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The ability of a low-fat, low-cholesterol diet to improve the risk-factor profiles of moderately hypercholesterolemic, premenopausal women was evaluated. Nineteen women were fed a typical American diet for 1 mo, after which a low-fat diet consisting of 2 1 % of total energy (en%) as fat, 59 en% carbohydrates, 19 en% protein, and 96 mg cholesterol/d (P:S 1.8) was given. After 5 months, total and low-density lipoprotein (LDL) cholesterol was decreased by 7% and 11%, respectively, and total triglycerides increased by [nearly equal to]30%. High-density-lipoprotein (HDL) cholesterol was decreased by 12% at month 2 and 5% at month 5 (P < 0.05). Although HD[L.sub.2] cholesterol decreased progressively throughout the diet period to -35% by month 5, HD[L.sub.3] cholesterol, which decreased to 5% at month 1, increased to +7% by month 5. Of the plasma apolipoproteins only apo A-II was altered (+ 15%) by the diet. Body mass index correlated to baseline values and affected response to diet; only the leanest women had significant decreases in total, LDL, and HD[L.sub.2] cholesterol in response to the low-fat diet.

In vitro studies suggest that insulin-like growth factor I (IGF-I) may modulate hepatic production and peripheral utilization of lipoproteins. We measured blood concentrations of IGF-I; total, high-density-lipoprotein, and low-density-lipoprotein (LDL) cholesterol; and apolipoproteins in 18 women with above average cholesterol after high- and low-fat diet periods. Total cholesterol fell 6% (P < 0.02) during the low-fat diet because of reduced concentrations of LDL cholesterol (P < 0.01). Serum concentrations of IGF-I were inversely correlated with total and LDL cholesterol and apolipoprotein B during both high-fat (r = -0.676, P < 0.005; r = -0.745, P < 0.001; and r = -0.504, P < 0.04, respectively) and low-fat (r = -0.656, P < 0.005; r = -0.757, P < 0.001; and r = -0.695, P < 0.001, respectively) diets. IGF-I increased with reduced fat intake in obese subjects only. Thus, IGF-I may contribute to the regulation of LDL cholesterol in mildly hypercholesterolemic women but may not mediate the beneficial response to reduced fat intake.

Low-fat diets are known to lower blood levels of fats and cholesterol-containing lipoproteins, with presumably beneficial effects on the risk of cardiovascular disease. However, the relationship between dietary fat intake and body weight and composition in women has not been well studied. The association between energy (calorie) intake and body weight has been studied extensively, but recent attention has been focused on the effects of different dietary proportions of carbohydrate, fat, and protein. Studies suggest that less weight is gained when more energy is provided as carbohydrate rather than fat. However, the effects of fat replacement by carbohydrate during weight maintenance have not been reported. Eighteen premenopausal women completed a 24-week course consisting of a standard diet containing 37 percent fat (high-fat, HF) for the first four weeks, followed by a 20-week course of a 20 percent fat (low-fat, LF) diet. Twelve subjects were nonobese and six subjects were obese. A nearly constant weight was maintained for each individual by adjusting caloric intake where needed. However, average body weight in both obese and nonobese subjects declined an average of 3 percent during the LF period and it dropped earlier in the obese women. Energy intake increased by 19 percent in the whole group by the end of the LF period. Total body fat and fat as a percentage of body weight declined significantly in all groups of subjects. Total lean weight increased in obese women, while the percent of lean weight increased in both groups. The study indicates that a low-fat high-carbohydrate diet, consumed for 20 weeks, causes a significant reduction in body weight and fat content in spite of increased calorie intake, independent of body type. (Consumer Summary produced by Reliance Medical Information, Inc.)

Purpose: There is minimal information regarding the Reach and Adoption of evidence-based weight loss maintenance interventions for African Americans of faith.Design: The WORD (Wholeness, Oneness, Righteousness, Deliverance) was an 18-month, cluster randomized trial designed to reduce and maintain weight loss in African American adults of faith. Participants received the Diabetes Prevention Program adapted core weight loss program for 6 months, and churches were subsequently randomized to 12-month maintenance treatment or control. All participants underwent body weight and associated behavioral and psychosocial assessments at baseline, 6, 12, and 18 months. The current article focuses on assessing Reach and Adoption at baseline and 6 months using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.Setting: Lower Mississippi Delta.Participants: Thirty churches, 61 WORD Leaders (WLs), and 426 participants.Intervention: Group delivered by trained community members (WLs).Measures: Body mass index and percentage weight lost from baseline to 6-month follow-up were measured. Reach was assessed at participant, WL, and church levels through calculating participation rates and sociodemographics of each level. Adoption was assessed at church and WL levels.Analysis: Descriptive statistics summarized baseline characteristics of each level. Continuous and categorical end point comparisons were made.Results: Participants’ participation rate was 0.84 (n = 437 agreed to participate, n = 519 eligible invited to participate); they were predominantly female, employed, and had a mean age of 49.8. Dropouts by 6 months were younger, had differential marital status, and religious attendance compared with retained participants. Church participation rate was 0.63 (n = 30 enrolled, n = 48 eligible approached) and the majority reported ≤100 active members. The WL participation rate was 0.61 (n = 61 implemented intervention, n = 100 eligible approached); they were primarily female and aged 53.9 (mean).Conclusion: Recruitment, engagement, and delivery strategies employed by the WORD show promise of sustained engagement and adoption in other faith-based behavioral weight management programs for African Americans.