Eating Pattern Response to a Low-Fat Diet Intervention and Cardiovascular Outcomes in Normotensive Women: The Women's Health Initiative

Linda Van Horn; Aaron K. Aragaki; Barbara V. Howard; Matthew A. Allison; Carmen R. Isasi; Jo Ann E. Manson; Marian L. Neuhouser; Yasmin Mossavar-Rahmani; Cynthia A. Thomson; Mara Z. Vitolin; Robert B. Wallace; Ross L. Prentice

doi:10.1093/cdn/nzaa021

Eating Pattern Response to a Low-Fat Diet Intervention and Cardiovascular Outcomes in Normotensive Women: The Women's Health Initiative

Linda Van Horn^*, Aaron K. Aragaki, Barbara V. Howard, Matthew A. Allison, Carmen R. Isasi, Jo Ann E. Manson, Marian L. Neuhouser, Yasmin Mossavar-Rahmani, Cynthia A. Thomson, Mara Z. Vitolin, Robert B. Wallace, Ross L. Prentice

^*Corresponding author for this work

Preventive Medicine

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Background: Women without cardiovascular disease (CVD) or hypertension at baseline assigned to intervention in the Women's Health Initiative Dietary Modification (DM) trial experienced 30% lower risk of coronary heart disease (CHD), whereas results in women with hypertension or prior CVD could have been confounded by postrandomization use of statins. Objectives: Intervention participants reported various self-selected changes to achieve the 20% total fat goals. Reviewed are intervention compared with comparison group HRs for CHD, stroke, and total CVD in relation to specific dietary changes in normotensive participants. Methods: Dietary change was assessed by comparing baseline with year 1 FFQ data in women (n = 10,371) without hypertension or CVD at baseline with intake of total fat above the median to minimize biases due to use of the FFQ in trial eligibility screening. Results: Intervention participants self-reported compensating reduced energy intake from total fat by increasing carbohydrate and protein. Specifically they increased plant protein, with those in the upper quartile (increased total protein by ≥3.3% of energy) having a CHD HR of 0.39 (95% CI: 0.22, 0.71), compared with 0.92 (95% CI: 0.57, 1.48) for those in the lower quartile of change (decreased total protein ≥0.6% of energy), with P-trend of 0.04. CHD HR did not vary significantly with change in percentage energy from carbohydrate, and stroke HR did not vary significantly with any macronutrient changes. Scores reflecting adherence to recommended dietary patterns including the Dietary Approaches to Stop Hypertension Trial and the Healthy Eating Index showed favorable changes in the intervention group. Conclusions: Intervention group total fat reduction replaced with increased carbohydrate and some protein, especially plant-based protein, was related to lower CHD risk in normotensive women without CVD who reported high baseline total fat intake. This trial was registered at clinicaltrials.gov as NCT00000611. Link to the WHI trial protocol: https://www.whi.org/about/SitePages/Dietary%20Trial.aspx.

Original language	English (US)
Article number	nzaa021
Journal	Current Developments in Nutrition
Volume	4
Issue number	3
DOIs	https://doi.org/10.1093/cdn/nzaa021
State	Published - Feb 12 2020

Funding

Copyright ©C The Author(s) 2020. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] Manuscript received January 8, 2020. Initial review completed February 4, 2020. Revision accepted February 6, 2020. Published online February 12, 2020. The WHI program is supported by the National Heart, Lung, and Blood Institute, NIH, Department of Health and Human Services, Bethesda, MD, USA, through contracts N01WH22110, 24152, 32100–2, 32105–6, 32108–9, 32111–13, 32115, 32118–32119, 32122, 42107–26, 42129–32, and 44221. Author disclosures: The authors report no conflicts of interest. Supplemental Tables 1–8 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/cdn/. Address correspondence to LVH (e-mail: [email protected]). Abbreviations used: AHEI, Alternative Healthy Eating Index; aMed, Alternate Mediterranean Diet; CHD, coronary heart disease; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension Trial; DBP, diastolic blood pressure; DM, dietary modification; DMT, Diet Modification Trial; HEI, Healthy Eating Index; PREDIMED, Prevention with Mediterranean Diet; SBP, systolic blood pressure; WHI, Women’s Health Initiative.

