title: Long-term cholesterol-lowering effects of 4 fat-restricted diets in hypercholesterolemic and combined hyperlipidemic men. The Dietary Alternatives Study.
abstract: BACKGROUND
  The long-term effect of aggressively vs moderately fat-restricted diets has not been studied extensively in free-living subjects with different types of hyperlipidemia.
  
  
  OBJECTIVE
  To compare the cholesterol-lowering effects of 4 levels of dietary fat intake restriction after 1 year.
  
  
  METHODS
  Randomized, parallel, comparison trial.
  
  
  METHODS
  Male employees of a large industry.
  
  
  METHODS
  A total of 444 men had low-density lipoprotein cholesterol (LDL-C) levels above the 75th age-specific percentile. Subjects with triglyceride (TG) levels less than the 75th age-specific percentile were defined as hypercholesterolemic (HC) and those with TG levels at or above the 75th age-specific percentile were defined as combined hyperlipidemic (CHL).
  
  
  METHODS
  Hypercholesterolemic subjects were randomized to diets 1, 2, 3, and 4 taught to contain 30%, 26%, 22%, and 18% fat, and the CHL subjects were randomized to diets 1, 2, and 3. All 4 diets were taught to subjects and spouses or partners in 8 weekly 2-hour classes.
  
  
  METHODS
  Plasma lipoprotein levels after 1 year.
  
  
  RESULTS
  Fat intake after 1 year declined from a mean of 34% to 36% of energy to 27%, 26%, 25%, and 22% in the 4 HC diet groups and 28%, 26%, and 25% in the 3 CHL diet groups. Mean+/-SD percent LDL-C reductions were 5.3%+/-16.2%, 13.4%+/-12.6%, 8.4%+/-11.2%, and 13.0%+/-15.7% in the HC diet groups and 7.0%+/-16.2%, 2.8%+/-15.8%, and 4.6%+/-13.5% in the CHL diet groups (P<.01 in all but 1 instance). Apoprotein B levels decreased 8.6%, 10.7%, 4.3%, and 5.3% in the HC groups and 14.6%, 11.4%, and 9.9% in the CHL groups (P<.05-.01 in each instance). Triglyceride levels increased significantly in subjects following HC diets 3 and 4, 21.7% and 38.7% (P<.05 and .01), but not in any CHL subjects. High-density lipoprotein cholesterol decreased 2.8% and 3.2% in subjects on HC diets 3 and 4, respectively (P<.05 in both cases).
  
  
  CONCLUSIONS
  After 1 year, moderate restriction of dietary fat intake attains meaningful and sustained LDL-C reductions in HC subjects and apoprotein B reductions in both HC and CHL subjects. More extreme restriction of fat intake offers little further advantage in HC or CHL subjects and potentially undesirable effects in HC subjects.
authors.affiliation: Northwest Lipid Research Clinic, Department of Medicine, University of Washington, Seattle 98104, USA. rhknopp@u.washington.edu
authors.forename: R H
authors.initials: RH
authors.lastname: Knopp
authors.forename: C E
authors.initials: CE
authors.lastname: Walden
authors.forename: B M
authors.initials: BM
authors.lastname: Retzlaff
authors.forename: B S
authors.initials: BS
authors.lastname: McCann
authors.forename: A A
authors.initials: AA
authors.lastname: Dowdy
authors.forename: J J
authors.initials: JJ
authors.lastname: Albers
authors.forename: G O
authors.initials: GO
authors.lastname: Gey
authors.forename: M N
authors.initials: MN
authors.lastname: Cooper
mesh_terms: D001053:Apolipoproteins / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D018752:Diet, Fat-Restricted; D004041:Dietary Fats / Q000008:administration & dosage*; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000178:diet therapy*; D006949:Hyperlipidemias / Q000097:blood / Q000178:diet therapy*; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D013223:Statistics as Topic; D014280:Triglycerides / Q000097:blood
chemical_list: D001053:Apolipoproteins; D008078:Cholesterol, LDL; D004041:Dietary Fats; D008074:Lipoproteins; D014280:Triglycerides