Change In Saturated Fat Intake Research Articles

Dietary changes in an acceptance-based weight loss pilot intervention study

ObjectiveTo evaluate pre-post changes in dietary intake and the possible role of emotional eating (EE) as a mediator of dietary changes in a novel behavioral weight loss intervention (Live FREE). DesignSecondary analysis of an open label pilot study. ParticipantsThirty-nine adults with overweight/obesity and EE. InterventionLive FREE is a 16-week group-based program in which participants learn emotional regulation skills from Dialectical Behavior Therapy followed by traditional behavioral weight loss techniques. Main outcome measureDietary intake and EE were measured at baseline and post-treatment with the Automated Self-Administered 24-Hour Dietary Assessment Tool and the depression subscale of the revised Emotional Eating Scale. AnalysisPaired sample t-tests and mediation for repeated measures designs. ResultsConsumption of calories (t(33) = 5.31, p < .001), saturated fat (t(33) = 5.25, p < .001), and added sugar (t(33) = 4.44, p < .001) decreased from pre-post-treatment. EE change mediated the effect of the intervention on change in saturated fat intake pre-post-treatment, B = 6.16, BootSE = 2.47, 95 % CI (1.53 to 11.37), but did not mediate change in caloric or added sugar intake. Conclusions and implicationsParticipants reported improvement in caloric, saturated fat, and added sugar intake. Improvement in EE may be closely related to decreasing saturated fat consumption. (200).

Evaluation of an intervention to provide brief support and personalized feedback on food shopping to reduce saturated fat intake (PC-SHOP): A randomized controlled trial.

Guidelines recommend reducing saturated fat (SFA) intake to decrease cardiovascular disease (CVD) risk, but there is limited evidence on scalable and effective approaches to change dietary intake, given the large proportion of the population exceeding SFA recommendations. We aimed to develop a system to provide monthly personalized feedback and healthier swaps based on nutritional analysis of loyalty card data from the largest United Kingdom grocery store together with brief advice and support from a healthcare professional (HCP) in the primary care practice. Following a hybrid effectiveness-feasibility design, we tested the effects of the intervention on SFA intake and low-density lipoprotein (LDL) cholesterol as well as the feasibility and acceptability of providing nutritional advice using loyalty card data. The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study is a parallel randomized controlled trial with a 3 month follow-up conducted between 21 March 2018 to 16 January2019. Adults ≥18 years with LDL cholesterol >3 mmol/L (n = 113) were recruited from general practitioner (GP) practices in Oxfordshire and randomly allocated to "Brief Support" (BS, n = 48), "Brief Support + Shopping Feedback" (SF, n = 48) or "Control" (n = 17). BS consisted of a 10-minute consultation with an HCP to motivate participants to reduce their SFA intake. Shopping feedback comprised a personalized report on the SFA content of grocery purchases and suggestions for lower SFA swaps. The primary outcome was the between-group difference in change in SFA intake (% total energy intake) at 3 months adjusted for baseline SFA and GP practice using intention-to-treat analysis. Secondary outcomes included %SFA in purchases, LDL cholesterol, and feasibility outcomes. The trial was powered to detect an absolute reduction in SFA of 3% (SD3). Neither participants nor the study team were blinded to group allocation. A total of 106 (94%) participants completed the study: 68% women, 95% white ethnicity, average age 62.4 years (SD 10.8), body mass index (BMI) 27.1 kg/m2 (SD 4.7). There were small decreases in SFA intake at 3 months: control = -0.1% (95% CI -1.8 to 1.7), BS = -0.7% (95% CI -1.8 to 0.3), SF = -0.9% (95% CI -2.0 to 0.2); but no evidence of a significant effect of either intervention compared with control (difference adjusted for GP practice and baseline: BS versus control = -0.33% [95% CI -2.11 to 1.44], p = 0.709; SF versus control = -0.11% [95% CI -1.92 to 1.69], p = 0.901). There were similar trends in %SFA based on supermarket purchases: control = -0.5% (95% CI -2.3 to 1.2), BS = -1.3% (95% CI -2.3 to -0.3), SF = -1.5% (95% CI -2.5 to -0.5) from baseline to follow-up, but these were not significantly different: BS versus control p = 0.379; SF versus control p = 0.411. There were small reductions in LDL from baseline to follow-up (control = -0.14 mmol/L [95% CI -0.48, 0.19), BS: -0.39 mmol/L [95% CI -0.59, -0.19], SF: -0.14 mmol/L [95% CI -0.34, 0.07]), but these were not significantly different: BS versus control p = 0.338; SF versus control p = 0.790. Limitations of this study include the small sample of participants recruited, which limits the power to detect smaller differences, and the low response rate (3%), which may limit the generalisability of these findings. In this study, we have shown it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and to provide personalized advice to encourage healthier choices using supermarket loyalty card data. There was no evidence of large reductions in SFA, but we are unable to exclude more modest benefits. The feasibility, acceptability, and scalability of these interventions suggest they have potential to encourage small changes in diet, which could be beneficial at the population level. ISRCTN14279335.

