To the Editor: In the Women's Healthy Eating and Living (WHEL) randomized trial, Dr Pierce and colleagues1 evaluated the effect of increased dietary fruits and vegetables on breast cancer recurrence. We agree with the authors that the differences they report in between-group fat intake for participants in this trial may not have been sufficient to adequately test the dietary fat hypothesis that was raised by the interim results of the Women's Intervention Study (WINS).2
In the WHEL study, while there was a significant difference between groups in fat intake, the long-term reduction in fat from baseline entry in the intervention group was minimal. The reported percentage energy from fat was 28.5% at baseline, 27.1% at 48 months, and 28.9% at 72 months; there were no weight differences between groups. In WINS, patients were entered only up to 1 year after diagnosis (mean, 7.4 months) while the patients in the WHEL study were entered up to 4 years after diagnosis (mean, 23.5 months), thus missing the early recurrence peak seen for receptor negative cancers,3 the type for which greatest benefit for dietary intervention was seen with the WINS intervention.2 In addition, the WHEL study had statistically significant differences between the dietary intervention and control groups in both prior bilateral oophorectomy (P = .01) and ever antiestrogen use (P = .03), which required a post hoc analytic plan incorporating a new stratum; this complicates interpretation of the study results.
The hypothesis raised by the interim results of WINS is that in postmenopausal women, a substantial reduction in dietary fat intake associated with moderate weight loss may reduce breast cancer recurrence, most prominently in women with receptor-negative cancers.2 The WHEL study entered both premenopausal and postmenopausal women, led to limited long-term fat intake reduction, did not find a weight difference between groups, and frequently entered patients after the period of early receptor-negative cancer recurrence. Because of these differences, we believe that the WHEL results provide no direct test of the interim WINS findings. As defined by the study protocol, definitive results regarding the potential effect of the WINS dietary intervention on survival are anticipated in mid-2008.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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