Cited by 62Nutritional Studies and DietCancer Risks and FactorsDiet and metabolism studies

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

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Prentice, Ross L, Aragaki, Aaron K, Howard, Barbara V, Chlebowski, Rowan T, Thomson, Cynthia A, Van Horn, Linda, Tinker, Lesley F, Manson, JoAnn E +6 more·2019·The Journal of Nutrition

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.

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Authors
Prentice, R. L., Aragaki, A. K., Howard, B. V., Chlebowski, R. T., Thomson, C. A., Van Horn, L., Tinker, L. F., Manson, J. E., Anderson, G. L., Kuller, L. E., Neuhouser, M. L., Johnson, K. C., Snetselaar, L., & Rossouw, J. E.
Affiliations
  • Fred Hutch Cancer Center (US)
  • Georgetown University Medical Center (US)
  • The Lundquist Institute (US)
  • University of Arizona (US)
  • Brigham and Women's Hospital (US)
  • University of Tennessee Health Science Center (US)
  • University of Iowa (US)
  • National Heart, Lung, and Blood Institute (US)
Corresponding author
Prentice, Ross L
Venue
The Journal of Nutrition
Publisher
Elsevier BV
Published
2019-09
Volume
149
Issue
9
Pages
1565-1574
ISSN
0022-3166 (ISSN-L)
OpenAlex
W2971070863
Cited by
62
References
28
Citations by year
2026: 3 · 2025: 8 · 2024: 9 · 2023: 11 · 2022: 12 · 2021: 9 · 2020: 10
FWCI
7.13
Type
journal article
Language
en
Open access
Locations
  • Journal of Nutrition (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, HHSN268201600004C)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
Keywords
dietary fat reduction, postmenopausal women, breast cancer, colorectal cancer, coronary artery disease, diabetes mellitus, type 1 diabetes, fruit and vegetable intake, grain consumption, macronutrient composition, Women's Health Initiative Dietary Modification Trial, long-term health effects
MeSH terms
Aged, Breast Neoplasms, Coronary Disease, Diabetes Mellitus, Female, Humans, Middle Aged, Colorectal Neoplasms, Women's Health, Postmenopause, Diet, Fat-Restricted

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