# Estimating the effect of hypothetical dietary protein interventions on changes in body composition of postmenopausal women over 3 years using data from the Women’s Health Initiative (WHI) Study: an emulated target trial

## TL;DR

This study estimates that higher protein diets may improve body composition in postmenopausal women, reducing fat and increasing lean tissue over three years.

## Contribution

The study uses emulated target trial methods to estimate the effect of hypothetical protein interventions on body composition in postmenopausal women.

## Key findings

- Higher protein intake (≥1.2 g/kg/day) is linked to reduced abdominal fat and increased lean tissue over 3 years.
- Protein intake of ≥1.5 g/kg/day shows the greatest estimated benefits in body composition changes.
- Current dietary guidelines may underestimate optimal protein levels for postmenopausal women's health.

## Abstract

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.