Brief support and personalised feedback on food shopping to encourage saturated fat reduction: the PC-SHOP randomised controlled trial

AbstractReducing saturated fat (SFA) intake can lower low-density lipoprotein (LDL)-cholesterol and thereby cardiovascular disease (CVD) but there are no brief interventions sufficiently scalable to achieve this. The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study developed and tested a behavioural intervention to provide health professional (HP) advice alone or in combination with personalised feedback on food shopping, which was delivered using a bespoke tool that created a nutritional profile of the grocery shopping based on loyalty card data from the UK largest supermarket.Participants with raised LDL-cholesterol were randomly allocated to one of three groups: ‘No Intervention’ (n = 17), ‘Brief Support’ (BS, n = 48), ‘Brief Support plus Shopping Feedback’ (BSSF, n = 48). BS consisted of a 10-minute consultation with a nurse to inform and motivate participants to reduce their SFA intake. The BSSF group received brief support as well as personalised feedback on the SFA content of their grocery shopping including lower SFA swaps. The primary outcome was the between-group difference in the change between baseline and 3 months in SFA intake (% total energy intake) adjusted for baseline SFA intake and GP practice. The trial was powered to detect a reduction in SFA of 3% (SD3).There was no evidence of a difference between the groups. Changes in SFA intake from baseline to follow-up were: -0.7% (SD3.5) in BS, -0.9% (SD3.6) in BSSF and -0.1% (SD3.3) with no intervention. Compared to no intervention, the adjusted difference in SFA intake was -0.33%; 95%CI -2.11, 1.44 with BS and -0.11%; 95%CI -1.92, 1.69 with BSSF. There was no significant difference in total energy intake (BS: -152kcal; 95%CI -513, 209; BSSF: -152kcal; 95%CI -516, 211); body weight (BS: -1.0 kg; 95%CI -2.5, 0.5; BSSF: -0.6 kg 95%CI -2.1, 1.0); or LDL-cholesterol (BS: -0.15mmol/L; 95%CI -0.47, 0.16; BSSF: -0.04mmol/L; 95%CI -0.28, 0.36) compared to no intervention.This trial shows that it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and we have developed a system to provide personalised advice to encourage healthier choices using supermarket loyalty data. This small trial showed no evidence of large benefits but we are unable to exclude more modest benefits. Even a reduction of 1% in SFA intake when replaced by polyunsaturated fat may reduce CVD incidence by 8%, suggesting that a larger trial to assess whether benefits of this size may occur is now warranted.

Lipid findings from the Diabetes Education to Lower Insulin, Sugars, and Hunger (DELISH) Study

BackgroundA carbohydrate-restricted (CR) diet can improve glycemic control in people with type 2 diabetes mellitus (T2DM). There are concerns, however, that the high dietary fat content of CR diets can increase low-density lipoprotein cholesterol (LDL-C), thus increasing cardiovascular disease (CVD) risk. Quantifying CVD risk associated with changes in LDL-C in the context of CR diets is complicated by the fact that LDL-C reflects heterogeneous lipids. For example, small LDL particle number (sLDL-P) is more closely associated with CVD risk than is total LDL-C, and CR diets tend to decrease the proportion of sLDL-C in LDL-C, which standard lipid measures do not indicate. Advanced lipoprotein assays, such as nuclear magnetic resonance (NMR) testing, can subfractionate lipoproteins by size and density and may better depict the effects of CR diets on CVD risk.MethodsAdults (N = 58) with T2DM (n = 37 women; baseline HbA1c ≥ 6.5%) completed a 6-month group-based CR diet intervention. We obtained a standard lipid panel, advanced lipoprotein assays (NMR testing), and two 24-h diet recalls at baseline and post-intervention (6 months). Participants also completed home-based blood ketone testing (a biological index of dietary adherence) during the final five weeks of the intervention.ResultsFrom baseline to post-intervention, participants had increased mean HDL-C, decreased triglycerides and triglyceride/HDL ratio, decreased mean sLDL-P, and increased LDL size, which reflect reductions in CVD risk (ps < 0.05). Participants did not have statistically significant changes in total cholesterol, non-HDL-C cholesterol, LDL-P, or HDL-P. Twelve participants (23.1%) had a ≥ 5% increase in sLDL-P. Exploratory analyses revealed that participants with sLDL-P increases of ≥ 5% reported larger increases in servings of red meat than participants without sLDL-P increases of ≥ 5% (+ 0.69 vs − 0.29 servings; p = 0.033). Changes in saturated fat intake were not associated with changes in sLDL-P.ConclusionsAmong most participants, we observed changes in several lipid measures consistent with decreased CVD risk. Approximately one in four participants evidenced increases in sLDL-P. Further research should clarify whether individuals with increased sLDL-P after implementing a CR diet can reverse observed increases by limiting red meat consumption.Trial registrationClinicalTrials.gov, NCT03207711, Registered 6/11/2017. Retrospectively registered.

