Dietary Patterns in Women Treated for Breast Cancer Who Successfully Reduce Fat Intake: the Women's Intervention Nutrition Study (WINS)

Objective: The objectives of this study were to assess the types of dietary changes made by women who successfully reduced their fat intake in response to low-fat diet instruction and to evaluate the effects of these changes on nutrient intake.

Design: Two hundred women enrolled in the low-fat intervention arm of the Women's Intervention Nutrition Study (WINS) were randomly selected. Woman whose baseline fat intake was less than 20% energy from fat were excluded from the study, resulting in a total population of 163. These women were categorized into either the strictly adherent (SA) (those who met their fat gram goal and reported less than 20 % calories from fat, n=50) or the not strictly adherent (NSA) (those who exceeded their fat gram goal and reported 20% or greater calories from fat, n=113) group. The food choices made by SA and NSA subjects were analyzed to identify those that promoted greater adherence.

Subjects/setting: The participants were free-living women who had been instructed to follow a diet that would meet a specific fat gram goal calculated to provide 15% of calories from fat.

Statistical Analyses Performed: Descriptive statistics were used to describe food groups and subgroups. t tests were used to determine statistical significance between and within groups. chi(2) analysis was used to assess differences in demographic variables.

Results: There were no marked differences in food patterns of the SA and NSA subjects when compared with the Food Guide Pyramid (FGP) recommendations. Both met FGP serving recommendations at baseline. At 12 months, both showed reductions in the number of servings from fats and oils; SA subjects showed a greater reduction (from 4.18+/-3.6 to 3.0+/-2.4) as well as a reduction in servings from the bread group intake (5.7+/-2.2 to 4.8+/-2.1). Evaluation of food subgroups from within FGP groups showed strategies that promoted fat reduction, such as reducing portion sizes of high-fat foods. The use of these strategies was greater in the SA subjects. The reduction in fat intake had little impact on nutrient adequacy. SA and NSA subjects reduced energy intake from baseline to follow-up, with SA subjects reporting lower intakes. There were few differences in nutrient intakes between the SA and NSA subjects at either time period.

Conclusions: The results from this study suggest specific strategies that promote successful reduction in fat intake without compromising nutrient intake. This information can be used to guide others in making dietary changes.