Abstract 1152: Diet Quality, Lifestyle and Weight Change in Framingham Women and Men: The Framingham Nutrition Studies
Overweight and obesity, major cardiovascular disease risk factors, affect 23% and 10% of adults globally. This study evaluated weight change patterns and predictors among 1,515 healthy adults, aged ≥30 years, with BMI≥18.5 kg/m2, of the Framingham Offspring/Spouse cohort over 16 years of follow-up. Diet was assessed using three-day dietary records. Diet quality was evaluated using the validated 19-nutrient Framingham Nutritional Risk Score, derived from the mean of the subjects’ ranked levels of nutrient intake; a higher rank reflects poor dietary quality. Among men, 55% gained weight, 21% lost weight and 24% maintained stable weight; corresponding proportions in women were 62%, 18% and 20%. Multivariate-adjusted weight change (mean±SE) in normal, overweight, and obese men was 4.4±0.6, 3.5±0.4 and 2.3±0.9 kg; equivalent rates in women were 4.9±0.4, 5.0±0.6 and 1.9±1.2 kg. In multivariate linear regression analysis, age in both sexes (p<0.0001), physical activity in women (p<0.05) and smoking in men (p<0.05) predicted lower weight gain; weight fluctuation (p<0.01) and smoking cessation (p<0.0001) predicted larger weight gain in men. Diet quality was not associated with weight change in men. Among women, smoking cessation modified the effect of diet quality on weight gain (p for interaction=0.02). Former smokers with lower diet quality gained on average 5.2 more kilograms relative to those with higher diet quality (p for trend=0.06) in multivariate-adjusted models. Multivariate-adjusted weight change (mean±SE) in non-smokers, former smokers and smokers was 4.4±0.3, 5.8±0.8 and 3.5±0.9 kg (p<0.05). Baseline BMI status further modified the effects (p for interaction=0.004): Obese former smokers with lower diet quality gained on average 18.2 more kilograms compared to those with higher diet quality (p for trend=0.07; age-adjusted model). In conclusion, age and smoking cessation in men and women, weight fluctuation and smoking in men and physical activity in women were stronger predictors of weight change than diet quality among Framingham adults. Obese women who stop smoking and have poor diet quality had the largest weight gains. Gender-related lifestyle factors should be considered when developing preventive nutrition interventions.