| For medical practitioners and the general public - Cholesterol Journal Article Catalog. |
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| Diet will help reduce cholesterol levels Cook, Z. (2005), Prof Nurse 20(8): 44. Abstract: A cardio-protective diet, rich in omega-3 oils and fresh fruit and vegetables, will help lower cholesterol levels. In this article, a dietitian provides answers to frequently asked questions and advice on good dietary practice. |
| Diet with controlled content of fat and cholesterol--practical aspects and realized evaluation Owczarek, L. (1990), Wiad Lek 43(15-16): 834-45. |
| Diet, blood cholesterol levels, and coronary heart disease Stone, N. J. (1993), Coron Artery Dis 4(10): 871-81. |
| Diet, cholesterol and coronary heart disease. A perspective Menotti, A. (1999), Acta Cardiol 54(3): 169-72. Abstract: After pioneering, scattered observations in the context of the so-called geographical pathology, collected during the first part of this century, a systematic approach into the search of causality of the association between diet and coronary heart disease has characterized the past 50 years. The possible link of eating habits leading to a diet high in calories, total fat, saturated fatty acids and cholesterol, to coronary events, through the mediation of serum cholesterol, represents the classic diet-heart theory. This theory is supported by results from ecological analyses, prospective studies, animal experiments, clinical observations, controlled trials, biochemical and nutritional studies. This traditional view of the problem has partly changed recently and a number of other dietary components in the possibly causal chain have emerged, with effects not necessarily involving serum cholesterol and lipids. The role of other nutrients in the atherosclerotic process and of precipitating factors (e.g. vitamins, anti-oxidants, fibre, sub-categories of fatty acids, phytosterols, flavonoids, etc.) has been identified but is not always fully understood. At the same time other blood lipids, other blood components and other pathways have been identified between diet and coronary outcomes. New challenges are open for future research since the association of diet with coronary disease is not as simple and linear as supposed. The main issues are the need to explain a number of still unknown mechanisms, to determine which "natural diet" carries the minimum coronary risk and whether "new" foods produced by modern technology are really needed to contrast this epidemic. |
| Diet, cholesterol and the late consequences Ballabriga, A. (1992), An Esp Pediatr 36 Suppl 48: 39-52. |
| Diet, menopause, and serum cholesterol levels in women: the Framingham Study Posner, B. M., L. A. Cupples, et al. (1993), Am Heart J 125(2 Pt 1): 483-9. Abstract: Cross-sectional relationships between diet and total serum cholesterol levels were studied in a sample of 428 women from the Framingham Heart Study Cohort, aged 37 to 70 years, from 1957 to 1960. Multiple linear regression was used to control for total calorie intake, systolic blood pressure, physical activity, Metropolitan relative weight, glucose intolerance, and cigarette smoking. There was little evidence for a relationship between total serum cholesterol and dietary fat intake; whereas a marginally significant direct association was found with total fat in postmenopausal women, total and plant fat and cholesterol were inversely associated, and only cholesterol was significant in premenopausal women. A consistent inverse association was observed between total serum cholesterol levels and intake of protein, particularly from plant sources, and a weak inverse association was found with complex carbohydrate intake. Serum cholesterol in women may be influenced by a number of dietary factors and appears to differ according to menopausal status. |
