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Low-Fat Dietary Pattern and Cancer Mortality in the Women’s Health Initiative (WHI) Randomized Controlled Trial

Published on Oct 1, 2018in JNCI Cancer Spectrum
· DOI :10.1093/jncics/pky065
Rowan T. Chlebowski80
Estimated H-index: 80
(Los Angeles Biomedical Research Institute),
Garnet L. Anderson70
Estimated H-index: 70
(Fred Hutchinson Cancer Research Center)
+ 15 AuthorsCynthia A. Thomson56
Estimated H-index: 56
(UA: University of Arizona)
Abstract
Background: In the Women's Health Initiative Dietary Modification trial, a low-fat dietary pattern reduced deaths after breast cancer. Mortality from other cancer sites has not been reported. Methods: A low-fat dietary pattern influence on deaths from and after site-specific cancers was examined during 8.5 years (median) of dietary intervention and cumulatively during 17.7 years (median) of follow-up. A total 48 835 postmenopausal women, ages 50-79 years, were randomly assigned from 1993 to 1998 at 40 US clinical centers to dietary intervention (40%, n = 19 541 or a usual diet comparison group (60%, n = 29 294). Dietary intervention influence on mortality from protocol-specified cancers (breast, colon and rectum, endometrium and ovary), individually and as a composite, represented the primary analyses. Results: During the dietary intervention period, a reduction in deaths after breast cancer (HR = 0.65 95% CI = 0.45 to 0.94, P = .02) was the only statistically significant cancer mortality finding. During intervention, the HRs for deaths after the protocol-specified cancer composite were 0.90 (95% CI = 0.73 to 1.10) and 0.95 (95% CI = 0.85 to 1.06) for deaths after all cancers. During 17.7 years of follow-up with 3867 deaths after all cancers, reduction in deaths after breast cancer continued in the dietary intervention group (HR = 0.85, 95% CI = 0.74 to 0.99, P = .03). However, no dietary intervention influence on deaths from or after any other cancer or cancer composite was seen. Conclusions: A low-fat dietary pattern reduced deaths after breast cancer. No reduction in mortality from or after any other cancer or cancer composite was seen.
  • References (37)
  • Citations (2)
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References37
Newest
#1Rowan T. Chlebowski (City of Hope National Medical Center)H-Index: 80
#2Aaron K. Aragaki (Fred Hutchinson Cancer Research Center)H-Index: 42
Last. Ross L. Prentice (Fred Hutchinson Cancer Research Center)H-Index: 102
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Importance In a randomized clinical trial, a low-fat eating pattern was associated with lower risk of death after breast cancer. However, the extent to which results were driven by dietary influence on survival after breast cancer diagnosis was unknown. Objective To determine the association of a low-fat dietary pattern with breast cancer overall survival (breast cancer followed by death from any cause measured from cancer diagnosis). Design, Setting, and Participants This is a secondary analysi...
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#1Li JiaoH-Index: 33
#2Liang Chen (BCM: Baylor College of Medicine)H-Index: 7
Last. Hashem B. El-Serag (BCM: Baylor College of Medicine)H-Index: 106
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Background: Observational studies suggest that diet may influence pancreatic cancer risk. We investigated the effect of a low-fat dietary intervention on pancreatic cancer incidence. Methods: The Women's Health Initiative Dietary Modification (WHI-DM) trial is a randomized controlled trial conducted in 48 835 postmenopausal women age 50 to 79 years in the United States between 1993 and 1998. Women were randomly assigned to the intervention group (n = 19 541), with the goal of reducing total fat ...
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#1Barbara V. Howard (Georgetown University)H-Index: 116
#2Aaron K. Aragaki (Fred Hutchinson Cancer Research Center)H-Index: 42
Last. Ross L. Prentice (Fred Hutchinson Cancer Research Center)H-Index: 102
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OBJECTIVE We performed a secondary analysis to evaluate the effect of the Women’s Health Initiative dietary intervention on incident diabetes and diabetes treatment in postmenopausal women. RESEARCH DESIGN AND METHODS A total of 48,835 women were randomized to a comparison group or an intervention group that underwent a behavioral/nutritional modification program to decrease fat and increase vegetable, fruit, and grain intake for an average of 8.1 years. Ninety-three percent of participants comp...
