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In the January 4, 1985, issue of Science, Gina Kolata covered the 47th consensus panel report from the National Institutes of Health (NIH), published some three weeks earlier. Since 1961, [...]

Background: Evidence from animal models suggests that fetal undernutrition can predispose to hypercholesterolemia and metabolic disorders directly by programming cholesterol metabolism and may indirectly influence lifestyle choices. We have shown that persons who were exposed to the Dutch famine in early gestation have a more atherogenic lipid profile. Objective: We now investigate whether the excess in hypercholesterolemia may be a result of a more atherogenic diet or a reduction in physical activity. Design: We measured lipid profiles, dietary intake, and physical activity in 730 men and women (aged 58 y) born in the Wilhelmina Gasthuis in Amsterdam, Netherlands, around the time of the Dutch famine, whose birth records have been kept. Results: No differences were observed in mean intake of total energy or percentage of protein, carbohydrate, and fat in the diet between the different exposure groups. However, persons exposed to famine in early gestation were twice as likely (odds ratio: 2.1; 95% CI: 1.2, 3.9) to consume a high-fat diet (defined as the highest quartile of percentage of fat in the diet: >39% of energy from fat). They also tended to be less physically active (45% did sports compared with 52% in the unexposed group), although this did not reach statistical significance. Conclusions: This is the first direct evidence in humans that prenatal nutrition may affect dietary preferences and may contribute to more atherogenic lipid profiles in later life.

A new study shows that it is possible to produce a butterfat that reduces high and low density lipoprotein cholesterol and could lower the risk of strokes and heart disease. [...]

I cannot turn on the TV without seeing an ad for a drug to reduce serum cholesterol in order to reduce the risk of having a heart attack caused by [...]

Many people think that a cholesterol reading of 200 is safe, but only a reading of 150 or below is in the safety area. However, a higher reading can be considered safe if the total-to-high-density lipoprotein is at a ratio below four. The use of exercise and a low-fat diet can help achieve this goal., I married a very smart man. But even smarties can be dumb when it comes to cholesterol numbers. For instance: What's your cholesterol? I asked my human e cyclopedia. It's [...]

Background. Animal experiments and epidemiological studies have suggested that coronary disease could be prevented, arrested, or even reversed by maintaining total serum cholesterol levels below 150 mg/dL (3.88 mmol/L). L). [...]

Objective: To assess the nutritional adequacy of low-fat, low-saturated fat, low-cholesterol-modified diets of children with hyperlipidemia. Design: Case comparison study. Setting: Tertiary care ambulatory pediatric atherosclerosis prevention center. Patients and Other Participants: White middleclass suburban children. Subjects were 54 consecutive children with hyperlipidemia (26 boys) with a mean ([+ or -]SD) age of 10.8[+ or -]3.4 years. Controls were 44 healthy children (19 boys) aged 10.8[+ or -]0.9 years recruited from a local elementary school. Intervention: The subjects received individual nutrition counseling on a National Cholesterol Education Program Step I Diet from a registered dietitian. Main Outcome Measure: The 3-day written food records were analyzed by a registered dietitian using the Minnesota Nutrient Data System. Outcome measures were intakes of energy, fat-soluble vitamins, and minerals as a percentage of the Recommended Dietary Allowance. The means between cases and controls were compared by Student's t test. Results: There was no significant difference in consumption of energy, minerals, or vitamins D and E between the groups. The control group's diet contained significantly greater amounts of fat, saturated fat, and cholesterol. The children with hyperlipidemia consumed significantly more vitamin A (P< .005). Conclusion: The nutrient quality of fat- and cholesterol-modified diets of children who have received nutritional counseling compares favorably with the nutrient quality of controls on an unrestricted diet. Therefore, pediatricians can prescribe with confidence a Step I Diet for children with hyperlipidemia and adolescents when nutritional counseling is available. (Arch Pediatr Adolesc Med. 1995;149:333-336), Low fat diets for children with high blood levels of fat and cholesterol may provide sufficient nutrition if children and their parents receive nutrition counseling. A study of 54 children with hyperlipidemia (high levels of fat in the blood) found that diets that were low in fat, cholesterol, and saturated fats, may have an equal energy value to unrestricted diets and equal or better nutritional value. Nutritional counseling may improve the energy and nutritional values of low fat diets by educating parents and children of the need for a well-balanced diet without excessive fat restrictions. Low fat, nutrient-dense foods, including low fat dairy foods, lean meats, and whole grains, may provide a nutritious modified diet.

