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Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein.

Abstract

CONTEXT

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.

OBJECTIVE

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).

DESIGN

Randomized controlled trial conducted between October and December 2002.

SETTING AND PARTICIPANTS

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.

INTERVENTIONS

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).

MAIN OUTCOME MEASURES

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.

RESULTS

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.

CONCLUSION

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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  • Authors+Show Affiliations

    ,

    Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Ontario, Canada. cyril.kendall@utoronto.ca

    , , , , , , , , , , , ,

    Source

    JAMA 290:4 2003 Jul 23 pg 502-10

    MeSH

    Anticholesteremic Agents
    C-Reactive Protein
    Cholesterol, Dietary
    Diet, Atherogenic
    Diet, Vegetarian
    Dietary Fiber
    Female
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Hyperlipidemias
    Lipids
    Lovastatin
    Male
    Middle Aged

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    12876093

    Citation

    Jenkins, David J A., et al. "Effects of a Dietary Portfolio of Cholesterol-lowering Foods Vs Lovastatin On Serum Lipids and C-reactive Protein." JAMA, vol. 290, no. 4, 2003, pp. 502-10.
    Jenkins DJ, Kendall CW, Marchie A, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA. 2003;290(4):502-10.
    Jenkins, D. J., Kendall, C. W., Marchie, A., Faulkner, D. A., Wong, J. M., de Souza, R., ... Connelly, P. W. (2003). Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA, 290(4), pp. 502-10.
    Jenkins DJ, et al. Effects of a Dietary Portfolio of Cholesterol-lowering Foods Vs Lovastatin On Serum Lipids and C-reactive Protein. JAMA. 2003 Jul 23;290(4):502-10. PubMed PMID: 12876093.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. AU - Jenkins,David J A, AU - Kendall,Cyril W C, AU - Marchie,Augustine, AU - Faulkner,Dorothea A, AU - Wong,Julia M W, AU - de Souza,Russell, AU - Emam,Azadeh, AU - Parker,Tina L, AU - Vidgen,Edward, AU - Lapsley,Karen G, AU - Trautwein,Elke A, AU - Josse,Robert G, AU - Leiter,Lawrence A, AU - Connelly,Philip W, PY - 2003/7/24/pubmed PY - 2003/7/29/medline PY - 2003/7/24/entrez SP - 502 EP - 10 JF - JAMA JO - JAMA VL - 290 IS - 4 N2 - CONTEXT: 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. OBJECTIVE: 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). DESIGN: Randomized controlled trial conducted between October and December 2002. SETTING AND PARTICIPANTS: 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. INTERVENTIONS: 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). MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSION: In this study, diversifying cholesterol-lowering components in the same dietary portfolio increased the effectiveness of diet as a treatment of hypercholesterolemia. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/12876093/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.290.4.502 DB - PRIME DP - Unbound Medicine ER -