Low-fat dietary pattern and risk of colorectal cancer: The Women's Health Initiative randomized controlled dietary modification trial

Shirley A.A. Beresford, Karen C. Johnson, Cheryl Ritenbaugh, Norman L. Lasser, Linda G. Snetselaar, Henry R. Black, Garnet L. Anderson, Annlouise R. Assaf, Tamsen Bassford, Deborah Bowen, Robert L. Brunner, Robert G. Brzyski, Bette Caan, Rowan T. Chlebowski, Margery Gass, Rosanne C. Harrigan, Jennifer Hays-Grudo, David Heber, Gerardo Heiss, Susan L. HendrixBarbara V. Howard, Judith Hsia, F. Allan Hubbell, Rebecca D. Jackson, Jane Morley Kotchen, Lewis H. Kuller, Andrea Z. LaCroix, Dorothy S. Lane, Robert D. Langer, Cora E. Lewis, Jo Ann E. Manson, Karen L. Margolis, Yasmin Mossavar-Rahmani, Judith K. Ockene, Linda M. Parker, Michael G. Perri, Lawrence Phillips, Ross L. Prentice, John Robbins, Jacques E. Rossouw, Gloria E. Sarto, Marcia L. Stefanick, Linda Van Horn, Mara Z. Vitolins, Jean Wactawski-Wende, Robert B. Wallace, Evelyn Whitlock

Research output: Contribution to journalArticle

303 Citations (Scopus)

Abstract

Context: Observational studies and polyp recurrence trials are not conclusive regarding the effects of a low-fat dietary pattern on risk of colorectal cancer, necessitating a primary prevention trial. Objective: To evaluate the effects of a low-fat eating pattern on risk of colorectal cancer in postmenopausal women. Design, Setting, and Participants: The Women's Health Initiative Dietary Modification Trial, a randomized controlled trial conducted in 48 835 postmenopausal women aged 50 to 79 years recruited between 1993 and 1998 from 40 clinical centers throughout the United States. Interventions: Participants were randomly assigned to the dietary modification intervention (n = 19 541; 40%) or the comparison group (n = 29 294; 60%).The intensive behavioral modification program aimed to motivate and support reductions in dietary fat, to increase consumption of vegetables and fruits, and to increase grain servings by using group sessions, self-monitoring techniques, and other tailored and targeted strategies. Women in the comparison group continued their usual eating pattern. Main Outcome Measure: Invasive colorectal cancer incidence. Results: A total of 480 incident cases of invasive colorectal cancer occurred during a mean follow-up of 8.1 (SD, 1.7) years. Intervention group participants significantly reduced their percentage of energy from fat by 10.7% more than did the comparison group at 1 year, and this difference between groups was mostly maintained (8.1% at year 6). Statistically significant increases in vegetable, fruit, and grain servings were also made. Despite these dietary changes, there was no evidence that the intervention reduced the risk of invasive colorectal cancer during the follow-up period. There were 201 women with invasive colorectal cancer (0.13% per year) in the intervention group and 279 (0.12% per year) in the comparison group (hazard ratio, 1.08; 95% confidence interval, 0.90-1.29). Secondary analyses suggested potential interactions with baseline aspirin use and combined estrogen-progestin use status (P = .01 for each). Colorectal examination rates, although not protocol defined, were comparable between the intervention and comparison groups. Similar results were seen in analyses adjusting for adherence to the intervention. Conclusion: In this study, a low-fat dietary pattern intervention did not reduce the risk of colorectal cancer in postmenopausal women during 8.1 years of follow-up.

Original languageEnglish
Pages (from-to)643-654
Number of pages12
JournalJournal of the American Medical Association
Volume295
Issue number6
DOIs
StatePublished - 8 Feb 2006

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Diet Therapy
Dietary Fats
Women's Health
Colorectal Neoplasms
Vegetables
Fruit
Eating
Fats
Progestins
Primary Prevention
Polyps
Aspirin
Observational Studies
Estrogens
Randomized Controlled Trials
Outcome Assessment (Health Care)
Confidence Intervals
Recurrence
Incidence