The effects of stearic acid on metabolism must be evaluated for stearic acid as an isolated dietary constituent and for stearic acid as a component of a natural fat. Beef products are the most common source of dietary stearic acid in the United States. Two components of beef products, beef protein and beef fat, can potentially impart cholesterol-raising properties. Protein has minimal effects on cholesterol concentrations in humans, but studies suggest that beef fat raises serum cholesterol concentrations. Because beef fat is 19% not as stearic acid, the cholesterol-raising potential of beef is not as great as predicted by its total saturated fatty acid content. However, beef tallow is hypercholesterolemic compared with fats containing less cholesterol-raising saturated fatty acid. Therefore, curtailment of beef tallow in a cholesterol-lowering diet seems appropriate. Data suggest that lean beef is no more hypercholesterolemic than chicken or fish and, therefore, lean beef need not be eliminated from cholesterol-lowering diets.

Background: The efficacy of the step 1 diet in outpatient women with hypercholesterolemia has been debated. Methods: Forty-one normotriglyceridemic women whose low-density lipoprotein (LDL) cholesterol levels were 3.62 to 5.17 mmol/L (140 to 200 mg/dL) participated in a two-period outpatient diet counseling study that used a 1-month high-fat, high-saturated fatty acid period (Hi-Sat diet) and a 4-month low-fat, low-saturated fatty acid period (step 1 diet). All women were postmenopausal and were not taking hormone replacement therapy. Levels of lipids, lipoproteins, and plasma triglyceride fatty acids were measured five times during the last 2 weeks of each dietary period. Dietary intake was assessed by 7-day food records. Results: The mean reduction in total cholesterol level achieved by the step 1 diet was 0.36 mmol/L (14 mg/ dL). The reduction in total cholesterol level was seen in both LDL cholesterol levels (0. 28 mmol/L [11 mg/dL]; P

The effects of the three-carbon compound pyruvate on plasma lipid concentrations and body composition were evaluated in hyperlipidemic patients consuming a low-cholesterol (165-180 mg), low-fat (22-24% of energy; 18-20% of energy as saturated fatty acid) diet (0.091-0.099 MJ[multiplied by]kg body [wt.sup.-1][multiplied by][d.sup.-1]). After consuming the above diet for 4 wk, during which time plasma lipid concentrations decreased, 34 subjects were randomly assigned to receive either 22-44 g pyruvate (n = 17) or 18-35 g polyglucose (placebo, Polycose, n = 17), isoenergetically substituted for a portion of carbohydrate energy for 6 wk. Despite greater weight and fat losses with pyruvate (P < 0.05), plasma concentrations of cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride were not different between the two groups of subjects. We conclude that subsequent to diet-induced reduction in plasma lipid concentrations, pyruvate supplementation of a low-cholesterol, low-fat diet providing 6.7-7.6 MJ/d for 6 wk has no effect on plasma lipid concentrations but enhances body weight and fat losses.

Dietary adherence to four different fat-modified diets was examined in 160 subjects by determining the fatty acid composition of serum cholesterol esters (CEs) and erythrocyte (ER) and platelet (PT) membranes in addition to food records. Subjects were randomly assigned to one of the following diet groups: 1) high-sat--35/14:10:4 (% of energy from total/ saturated: monounsaturated: polyunsaturated fatty acids in the actual diet) 2) AHA (American Heart Association) type-32/ 10:8:8 3) monoene-enriched--34/11:11:5, or 4) low-fat--30/ 12:8:3 for 6 mo. Decreases in the proportions of palmitic acid in CEs were found in the AHA-type and monoene-enriched-diet groups. An increased proportion of linoleic acid in CEs was found in the AHA-type group. The differences in the proportions of palmitic acid in CEs and linoleic and palmitoleic acids in PTs were significant in the AHA-type and monoene-enriched-diet groups compared with the high-sat group. An increase in [alpha]-linolenic acid in CEs was an indicator of the use of low erucic acid rapeseed oil, which was the main source of monoenes in the monoene-enriched-diet group.

