National Cholesterol Education Program Step Research Articles

Effects of different dietary cholesterol concentrations on lipoprotein plasma concentrations and on cholesterol efflux from Fu5AH cells

BackgroundThe fatty acid composition of the diet can modulate the effect of dietary cholesterol on plasma lipoproteins.However, HDL composition and its capacity to promote cholesterol efflux can be influenced by the diet. ObjectiveModifications in plasma lipids and in the capacity of serum to stimulate the cholesterol efflux induced by a low-fat diet [National Cholesterol Education Program (NCEP) Step I diet], by a monounsaturated fatty acid (MUFA)–rich diet, and by addition of cholesterol to both diets was studied. DesignFifteen young, healthy men followed 2 NCEP Step I diets ((<30% of fat as energy, with (< 10% saturated fat and 14% MUFAs) for 24 d, providing 0.027 or 0.068 mg cholesterol kJ-1d-1, and 2 oleic acid–enriched diets (38% of energy as fat,with 24% MUFAs) providing the same amount of dietary cholesterol as the NCEP Step I diets. ResultsTotal cholesterol, LDL cholesterol, apolipoprotein (apo)B, and apo A-I concentrations decreased after the NCEP Step I and MUFA diets compared with the usual diet. HDL cholesterol also decreased after the NCEP Step I diet. Total:HDL cholesterol, apo B, and apo B:apo A-I were lower after the MUFA diets than after the NCEP Step I diets. There were no significant differences between the lipid profiles obtained after the NCEP Step I and MUFA diets were enriched with cholesterol. The capacity of serum to promote cholesterol efflux was significantly higher after the cholesterol-enriched NCEP Step I diet than after the NCEP Step I diet. ConclusionsThe MUFA diet induced a better lipid profile than the NCEP Step I diet; however, the increase in the cholesterol content of both diets produced similar plasma lipid changes. The cholesterol in the NCEP Step I diet increased the cholesterol efflux induced by total serum. Am J Clin Nutr 1998;68:1028–33.

Almond Bioaccessibility in a Randomized Crossover Trial: Is a Calorie a Calorie?

ObjectiveTo investigate the energy and macronutrient bioaccessibility of almonds in individuals with hyperlipidemia. MethodsIn a previously reported randomized crossover trial, men and postmenopausal women with hyperlipidemia incorporated 3 isoenergetic supplements into a National Cholesterol Education Program Step 2 diet for 1 month each between September 20, 2000, and June 27, 2001. Supplements provided consisted of full-dose almonds (73±5 g/d), half-dose almonds (38±3 g/d) plus half-dose muffins, and full-dose muffins (control). Energy and macronutrients, including individual fatty acids, were measured in the dietary supplements and fecal samples using gas chromatography and Association of Official Analytical Chemists methods. Serum was measured for lipids and fatty acids. Bioaccessibility of energy and macronutrients from almond consumption was assessed from dietary intake (7-day food records) and fecal output. ResultsAlmond-related energy bioaccessibility was 78.5%±3.1%, with an average energy loss of 21.2%±3.1% (40.6 kcal/d in the full-dose almond phase). Bioaccessibility of energy and fat from the diet as a whole was significantly less with almond consumption (in both half- and full-dose phases) compared with the control. Bioaccessibility of fat was significantly different between treatment phases (P<.001) and on average lower by 5.1% and 6.3% in the half- and full-dose almond phases, respectively, compared with the control phase. Energy bioaccessibility was significantly different between the treatment phases (P=.02), decreasing by approximately 2% with the inclusion of the full dose of almonds compared with the control. ConclusionEnergy content of almonds may not be as bioaccessible in individuals with hyperlipidemia as predicted by Atwater factors, as suggested by the increased fat excretion with almond intake compared with the control. Trial RegistrationClinicalTrials.gov identifier: NCT00507520.

Effect of phytosterol capsule supplementation associated with the National Cholesterol Education Program Step 2 diet on low-density lipoprotein in children and adolescents with dyslipidemia: A double-blind crossover trial.

