Individual cholesterol variation in response to a margarine- or butter-based diet: A study in families.
BACKGROUND
The effectiveness of dietary modification in reducing low-density lipoprotein cholesterol (LDL-C) levels can be reliably predicted for populations, but not for individuals.


OBJECTIVE
To determine whether individual variation in cholesterol response to dietary modification is a familial trait.


METHODS
Two-period, outpatient crossover trial conducted from September 1997 to September 1999.


METHODS
Fifty-six families from the Dallas-Ft Worth, Tex, area with 2 biological parents and at least 2 children aged 5 years or older volunteered; 46 families (n = 92 adults and n = 134 children) completed the study.


METHODS
All families followed two 5-week dietary regimens that included individualized daily dietary prescriptions and emphasized a low-saturated fat diet supplemented with specially manufactured baked goods and spreadable fat. One regimen used butter only and the other used margarine only.


METHODS
Mean LDL-C levels during the last 2 weeks of each dietary period.


RESULTS
Margarine intake compared with butter intake lowered LDL-C levels 11% in adults (95% confidence interval [CI], 13% to 9%) and 9% in children (95% CI, 12% to 6%) (P<.001 for both adults and children). The distribution of individual responses were peaked around the mean response. For adults and children together, family membership accounted for 19% of variability in response (P =.007). In children, family membership accounted for 40% of variability in response of percent change in LDL-C levels (P =.002). Body mass index and change in cholesterol ester (CE) 18:2/18:1 ratio accounted for 26% of variation, leaving 26% still attributable to family membership. In all participants, BMI predicted response-heavier individuals had higher LDL-C levels, less excursion in CE fatty acids, and less LDL-C response to dietary change.


CONCLUSIONS
Our results suggest that individual variation in response to a cholesterol-lowering diet is a familial trait. Body weight is an important modifiable factor that influences response. JAMA. 2000;284:2740-2747.
Denke
M A
MA
Department of Internal Medicine, Center for Human Nutrition, 5323 Harry Hines Blvd, Room Y3.234, Dallas, TX 75390-9052, USA. mdenke@mednet.swmed.edu
Adams-Huet
B
B
Nguyen
A T
AT
D000328:Adult; D001057:Apolipoproteins E / Q000235:genetics; D015992:Body Mass Index; D002079:Butter; D002648:Child; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D018592:Cross-Over Studies; D004041:Dietary Fats; D005190:Family; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D006937:Hypercholesterolemia / Q000235:genetics / Q000517:prevention & control; D008297:Male; D008383:Margarine; D008660:Metabolism / Q000235:genetics*; D012044:Regression Analysis; D015203:Reproducibility of Results
D001057:Apolipoproteins E; D008078:Cholesterol, LDL; D004041:Dietary Fats; D002079:Butter; D008383:Margarine; D002784:Cholesterol