Substituting polyunsaturated fat for saturated fat: A health impact assessment of a fat tax in seven European countries.

There is evidence that replacing saturated fat (SFA) with polyunsaturated fat (PUFA) lowers ischemic heart disease (IHD). In order to improve the population’s diet, the World Health Organization has called for the taxation of foods that are high in SFA. We aimed to assess the potential health gains of a European fat tax by applying the SFA intake reduction that has been observed under the Danish fat tax to six other European countries. For each country, we created a fat tax scenario with a decreased SFA intake and a corresponding increase in PUFA. We compared this fat tax scenario to a reference scenario with no change in SFA intake, and to a guideline scenario with a population-wide SFA intake in line with dietary recommendations. We used DYNAMO-HIA to dynamically project the policy-attributable IHD cases of these three scenarios 10 years into the future. A fat tax would reduce prevalent IHD cases by a minimum of 500 and 300 among males and females in Denmark, respectively, up to a maximum of 5,600 and 4,000 among males and females in the UK. Thereby, the prevented IHD cases under a fat tax scenario would correspond to between 11.0% (in females in the Netherlands) and 29.5% (in females in Italy) of the prevented IHD cases under a guideline scenario, which represents the maximum preventable disease burden. Henceforth, our quantification of beneficial health impacts makes the case for the policy debate on fat taxes.

Modification in a single meal is sufficient to provoke benefits in inflammatory responses of individuals at low-to-moderate cardiometabolic risk

Postprandial state is characterized by metabolic changes which may elevate circulating inflammatory biomarkers, used to assess cardiometabolic risk. It is unclear if biological benefits of certain food components could be obtained by a short-term change in a single meal of Brazilian's habitual diet. We investigated the postprandial effects of 2 fat tolerance tests (FTT) with different isocaloric meals (a typical Brazilian and a modified meal) differing by type of fatty acids and fiber contents, prior to and after breakfast interventions. This crossover clinical trial included 80 overweight individuals with at least one cardiometabolic risk factor, (35-69 years) who received two isocaloric breakfast interventions for 4 weeks, with a 2-week washout. The Brazilian breakfast was saturated fat-enriched while the modified one was rich in unsaturated fatty acids and fibers. Before and after intervention periods, individuals underwent two FTT with meals with similar composition to the interventions breakfasts but higher energy content. Variables were compared by repeated-measures ANOVA. Correlations were assessed by Pearson's coefficient. At the end of both interventions, participants did not change plasma glucose or triglycerides. The higher IL-6 and IL-8 responses to the FTT with the Brazilian meal compared to that with the modified meal was accentuated after the interventions (p-diet <0.01; p-time <0.01). Acutely, E-selectin, TNF-α, IFN-γ, IL-10 and IL-17 concentrations did not increase in response to the FTTs, but showed higher values only after the Brazilian intervention. In contrast, intervention with the modified breakfast induced reductions in fasting and postprandial cytokines (p-diet <0.01). Changes in MUFA and PUFA intakes were inversely correlated to changes in inflammatory markers, while changes in saturated fat intake were directly correlated to IFN-γ and IL-6. Isocaloric meals with distinct nutrient composition elicit different postprandial inflammatory responses after a relatively short intervention in a single meal. Each saturated fat-enriched meal consumed, as well as each unsaturated fat and fiber-enriched meal may induce pro- or anti-inflammatory responses that could impact on the cardiometabolic risk profile.

