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In Reply: Dr Mozaffarian raises 2 important issues. The first is whether changes in the dietary intake other than fat might have had counterbalancing effects on outcomes. In this article, we focused on the decreases in saturated and trans fatty acids, which corresponded to changes in low-density lipoprotein-cholesterol levels and changes in coronary heart disease outcomes. No comparable relationships with either low-density lipoprotein-cholesterol or coronary heart disease were observed in our analyses of monounsaturated fatty acid intake or in nut consumption. We are currently reanalyzing our food records to compute glycemic index and to more precisely define types of carbohydrates and grains; we plan to present these analyses in future publications. As Mozaffarian points out, post hoc analyses are confounded by adherence and other immeasurable factors, just as are the observational studies that led to the hypotheses that nut and monounsaturated fatty acid intake are related to cardiovascular disease.

The . . . [Full Text of this Article]

Barbara V. Howard, PhD
barbara.v.howard@medstar.net
MedStar Research Institute
Washington, DC

Garnet L. Anderson, PhD
Fred Hutchinson Cancer Institute
Seattle, Wash

Bette Caan, DrPH
Kaiser Permanente
Portland, Ore

Judith Hsia, MD
George Washington University
Washington, DC

Karen Johnson, MD
University of Tennessee
Memphis

Marian Limacher, MD
University of Florida
Gainesville

JoAnn E. Manson, MD
Harvard Medical School
Boston, Mass

Ross L. Prentice, PhD
Fred Hutchinson Cancer Institute
Seattle, Wash

Marcia L. Stefanick, PhD
Stanford Prevention Research Center
Stanford, Calif

Sylvia Wassertheil-Smoller, PhD
Albert Einstein College of Medicine
Bronx, NY

Linda Van Horn, PhD
Northwestern University
Chicago/Evanston, Ill

for the Writing Groups for the WHI Investigators

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