Keywords

cardiovascular outcomes
food choices
low-fat diet
normotensive women
self-selected dietary change
vegetable protein

ASJC Scopus subject areas

Food Science
Nutrition and Dietetics
Medicine (miscellaneous)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/cdn/nzaa021

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Van Horn, L., Aragaki, A. K., Howard, B. V., Allison, M. A., Isasi, C. R., Manson, J. A. E., Neuhouser, M. L., Mossavar-Rahmani, Y., Thomson, C. A., Vitolin, M. Z., Wallace, R. B., & Prentice, R. L. (2020). Eating Pattern Response to a Low-Fat Diet Intervention and Cardiovascular Outcomes in Normotensive Women: The Women's Health Initiative. Current Developments in Nutrition, 4(3), Article nzaa021. https://doi.org/10.1093/cdn/nzaa021

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title = "Eating Pattern Response to a Low-Fat Diet Intervention and Cardiovascular Outcomes in Normotensive Women: The Women's Health Initiative",

abstract = "Background: Women without cardiovascular disease (CVD) or hypertension at baseline assigned to intervention in the Women's Health Initiative Dietary Modification (DM) trial experienced 30% lower risk of coronary heart disease (CHD), whereas results in women with hypertension or prior CVD could have been confounded by postrandomization use of statins. Objectives: Intervention participants reported various self-selected changes to achieve the 20% total fat goals. Reviewed are intervention compared with comparison group HRs for CHD, stroke, and total CVD in relation to specific dietary changes in normotensive participants. Methods: Dietary change was assessed by comparing baseline with year 1 FFQ data in women (n = 10,371) without hypertension or CVD at baseline with intake of total fat above the median to minimize biases due to use of the FFQ in trial eligibility screening. Results: Intervention participants self-reported compensating reduced energy intake from total fat by increasing carbohydrate and protein. Specifically they increased plant protein, with those in the upper quartile (increased total protein by ≥3.3% of energy) having a CHD HR of 0.39 (95% CI: 0.22, 0.71), compared with 0.92 (95% CI: 0.57, 1.48) for those in the lower quartile of change (decreased total protein ≥0.6% of energy), with P-trend of 0.04. CHD HR did not vary significantly with change in percentage energy from carbohydrate, and stroke HR did not vary significantly with any macronutrient changes. Scores reflecting adherence to recommended dietary patterns including the Dietary Approaches to Stop Hypertension Trial and the Healthy Eating Index showed favorable changes in the intervention group. Conclusions: Intervention group total fat reduction replaced with increased carbohydrate and some protein, especially plant-based protein, was related to lower CHD risk in normotensive women without CVD who reported high baseline total fat intake. This trial was registered at clinicaltrials.gov as NCT00000611. Link to the WHI trial protocol: https://www.whi.org/about/SitePages/Dietary%20Trial.aspx.",

keywords = "cardiovascular outcomes, food choices, low-fat diet, normotensive women, self-selected dietary change, vegetable protein",

author = "{Van Horn}, Linda and Aragaki, {Aaron K.} and Howard, {Barbara V.} and Allison, {Matthew A.} and Isasi, {Carmen R.} and Manson, {Jo Ann E.} and Neuhouser, {Marian L.} and Yasmin Mossavar-Rahmani and Thomson, {Cynthia A.} and Vitolin, {Mara Z.} and Wallace, {Robert B.} and Prentice, {Ross L.}",

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year = "2020",

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doi = "10.1093/cdn/nzaa021",

language = "English (US)",

volume = "4",

journal = "Current Developments in Nutrition",

issn = "2475-2991",

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Van Horn, L, Aragaki, AK, Howard, BV, Allison, MA, Isasi, CR, Manson, JAE, Neuhouser, ML, Mossavar-Rahmani, Y, Thomson, CA, Vitolin, MZ, Wallace, RB & Prentice, RL 2020, 'Eating Pattern Response to a Low-Fat Diet Intervention and Cardiovascular Outcomes in Normotensive Women: The Women's Health Initiative', Current Developments in Nutrition, vol. 4, no. 3, nzaa021. https://doi.org/10.1093/cdn/nzaa021

TY - JOUR

T1 - Eating Pattern Response to a Low-Fat Diet Intervention and Cardiovascular Outcomes in Normotensive Women

T2 - The Women's Health Initiative

AU - Van Horn, Linda

AU - Aragaki, Aaron K.

AU - Howard, Barbara V.

AU - Allison, Matthew A.

AU - Isasi, Carmen R.

AU - Manson, Jo Ann E.

AU - Neuhouser, Marian L.

AU - Mossavar-Rahmani, Yasmin

AU - Thomson, Cynthia A.

