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Diabetes Care. 2018 Apr;41(4):680-687. doi: 10.2337/dc17-0534. Epub 2017 Dec 27.

A Low-Fat Dietary Pattern and Diabetes: A Secondary Analysis From the Women's Health Initiative Dietary Modification Trial.

Author information

1
MedStar Health Research Institute, Hyattsville, MD barbara.v.howard@medstar.net.
2
Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC.
3
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
4
Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA.
5
Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ.
6
University of Tennessee Health Science Center, Memphis, TN.
7
Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
8
University of Alabama at Birmingham, Birmingham, AL.
9
University of Iowa, Iowa City, IA.
10
University of Washington, Seattle, WA.

Abstract

OBJECTIVE:

We performed a secondary analysis to evaluate the effect of the Women's Health Initiative dietary intervention on incident diabetes and diabetes treatment in postmenopausal women.

RESEARCH DESIGN AND METHODS:

A total of 48,835 women were randomized to a comparison group or an intervention group that underwent a behavioral/nutritional modification program to decrease fat and increase vegetable, fruit, and grain intake for an average of 8.1 years. Ninety-three percent of participants completed the intervention, and 71% participated in active follow-up through 30 September 2015 (median 17.3 years). We measured time to development of treated diabetes and progression from oral antihyperglycemic agents to insulin. Serum glucose and insulin were measured in a subsample of women (N = 2,324) at baseline and years 1, 3, and 6.

RESULTS:

During the trial, intervention group women had lower rates of initiation of insulin therapy (hazard ratio [HR] 0.74 [95% CI 0.59, 0.94]; P = 0.01). Moreover, women with baseline waist circumference ≥88 cm (P interaction = 0.01) and worse metabolic syndrome scores (P interaction = 0.02) had the greatest reduction in risk of initiating insulin therapy. The decreased risk from the intervention was present during the cumulative follow-up (HR 0.88 [95% CI 0.78, 0.99]; P = 0.04). In participants with measured biomarkers (5.8% subsample) who had baseline glucose <100 mg/dL, the intervention reduced the risk of developing glucose ≥100 mg/dL by 25% (odds ratio 0.75 [95% CI 0.61, 0.93]; P = 0.008). Adjustment for weight change did not alter the results.

CONCLUSIONS:

In this secondary analysis, a dietary intervention in postmenopausal women aimed at reducing fat and increasing intake of vegetables, fruits, and grains did not increase risk of diabetes and may have slowed progression.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00000611.

PMID:
29282203
PMCID:
PMC5860839
DOI:
10.2337/dc17-0534
[Indexed for MEDLINE]
Free PMC Article

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