Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia.
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.
Jenkins
David J A
DJ
Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Ontario, Canada.
Kendall
Cyril W C
CW
Faulkner
Dorothea A
DA
Nguyen
Tri
T
Kemp
Thomas
T
Marchie
Augustine
A
Wong
Julia M W
JM
de Souza
Russell
R
Emam
Azadeh
A
Vidgen
Edward
E
Trautwein
Elke A
EA
Lapsley
Karen G
KG
Holmes
Candice
C
Josse
Robert G
RG
Leiter
Lawrence A
LA
Connelly
Philip W
PW
Singer
William
W
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
D000924:Anticholesteremic Agents; D002791:Cholesterol, Dietary; D008078:Cholesterol, LDL; D004043:Dietary Fiber; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010840:Phytosterols; D030262:Soybean Proteins