or insulin prior to treatment initiation to perform intention-to-treat analyses. We used 1:1 propensity score matching on demographic characteristics, lifestyle behaviors, diabetes duration, comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and cancer), body mass index, and concomitant medications to balance treatment groups on key confounders. RESULTS:Among 438 propensity score-matched women with type 2 diabetes, the incidence rate of death before age 90 per 100 person-years in women initiating metformin monotherapy was 3.7 (95% CI: 3.1-4.4) compared with 5.0 (95% CI: 4.2-5.8) for sulfonylurea monotherapy. The adjusted risk of death before age 90 was 30% lower for initiation of metformin monotherapy versus sulfonylurea monotherapy (hazard ratio, 0.70; 95% CI: 0.56-0.88). CONCLUSIONS:In this first target trial emulation of metformin and exceptional longevity, we found that metformin initiation increased exceptional longevity compared with sulfonylurea initiation among women with type 2 diabetes. Because this comparison was not made to placebo in a randomized controlled trial and given the observational design with potential for residual confounding, causality cannot be inferred.

A 2020 consensus statement proposed body mass index (BMI)-specific waist circumference (WC) thresholds to improve patient care. To determine whether stratifying BMI categories by BMI-specific WC thresholds improves mortality risk prediction. Prospective cohort study. Women's Health Initiative multicenter, population-based U.S. study, with enrollment from 1993 to 1998 and follow-up through 2021. 139 213 postmenopausal women aged 50 to 79 years were included in a development cohort (n = 67 774) and 2 external validation cohorts. Validation Cohort 1 had high prevalence of overweight or obesity (n = 48 335), and Validation Cohort 2 included diverse, geographically separate centers (n = 23 104). Height, weight, and WC measured at enrollment. BMI categories were normal weight (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), obesity-1 (30 to <35 kg/m2), obesity-2 (35 to <40 kg/m2), and obesity-3 (≥40 kg/m2), with further stratification by prespecified WC thresholds (≥80, ≥90, ≥105, ≥115, and ≥115 cm, respectively). Mortality was ascertained annually and was supplemented with serial National Death Index queries. Ten- and 20-year mortality prediction models that included BMI categories were compared to models with BMI categories stratified by WC thresholds using c-statistics and continuous net reclassification improvement (NRI). Over a median of 24 years of follow-up, 69 297 participants died. Multivariable-adjusted mortality risk was consistently greater for BMI categories with large WC than those with normal WC. Compared with women with normal weight and normal WC, women with normal or overweight BMI but large WC (hazard ratios [HRs], 1.17 [95% CI, 1.12 to 1.21] and 1.19 [CI, 1.15 to 1.24], respectively) had risk similar to those with obesity-1 but normal WC (HR, 1.12 [CI, 1.08 to 1.16]). Mortality associated with obesity-1 and large WC (HR, 1.45 [CI, 1.35 to 1.55]) was similar to that with obesity-3 and normal WC (HR, 1.40 [CI, 1.28 to 1.54]). Models with BMI-specific WC thresholds improved discrimination and risk stratification at 10 years for Validation Cohort 1; c-statistics improved by 0.7% (CI, 0.3% to 1.0%) to 61.3% (CI, 60.2% to 62.5%), and continuous NRI was 20.4% (CI, 17.3% to 23.6%). Results were mixed for Validation Cohort 2; risk stratification improved (continuous NRI, 12.3% [CI, 8.5% to 16.0%]), but not discrimination. Results were similar at 20 years. The study did not include men or younger women. Further stratifying BMI categories by WC thresholds modestly improved mortality risk stratification, with larger WC predicting greater mortality, although the degree of improvement varied by cohort. Discrimination did not improve consistently. National Heart, Lung, and Blood Institute of the National Institutes of Health.

Postmenopausal women experience significant changes in body composition, particularly abdominal adipose tissue (AAT) deposition patterns, which influence cardiometabolic risk. Physical activity has demonstrable effects on body composition and overall health; however, there is little evidence for how physical activity influences AAT patterns and body composition in postmenopausal women. We emulated a target trial of physical activity interventions, including the 2018 Physical Activity Guidelines for Americans recommendations (≥150 minutes/week), on 3-year changes in AAT and body composition. We analyzed data from 4451 postmenopausal women aged 50-79 years in the Women's Health Initiative (WHI) with repeated whole body Dual X-Ray Absorptiometry (DXA) scans with derived abdominal visceral (VAT) and subcutaneous adipose tissue (SAT). The mean AAT and body composition measures were estimated with the parametric-g formula. Over 3 years, interventions of increasing minutes of moderate activity would result in dose-dependent reductions in AAT, overall body fat and increases in lean soft tissue, with the greatest estimated benefit at the 2018 physical activity guideline recommendations. Compared to no intervention, if all participants had adhered to ≥150 mins/week of moderate physical activity, they would have 16.8 cm2 lower VAT (95% CI: -23.1, -10.4), 26.8 cm2 lower SAT (95% CI: -36.3, -17.3), 1.3% lower total body fat (95% CI: -1.8, -0.7), 1.2% higher total lean soft tissue (95% CI: 0.7-1.8), and 2.6 kg lower bodyweight (95% CI, -3.6, -1.5). We saw similar patterns in vigorous-intensity activity interventions. These results suggest that postmenopausal women who adhere to physical activity guideline recommendations would experience beneficial body composition changes over 3 years.