To evaluate the effect of phytosterol capsule supplementation associated with the National Cholesterol Education Program (NCEP) Step 2 diet on LDL-C levels in children and adolescents with dyslipidemia. This is a randomized, double-blind, crossover trial conducted with children and adolescents (n = 31; mean ± SD, age 9.0 ± 2.22 years, BMI zscore 1.65 ± 1.47 kg/m2) with dyslipidemia. After a run-in period, the participants were randomly allocated to control or intervention groups. The intervention group received capsules containing 1.5 g/day of phytosterols, and the control group received capsules containing 2 g/day of sunflower oil for 8 weeks. Patients in both groups were instructed to follow the NCEP Step 2 diet during the study. The primary outcome was LDL-C and secondary outcomes were total cholesterol (TC), HDL-C, triglyceride, insulin, blood pressure, and anthropometric measures. Intention-to-treat analyses were performed using the proc mixed procedure in SAS. The rate of change for LDL-C was not different between intervention and control groups (p=0.30). No significant reduction was also observed for TC (p=0.47), HDL-C (p=0.97), insulin (p=0.27), triglycerides (p=0.38), systolic blood pressure (p=0.11), and diastolic blood pressure (p=0.57) compared to control group. Although we observed a high adherence to the capsule intake (95.7% in phytosterol and 93.8% in the control group), the low adherence to the diet may have contributed to explaining the results. Daily phytosterol capsules supplementation associated with the NCEP Step 2 diet did not reduce LDL-cholesterol concentrations in children and adolescents with dyslipidemia.

Effect of almond consumption on vascular function in patients with coronary artery disease: a randomized, controlled, cross-over trial.

ObjectiveAlmonds reduce cardiovascular disease risk via cholesterol reduction, anti-inflammation, glucoregulation, and antioxidation. The objective of this randomized, controlled, cross-over trial was to determine whether the addition of 85 g almonds daily to a National Cholesterol Education Program (NCEP) Step 1 diet (ALM) for 6 weeks would improve vascular function and inflammation in patients with coronary artery disease (CAD).Research design and methodsA randomized, controlled, crossover trial was conducted in Boston, MA to test whether as compared to a control NCEP Step 1 diet absent nuts (CON), incorporation of almonds (85 g/day) into the CON diet (ALM) would improve vascular function and inflammation. The study duration was 22 weeks including a 6-weeks run-in period, two 6-weeks intervention phases, and a 4-weeks washout period between the intervention phases. A total of 45 CAD patients (27 F/18 M, 45–77 y, BMI = 20-41 kg/m2) completed the study. Drug therapies used by patients were stable throughout the duration of the trial.ResultsThe addition of almonds to the CON diet increased plasma α-tocopherol status by a mean of 5.8 %, reflecting patient compliance (P ≤0.05). However, the ALM diet did not alter vascular function assessed by measures of flow-mediated dilation, peripheral arterial tonometry, and pulse wave velocity. Further, the ALM diet did not significantly modify the serum lipid profile, blood pressure, C-reactive protein, tumor necrosis factor-α or E-selectin. The ALM diet tended to decrease vascular cell adhesion molecule-1 by 5.3 % (P = 0.064) and increase urinary nitric oxide by 17.5 % (P = 0.112). The ALM intervention improved the overall quality of the diet by increasing calcium, magnesium, choline, and fiber intakes above the Estimated Average Requirement (EAR) or Recommended Dietary Allowance (RDA).ConclusionsThus, the addition of almonds to a NECP Step 1 diet did not significantly impact vascular function, lipid profile or systematic inflammation in CAD patients receiving good medical care and polypharmacy therapies but did improve diet quality without any untoward effect.Trial registrationThe trial was registered with the ClinicalTrials.Gov with the identifier: NCT00782015.

The role of apolipoprotein E polymorphism in improving dyslipidemia in obese adolescents following physical exercise and National Cholesterol Education Program Step II intervention.

Lifestyle changes are important factors for managing dyslipidemia before considering blood lipid-lowering drugs. However, genetic factors can influence the response outcome. We aimed to determine a dyslipidemia management strategy in obese adolescents. A total of 60 dyslipidemic obese adolescents received physical exercise and the NCEP step II diet for 28 days. Apolipoprotein E (apo E) genotypes and blood lipid levels were compared before and after interventions. The apo E3/E3 genotype was found to be common in all subjects. Mean levels of total cholesterol, triglyceride, and low-density lipoprotein-cholesterol (LDL-C) improved in subjects with the E3 allele after the intervention, but not the E2 allele. Total cholesterol and LDL-C, but not triglyceride levels, improved in subjects with the E4 allele. Apo E alleles might influence improvement in lipid profiles after diet and exercise interventions. These results could inform personalized dyslipidemia management in obese adolescents, to determine which subjects would benefit from blood lipid-lowering drugs.

