Abstract
Lifestyle modification to decrease cardiovascular disease (CVD) risk has recently been reaffirmed by both the National Cholesterol Education Program and American Heart Association (AHA). Using a randomized crossover design, the Therapeutic Lifestyle Change (TLC)/Step 2 diet relative to a typical Western diet was assessed in 36 moderately hypercholesterolemic subjects in a clinical setting under iso-weight conditions. Mean lipoprotein and apolipoprotein levels (fasting and non-fasting), fatty acid profiles, parameters of HDL metabolism, and glucose homeostasis were determined. Relative to the Western diet, the TLC/Step 2 diet resulted in 11% and 7% lower LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C), respectively, with no significant change in TG levels or total cholesterol-HDL-C ratio. Similar responses were observed in the non-fasting state. Linoleic (18:2n-6c) and α-linolenic (18:3n-3) acids increased at the expense of oleic acid (18:1n-9c) in the cholesteryl ester, TG, and phospholipid subfractions. The dietary changes had no significant effect on fractional esterification rate of HDL, phospholipid transfer protein (PLTP), or cholesterol ester transfer protein activities, or glucose and insulin levels. Female and male subjects responded similarly. The TLC/Step 2 diet resulted in a decrease in some CVD risk factors and no apparent adverse effects in others.—Lichtenstein, A. H., L. M. Ausman, S. M. Jalbert, M. Vilella-Bach, M. Jauhiainen, S. McGladdery, A. T. Erkkilä, C. Ehnholm, J. Frohlich, and E. J. Schaefer. Efficacy of a Therapeutic Lifestyle Change/Step 2 diet in moderately hypercholesterolemic middle-aged and elderly female and male subjects.
Highlights
Lifestyle modification to decrease cardiovascular disease (CVD) risk has recently been reaffirmed by both the National Cholesterol Education Program and American Heart Association (AHA)
We investigated the effect of implementing such changes on a range of parameters associated with disease risk, lipoprotein profiles in the fasted and non-fasted state, measures of HDL metabolism, glucose and insulin levels, and fatty acid profiles
ApoB and Apolipoprotein A-I (apoA-I) levels were lower after subjects consumed the Therapeutic Lifestyle Change (TLC)/Step 2 diet relative to the Western diet, following a pattern similar to that of LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C), respectively, the difference in apolipoprotein B (apoB) levels did not reach statistical significance in the male subjects
Summary
Thirty-six subjects (18 women and 18 men) with a mean age of 64 years (age range, 55 to 74 years) were selected to have LDL-C levels greater than 130 mg/dl (3.36 mmol/l) while consuming their usual diets. All subjects provided a medical history, underwent a physical examination, and had clinical chemistr y analysis performed prior to enrollment. The subjects had no evidence of any chronic illness, including hepatic, renal, thyroid, or cardiac dysfunction. They did not smoke and were not taking medications known to affect plasma lipid levels (lipid-lowering drugs, -blockers, diuretics, or hormones) or vitamin and/or mineral supplements. Subjects were older than 50 years, and all women were postmenopausal and not taking hormone replacement therapy. The study was approved by the Human Investigation Review Board of Tufts University and New England Medical Center, and all subjects gave informed consent prior to the start of the study
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