Implementation of a 4-y, high-fiber, high-fruit-and-vegetable, low-fat dietary intervention: results of dietary changes in the Polyp Prevention Trial

Lanza, Elaine; Schatzkin, Arthur; Daston, Cassandra; Corle, Don; Freedman, Laurence S.; Ballard‐Barbash, Rachel; Caan, Bette J.; Lance, Peter; Marshall, James R.; Iber, Frank L.; Shike, Moshe; Weissfeld, Joel L.; Slattery, Martha L.; Paskett, Electra D.; Mateski, Donna J.; Albert, Paul S.

doi:10.1093/ajcn/74.3.387

Cited by 155 publications

(160 citation statements)

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“…However, given the errors associated with self-reported dietary intake measuring instruments, lifestyle interventions may report substantial changes in self-reported dietary intake that are not reflected in biomarker change (33,34). The WHEL Study achieved significant increases in carotenoid concentration at 12 months.…”

Section: Discussionmentioning

confidence: 99%

Increases in Plasma Carotenoid Concentrations in Response to a Major Dietary Change in the Women's Healthy Eating and Living Study

Pierce

Natarajan

Sun

et al. 2006

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Cohort studies suggest that higher circulating carotenoid concentrations through food sources may reduce breast cancer events. Other intervention studies have not achieved the level of change in circulating carotenoids required to properly test this hypothesis. Methods: In a randomized trial of 2,922 breast cancer survivors, we examined blood and self-reported diet at baseline and 1 year. Intensive telephone counseling encouraged a plant-based diet in the intervention group. Diet was measured via 24-hour recalls, and a panel of plasma carotenoid concentrations was assessed at both time points. Results: The study intervention was associated with a 51% increase in total carotenoid concentration, from 2.272 F 1.294 to 3.440 F 2.320 Mmol/L, achieved mainly by marked increases in targeted carotenoids: A-carotene, B-carotene, and lutein. For each of these targeted carotenoids, the proportion of the

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Section: Discussionmentioning

confidence: 99%

Increases in Plasma Carotenoid Concentrations in Response to a Major Dietary Change in the Women's Healthy Eating and Living Study

Pierce

Natarajan

Sun

et al. 2006

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Recruitment activities occurred at eight U.S. clinical centers, starting in the spring of 1991 and ending in January 1994. More detailed descriptions of the exclusion criteria (22), dietary intervention (17,23), and trial results (16) are reported elsewhere.…”

Section: Methodsmentioning

confidence: 99%

“…According to food frequency data, the difference in intakes for the three trial dietary goals in the intervention and control groups at the end of the 4-year trial was À9.7% (FSE) of calories (23.8 F 0.2 in the intervention group; 33.9 F 0.2 in the control group), +6.9 g fiber/1,000 kcal (17.4 F 0.2 in the intervention group; 10.0 F 0.1 in the control group), and +1.13 servings of fruits and vegetables/1,000 kcal (3.41 F 0.04 in the intervention group; 2.23 F 0.03 in the control group; ref. 17). Despite these differences in diet, there was no difference in adenoma recurrence.…”

Section: Introductionmentioning

confidence: 94%

The Polyp Prevention Trial–Continued Follow-up Study: No Effect of a Low-Fat, High-Fiber, High-Fruit, and -Vegetable Diet on Adenoma Recurrence Eight Years after Randomization

