Plasma lipid response and nutritional adequacy in hypercholesterolemic subjects on the American Heart Association Step-One Diet
C. Y. Bae, J. M. Keenan, P. Fontaine, J. Wenz, C. M. Ripsin and D. J. McCaffrey
Department of Family Medicine, Keimyung University Medical School, Taegu, Korea.
OBJECTIVES: To determine the efficacy of the American Heart Association
Step-One Diet for lowering blood lipid levels and to assess its nutritional
adequacy in younger (< 50 years old) and older (> or = 50 years old)
subgroups. STUDY DESIGN: A prospective cohort study; 383 subjects were
instructed in the American Heart Association Step-One Diet. Adherence to
the diet was assessed at 6 weeks. Eighty-seven subjects continued the diet
for an additional 12 weeks. SETTING: General community participants:
volunteers from community cholesterol screening programs and chart reviews
at family practice clinics. STUDY PARTICIPANTS: Men and women, aged 20 to
70 years, with baseline low-density lipoprotein cholesterol levels between
the 50th and 95th percentile, and excluded if receiving any medications
that affect blood lipid levels or if there was a history of diabetes, gout,
peptic ulcer, or liver disease. INTERVENTION: Instruction by a registered
dietitian and adherence to the American Heart Association Step-One Diet for
6 (n = 383) and 18 weeks (n = 87). This diet involves an intake of total
fat not to exceed 30% of calories, saturated fatty acids not to exceed 10%
of calories, and dietary cholesterol limited to 300 mg/d. RESULTS: Subjects
aged 50 to 70 years averaged a reduction in total cholesterol level and
low-density lipoprotein cholesterol level of 4% after 6 weeks. At the end
of 18 weeks, mean total cholesterol and low-density lipoprotein cholesterol
levels in subjects younger than 50 years exceeded their baseline levels,
and in those older than 50 years returned to baseline lipid levels.
Inadequate intake of several micronutrients were reported, notably, zinc,
calcium, and vitamins A, D, and E. CONCLUSIONS: When recommending the
American Heart Association Step-One Diet to persons with hyperlipidemia,
baseline dietary behavior should be assessed to determine whether that diet
offers therapeutic advantage over the persons's self-selected diet.
Follow-up should include monitoring of lipid response and nutritional
adequacy. Special emphasis should be placed on selection of foods with
appropriate micronutrient content.
