Chlebowski R T, Blackburn G L, Buzzard I M, Rose D P, Martino S, Khandekar J D, York R M, Jeffery R W, Elashoff R M, Wynder E L
Harbor-University of California, Los Angeles Medical Center, Torrance 90509.
J Clin Oncol. 1993 Nov;11(11):2072-80. doi: 10.1200/JCO.1993.11.11.2072.
To evaluate the feasibility of integrating a program based on dietary fat intake reduction into adjuvant treatment strategies for postmenopausal women receiving therapy for early breast cancer.
Two hundred ninety postmenopausal women with localized (stage I to IIIa) breast cancer receiving conventional systemic therapy provided informed consent and were randomized in a multicenter trial to either a dietary intervention group receiving a program of individualized instruction for reducing total fat intake or a dietary control group with minimal dietary counseling.
Significantly reduced (P < .001) fat intake (in terms of percent calories derived from fat) was observed in the intervention group versus the control group at 3 months (20.3% +/- 2.4% v 31.5% +/- 2.6%, mean +/- SD, respectively) and maintained throughout 24 months of observation. The 50% reduction in daily fat-gram intake (from 66 +/- 23 to 33 +/- 14 g, P < .001) seen at 6 months was associated with reduced saturated fat, monounsaturated fat, polyunsaturated fat, and linoleic acid (P < .001). Significantly lower body weight was also seen in intervention compared with control patients at all observation periods, resulting in a 3.3-kg weight difference 18 months after randomization (P < .001).
Substantial and sustained dietary fat reduction with associated weight change can be achieved at relatively low cost within the context of conventional multimodality clinical management of postmenopausal women with localized breast cancer. This result supports the feasibility of conducting a full-scale evaluation of the influence of dietary fat intake reduction on the clinical outcome of breast cancer patients.
评估将基于减少膳食脂肪摄入的方案纳入接受早期乳腺癌治疗的绝经后妇女辅助治疗策略的可行性。
290名接受传统全身治疗的绝经后局部（I至IIIa期）乳腺癌患者提供了知情同意书，并在一项多中心试验中被随机分为两组，一组为饮食干预组，接受关于减少总脂肪摄入的个体化指导方案；另一组为饮食对照组，仅接受最少的饮食咨询。
与对照组相比，干预组在3个月时脂肪摄入量（以脂肪提供的卡路里百分比计）显著降低（P <.001）（分别为20.3%±2.4%和31.5%±2.6%，均值±标准差），并在整个24个月的观察期内保持。6个月时每日脂肪克摄入量减少50%（从66±23克降至33±14克，P <.001），同时饱和脂肪、单不饱和脂肪、多不饱和脂肪和亚油酸均减少（P <.001）。在所有观察期内，干预组患者的体重也显著低于对照组，随机分组18个月后体重相差3.3千克（P <.001）。
在绝经后局部乳腺癌患者的传统多模式临床管理背景下，以相对较低的成本可以实现大量且持续的膳食脂肪减少以及相关的体重变化。这一结果支持了对减少膳食脂肪摄入对乳腺癌患者临床结局影响进行全面评估的可行性。