Change in the family food environment is associated with positive dietary change in children

BackgroundThe family food environment is an important influence in the development of children’s dietary habits. Research suggests that influences of current dietary behaviour and behaviour change may differ. The aims of this paper were to: (1) investigate the association between the food environment at baseline and change in children’s saturated fat intake; and (2) to explore whether a change in the food environment was associated with a change in children’s saturated fat intake.MethodSecondary analysis of a 12 week cluster randomised controlled trial in 133 4-13 year old children. Families were randomly allocated to parental education regarding changing to reduced-fat dairy foods or a comparison non-dietary behaviour. The interventions were family focused. Parents received education from a dietitian in 3x30minute sessions to facilitate behaviour change. Parents completed a comprehensive questionnaire capturing three domains of the food environment – Parent knowledge and attitudes; shaping practices; and behaviours and role modelling. Children’s dietary intake was assessed via multiple 24-hour recalls at baseline and week 12. Changes in the family food environment and primary outcome (saturated fat) were calculated. Hierarchical linear regression models were performed to explore the association between baseline and change in food environment constructs and change in saturated fat intake. Standardised Beta are presented (p<0.05).ResultsAfter adjustments for child and family demographics, higher levels of perceived food availability (β=-0.2) at baseline was associated with greater reduction in saturated fat intake, where as higher perceived responsibility (β=0.2), restriction (β=0.3) and pressure to eat (β=0.3) were associated with lesser change in saturated fat. An increase in nutrition knowledge (β=-0.2), perceived responsibility (β=-0.3) and restriction (β=-0.3) from baseline to week 12 were associated with greater reduction in saturated fat intake.ConclusionsThe present study was one of the first to quantify changes in the family food environment, and identify a number of factors which were associated with a positive dietary change. Because interventions focus on behaviour change, the findings may provide specific targets for intervention strategies in the future.Trial registrationAustralia New Zealand Clinical Trials Registry ACTRN12609000453280.

Replacing foods high in saturated fat by low-saturated fat alternatives: a computer simulation of the potential effects on reduction of saturated fat consumption

This simulation study aimed to assess the change in saturated fat intake achieved by replacing one to three of the products contributing most to individual saturated fat intake by alternative products low in saturated fat. Food consumption data of 750 participants (aged 19-30 years) from a recent Dutch food consumption survey were used. For each participant, the three products (from different product groups) that contributed most to their saturated fat intake were ranked in order of diminishing contribution. These products were sequentially replaced by lower saturated fat alternatives that were available in Dutch supermarkets. Mean percentage energy (en%) from saturated fat and energy intake in kJ per d were calculated before and after each of the three replacements. Dutch cheese, meat (for dinner) and milk were the main contributors to saturated fat intake for most participants. Starting at a mean en% from saturated fat of 12.4, the three replacements together resulted in a mean reduction of 4.9 en% from saturated fat. The percentage of participants meeting the recommendation for saturated fat ( < 10 en%) increased from 23.3 % to 86.0 %. We conclude that the replacement of relatively few important high-saturated fat products by available lower-saturated fat alternatives can significantly reduce saturated fat intake and increase the proportion of individuals complying with recommended intake levels.

Effects of saturated and unsaturated fatty acids on estimated desaturase activities during a controlled dietary intervention

Background and aims Direct measurement of desaturase activities are difficult to obtain in humans. Consequently, surrogate measures of desaturase activity (estimated desaturase activities) have been frequently used in observational studies, and estimated Δ 9- (or stearoyl-CoA-desaturase (SCD)), Δ 6- and Δ 5-desaturase activities have been associated with cardiometabolic disease. Data on how the markers of desaturase activities are modified by changes in dietary fat quality are lacking and therefore warrant examination. Methods and results In a two-period (three weeks) strictly controlled cross-over study, 20 subjects (six women and 14 men) consumed a diet high in saturated fat (SAT-diet) and a rapeseed oil diet (RO-diet), rich in oleic acid (OA), linoleic acid (LA) and α-linolenic acid (ALA). Estimated desaturase activities were calculated as precursor to product FA ratios in serum cholesteryl esters and phospholipids. The estimated SCD [16:1 n-7/16:0] and Δ 6-desaturase [20:3 n-6/18:2 n-6] was significantly higher while Δ 5-desaturase [20:4 n-6/20:3 n-6] was significantly lower in the SAT-diet ( P < 0.001 for all), compared to the RO-diet. The serum proportions of palmitic, stearic, palmitoleic and dihomo-γ-linolenic acids were significantly higher in the SAT-diet while the proportions of LA and ALA were significantly higher in the RO-diet. Conclusion This is the first study to demonstrate that surrogate measures of desaturase activities change as a consequence of an alteration in dietary fat quality. Both the [16:1/16:0]-ratio and 16:1 seem to reflect changes in saturated fat intake and may be useful markers of saturated fat intake in Western countries.