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Beresford, S. A. A., Johnson, K. C., Ritenbaugh, C., Lasser, N. L., Snetselaar, L. G., Black, H. R., ... Whitlock, E. (2006). Low-fat dietary pattern and risk of colorectal cancer: The Women's Health Initiative randomized controlled dietary modification trial. Journal of the American Medical Association, 295(6), 643-654. https://doi.org/10.1001/jama.295.6.643
Beresford, Shirley A.A. ; Johnson, Karen C. ; Ritenbaugh, Cheryl ; Lasser, Norman L. ; Snetselaar, Linda G. ; Black, Henry R. ; Anderson, Garnet L. ; Assaf, Annlouise R. ; Bassford, Tamsen ; Bowen, Deborah ; Brunner, Robert L. ; Brzyski, Robert G. ; Caan, Bette ; Chlebowski, Rowan T. ; Gass, Margery ; Harrigan, Rosanne C. ; Hays-Grudo, Jennifer ; Heber, David ; Heiss, Gerardo ; Hendrix, Susan L. ; Howard, Barbara V. ; Hsia, Judith ; Hubbell, F. Allan ; Jackson, Rebecca D. ; Kotchen, Jane Morley ; Kuller, Lewis H. ; LaCroix, Andrea Z. ; Lane, Dorothy S. ; Langer, Robert D. ; Lewis, Cora E. ; Manson, Jo Ann E. ; Margolis, Karen L. ; Mossavar-Rahmani, Yasmin ; Ockene, Judith K. ; Parker, Linda M. ; Perri, Michael G. ; Phillips, Lawrence ; Prentice, Ross L. ; Robbins, John ; Rossouw, Jacques E. ; Sarto, Gloria E. ; Stefanick, Marcia L. ; Van Horn, Linda ; Vitolins, Mara Z. ; Wactawski-Wende, Jean ; Wallace, Robert B. ; Whitlock, Evelyn. / Low-fat dietary pattern and risk of colorectal cancer : The Women's Health Initiative randomized controlled dietary modification trial. In: Journal of the American Medical Association. 2006 ; Vol. 295, No. 6. pp. 643-654.
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abstract = "Context: Observational studies and polyp recurrence trials are not conclusive regarding the effects of a low-fat dietary pattern on risk of colorectal cancer, necessitating a primary prevention trial. Objective: To evaluate the effects of a low-fat eating pattern on risk of colorectal cancer in postmenopausal women. Design, Setting, and Participants: The Women's Health Initiative Dietary Modification Trial, a randomized controlled trial conducted in 48 835 postmenopausal women aged 50 to 79 years recruited between 1993 and 1998 from 40 clinical centers throughout the United States. Interventions: Participants were randomly assigned to the dietary modification intervention (n = 19 541; 40{\%}) or the comparison group (n = 29 294; 60{\%}).The intensive behavioral modification program aimed to motivate and support reductions in dietary fat, to increase consumption of vegetables and fruits, and to increase grain servings by using group sessions, self-monitoring techniques, and other tailored and targeted strategies. Women in the comparison group continued their usual eating pattern. Main Outcome Measure: Invasive colorectal cancer incidence. Results: A total of 480 incident cases of invasive colorectal cancer occurred during a mean follow-up of 8.1 (SD, 1.7) years. Intervention group participants significantly reduced their percentage of energy from fat by 10.7{\%} more than did the comparison group at 1 year, and this difference between groups was mostly maintained (8.1{\%} at year 6). Statistically significant increases in vegetable, fruit, and grain servings were also made. Despite these dietary changes, there was no evidence that the intervention reduced the risk of invasive colorectal cancer during the follow-up period. There were 201 women with invasive colorectal cancer (0.13{\%} per year) in the intervention group and 279 (0.12{\%} per year) in the comparison group (hazard ratio, 1.08; 95{\%} confidence interval, 0.90-1.29). Secondary analyses suggested potential interactions with baseline aspirin use and combined estrogen-progestin use status (P = .01 for each). Colorectal examination rates, although not protocol defined, were comparable between the intervention and comparison groups. Similar results were seen in analyses adjusting for adherence to the intervention. Conclusion: In this study, a low-fat dietary pattern intervention did not reduce the risk of colorectal cancer in postmenopausal women during 8.1 years of follow-up.",
author = "Beresford, {Shirley A.A.} and Johnson, {Karen C.} and Cheryl Ritenbaugh and Lasser, {Norman L.} and Snetselaar, {Linda G.} and Black, {Henry R.} and Anderson, {Garnet L.} and Assaf, {Annlouise R.} and Tamsen Bassford and Deborah Bowen and Brunner, {Robert L.} and Brzyski, {Robert G.} and Bette Caan and Chlebowski, {Rowan T.} and Margery Gass and Harrigan, {Rosanne C.} and Jennifer Hays-Grudo and David Heber and Gerardo Heiss and Hendrix, {Susan L.} and Howard, {Barbara V.} and Judith Hsia and Hubbell, {F. Allan} and Jackson, {Rebecca D.} and Kotchen, {Jane Morley} and Kuller, {Lewis H.} and LaCroix, {Andrea Z.} and Lane, {Dorothy S.} and Langer, {Robert D.} and Lewis, {Cora E.} and Manson, {Jo Ann E.} and Margolis, {Karen L.} and Yasmin Mossavar-Rahmani and Ockene, {Judith K.} and Parker, {Linda M.} and Perri, {Michael G.} and Lawrence Phillips and Prentice, {Ross L.} and John Robbins and Rossouw, {Jacques E.} and Sarto, {Gloria E.} and Stefanick, {Marcia L.} and {Van Horn}, Linda and Vitolins, {Mara Z.} and Jean Wactawski-Wende and Wallace, {Robert B.} and Evelyn Whitlock",
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month = "2",
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Beresford, SAA, Johnson, KC, Ritenbaugh, C, Lasser, NL, Snetselaar, LG, Black, HR, Anderson, GL, Assaf, AR, Bassford, T, Bowen, D, Brunner, RL, Brzyski, RG, Caan, B, Chlebowski, RT, Gass, M, Harrigan, RC, Hays-Grudo, J, Heber, D, Heiss, G, Hendrix, SL, Howard, BV, Hsia, J, Hubbell, FA, Jackson, RD, Kotchen, JM, Kuller, LH, LaCroix, AZ, Lane, DS, Langer, RD, Lewis, CE, Manson, JAE, Margolis, KL, Mossavar-Rahmani, Y, Ockene, JK, Parker, LM, Perri, MG, Phillips, L, Prentice, RL, Robbins, J, Rossouw, JE, Sarto, GE, Stefanick, ML, Van Horn, L, Vitolins, MZ, Wactawski-Wende, J, Wallace, RB & Whitlock, E 2006, 'Low-fat dietary pattern and risk of colorectal cancer: The Women's Health Initiative randomized controlled dietary modification trial', Journal of the American Medical Association, vol. 295, no. 6, pp. 643-654. https://doi.org/10.1001/jama.295.6.643