* Objective: Reducing serum cholesterol lowers the risk for ischemic heart disease, but its effects on other vascular diseases are unknown. Published trials were reviewed to determine the effect of cholesterol-lowering interventions on fatal and nonfatal stroke. * Design: Meta-analysis of randomized, controlled trials. * Data Identification: A literature search of English-language studies examining the effect of modified diets or medications on cardiovascular end points from 1965 to 1992 using MEDLINE and a review of references of five quantitative overviews of cholesterol reduction and coronary disease. * Data Analysis: Thirteen studies met three eligibility criteria: patients randomized to intervention or control; fatal or nonfatal stroke reported separately; and end points assessed without knowledge of treatment status. Heterogeneity among studies and overall effects of treatment on fatal and nonfatal stroke were estimated using the Mantel-Haenszel-Peto method to combine independent study results. The influence of various study designs and interventions was explored using subgroup comparisons. * Results: For fatal stroke, the overall odds ratio associated with cholesterol-lowering interventions in 13 trials was 1.32 (95% Cl, 0.94 to 1.86), and the odds ratio for the 10 single-intervention trials was 1.34 (Cl, 0.91 to 1.96). Among eight trials reporting nonfatal events, the summary odds ratio for nonfatal stroke for treated participants compared with controls was 0.88 (Cl, 0.70 to 1.11), and the odds ratio for total strokes was 0.98 (Cl, 0.80 to 1.19). Among three trials using clofibrate, treatment significantly increased the risk for fatal stroke (odds ratio, 2.64; Cl, 1.42 to 4.92) but not for nonfatal stroke (odds ratio, 0.87; Cl, 0.61 to 1.26). Regression analysis showed no statistical association between the magnitude of cholesterol reduction and the risk for fatal stroke. * Conclusions: Lowering serum cholesterol through modified diets or medications does not reduce stroke mortality or morbidity in middle-aged men. Clofibrate appears to increase the risk for fatal strokes, but the mechanism for this effect is unknown., Men who reduce their blood levels of cholesterol may not have a lower risk of a fatal stroke than those who do not. Blood levels of cholesterol can be reduced with drugs or by lowering dietary intake of high-cholesterol foods. A research study reviewed 13 articles in the medical literature that examined the association between cholesterol reduction and non-fatal and fatal strokes in men. A statistical analysis found no significant association between cholesterol reduction and a lower risk of a fatal stroke. A significant association was not found between cholesterol reduction and a lower risk of a non-fatal stroke. Treatment with the cholesterol-reducing drug clofibrate may increase the risk of a fatal stroke. An association has been found between increased blood levels of cholesterol and coronary heart disease.

Background. Dyslipidemia constitutes a serious health problem that should be diagnosed and treated by the family physician. Little is known about the efficacy of typical dietary therapy for patients with [...]

* Background.--Lack of response to a cholesterol-lowering diet can be caused by physiological nonresponsiveness, inadequate knowledge, or inability to change dietary habits (poor compliance). The purpose of this study was to evaluate the dietary compliance of hyperlipidemic individuals who received intensive initial dietary education and follow-up, and who showed an initial reduction of their plasma cholesterol levels. Methods.--One hundred five individuals with fasting cholesterol levels of 5.17 mmol/L (200 mg/dL) or greater received intensive education and follow-up on the American Heart Association Step I diet during an initial 12-week period. The participants provided 3-day dietary records every week, and fasting lipoprotein analysis was performed biweekly. Six months after termination of this period, the subjects were requested to return for a follow-up evaluation of their lipoprotein profile and dietary adherence. Results.--Seventy-three (70%) of the subjects returned for a follow-up evaluation of lipoprotein cholesterol levels. Of these, 42 (58%) had a 10% or greater average initial decrease in total cholesterol levels at weeks 3 and 4 ('base-line'), and they were considered to be 'high responders.' At the 6-month follow up, the average plasma cholesterol level in these responders remained 6.4% below that at entry level, but it had increased by 19% compared with baseline values (6.30 mmol/L [244 mg/dL] vs 5.43 mmol/L [210 mg(dL], respectively). Corresponding significant increases at 6 months were found in high-density lipoprotein cholesterol (8%), low-density lipoprotein cholesterol (16%), and very-low-density lipoprotein cholesterol (66%) levels. Analysis of dietary histories revealed that dietary cholesterol and percent calories from fat increased significantly, but remained within the recommended guidelines. However, the increase in percent calories from saturated fat (from 10.0% [+ or -] 0.5% to 14.4% [+ or -] 1.0% [mean [+ or -] SEM]) deviated markedly from these guidelines. Conclusions.--The results suggest the long-term compliance to the reduction of dietary saturated fat remains a problem, even in individuals who receive intensive initial training and show an early favorable response. Follow-up evaluation of hyperlipidemic patients who are receiving dietary therapy should take into account this behavioral pattern. it remains to be determined whether continuing supervision and better nutritional labeling will facilitate dietary compliance. (Arch Intern Med. 1992;152:1167-1174)