| Dietary (n-3) fat and cholesterol alter tissue antioxidant enzymes and susceptibility to oxidation in SHR and WKY rats Yuan, Y. V. and D. D. Kitts (2003), J Nutr 133(3): 679-88. Abstract: Previously, 8% fish oil blend diets, compared to butter and soybean oil blend diets, reduced specific antioxidant enzyme activities and tissue susceptibility to in vitro oxidative stress in spontaneously hypertensive (SHR) and Wistar Kyoto (WKY) rats. Moreover, high cholesterol (5.0 g/kg diet) diets protected against in vitro tissue lipid oxidation. In this study, we hypothesized that 160 g fat/kg diet as blends of (n-6) or (n-3) oils and cholesterol would alter antioxidant enzyme activities and thus increase tissue susceptibility to oxidation. The effects of diet blends of saturated (butter, B), (n-6) (soybean oil, SBO) or (n-3) (menhaden oil, MO) oils with cholesterol (0.5 or 5.0 g/kg) on systolic blood pressure (SBP), plasma lipids, antioxidant enzymes and susceptibility to oxidation were examined in SHR and WKY rats. SBP at 13 wk of age was greater (P < 0.001) in SHR than in WKY rats, but was not affected by diets. Plasma cholesterol and triacylglycerols were decreased (P < 0.001) by MO diets. Hepatic glutathione reductase activities were reduced (P < 0.001) in SBO-fed SHR and enhanced in SBO- and MO-fed WKY rats. Glutathione levels were reduced (P < 0.001) in RBC and enhanced (P < 0.001) in livers of MO-fed rats. Lipid oxidation was enhanced (P < 0.001) in red blood cells (RBC) from SBO groups, and hearts and livers of MO groups. High cholesterol diets reduced (P < or = 0.001) susceptibility to lipid peroxidation in RBC and liver of SHR and WKY rats. Greater amounts of dietary (n-3) fat enhance tissue susceptibility to oxidation, which can be modulated by increased dietary cholesterol in SHR and WKY rats. |
| Dietary advice given by a dietitian versus other health professional or self-help resources to reduce blood cholesterol Thompson, R. L., C. D. Summerbell, et al. (2003), Cochrane Database Syst Rev(3): CD001366. Abstract: BACKGROUND: The average level of blood cholesterol is an important determinant of the risk of coronary heart disease. Blood cholesterol can be reduced by dietary means. Although dietitians are trained to provide dietary advice, for practical reasons it is also given by other health professionals and occasionally through the use of self-help resources. OBJECTIVES: To assess the effects of dietary advice given by a dietitian compared with another health professional, or the use of self-help resources, in reducing blood cholesterol in adults. SEARCH STRATEGY: We searched The Cochrane Library (to Issue 3 2002), the EPOC trial register (October 2002), MEDLINE (1966 to September 2002), EMBASE (1980 to September 2002), Cinahl (1982 to August 2002), Human Nutrition (1991 to 1998), Science Citation Index, Social Sciences Citation Index, hand searched conference proceedings on nutrition and heart disease, and contacted experts in the field. SELECTION CRITERIA: Randomised trials of dietary advice given by a dietitian compared with another health professional or self-help resources. The main outcome was difference in blood cholesterol between dietitian groups compared with other intervention groups. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Twelve studies with 13 comparisons were included, involving 727 people receiving advice from dietitians, 515 from other health professionals and 551 people using self-help resources. Four studies compared dietitian with doctor, seven with self-help resources, and only one study was found for each of the dietitian versus nurse and dietitian versus counsellor comparisons. Participants receiving advice from dietitians experienced a greater reduction in blood cholesterol than those receiving advice only from doctors (-0.25 mmol/L (95% CI -0.37, -0.12 mmol/L)). There was no statistically significant difference in change in blood cholesterol between dietitians and self-help resources (-0.10 mmol/L (95% CI -0.22, 0.03 mmol/L)). No statistically significant differences were detected for secondary outcome measures between any of the comparisons with the exception of dietitian versus nurse for HDLc, where the dietitian group showed a greater reduction (-0.06 mmol/L (95% CI -0.11, -0.01)) and dietitian versus counsellor for body weight, where the dietitian group showed a greater reduction (-5.80 kg (95% CI -8.91, -2.69 kg)). No significant heterogeneity between the studies was detected. REVIEWER'S CONCLUSIONS: Dietitians were better than doctors at lowering blood cholesterol in the short to medium term, but there was no evidence that they were better than self-help resources. The results should be interpreted with caution as the studies were not of good quality and the analysis was based on a limited number of trials. More evidence is required to assess whether change can be maintained in the longer term. There was no evidence that dietitians provided better outcomes than nurses. |
