Intermittent energy restriction may result in greater improvements in insulin sensitivity and weight control than daily energy restriction (DER). We tested two intermittent energy and carbohydrate restriction (IECR) regimens, including one which allowed ad libitum protein and fat (IECR þ PF). Overweight women (n 115) aged 20 and 69 years with a family history of breast cancer were randomised to an overall 25 % energy restriction, either as an IECR (2500 -2717 kJ/d, , 40 g carbohydrate/d for 2 d/week) or a 25 % DER (approximately 6000 kJ/d for 7 d/week) or an IECR þ PF for a 3-month weight-loss period and 1 month of weight maintenance (IECR or IECR þ PF for 1 d/week). Insulin resistance reduced with the IECR diets (mean 20·34 (95 % CI 2 0·66, 2 0·02) units) and the IECR þ PF diet (mean 2 0·38 (95 % CI 20·75, 2 0·01) units). Reductions with the IECR diets were significantly greater compared with the DER diet (mean 0·2 (95 % CI 2 0·19, 0·66) mU/unit, P¼0·02). Both IECR groups had greater reductions in body fat compared with the DER group (IECR: mean 2 3·7 (95 % CI 22·5, 24·9) kg, P¼0·007; IECR þ PF: mean 23·7 (95 % CI 2 2·8, 24·7) kg, P¼0·019; DER: mean 22·0 (95 % CI 21·0, 3·0) kg). During the weight maintenance phase, 1 d of IECR or IECR þ PF per week maintained the reductions in insulin resistance and weight. In the short term, IECR is superior to DER with respect to improved insulin sensitivity and body fat reduction. Longer-term studies into the safety and effectiveness of IECR diets are warranted.Key words: Intermittent energy restriction: Low-carbohydrate diets: Weight loss: Daily energy restriction: Insulin resistanceThe global health burden of obesity-related conditions such as diabetes, CVD, dementia and certain cancers, including breast cancer, may be reduced by weight loss and the associated improvements in insulin sensitivity. The difficulties of achieving and sustaining weight loss by energy restriction are well known (1) . Even when reduced weights are maintained, metabolic benefits achieved with weight loss are often attenuated because of non-compliance or adaptation (2 -4) . Effective dietary interventions are needed that promote long-term adherence and sustained beneficial effects on metabolic and disease markers. Such interventions need to be palatable and satiating, meet minimal nutritional requirements, promote loss of fat and preserve lean body mass, ensure long-term safety, be simple to administer and monitor and have widespread public health utility. Multiple dietary approaches have been studied that vary in macronutrient composition (5) and the degree of energy restriction (6) . These typically achieve long-term 5 % weight loss in

This article examines published evidence from longitudinal studies of the menopausal transition that address the following questions: (1) Which symptoms do women report during the perimenopause, and how prevalent are these symptoms as women traverse the menopausal transition? (2) How severe are symptoms and for how long do they persist? (3) To what do women attribute their symptoms, and do their attributions match findings from epidemiologic studies of community-based populations? (4) How significant are these symptoms in women's lives? Data from published longitudinal studies were examined for evidence bearing on each of these questions. Only vasomotor symptoms, vaginal dryness, and sleep disturbance symptoms varied in prevalence significantly across menopausal transition stages and postmenopause in >1 population studied. A minority of women report severe symptoms. Given the limited follow-up data available, it is unclear how long symptoms persist after menopause. Women attribute their symptoms to a variety of biologic and psychosocial factors, and their attributions correspond well to those correlates identified in epidemiologic studies of community-based populations. The significance of symptoms for women's lives remains uncertain. The impact of symptoms during the perimenopause on well-being, role performance, adaptation to demands of daily living, and quality of life warrants additional study. The appraisal of the consequences of perimenopausal symptoms by women from different ethnic groups will be enhanced significantly as a result of the Study of Women's Health Across the Nation (SWAN) and other studies in progress.

Women going through the menopausal transition have deleterious changes in inflammatory markers and adipokines that correlate with increased visceral adiposity.

Sleep symptoms during the MT may be amenable to symptom management strategies that take into account the symptom clusters and promote women's general health rather than focusing only on the MT.

The majority of women for the majority of the time experienced MT without a high severity of depressed mood while a small group of women had mood worsening over time and others improved. Depressed mood that occurs during the MT should not be attributed automatically to menstrual cycle changes or normative changes. Instead, features of a woman's life that contribute to depression should also be considered.

Our purpose in conducting this study was to determine how a cohort of women born between 1935 and 1955 defined midlife, and what midlife events they viewed as important, distressing, and satisfying. A random sample of women enrolled in the Seattle Midlife Women's Health Study (n = 131) participated in a telephone interview about the meaning of midlife and important events occurring during the past year. They described midlife similarly to women from earlier birth cohorts with one important exception: the centrality of work and personal achievements in their lives. Contemporary midlife women's views of midlife reflect their roles in society.

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Although women in the late MT stage are vulnerable to depressed mood, factors that account for depressed mood earlier in the life span continue to have an important influence and should be considered in studies of etiology and therapeutics.