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Assessment of the longer-term effects of a portfolio of cholesterol-lowering foods in hypercholesterolemia

Jenkins, D.J.A, C.W.C. Kendall, D.A. Faulkner, T. Nguyen, T. Kemp, A. Marchie, J. M. W. Wong, R. de Souza, A. Emam, E. Vidgen, E. A. Trautwein, K. G. Lapsley, C. Holmes, R. G. Josse, L. A. Leiter, P. W. Connelly, and W. Singer, 2006. Assessment of the longer-term effects of a portfolio of cholesterol-lowering foods in hypercholesterolemia. Am J Clin Nutr. 83:582-91.

Background: Cholesterol-lowering foods may be more effective when consumed as combinations rather than as single foods. Objectives: Our aims were to determine the effectiveness of consuming a combination of cholesterol-lowering foods (dietary portfolio) under real-world conditions and to compare these results with published data from the same participants who had undergone 4-wk metabolic studies to compare the same dietary portfolio with the effects of a statin. Design: For 12 mo, 66 hyperlipidemic participants were prescribed diets high in plant sterols (1.0 g/1000 kcal), soy protein (22.5 g/1000 kcal), viscous fibers (10 g/1000 kcal), and almonds (23 g/1000 kcal). Fifty-five participants completed the 1-y study. The 1-y data were also compared with published results on 29 of the participants who had also undergone separate 1-mo metabolic trials of a diet and a statin. Results: At 3 mo and 1 y, mean (±SE) LDL-cholesterol reductions appeared stable at 14.0 ± 1.6% (P < 0.001) and 12.8 ± 2.0% (P <0.001), respectively (n = 66). These reductions were less than those observed after the 1-mo metabolic diet and statin trials. Nevertheless, 31.8% of the participants (n = 21 of 66) had LDL-cholesterol reductions of >20% at 1 y (x ± SE: -29.7 ± 1.6%). The LDL cholesterol reductions in this group were not significantly different from those seen after their respective metabolically controlled portfolio or statin treatments. A correlation was found between total dietary adherence and LDL-cholesterol change (r =-0.42, P<0.001). Only 2 of the 26 participants with <55% compliance achieved LDL-cholesterol reductions >20% at 1 y. Conclusions: More than 30% of motivated participants who ate the dietary portfolio of cholesterol-lowering foods under real-world conditions were able to lower LDL-cholesterol concentrations >20%, which was not significantly different from their response to a first-generation statin taken under metabolically controlled conditions.