| Dietary alpha-linolenic acid is as effective as oleic acid and linoleic acid in lowering blood cholesterol in normolipidemic men Chan, J. K., V. M. Bruce, et al. (1991), Am J Clin Nutr 53(5): 1230-4. Abstract: The effect of dietary oleic acid (OA), linoleic acid (LA), and linolenic acid (LNA) on plasma lipid metabolism was studied in eight normolipidemic men. A mixed-fat diet composed of conventional foods was fed during 6-d pre- and post-experimental periods. The same basic diet but with 75% of the fat (26% of total energy) provided by sunflower and olive; canola; soybean; and sunflower, olive, and flax oils was fed during four 18-d experimental periods. Mean plasma total cholesterol (-18%), low-density-lipoprotein-cholesterol, (-22%) and very-low-density-lipoprotein-cholesterol (-41%) concentrations were significantly (P less than 0.004) lower after the experimental diets than after the mixed-fat diet. Mean serum apolipoprotein B (-19%) and apolipoprotein A-I (-9%) concentrations were also significantly (P less than 0.0007) lower after the experimental diets. The experimental diets were equally effective in lowering total and lipoprotein cholesterol and apolipoprotein concentrations in plasma, indicating that dietary OA, LA, and LNA were equally hypocholesterolemic. |
| Dietary and hypothyroid hypercholesterolemia induces hepatic apolipoprotein E expression in the rat: direct role of cholesterol Santillo, M., A. Migliaro, et al. (1999), FEBS Lett 463(1-2): 83-6. Abstract: Apolipoprotein E (apo E) exerts a protective effect against atherosclerosis, related to its role in intracellular cholesterol removal and remnants clearance. In this study we investigated the effect of dietary and hypothyroid hypercholesterolemia, induced respectively by a high cholesterol diet and by propylthiouracil, on hepatic apo E expression in Wistar male rats. The Northern and Western blot analysis of hepatic mRNA and protein levels showed a 2-3-fold increase of apo E in hypercholesterolemic rats compared to controls. The incubation of FAO rat hepatoma cells with 25-OH cholesterol and mevalonate led to a three-fold increase of apo E mRNA, demonstrating a direct role of cholesterol on apo E expression. This effect was completely abolished by elevating intracellular cAMP levels with forskolin. Immunoblot and immunofluorescence analysis revealed that 25-OH cholesterol/mevalonate strongly increased also apo E protein synthesis and secretion in FAO cells. Our data demonstrate that hypercholesterolemia, apart of the cause (diet or hypothyroidism) induces liver apo E expression in the rat and that this effect can be directly related, via cAMP, to cholesterol. |
| Dietary and non-dietary predictors of serum total and HDL-cholesterol in men and women: results from the Scottish Heart Health Study Bolton-Smith, C., M. Woodward, et al. (1991), Int J Epidemiol 20(1): 95-104. Abstract: An analysis of the associations between dietary and non-dietary variables and serum total cholesterol (Total-C) and high density lipoprotein cholesterol (HDL-C) was performed using data from the Scottish Heart Health Study--a cross-sectional survey of men (n = 5123) and women (n = 5236), aged 40-59. Subjects completed a questionnaire which provided health, socio-demographic and food frequency data. Nutrient intakes were calculated from UK food composition tables using standard portion sizes. For men, the significant independent dietary predictors of Total-C, after adjustment for all the other dietary variables, were saturated fat and cereal fibre, and after adjustment for the non-dietary variables, were cereal fibre, saturated fat and cholesterol. For women, intake of vegetable fibre, white fish and beta-carotene were significant independent predictors of Total-C after adjustment for all the other dietary variables. Only beta-carotene remained significant after adjustment for all the non-dietary variables. Alcohol intake and body mass index were respectively the strongest positive and negative predictors of HDL-C for both sexes. In conclusion: (1) certain dietary factors may affect serum cholesterol levels differently for men and women; (2) a possible role for the antioxidant vitamins and fibre in the prediction of serum cholesterol, may be indicated, in addition to the 'classical' role of dietary cholesterol and saturated fat and (3) confounding between the social and dietary variables does occur, and confirms the need for multiple adjustments in studies of this nature. |
