Response

Extract

We agree with Dr. Hunter et al. that assessing the association between dietary fat intake and risk of cardiovascular disease is a complex issue. As we pointed out, earlier studies that used food-frequency questionnaires were unable to confirm the relationship between dietary fat intake and the risk of cardiovascular disease. Present food-frequency questionnaires do have increased precision but may not accurately capture the fat intake from fat-modified products. New studies (1,2) suggest that failure to measure fat intake from fat-modified foods may result in misclassification of energy and fat intake in epidemiologic studies.

Hunter et al. conclude that we (3) stated that the randomized trial component of the Women's Health Initiative will answer whether lower fat intake reduces breast cancer risk. In contrast, we concluded our review with support for the conduct of carefully controlled trials such as that of the Canadian Diet and Breast Cancer Prevention Study Group (4). We are also investigating the prevention of breast cancer recurrence in postmenopausal women in the Women's Intervention Nutrition Study (WINS) (5), a randomized trial of a diet consisting of 15% energy from fat in this population.