Dietary Intervention Favorably Influences Physical Functioning: The Women’s Health Initiative Randomized Dietary Modification Trial - 17/10/24
, Aaron K. Aragaki, MS 2, Kathy Pan, MD 3, Rebecca A. Nelson, PhD 4, Ana Barac, MD, PhD 5, JoAnn E. Manson, MD, DrPH 6, Marcia L. Stefanick, PhD 7, Farha S. Ikramuddin, MD, MPH 8, Karen C. Johnson, MD, MPH 9, Jessica L. Krok-Schoen, PhD 10, Deepika Laddu, PhD 11, Margaret S. Pichardo, MD, PhD 12, Linda G. Snetselaar, PhD, RDN, LD, FAND 13, Meryl S. LeBoff, MD 14, Yvonne Michael, ScD 15Abstract |
Background |
In the Women’s Health Initiative Dietary Modification randomized trial, the dietary intervention reduced breast cancer mortality by 21% (P = .02) and increased physical activity as well.
Objective |
Therefore, the aim was to examine whether or not these lifestyle changes attenuated age-related physical functioning decline.
Design |
In a randomized trial, the influence of 8 years of a low-fat dietary pattern intervention was examined through 20 years of cumulative follow-up.
Participants and setting |
From 1993 to 1998, 48,835 postmenopausal women, ages 50 to 79 years with no prior breast cancer and negative baseline mammogram were randomized at 40 US clinical centers to dietary intervention or usual diet comparison groups (40 out of 60). The intervention significantly reduced fat intake and increased vegetable, fruit, and grain intake.
Main outcome measures |
In post hoc analyses, physical functioning, assessed using the RAND 36-Item Short Form Health Survey, evaluated quality or limitations of 10 hierarchical physical activities. Longitudinal physical functioning, reported against a disability threshold (when assistance in daily activities is required) was the primary study outcome.
Statistical analyses performed |
Semiparametric linear mixed effect models were used to contrast physical functioning trajectories by randomization groups.
Results |
Physical functioning score, assessed 495,317 times with 11.0 (median) assessments per participant, was significantly higher in the intervention vs comparison groups through 12 years of cumulative follow-up (P = .001), representing a reduction in age-related functional decline. The intervention effect subsequently attenuated and did not delay time to the disability threshold. Among women in the dietary intervention vs comparison groups, aged 50 to 59 years, who were physically inactive at entry, a persistent, statistically significant, favorable influence on physical functioning with associated delay in crossing the disability threshold by approximately a year was seen (P value for interaction = .007).
Conclusions |
In the Women’s Health Initiative Dietary Modification randomized trial, a dietary intervention that significantly reduced breast cancer mortality also significantly reduced age-related functional decline through 12 years, which was attenuated with longer follow-up.
Le texte complet de cet article est disponible en PDF.Keywords : Women’s Health Initiative, Low-fat dietary pattern, Physical functioning, Randomized trial, Disability threshold
Plan
| Supplementary materials: Table 1, Table 2, Table 4, and Table 5 and Figure 1 and Figure 3 are available at www.jandonline.org/. |
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| STATEMENT OF POTENTIAL CONFLICT OF INTEREST R. Chlebowski has receiving personal fees from Pfizer and UpToDate. |
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| FUNDING/SUPPORT The development of this article was partially supported by National Cancer Institute grants R01 CA119171 and R01 CA10921. The Women's Health Initiative program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C. |
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| This study was registered at ClinicalTrials.gov, NCT00000611. |
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| ACKNOWLEDGEMENTS The authors acknowledge the commitment of the World Health Initiative (WHI) investigators, staff, and the trial participants. Program Office: Jacques Roscoe, Shari Ludlum, Dale Burden, Joan McGowan, Leslie Ford, and Nancy Geller (National Heart, Lung, and Blood Institute, Bethesda, MD) Clinical Coordinating Center: Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kopperberg (Fred Hutchinson Cancer Research Center, Seattle, WA) Investigators and Academic Centers: JoAnn E. Manson (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA); Barbara V. Howard (MedStar Health Research Institute/Howard University, Washington, DC); Marcia L. Stefanick (Stanford Prevention Research Center, Stanford, CA); Rebecca Jackson (The Ohio State University, Columbus, OH); Cynthia A. Thompson (University of Arizona, Tucson/Phoenix, AZ); Jean Wactawski-Wende (University at Buffalo, Buffalo, NY); Marian Limacher (University of Florida, Gainesville/Jacksonville, FL); Robert Wallace (University of Iowa, Iowa City/Davenport, IA); Lewis Kuller (University of Pittsburgh, Pittsburgh, PA); Rowan T. Chlebowski (The Lundquist Institute, Torrance, CA; and Sally Shumaker (Wake Forest University School of Medicine, Winston-Salem, NC). |
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| A full list of all the investigators who have contributed to WHI science can be retrieved at: WHI%20Investigator%20Long%20List.pdf. |
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| This research was presented in part at the American Society of Clinical Oncology Annual Meeting, June 3-7, 2022, Chicago, IL. Abstract 10552. |
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| AUTHOR CONTRIBUTIONS A. Aragaki and R. Chlebowski had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design was conducted by K. Pan, A. Aragaki and R. Chlebowski. Acquisition, analysis, or interpretation of data was conducted by all authors. Drafting of the manuscript was conducted by R. Chlebowski, A. Aragaki, and K. Pan. Critical revision of the manuscript for important intellectual content was conducted by R. Chlebowski, A. Aragaki, K. Pan, R. Nelson, Y. Michael, J. Manson, A. Barac, M. Stefanick, M. Pichardo, F. Ikramuddin, K. Johnson, J. Krok-Schoen, D. Laddu, L. Snetselaar, and M. LeBoff. Statistical analysis was conducted by A. Aragaki. Obtaining funding was conducted by R. Chlebowski, M. Stefanick, K. Johnson, and J. Manson. Administrative, technical, or material support was provided by A. Aragaki, R. Chlebowski, and J. Manson. Supervision was provided by R. Chlebowski and A. Aragaki. |
Vol 124 - N° 11
P. 1409 - novembre 2024 Retour au numéro
Article précédent
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