Low-fat dietary pattern and lipoprotein risk factors: the Women’s Health Initiative Dietary Modification Trial1234

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Background: The Women’s Health Initiative Dietary Modification Trial tested the effects on chronic disease of a dietary pattern lower in fat and higher in vegetables, fruit, and grains.

Objective: The objective was to evaluate the effects of dietary carbohydrate changes on lipids and lipoprotein composition.

Design: Postmenopausal women were randomly assigned to an intervention or a comparison group for a mean of 8.1 y. Lipoprotein analyses and subclasses were based on subsamples of 2730 and 209 participants, respectively.

Results: At year 6, the total reported fat intake was 7.8% lower and carbohydrate intake was 7.6% higher in the intervention group than in the comparison group. Triglyceride change between groups differed by 2.3, 3.8, and −0.8 mg/dL at 1, 3, and 6 y, respectively, and HDL-cholesterol change differed by −1.6, −0.7, and −1.0 mg/dL at 1, 3, and 6 y, respectively. Changes did not differ by age, ethnicity, or obesity. In diabetic intervention women who were white, the triglyceride difference between the intervention and comparison groups was 33.8 mg/dL, whereas in black women with diabetes (n = 50 in the intervention group; n = 83 in the comparison group), the triglyceride difference was 6.4 mg/dL (P for 3-factor interaction = 0.049). No significant changes were observed in apolipoprotein or lipoprotein particles. Reductions in LDL cholesterol varied by quartile of reported lowering of saturated or trans fat.

Conclusions: The replacement of 7–8% of fat intake with complex carbohydrates over 6 y was not associated with clinically adverse effects on triglycerides, HDL cholesterol, or lipoprotein subclasses. Diabetic white women with higher triglyceride concentrations may have greater increases in triglycerides.

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From the MedStar Research Institute, Hyattsville, MD, and Georgetown University School of Medicine, Washington, DC (BVH); the University of Hawaii, Honolulu, HI (JDC); Brown University, Providence, RI (CBE); Fred Hutchinson Cancer Research Center, Seattle, WA (CK and MP); the University of Massachusetts/Fallon Clinic, Worcester, MA (JO); the University of Medicine and Dentistry of New Jersey, Newark, NJ (JBK); University of Pittsburgh, Pittsburgh, PA (AR); the University of Iowa, Iowa City/Davenport,IA (JGR); the National Heart, Lung, and Blood Institute, Bethesda, MD (JR); the University of Wisconsin, Madison, WI (GS); the University of Alabama at Birmingham, Birmingham, AL (JMS); and Northwestern University, Chicago/Evanston, IL (LVH).

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The Women’s Health Initiative Investigators are listed in Appendix A.

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The WHI is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221.

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Address correspondence to BV Howard, MedStar Health Research Institute and Georgetown University, 6525 Belcrest Road, Hyattsville, MD 20782. E-mail: [email protected].