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Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial.

Abstract

CONTEXT

The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial.

OBJECTIVE

To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence.

DESIGN AND SETTING

A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005.

PARTICIPANTS

A total of 48,835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled.

INTERVENTIONS

Women were randomly assigned to the dietary modification intervention group (40% [n = 19,541]) or the comparison group (60% [n = 29,294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes.

MAIN OUTCOME MEASURE

Invasive breast cancer incidence.

RESULTS

Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor.

CONCLUSIONS

Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov Identifier: NCT00000611.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Wash 98109, USA. rprentice@whi.org

    , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

    Source

    JAMA 295:6 2006 Feb 08 pg 629-42

    MeSH

    Aged
    Biomarkers
    Body Weight
    Breast Neoplasms
    Cholesterol, LDL
    Diet Records
    Diet, Fat-Restricted
    Female
    Follow-Up Studies
    Gonadal Steroid Hormones
    Humans
    Incidence
    Middle Aged
    Postmenopause
    Primary Prevention
    Proportional Hazards Models
    Risk
    Sex Hormone-Binding Globulin

    Pub Type(s)

    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    16467232

    Citation

    Prentice, Ross L., et al. "Low-fat Dietary Pattern and Risk of Invasive Breast Cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial." JAMA, vol. 295, no. 6, 2006, pp. 629-42.
    Prentice RL, Caan B, Chlebowski RT, et al. Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295(6):629-42.
    Prentice, R. L., Caan, B., Chlebowski, R. T., Patterson, R., Kuller, L. H., Ockene, J. K., ... Henderson, M. M. (2006). Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA, 295(6), pp. 629-42.
    Prentice RL, et al. Low-fat Dietary Pattern and Risk of Invasive Breast Cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006 Feb 8;295(6):629-42. PubMed PMID: 16467232.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. AU - Prentice,Ross L, AU - Caan,Bette, AU - Chlebowski,Rowan T, AU - Patterson,Ruth, AU - Kuller,Lewis H, AU - Ockene,Judith K, AU - Margolis,Karen L, AU - Limacher,Marian C, AU - Manson,JoAnn E, AU - Parker,Linda M, AU - Paskett,Electra, AU - Phillips,Lawrence, AU - Robbins,John, AU - Rossouw,Jacques E, AU - Sarto,Gloria E, AU - Shikany,James M, AU - Stefanick,Marcia L, AU - Thomson,Cynthia A, AU - Van Horn,Linda, AU - Vitolins,Mara Z, AU - Wactawski-Wende,Jean, AU - Wallace,Robert B, AU - Wassertheil-Smoller,Sylvia, AU - Whitlock,Evelyn, AU - Yano,Katsuhiko, AU - Adams-Campbell,Lucile, AU - Anderson,Garnet L, AU - Assaf,Annlouise R, AU - Beresford,Shirley A A, AU - Black,Henry R, AU - Brunner,Robert L, AU - Brzyski,Robert G, AU - Ford,Leslie, AU - Gass,Margery, AU - Hays,Jennifer, AU - Heber,David, AU - Heiss,Gerardo, AU - Hendrix,Susan L, AU - Hsia,Judith, AU - Hubbell,F Allan, AU - Jackson,Rebecca D, AU - Johnson,Karen C, AU - Kotchen,Jane Morley, AU - LaCroix,Andrea Z, AU - Lane,Dorothy S, AU - Langer,Robert D, AU - Lasser,Norman L, AU - Henderson,Maureen M, PY - 2006/2/10/pubmed PY - 2006/2/14/medline PY - 2006/2/10/entrez SP - 629 EP - 42 JF - JAMA JO - JAMA VL - 295 IS - 6 N2 - CONTEXT: The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial. OBJECTIVE: To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence. DESIGN AND SETTING: A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005. PARTICIPANTS: A total of 48,835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled. INTERVENTIONS: Women were randomly assigned to the dietary modification intervention group (40% [n = 19,541]) or the comparison group (60% [n = 29,294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes. MAIN OUTCOME MEASURE: Invasive breast cancer incidence. RESULTS: Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor. CONCLUSIONS: Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov Identifier: NCT00000611. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/16467232/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.295.6.629 DB - PRIME DP - Unbound Medicine ER -