Shaw, C., Mortimer, P., & Judd, P.A. (2007). Randomized controlled trial comparing a low-fat diet with a weight-reduction diet in breast cancer-related lymphedema. Cancer, 109(10), 1949–1956.

To evaluate whether using dietary interventions could be beneficial in the treament of arm lymphedema in patients who have breast cancer-related lymphedema

• The study sample (N =64) was comprised of female patients.
• Patients were stratified by volume and treatment and then randomized to one of three groups.
  • Weight reduction with decreased calories to 1,000–1,200 a day
  • Low-fat diet without change in calories, reducing dietary fat to 20% of total calories
  • Control group without change from intake
• Fifty-one patients completed the study.

The study used a randomized controlled trial design with two interventions and one control group.

• The volume measurements were performed by lymphedema practitioners who were blinded to the intervention using a Perometer and a volume equation using circumference.
• Arm circumference was measured every 4 cm.
• Height and weight were measured.
• Skin fold thickness was measured at four sites.

Results showed significant reduction in body weight (p = 0.006), body mass index (p = 0.008), and skin fold thickness measured at four sites (p = 0.044) in the weight-reduction and low-fat groups but not in the control group. There was a reduction in excessive arm volume over the 24 weeks but no significant difference between groups. There was a significant correlation between weight loss and a reduction in excess am volume irrespective of the dietary group (p < 0.002). Weight loss for the control, weight-reduction, and low-fat groups were 60%, 95%, and 76%, respectively. Weight reduction appears to be an effective means of assisting in the reduction of arm volume during the treatment of the lymphedema arm.

A good study that identifies an important risk factor and intervention.

• The study was ambitious and could have benefited from a simple weight-controlled study.
• Patients used compression sleeves and bandages during the intervention; nevertheless, the patients were distributed throughout the groups.
• Patients had poor adherence to diets.
• Some patients who were instructed not to lose weight did.
• The calorie intake of 1,000–1,200 per day is low for anyone.