This study is a randomized, controlled, blinded, arteriographic trial to determine the effects of a low-cholesterol, low-fat, vegetarian diet, stress management and moderate aerobic exercise on geometric dimensions, shape and fluid dynamic characteristics of coronary artery stenoses in humans. Complex changes of different primary stenosis dimensions in opposite directions or to different degrees cause stenosis shape change with profound effects on fluid dynamic severity, not accounted for by simple percent narrowing. Accordingly, all stenosis dimensions were analyzed, including proximal, minimal, distal diameter, integrated length, exit angles and exit effects, determining stenosis shape and a single integrated measure of stenosis severity, stenosis flow reserve reflecting functional severity. In the control group, complex shape change and a stenosis -- molding characteristic of statistically significant progressing severity occurred with worsening of stenosis flow reserve. In the treated group, complex shape change and stenosis molding characteristic of significant regressing severity was observed with improved stenosis flow reserve, thereby documenting the multidimensional characteristics of regressing coronary artery disease in humans.

It has been widely reported that diets high in saturated fat and cholesterol increase the risk of developing heart disease, and that lowering blood cholesterol and fat levels can reduce the risk of heart disease. The first step in treating patients with hyperlipidemia (high blood levels of fats) involves a modified diet that restricts the intake of saturated fat and cholesterol. If this form of diet therapy fails, special drugs, lipid-lowering agents, may be required to reduce blood cholesterol levels. Studies have been performed to evaluate the effectiveness of modified diets used in combination with lipid-lowering drugs in treating patients with hyperlipidemia. However, none of these studies has examined the nutritional adequacy of this form of treatment. This is important because the modified diets restrict the consumption of red meat, which contains vitamins B-6, B-12, iron, and zinc. Therefore, a study was performed to evaluate the nutritional status of 272 men and women with hyperlipidemia who had been following a modified diet for one year and were receiving pravastatin (a drug that inhibits synthesis of cholesterol in the liver). When the subjects' daily records of dietary intake were evaluated for nutrient content, it was found that greater than 40 percent of the women were getting less than two thirds of the recommended dietary allowance (RDA) of vitamins B-6 and D, folic acid, zinc and calcium. The men had low dietary intakes of folic acid and zinc. It is concluded that patients with hyperlipidemia will comply with modified diets, even while they are taking lipid-lowering drugs, but that special attention should be paid to ensure proper daily intake of vitamins and minerals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Heart disease is still the nation's biggest killer. In an effort to reduce the toll of heart disease, various medical organizations have begun issuing guidelines that they hope will reduce the risk of cardiovascular deaths. One such suggestion is that the American public should adhere to a diet that is low in saturated fats and cholesterol. Some studies show that a low-fat diet can decrease the chance of heart disease. Over 800 men were recruited and monitored for both their dietary intake and their degree of coronary artery disease. Those members of the group who were between 45 and 55 years old and who followed a low-fat diet were found to have a lower rate of heart disease than those with a higher fat content to their diet. Those patients who were 55 and older experienced little effect from their diets on their rate of heart disease progression. Thus, recommending a low-fat, low-cholesterol diet might decrease the chance that the patient in question will develop coronary heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Using a 1-page bar-coded food frequency questionnaire, the food habits of 996 adults who participated in diet screening at the annual meetings of the American Heart Association (1989) and the American College of Cardiology (1990) were analyzed for sex, age and regional differences. Estimated nutrient intakes were also compared with those from the Department of Agriculture's 1985 and 1986 Continuing Survey of Food Intake of Individuals. The average diet reported in this study satisfied National Cholesterol Education Program guidelines for cholesterol intake, but was higher than that recommended for total and saturated fats. In addition, dietary