Lanza

Murphy

et al. 2007

Cancer Epidemiology, Biomarkers &Amp; Prevention

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The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial to evaluate the effects of a highfiber (18 g/1,000 kcal), high-fruit and -vegetable (3.5 servings/1,000 kcal), and low-fat (20% of total energy) diet on the recurrence of adenomatous polyps in the large bowel over a period of 4 years. Although intervention participants reported a significantly reduced intake of dietary fat, and increased fiber, fruit, and vegetable intakes, their risk of recurrent adenomas was not significantly different from that of the controls. Since the PPT intervention lasted only 4 years, it is possible that participants need to be followed for a longer period of time before treatment differences in adenoma recurrence emerge, particularly if diet affects early events in the neoplastic process. The PPTContinued Follow-up Study (PPT-CFS) was a postintervention observation of PPT participants for an additional 4 years from the completion of the trial. Of the 1,905 PPT participants, 1,192 consented to participate in the PPT-CFS and confirmed colonoscopy reports were obtained on 801 participants. The mean time between the main trial end point colonoscopy and the first colonoscopy in the PPT-CFS was 3.94 years (intervention group) and 3.87 years (control group). The baseline characteristics of 405 intervention participants and 396 control participants in the PPT-CFS were quite similar.Even though the intervention group participants increased their fat intake and decreased their intakes of fiber, fruits, and vegetables during the PPT-CFS, they did not go back to their prerandomization baseline diet (P < 0.001 from paired t tests) and intake for each of the three dietary goals was still significantly different from that in the controls during the PPT-CFS (P < 0.001 from t tests). As the CFS participants are a subset of the people in the PPT study, the nonparticipants might not be missing completely at random. Therefore, a multiple imputation method was used to adjust for potential selection bias. The relative risk (95% confidence intervals) of recurrent adenoma in the intervention group compared with the control group was 0.98 (0.88-1.09). There were no significant intervention-control group differences in the relative risk for recurrence of an advanced adenoma (1.06; 0.81-1.39) or multiple adenomas (0.92; 0.77-1.10). We also used a multiple imputation method to examine the cumulative recurrence of adenomas through the end of the PPT-CFS: the intervention-control relative risk (95% confidence intervals) for any adenoma recurrence was 1.04 (0.98-1.09). This study failed to show any effect of a low-fat, high-fiber, high-fruit and -vegetable eating pattern on adenoma recurrence even with 8 years of follow-up. (Cancer Epidemiol Biomarkers Prev 2007;16(9):1745 -52)

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“…In some trials, the control group did not receive any intervention which raises questions about study validity [41,46,47]. The majority of the identified interventions had no theoretical basis, and most of them used traditional methods of education such as individual/group counseling or printed material, and most did not achieve a significant change in dietary behaviour [40–45,48]. Whilst a few studies have reported change in one or another dietary behaviour using information technology tools most had one of the methodological flaws mentioned above [40,49,50,51].…”

Section: Discussionmentioning

confidence: 99%

Protocol for a cluster randomised controlled trial on information technology-enabled nutrition intervention among urban adults in Chandigarh (India): SMART eating trial

Kaur

Webster

et al. 2018

Global Health Action

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Nutrition is an important determinant of health. At present, nutrition programs in India mainly emphasize improving maternal and child nutrition. Adult nutrition has not received due attention, though diseases like hypertension and diabetes are largely preventable through changes in dietary and physical activity behaviour. Little is known about the best approaches to improve dietary behaviours, especially the role of modern information technology (IT) in health education. We describe the protocol of the SMART Eating (Small, Measurable and Achievable dietary changes by Reducing fat, sugar and salt consumption and Trying different fruits and vegetables) health promotion intervention. A Cluster Randomised Controlled Trial will evaluate the effect of an IT-enabled intervention on nutrition behaviour among urban adults of Chandigarh, India. Formative research using a qualitative exploratory approach was undertaken to inform the intervention. The IT-enabled intervention programme includes website development, Short Message Service (SMS), e-mail reminders and interactive help by mobile and landline phones. The IT-enabled intervention will be compared to the traditional nutrition education program of distributing pamphlets in the control group. The primary outcome will be the percentage of study participants meeting the dietary intake guidelines of the National Institute of Nutrition, Hyderabad, India and the change in intake of fat, sugar, salt, fruit and vegetables after the intervention. The difference in differences method will be used to determine the net change in dietary intakes resulting from the interventions. Measurements will be made at baseline and at 6 months post-intervention, using a food frequency questionnaire. The formative research led to the development of a comprehensive intervention, focusing on five dietary components and using multi-channel communication approach including the use of IT to target urban North Indians from diverse socio-economic backgrounds. The Cluster Randomised Controlled Trial design is suitable for evaluating the effectiveness of this IT-enabled intervention for dietary behaviour change.

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Implementation of a 4-y, high-fiber, high-fruit-and-vegetable, low-fat dietary intervention: results of dietary changes in the Polyp Prevention Trial

Abstract: Motivated, free-living individuals, given appropriate support, can make and sustain major dietary changes over a 4-y period.

Cited by 155 publications

References 43 publications

Increases in Plasma Carotenoid Concentrations in Response to a Major Dietary Change in the Women's Healthy Eating and Living Study

Increases in Plasma Carotenoid Concentrations in Response to a Major Dietary Change in the Women's Healthy Eating and Living Study

The Polyp Prevention Trial–Continued Follow-up Study: No Effect of a Low-Fat, High-Fiber, High-Fruit, and -Vegetable Diet on Adenoma Recurrence Eight Years after Randomization

Protocol for a cluster randomised controlled trial on information technology-enabled nutrition intervention among urban adults in Chandigarh (India): SMART eating trial

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