Reduction In Dietary Fat Intake Research Articles

Yoga, bioenergetics and eating behaviors: A conceptual review.

Yoga is an ancient oriental discipline that emerged from mystical and philosophical concepts. Today it is practiced in the west, partly due to the promotion of its benefits to improve the lifestyle and overall health. As compared to non-Hatha Yoga (HY) practitioners, healthier and better-eating patterns have been observed in those who practice it. Agreement with the brought benefits, HY can be used as a therapeutic method to correct abnormal eating behaviors (AEB), obesity, and some metabolic diseases. However, the energy expenditure during traditional protocols of HY is not high; hence, it is not very effective for reducing or maintaining body weight or to improve cardiovascular conditioning. Even so, several observational studies suggest significant changes in eating behaviors, like a reduction in dietary fat intake and increments in that of fresh vegetables, whole grains and soy-based products, which in turn may reduce the risk for cardiovascular diseases. Given the inconsistency of the results derived from cross-sectional studies, more case–control studies are needed to demonstrate the efficacy of HY as an alternative method in the clinical treatment of disordered eating and metabolic diseases.

Breastfeeding and Cardiometabolic Profile in Childhood

Although the observed association between breastfeeding and cardiometabolic profile in childhood and adolescence in previous studies has biological plausibility, the precise mechanism and magnitude remain far from being fully understood.1 Early nutrition and epigenetic programming,2 anti-inflammatory properties,3 and cardiorespiratory fitness4 are among numerous hypotheses that are currently being actively investigated. In this issue of Circulation, Martin et al5 report on this subject. Their intervention study began in 1996 to 1997 in 31 Belarussian maternity hospitals and affiliated outpatient clinics with an enrollment of 17046 breastfeeding mothers of healthy term infants. The trial was originally designed to assess the effects of a breastfeeding promotion and support intervention on duration of breastfeeding. Duration of both exclusive (infant only receives breast milk without any additional food or drink, not even water) and any breastfeeding (includes nonexclusive and exclusive) was assessed in the intervention and nonintervention groups.6 The planned 11.5-year follow-up of ≈80% of study participants who had fasted for the follow-up assessment and did not have diabetes mellitus allowed the authors to test whether an intervention to improve breastfeeding duration and exclusivity also influenced cardiometabolic risk factors in childhood. No significant differences between the intervention and control groups were found in levels of blood pressure, fasting insulin, adiponectin, glucose, apolipoprotein A1, or metabolic syndrome.

Nutrition and physical activity influence on breast cancer incidence and outcome

Introduction and aimsTo provide a current perspective on nutrition and physical activity influence on breast cancer. Methods and resultsA comprehensive literature review was conducted and selective presentation of findings follows. While some observational studies have associated higher dietary fat intake with higher breast cancer incidence, two full-scale randomized, clinical trials of dietary fat intake reduction programs were negative. However, a lifestyle intervention targeting fat intake reduction in the Women's Intervention Nutrition Study (WINS), resulted in weight loss and also reduced breast cancer recurrences in women with early stage disease. Observational studies evaluating specific nutrient intakes and dietary supplements have provided mixed results. Several observational studies find women with early stage breast cancer with lower 25-hydroxyvitamin D levels at higher recurrence risk, a finding requiring cautious interpretation. The lifestyle factor most strongly and consistently associated with both breast cancer incidence and breast cancer recurrence risk is physical activity. A meta-analyses of observational studies supports the concept that moderate recreational physical activity (about 3–4 h walking per week) may reduce breast cancer incidence and that women with early stage breast cancer who increased or maintain their physical activity may have lower recurrence risk as well. Feasibility of achieving increased physical activity and weight loss in women with early-stage breast cancer has been established. Two full-scale randomized clinical trials are evaluating weight loss/maintenance and increased physical activity in relation to recurrence risk in women with early-stage, resected breast cancer. Discussion/conclusionsDietary intake may influence breast cancer but influence is difficult to separate from influence of body weight. A consistent body of observational study evidence suggests higher physical activity has favorable influence on breast cancer incidence and outcome. While awaiting definitive evidence from ongoing randomized trials, breast cancer patients can reasonably be counseled to avoid weight gain and reduce body weight if overweight or obese and increase or maintain a moderate level of physical activity.

