Correlates of maintenance of a low-fat diet among women in the Women's Health Trial.
Correlates of maintenance of a low-fat diet among women in the Women's Health Trial.
复制标题
女性健康试验中女性维持低脂饮食的相关性。
DOI：
10.1016/0091-7435(92)90027-f
复制
发表时间：
1992
影响因子：
5.1
通讯作者：
Kristal,AR
中科院分区：
文献类型：
--
作者：
Urban,N;White,E;Anderson,GL;Curry,S;Kristal,AR
背景女性健康试验（WHT）是一项随机对照试验的可行性研究，旨在验证减少饮食脂肪可降低45至69岁女性乳腺癌发病率的假设。1984年至1988年，2 064名妇女参加了这两个阶段的活动。对525名随机接受WHT饮食干预计划的妇女进行了一项随访研究，以评估试验结束后平均1年的饮食维持情况。在448名参与者中，通过食物频率问卷测量的脂肪能量的平均百分比在基线时为40.0%，在试验结束时为26.3%，在随访时为27.7%。基于408名具有完整数据的女性，估计了一个递归模型，描述了女性基线特征对干预计划会议出席率的影响，试验期间坚持饮食，以及试验结束后长期维持饮食。试验期间妇女的经验对依从性和长期维持的影响也进行了调查。参加教育课程与试验期间的饮食依从性密切相关（P< 0.001），并且依从性是长期维持的最重要预测因素（P< 0.001）。基线时来自膳食脂肪的能量百分比是依从性（P< 0.001）和长期维持（P< 0.001）的重要相关因素。受过大学教育的女性在试验期间更有可能坚持饮食（P< 0.001）。剥夺感对长期维持有不利影响（P< 0.01），主要是通过其对试验期间依从性的影响（P= 0.01）。饮食在时间和金钱上的昂贵对长期维持有负面影响（P< 0.05）。对脂肪厌恶的发展促进了依从性（P= 0.06）。在WHT期间建立的低脂饮食模式在试验结束后维持了长达20个月。递归模型有助于分析长期维持饮食行为改变的过程和相关因素。这两个诱发变量和妇女的经验，而在低脂肪饮食与长期维护。结果表明，那些试图降低膳食脂肪的人应该避免被剥夺的感觉，也许可以通过使用低脂替代品，并且需要更多的研究来研究采用低脂饮食的人对脂肪的厌恶。
Background. The Women's Health Trial (WHT) was a feasibility study for a randomized controlled trial designed to test the hypothesis that a reduction in dietary fat reduces breast cancer incidence among women age 45 to 69. Between 1984 and 1988, 2,064 women participated in its two phases.Methods. A follow-up study of 525 women who were randomized to receive the WHT dietary intervention program was conducted to assess maintenance of the diet 1 year on average after the trial ended. Among 448 participants, the mean percentage of energy from fat as measured by a food frequency questionnaire was 40.0% at baseline, 26.3% at the end of the trial, and 27.7% at follow-up. Based on 408 women with complete data, a recursive model was estimated, describing the influence of baseline characteristics of the women on attendance at intervention program sessions, adherence to the diet during the trial, and long-term maintenance of the diet after the trial ended. The effects of women's experiences during the trial on adherence and long-term maintenance were investigated as well.Results. Attendance at the educational sessions was strongly related to adherence to the diet during the trial (P< 0.001), and adherence was the most important predictor of long-term maintenance (P< 0.001). The percentage of energy from dietary fat at baseline was an important correlate of both adherence (P< 0.001) and long-term maintenance (P< 0.001). College-educated women were more likely to adhere to the diet during the trial (P< 0.001). Feelings of deprivation adversely affected long-term maintenance (P< 0.01), primarily through their effect on adherence during the trial (P= 0.01). Costliness of the diet in time and money negatively influenced long-term maintenance (P< 0.05). Development of a distaste for fat encouraged adherence (P= 0.06).Conclusions. The low-fat dietary pattern established during the WHT was maintained for as long as 20 months after the trial ended. A recursive model was useful in analyzing the process and correlates of long-term maintenance of dietary behavior change. Both predisposing variables and women's experiences while on a low-fat diet were associated with long-term maintenance. The results suggest that feelings of deprivation should be avoided, perhaps by use of low-fat substitutes, by those attempting to lower their dietary fat and that more research is needed on the development of a distaste for fat among individuals who adopt low-fat diets.