Implementing a Low-Fat Eating Plan in the Women's Intervention Nutrition Study

Abstract

The Women’s Intervention Nutrition Study is a randomized clinical trial designed to evaluate if a lifestyle intervention targeting fat intake reduction influences breast cancer recurrence in women with early stage, resected disease receiving conventional cancer management. This report details the concept, content, and implementation of the low-fat eating plan used in the dietary intervention group of this trial. Intervention group participants were given a daily fat gram goal. The intervention was delivered by centrally trained, registered dietitians who applied behavioral, cognitive, and motivational counseling techniques. The low-fat eating plan was implemented in an intensive phase with eight biweekly (up to Month 4), individual counseling sessions followed by a maintenance phase (Month 5 up to and including Year 5) with registered dietitian visits every 3 months and optional monthly group sessions. Self-monitoring (daily fat gram counting and recording), goal setting, and motivational interviewing strategies were key components. Dietary fat intake was equivalent at baseline and consistently lower in the intervention compared with the control group at all time points (percent eneregy from fat at 60 months 23.2% ± 8.4% vs 31.2% ± 8.9%, respectively, P< 0.0001) and was associated with mean 6.1 lb mean weight difference between groups (P = 0.005) at 5 years (baseline and 5 years, respectively: control 160.0 ± 35.0 and 161.7 ± 32.8 lb; intervention 160.2 ± 35.1 and 155.6 ± 32.1 lb). Together with previously reported efficacy results, this information suggests that a lifestyle intervention that reduces dietary fat intake and is associated with modest weight loss may favorably influence breast cancer recurrence. The Women’s Intervention Nutrition Study low-fat eating plan can serve as a model for implementing such a long-term dietary intervention in clinical practice.

A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults

“…53 It can be useful in maintaining behaviour change as well as initiating change and supports participants in an ongoing, tailored way. 53,54 Brief interventions using MI have been effective in different areas of behaviour change including diet and physical activity. RCTs and systematic reviews of MI approaches have shown that it can be used successfully in interventions to change both diet and exercise.…”

“…64 No studies have tested MI as a WLM intervention, although a few have investigated longer-term WLM following an MI-based weight loss intervention. 53, 54 West et al 53 tested a weight loss intervention consisting of MI (plus a group-based weight control programme) in women with type 2 diabetes mellitus. They found that women in the MI group lost significantly more weight by the 18-month follow-up assessment than those in the control group (3.5 kg ± 6.8 kg loss in MI and 1.7 kg ± 5.7 kg in control subjects, p = 0.04).…”

Reach Out to Enhance Wellness Home-Based Diet-Exercise Intervention Promotes Reproducible and Sustainable Long-Term Improvements in Health Behaviors, Body Weight, and Physical Functioning in Older, Overweight/Obese Cancer Survivors

“…[7][8][9][10][11][12][13][14] Within cancer populations, only three studies (all dietary interventions in breast cancer) have reported long-term adherence (ie, periods exceeding 1 year). [15][16][17][18] Although adherence was good, all of these interventions were conducted continuously throughout the entire study period, and none assessed long-term durability after the intervention had ceased. This opportunity presented itself in conducting the Reach Out to Enhance Wellness (RENEW) trial.…”

Predictors for Reporting of Dietary Assessment Methods in Food-based Randomized Controlled Trials over a Ten-year Period

“…Similarly, 87.3% of studies also failed to report the manner in which the assessment was conducted while 5.3% reported it being telephone based. (Keyserling et al, 1999, Kris-Etherton et al, 2002Pierce et al, 2002;Ammerman et al, 2003, Appel et al, 2003Maskarinec et al, 2003;Acharya et al, 2004, Malaveille et al, 2004, Rock et al, 2004b, Rock et al, 2004a, Vincent et al, 2004, Gann et al, 2005Barnard et al, 2006, Chlebowski et al, 2006, Segovia-Siapco et al, 2007, Turner-McGrievy et al, 2008Barnard et al, 2009, Gold et al, 2009, Hoy et al, 2009), 4.9% paper based (Djuric et al, 1999b;Campbell et al, 2000, Glasgow and Toobert, 2000, Forli et al, 2001a, Forli et al, 2001b, Djuric et al, 2002a, De Mendonca et al, 2003, Djuric et al, 2003, Nydahl et al, 2003, Sondergaard et al, 2003, Wu et al, 2005, Marfella et al, 2006, Hawkes et al, 2009) and 2.5% computerised. (Berrino et al, 2001, Heath et al, 2001, Schatzkin et al, 2000a, Kaaks et al, 2003, He et al, 2004…”