Effects of a Dietary Portfolio of Cholesterol-Lowering Foods vs Lovastatin on Serum Lipids and C-Reactive Protein

Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Ontario, Canada.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 07/2003; 290(4):502-10. DOI: 10.1001/jama.290.4.502
Source: PubMed

ABSTRACT To enhance the effectiveness of diet in lowering cholesterol, recommendations of the Adult Treatment Panel III of the National Cholesterol Education Program emphasize diets low in saturated fat together with plant sterols and viscous fibers, and the American Heart Association supports the use of soy protein and nuts.
To determine whether a diet containing all of these recommended food components leads to cholesterol reduction comparable with that of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins).
Randomized controlled trial conducted between October and December 2002.
Forty-six healthy, hyperlipidemic adults (25 men and 21 postmenopausal women) with a mean (SE) age of 59 (1) years and body mass index of 27.6 (0.5), recruited from a Canadian hospital-affiliated nutrition research center and the community.
Participants were randomly assigned to undergo 1 of 3 interventions on an outpatient basis for 1 month: a diet very low in saturated fat, based on milled whole-wheat cereals and low-fat dairy foods (n = 16; control); the same diet plus lovastatin, 20 mg/d (n = 14); or a diet high in plant sterols (1.0 g/1000 kcal), soy protein (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds (14 g/1000 kcal) (n = 16; dietary portfolio).
Lipid and C-reactive protein levels, obtained from fasting blood samples; blood pressure; and body weight; measured at weeks 0, 2, and 4 and compared among the 3 treatment groups.
The control, statin, and dietary portfolio groups had mean (SE) decreases in low-density lipoprotein cholesterol of 8.0% (2.1%) (P =.002), 30.9% (3.6%) (P<.001), and 28.6% (3.2%) (P<.001), respectively. Respective reductions in C-reactive protein were 10.0% (8.6%) (P =.27), 33.3% (8.3%) (P =.002), and 28.2% (10.8%) (P =.02). The significant reductions in the statin and dietary portfolio groups were all significantly different from changes in the control group. There were no significant differences in efficacy between the statin and dietary portfolio treatments.
In this study, diversifying cholesterol-lowering components in the same dietary portfolio increased the effectiveness of diet as a treatment of hypercholesterolemia.

