Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density

The Women's Health Initiative Dietary Modification Trial

Anne McTiernan, Jean Wactawski-Wende, LieLing Wu, Rebecca J. Rodabough, Nelson B. Watts, Frances Tylavsky, Ruth Freeman, Susan Hendrix, Rebecca Jackson

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: The effects of dietary changes on osteoporosis, low bone density, and frequent falls are unestablished. Objective: We assessed the effect of the Women's Health Initiative Dietary Modification low-fat and increased fruit, vegetable, and grain intervention on incident hip, total, and site-specific fractures and self-reported falls, and, in a subset, on bone mineral density (BMD). Design: Postmenopausal women (n = 48,835) aged 50-79 y (18.6% of minority race-ethnicity) were randomly assigned to receive the Dietary Modification intervention (40%, n = 19,541) (daily goal: ≤20% of energy as fat, ≥5 servings of vegetables and fruit, and ≥6 servings of grains) or to a comparison group that received no dietary changes (60%; n = 29,294). Results: After a mean 8.1 y of follow-up, 215 women in the intervention group and 285 women in the comparison group (annualized rate: 0.14% and 0.12%, respectively) experienced a hip fracture (hazard ratio: 1.12; 95% CI: 0.94, 1.34; P = 0.21). The intervention group (n = 5423; annualized rate: 3.44%) had a lower rate of reporting ≥2 falls than did the comparison group (n = 8695; annualized rate: 3.67%) (HR: 0.92; 95% CI: 0.89, 0.96; P < 0.01). There was a significant interaction according to hormone therapy use; those in the comparison group receiving hormone therapy had the lowest incidence of hip fracture. In a subset of 3951 women, hip BMD at years 3, 6, and 9 was 0.4-0.5% lower in the intervention group than in the comparison group (P = 0.003). Conclusions: A low-fat and increased fruit, vegetable, and grain diet intervention modestly reduced the risk of multiple falls and slightly lowered hip BMD but did not change the risk of osteoporotic fractures. This trial was registered at clinicaltrials.gov as NCT00000611.

Original languageEnglish (US)
Pages (from-to)1864-1876
Number of pages13
JournalAmerican Journal of Clinical Nutrition
Volume89
Issue number6
DOIs
StatePublished - Jan 6 2009

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Diet Therapy
Women's Health
Vegetables
Bone Density
Fruit
Fats
Pelvic Bones
Hip Fractures
Hormones
Osteoporotic Fractures
Osteoporosis
Hip
Diet
Incidence
Therapeutics

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Medicine(all)

Cite this

Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density : The Women's Health Initiative Dietary Modification Trial. / McTiernan, Anne; Wactawski-Wende, Jean; Wu, LieLing; Rodabough, Rebecca J.; Watts, Nelson B.; Tylavsky, Frances; Freeman, Ruth; Hendrix, Susan; Jackson, Rebecca.

In: American Journal of Clinical Nutrition, Vol. 89, No. 6, 06.01.2009, p. 1864-1876.

Research output: Contribution to journalArticle

McTiernan, A, Wactawski-Wende, J, Wu, L, Rodabough, RJ, Watts, NB, Tylavsky, F, Freeman, R, Hendrix, S & Jackson, R 2009, 'Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density: The Women's Health Initiative Dietary Modification Trial', American Journal of Clinical Nutrition, vol. 89, no. 6, pp. 1864-1876. https://doi.org/10.3945/ajcn.2008.26956
McTiernan, Anne ; Wactawski-Wende, Jean ; Wu, LieLing ; Rodabough, Rebecca J. ; Watts, Nelson B. ; Tylavsky, Frances ; Freeman, Ruth ; Hendrix, Susan ; Jackson, Rebecca. / Low-fat, increased fruit, vegetable, and grain dietary pattern, fractures, and bone mineral density : The Women's Health Initiative Dietary Modification Trial. In: American Journal of Clinical Nutrition. 2009 ; Vol. 89, No. 6. pp. 1864-1876.
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abstract = "Background: The effects of dietary changes on osteoporosis, low bone density, and frequent falls are unestablished. Objective: We assessed the effect of the Women's Health Initiative Dietary Modification low-fat and increased fruit, vegetable, and grain intervention on incident hip, total, and site-specific fractures and self-reported falls, and, in a subset, on bone mineral density (BMD). Design: Postmenopausal women (n = 48,835) aged 50-79 y (18.6{\%} of minority race-ethnicity) were randomly assigned to receive the Dietary Modification intervention (40{\%}, n = 19,541) (daily goal: ≤20{\%} of energy as fat, ≥5 servings of vegetables and fruit, and ≥6 servings of grains) or to a comparison group that received no dietary changes (60{\%}; n = 29,294). Results: After a mean 8.1 y of follow-up, 215 women in the intervention group and 285 women in the comparison group (annualized rate: 0.14{\%} and 0.12{\%}, respectively) experienced a hip fracture (hazard ratio: 1.12; 95{\%} CI: 0.94, 1.34; P = 0.21). The intervention group (n = 5423; annualized rate: 3.44{\%}) had a lower rate of reporting ≥2 falls than did the comparison group (n = 8695; annualized rate: 3.67{\%}) (HR: 0.92; 95{\%} CI: 0.89, 0.96; P < 0.01). There was a significant interaction according to hormone therapy use; those in the comparison group receiving hormone therapy had the lowest incidence of hip fracture. In a subset of 3951 women, hip BMD at years 3, 6, and 9 was 0.4-0.5{\%} lower in the intervention group than in the comparison group (P = 0.003). Conclusions: A low-fat and increased fruit, vegetable, and grain diet intervention modestly reduced the risk of multiple falls and slightly lowered hip BMD but did not change the risk of osteoporotic fractures. This trial was registered at clinicaltrials.gov as NCT00000611.",
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