Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes
Open accessAbstract
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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Low-fat patterns generally target total fat intake between 20% and 30% of kilocalories alongside other healthy dietary guidelines.
“Low-fat patterns generally target total fat intake between 20% and 30% of kilocalories alongside other healthy dietary guidelines.20,[29][30][31][32][33][34][35][36]”
From Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. (2023) · cites this paper as [32]
Low-carbohydrate patterns generally refer to patterns with total carbohydrate targets between 20% and 40% of kilocalories.
“Low-carbohydrate patterns generally refer to patterns with total carbohydrate targets between 20% and 40% of kilocalaroies.20,[29][30][31][32][33][34][35][36]”
From Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. (2023) · cites this paper as [32]
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Prentice, R. L., Neuhouser, M. L., Tinker, L. F., & Howard, B. V. (2021) · Journal of Nutrition · doi:10.1093/jn/nxab095 · Cited by 1 · see citing works
Self-citationReply to R.T. Chlebowski et al
Ligibel, J. A. (2020) · Journal of Clinical Oncology · doi:10.1200/jco.20.01456 · Cited by 1 · see citing works
Reply to WC Willett and D Ludwig
Prentice, R. L., Howard, B. V., Horn, L. V., Manson, J. E., & Chlebowski, R. T. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab314
Self-citationA framework for predicting consumers’ sustainable purchase in COVID era
ابراهيم, ر. ش. ا., & محمود, ر. م. م. (2022) · التجارة والتمويل · doi:10.21608/caf.2022.251784
Weight Management, Micronutrients, and Supplements in Diabetes
Roberts, E., & Mechanick, J. I. (2022) · EMJ Diabetes · doi:10.33590/emjdiabet/10153468
Barbaresko, J., Lang, A. S., Szczerba, E., Bächle, C., Beckhaus, J., Schwingshackl, L., Neuenschwander, M., & Schlesinger, S. (2023) · doi:10.2337/figshare.21561987.v1
Diet and Chronic Disease Research in the Women’s Health Initiative
Prentice, R. L. (2023) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2023.11.012
Self-citationHow the Microbiome Affects the Risk for Colon Cancer
Drewes, J. L., & Bhatt, A. P. (2023) · Springer eBooks · doi:10.1007/978-3-031-46712-7_7
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Dietary habits and breast cancer in South Asian women: a systematic review protocol
Seneviwickrama, M., Dilhani, W. N. S., Jayakody, S., Denagamagei, S. S., & Nawaratne, S. D. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-087661
Effects of Lifestyle Interventions on Metabolic Dysfunction-Associated Steatotic Liver Disease
Sharma, A. R., & Barb, D. (2025) · Springer eBooks · doi:10.1007/978-3-031-82888-1_10
Li, W., Zhang, Z., Tang, A., Huang, H., Yao, W., Chen, M., & Zou, T. (2025) · Nutrition Reviews · doi:10.1093/nutrit/nuaf074
Macronutrient content and quality, and risk of multimorbidity in the UK Biobank
Vázquez‐Fernández, A., Yévenes‐Briones, H., Baylín, A., Caballero, F. F., & López‐García, E. (2025) · The Journals of Gerontology Series A · doi:10.1093/gerona/glaf267
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The interplay between lipid metabolism, cancer progression and anti-cancer immunity
Koh, C., Lee, Y., Kim, I., & Chung, Y. (2026) · Experimental & Molecular Medicine · doi:10.1038/s12276-026-01783-3
- 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
- ORCID
- Venue
- The Journal of Nutrition
- Publisher
- Elsevier BV
- Published
- 2019-09
- Volume
- 149
- Issue
- 9
- Pages
- 1565-1574
- ISSN
- 0022-3166 (ISSN-L)
- PMC
- PMC6736441
- 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
- hybrid
- doi.org
- Licence
- 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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