The Women’s Health Initiative Randomized Controlled Dietary Modification Trial (WHIRCDMT) was designed to test whether the US Department of Agriculture’s 1977 Dietary Guidelines for Americans protects against coronary heart disease (CHD) and other chronic diseases. The only significant finding in the original 2006 WHIRCDMT publication was that postmenopausal women with CHD randomised to a low-fat ‘heart-healthy’ diet in 1993 were at 26% greater risk of developing additional CHD events compared with women with CHD eating the control diet. A 2017 WHIRCDMT publication includes data for an additional 5 years of follow-up. It finds that CHD risk in this subgroup of postmenopausal women had increased further to 47%–61%. The authors present three post-hoc rationalisations to explain why this finding is ‘inadmissible’: (1) only women in this subgroup were less likely to adhere to the prescribed dietary intervention; (2) their failure to follow the intervention diet increased their CHD risk; and (3) only these women were more likely to not have received cholesterol-lowering drugs. These rationalisations appear spurious. Rather these findings are better explained as a direct consequence of postmenopausal women with features of insulin resistance (IR) eating a low-fat high-carbohydrate diet for 13 years. All the worst clinical features of IR, including type 2 diabetes mellitus (T2DM) in some, can be ‘reversed’ by the prescription of a high-fat low-carbohydrate diet. The Women’s Health Study has recently reported that T2DM (10.71-fold increased risk) and other markers of IR including metabolic syndrome (6.09-fold increased risk) were the most powerful predictors of future CHD development in women; blood low-density lipoprotein-cholesterol concentration was a poor predictor (1.38-fold increased risk). These studies challenge the prescription of the low-fat high-carbohydrate heart-healthy diet, at least in postmenopausal women with IR, especially T2DM. According to the medical principle of ‘first do no harm’, this practice is now shown to be not evidence-based, making it scientifically unjustifiable, perhaps unethical. The publication makes use of data already published in the scientific literature.

中文翻译：

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在低脂饮食试验中隐藏不健康的心脏结果：妇女健康倡议随机对照饮食调整试验发现，患有冠心病的绝经后妇女如果食用低脂“心脏健康”食品，出现不良结果的风险会增加饮食


妇女健康倡议随机对照膳食调整试验 (WHIRCDMT) 旨在测试美国农业部 1977 年美国人膳食指南是否可以预防冠心病 (CHD) 和其他慢性疾病。 2006 年 WHIRCDMT 原始出版物中唯一重要的发现是，1993 年随机接受低脂“心脏健康”饮食的绝经后患有先天性心脏病的女性，与食用对照饮食的患有先天性心脏病的女性相比，发生额外先天性心脏病的风险增加了 26% 。 2017 年 WHIRCDMT 出版物包含额外 5 年随访的数据。研究发现，绝经后女性亚组的冠心病风险进一步增加至 47%–61%。作者提出了三个事后合理化解释为什么这一发现“不可接受”：（1）只有该亚组中的女性不太可能遵守规定的饮食干预； （2）他们不遵循干预饮食会增加他们的冠心病风险； (3) 只有这些女性更有可能没有接受降胆固醇药物。这些合理化似乎是虚假的。相反，这些发现可以更好地解释为具有胰岛素抵抗 (IR) 特征的绝经后女性连续 13 年低脂高碳水化合物饮食的直接后果。 IR 的所有最严重的临床特征，包括某些人的 2 型糖尿病 (T2DM)，都可以通过高脂肪低碳水化合物饮食的处方来“逆转”。女性健康研究最近报告称，T2DM（风险增加 10.71 倍）和其他 IR 标志物，包括代谢综合征（风险增加 6.09 倍）是女性未来患 CHD 的最有力预测因素；血液低密度脂蛋白胆固醇浓度是一个较差的预测指标（1.风险增加 38 倍）。这些研究对低脂高碳水化合物有益心脏健康的饮食处方提出了挑战，至少对于患有 IR（尤其是 T2DM）的绝经后女性来说是这样。根据“首先不造成伤害”的医学原则，这种做法现在被证明是没有证据基础的，使其在科学上不合理，甚至可能不道德。该出版物利用了科学文献中已发表的数据。