A Low-Fat Dietary Pattern and Diabetes: A Secondary Analysis From the Women's Health Initiative Dietary Modification Trial.

Academic Article


  • OBJECTIVE: We performed a secondary analysis to evaluate the effect of the Women's Health Initiative dietary intervention on incident diabetes and diabetes treatment in postmenopausal women. RESEARCH DESIGN AND METHODS: A total of 48,835 women were randomized to a comparison group or an intervention group that underwent a behavioral/nutritional modification program to decrease fat and increase vegetable, fruit, and grain intake for an average of 8.1 years. Ninety-three percent of participants completed the intervention, and 71% participated in active follow-up through 30 September 2015 (median 17.3 years). We measured time to development of treated diabetes and progression from oral antihyperglycemic agents to insulin. Serum glucose and insulin were measured in a subsample of women (N = 2,324) at baseline and years 1, 3, and 6. RESULTS: During the trial, intervention group women had lower rates of initiation of insulin therapy (hazard ratio [HR] 0.74 [95% CI 0.59, 0.94]; P = 0.01). Moreover, women with baseline waist circumference ≥88 cm (P interaction = 0.01) and worse metabolic syndrome scores (P interaction = 0.02) had the greatest reduction in risk of initiating insulin therapy. The decreased risk from the intervention was present during the cumulative follow-up (HR 0.88 [95% CI 0.78, 0.99]; P = 0.04). In participants with measured biomarkers (5.8% subsample) who had baseline glucose <100 mg/dL, the intervention reduced the risk of developing glucose ≥100 mg/dL by 25% (odds ratio 0.75 [95% CI 0.61, 0.93]; P = 0.008). Adjustment for weight change did not alter the results. CONCLUSIONS: In this secondary analysis, a dietary intervention in postmenopausal women aimed at reducing fat and increasing intake of vegetables, fruits, and grains did not increase risk of diabetes and may have slowed progression.
  • Published In

  • Diabetes Care  Journal
  • Keywords

  • Aged, Diabetes Mellitus, Type 2, Diet Therapy, Diet, Fat-Restricted, Dietary Fats, Feeding Behavior, Female, Follow-Up Studies, Fruit, Humans, Incidence, Insulin, Middle Aged, Postmenopause, Risk Factors, Vegetables
  • Digital Object Identifier (doi)

    Author List

  • Howard BV; Aragaki AK; Tinker LF; Allison M; Hingle MD; Johnson KC; Manson JE; Shadyab AH; Shikany JM; Snetselaar LG
  • Start Page

  • 680
  • End Page

  • 687
  • Volume

  • 41
  • Issue

  • 4