title: Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial.
abstract: BACKGROUND
  Combining foods with recognized cholesterol-lowering properties (dietary portfolio) has proven highly effective in lowering serum cholesterol under metabolically controlled conditions.
  
  
  OBJECTIVE
  To assess the effect of a dietary portfolio administered at 2 levels of intensity on percentage change in low-density lipoprotein cholesterol (LDL-C) among participants following self-selected diets.
  
  
  METHODS
  A parallel-design study of 351 participants with hyperlipidemia from 4 participating academic centers across Canada (Quebec City, Toronto, Winnipeg, and Vancouver) randomized between June 25, 2007, and February 19, 2009, to 1 of 3 treatments lasting 6 months.
  
  
  METHODS
  Participants received dietary advice for 6 months on either a low-saturated fat therapeutic diet (control) or a dietary portfolio, for which counseling was delivered at different frequencies, that emphasized dietary incorporation of plant sterols, soy protein, viscous fibers, and nuts. Routine dietary portfolio involved 2 clinic visits over 6 months and intensive dietary portfolio involved 7 clinic visits over 6 months.
  
  
  METHODS
  Percentage change in serum LDL-C.
  
  
  RESULTS
  In the modified intention-to-treat analysis of 345 participants, the overall attrition rate was not significantly different between treatments (18% for intensive dietary portfolio, 23% for routine dietary portfolio, and 26% for control; Fisher exact test, P = .33). The LDL-C reductions from an overall mean of 171 mg/dL (95% confidence interval [CI], 168-174 mg/dL) were -13.8% (95% CI, -17.2% to -10.3%; P < .001) or -26 mg/dL (95% CI, -31 to -21 mg/dL; P < .001) for the intensive dietary portfolio; -13.1% (95% CI, -16.7% to -9.5%; P < .001) or -24 mg/dL (95% CI, -30 to -19 mg/dL; P < .001) for the routine dietary portfolio; and -3.0% (95% CI, -6.1% to 0.1%; P = .06) or -8 mg/dL (95% CI, -13 to -3 mg/dL; P = .002) for the control diet. Percentage LDL-C reductions for each dietary portfolio were significantly more than the control diet (P < .001, respectively). The 2 dietary portfolio interventions did not differ significantly (P = .66). Among participants randomized to one of the dietary portfolio interventions, percentage reduction in LDL-C on the dietary portfolio was associated with dietary adherence (r = -0.34, n = 157, P < .001).
  
  
  CONCLUSIONS
  Use of a dietary portfolio compared with the low-saturated fat dietary advice resulted in greater LDL-C lowering during 6 months of follow-up.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00438425.
authors.affiliation: Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, 61 Queen St E, Toronto, ON M5C 2T2, Canada. cyril.kendall@utoronto.ca
authors.forename: David J A
authors.initials: DJ
authors.lastname: Jenkins
authors.forename: Peter J H
authors.initials: PJ
authors.lastname: Jones
authors.forename: Benoit
authors.initials: B
authors.lastname: Lamarche
authors.forename: Cyril W C
authors.initials: CW
authors.lastname: Kendall
authors.forename: Dorothea
authors.initials: D
authors.lastname: Faulkner
authors.forename: Luba
authors.initials: L
authors.lastname: Cermakova
authors.forename: Iris
authors.initials: I
authors.lastname: Gigleux
authors.forename: Vanu
authors.initials: V
authors.lastname: Ramprasath
authors.forename: Russell
authors.initials: R
authors.lastname: de Souza
authors.forename: Chris
authors.initials: C
authors.lastname: Ireland
authors.forename: Darshna
authors.initials: D
authors.lastname: Patel
authors.forename: Korbua
authors.initials: K
authors.lastname: Srichaikul
authors.forename: Shahad
authors.initials: S
authors.lastname: Abdulnour
authors.forename: Balachandran
authors.initials: B
authors.lastname: Bashyam
authors.forename: Cheryl
authors.initials: C
authors.lastname: Collier
authors.forename: Sandy
authors.initials: S
authors.lastname: Hoshizaki
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: Jiri
authors.initials: J
authors.lastname: Frohlich
mesh_terms: D008078:Cholesterol, LDL / Q000097:blood*; D003376:Counseling; D004032:Diet; D004041:Dietary Fats; D004043:Dietary Fiber / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D009754:Nuts; D010349:Patient Compliance; D010840:Phytosterols / Q000008:administration & dosage; D030262:Soybean Proteins / Q000008:administration & dosage
chemical_list: D008078:Cholesterol, LDL; D004041:Dietary Fats; D004043:Dietary Fiber; D010840:Phytosterols; D030262:Soybean Proteins