fat intake was influenced by sex, age and geographic region. Reduction in total and saturated fat intake was confined to men >35 years of age; intake of these nutrients was highest among young, Mid-western women. These results suggest the need for diet intervention programs, targeted specifically to young adults with additional consideration given to regional variation. Repeated surveys of cardiac care givers might be used as an early indicator of the nationwide effectiveness of dietary intervention programs. (Am J Cardiol 1991;67:1090-1096), The National Cholesterol Education Program (NCEP) recommends cholesterol screening and a low-fat, low-cholesterol diet for the one in four adults whose low-density lipoprotein cholesterol is over 130 milligrams per deciliter. Studies have reported that Americans have decreased their dietary consumption of fats and cholesterol over the past several years, and that those of higher socioeconomic status are more likely to follow the NCEP guidelines. The attendees at the 1989 American Heart Association (AHA) and 1990 American College of Cardiology (ACC) annual meetings were generally of high socioeconomic status, and represent all geographic areas of the United States. They are also highly educated in heart disease and are familiar with the NCEP dietary recommendations. The food habits of 996 individuals who participated in diet screening at the two meetings were analyzed. The average diets of these people met NCEP guidelines for cholesterol intake, but they were higher in total and saturated fats than the NCEP recommends. As a group, they ate less beef, pork, ham and eggs than the average American, and consumed less alcohol. Limiting alcohol consumption has numerous benefits, including reducing high blood pressure and triglyceride (fat) levels in the blood. Attendees at these meetings already had an interest in cardiology, and greater knowledge than the average person. This may have led to higher receptivity to dietary advice. However, only those over 35 years reduced their intakes of total and saturated fat, even though cardiac risk factor intervention is most cost-effective when begun at an early age. Dietary intervention programs should probably be targeted to young adults. Geographic and sex differences emerged, with the highest fat consumption among young Midwestern women. These factors must be considered when intervention programs are planned. (Consumer Summary produced by Reliance Medical Information, Inc.)

Introduction Coronary heart disease represents an important health problem in most industrialised countries. There is strong evidence that lowering serum cholesterol concentration will reduce the incidence of the disease. [1-4] [...]

Although elevated serum cholesterol has been associated with increased risk of heart disease in numerous studies, the effects of modified dietary habits on cholesterol levels seem to be modest and variable. Sixty-six individuals were identified with high serum cholesterol, high low-density lipoprotein cholesterol, and low general fitness. These subjects were randomly assigned to receive either dietary counselling or dietary counselling in combination with an exercise program. A total of 51 subjects completed the program, 27 in the diet-only group and 24 in the diet and exercise group. Both groups experienced a reduction in total cholesterol, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol. Although the reductions were greater in the diet and exercise group, the differences between the two groups were not statistically significant. It is worthy of note that the HDL cholesterol decreased in both groups; the proportional reduction in HDL cholesterol was greater than that for LDL cholesterol. An increase in HDL cholesterol is thought to be desirable, and the reason for its reduction among the subjects in the present study is not known. However, previous studies have suggested that moderate exercise is not sufficient to elevate HDL cholesterol, and that more vigorous exercise is necessary. Since previous studies on the effects of diet and exercise on serum cholesterol have been conducted on subjects with normal or borderline cholesterol levels, the effects of diet and exercise on patients with high serum cholesterol clearly require further research. (Consumer Summary produced by Reliance Medical Information, Inc.)

NOW THAT YOU'VE GOT THE LAWS DOWN, PUT THEM INTO PRACTICE FOR SIX WEEKS USING A SAMPLE SEVEN-DAY FAT-BURNING MEAL PLAN. HERE ARE SOME THINGS TO KEEP IN MIND: * [...]

Frequently, patients are confused about what is included in a low-cholesterol diet. I sum up the diet in a single sentence that is hard to forget: "Nowhere on God's green [...]