Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer The Women’s Healthy Eating and Living (WHEL) Randomized Trial

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dc.contributor.authorPierce, John P.
dc.contributor.authorNatarajan, Loki
dc.contributor.authorCaan, Bette J.
dc.contributor.authorParker, Barbara A.
dc.contributor.authorGreenberg, E. Robert
dc.contributor.authorFlatt, Shirley W.
dc.contributor.authorRock, Cheryl L.
dc.contributor.authorKealey, Sheila
dc.contributor.authorAl-Delaimy, Wael K.
dc.contributor.authorBardwell, Wayne A.
dc.contributor.authorCarlson, Robert W.
dc.contributor.authorEmond, Jennifer A.
dc.contributor.authorFaerber, Susan
dc.contributor.authorGold, Ellen B.
dc.contributor.authorHajek, Richard A.
dc.contributor.authorHollenbach, Kathryn
dc.contributor.authorJones, Lovell A.
dc.contributor.authorKaranja, Njeri
dc.contributor.authorMadlensky, Lisa
dc.contributor.authorMarshall, James
dc.contributor.authorNewman, Vicky A.
dc.contributor.authorRitenbaugh, Cheryl
dc.contributor.authorThomson, Cynthia A.
dc.contributor.authorWasserman, Linda
dc.contributor.authorStefanick, Marcia L.
dc.date.accessioned2019-08-14T15:00:20Z
dc.date.available2019-08-14T15:00:20Z
dc.date.issued2007
dc.description.abstractContext Evidence is lacking that a dietary pattern high in vegetables, fruit, and fiber and low in total fat can influence breast cancer recurrence or survival. Objective To assess whether a major increase in vegetable, fruit, and fiber intake and a decrease in dietary fat intake reduces the risk of recurrent and new primary breast cancer and all-cause mortality among women with previously treated early stage breast cancer. Design, Setting, and Participants Multi-institutional randomized controlled trial of dietary change in 3088 women previously treated for early stage breast cancer who were 18 to 70 years old at diagnosis. Women were enrolled between 1995 and 2000 and followed up through June 1, 2006. Intervention The intervention group (n=1537) was randomly assigned to receive a telephone counseling program supplemented with cooking classes and newsletters that promoted daily targets of 5 vegetable servings plus 16 oz of vegetable juice; 3 fruit servings; 30 g of fiber; and 15% to 20% of energy intake from fat. The comparison group (n=1551) was provided with print materials describing the “5-A-Day” dietary guidelines. Main Outcome Measures Invasive breast cancer event (recurrence or new primary) or death from any cause. Results From comparable dietary patterns at baseline, a conservative imputation analysis showed that the intervention group achieved and maintained the following statistically significant differences vs the comparison group through 4 years: servings of vegetables, 65%; fruit,25%; fiber,30%, and energy intake from fat, −13%. Plasma carotenoid concentrations validated changes in fruit and vegetable intake. Throughout the study, women in both groups received similar clinical care. Over the mean 7.3-year follow-up, 256 women in the intervention group (16.7%) vs 262 in the comparison group (16.9%) experienced an invasive breast cancer event (adjusted hazard ratio, 0.96; 95% confidence interval, 0.80-1.14; P=.63), and 155 intervention group women (10.1%) vs 160 comparison group women (10.3%) died (adjusted hazard ratio, 0.91; 95% confidence interval, 0.72-1.15; P=.43). No significant interactions were observed between diet group and baseline demographics, characteristics of the original tumor, baseline dietary pattern, or breast cancer treatment. Conclusion Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, and fiber and low in fat did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period.
dc.description.urihttp://jama.ama-assn.org/content/298/3/289
dc.identifierhttps://doi.org/10.13016/6dnr-481o
dc.identifier.citationPierce, John P. and Natarajan, Loki and Caan, Bette J. and Parker, Barbara A. and Greenberg, E. Robert and Flatt, Shirley W. and Rock, Cheryl L. and Kealey, Sheila and Al-Delaimy, Wael K. and Bardwell, Wayne A. and Carlson, Robert W. and Emond, Jennifer A. and Faerber, Susan and Gold, Ellen B. and Hajek, Richard A. and Hollenbach, Kathryn and Jones, Lovell A. and Karanja, Njeri and Madlensky, Lisa and Marshall, James and Newman, Vicky A. and Ritenbaugh, Cheryl and Thomson, Cynthia A. and Wasserman, Linda and Stefanick, Marcia L. (2007) Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer The Women’s Healthy Eating and Living (WHEL) Randomized Trial. Journal of the American Medical Association, 298 (3). pp. 289-298.
dc.identifier.otherEprint ID 761
dc.identifier.urihttp://hdl.handle.net/1903/22764
dc.subjectHealth Equity
dc.subjectNutrition
dc.subjectChronic Illness & Diseases
dc.subjectCancer
dc.subjectstudies
dc.subjectdietary pattern
dc.subjectvegetables
dc.subjectfruit
dc.subjectfiber
dc.subjectbreast cancer recurrence or survival
dc.subjectpreviously treated early stage breast cancer
dc.titleInfluence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer The Women’s Healthy Eating and Living (WHEL) Randomized Trial
dc.typeArticle

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