Low-fat dietary pattern and risk of colorectal cancer : The Women's Health Initiative randomized controlled dietary modification trial. / Beresford, Shirley A.A.; Johnson, Karen C.; Ritenbaugh, Cheryl; Lasser, Norman L.; Snetselaar, Linda G.; Black, Henry R.; Anderson, Garnet L.; Assaf, Annlouise R.; Bassford, Tamsen; Bowen, Deborah; Brunner, Robert L.; Brzyski, Robert G.; Caan, Bette; Chlebowski, Rowan T.; Gass, Margery; Harrigan, Rosanne C.; Hays-Grudo, Jennifer; Heber, David; Heiss, Gerardo; Hendrix, Susan L.; Howard, Barbara V.; Hsia, Judith; Hubbell, F. Allan; Jackson, Rebecca D.; Kotchen, Jane Morley; Kuller, Lewis H.; LaCroix, Andrea Z.; Lane, Dorothy S.; Langer, Robert D.; Lewis, Cora E.; Manson, Jo Ann E.; Margolis, Karen L.; Mossavar-Rahmani, Yasmin; Ockene, Judith K.; Parker, Linda M.; Perri, Michael G.; Phillips, Lawrence; Prentice, Ross L.; Robbins, John; Rossouw, Jacques E.; Sarto, Gloria E.; Stefanick, Marcia L.; Van Horn, Linda; Vitolins, Mara Z.; Wactawski-Wende, Jean; Wallace, Robert B.; Whitlock, Evelyn.

In: Journal of the American Medical Association, Vol. 295, No. 6, 08.02.2006, p. 643-654.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Low-fat dietary pattern and risk of colorectal cancer

T2 - The Women's Health Initiative randomized controlled dietary modification trial

AU - Beresford, Shirley A.A.

AU - Johnson, Karen C.

AU - Ritenbaugh, Cheryl

AU - Lasser, Norman L.

AU - Snetselaar, Linda G.

AU - Black, Henry R.

AU - Anderson, Garnet L.

AU - Assaf, Annlouise R.

AU - Bassford, Tamsen

AU - Bowen, Deborah

AU - Brunner, Robert L.

AU - Brzyski, Robert G.

AU - Caan, Bette

AU - Chlebowski, Rowan T.

AU - Gass, Margery

AU - Harrigan, Rosanne C.

AU - Hays-Grudo, Jennifer

AU - Heber, David

AU - Heiss, Gerardo

AU - Hendrix, Susan L.

AU - Howard, Barbara V.

AU - Hsia, Judith

AU - Hubbell, F. Allan

AU - Jackson, Rebecca D.

AU - Kotchen, Jane Morley

AU - Kuller, Lewis H.

AU - LaCroix, Andrea Z.

AU - Lane, Dorothy S.

AU - Langer, Robert D.

AU - Lewis, Cora E.

AU - Manson, Jo Ann E.

AU - Margolis, Karen L.

AU - Mossavar-Rahmani, Yasmin

AU - Ockene, Judith K.

AU - Parker, Linda M.

AU - Perri, Michael G.

AU - Phillips, Lawrence

AU - Prentice, Ross L.

AU - Robbins, John

AU - Rossouw, Jacques E.

AU - Sarto, Gloria E.

AU - Stefanick, Marcia L.