Background Obesity, classified by body mass index (BMI), is associated with higher postmenopausal breast cancer (BCa) risk. Yet, the associations between abdominal visceral (VAT) and subcutaneous adipose tissue (SAT) with BCa are unclear.Methods We assessed BCa associations with abdominal VAT and SAT in a prospective cohort of postmenopausal women without a history of cancer and with 27 years follow-up (N = 9950), during which all new cancers were adjudicated. Dual-energy x-ray absorptiometry scans assessed adiposity at baseline, year 3, and year 6. Competing-risks multivariable sub-hazard ratios (SHR), with adjustments for sociodemographic, behavioral, reproductive, and anthropometric characteristics, were estimated for baseline and time-dependent associations between VAT, SAT, and incident BCa.Results Participants averaged 63.3 +/- 7.4 years of age and a BMI of 28.20 +/- 5.72 kg/m2 at baseline. The models included 738 incident BCa case patients (N = 593 invasive; N = 145 in situ). Baseline VAT and SAT area were associated with statistically significantly increased BCa risk, by 36% and 19%, respectively. Increasing VAT/SAT ratio was associated with an 8% increase in incident BCa. Time-dependent models produced similar results. VAT and VAT/SAT associated BCa risk was highest for African American/Black women, although not statistically significantly different from other groups. Quartiles (Q) of VAT/SAT were also explored; the SHR for Q4 compared with Q1 was 1.49 (95% CI = 1.18 to 1.87).Conclusion Higher abdominal VAT and SAT are associated with an increased risk of postmenopausal BCa, and VAT/SAT may provide a distinctive risk estimate. Potential racial and ethnic differences require replication in a larger sample (Women's Health Initiative; NCT00000611; https://clinicaltrials.gov/study/NCT00000611).

BACKGROUND:This study extends prior research from the MRI substudy of the Women's Health Initiative Memory Study (WHIMS-MRI) linking BMI to reduced brain atrophy and ischemic lesion load by examining DXA-based measurements of total body fat, total abdominal adipose tissue (TAT), abdominal visceral (VAT) and subcutaneous (SAT) adipose tissue, gynoid fat, and overall leg fat. METHODS:The analytic sample consisted of 61 postmenopausal women (baseline mean age 69.5 [3.6]) enrolled in WHIMS-MRI who had undergone DXA scans. DXA scans were completed at years 0, 3, and 6, and MRI scans were conducted ~8 years after baseline. Adjusted linear regression models were used to analyze the association between adiposity averaged across the 3-time points and volumes of brain regions previously linked to dementia. RESULTS:Higher levels of total body fat, TAT, VAT, SAT, gynoid, and overall leg fat were associated with larger hippocampal volume (β 0.02 [95% CI, 0.004-0.04]; 0.11 [0.02-0.21]; 0.26 [0.04-0.47]; 0.18 [0.03-0.33]; 0.18 [0.05-0.30]; 0.07 [0.009-0.12], respectively). No other significant associations were observed. CONCLUSION:Higher levels of adiposity were positively associated with hippocampal volume. Additional research with larger sample sizes is needed to ascertain the significance of this association.

Energy intake, fiber intake, and percentage of calories from carbohydrates, sugar, protein, and fat calculated from 24-hour diet recalls. Data are represented as mean ± SD

AbstractPurpose: Chronic inflammation is integral to myeloproliferative neoplasm (MPN) pathogenesis. JAK inhibitors reduce cytokine levels, but not without significant side effects. Nutrition is a low-risk approach to reduce inflammation and ameliorate symptoms in MPN. We performed a randomized, parallel-arm study to determine the feasibility of an education-focused Mediterranean diet intervention among patients with MPN. Experimental Design: We randomly assigned patients with MPN to either a Mediterranean diet or standard U.S. Dietary Guidelines for Americans (USDA). Groups received equal but separate education with registered dietician counseling and written dietary resources. Patients were prospectively followed for feasibility, adherence, and symptom burden assessments. Biological samples were collected at four timepoints during the 15-week study to explore changes in inflammatory biomarkers and gut microbiome. Results: The Mediterranean diet was as easy to follow for patients with MPN as the standard USDA diet. Approximately 80% of the patients in the Mediterranean diet group achieved a Mediterranean Diet Adherence Score of ≥8 throughout the entire active intervention period, whereas less than 50% of the USDA group achieved a score of ≥8 at any timepoint. Improvement in symptom burden was observed in both diet groups. No significant changes were observed in inflammatory cytokines. The diversity and composition of the gut microbiome remained stable throughout the duration of the intervention. Conclusions: With dietician counseling and written education, patients with MPN can adhere to a Mediterranean eating pattern. Diet interventions may be further developed as a component of MPN care, and potentially incorporated into the management of other hematologic conditions. Significance: Diet is a central tenant of management of chronic conditions characterized by subclinical inflammation, such as cardiovascular disease, but has not entered the treatment algorithm for clonal hematologic disorders. Here, we establish that a Mediterranean diet intervention is feasible in the MPN patient population and can improve symptom burden. These findings warrant large dietary interventions in patients with hematologic disorders to test the impact of diet on clinical outcomes.