A Randomized Trial of Dietary Intervention for Breast Cancer Prevention

Epidemiologic data and animal experiments suggest that dietary fat may influence risk of breast cancer. To determine whether intervention with a low-fat, high-carbohydrate diet would reduce breast cancer incidence in women at increased risk of the disease, we carried out a randomized controlled trial in Canada. We recruited 4,690 women with extensive mammographic density and randomized them to an intervention group or a comparison group. The intervention group received intensive dietary counseling to reduce fat intake to a target of 15% of calories and increase carbohydrate to 65% of calories. Dietary intakes were assessed throughout using food records. Subjects were followed for at least 7 years and for an average of 10 years. The main outcome was invasive breast cancer. Percentage of calories from fat in the intervention group decreased from 30% at baseline to 20% after randomization and remained 9% to 10% lower than the comparison group throughout. There were 118 invasive breast cancers in the intervention group and 102 in the comparison group [adjusted hazard ratio = 1.19 (95% CI: 0.91-1.55)]. Analysis of food records showed that fat intake at baseline and after randomization was not associated with total breast cancer incidence. Greater weight and lower carbohydrate intake at baseline and after randomization were associated with an increased risk of estrogen receptor (ER)-positive breast cancer. Our findings suggest that a sustained reduction in dietary fat intake did not reduce risk of breast cancer in women with extensive mammographic density. Weight and carbohydrate intakes were associated with risk of ER-positive breast cancer.

Melanocortin activity in the amygdala controls appetite for dietary fat

The amygdala is rich in melanocortin 4 receptors. Because the reduction in dietary fat intake after enterostatin is injected in the central nucleus of the amygdala (CeA) is blocked by a melanocortin 4 receptor antagonist, we investigated the role of melanocortin activity in the CeA in regulating food intake and macronutrient choice. Sprague-Dawley rats, fitted with CeA cannulas, were fed either chow, a high-fat (HF) diet, or adapted to a two-choice HF or low-fat (LF) diet. Injections of the MC4R agonist melanotan II (MTII) in the CeA had a dose-dependent inhibitory effect on food intake that lasted for at least 24 h. This response was greater in rats fed a HF diet. The inverse agonist agouti-related protein (AgRP) and antagonist SHU-9119 increased food intake in a dose-dependent manner, with the hyperphagia lasting for 60 h. In rats adapted to a two-choice HF/LF diet, MTII decreased HF consumption but had no effect on LF consumption, resulting in a long-lasting decrease in total calorie intake (-35.5% after 24 h, P < 0.05). Total calorie intake increased in both AgRP- and SHU-9119-treated rats (32 and 109% after 24 h, respectively) as the result of increased intake of HF diet. There was no modification of LF consumption with AgRP treatment and a transient nonsignificant decrease with SHU-9119 treatment. Amygdala brain-derived neurotrophic factor expression was increased by AgRP in fed rats. These results identify the amygdala as a site of action for the melanocortin system to control food intake and dietary preferences.

Lifestyle changes and breast cancer prognosis: a review

Because of its high incidence and improving survival, breast cancer is currently the most prevalent cancer in the world. We reviewed the published literature in our search for modifiable factors valuable as an adjuvant health measure to surgery, radio and systemic therapy for breast cancer. We included material which was identified from computerised searches of PubMed (1966 to May, 2007). Published material was restricted to prospective cohort studies and randomised clinical trials. We reviewed the literature concerning the association between physical activity, smoking, weight gain after the diagnosis, diet and prognosis. We conclude that life style changes following standard breast cancer therapy are highly recommended (although scientific evidence is still lacking for some of inconsistency regarding available data). They include physical activity, weight control, high consumption of fruit and vegetables, and a reduction of dietary fat intake.

The Pro12Ala polymorphism in PPARG2 increases the effectiveness of primary prevention of cardiovascular disease by a lifestyle intervention

To the Editor: Genetic factors interact with modifiable risk factors to influence the risk of cardiovascular disease [1]. They also modulate the effectiveness of interventions for the primary prevention of cardiovascular disease [2]; thus, the identification of the genes involved may help to more efficiently prevent cardiovascular disease [1, 2]. With regard to glucose metabolism, gene–environment and gene–nutrient interactions have previously been demonstrated for the polymorphism in the peroxisome proliferator–activator receptor γ2 gene (PPARG2) that results in the substitution of Pro for Ala at codon 12 [3]. In addition, carriers of the Ala-encoding allele have an improved response to aerobic exercise in terms of glucose metabolism [3]. Because PPARG2 is also considered to play a role in the process of atherosclerosis [3], we tested whether PPARG2 interacts with the effects of lifestyle intervention on cardiovascular traits. Specifically, we studied the effect of this common polymorphism on the increase in flowmediated vasodilation (FMD) and the decrease in serum levels of C-reactive protein (CRP) during a 9 month lifestyle intervention in 166 non-diabetic subjects (58 men, 108 women; age 46±11 years). The population was at increased risk of type 2 diabetes and cardiovascular disease because of one or more of the following risk factors: being overweight (BMI >27 kg/m), being a first-degree relative of a patient with type 2 diabetes, or having IGT or a history of gestational diabetes. After the baseline visit, which included an OGTT and FMD, all subjects started an exercise and dietary lifestyle intervention (Tubingen Lifestyle Intervention Program [TULIP]). The study was approved by the local ethics committee. All subjects gave their written informed consent. This programme includes the goals of the Diabetes Prevention Study [4]: a reduction of body weight by >5%, a reduction of dietary fat intake to 15 g per 4,187 kJ, and an increase in the amount of weekly exercise to >3 h/week. The TULIP study design includes a baseline and two follow-up visits, one after 9 months and the other after 24 months. In this analysis, data from 166 subjects who completed the baseline visit and the first follow-up visit are reported (mean follow-up time [±SD] 264±56 days, range 151– 465 days). At the time of data analysis, less than 50% of these subjects had completed the second follow-up visit, and so these data are not presented. At baseline and at follow-up, FMD of the brachial artery was measured with high-resolution ultrasound (13 MHz) [5]. Subjects with serum levels of CRP of >10 mg/l at baseline or at followup were excluded from the analysis. Genomic DNA was extracted from peripheral blood lymphocytes. Genetic analyses were performed by PCR with subsequent restriction analysis with BstXI, as described previously [6]. The statistical software package JMP (SAS Institute, Cary, NC, USA) was used. Of the 166 subjects, 131 had the Pro/Pro genotype and 35 had an X/Ala genotype. These two genotype groups were not different in terms of baseline FMD (7.2±0.3 vs 7.3±0.6%, respectively; p=0.69) or CRP (1.6±0.1 vs 1.6±0.3 mg/l, respectively; p=0.43). During lifestyle intervention, BMI was reduced (from 29.3±0.4 to Diabetologia (2007) 50:1345–1347 DOI 10.1007/s00125-007-0664-6

Wise Mind Project: A School‐based Environmental Approach for Preventing Weight Gain in Children

The Wise Mind pilot study compared the efficacy of an environmental approach for prevention of inappropriate weight gain in children with an active control condition that used an environmental approach for modifying expectancies related to the use of alcohol, tobacco, and drugs. A total of 670 second to sixth grade students from four schools were enrolled in the study. The study spanned 2 academic years, and 586 students were available for evaluation at the end of the study. Two schools were randomly assigned to each treatment arm. The environmental approach for weight gain prevention focused on modification of eating habits and physical activity, and the active control group focused on modification of expectancies related to substance use. Using an intention to treat design, the study found no differences in weight gain prevention between the two interventions. The weight gain prevention program was associated with reduction of total caloric intake, reduction of dietary fat intake, reduction of protein intake, and increased physical activity in comparison with the active control group and relative to baseline. These changes in food intake were attributed to changes in food selections that resulted from modification of school cafeteria menus and food preparation. The Wise Mind school-based weight gain prevention program induced behavioral changes in healthy eating and physical activity but did not induce significant changes in body weight in comparison with the control arm. Recommendations for future research are provided.

Cyclical mastopathy: a critical review of therapy.

Because of a recently completed trial which demonstrated that dietary fat reduction improved the symptoms of cyclical mastopathy, we have carried out a critical review of other studies of treatment for this disorder to determine what, if any, mechanisms of action were shared by effective treatments. Therapies were classified as 'definitely effective' if their effectiveness was demonstrated in at least one randomized placebo-controlled study of women with cyclical mastopathy, 'probably effective' if their effectiveness in relieving breast symptoms was demonstrated in at least one study in women with premenstrual syndrome, and 'probably not effective' if they had not been shown to improve breast symptoms in at least two studies in women with premenstrual syndrome. Bromocriptine, danazol, evening primrose oil, tamoxifen and reduction of dietary fat intake were classified as definitely effective and norethisterone and Bellergal as probably effective. Several therapeutic manoeuvres, including reduction of methylxanthine ingestion and the administration of vitamin E or diuretics, have not been adequately evaluated in women with cyclical breast symptoms. A review of the published reports of the physiological effects of therapies that were definitely or probably effective revealed that these agents acted either to alter serum prolactin levels or lipid metabolism, or both. As evidence exists that prolactin influences lipid metabolism it is postulated that cyclical mastopathy may be a disorder of lipid metabolism.

Dietary fat reduction in postmenopausal women with primary breast cancer: Phase III Women’s Intervention Nutrition Study (WINS)

10 Background: Despite preclinical and observational studies suggesting benefit, dietary fat influence on breast cancer outcomes has been controversial. Methods: We conducted a randomized trial to test whether an intensive dietary intervention designed to reduce dietary fat intake was effective in influencing relapse-free survival in postmenopausal women with primary breast cancer. A total of 2,437 women with early stage resected breast cancer, 48–79 years old, were randomized within 365 days from surgery in a 40:60 ratio to dietary intervention or control groups at 37 U.S. sites. All received standard breast cancer management: mastectomy or lumpectomy plus radiation; tamoxifen for ER positive, protocol-defined chemotherapy for ER negative and optional chemotherapy for ER positive cases. The dietary intervention included eight bi-weekly individual counseling sessions conducted by centrally trained nutritionists who provided ongoing contacts throughout. Results: Patient characteristics and recurrence risk factors were balanced. Dietary fat intake reduction was greater in the dietary group (fat gram intake/day at 12 months, 33.3 ± 16.7, mean ± standard deviation (SD) versus 51.3 ± 24.4 in controls, respectively, p<0.001). After 60 months median follow-up, the 277 reported relapse events are outlined below by treatment group and receptor status. Conclusion: Life-style intervention resulting in dietary fat intake reduction may improve the relapse-free survival of postmenopausal breast cancer patients. No significant financial relationships to disclose.

Low-Fat High-Fiber Diet Decreased Serum and Urine Androgens in Men

To validate our hypothesis that reduction in dietary fat may result in changes in androgen metabolism, 39 middle-aged, white, healthy men (50-60 yr of age) were studied while they were consuming their usual high-fat, low-fiber diet and after 8 wk modulation to an isocaloric low-fat, high-fiber diet. Mean body weight decreased by 1 kg, whereas total caloric intake, energy expenditure, and activity index were not changed. After diet modulation, mean serum testosterone (T) concentration fell (P < 0.0001), accompanied by small but significant decreases in serum free T (P = 0.0045), 5 alpha-dihydrotestosterone (P = 0.0053), and adrenal androgens (androstendione, P = 0.0135; dehydroepiandrosterone sulfate, P = 0.0011). Serum estradiol and SHBG showed smaller decreases. Parallel decreases in urinary excretion of some testicular and adrenal androgens were demonstrated. Metabolic clearance rates of T were not changed, and production rates for T showed a downward trend while on low-fat diet modulation. We conclude that reduction in dietary fat intake (and increase in fiber) results in 12% consistent lowering of circulating androgen levels without changing the clearance.

Potential of essential fatty acid deficiency with extremely low fat diet in lipoprotein lipase deficiency during pregnancy: A case report

BackgroundPregnancy in patients with lipoprotein lipase deficiency is associated with high risk of maternal pancreatitis and fetal death. A very low fat diet (< 10% of calories) is the primary treatment modality for the prevention of acute pancreatitis, a rare but potentially serious complication of severe hypertriglyceridemia. Since pregnancy can exacerbate hypertriglyceridemia in the genetic absence of lipoprotein lipase, a further reduction of dietary fat intake to < 1–2% of total caloric intake may be required during the pregnancy, along with the administration of a fibrate. It is uncertain if essential fatty acid deficiency will develop in the mother and fetus with this extremely low fat diet, or whether fibrates will cross the placenta and concentrate in the fetus.Case presentationA 23 year-old gravida 1 woman with primary lipoprotein lipase deficiency was seen at 7 weeks of gestation in the Lipid Clinic for management of severe hypertriglyceridemia that had worsened with pregnancy. While on her habitual fat intake of 10% of total calories, her pregnancy resulted in an exacerbation of the hypertriglyceridemia, which prompted further restriction of fat intake to < 2% of total calories, as well as administration of gemfibrozil at a lower than average dose. The level of gemfibrozil, as the active metabolite, in the venous and arterial fetal cord blood was within the expected therapeutic range for adults. The clinical signs and a biomarker of essential fatty acid deficiency, namely the ratio of 20:3 [n-9] to 20:4 [n-6] fatty acids, were closely monitored throughout her pregnancy. Despite her extremely low fat diet, the levels of essential fatty acids measured in the mother and in the fetal blood immediately postpartum were normal. Normal essential fatty acid levels may have been achieved by the topical application of sunflower oil.ConclusionsAn extremely low fat diet in combination with topical sunflower oil and gemfibrozil administration was safely implemented in pregnancy associated with the severe hypertriglyceridemia of lipoprotein lipase deficiency.

Stage of Change Movement across Three Health Behaviors: The Role of Self-Efficacy

In this study, we examined the influence of self-efficacy in predicting stage of change (SOC) movement, without intervention, over a 1-month period for smoking cessation, exercise adoption, and dietary fat reduction. The design of this study was longitudinal. Patients' stage of change and self-efficacy were assessed at baseline, and stage of change was reassessed at a 1-month follow-up. Patients were categorized as (1) Regressors (moved backward at least one stage), (2) Stables (no change), or (3) Progressors (moved forward at least one stage). Chi-square analyses were used to determine the ability of self-efficacy to predict stage movement at 1-month follow-up. The data were collected at a large, inner city, academic hospital in the southeastern United States. Patients were attending primary care clinics. Five hundred fifty-four low income, predominantly African-American, individuals attending primary care clinics were participants in the study. Previously validated scales of stage of change and self-efficacy from Prochaska's laboratory were used in this study. Results showed statistically significant differences between predicted and actual SOC movement for smoking cessation, exercise adoption, and dietary fat intake reduction. Baseline self-efficacy ratings were significantly related to stage progression, regression, and stability of stage of change for all three health behaviors. Thirty-seven percent of smokers who were predicted to progress on the basis of their self-efficacy scores progressed. For exercise adoption and dietary fat reduction, 50% and 44%, respectively, of individuals expected to progress at least one stage on the basis of self-efficacy scores progressed. Self-efficacy influences SOC movement for smoking cessation, dietary fat reduction, and exercise adoption.

Macronutrient intakes and food sources in Irish adults: findings of the North/South Ireland Food Consumption Survey.

To describe macronutrient intakes and food sources of the adult population in the Republic of Ireland and Northern Ireland and to assess adherence of this population to current dietary recommendations. A cross-sectional food consumption survey collected food intake data using a 7-day food diary. Northern Ireland and the Republic of Ireland between October 1997 and October 1999. One thousand three hundred and seventy-nine adults aged 18-64 years (662 males and 717 females). Mean daily energy intakes in men were 11 MJ per day, 15.5% was derived from protein, 34.8% from fat, 43.5% from carbohydrate and 5.9% from alcohol. Corresponding figures for women were 7.6 MJ per day, 15.6%, 35.6%, 45.1% and 3.5%. When alcohol energy was excluded the contribution of fat and carbohydrate to energy did not differ between men and women. When compared with existing dietary recommendations, 93% of men and 86% of women had protein intakes above the Population Reference Intake. Two approaches were used to assess adherence to the fat and carbohydrate dietary recommendations: (1) the proportion of individuals in the population attaining these dietary targets and (2) the proportion of the population that was included in a 'compliers' group which had a group mean equal to these dietary targets. Thirty-three per cent of men and 34% of women met the target of 35% of food energy from fat and 78% of men and 80% of women comprised the 'compliers' group having a group mean of 35% of food energy from fat. Twenty-three per cent of men and 27% of women met the target of 50% of food energy from carbohydrate and 56% of men and 62% of women made up the 'compliers' group. Meat and meat products were the main source of fat (23%) and protein (37%), and bread and rolls (25%) were the main source of carbohydrate. A reduction in dietary fat intake remains an important public health issue in the Republic of Ireland and Northern Ireland. An increase in carbohydrate intake and attention to the rise in alcohol intake is also warranted.

Reduction in fat intake is not associated with weight loss in most women after breast cancer diagnosis

A reduction in dietary fat intake has been suggested as a method to promote weight loss in women at risk for breast cancer recurrence. Weight change in response to diet intervention was examined in 1010 women who had completed treatment for Stage I, Stage II, or Stage IIIA (American Joint Committee on Cancer staging system) primary operable breast cancer during their first year of participation in a randomized, controlled, diet intervention trial to reduce risk of recurrence. Diet intervention was performed by telephone counseling and promoted a low fat diet that also was high in fiber, vegetables, and fruit. The comparison group was provided with general dietary guidelines to reduce disease risk. Multiple linear regression models were used to examine the relations among demographic and personal characteristics, changes in diet composition and exercise level, and change in body weight or body mass index. The average weight change in the 1-year period was 0.04 kg for the intervention group and 0.46 kg for the comparison group. For the total group, body weight was stable (+/- 5% baseline weight) for 743 women (74%), whereas 114 (11%) lost weight, and 153 (15%) gained weight. These distributions were similar in the two study groups inclusive of all study participants and for only those women with a baseline body mass index of > or = 25 kg/m2. Initial body mass index and changes in fiber and vegetable intakes, but not change in percent of energy obtained from fat, were associated independently with change in weight or body mass index. For most women at risk for breast cancer recurrence, diet intervention to promote a reduction in fat intake was not associated with significant weight loss. Testing the effect of a substantial change in diet composition on risk for breast cancer recurrence is unlikely to be confounded by weight loss in subjects who were the recipients of intensive intervention efforts.

Designing a Quality Assurance System for Dietary Data in a Multicenter Clinical Trial: Women's Intervention Nutrition Study

Reliable dietary intake data are essential for determining outcomes in nutrition-related clinical trials. Nevertheless, systems for quality assurance of dietary intake data are often slighted in the design of such trials and not incorporated or monitored as the trials continue. The Women's Intervention Nutrition Study (WINS), a multicenter clinical trial investigating the effect of reduction of dietary fat intake together with adjuvant systemic therapy on recurrence rates in and survival of postmenopausal women with early stage, surgically treated, breast cancer, has developed a quality assurance system to minimize errors and to produce data that are complete and reliable. The system involves development of standardized procedures for data collection, a quality control program to evaluate the data collected, and continual monitoring and reevaluation. The WINS system is offered as a model for studies collecting dietary intake data, no matter how simple or complex the trial design. J Am Diet Assoc. 2000; 100:1186-1190.

Nutrition Intervention Group Program based on Preaction-stage–oriented Change Processes of the Transtheoretical Model Promotes Long-term Reduction in Dietary Fat Intake

Objective To develop and evaluate the long-term effectiveness of an intervention program, based on preaction-stage–oriented change processes of the Transtheoretical Model of Behavior Change, that could be delivered in a group setting to help participants lower dietary fat intake. Design An enhanced version of the nonequivalent control group experimental design was used. Entire sections of an undergraduate introductory nutrition science course were assigned to an experimental, pretest/posttest control, or posttest-only control group. Daily fat intake and stage of change of the experimental and pretest/posttest control groups were determined at the pretest and posttest and 1-year later at a follow-up test. Every 1 to 2 weeks during the study, stage of change of the experimental group was assessed. Daily fat intake of the experimental group was assessed at study midpoint. Daily fat intake and stage of change of the posttest-only control group was determined at the posttest. Pretest results were used to place participants of the experimental and pretest/posttest control groups in either the preaction stage (ie, precontemplation, contemplation, or preparation) or the action/maintenance stage. Subjects/setting The sample consisted of 38, 30, and 42 undergraduate students who were assigned to the experimental, pretest/posttest control, and posttest-only control groups, respectively. Intervention The experimental group participated in a group-based, dietary fat intake intervention that included a series of 11 lessons taught over a 14-week period. Each lesson was based on 1 or 2 of the preaction-stage–oriented change processes of the Transtheoretical Model. Main outcome measures Data were evaluated to determine the effects of the intervention program on long-term dietary fat reduction and stage of change progression. Statistical analysis performed Analysis of variance, repeated-measures analysis of variance, and paired t tests. Results For pretest and posttest dietary fat intake scores, stage and time were significant, and there was a significant time-by-stage interaction. Time was significant for pretest and posttest stage scores. Subjects in the preaction-stage experimental group significantly increased their mean stage of change and reduced their fat intake between the pretest and posttest; these changes persisted for 1 year. Pretest/posttest control group participants who began in a preaction stage also significantly increased their mean stage and reduced fat intake by the posttest, but these changes did not endure until the follow-up test. Applications/conclusions This intervention program produced an enduring, significant reduction in mean dietary fat consumption and a significant progression in mean stage of change of subjects in the experimental group who were in the preaction stage. It may be appropriate to design group interventions to use preaction stage processes rather than the more traditionally used action and maintenance stages change processes. J Am Diet Assoc. 2000;100:335-342.

Centralized Retention Strategies in the Multi-Center Women's Intervention Nutrition Study (WINS)

High attrition rates in large-scale clinical trials can ultimately result in decreased statistical power. WINS is a randomized trial with a recruitment goal of 2,500 women, evaluating the influence of dietary fat intake reduction on breast cancer recurrence, conducted at 38 clinical sites. To date, WINS has enrolled 1735 participants, with a 7.7% “inactive” rate (56% low-fat intervention group, 44% control group). Reasons for attrition include: unable to contact/not interested (23.8%), other medical/family problems (16.4%), caring for sick relative (9.7%), cancer recurrence (8.9%) (participants with a recurrence are encouraged to remain in the trial), too busy (7.5%), and wanted to be in the intervention group (7.5%). In response to an identified need to implement behaviorally oriented retention strategies study-wide, local and centralized procedures were developed by the WINS Intervention Unit (IU). Working with all clinical sites, the IU facilitates ongoing communication and development of local action plans for retention problems. In addition, the IU identifies “inactive” participants refractory to local clinic strategies, collects background information on such participants from clinical site Nutritionists, and via telephone, implements retention strategies by a behaviorally trained Nutrition Intervention Coordinator (NIC). During this contact, the NIC discusses participant's concerns and attempts to negotiate a compromise resulting in study continuation, such as taking “time-off” from the study or participation in a modified capacity. Following recent implementation, approximately 2-4 participants/month have been identified as candidates for this intervention. Data collection procedures are in place to evaluate effectiveness. A centralized IU can be used to develop local retention action plans and deliver behaviorally oriented telephone interventions in a large-scale clinical trial. The effectiveness of this approach is currently under evaluation.

Decisional balance and stage of change in relation to weight loss, exercise and dietary fat reduction among Pacific Islands people

It has been postulated that changes in lifestyle follow five 'stages of change', which reflect a 'decisional balance' between the advantages and disadvantages of making such a change. We have assessed this model among Pacific Islands people in New Zealand. We questioned 105 Pacific Islands volunteers to identify their decisional balance for their reduction in dietary fat intake (DFI), weight control (WC) and the adoption of regular exercise habits (REH). Answers were used to develop a closed questionnaire, which was completed by a second group of 195 Pacific Islands volunteers. The major reported advantages were good health (45%) and increased physical attractiveness (41%) for WC; disease prevention (70%) for DFI; and increased fitness (71%) for REH. The major reported disadvantages were losing too much weight (40%) for WC; eating fatty foods was enjoyable (50%) for DFI; and the time required (47%) for REH. Major differences in responses were found by age, sex, Islands group and educational status. The derived decisional balance questions related to the stage of change with advantages outweighing disadvantages for those in the maintenance/action phases and the converse for those in the precontemplative phase. The use of this model will be helpful in evaluating long-term programs aimed at the primary prevention of non-insulin-dependent diabetes through lifestyle change.

Dietary control of exertional rhabdomyolysis in horses

To determine whether feeding a low-carbohydrate, high-fat diet would decrease severity of exercise-induced muscle injury in horses with exertional rhabdomyolysis.19 horses with a history of exertional rhabdomyolysis.Case series.Specimens of the semitendinosus or semimembranosus muscle were obtained for histologic examination, and serum creatine kinase (CK) and aspartate transaminase (AST) activities 4 hours after exercise were determined. Horses were then fed a low-carbohydrate, high-fat diet, and serum CK and AST activities 4 hours after exercise were reevaluated at approximately monthly intervals for 3 to 6 months.Serum CK and AST activities 4 hours after exercise were high before any change in diet. All 19 horses had evidence of chronic myopathic change and abnormal glycogen accumulation in muscle biopsy specimens; 11 horses also had evidence of complex polysaccharide accumulation. Adaptation to diet change required approximately 3 to 6 months. Sixteen horses did not have any episodes of exertional rhabdomyolysis after 3 to 6 months of diet change, and 3 horses had mild episodes of exertional rhabdomyolysis following either a reduction in dietary fat intake or restriction in exercise. Postexercise serum CK and AST activities 3 to 6 months after the change in diet were significantly less than initial values.Results indicated that exertional rhabdomyolysis may be a result of abnormal carbohydrate metabolism in some horses. Feeding a diet with low carbohydrate and high fat content may reduce severity of exercise-induced injury in some horses with exertional rhabdomyolysis.