Effects of psyllium on LDL-cholesterol concentrations in Brazilian children and adolescents: a randomised, placebo-controlled, parallel clinical trial.

The present study investigated the LDL-cholesterol (LDL-C)-lowering effects of psyllium in Brazilian dyslipidaemic children and adolescents. A total of fifty-one individuals (6-19 years) with mild-to-moderate hypercholesterolaemia were evaluated by conducting a randomised, double-blind, placebo-controlled, parallel clinical trial. Over an 8-week trial period, the participants were randomly allocated to one of two groups (control: n 25 and psyllium: n 26) using a computer-generated random number sequence. Fasting blood samples, dietary records and anthropometric data were collected. Both groups were treated with the National Cholesterol Education Program Step 2 diet for 6 weeks before randomisation. After this run-in period, a daily supplement of 7·0 g psyllium was given to the intervention group, while an equivalent amount of cellulose was given to the control group. Statistically significant changes between the control and intervention groups over time were observed for total cholesterol (7·7%; - 0·39 mmol/l; P= 0·003) and LDL-C (10·7%; - 0·36 mmol/l; P= 0·01). None of the participants reported any aversion to the smell, taste, appearance or texture of psyllium. No serious adverse effects were reported during the study. In addition to causing a significant reduction in LDL-C concentrations, psyllium therapy was found to be both safe and acceptable for the treatment of hypercholesterolaemic children and adolescents.

Cardiovascular and cancer events in hyper-high-density lipoprotein cholesterolemic patients: a post hoc analysis of the MEGA study.

BackgroundThe prognosis for hyper-high-density lipoprotein (HDL) cholesterolemic patients has not been fully elucidated. We conducted a post hoc analysis of MEGA study data to investigate prospectively the incidence of cardiovascular events and cancer in hyper-HDL cholesterolemic patients.MethodsA total of 7832 patients with mild hypercholesterolemia were randomly allocated to either the National Cholesterol Education Program step 1 diet alone (n = 3966) or the diet plus pravastatin (n = 3866) and followed for 5 years. The incidences of coronary heart disease (CHD), CHD plus cerebral infarction (CI), cardiovascular disease (CVD), and cancer were calculated using the Cox proportional hazards model according to the level of HDL cholesterol (HDL-C).ResultsCHD incidence was lower in patients with HDL-C >60–90 mg/dL (-52%, p = 0.0018) and HDL-C > 90 mg/dL (-46%, p = 0.4007) than in patients with HDL-C ≤ 60 mg/dL. The incidences of CHD, CHD plus CI, and CVD were significantly lower in patients with HDL-C >60–90 mg/dL than in those with HDL-C ≤ 60 mg/dL in both diet-alone and diet-plus-pravastatin groups. Cancer incidence was not increased in patients with HDL-C >60–90 mg/dL.ConclusionPatients not receiving statin therapy should aim for a target HDL-C of between 60 and 90 mg/dL to achieve a significant reduction in CHD without the occurrence of adverse events.Trial registrationClinical trials.gov NCT00211705.

Abstract 8968: Reduction of Non-hdl-cholesterol by More Than 5% with NCEP Diet Reduces CHD Risk

Background and aims: Dietary management is considered to be very important to lower plasma lipids. Non-HDL-cholesterol may be a better indicator of coronary heart disease (CHD) than traditional lipid risk markers (LDL-cholesterol, HDL-cholesterol), which was confirmed in previous studies. However the extent to which non-HDL-cholesterol must be lowered to decrease CHD risk with diet remains to be clarified. To answer this question, we conducted a post-hoc analysis of the dietary treatment group in a large-scale randomized primary prevention trial in Japanese. Materials and methods 7832 patients with mild hypercholesterolemia were randomly allocated to either diet alone (n=3966) or diet+pravastatin (n=3866) and followed for an average of 5 years. The patients were instructed to follow the National Cholesterol Education Program (NCEP) guideline step 1 diet, which is low in cholesterol and saturated fats, with the addition of fish, like in the usual Japanese diet. Incidence rates of CHD, CHD+cerebral infarction (CI), and all cardiovascular events were calculated by the Cox proportional hazard model according to the reduction rates of non-HDL-cholesterol. Results Baseline non-HDL-cholesterol level in the diet group was 184.4±18.6 mg/dL. CHD incidence was significantly reduced by 42% (p=0.02) and by 50% (p=0.007) in relation to a 3% and 5% lowering of non-HDL-cholesterol respectively. The total cardiovascular event rate was significantly reduced by 34% (p=0.02) with a 5% lowering of non-HDL-cholesterol. Neither stroke nor all-cause mortality was affected significantly. On treatment non-HDL-cholesterol levels were less than 174 mg/dL, indicating the reduction of CHD and cardiovascular events. Conclusion A reduction of 5% or more of non-HDL-cholesterol with the modified NCEP step 1 diet was associated with a significant reduction in CHD and cardiovascular events.

Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus

Almond consumption is associated with ameliorations in obesity, hyperlipidemia, hypertension, and hyperglycemia. The hypothesis of this 12-week randomized crossover clinical trial was that almond consumption would improve glycemic control and decrease the risk for cardiovascular disease in 20 Chinese patients with type 2 diabetes mellitus (T2DM) (9 male, 11 female; 58 years old; body mass index, 26 kg/m 2) with mild hyperlipidemia. After a 2-week run-in period, patients were assigned to either a control National Cholesterol Education Program step II diet (control diet) or an almond diet for 4 weeks, with a 2-week washout period between alternative diets. Almonds were added to the control diet to replace 20% of total daily calorie intake. Addition of approximately 60 g almonds per day increased dietary intakes of fiber, magnesium, polyunsaturated fatty acid, monounsaturated fatty acid, and vitamin E. Body fat determined with bioelectrical impedance analysis was significantly lower in patients consuming almonds (almonds vs control: 29.6% vs 30.4%). The almond diet enhanced plasma α-tocopherol level by a median 26.8% (95% confidence intervals, 15.1-36.6) compared with control diet. Furthermore, almond intake decreased total cholesterol, low-density lipoprotein cholesterol, and the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol by 6.0% (1.6-9.4), 11.6% (2.8-19.1), and 9.7% (0.3-20.9), respectively. Plasma apolipoprotein (apo) B levels, apo B/apo A-1 ratio, and nonesterified fatty acid also decreased significantly by 15.6% (5.1-25.4), 17.4% (2.8-19.9), and 5.5% (3.0-14.4), respectively. Compared with subjects in the control diet, those in the almond diet had 4.1% (0.9-12.5), 0.8% (0.4-6.3), and 9.2% (4.4-13.2) lower levels of fasting insulin, fasting glucose, and homeostasis model assessment of insulin resistance index, respectively. Our results suggested that incorporation of almonds into a healthy diet has beneficial effects on adiposity, glycemic control, and the lipid profile, thereby potentially decreasing the risk for cardiovascular disease in patients with type 2 diabetes mellitus.

A Prudent Algorithm for Hyperlipoproteinemia in Renal Transplant Recipients

Background Hyperlipidemia and particularly low-density lipoprotein cholesterol (LDL-C) have been proposed as independent risk factors predisposing to chronic allograft nephropathy. Objective The primary objective of this prospective randomized study was to evaluate the efficacy of the modified National Cholesterol Education Program (NCEP) Step I Diet to prevent posttransplantation hyperlipidemia. The secondary objective was to assess the impact of fluvastatin on the lipid profile of patients unresponsive to dietary measures. Methods The study population consisted of 143 consecutive patients who underwent transplantation between October 1998 and January 2005. Patients who failed to demonstrate total and LDL-C levels below the optimal values of 200 mg/dL and 130 mg/dL respectively, were recruited for fluvastatin treatment. The remaining patients who achieved and maintained the target lipid levels continued on the same dietary regimen. Results Baseline demographic characteristics were not different among the fluvastatin and modified Step I Diet groups. Mean total cholesterol (231.2 vs 187.3 mg/dL; P < .000), LDL-C (134.5 vs 99.2 mg/dL; P < .000), high-density lipoprotein cholesterol (HDL-C; 62.9 vs 55.7 mg/dL; P = .012), and triglyceride (170.3 vs 138.7 mg/dL; P = .011) levels following the dietary run-in period were significantly different between the patients assigned to fluvastatin treatment and those left on the diet, respectively. Fluvastatin achieved reductions ranging from 12% to 14% in the concentrations of total cholesterol (231.2 ± 4.29 mg/dL to 202.7 ± 3.89 mg/dL; P < .000) and LDL-C (134.5 ± 3.53 mg/dL to 115.6 ± 3.18 mg/dL; P < .000) among 91% of patients after 1 year of treatment. A substantial decrease in all lipoprotein concentrations occurred in 53 patients in the modified Step I Diet group with significant reductions in total cholesterol (187.3 ± 4.98 mg/dL to 172.7 ± 3.8 mg/dL; P < .000) and LDL-C (99.2 ± 4.0 mg/dL to 96.2 ± 3.44 mg/dL; P < .000). Conclusion Initiation and education of the Step I Diet should be provided during hospitalization. The 3-month dietary run-in period was deemed sufficient to determine the effect of diet on lipid abnormalities. Reduction of lipoprotein levels by a 40-mg daily fluvastatin dose was sufficient, safe, and tolerable.

