Low-Fat Dietary Pattern and Breast Cancer Mortality in the Women's Health Initiative Randomized Controlled Trial
Low-Fat Dietary Pattern and Breast Cancer Mortality in the Women's Health Initiative Randomized Controlled Trial
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DOI：
10.1200/jco.2016.72.0326
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发表时间：
2017-09-01
影响因子：
45.3
通讯作者：
Prentice, Ross L.
中科院分区：
文献类型：
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作者：
Chlebowski, Rowan T.;Aragaki, Aaron K.;Prentice, Ross L.
早期妇女健康倡议饮食调整试验结果表明，低脂饮食模式可能会降低乳腺癌的死亡率。因此，作为一项随机预防试验的主要结果相关分析，我们研究了在8.5年（中位数）的饮食干预期间，以及在16.1年（中位数）的随访期间，这种干预对所有诊断为乳腺癌的乳腺癌死亡的长期影响。1993年至1998年，在美国40个临床中心，835名乳腺X线检查正常且既往无乳腺癌的绝经后妇女接受饮食干预，目标是将脂肪摄入量减少至能量的20%，并增加水果、蔬菜和谷物的摄入量结果饮食组的脂肪摄入量和体重均下降（P <0.001），而对照组的脂肪摄入量和体重均下降（P <0.001）。在8.5年的饮食干预期间，有1，764例乳腺癌事件，饮食组中因乳腺癌导致的死亡较少，这在统计学上不显著（27例死亡[每年0.016%] vs 61例死亡[每年0.024%];风险比[HR]，0.67; 95%CI，0.43至1.06; P = 0.08）。在同一时期，通过饮食干预，乳腺癌后死亡（n = 134）显著减少（40例死亡[每年0.025%] vs 94例死亡[每年0.038%]; HR，0.65; 95%CI，0.45至0.94; P = 0.02）。在16.1年的随访中，有3,030例乳腺癌患者，乳腺癌后的死亡率也显著降低（234例死亡[每年0.085%] vs 443例死亡[每年0.11%]; HR，0.82; 95% CI，0.70 - 0.96;结论与普通饮食对照组相比，低脂饮食模式导致乳腺癌后死亡率降低。(C)2017年美国临床肿瘤学会
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. (C) 2017 by American Society of Clinical Oncology