Lipid lowering and weight reduction by home-delivered dietary modification in coronary heart disease patients taking statins

Abstract

W diet therapy remains a standard treatment for hypercholesterolemia either alone or in combination with drug treatment,1–5 difficulties continue to exist with dietary compliance. In today’s fast food environment where fewer meals are prepared in the home, a dietary intervention program where meals and snacks are home-delivered may have beneficial effects in increasing diet adherence, while providing continuing nutrition education. This study examines if such a dietary program would result in additional serum lipid reductions beyond the reductions achieved by concurrent drug treatment for hypercholesterolemia in heart disease patients. • • • Forty-seven subjects with established heart disease were recruited from the greater Boston area to participate in a 10-week (8-week intervention, 2-week lead-in period) dietary and lifestyle modification study. Our results are based on 29 subjects (19 men and 10 postmenopausal women, mean age of 61 6 9 years, mean baseline body mass index [BMI] 32.4 6 5.4 kg/m). Six subjects were excluded from this analysis because they were not concurrently being treated with statins, 5 subjects withdrew, 5 subjects violated the protocol by making changes to current medications, and 2 subjects were excluded because of a lack of laboratory measurements. Informed consent, a brief medical history, and a list of current medications were collected at the first study visit. All subjects had been taking statins for at least 6 weeks on a stable dose before enrollment and were not taking vitamins for 4 weeks. Sixty-two percent of subjects were taking atorvastatin, 17% simvastatin, 14% pravastatin, and 7% lovastatin with mean doses (range) of 27 (10 to 60), 24 (20 to 40), 20 (20), and 30 (10 to 40) mg/day, respectively. At each of the 3 study visits (baseline, 4 weeks, and 8 weeks), anthropometric measurements (height, weight, waist circumference, hip circumference, waist-to-hip ratio, and BMI), blood pressure, fasting lipid profile (total cholesterol, low-density lipoprotein [LDL] cholesterol, triglycerides, and high-density lipoprotein [HDL] cholesterol), and 3-day food record were collected. Lipid profiles were processed by the Lipid Metabolism Lab of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University as previously described.5 LDL cholesterol was measured directly as previously described.6 Levels of serum vitamins, cysteine, and homocysteine were measured.7,8 All assays had coefficients of variation of ,5%. A registered dietitian analyzed food records using Nutritionist Five software, version 2.1, (First Data Bank, Inc. San Bruno, California). All other dietary interventions were facilitated by the LifeSpring Nutrition Inc., Richmond, California, registered dietitian. The LifeSpring-registered dietitian telephoned each subject to complete an in-depth interview, dietary assessment, and calculation of energy needs based on the Harris-Benedict equations to achieve weight loss (1 to 2 pounds/week) or maintenance (BMI goal of 23 kg/m). Weekly menu plans included a full week of breakfast, lunch, dinner, and snack recommendations and they were individualized to meet needs (diet restrictions, eating pattern, food allergies or intolerances, and food preferences). Weekly calls were made by the LifeSpring registered dietitian to discuss any questions, problems, to give encouragement, and to adjust calorie levels as needed to reach weight loss goals. Subjects were provided a LifeSpring program kit containing diet education materials From the New England Medical Center, Boston, Massachusetts; Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts; and LifeSpring Nutrition Inc., Richmond, California. E-mail: www.homenutrition.com. This report was supported by LifeSpring Nutrition Inc., Richmond, California; and Grant RO1 HL57477 From the National Institutes of Health, Bethesda, Maryland. Dr. Schaefer’s address is: Lipid Metabolism Laboratory, Tufts University, 711 Washington Street, Boston, Massachusetts 02111. E-mail: eschaefer@hnrc.tufts.edu. Manuscript received July 26, 2000; revised manuscript received and accepted November 6, 2000. TABLE 1 Mean Vitamin Content of Weekly LifeSpring Meal Plan