One-Year Effects of Increasingly Fat-Restricted, Carbohydrate-Enriched Diets on Lipoprotein Levels in Free-Living Subjects

Abstract. Restriction of all dietary fat is a popular strategy for restricting saturated fat intake to lower LDL cholesterol. Some authorities advise the restriction of fat intake to the extreme of less than 10% of daily energy on the assumption that more fat restriction is better. The two studies described herein address questions relating to whether increasing fat restriction produces proportionally increasing benefit on cardiovascular risk factors in hyperlipidemic subjects.The first study is the Dietary Alternatives Study (DAS). The DAS was conducted in 531 male Boeing employees over a 2-year period. Subjects were defined as hypercholesterolemic (HC) or combined hyperlipidemic (CHL) based on age-specific 75th percentiles for plasma LDL-C and triglyceride levels. Hypothesis test analyses were performed at 1 year. HC subjects were randomized to diets taught to attain fat intakes of 30, 26, 22, and 18% (Diets levels 1–4, respectively). CHL subjects (slightly fewer in number) were randomized to Diets 1–3. After 1 year, subjects' total fat intakes were 27, 26, 25, and 22% of energy (en%), resulting in saturated fat intakes of 8, 7, 7, and 6%, respectively. In HC subjects the greatest LDL-C decrease was with Diet 2 (mean of 13.4%) and in CHL subjects with Diet 1 (7.0%). Surprisingly, plasma triglyceride concentrations rose in HC subjects 20% and 40% above baseline on Diets 3 and 4, respectively, with reciprocal reductions in HDL cholesterol of 2.5% and 3%, respectively. Furthermore, apo B reductions were attenuated below Diet 2 in HC subjects and Diet 1 in CHL subjects, and no further reductions were seen in plasma glucose and insulin concentrations, blood pressure, or body weight. Measurements of plasma total fatty acid composition showed a slight increase in plasma palmitate, whereas stearate decreased slightly, supporting the idea that de novo synthesis of palmitic acid was increased in the chronic high-carbohydrate feeding condition. The second study asked if the most effective diet in HC subjects, Diet 2, has an equivalent effect in women and men. To answer this question, men and women Boeing employees were taught the closely similar National Cholesterol Education Program (NCEP) Step II diet. After 6 and 12 months, equivalent reductions in LDL cholesterol were observed in women compared with men. HDL cholesterol levels in men were unchanged from baseline at 6 and 12 months, but were reduced 8% in HC women, with accompanying decreases of 18% in HDL2-cholesterol and 5% in apoprotein A-I (all P < 0.01). These data indicate that intakes of fat below about 25 en% and carbohydrate intake above ≈ 60 en% yield no further LDL-C lowering in HC and CHL male subjects and can be counterproductive to triglyceride, HDL-C, and apo B levels. This lack of benefit appears to be explained by an enhanced endogenous synthesis of palmitic acid, which negates the benefit of further saturated fat restriction. The HDL-C decrease in HC women may have a similar cause and points to an underlying male-female difference. Alternative dietary approaches to limit saturated fat intake deserve intensive study.

Statins Are Safe for the Treatment of Hypercholesterolemia in Patients With Chronic Liver Disease

Statins Are Safe for the Treatment of Hypercholesterolemia in Patients With Chronic Liver Disease

Comparison of a dietary portfolio diet of cholesterol-lowering foods and a statin on LDL particle size phenotype in hypercholesterolaemic participants

