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Implementation of a 4-y, high-fiber, high-fruit-and-vegetable, low-fat dietary intervention: results of dietary changes in the Polyp Prevention Trial^1,2

¹ From the National Cancer Institute, Bethesda, MD; Westat, Rockville, MD; the Kaiser Foundation Research Institute, Oakland, CA; the University at Buffalo (SUNY), Buffalo, NY; the University of Arizona, Tucson; the Edward Hines, Jr Hospital, Veterans Administration Medical Center, Hines, IL; the Memorial Sloan Kettering Cancer Center, New York; the University of Pittsburgh; the University of Utah, Salt Lake City; Wake Forest University, Winston-Salem, NC; and the Walter Reed Army Medical Center, Washington, DC.

Background: The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial designed to determine the effects of a high-fiber (4.30 g/MJ), high-fruit-and-vegetable (0.84 servings/MJ), low-fat (20% of energy from fat) diet on the recurrence of adenomatous polyps in the large bowel.

Objective: Our goal was to determine whether the PPT intervention plan could effect change in 3 dietary goals and to examine the intervention's effect on the intake of other food groups and nutrients.

Design: Participants with large-bowel adenomatous polyps diagnosed in the past 6 mo were randomly assigned to either the intervention (n = 1037) or the control (n = 1042) group and remained in the trial for 4 y. Three dietary assessment instruments were used to measure dietary change: food-frequency questionnaires (in 100% of the sample), 4-d food records (in a 20% random cohort), and 24-h dietary recalls (in a 10% random sample).

Results: Intervention participants made and sustained significant changes in all PPT goals as measured by the dietary assessment instruments; the control participants' intakes remained essentially the same throughout the trial. The absolute differences between the intervention and control groups over the 4-y period were 9.7% of energy from fat (95% CI: 9.0%, 10.3%), 1.65 g dietary fiber/MJ (95% CI: 1.53, 1.74), and 0.27 servings of fruit and vegetables/MJ (95% CI: 0.25, 0.29). Intervention participants also reported significant changes in the intake of other nutrients and food groups. The intervention group also had significantly higher serum carotenoid concentrations and lower body weights than did the control group.

Conclusion: Motivated, free-living individuals, given appropriate support, can make and sustain major dietary changes over a 4-y period.

Key Words: Dietary intervention • nutrition intervention • dietary change • dietary fiber intake • dietary fat intake • fruit and vegetable intake • clinical trial • plasma cholesterol • serum carotenoids • body weight • Polyp Prevention Trial

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