For example, in the WHI Randomized Controlled Dietary Modification Trial, over a mean of 8.1 years, the dietary intervention reduced total fat intake and increased intakes of vegetables, fruits, and grains but did not significantly reduce the risk of coronary heart disease, stroke, or cardiovascular death in postmenopausal women and achieved only modest effects on cardiovascular risk factors.358 In addition, a 2-year behavior- ally based physical activity and diet program implemented to reduce obesity in a primary care setting showed a significant reduction in waist circumference at 6 and 12 months, but the reduction in waist circumference was sustained in men but not On the other hand, a recent primary Table 10. Relationship Between Elevated BMI and Stroke HR (95% CI) First Author Study Site n Follow-up, y Study Type End Point BMI, kg/m2 Women Men China 154736 Mean: 8.3 Prospective cohort Clinically defined total stroke* Finland 49996 Mean: 19.5 Prospective cohort Clinically defined total stroke Germany 1137 1 Case-control Clinically defined total stroke, TIA Japan 71722 Median: 7.9 Prospective cohort Clinically defined total stroke USA 39053 Mean: 10 Prospective cohort Clinically defined total stroke NA cohort Clinically defined total stroke USA 13549 Median: 16.9 Prospective cohort Clinically defined ischemic stroke# China 67083 Mean: 7.3 Prospective cohort Clinically defined total stroke** NA Sweden 33578 Mean: 11 Prospective cohort Clinically defined total stroke NA cohort Clinically defined total stroke NA cohort Clinically defined total stroke BMI indicates body mass index; CI, confidence interval; HR, hazard ratio; NA, not available; and TIA, transient ischemic attack. *Adjusted for age, smoking, alcohol consumption, physical inactivity, education, residence in northern China, and residence in urban area. Adjusted for age, study year, smoking, physical activity, educational level, family history of stroke, alcohol consumption, systolic blood pressure, total cholesterol level, and history of diabetes mellitus. 