The effect of diet v. statins on LDL particle size as a risk factor for CVD has not been examined. We compared, in the same subjects, the impact of a dietary portfolio of cholesterol-lowering foods and a statin on LDL size electrophoretic characteristics. Thirty-four hyperlipidaemic subjects completed three 1-month treatments as outpatients in random order: a very-low saturated fat diet (control); the same diet with 20 mg lovastatin; a dietary portfolio high in plant sterols (1 g/4200 kJ), soya proteins (21.4 g/4200 kJ), soluble fibres (9.8 g/4200 kJ) and almonds (14 g/4200 kJ). LDL electrophoretic characteristics were measured by non-denaturing polyacrylamide gradient gel electrophoresis of fasting plasma at 0, 2 and 4 weeks of each treatment. The reductions in plasma LDL-cholesterol levels with the dietary portfolio and with statins were comparable and were largely attributable to reductions in the estimated concentration of cholesterol within the smallest subclass of LDL (portfolio - 0.69 (se 0.10) mmol/l, statin - 0.99 (se 0.10) mmol/l). These were significantly greater (P < 0.01) than changes observed after the control diet ( - 0.17 (se 0.08) mmol/l). Finally, baseline C-reactive protein levels were a significant predictor of the LDL size responsiveness to the dietary portfolio but not to the other treatments. The dietary portfolio, like the statin treatment, had only minor effects on several features of the LDL size phenotype, but the pronounced reduction in cholesterol levels within the small LDL fraction may provide additional cardiovascular benefit over the traditional low-fat diet of National Cholesterol Education Program Step II.

The effect of a combination of plant sterol-enriched foods in mildly hypercholesterolemic subjects

The purpose of this study was to evaluate the effect of low-fat products enriched with plant sterols in addition to a National Cholesterol Education Program step 1 diet on serum lipids and lipoproteins. This study was a double-blind, randomised, placebo-controlled cross-over design with a run-in period and 2 intervention periods, each lasting 4 weeks. A total of 46 mildly hypercholesterolemic subjects (age 50.6+/-9.8) completed the trial. The study products consisted of 20 g low-fat margarine (35% fat) and 250 ml low-fat milk (0.7% fat), in total delivering 2.3g plant sterols/d. Serum total and low-density lipoprotein cholesterol were significantly reduced by 5.5% (p<0.001, 95% CI: 2.5; 8.3) and 7.7% (p=0.001, 95% CI: 3.4; 11.9), respectively, by plant sterol-enriched products compared to placebo. Serum apolipoprotein B was significantly reduced by 4.6% (p<0.05, 95% CI: 1.7; 7.5), and apolipoprotein B/apolipoprotein A-I by 3.4% (p<0.05, 95% CI: 0.1; 6.6) after plant sterol intake compared to the placebo supplement. A combination of low-fat margarine and milk enriched with plant sterols significantly reduced low-density lipoprotein cholesterol, apolipoprotein B and the ratio of apolipoprotein B to apolipoprotein A-I in mildly hypercholesterolemic subjects, but had no effect on C-reactive protein and lipoprotein (a) concentrations. Unilever Denmark A/S.

Minor compounds of olive oil have postprandial anti-inflammatory effects

High postprandial levels of TAG may further induce endothelial dysfunction and inflammation in subjects with high fasting levels of TAG, an effect that seems to be related to oxidative stress. The present study investigated whether minor compounds of olive oil with antioxidant activity decrease postprandial levels of soluble isoforms of intercellular adhesion molecule 1 (sICAM-1) and vascular cell adhesion molecule 1 (sVCAM-1), as surrogate markers of vascular inflammation, after a high-fat meal. A randomized crossover and blind trial on fourteen healthy and fourteen hypertriacylglycerolaemic subjects was performed. The study involved a 1-week adaptation lead-in period on a National Cholesterol Education Program Step I diet supplemented with extra-virgin olive oil (EVOO) containing 1125 mg polyphenols/kg and 350 mg tocopherols/kg, or refined olive oil (ROO) with no polyphenols or tocopherols. After a 12 h fast, the participants ate a high-fat meal enriched in EVOO or ROO (50 g/m2 body surface area), which on average provided 3700 kJ energy with a macronutrient profile of 72% fat, 22% carbohydrate and 6% protein. Blood samples drawn hourly over the following 8 h demonstrated a similar postprandial TAG response for both EVOO and ROO meals. However, in both healthy and hypertriacylglycerolaemic subjects the net incremental area under the curve for sICAM-1 and sVCAM-1 were significantly lower after the EVOO meal. In conclusion,the consumption of EVOO with a high content of minor antioxidant compounds may have postprandial anti-inflammatory protective effects.