| Dietary animal proteins and cholesterol metabolism in rabbits Lovati, M. R., C. E. West, et al. (1990), Br J Nutr 64(2): 473-85. Abstract: The effect in rabbits of giving isonitrogenous purified diets containing casein, ovalbumin, fish protein, milk-whey protein and soya-bean protein were compared. The diets were balanced for cholesterol and for the amount and type of fat. When incorporated into low-cholesterol diets (0.08 g cholesterol/kg), casein, ovalbumin and soya-bean protein produced similar levels of serum cholesterol. With a high background of dietary cholesterol (1.5 g/kg), serum cholesterol concentrations increased with soya-bean protein, whey protein, casein and fish protein, in that order. Thus, the hypercholesterolaemic effect of casein in carefully balanced diets was only seen against a high-cholesterol background. The development of hypercholesterolaemia produced by giving fish protein was different from that produced by casein. First, less cholesterol accumulated in the very-low-density-lipoprotein fractions and more in the lipoproteins of higher density with fish protein than with casein. Second, fish protein, unlike casein, did not increase liver cholesterol. Third, transfer of rabbits from a diet containing soya-bean protein to one containing casein resulted in an immediate marked depression in neutral steroid and bile acid excretion in faeces. However, when rabbits were fed on the diet with fish protein after the diet with soya-bean protein, there was no significant depression in neutral steroid output and the depression in bile acid output was delayed. The present study suggests that different animal proteins cause hypercholesterolaemia by different mechanisms. |
| Dietary antioxidant lack, impaired hepatic glutathione reserve, and cholesterol gallstones Worthington, H. V., L. P. Hunt, et al. (2004), Clin Chim Acta 349(1-2): 157-65. Abstract: BACKGROUND: Theoretical considerations and experimental studies suggest a causal connection between micronutrient antioxidant insufficiency and the development of human gallstones. METHODS: Fasting plasma/serum samples from 24 patients with cholesterol gallstones-on unchanged lifestyles-were analysed for the four main micronutrient antioxidants, glutathione and factors that impact or report upon glutathione homeostasis. The results were assessed by comparison with laboratory referent ranges. RESULTS: The vitamin E:cholesterol ratio was lower in patients than controls (P=0.021) as also concentrations of beta-carotene (P=0.001) and vitamin C (P=0.001) but not selenium (P=0.280). A fall in plasma glutathione (P=0.001) was also accompanied by lower values of pyridoxyl-5-phosphate (the coenzyme that participates in vitamin B6-dependent enzyme reactions) which is involved in glutathione biosynthesis (P<0.001), and of folate (P=0.012) but not vitamin B12 (P=0.377) that participate in its regeneration via the methionine-homocysteine pathway. Despite these defects, values for plasma homocysteine were not significantly different from controls (P=0.092)-an anomaly rationalised by poor levels of precursor methionine (P=0.003) and cysteine (P=0.046). CONCLUSIONS: Micronutrient antioxidant-including sulphur amino acid-lack, with disturbed glutathione homeostasis, are features of cholesterol gallstone disease. |
| Dietary antioxidants preserve endothelium-dependent vessel relaxation in cholesterol-fed rabbits Keaney, J. F., Jr., J. M. Gaziano, et al. (1993), Proc Natl Acad Sci U S A 90(24): 11880-4. Abstract: Recent evidence suggests that dietary therapy with lipid-soluble antioxidants may be beneficial for patients with atherosclerotic vascular disease but the potential mechanism(s) for these observations remain obscure. Abnormalities in endothelium-dependent control of vascular tone develop early in the course of atherosclerosis and may result from oxidative modification of low density lipoproteins. We examined the role of dietary antioxidants in preserving normal endothelial cell vasodilator function in cholesterol-fed rabbits with particular attention to possible effects on serum lipoproteins, low density