AU - Vitolin, Mara Z.

AU - Wallace, Robert B.

AU - Prentice, Ross L.

PY - 2020/2/12

Y1 - 2020/2/12

N2 - Background: Women without cardiovascular disease (CVD) or hypertension at baseline assigned to intervention in the Women's Health Initiative Dietary Modification (DM) trial experienced 30% lower risk of coronary heart disease (CHD), whereas results in women with hypertension or prior CVD could have been confounded by postrandomization use of statins. Objectives: Intervention participants reported various self-selected changes to achieve the 20% total fat goals. Reviewed are intervention compared with comparison group HRs for CHD, stroke, and total CVD in relation to specific dietary changes in normotensive participants. Methods: Dietary change was assessed by comparing baseline with year 1 FFQ data in women (n = 10,371) without hypertension or CVD at baseline with intake of total fat above the median to minimize biases due to use of the FFQ in trial eligibility screening. Results: Intervention participants self-reported compensating reduced energy intake from total fat by increasing carbohydrate and protein. Specifically they increased plant protein, with those in the upper quartile (increased total protein by ≥3.3% of energy) having a CHD HR of 0.39 (95% CI: 0.22, 0.71), compared with 0.92 (95% CI: 0.57, 1.48) for those in the lower quartile of change (decreased total protein ≥0.6% of energy), with P-trend of 0.04. CHD HR did not vary significantly with change in percentage energy from carbohydrate, and stroke HR did not vary significantly with any macronutrient changes. Scores reflecting adherence to recommended dietary patterns including the Dietary Approaches to Stop Hypertension Trial and the Healthy Eating Index showed favorable changes in the intervention group. Conclusions: Intervention group total fat reduction replaced with increased carbohydrate and some protein, especially plant-based protein, was related to lower CHD risk in normotensive women without CVD who reported high baseline total fat intake. This trial was registered at clinicaltrials.gov as NCT00000611. Link to the WHI trial protocol: https://www.whi.org/about/SitePages/Dietary%20Trial.aspx.

AB - Background: Women without cardiovascular disease (CVD) or hypertension at baseline assigned to intervention in the Women's Health Initiative Dietary Modification (DM) trial experienced 30% lower risk of coronary heart disease (CHD), whereas results in women with hypertension or prior CVD could have been confounded by postrandomization use of statins. Objectives: Intervention participants reported various self-selected changes to achieve the 20% total fat goals. Reviewed are intervention compared with comparison group HRs for CHD, stroke, and total CVD in relation to specific dietary changes in normotensive participants. Methods: Dietary change was assessed by comparing baseline with year 1 FFQ data in women (n = 10,371) without hypertension or CVD at baseline with intake of total fat above the median to minimize biases due to use of the FFQ in trial eligibility screening. Results: Intervention participants self-reported compensating reduced energy intake from total fat by increasing carbohydrate and protein. Specifically they increased plant protein, with those in the upper quartile (increased total protein by ≥3.3% of energy) having a CHD HR of 0.39 (95% CI: 0.22, 0.71), compared with 0.92 (95% CI: 0.57, 1.48) for those in the lower quartile of change (decreased total protein ≥0.6% of energy), with P-trend of 0.04. CHD HR did not vary significantly with change in percentage energy from carbohydrate, and stroke HR did not vary significantly with any macronutrient changes. Scores reflecting adherence to recommended dietary patterns including the Dietary Approaches to Stop Hypertension Trial and the Healthy Eating Index showed favorable changes in the intervention group. Conclusions: Intervention group total fat reduction replaced with increased carbohydrate and some protein, especially plant-based protein, was related to lower CHD risk in normotensive women without CVD who reported high baseline total fat intake. This trial was registered at clinicaltrials.gov as NCT00000611. Link to the WHI trial protocol: https://www.whi.org/about/SitePages/Dietary%20Trial.aspx.

KW - cardiovascular outcomes

KW - food choices

KW - low-fat diet

KW - normotensive women

KW - self-selected dietary change

KW - vegetable protein

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U2 - 10.1093/cdn/nzaa021

DO - 10.1093/cdn/nzaa021

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AN - SCOPUS:85081743613

SN - 2475-2991

VL - 4

JO - Current Developments in Nutrition

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ER -

Eating Pattern Response to a Low-Fat Diet Intervention and Cardiovascular Outcomes in Normotensive Women: The Women's Health Initiative

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UN SDGs

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