In Reply Dr Kerley raises 4 concerns with the design and conduct of the MEAL trial: (1) evidence of dietary changes in the control group; (2) a potential placebo effect in the control group; (3) an inability to achieve predefined dietary targets in the intervention group; and (4) a failure of the intervention to incorporate fat intake. We believe these issues do not change the validity of our conclusions.
First, while we observed small changes from baseline in some dietary components in the control group, most were small and insignificant compared with the intervention group and did not last beyond 12 months. Moreover, at least 1 change was counterproductive: after 24 months, control participants were eating fewer tomatoes compared with at baseline.1
Parsons JK, Pierce JP, Marshall JR. Vegetable Consumption and Progression of Prostate Cancer—Reply. JAMA. 2020;323(24):2530. doi:10.1001/jama.2020.6732
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