lipoprotein oxidation, and atherogenesis. Male New Zealand White rabbits were fed diets containing no additive (controls), 1% cholesterol (cholesterol group), or 1% cholesterol chow supplemented with either beta-carotene (0.6 g/kg of chow) or alpha-tocopherol (1000 international units/kg of chow) for a 28-day period. After dietary therapy, thoracic aortae were harvested for assay of vascular function and for pathologic examination and tissue antioxidant levels. Compared to controls, acetylcholine- and A23187-mediated endothelium-dependent relaxations were significantly impaired in vessels from the cholesterol group (P < 0.001), whereas vessels from animals treated with beta-carotene or alpha-tocopherol demonstrated normal endothelium-dependent arterial relaxation. Preservation of endothelial function was associated with vascular incorporation of alpha-tocopherol and beta-carotene but was unrelated to plasma lipoprotein levels, smooth muscle cell function, or the extent of atherosclerosis. Increased low density lipoprotein resistance to ex vivo copper-mediated oxidation was observed only in the alpha-tocopherol group. Our results suggest that dietary antioxidants may benefit patients with atherosclerosis by preserving endothelial vasodilator function through a mechanism related to vascular tissue antioxidant content and not reflected by assay of low density lipoprotein resistance to ex vivo oxidation. |
| Dietary associates of serum total, LDL, and HDL cholesterol and triglycerides in patients with coronary heart disease Erkkila, A. T., E. S. Sarkkinen, et al. (1999), Prev Med 28(6): 558-65. Abstract: BACKGROUND: Diet-lipid associations established in clinical trials have in general been weak or nonexistent in cross-sectional studies within a population. Our objective was to analyze the dietary associates of serum lipids in patients with coronary heart disease (CHD) not using lipid-lowering medication. METHODS: Patients with coronary bypass grafting (n = 49), balloon angioplasty (n = 46), acute myocardial infarction (n = 79), and acute myocardial ischemia (n = 79) participated in a survey (EUROASPIRE). Patients were selected from hospital records at least 6 months after hospitalization. Diet was assessed by a food record, a short questionnaire, and fatty acid composition of serum cholesteryl esters (CE). RESULTS: Neither the intake of total fat nor that of saturated, monounsaturated, or polyunsaturated fatty acids was associated with serum lipids. Use of soft margarine on bread (though not in cooking or baking) and high intake of fiber and cereal products were associated with low total cholesterol. Linoleic acid in CE was inversely associated with total cholesterol and triglycerides, and eicosapentaenoic acid was inversely associated with triglycerides and positively associated with HDL cholesterol. CONCLUSIONS: In the present study use of soft margarine on bread (though not in cooking or baking) and high intake of fiber and cereal products were associates of lowered serum cholesterol concentrations in CHD patients. Fatty acid composition of CE reflected dietary fatty acid intake involved in cholesterol lowering better than food records. |
| Dietary beta-carotene reduces serum lipid concentrations in spontaneously hypertensive rats fed a vitamin A-fortified and cholesterol-enriched diet Tsai, A. C., H. A. Mazeedi, et al. (1992), J Nutr 122(9): 1768-71. Abstract: The effects of dietary beta-carotene on serum lipid concentrations were examined in spontaneously hypertensive (SH) rats. Groups of SH rats were fed a semipurified, vitamin A-fortified and cholesterol-enriched diet supplemented with 0, 125, 250 or 500 mg beta-carotene/kg diet for a period of 44 d. beta-Carotene supplementation resulted in significant dose-related decreases in serum total, LDL and HDL cholesterol concentrations and serum total, VLDL and LDL triacylglycerol concentrations. The ratio of HDL cholesterol to total cholesterol was unchanged or slightly increased by dietary beta-carotene. The study suggests that dietary beta-carotene has antihyperlipidemic effects in SH rats. The effects in humans and the mechanism of the effects remain to be investigated. |