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Available from: Julia M W Wong, Sep 26, 2015
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    • "This finding suggests that a combination of LDL-lowering dietary strategies (e.g., vicous fiber, plant stanols, soy protein, almonds) has additive effects when added to a healthy diet and can produce clinically significant reductions in CHD risk (Kendall and Jenkins, 2004). A number of other benefits such as lower inflammation lower CRP (c-reactive protein) blood levels and weight loss were also witnessed (Jenkins et al., 2003). Viscous fibers facilitate bile acid loss from the gut (which binds cholesterol), plant sterols reduce cholesterol absorption from the gut, soy proteins reduce hepatic cholesterol synthesis and may increase hepatic LDL receptor uptake of cholesterol. "
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    ABSTRACT: The traditional diet in Okinawa is anchored by root vegetables (principally sweet potatoes), green and yellow vegetables, soybean-based foods, and medicinal plants. Marine foods, lean meats, fruit, medicinal garnishes and spices, tea, alcohol are also moderately consumed. Many characteristics of the traditional Okinawan diet are shared with other healthy dietary patterns, including the traditional Mediterranean diet, DASH diet, and Portfolio diet. All these dietary patterns are associated with reduced risk for cardiovascular disease, among other age-associated diseases. Overall, the important shared features of these healthy dietary patterns include: high intake of unrefined carbohydrates, moderate protein intake with emphasis on vegetables/legumes, fish, and lean meats as sources, and a healthy fat profile (higher in mono/polyunsaturated fats, lower in saturated fat; rich in omega-3). The healthy fat intake is likely one mechanism for reducing inflammation, optimizing cholesterol, and other risk factors. Additionally, the lower caloric density of plant-rich diets results in lower caloric intake with concomitant high intake of phytonutrients and antioxidants. Other shared features include low glycemic load, less inflammation and oxidative stress, and potential modulation of aging-related biological pathways. This may reduce risk for chronic age-associated diseases and promote healthy aging and longevity.
    Mechanisms of ageing and development 01/2014; 136-137. DOI:10.1016/j.mad.2014.01.002 · 3.40 Impact Factor
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    • "A study by Tonstad et al.( 6 ) found that plasma lipids in children with FH was associated with body fatness of the child, the diet and the parental lipid profile rather than the type of FH mutation, suggesting that lifestyle is important for plasma lipids in children with FH. In non-FH patients, a total serum cholesterol level reduction of 10–30 % has been shown achievable through dietary adjustments( 7 , 8 ). However, little is known about the effectiveness of dietary treatment in FH subjects and only a very few studies have investigated relationships between diet and cholesterol levels in children with FH. "
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    ABSTRACT: Familial hypercholesterolaemia (FH) leads to elevated plasma levels of LDL-cholesterol and increased risk of premature atherosclerosis. Dietary treatment is recommended to all patients with FH in combination with lipid-lowering drug therapy. Little is known about how children with FH and their parents respond to dietary advice. The aim of the present study was to characterise the dietary habits in children with FH. A total of 112 children and young adults with FH and a non-FH group of children (n 36) were included. The children with FH had previously received dietary counselling. The FH subjects were grouped as: 12–14 years (FH (12–14)) and 18–28 years (FH (18–28)). Dietary data were collected by SmartDiet, a short self-instructing questionnaire on diet and lifestyle where the total score forms the basis for an overall assessment of the diet. Clinical and biochemical data were retrieved from medical records. The SmartDiet scores were significantly improved in the FH (12–14) subjects compared with the non-FH subjects (SmartDiet score of 31 v. 28, respectively). More FH (12–14) subjects compared with non-FH children consumed low-fat milk (64 v. 18 %, respectively), low-fat cheese (29 v. 3%, respectively), used margarine with highly unsaturated fat (74 v. 14 %, respectively). In all, 68 % of the FH (12–14) subjects and 55 % of the non-FH children had fish for dinner twice or more per week. The FH (18–28) subjects showed the same pattern in dietary choices as the FH (12–14) children. In contrast to the choices of low-fat dietary items, 50 % of the FH (12–14) subjects consumed sweet spreads or sweet drinks twice or more per week compared with only 21 % in the non-FH group. In conclusion, ordinary out-patient dietary counselling of children with FH seems to have a long-lasting effect, as the diet of children and young adults with FH consisted of more products that are favourable with regard to the fatty acid composition of the diet.
    10/2013; 2. DOI:10.1017/jns.2013.27
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    • "Dietary changes may include a reduction in saturated fats and cholesterol intake together with increased consumption of unsaturated fats, vegetables and whole cereals, as well as almonds and nuts. A portfolio of several dietary components, proposed by Jenkins et al., has been shown to lower LDLcholesterol in a metabolically controlled randomized trial similar to cholesterol reductions seen with lavastatin (~30%) (Jenkins, 2003); this diet included soy protein foods (Jenkins, 2010), viscous fibers (Jenkins, 2002), almonds (FDA, 2003) and plant sterols (FDA, 2000). At comparable levels of intake (2 g/d), phytosterols/stanols may reduce LDL-cholesterol by 10- 14% (Baumgartner). "
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    ABSTRACT: Objective: To investigate the effect of a natural cholesterol-lowering supplement (NCLS) containing red yeast rice, policosanols and artichoke leaf extracts on blood lipid concentrations as well as on safety parameters when given over 16 weeks in 100 volunteers with untreated moderate hypercholesterolemia, in a randomized, double-blind, placebo-controlled trial. Results: Reduction of primary outcome low-density lipoprotein cholesterol [-0.22 g/L (95% confidence interval, CI: -0.31 to -0.12) corresponding to -14.3% from baseline (95% CI: -21.5 to -7.2) compared to placebo], as well as total cholesterol, apolipoprotein B100 and apolipoprotein B100/apolipoprotein A-I ratio, were observed after 16 weeks of supplementation with NCLS. These effects were already observed at Week 4 and 10 of supplementation. No significant changes were observed in high-density lipoprotein, triacylglycerol, creatine kinase, lactate dehydrogenase and coenzyme Q10 levels, as well as in markers of liver and renal function. Conclusions: The NCLS was effective in reducing low-density lipoprotein cholesterol and apolipoprotein B100 in subjects with moderate hypercholesterolemia, without modifying safety parameters.
    International Journal of Food Sciences and Nutrition 07/2013; 64(7). DOI:10.3109/09637486.2013.809405 · 1.21 Impact Factor
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