significant; quite high doses are required to produce a reduction of triglycerides or cholesterol levels. Their action on platelet aggregation at different doses should be defined. The possibility that they directly retard the development of atherosclerotic lesions, as suggested by preliminary studies in laboratory animals, must be further examined. The possible benefits of eating fish, in distinction from n-3 fatty acids, should be explored. At the same time, investigations are required to determine possible adverse effects of ingesting large quantities of these metabolically active fatty acids. At present, it is reasonable to permit a liberal ingestion of fatty fish in an overall fat-modified diet although specific indications for therapeutic use of supplemental fish oil have not been defined. The available epidemiological data alone do not justify recommendations for significant supplementation of the diet with n-3 fatty acids beyond that consumed in fish. Nevertheless, more research on this question should be encouraged. Dietary cholesterol remains one determinant of the LDL level. However, the threshold effect with a diminishing rise in LDL at high intakes of cholesterol, the variability in the response among subjects, and the interaction of dietary cholesterol and fatty acids (leading to a dampening in the LDL increment in the presence of polyunsaturated fatty acids) complicate the advice on dietary cholesterol. Moderate reduction of dietary cholesterol therefore seems prudent, and this would be substantially achieved by reducing intake of eggs and foods containing saturated fatty acids from dairy products and other animal sources. The implications to the food industry of either intervention strategy are substantial. Public education programs or advice to individual patients will generate major demands for alternative foods. Neither program can succeed without the active participation of the food industry. Adjustments will be necessary for some manufacturers and primary producers but eventual economic benefits to the industry as a whole are highly probable. A simple, inexpensive form of ingredient labeling is advisable.
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