title: Systematic review of dietary intervention trials to lower blood total cholesterol in free-living subjects.
abstract: OBJECTIVE
  To estimate the efficacy of dietary advice to lower blood total cholesterol concentration in free-living subjects and to investigate the efficacy of different dietary recommendations.
  
  
  METHODS
  Systematic overview of 19 randomised controlled trials including 28 comparisons.
  
  
  METHODS
  Free-living subjects.
  
  
  METHODS
  Individualised dietary advice to modify fat intake.
  
  
  METHODS
  Percentage difference in blood total cholesterol concentration between the intervention and control groups.
  
  
  RESULTS
  The percentage reduction in blood total cholesterol attributable to dietary advice after at least six months of intervention was 5.3% (95% confidence interval 4.7% to 5.9%). Including both short and long duration studies, the effect was 8.5% at 3 months and 5.5% at 12 months. Diets equivalent to the step 2 diet of the American Heart Association were of similar efficacy to diets that aimed to lower total fat intake or to raise the polyunsaturated to saturated fatty acid ratio. These diets were moderately more effective than the step 1 diet of the American Heart Association (6.1% v 3.0% reduction in blood total cholesterol concentration; P<0.0001). On the basis of reported food intake, the targets for dietary change were seldom achieved. The observed reductions in blood total cholesterol concentrations in the individual trials were consistent with those predicted from dietary intake on the basis of the Keys equation.
  
  
  CONCLUSIONS
  Individualised dietary advice for reducing cholesterol concentration is modestly effective in free-living subjects. More intensive diets achieve a greater reduction in serum cholesterol concentration. Failure to comply fully with dietary recommendations is the likely explanation for this limited efficacy.
authors.affiliation: Division of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE, UK.
authors.forename: J L
authors.initials: JL
authors.lastname: Tang
authors.forename: J M
authors.initials: JM
authors.lastname: Armitage
authors.forename: T
authors.initials: T
authors.lastname: Lancaster
authors.forename: C A
authors.initials: CA
authors.lastname: Silagy
authors.forename: G H
authors.initials: GH
authors.lastname: Fowler
authors.forename: H A
authors.initials: HA
authors.lastname: Neil
mesh_terms: D002784:Cholesterol / Q000097:blood*; D003376:Counseling; D018752:Diet, Fat-Restricted; D006293:Health Promotion; D006801:Humans; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic
chemical_list: D002784:Cholesterol