WHEL Study
(Women’s Healthy Eating & Living Study)Breast Cancer Recurrence and Survival
The WHEL Study was designed to address the question of whether a diet very high in vegetables, fruits, fiber, and low in fat could reduce breast cancer recurrence. In addition, the data collected on more than 3000 breast cancer survivors over an average of 7 years has allowed us to look at how several other factors may be related to breast cancer survival, including physical activity, blood carotenoids, and hot flashes. Published findings include the following:
- 5-7 servings/day of vegetables and fruits plus 30 minutes/day moderate exercise reduced mortality by 50%. More information here.
- Eating more than 7 servings/day of vegetables and fruits did not reduce recurrence or mortality. View the News Release and the Video.
- Women with higher serum carotenoids (indicating more colorful vegetables/fruits) had lower recurrence rates. More information here.
For more information on WHEL publications to date, click here.
Dietary Change/Telephone Counseling
Changing a health-related behavior can be a challenge. To help women in the WHEL intervention group adopt a diet very high in vegetables, fruits, and fiber and low in fat, the WHEL Study used an innovative telephone counseling program, supplemented by newsletters and cooking classes. The dietary changes achieved and maintained were some of the biggest differences in dietary pattern ever reported in a large randomized clinical trial, providing further evidence of the effectiveness of telephone counseling in helping people to change behaviors. More information here.
Dietary Intake
Over the course of the WHEL Study, we collected detailed information on what participants were eating. Dietary recalls collected over the telephone conducted at regular intervals were the main method used to gather dietary intake data. This data has allowed us to characterize the diets of breast cancer survivors, and examine associations between dietary intake and other variables. More information here.
Dietary Intake Biomarkers
WHEL Study participants gave blood samples throughout the study. To date, the main analyses performed on these samples have been related to carotenoids. Carotenoids are compounds that play a large role in the colorful appearance of many plants, and research suggests that consuming carotenoid-containing foods may decrease disease risk. WHEL Study participants who consumed more vegetables and fruits had greater blood concentration of carotenoids, which provides an objective measure to confirm the self-reported dietary intake assessed by 24-hour recall. We also measured and report on plasma triacylglycerol, high-density lipoprotein cholesterol, reproductive steroid hormones, homocysteine, Insulin-like growth factor I, insulin-like growth factor I binding protein 1, insulin, glucose, and leptin. More information here.
Dietary Measurement Methodology
One of the most challenging aspects of dietary intervention studies is getting an accurate measure of a participant’s dietary intake. The WHEL Study used three methods to assess dietary intake, providing an excellent opportunity to examine methodological issues related to the different methods. Two methods were self-report measures: one was repeated 24-hour recalls which obtained intake within a 3-week period (primary measure), and the other used a food frequency questionnaire to obtain usual intake during the prior 3-month period. The third method was a biochemical validation (plasma carotenoid concentrations). More information here.
Dietary Supplement Use
The large and ever-growing number of dietary supplements available makes it difficult to accurately assess what people are consuming. Because dietary supplement use may influence overall nutritional status, or increase risk of excess intakes of nutrients, details about supplement use was an important component of the WHEL Study. To address this problem, we developed a comprehensive database of dietary supplements. Generally, the use of dietary supplements by various populations has not been well described. These WHEL Study publications were among the first to depict supplement use in breast cancer survivors. More information here.
Physical Activity
Many studies have shown that physical activity after a diagnosis of breast cancer is associated with a better quality of life, and new research suggests that being physically active might extend survival in women with breast cancer. Determining the best way to accurately assess physical activity levels in a large sample of women is a challenge for researchers, and few studies have assessed physical activity level after a diagnosis of breast cancer. The WHEL Study collected information on physical activity in all participants, and a sub-sample of WHEL women participated in a study to help determine the accuracy of physical activity measures. Information published will help new studies investigating the relationship between physical activity and breast cancer survival. More information here.
Quality of Life and Psychosocial
Many researchers believe that measures of a cancer survivor’s Quality of life are important to consider as a supplement to objective clinical or biological measures of disease. The increasing use of these measures highlights a growing appreciation of the importance of how patients feel in addition to the traditional focus on disease outcomes. Psychosocial functioning is another critical aspect of a breast cancer survivor’s health that deserves more research. The WHEL Study collected information on quality of life and psychosocial functioning, and published several papers related to this area of research. More information here.
Weight Management
Weight gain has been reported in the majority of women undergoing adjuvant therapy for breast cancer. Multiple reasons for marked post-diagnosis weight gain have been suggested including receiving chemotherapy, being or becoming postmenopausal after diagnosis, decreased physical activity and increased total caloric intake. Weight gain following breast cancer diagnosis appears to be associated with loss of lean muscle mass. Studying factors related to weight gain in breast cancer survivors is an important area of research, as obesity has generally been associated with a poorer prognosis. The WHEL Study provided a good opportunity to investigate factors related to weight gain in breast cancer survivors. More information here.
Other
The WHEL Study has also published papers relating to cost, statistical issues, and family history. More information here.