Dietary Indiscretion and Statin Use

To determine whether statin use leads to dietary indiscretion, this longitudinal cohort study examined the impact of statin initiation on saturated fat intake. We interviewed 71 patients who had received a new prescription for statins for primary prevention of cardiovascular disease, first at the time of prescription and then again 3 and 6 months later. Patients were asked about their beliefs regarding diet and medications as well as their diet during the past 24 hours in all interviews and about their adherence to statins in the 3- and 6-month follow-up interviews. At the time of statin prescription, 54 participants (76 percent) wanted to reduce dietary fat, 50 (70 percent) believed statin use could cure their hyperlipidemia, and 31 (44 percent) thought that physicians prescribed statins to them despite their preference to continue to try dietary changes. After 6 months of statin use, no significant change in saturated fat intake was noted.

Change in saturated fat intake is associated with progression of carotid and femoral intima-media thickness, and with levels of soluble intercellular adhesion molecule-1

Background: A high saturated fat (SFA) intake may stimulate progression of atherosclerosis, and may be positively associated with expression of adhesion molecules. Methods: In moderately hypercholesterolaemic participants of a dietary intervention study ( n=103; 55±10 years), we examined associations between reported changes in SFA intake and changes in carotid and femoral intima-media thickness (IMT) and soluble intercellular adhesion molecule-1 (sICAM-1) levels after 2 years. The carotid and femoral IMT was assessed by high-resolution B-mode ultrasound images. Results: After 2 years, dietary intake of SFA decreased with 1.8±2.6% of energy ( P<0.01). In the lowest quintile of change in SFA intake (−5.9±1.4% of energy), changes in carotid and femoral IMT were +0.03 mm (SEM 0.03) and −0.09 mm (SEM 0.07), respectively, versus +0.10 mm (SEM 0.03), +0.17 mm (SEM 0.07) in the top quintile (+1.6±0.7% of energy) ( P linear trend 0.07 (carotis), 0.02 (femoralis)). Changes in sICAM-1 were −19.0 ng/nl (SEM 5.6) in the lowest quintile, versus +8.6 ng/ml (SEM 5.3) in the top quintile ( P linear trend <0.001), adjusted for baseline level, SFA intake, body mass index, age, changes in intake of fruit, polyunsaturated fat, and dietary cholesterol. Adjustments for changes in established risk factors did not alter these results. Conclusions: Decreased SFA intake may reduce progression of atherosclerosis, as assessed by IMT, and is associated with reduced levels of sICAM-1 after 2 years. Further research using randomised placebo-controlled trials is necessary to exclude potential confounding variables and to confirm causality.

Twenty-year dynamics of serum cholesterol levels in the middle-aged population of eastern Finland.

In cross-sectional analyses, serum cholesterol levels differ among different age groups. However, secular time trends in cholesterol levels can be seen across age groups in a population. A birth cohort analysis provides useful information on the combined effect of age and time on changes in serum cholesterol levels. To analyze the 20-year dynamics of serum total cholesterol levels in relation to age, sex, birth cohort, time period, mortality rate, and changes in the intake of saturated fats. Cross-sectional measurements of serum total cholesterol levels in five independent population surveys done in 1972, 1977, 1982, 1987, and 1992. Kuopio and North Karelia provinces in eastern Finland. Random sample of 16,711 men and 17,542 women 25 to 64 years of age. Persons in the oldest birth cohort were born in 1913; persons in the youngest birth cohort were born in 1967. Total serum cholesterol levels and daily intake of dietary fat. Between 1972 and 1992, mean cholesterol levels decreased with time in each age group and for both sexes. According to the cross-sectional data, cholesterol levels increased with age and increased more steeply in women than in men. Contrary to these data, cholesterol levels in birth cohorts did not increase with age. Cholesterol levels did not change at all within birth cohorts of women and started to decrease after 45 years of age in birth cohorts of men. Cholesterol levels in the youngest birth cohorts (persons 25 to 29 years of age) entering the study each study year were markedly lower than levels in the same age group in the previous survey of risk factors. Daily intake of saturated fat decreased markedly between 1972 and 1992. Most of this decrease could be explained by change in intake of liquid dairy products and spreadable fats. In both sexes, changes in saturated fat intake were correlated with the time period, whereas the association with age was weak. In this Finnish population, total serum cholesterol levels are more closely associated with birth cohort than with age. Changes in dietary intake of saturated fat over time may account for changes in cholesterol levels. This finding suggests that community-based strategies for preventing cardiovascular disease can affect most of the population.