| Dietary cardiovascular risk factors and serum cholesterol in an Old Order Mennonite community Glick, M., A. C. Michel, et al. (1998), Am J Public Health 88(8): 1202-5. Abstract: OBJECTIVES: Dietary and coronary heart disease risk factors in Old Order Mennonite men and women were examined. METHODS: A food frequency questionnaire was mailed to 250 Mennonites who had participated in a previous study of coronary heart disease risk factors. RESULTS: Mennonites consumed a diet high in total fat, saturated fats, and cholesterol. Men had lower average serum cholesterol levels (174 mg/dL) than women (191 mg/dL). CONCLUSIONS: The Mennonites' diet was similar to that of the overall US population in saturated fat percentage and higher in cholesterol. Serum cholesterol levels, adiposity, and blood pressure were lower than expected among Mennonite men, perhaps because of their higher levels of physical activity. |
| Dietary casein and soybean protein affect the concentrations of serum cholesterol, triglyceride and free amino acids in rats Horigome, T. and Y. S. Cho (1992), J Nutr 122(11): 2273-82. Abstract: This work was undertaken to investigate the concentrations of free amino acids in blood after food was withheld from growing, male Wistar rats fed cholesterol-free, low fat (1 g corn oil/100 g) diets with casein or soybean protein for 2 wk. A diet containing 22.5 or 23.5 g/100 g of soybean protein was hypocholesterolemic compared with a diet containing 20.0 g casein/100 g diet. A comparison of serum amino acids in soybean protein-fed vs. casein-fed rats showed that, whereas concentrations of many amino acids were lower in the soybean protein-fed rats compared with the casein-fed groups, glycine was the only amino acid having a higher concentration. Further, alanine was significantly lower in the soybean protein-fed rats compared with the casein-fed rats, and the protein-induced differences in glycine and alanine concentrations of unfed rats were reproducible. When diets containing 15.0% casein or 30.0% soybean protein, a casein diet supplemented with glycine and a soybean protein diet supplemented with methionine were compared, the changes in serum glycine and alanine correlated with the changes in serum cholesterol. Concentrations of several amino acids, particularly valine, leucine and tyrosine, also changed when serum cholesterol concentrations varied, but these effects could not be explained by our experiments. The results suggest that a change in serum concentration of glycine and alanine of unfed rats may be related to the change in serum cholesterol concentration. |
| Dietary changes influence cholesterol levels less than expected Werko, L. (1992), Lakartidningen 89(13): 1046, 1049. |
| Dietary cholesterol absorption, and sterol and bile acid excretion in hypercholesterolemia-resistant white rabbits Overturf, M. L., S. A. Smith, et al. (1990), J Lipid Res 31(11): 2019-27. Abstract: The New Zealand white (NZW) rabbit fed a 0.1% cholesterol-enriched diet (CD) typically responds (normoresponsive, NR) by quickly developing hypercholesterolemia. To study the underlying mechanisms responsible for the widespread phenomenon of inter-individual variability of response to dietary cholesterol, a unique hypercholesterolemia-resistant (RT) rabbit model was developed. These animals were utilized to investigate selected potential mechanisms that might enable the RT animal to compensate for dietary cholesterol overload. When rabbits were fed the low-cholesterol stock diet, there was no significant difference in the plasma cholesterol concentrations of the NR and the RT animals. However, a significant rise was observed in the NR rabbits within 1 month of their being placed on the cholesterol-enriched diet; the plasma cholesterol concentration of the RT animals was not affected. During consumption of the cholesterol diet the cholesterol absorption rate was somewhat greater in the NR rabbits (P less than 0.05), whereas intestinal transit times and the fecal excretion of neutral steroids were substantially the same in both groups. In contrast, the fecal bile acid excretion of the RT animals was more than twice as great (P less than 0.0001) as that of the NR animals. We conclude that the response to dietary cholesterol is a heritable trait in these rabbits and that, although less dietary cholesterol was absorbed by the RT animals, it appears that a major mechanism controlling plasma cholesterol levels involves the rate of conversion of cholesterol to bile acids and their subsequent excretion. |