Abstract
AimsTo systematically evaluate the evidence regarding the effects of foods on LDL cholesterol levels and to compare the findings with current guidelines. Data synthesisFrom inception through June 2019, we searched PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials for guidelines, systematic reviews, and RCTs (for coffee intake only) of at least 13 days duration. Additionally, we searched Trip database for guidelines from 2009 through Oct 2019. Language was restricted to English. The strength of evidence was evaluated using The Grading of Recommendations Assessment, Development, and Evaluation (GRADE). A total of 37 guidelines, 108 systematic reviews, and 20 RCTs were included. With high evidence, foods high in unsaturated and low in saturated and trans fatty acids (e.g. rapeseed/canola oil), with added plant sterols/stanols, and high in soluble fiber (e.g. oats, barley, and psyllium) caused at least moderate (i.e. 0.20–0.40 mmol/L) reductions in LDL cholesterol. Unfiltered coffee caused a moderate to large increase. Soy protein, tomatoes, flaxseeds, and almonds caused small reductions. With moderate evidence, avocados and turmeric caused moderate to large reductions. Pulses, hazelnuts, walnuts, high-fiber/wholegrain foods, and green tea caused small to moderate reductions, whereas sugar caused a small increase. Other identified foods were either neutral or had low or very low evidence regarding their effects. ConclusionsSeveral foods distinctly modify LDL cholesterol levels. The results may aid future guidelines and dietary advice for hypercholesterolemia.
Highlights
Lifestyle management remains the foundation for the prevention of cardiovascular disease (CVD)
The dietary choices that influence the level of low-density lipoprotein (LDL) cholesterol are distinctly different from those concerning hypertriglyceridemia, which can be improved by omega-3 supplements and reduced intakes of alcohol or carbohydrates [2]
Two randomized controlled trials (RCTs) compared special coffees for which no meta-analysis was performed, but there was no significant effect on LDL cholesterol in either study [26,27]. In this umbrella review of guidelines and systematic reviews, as well as systematic review and meta-analysis of RCTs on coffee, previously established evidence was consolidated for the beneficial effects of foods high in unsaturated and low in saturated or trans fatty acids, e.g. non-tropical oils in place of solid animal and industrially processed fats; for soluble/viscous fiber, especially from oats, barley, and psyllium; for functional foods with added plant sterols and stanols; and for foods rich in plant proteins, especially soybeans
Summary
Lifestyle management remains the foundation for the prevention of cardiovascular disease (CVD). The dietary choices that influence the level of low-density lipoprotein (LDL) cholesterol are distinctly different from those concerning hypertriglyceridemia, which can be improved by omega-3 supplements and reduced intakes of alcohol or carbohydrates [2]. This distinction may require clarification, as only LDL cholesterol is considered as a critical [5], causal, and cumulative risk factor [2]; and represents the primary target for CVD risk reduction [2]. This study aimed to systematically evaluate the evidence from RCTs reporting effects of foods on LDL cholesterol levels and to compare the findings with current guidelines
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