{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:55:08Z","timestamp":1781067308471,"version":"3.54.1"},"reference-count":25,"publisher":"American Diabetes Association","issue":"4","license":[{"start":{"date-parts":[[2018,3,20]],"date-time":"2018-03-20T00:00:00Z","timestamp":1521504000000},"content-version":"vor","delay-in-days":83,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["HHSN268201600018C"],"award-info":[{"award-number":["HHSN268201600018C"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["HHSN268201600001C"],"award-info":[{"award-number":["HHSN268201600001C"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["HHSN268201600002C"],"award-info":[{"award-number":["HHSN268201600002C"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["HHSN268201600003C"],"award-info":[{"award-number":["HHSN268201600003C"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["HHSN268201600004C"],"award-info":[{"award-number":["HHSN268201600004C"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P01-CA-53996"],"award-info":[{"award-number":["P01-CA-53996"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01-CA-210921"],"award-info":[{"award-number":["R01-CA-210921"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Science","doi-asserted-by":"crossref","award":["UL1-TR001409"],"award-info":[{"award-number":["UL1-TR001409"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,4,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>We performed a secondary analysis to evaluate the effect of the Women\u2019s Health Initiative dietary intervention on incident diabetes and diabetes treatment in postmenopausal women.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>A total of 48,835 women were randomized to a comparison group or an intervention group that underwent a behavioral\/nutritional modification program to decrease fat and increase vegetable, fruit, and grain intake for an average of 8.1 years. Ninety-three percent of participants completed the intervention, and 71% participated in active follow-up through 30 September 2015 (median 17.3 years). We measured time to development of treated diabetes and progression from oral antihyperglycemic agents to insulin. Serum glucose and insulin were measured in a subsample of women (N = 2,324) at baseline and years 1, 3, and 6.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>During the trial, intervention group women had lower rates of initiation of insulin therapy (hazard ratio [HR] 0.74 [95% CI 0.59, 0.94]; P = 0.01). Moreover, women with baseline waist circumference \u226588 cm (P interaction = 0.01) and worse metabolic syndrome scores (P interaction = 0.02) had the greatest reduction in risk of initiating insulin therapy. The decreased risk from the intervention was present during the cumulative follow-up (HR 0.88 [95% CI 0.78, 0.99]; P = 0.04). In participants with measured biomarkers (5.8% subsample) who had baseline glucose &amp;lt;100 mg\/dL, the intervention reduced the risk of developing glucose \u2265100 mg\/dL by 25% (odds ratio 0.75 [95% CI 0.61, 0.93]; P = 0.008). Adjustment for weight change did not alter the results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>In this secondary analysis, a dietary intervention in postmenopausal women aimed at reducing fat and increasing intake of vegetables, fruits, and grains did not increase risk of diabetes and may have slowed progression.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc17-0534","type":"journal-article","created":{"date-parts":[[2017,12,28]],"date-time":"2017-12-28T01:10:32Z","timestamp":1514423432000},"page":"680-687","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":37,"title":["A Low-Fat Dietary Pattern and Diabetes: A Secondary Analysis From the Women\u2019s Health Initiative Dietary Modification Trial"],"prefix":"10.2337","volume":"41","clinical-trial-number":[{"clinical-trial-number":"nct00000611","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4216-7859","authenticated-orcid":false,"given":"Barbara V.","family":"Howard","sequence":"first","affiliation":[{"name":"MedStar Health Research Institute, Hyattsville, MD"},{"name":"Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron K.","family":"Aragaki","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley F.","family":"Tinker","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Allison","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie D.","family":"Hingle","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen C.","family":"Johnson","sequence":"additional","affiliation":[{"name":"University of Tennessee Health Science Center, Memphis, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoAnn E.","family":"Manson","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aladdin H.","family":"Shadyab","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Shikany","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6615-0779","authenticated-orcid":false,"given":"Linda G.","family":"Snetselaar","sequence":"additional","affiliation":[{"name":"University of Iowa, Iowa City, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia A.","family":"Thomson","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oleg","family":"Zaslavsky","sequence":"additional","affiliation":[{"name":"University of Washington, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross L.","family":"Prentice","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2017,12,27]]},"reference":[{"key":"2022031301484221500_B1","first-page":"1033","article-title":"Economic costs of diabetes in the U.S. in 2012","volume-title":"Diabetes Care","author":"American Diabetes Association","year":"2013"},{"key":"2022031301484221500_B2","unstructured":"International Diabetes Federation. IDF Diabetes Atlas, 8th ed [Internet], 2013. Available from http:\/\/www.idf.org\/diabetesatlas. Accessed 5 February 2018"},{"key":"2022031301484221500_B3","unstructured":"Centers for Disease Control and Prevention. National Diabetes Statistics Report [Internet], 2017. Available from https:\/\/www.cdc.gov\/diabetes\/data\/statistics\/statistics-report.html. Accessed 5 February 2018"},{"key":"2022031301484221500_B4","unstructured":"World Health Organization. Diabetes [Internet]. Available from http:\/\/www.who.int\/diabetes\/en\/. 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