Particle size of LDL is affected by the National Cholesterol Education Program (NCEP) step II diet in dyslipidaemic adolescents

The objective was to determine the effects of the National Cholesterol Education Program (NCEP) step II diet on LDL and HDL particle size in dyslipidaemic adolescents. Forty-four dyslipidaemic adolescents, aged 10-18 years, participated in this case-control study. The control diet was a diet similar to what most Tehranian adolescents eat. NCEP step II diet was a diet with 30 % of energy as total fat, less than 7 % saturated fat, less than 200 mg cholesterol/d, less than 15 % of energy as MUFA and less than 10 % as PUFA. Lipoprotein particle size was the major outcome variable, which was measured after 3 months of intervention. Comparison was made by the repeated measurement ANOVA. The mean BMI was 26.3 (sd 4.2) kg/m2. There were no significant changes in weight or physical activity in the two groups during the study. The NCEP diet resulted in higher reduction in total cholesterol ( - 13 (sd 4) v. - 2 (sd 0.3) mg/dl, P < 0.001) and LDL ( - 9 (sd 2) v. 3 (sd 0.6) mg/dl, P < 0.01), and higher increase in size of the LDL (1.7 (sd 0.4) v. 0.1 (sd 0.4) nanometer, P < 0.001). HDL particle size did not change significantly. NCEP step II diet had a favourable effect on the LDL particle size. The related mechanism needs to be studied in future experimental designs.

Effect of a Six-Week National Cholesterol Education Program Step 1 Diet on Plasma Sex Hormone-Binding Globulin Levels In Overweight Premenopausal Women

Low circulating sex hormone-binding globulin (SHBG) concentrations have been associated with the presence of several features of the metabolic syndrome in both men and women. Nutritional factors including dietary lipids and fibers in particular have been suggested to modulate plasma SHBG levels. The primary objective of the present study was to investigate the effect of an oat bran-rich supplement in conjunction with the National Cholesterol Education Program (NCEP) Step 1 diet (< 30% of total energy from fat, < 10% of energy from saturated fat, and < 300 mg cholesterol per day) on plasma SHBG levels in 35 overweight premenopausal women. Subjects (age 38.6 +/- 7.4 years) had normal menstrual cycles and were tested in the midluteal phase. Since no effect of the oat bran supplement was observed on plasma SHBG levels, data were analyzed according to the 6-week NCEP Step 1 diet. The NCEP Step 1 nutritional intervention caused a significant decrease in energy intake ( -11%, p < 0.05), percent fat intake (-10%, p < 0.005), as well as saturated (-20%, p < 0.005) and monounsaturated (-10%, p < 0.05) fatty acid intake. Body mass index (BMI) decreased slightly but significantly (from 29.2 +/- 4.5 to 28.8 +/- 4.3 kg/m(2), p < 0.005). Plasma SHBG levels increased significantly (from 70.6 +/- 17.7 to 79.9 +/- 15.3 pmol/L, p < 0.0005) following the 6-week NCEP Step 1 diet, whereas plasma insulin levels were not modified significantly. Significant correlations were observed between the change in plasma SHBG levels and baseline BMI (r = 0.36, p < 0.04), as well as baseline (r = -0.42, p < 0.05) and postintervention (r = -0.35, p < 0.05) HDL cholesterol levels. We observed that a 6-week NCEP Step 1 diet significantly increased plasma SHBG levels, despite the finding that fasting insulin was not modified. Further studies are needed to elucidate physiological mechanisms underlying a direct effect of dietary composition on SHBG production by the liver.

Lipoprotein effects of combined ezetimibe and colesevelam hydrochloride versus ezetimibe alone in hypercholesterolemic subjects: a pilot study

