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Dietary Modification and CVD Outcomes in the WHI
A dietary intervention that focused on total fat intake, rather than more-specific dietary dimensions, did not improve cardiovascular outcomes in postmenopausal women.
Recently published data from the Women’s Health Initiative (WHI) Dietary Modification Trial showed that a low-fat, high-carbohydrate diet was not associated with weight gain in postmenopausal women (Journal Watch Cardiology Feb 23 2006). Now, researchers report on cardiovascular disease (CVD) outcomes in this trial.
Participants (mean age, 62) were randomized to a control strategy (29,294 women) or an intervention strategy (19,541 women): a diet high in fruit, vegetables, and grains (targets, 5 fruit and vegetable servings/day, 6 grain servings/day, 20% of daily calories from fat) with no overall weight-loss or calorie-restriction goals. The intervention group was scheduled for 18 group support sessions over 1 year and quarterly sessions thereafter; controls simply received educational materials. Mean CVD follow-up was 8.1 years.
As reported previously, the intervention group lost significantly more weight than the control group (2.2 kg more at 1 year, 0.5 kg more at 7.5 years). The intervention group also had significant advantages at 6 years in daily energy intake from fat (mean, 8% lower) and fruit and vegetable intake (mean, 1 serving more per day), but not in grain intake. Changes in mean levels of LDL cholesterol, triglycerides, glucose, and insulin did not differ between the two groups, nor did the incidence of coronary heart disease events, stroke, or CVD events overall.
Comment: In this large study of postmenopausal women, a dietary intervention that yielded modest reductions in fat intake and modest increases in fruit and vegetable intake did not improve important CVD risk factors or outcomes. Unfortunately, the intervention did not test current dietary guidelines, which focus less on total fat intake and more on saturated fats, cholesterol, sodium, and weight maintenance. Despite these findings, dietary changes have been shown to improve CVD risk-factor profiles, although only when part of comprehensive lifestyle changes (see Journal Watch Cardiology Mar 2 2001). Still, CVD outcomes data on dietary interventions are not yet firm. We still need randomized trials that test the effects of specific guideline-recommended diets on outcomes.
— JoAnne M. Foody, MD
Published in Journal Watch Cardiology February 23, 2006
Citation(s):
Howard BV et al. Low-fat dietary pattern and risk of cardiovascular disease: The Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 2006 Feb 8; 295:655-66.
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- Medline abstract (Free)
Anderson CM and Appel LJ. Dietary modification and CVD prevention: A matter of fat. JAMA 2006 Feb 8; 295:693-5.
- Original article (Subscription may be required)
- Medline abstract (Free)