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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

CONTEXT

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.

DESIGN, SETTING, AND PARTICIPANTS

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.

INTERVENTION

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.

MAIN OUTCOME MEASURES

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).

CONCLUSION

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.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00438425.

Links

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  • Authors+Show Affiliations

    ,

    Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, 61 Queen St E, Toronto, ON M5C 2T2, Canada. cyril.kendall@utoronto.ca

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

    Source

    JAMA 306:8 2011 Aug 24 pg 831-9

    MeSH

    Cholesterol, LDL
    Counseling
    Diet
    Dietary Fats
    Dietary Fiber
    Female
    Humans
    Hyperlipidemias
    Male
    Middle Aged
    Nuts
    Patient Compliance
    Phytosterols
    Soybean Proteins

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    21862744

    Citation

    Jenkins, David J A., et al. "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." JAMA, vol. 306, no. 8, 2011, pp. 831-9.
    Jenkins DJ, Jones PJ, Lamarche B, et al. 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. JAMA. 2011;306(8):831-9.
    Jenkins, D. J., Jones, P. J., Lamarche, B., Kendall, C. W., Faulkner, D., Cermakova, L., ... Frohlich, J. (2011). 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. JAMA, 306(8), pp. 831-9. doi:10.1001/jama.2011.1202.
    Jenkins DJ, et al. 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. JAMA. 2011 Aug 24;306(8):831-9. PubMed PMID: 21862744.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - 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. AU - Jenkins,David J A, AU - Jones,Peter J H, AU - Lamarche,Benoit, AU - Kendall,Cyril W C, AU - Faulkner,Dorothea, AU - Cermakova,Luba, AU - Gigleux,Iris, AU - Ramprasath,Vanu, AU - de Souza,Russell, AU - Ireland,Chris, AU - Patel,Darshna, AU - Srichaikul,Korbua, AU - Abdulnour,Shahad, AU - Bashyam,Balachandran, AU - Collier,Cheryl, AU - Hoshizaki,Sandy, AU - Josse,Robert G, AU - Leiter,Lawrence A, AU - Connelly,Philip W, AU - Frohlich,Jiri, PY - 2011/8/25/entrez PY - 2011/8/25/pubmed PY - 2011/8/27/medline SP - 831 EP - 9 JF - JAMA JO - JAMA VL - 306 IS - 8 N2 - CONTEXT: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. INTERVENTION: 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. MAIN OUTCOME MEASURES: 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). CONCLUSION: 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00438425. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/21862744/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_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2011.1202 DB - PRIME DP - Unbound Medicine ER -