Two drug classes act in the intestine to lower cholesterol. Ezetimibe inhibits cholesterol absorption, whereas bile acid–binding resins enhance cholesterol excretion via enhanced conversion to bile acids. Combining these 2 classes may be beneficial, but cholestyramine binds ezetimibe, and the combined effect of colesevelam hydrochloride and ezetimibe was little studied. The aim of the study was to determine if adding colesevelam HCl to ezetimibe provides additional lowering of low-density lipoprotein– and apolipoprotein B–containing lipoproteins or alters ezetimibe levels. Twenty subjects with low-density lipoprotein cholesterol (LDL-C) levels of 130 mg/dL or higher were enrolled and taught a National Cholesterol Education Program Step I diet. At a second baseline visit, lipoproteins were measured and subjects were randomly allocated to (1) ezetimibe 10 mg daily with placebo colesevelam HCl twice daily (E) or (2) ezetimibe 10 mg daily with 1.875 g colesevelam HCl twice daily (E + C). Lipoproteins were measured 6 and 12 weeks after initiating treatment. Baseline characteristics (mean ± SD) were statistically indistinguishable in E vs E + C: LDL-C (mg/dL), 167 ± 26 and 158 ± 27; triglyceride, 134 ± 75 and 140 ± 67; and BMI, 29.4 ± 4.9 and 27.8 ± 6.6 kg/m 2, respectively. Percent changes after 12 weeks in E vs E + C were as follows: LDL-C, −24 ± 12 vs −30 ± 11 ( P = .102); triglyceride, −19 ± 34 vs 36 ± 85 ( P = .054; at 6 weeks, P = .009); total cholesterol, −19 ± 9 vs −15 ± 8 ( P = .50); non–high-density lipoprotein cholesterol, −25 ± 10 vs −21 ± 11 ( P = .70); apolipoprotein B, −31 ± 14 vs −22 ± 14 ( P = .41). Plasma ezetimibe levels at 12 weeks were 21% lower in E + C vs E, a nonsignificant difference ( P = .54). In conclusion, in the short term, colesevelam HCl may not consistently add cholesterol-lowering benefit to ezetimibe. This observation requires confirmation.

Cholesterol Feeding Increases C-Reactive Protein and Serum Amyloid A Levels in Lean Insulin-Sensitive Subjects

Inflammatory markers associated with elevated cardiovascular risk are increased by cholesterol feeding in animal models. However, whether dietary cholesterol increases inflammatory marker levels in humans is not known. C-reactive protein (CRP), serum amyloid A (SAA), and lipoprotein levels were compared in 201 healthy subjects on an American Heart Association-National Cholesterol Education Program step 1 diet at baseline and after addition of 4 eggs per day for 4 weeks. Subjects were classified a priori into 3 groups based on their body mass index (BMI) and insulin sensitivity index (SI): lean insulin sensitive (LIS), mean+/-SEM BMI, 23.2+/-0.3 kg/m2, and SI, 6.7+/-0.3x10(-4)min(-1)/(microU/mL), n=66; lean insulin resistant (LIR), BMI, 24.5+/-0.2 kg/m2 and SI, 2.9+/-0.1x10(-4)min(-1)/(microU/mL), n=76; or obese insulin resistant (OIR), BMI, 31.4+/-0.5 kg/m2 and SI, 2.1+/-0.1x10(-4)min(-1)/(microU/mL), n=59. Insulin resistance and obesity each were associated with increased baseline levels of both CRP (P for trend, <0.001) and SAA (P for trend=0.015). Egg feeding was associated with significant increases in both CRP and SAA in the LIS group (both P<0.01) but not in the LIR or OIR groups. Egg feeding also was associated with a significant increase in non-HDL cholesterol (P<0.001) in LIS subjects; however, there was no correlation between the change in non-HDL cholesterol or changes in either CRP or SAA in this group. A high-cholesterol diet leads to significant increases in both inflammatory markers and non-HDL cholesterol levels in insulin-sensitive individuals but not in lean or obese insulin-resistant subjects.

Cholesterol-Lowering Benefits of Oat-Containing Cereal in Hispanic Americans

This randomized, controlled trial of cholesterol lowering by an oat bran cereal containing beta glucan vs a corn cereal without soluble fiber in Hispanic Americans was conducted for 11 weeks. One-hundred fifty-two men and women, ages 30 to 70 years, with baseline low-density lipoprotein cholesterol (LDL-C) levels between 120 and 190 mg/dL and triglycerides <400 mg/dL were included. After eating a National Cholesterol Education Program Step 1 diet for 5 weeks, subjects were randomly assigned to the corn or the oat cereal for the next 6 weeks. The daily dose of beta glucan was 3 g. Consumption of oat cereal was associated with a reduction in plasma levels of both total cholesterol (−10.9±21.6 mg/dL; –4.5%) and LDL-C (−9.4±20.3 mg/dL; −5.3%). Consumption of corn cereal did not affect either total cholesterol (+1.2±18.3 mg/dL; 1.1%) or LDL-C (+1.2±17.5 mg/dL; 2.2%). Differences between the effects of the two cereals on total cholesterol and LDL-C were significant, P=.0003 and P=.0007, respectively.