Low-Fat Dietary Pattern and Breast Cancer Mortality in the Women's Health Initiative Randomized Controlled Trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2017;35(25):2919-2926

Plain language summary

In the Women’s Health Initiative Dietary Modification (WHI DM) trial, 48,835 postmenopausal women were randomly assigned to a dietary modification group or usual diet comparison group to assess low-fat dietary pattern effects on breast cancer incidence. The aim of this study was to present results of dietary modification influence on deaths as a result of breast cancer and on the more general outcome of deaths after breast cancer (breast cancer followed by death as a result of any cause). The study recruited postmenopausal women between 50 and 79 years of age with no record of previous breast cancer. The participants were randomly assigned to a low-fat dietary pattern intervention group or a usual diet comparison group. Results indicate that with long-term follow-up of the WHI DM trial, deaths after breast cancer were significantly reduced in the low-fat dietary group both during the dietary intervention period and throughout the 16.1-year cumulative follow-up period. Authors conclude that women assigned to a low-fat dietary pattern had a significantly reduced risk of death from breast cancer.


Purpose Earlier Women's Health Initiative Dietary Modification trial findings suggested that a low-fat eating pattern may reduce breast cancers with greater mortality. Therefore, as a primary outcome-related analysis from a randomized prevention trial, we examined the long-term influence of this intervention on deaths as a result of and after breast cancer during 8.5 years (median) of dietary intervention and cumulatively for all breast cancers diagnosed during 16.1 years (median) of follow-up. Patients and Methods The trial randomly assigned 48,835 postmenopausal women with normal mammograms and without prior breast cancer from 1993 to 1998 at 40 US clinical centers to a dietary intervention with goals of a reduction of fat intake to 20% of energy and an increased intake of fruits, vegetables, and grains (40%; n = 19,541) or to a usual diet comparison (60%; n = 29,294). Results In the dietary group, fat intake and body weight decreased (all P < .001). During the 8.5-year dietary intervention, with 1,764 incident breast cancers, fewer deaths occurred as a result of breast cancer in the dietary group, which was not statistically significant (27 deaths [0.016% per year] v 61 deaths [0.024% per year]; hazard ratio [HR], 0.67; 95% CI, 0.43 to 1.06; P = .08). During the same period, deaths after breast cancer (n = 134) were significantly reduced (40 deaths [0.025% per year] v 94 deaths [0.038% per year]; HR, 0.65; 95% CI, 0.45 to 0.94; P = .02) by the dietary intervention. During the 16.1-year follow-up, with 3,030 incident breast cancers, deaths after breast cancer also were significantly reduced (234 deaths [0.085% per year] v 443 deaths [0.11% per year]; HR, 0.82; 95% CI, 0.70 to 0.96; P = .01) in the dietary group. Conclusion Compared with a usual diet comparison group, a low-fat dietary pattern led to a lower incidence of deaths after breast cancer.

Lifestyle medicine

Fundamental Clinical Imbalances : Immune and inflammation ; Structural
Patient Centred Factors : Triggers/Low-fat dietary pattern
Environmental Inputs : Diet ; Nutrients
Personal Lifestyle Factors : Nutrition
Functional Laboratory Testing : Imaging

Methodological quality

Jadad score : 2
Allocation concealment : Yes


Nutrition Evidence keywords : Weight loss ; Calorie restriction ; Body mass index ; BMI ; Physical activity