Individual Responsiveness to a Cholesterol-Lowering Diet in Postmenopausal Women With Moderate Hypercholesterolemia

The efficacy of the step 1 diet in outpatient women with hypercholesterolemia has been debated. Forty-one normotriglyceridemic women whose low-density lipoprotein (LDL) cholesterol levels were 3.62 to 5.17 mmol/L (140 to 200 mg/dL) participated in a two-period outpatient diet counseling study that used a 1-month high-fat, high-saturated fatty acid period (Hi-Sat diet) and a 4-month low-fat, low-saturated fatty acid period (step 1 diet). All women were postmenopausal and were not taking hormone replacement therapy. Levels of lipids, lipoproteins, and plasma triglyceride fatty acids were measured five times during the last 2 weeks of each dietary period. Dietary intake was assessed by 7-day food records. The mean reduction in total cholesterol level achieved by the step 1 diet was 0.36 mmol/L (14 mg/dL). The reduction in total cholesterol level was seen in both LDL cholesterol levels (0.28 mmol/L [11 mg/dL]; P < .005) and high-density lipoprotein cholesterol levels (0.08 mmol/L [3 mg/dL]; P = .08). Although individual LDL responsiveness to diet was normally distributed, there was marked variation in response, which could be explained only partially by compliance (change in saturated fat intake, 10%), change in body weight (3%), and an interaction between the palmitic acid content of the plasma and body weight (3%). A step 1 diet lowers total and LDL cholesterol levels in postmenopausal women. A nonsignificant reduction in high-density lipoprotein cholesterol levels was also observed. Since some women achieved LDL cholesterol levels low enough to obviate the need for drug therapy as primary prevention of coronary heart disease, dietary therapy should remain the first step in the management of hypercholesterolemia in postmenopausal women.

Habitual Dietary Intake and Glucose Tolerance in Euglycaemic Men: The Zutphen Study

Relationships between specific dietary factors and aspects of glucose tolerance were examined using data from the Zutphen Study. In 1970, an oral glucose tolerance test was carried out in 394 non-diabetic men aged 50-70. Habitual dietary intake was assessed using the cross-check dietary history method. In univariate analyses, positive associations were observed between fasting glucose and the intake of saturated fat (correlation coefficient (r) = 0.13, p less than 0.01) and dietary cholesterol (r = 0.16, p less than 0.01), and also reflected by an association with egg consumption. These results were confirmed in multivariate analyses, taking into account total energy intake, subscapular skinfold thickness and age. In univariate analyses, significant inverse associations were found between the incremental area under the curve (IAUC) and the intake of mono- and disaccharides (r = -0.22, p less than 0.001) and pectin (r = -0.15, p less than 0.01), as well as the consumption of sugar products. Similar results were obtained in multivariate analyses. The change in saturated fat intake in the period 1960-1970 was positively associated with IAUC, independent of concurrent intake in 1970, age, subscapular skinfold and change in energy intake. In a similar model the change in pectin intake was inversely associated with IAUC. These findings suggest that the intake of saturated fat and dietary cholesterol may be detrimental to glucose tolerance, in contrast to the intake of pectin and mono- and disaccharides.

Change in health behaviour in relation to estimated coronary heart disease risk during a community-based cardiovascular disease prevention programme.

The relationship between change in one coronary heart disease risk factor and levels of other risk factors was investigated in independent pre-and post-intervention samples and in a cohort surveyed both before and after a community-based cardiovascular disease prevention programme. A risk score that did not include the factor being analysed for change was developed and used to estimate risk. In the independent samples generally neither change in smoking nor change in saturated fat intake was related to coronary heart disease risk estimated from other factors in either men or women. Only the intake of saturated fats reduced slightly more among the hypertensive than other men (p less than 0.05). In the cohort, only change in smoking by women was related to initial risk estimated from other factors (p less than 0.05). Since change in behaviour had no consistent relation to the preprogramme risk level, it was concluded that health behaviour change in the population was based on common lifestyle changes in th intervention community, and that either face-to-face counselling or new techniques of mass communication are needed to induce high-risk individuals to do more to change their risk-inducing behaviours.