title: Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia.
abstract: BACKGROUND
  Cholesterol-lowering foods may be more effective when consumed as combinations rather than as single foods.
  
  
  OBJECTIVE
  Our aims were to determine the effectiveness of consuming a combination of cholesterol-lowering foods (dietary portfolio) under real-world conditions and to compare these results with published data from the same participants who had undergone 4-wk metabolic studies to compare the same dietary portfolio with the effects of a statin.
  
  
  METHODS
  For 12 mo, 66 hyperlipidemic participants were prescribed diets high in plant sterols (1.0 g/1000 kcal), soy protein (22.5 g/1000 kcal), viscous fibers (10 g/1000 kcal), and almonds (23 g/1000 kcal). Fifty-five participants completed the 1-y study. The 1-y data were also compared with published results on 29 of the participants who had also undergone separate 1-mo metabolic trials of a diet and a statin.
  
  
  RESULTS
  At 3 mo and 1 y, mean (+/-SE) LDL-cholesterol reductions appeared stable at 14.0 +/- 1.6% (P < 0.001) and 12.8 +/- 2.0% (P < 0.001), respectively (n = 66). These reductions were less than those observed after the 1-mo metabolic diet and statin trials. Nevertheless, 31.8% of the participants (n = 21 of 66) had LDL-cholesterol reductions of >20% at 1 y (x +/- SE: -29.7 +/- 1.6%). The LDL-cholesterol reductions in this group were not significantly different from those seen after their respective metabolically controlled portfolio or statin treatments. A correlation was found between total dietary adherence and LDL-cholesterol change (r = -0.42, P < 0.001). Only 2 of the 26 participants with <55% compliance achieved LDL-cholesterol reductions >20% at 1 y.
  
  
  CONCLUSIONS
  More than 30% of motivated participants who ate the dietary portfolio of cholesterol-lowering foods under real-world conditions were able to lower LDL-cholesterol concentrations >20%, which was not significantly different from their response to a first-generation statin taken under metabolically controlled conditions.
authors.affiliation: Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: David J A
authors.initials: DJ
authors.lastname: Jenkins
authors.forename: Cyril W C
authors.initials: CW
authors.lastname: Kendall
authors.forename: Dorothea A
authors.initials: DA
authors.lastname: Faulkner
authors.forename: Tri
authors.initials: T
authors.lastname: Nguyen
authors.forename: Thomas
authors.initials: T
authors.lastname: Kemp
authors.forename: Augustine
authors.initials: A
authors.lastname: Marchie
authors.forename: Julia M W
authors.initials: JM
authors.lastname: Wong
authors.forename: Russell
authors.initials: R
authors.lastname: de Souza
authors.forename: Azadeh
authors.initials: A
authors.lastname: Emam
authors.forename: Edward
authors.initials: E
authors.lastname: Vidgen
authors.forename: Elke A
authors.initials: EA
authors.lastname: Trautwein
authors.forename: Karen G
authors.initials: KG
authors.lastname: Lapsley
authors.forename: Candice
authors.initials: C
authors.lastname: Holmes
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.forename: Philip W
authors.initials: PW
authors.lastname: Connelly
authors.forename: William
authors.initials: W
authors.lastname: Singer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002791:Cholesterol, Dietary / Q000008:administration & dosage*; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects; D003131:Combined Modality Therapy; D004043:Dietary Fiber / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000178:diet therapy* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010840:Phytosterols / Q000008:administration & dosage / Q000627:therapeutic use; D027861:Prunus; D030262:Soybean Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D002791:Cholesterol, Dietary; D008078:Cholesterol, LDL; D004043:Dietary Fiber; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010840:Phytosterols; D030262:Soybean Proteins