STUDY QUESTION: productive health history (e.g. age at menarche, menopause, reproductive lifespan) with abdominal adiposity in postmenopausal women? SUMMARY ANSWER: Higher visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) tissue levels were observed among women with earlier menarche, earlier menopause, and greater parity. WHAT IS KNOWN ALREADY: Postmenopausal women are predisposed to accumulation of VAT and SAT. Reproductive health variables are known predictors of overall obesity status in women, defined by BMI. STUDY DESIGN, SIZE, DURATION: This study is a secondary analysis of data collected from the baseline visit of the Women's Health Initiative (WHI). The WHI is a large prospective study of postmenopausal women, including both a randomized trial and observational study. There were 10 184 women included in this analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data were collected from a reproductive health history questionnaire, dual-energy x-ray absorptiometry scans, and anthropometric measures at WHI baseline. Reproductive history was measured via self-report, and included age at menarche, variables related to pregnancy, and age at menopause. Reproductive lifespan was calculated as age at menopause minus age at menarche. Statistical analyses included descriptive analyses and multivariable linear regression models to examine the association between reproductive history with VAT, SAT, total body fat, and BMI. MAIN RESULTS AND THE ROLE OF CHANCE: Women who reported early menarche (<10 years) or early menopause (<40 years) had the highest levels of VAT. Adjusted multivariable linear regression results demonstrate women who experienced menarche >15 years had 23 cm(2) less VAT (95% CI: -31.4, -14.4) and 47 cm(2) less SAT (95% CI: -61.8, -33.4) than women who experienced menarche at age 10 years or earlier. A similar pattern was observed for age at menopause: compared to women who experienced menopause <40 years, menopause at 50-55 years was associated with 19.3 cm(2) (95% CI: -25.4, -13.3) less VAT and 27.4 cm(2) (-29.6, 10.3) less SAT. High parity (>3 pregnancies) was also associated with VAT and SAT. For example, adjusted beta coefficients for VAT were 8.36 (4.33, 12.4) and 17.9 (12.6, 23.2) comparing three to four pregnancies with the referent, one to two pregnancies. LIMITATIONS, REASONS FOR CAUTION: The WHI reproductive health history questionnaire may be subject to poor recall owing to a long look-back window. Residual confounding may be present given lack of data on early life characteristics, such as maternal and pre-menarche characteristics. WIDER IMPLICATIONS OF THE FINDINGS: This study contributes to our understanding of reproductive lifespan, including menarche and menopause, as an important predictor of late-life adiposity in women. Reproductive health has also been recognized as a sentinel marker for chronic disease in late life. Given established links between adiposity and cardiometabolic outcomes, this research has implications for future research, clinical practice, and public health policy that makes use of reproductive health history as an opportunity for chronic disease prevention.

Objective This study estimated the effect of hypothetical interventions of higher and lower frequency of breakfast and post-dinner snack consumption (breakfast consumption 0-4 vs. 5-7 times/week and post-dinner snack consumption 0-2 vs. 3-7 times/week) on changes in body weight and composition over 18 months after a successful 6-month standard behavioral weight-loss program. Methods The study analyzed data from the Innovative Approaches to Diet, Exercise and Activity (IDEA) study. ResultsIf all participants consumed a breakfast meal 5 to 7 times/week over 18 months, they would have regained 2.95 kg of body weight on average (95% CI: 2.01 to 3.96), which is 0.59 kg (95% CI: -0.86 to -0.32) lower than if all participants consumed breakfast 0 to 4 times/week. If all participants consumed a post-dinner snack 0 to 2 times/week, they would have regained 2.86 kg of body weight on average (95% CI: 0.99 to 5.25), which is 0.83 kg (95% CI: -1.06 to -0.59) lower than if all consumed a post-dinner snack 3 to 7 times/week. Conclusions Regular breakfast consumption and minimizing post-dinner snacking may modestly mitigate weight and body fat regain over 18 months after initial weight loss.