AU - Van Horn, Linda

AU - Vitolins, Mara Z.

AU - Wactawski-Wende, Jean

AU - Wallace, Robert B.

AU - Whitlock, Evelyn

PY - 2006/2/8

Y1 - 2006/2/8

N2 - Context: Observational studies and polyp recurrence trials are not conclusive regarding the effects of a low-fat dietary pattern on risk of colorectal cancer, necessitating a primary prevention trial. Objective: To evaluate the effects of a low-fat eating pattern on risk of colorectal cancer in postmenopausal women. Design, Setting, and Participants: The Women's Health Initiative Dietary Modification Trial, a randomized controlled trial conducted in 48 835 postmenopausal women aged 50 to 79 years recruited between 1993 and 1998 from 40 clinical centers throughout the United States. Interventions: Participants were randomly assigned to the dietary modification intervention (n = 19 541; 40%) or the comparison group (n = 29 294; 60%).The intensive behavioral modification program aimed to motivate and support reductions in dietary fat, to increase consumption of vegetables and fruits, and to increase grain servings by using group sessions, self-monitoring techniques, and other tailored and targeted strategies. Women in the comparison group continued their usual eating pattern. Main Outcome Measure: Invasive colorectal cancer incidence. Results: A total of 480 incident cases of invasive colorectal cancer occurred during a mean follow-up of 8.1 (SD, 1.7) years. Intervention group participants significantly reduced their percentage of energy from fat by 10.7% more than did the comparison group at 1 year, and this difference between groups was mostly maintained (8.1% at year 6). Statistically significant increases in vegetable, fruit, and grain servings were also made. Despite these dietary changes, there was no evidence that the intervention reduced the risk of invasive colorectal cancer during the follow-up period. There were 201 women with invasive colorectal cancer (0.13% per year) in the intervention group and 279 (0.12% per year) in the comparison group (hazard ratio, 1.08; 95% confidence interval, 0.90-1.29). Secondary analyses suggested potential interactions with baseline aspirin use and combined estrogen-progestin use status (P = .01 for each). Colorectal examination rates, although not protocol defined, were comparable between the intervention and comparison groups. Similar results were seen in analyses adjusting for adherence to the intervention. Conclusion: In this study, a low-fat dietary pattern intervention did not reduce the risk of colorectal cancer in postmenopausal women during 8.1 years of follow-up.

AB - Context: Observational studies and polyp recurrence trials are not conclusive regarding the effects of a low-fat dietary pattern on risk of colorectal cancer, necessitating a primary prevention trial. Objective: To evaluate the effects of a low-fat eating pattern on risk of colorectal cancer in postmenopausal women. Design, Setting, and Participants: The Women's Health Initiative Dietary Modification Trial, a randomized controlled trial conducted in 48 835 postmenopausal women aged 50 to 79 years recruited between 1993 and 1998 from 40 clinical centers throughout the United States. Interventions: Participants were randomly assigned to the dietary modification intervention (n = 19 541; 40%) or the comparison group (n = 29 294; 60%).The intensive behavioral modification program aimed to motivate and support reductions in dietary fat, to increase consumption of vegetables and fruits, and to increase grain servings by using group sessions, self-monitoring techniques, and other tailored and targeted strategies. Women in the comparison group continued their usual eating pattern. Main Outcome Measure: Invasive colorectal cancer incidence. Results: A total of 480 incident cases of invasive colorectal cancer occurred during a mean follow-up of 8.1 (SD, 1.7) years. Intervention group participants significantly reduced their percentage of energy from fat by 10.7% more than did the comparison group at 1 year, and this difference between groups was mostly maintained (8.1% at year 6). Statistically significant increases in vegetable, fruit, and grain servings were also made. Despite these dietary changes, there was no evidence that the intervention reduced the risk of invasive colorectal cancer during the follow-up period. There were 201 women with invasive colorectal cancer (0.13% per year) in the intervention group and 279 (0.12% per year) in the comparison group (hazard ratio, 1.08; 95% confidence interval, 0.90-1.29). Secondary analyses suggested potential interactions with baseline aspirin use and combined estrogen-progestin use status (P = .01 for each). Colorectal examination rates, although not protocol defined, were comparable between the intervention and comparison groups. Similar results were seen in analyses adjusting for adherence to the intervention. Conclusion: In this study, a low-fat dietary pattern intervention did not reduce the risk of colorectal cancer in postmenopausal women during 8.1 years of follow-up.

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U2 - 10.1001/jama.295.6.643

DO - 10.1001/jama.295.6.643

M3 - Article

C2 - 16467233

AN - SCOPUS:32144432645

VL - 295

SP - 643

EP - 654

JO - Journal of the American Medical Association

JF - Journal of the American Medical Association

SN - 0098-7484

IS - 6

ER -