Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes

Ross L. Prentice, Aaron K. Aragaki, Barbara V. Howard, Rowan T. Chlebowski, Cynthia Thomson, Linda Van Horn, Lesley F. Tinker, Jo Ann E. Manson, Garnet L. Anderson, Lewis E. Kuller, Marian L. Neuhouser, Karen C. Johnson, Linda Snetselaar, Jacques E. Rossouw

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The preferred macronutrient dietary composition, and the health consequences of dietary fat reduction specifically, have been debated for decades. Here we provide a comprehensive overview of long-term health outcomes in the Women's Health Initiative Dietary Modification (DM) trial. OBJECTIVE: The DM trial aimed to examine whether a low-fat dietary pattern would reduce the risk of invasive breast cancer, colorectal cancer, and, secondarily, coronary heart disease (CHD), with various other health outcomes also considered. METHODS: The DM trial is a randomized controlled trial conducted at 40 centers in the US, among 48,835 postmenopausal women aged 50-79 y with baseline intake of ≥32% energy from fat. Participants were randomly assigned to a low-fat dietary pattern intervention group or to a usual-diet comparison group, during 1993-1998. Intervention goals were to reduce fat intake from ∼35% to 20% of total energy, in conjunction with increasing vegetables and fruit to 5 servings/d and grains to 6 servings/d. RESULTS: Over an 8.5-y (median) intervention period, intervention and comparison group differences included lower fat by 8-10%, and higher carbohydrate by 8-10%, of total energy, in conjunction with higher consumption of vegetables, fruit, and grains. Time-to-outcome analyses did not show significant differences between intervention and comparison groups for invasive breast cancer, colorectal cancer, or CHD, either over the intervention period or over longer-term cumulative follow-up. Additional analyses showed significant intervention group benefits related to breast cancer, CHD, and diabetes, without adverse effects. Over a 19.6-y (median) follow-up period, HRs (95% CIs) were 0.84 (0.74, 0.96) for breast cancer followed by death, and 0.87 (0.77, 0.98) for diabetes requiring insulin. CONCLUSIONS: Reduction in dietary fat with corresponding increase in vegetables, fruit, and grains led to benefits related to breast cancer, CHD, and diabetes, without adverse effects, among healthy postmenopausal US women. This trial was registered at clinicaltrials.gov as NCT00000611.

Original languageEnglish (US)
Pages (from-to)1565-1574
Number of pages10
JournalThe Journal of nutrition
Volume149
Issue number9
DOIs
StatePublished - Sep 1 2019

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Dietary Fats
Diet Therapy
Cardiovascular Diseases
Coronary Disease
Breast Neoplasms
Vegetables
Fruit
Fats
Neoplasms
Colorectal Neoplasms
Health
Women's Health
Energy Intake
Randomized Controlled Trials
Carbohydrates
Insulin
Diet

Keywords

  • cancer
  • carbohydrate
  • cardiovascular disease
  • diabetes
  • health benefits and risks
  • low-fat dietary pattern
  • nutritional behavioral intervention
  • randomized controlled trial

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Prentice, R. L., Aragaki, A. K., Howard, B. V., Chlebowski, R. T., Thomson, C., Van Horn, L., ... Rossouw, J. E. (2019). Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes. The Journal of nutrition, 149(9), 1565-1574. https://doi.org/10.1093/jn/nxz107

Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes. / Prentice, Ross L.; Aragaki, Aaron K.; Howard, Barbara V.; Chlebowski, Rowan T.; Thomson, Cynthia; Van Horn, Linda; Tinker, Lesley F.; Manson, Jo Ann E.; Anderson, Garnet L.; Kuller, Lewis E.; Neuhouser, Marian L.; Johnson, Karen C.; Snetselaar, Linda; Rossouw, Jacques E.

In: The Journal of nutrition, Vol. 149, No. 9, 01.09.2019, p. 1565-1574.

Research output: Contribution to journalArticle

Prentice, RL, Aragaki, AK, Howard, BV, Chlebowski, RT, Thomson, C, Van Horn, L, Tinker, LF, Manson, JAE, Anderson, GL, Kuller, LE, Neuhouser, ML, Johnson, KC, Snetselaar, L & Rossouw, JE 2019, 'Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes', The Journal of nutrition, vol. 149, no. 9, pp. 1565-1574. https://doi.org/10.1093/jn/nxz107
Prentice, Ross L. ; Aragaki, Aaron K. ; Howard, Barbara V. ; Chlebowski, Rowan T. ; Thomson, Cynthia ; Van Horn, Linda ; Tinker, Lesley F. ; Manson, Jo Ann E. ; Anderson, Garnet L. ; Kuller, Lewis E. ; Neuhouser, Marian L. ; Johnson, Karen C. ; Snetselaar, Linda ; Rossouw, Jacques E. / Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes. In: The Journal of nutrition. 2019 ; Vol. 149, No. 9. pp. 1565-1574.
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AU - Thomson, Cynthia

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N2 - BACKGROUND: The preferred macronutrient dietary composition, and the health consequences of dietary fat reduction specifically, have been debated for decades. Here we provide a comprehensive overview of long-term health outcomes in the Women's Health Initiative Dietary Modification (DM) trial. OBJECTIVE: The DM trial aimed to examine whether a low-fat dietary pattern would reduce the risk of invasive breast cancer, colorectal cancer, and, secondarily, coronary heart disease (CHD), with various other health outcomes also considered. METHODS: The DM trial is a randomized controlled trial conducted at 40 centers in the US, among 48,835 postmenopausal women aged 50-79 y with baseline intake of ≥32% energy from fat. Participants were randomly assigned to a low-fat dietary pattern intervention group or to a usual-diet comparison group, during 1993-1998. Intervention goals were to reduce fat intake from ∼35% to 20% of total energy, in conjunction with increasing vegetables and fruit to 5 servings/d and grains to 6 servings/d. RESULTS: Over an 8.5-y (median) intervention period, intervention and comparison group differences included lower fat by 8-10%, and higher carbohydrate by 8-10%, of total energy, in conjunction with higher consumption of vegetables, fruit, and grains. Time-to-outcome analyses did not show significant differences between intervention and comparison groups for invasive breast cancer, colorectal cancer, or CHD, either over the intervention period or over longer-term cumulative follow-up. Additional analyses showed significant intervention group benefits related to breast cancer, CHD, and diabetes, without adverse effects. Over a 19.6-y (median) follow-up period, HRs (95% CIs) were 0.84 (0.74, 0.96) for breast cancer followed by death, and 0.87 (0.77, 0.98) for diabetes requiring insulin. CONCLUSIONS: Reduction in dietary fat with corresponding increase in vegetables, fruit, and grains led to benefits related to breast cancer, CHD, and diabetes, without adverse effects, among healthy postmenopausal US women. This trial was registered at clinicaltrials.gov as NCT00000611.

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