ResearchPerspectives in PracticeImplementing a Low-Fat Eating Plan in the Women's Intervention Nutrition Study
Section snippets
Methods
The goal of the dietary intervention (the WINS low-fat eating plan) was to reduce the percentage of total energy intake from fat down to 15% while maintaining nutritional adequacy. This goal was based on findings from feasibility trials indicating that a 15% goal would result in a sustained reduction of fat intake of about 20% of energy intake (4, 5). Randomization for this trial was 40:60 for the low-fat intervention vs control group to save resources at minimal loss in statistical power.
Results
A total of 2,437 women were randomly assigned, 975 to the dietary intervention and 1,462 to the control group. Dietary data is available for at least three of six time periods after baseline on 80% of participants. In the control group, 66 were lost to follow-up and 106 discontinued study participation. In the intervention group, 45 were lost to follow-up and 170 discontinued the dietary intervention. Only six women cited that they “did not like the low-fat eating plan” as the reason.
Dietary
Discussion
The WINS low-fat eating plan resulted in significant and sustained reductions in both fat intake as well as body weight. These results, together with outcomes from other full scale trials (16, 17, 18) indicate that demanding lifestyle interventions involving significant modification of dietary intake can be successfully implemented over extended periods of time (16, 17, 18, 19). In an interim efficacy report from the WINS trial, breast cancer recurrence was less frequent in women randomized to
Conclusions
The WINS low-fat eating plan is a comprehensive, theory-based lifestyle intervention that resulted in reduced fat intake, modest weight loss and a suggested favorable affect on breast cancer recurrence especially in postmenopausal women with hormone receptor negative disease. A description of the methodology used in implementing this low-fat eating plan can serve as a model for its use by RDs in clinical practice.
Because both reduced fat intake and modest weight loss were seen in the WINS
M. K. Hoy is research manager, Produce for Better Health Foundation, Wilmington, DE; at the time of the study, she was Women's Intervention Nutrition Study (WINS) national coordinator and WINS assistant national coordinator, Institute for Cancer Prevention, formerly American Health Foundation, New York, NY
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Evidence-Based Guidance for Breast Cancer Survivorship
2023, Hematology/Oncology Clinics of North AmericaCitation Excerpt :The Mediterranean diet and plant-based diets have been linked to lower risks for breast cancer in epidemiologic and observational studies, although it is not clear if these are indirect associations that result from the importance of BMI and other patient and disease-related factors.108–110 Two randomized trials of dietary interventions among breast cancer survivors, the Women’s Intervention Nutrition Study (WINS), focused on dietary fat reduction and the Women’s Healthy Eating and Living Study, focused on increasing fruit and vegetable intake, did not report statistically significant reductions in mortality, though WINS identified a reduction in breast cancer recurrence rate with a low-fat diet.111,112 There has also been interest in ketosis-related diets such as intermittent fasting, but evidence for benefit is limited; one epidemiologic study reported an association between prolonged nightly fasting lower breast cancer recurrence risk: among 2413 women, patients who fasted over 13 hours per night experienced a lower risk for breast cancer recurrence compared with women who fasted less than this amount of time.113,114
The Use of Behavior Change Theories in Dietetics Practice in Primary Health Care: A Systematic Review of Randomized Controlled Trials
2020, Journal of the Academy of Nutrition and DieteticsCitation Excerpt :Thirty articles representing 19 RCTs, published between 2001 and 2016, were eligible for inclusion28-57 (Figure 1). The 11 additional articles, typically protocol articles, were used to extract data not available in the results article.29,31,33,36,38,40,43,49,51,53,55 The majority of RCTs were of two-arm parallel design (n=13)30,39,41,42,45-48,50,52,54,56,57 or wait-list/delayed-start arms (n=2).28,35
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2016, Cell ReportsCitation Excerpt :Large prospective studies have shown that dietary fat intake is associated with the risk of postmenopausal invasive BC. The Women’s Intervention Nutrition Study (WINS) trial reported that low-fat diet and corresponding weight loss has a favorable effect on BC recurrence, especially in postmenopausal women with ER-negative cancer (Hoy et al., 2009). The recent WINS report highlighted that deaths of women with TNBC were reduced by up to 54% when they followed a program to reduce their dietary fat intake (Chlebowski and Blackburn, 2015).
M. K. Hoy is research manager, Produce for Better Health Foundation, Wilmington, DE; at the time of the study, she was Women's Intervention Nutrition Study (WINS) national coordinator and WINS assistant national coordinator, Institute for Cancer Prevention, formerly American Health Foundation, New York, NY
B. L. Winters is a research scientist, Campbell Soup Company, Camden NJ; at the time of the study, she was WINS national coordinator, American Health Foundation, New York, NY
R. Chlebowski is WINS principal investigator, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
C. Papoutsakis is a teaching and research Associate, Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece; at the time of the study, she was WINS protocol coordinator, American Health Foundation, New York, NY
A. Shapiro is a research scientist, Institute at Park Nicollet Health Services, Minneapolis, MN; at the time of the study, she was principal investigator, Institute for Park Nicollet Health Services, Minneapolis, MN
M. P. Lubin is a nutritionist, Winthrop University Hospital Department of Surgery, Mineola, NY; at the time of the study, she was WINS intervention coordinator, Institute for Cancer Prevention, formerly American Health Foundation, New York, NY
C. A. Thomson is an associate professor, University of Arizona, Arizona Cancer Center and Department of Nutritional Sciences, Tucson; at the time of the study, she was principal investigator, University of Arizona Cancer Center, Tucson
M. B. Grosvenor is an adjunct professor, Delta Montrose Technical College, Department of Nursing, Delta, CO; at the time of the study, she was WINS dietary assessment coordinator, Institute for Cancer Prevention, formerly American Health Foundation, New York, NY
T. Copeland is a research coordinator, Harvard School of Public Health, Boston, MA; at the time of the study, she was national assessment operations manager, Beth Israel Deaconess Hospital, Boston, MA
E. Falk is a nutritionist, Cedar Associates Eating Disorder Center, Mt Kisco, NY; at the time of the study, she was WINS protocol coordinator, Institute for Cancer Prevention, formerly American Health Foundation, New York, NY
K. Day is research nutritionist and G. L. Blackburn is WINS principal investigator, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA