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To the Editor: In the report of the Women's Health Initiative (WHI) Dietary Modification Trial by Dr Howard and colleagues,¹ reduced consumption of total fat and increased consumption of fruits, vegetables, and grains did not significantly affect the incidence of coronary heart disease or stroke among postmenopausal women during 8.1 years of follow-up. The authors' primary explanation for the negative results was that the magnitude of dietary changes may have been insufficient to significantly alter risk.

A second plausible explanation is that the dietary intervention may have failed to influence risk because it balanced beneficial effects of some dietary changes with harmful effects of other changes. Modest benefits from small increases in fruit and vegetable intake (+1.1 servings/d) and whole grain intake (+0.2 servings/d) and decreases in trans fatty acid intake (–0.6% of energy) may have been counterbalanced by modest harms from small decreases in nut consumption (–0.8 servings/wk) and . . . [Full Text of this Article]

Dariush Mozaffarian, MD, MPH
dmozaffa@hsph.harvard.edu
Department of Medicine
Brigham and Women's Hospital
Boston, Mass

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