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#1Rowan T. Chlebowski (Los Angeles Biomedical Research Institute)H-Index: 80
#2Aaron K. Aragaki (Fred Hutchinson Cancer Research Center)H-Index: 42
Last. Ross L. Prentice (Fred Hutchinson Cancer Research Center)H-Index: 102
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PurposeEarlier Women’s Health Initiative Dietary Modification trial findings suggested that a low-fat eating pattern may reduce breast cancers with greater mortality. Therefore, as a primary outcome-related analysis from a randomized prevention trial, we examined the long-term influence of this intervention on deaths as a result of and after breast cancer during 8.5 years (median) of dietary intervention and cumulatively for all breast cancers diagnosed during 16.1 years (median) of follow-up.Pa...
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#1Ross L. Prentice (Fred Hutchinson Cancer Research Center)H-Index: 102
#2Aaron K. Aragaki (Fred Hutchinson Cancer Research Center)H-Index: 42
Last. Barbara V. Howard (Georgetown University)H-Index: 116
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: Background: The influence of a low-fat dietary pattern on the cardiovascular health of postmenopausal women continues to be of public health interest.Objective: This report evaluates low-fat dietary pattern influences on cardiovascular disease (CVD) incidence and mortality during the intervention and postintervention phases of the Women's Health Initiative Dietary Modification Trial.Design: Participants comprised 48,835 postmenopausal women aged 50-79 y; 40% were randomly assigned to a low-fat...
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#1Marina M. Reeves (UQ: University of Queensland)H-Index: 34
#2Elizabeth Winkler (UQ: University of Queensland)H-Index: 37
Last. Elizabeth G. Eakin (UQ: University of Queensland)H-Index: 57
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Aim Obesity is associated with poor prognosis and risk of treatment side-effects in breast cancer survivors. This pilot study assessed the feasibility, acceptability, safety and efficacy of a telephone-delivered weight loss intervention, among women (BMI 25–40 kg/m2) following treatment for stage I–III breast cancer, on weight loss (primary outcome), quality of life and treatment-related side-effects (vs usual care). Methods Ninety women (mean ± SD age: 55.3 ± 8.7years; BMI: 31.0 ± 4.3 kg/m2; 15...
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#1Béatrice Lauby-Secretan (IARC: International Agency for Research on Cancer)H-Index: 15
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The International Agency for Research on Cancer convened a workshop on the relationship between body fatness and cancer, from which an IARC handbook on the topic will appear. An executive summary of the evidence is presented.
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Observational studies assessing the association of dietary fat and risk of ovarian cancer yield discrepant results. Pertinent prospective cohort studies were identified by a PubMed search from inception to December 2015. Sixteen independent case-control and nine cohort studies on dietary fat intake were included, with approximately 900,000 subjects in total. Relative risks (RRs) with 95% confidence intervals were pooled using a random effects model. Heterogeneity, sensitivity analysis and public...
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#1Yi Cao (Qingdao University)H-Index: 1
#2Lin Hou (Qingdao University)H-Index: 1
Last. Weijing Wang (Qingdao University)H-Index: 1
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Results from prospective cohort studies on the association between dietary total fat and fatty acids intake and risk of breast cancer remain controversial. Pertinent prospective cohort studies were identified by a search of Embase and PubMed from inception to September 2015. Study-specific relative risks (RRs) with 95% confidence intervals were pooled using a random-effect model. Between-study heterogeneity and publication bias were assessed, and sensitivity analysis was conducted. Twenty-four i...
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Abstract Background Intensive dietary intervention programs may lead to benefits in vitality and other components of health quality. The Women's Health Initiative Dietary Modification (DM) intervention includes a large randomized controlled trial of an intensive intervention. Objective To evaluate whether the intervention is associated with improved health-related quality of life (HRQoL) subscales, overall self-reported health, depression symptoms, cognitive functioning, and sleep quality. Desig...
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Cardiorespiratory fitness (CRF) is an independent predictor for all-cause and disease-specific morbidity and mortality. CRF is a modifiable risk factor, and exercise training and increased physical activity, as well as targeted medical therapies, can improve CRF. Although nutrition is a modifiable risk factor for chronic noncommunicable diseases, little is known about the effect of dietary patterns and specific nutrients on modifying CRF. This review focuses specifically on trials that implement...
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#1Ross L. Prentice (Fred Hutchinson Cancer Research Center)H-Index: 102
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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.
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