title: Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women's Healthy Eating and Living (WHEL) randomized trial.
abstract: BACKGROUND
  Evidence is lacking that a dietary pattern high in vegetables, fruit, and fiber and low in total fat can influence breast cancer recurrence or survival.
  
  
  OBJECTIVE
  To assess whether a major increase in vegetable, fruit, and fiber intake and a decrease in dietary fat intake reduces the risk of recurrent and new primary breast cancer and all-cause mortality among women with previously treated early stage breast cancer.
  
  
  METHODS
  Multi-institutional randomized controlled trial of dietary change in 3088 women previously treated for early stage breast cancer who were 18 to 70 years old at diagnosis. Women were enrolled between 1995 and 2000 and followed up through June 1, 2006.
  
  
  METHODS
  The intervention group (n = 1537) was randomly assigned to receive a telephone counseling program supplemented with cooking classes and newsletters that promoted daily targets of 5 vegetable servings plus 16 oz of vegetable juice; 3 fruit servings; 30 g of fiber; and 15% to 20% of energy intake from fat. The comparison group (n = 1551) was provided with print materials describing the "5-A-Day" dietary guidelines.
  
  
  METHODS
  Invasive breast cancer event (recurrence or new primary) or death from any cause.
  
  
  RESULTS
  From comparable dietary patterns at baseline, a conservative imputation analysis showed that the intervention group achieved and maintained the following statistically significant differences vs the comparison group through 4 years: servings of vegetables, +65%; fruit, +25%; fiber, +30%, and energy intake from fat, -13%. Plasma carotenoid concentrations validated changes in fruit and vegetable intake. Throughout the study, women in both groups received similar clinical care. Over the mean 7.3-year follow-up, 256 women in the intervention group (16.7%) vs 262 in the comparison group (16.9%) experienced an invasive breast cancer event (adjusted hazard ratio, 0.96; 95% confidence interval, 0.80-1.14; P = .63), and 155 intervention group women (10.1%) vs 160 comparison group women (10.3%) died (adjusted hazard ratio, 0.91; 95% confidence interval, 0.72-1.15; P = .43). No significant interactions were observed between diet group and baseline demographics, characteristics of the original tumor, baseline dietary pattern, or breast cancer treatment.
  
  
  CONCLUSIONS
  Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, and fiber and low in fat did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00003787.
authors.affiliation: Moores UCSD Cancer Center, University of California, San Diego, La Jolla , CA 92093-0901, USA. jppierce@ucsd.edu
authors.forename: John P
authors.initials: JP
authors.lastname: Pierce
authors.forename: Loki
authors.initials: L
authors.lastname: Natarajan
authors.forename: Bette J
authors.initials: BJ
authors.lastname: Caan
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Parker
authors.forename: E Robert
authors.initials: ER
authors.lastname: Greenberg
authors.forename: Shirley W
authors.initials: SW
authors.lastname: Flatt
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Rock
authors.forename: Sheila
authors.initials: S
authors.lastname: Kealey
authors.forename: Wael K
authors.initials: WK
authors.lastname: Al-Delaimy
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Bardwell
authors.forename: Robert W
authors.initials: RW
authors.lastname: Carlson
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Emond
authors.forename: Susan
authors.initials: S
authors.lastname: Faerber
authors.forename: Ellen B
authors.initials: EB
authors.lastname: Gold
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hajek
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hollenbach
authors.forename: Lovell A
authors.initials: LA
authors.lastname: Jones
authors.forename: Njeri
authors.initials: N
authors.lastname: Karanja
authors.forename: Lisa
authors.initials: L
authors.lastname: Madlensky
authors.forename: James
authors.initials: J
authors.lastname: Marshall
authors.forename: Vicky A
authors.initials: VA
authors.lastname: Newman
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ritenbaugh
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Thomson
authors.forename: Linda
authors.initials: L
authors.lastname: Wasserman
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000628:therapy; D004032:Diet; D018752:Diet, Fat-Restricted; D038441:Diet, Mediterranean; D004043:Dietary Fiber; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D014675:Vegetables