Feasibility of a randomized trial of a low-fat diet for the prevention of breast cancer: dietary compliance in the Women's Health Trial Vanguard Study

The Women's Health Trial Vanguard Study was conducted to examine the feasibility of a nationwide, randomized multicenter intervention trial to test the hypothesis that a low-fat diet followed for a period of 10 years will reduce breast cancer risk. Women ages 45-69 years at increased risk of breast cancer were randomized into intervention (low-fat diet, n = 184) and control (usual diet, n = 119) groups. On the basis of 4-day food records, baseline fat intakes were comparable in the two groups, averaging 1,718 kcal with 39% of energy as fat. Intervention women reported substantially lower fat intake at 6 (20.9% kcal), 12 (21.6%), and 24 months (22.6% kcal). In contrast, control women reported only slight reductions in fat intake (37.3% kcal at 12 months and 36.8% kcal at 24 months). Evidence that these women were indeed complying with the low-fat dietary intervention comes from (a) the reasonable nature of reported nutrient changes within food groups in the intervention women and (b) agreement between observed and expected differences in plasma total cholesterol between the control and the intervention groups. At 12 months, the observed control - intervention plasma cholesterol difference was 13.1 +/- 4.6 mg/dl while the expected difference based on the Keys equation was 15.1 +/- 1.1 mg/dl; at 24 months, the observed difference was 15.5 +/- 4.3 mg/dl and the expected difference was 12.0 +/- 1.2 mg/dl. These analyses indicate that the intervention women made substantial dietary changes and have successfully maintained these changes over a 2-year period. This study thus demonstrates the feasibility of a randomized trial with an intensive low-fat dietary intervention.     

Effect of dietary control and exercise training on daily food intake and serum lipids in postmyocardial infarction patients.

The effects of 12 weeks of exercise training without dietary control (n = 30) and exercise training with dietary control by dietition counseling (n = 30) and exercise training with dietary control by dietition counseling (n = 30) on serum cholesterol, serum triglycerides, and total substrate contents were studied in 60 postmyocardial infarction patients. Both groups showed reductions (P less than 0.01) in mean total daily kilocalories consumed (2867 +/- 82 versus 2088 +/- 77 and 2848 +/- 15 versus 1285 +/- 68, respectively); however, no significant change occurred in total body weight. The dietary control group consumed relatively more kilocalories as protein than the group without dietary control (285 of 1,285 versus 389 of 2,088, respectively) and less (P less than 0.05) as fat (443 of 1285 versus 804 of 2,089, respectively). Both groups had lower (P less than 0.01) mean daily dietary cholesterol after 12 weeks (811 +/- 44 versus 232 +/- 17 mg) versus (325 +/- 18 versus 309 +/- 23 mg, respectively). A reduction in serum cholesterol (P less than 0.05) was seen in the dietary control group (270 +/- 8 versus 243 +/- 7 mg/dl) but not in the group without dietary control (260 +/- 6 versus 261 +/- 7 mg/dl). The dietary control group had a lower mean triglyceride level (P less than 0.05) (229 +/- 24 versus 155 +/- 18 mg/dl)) but no differences were seen in the group without dietary control (189 +/- 15 versus 180 +/- 13 mg/dl). It is concluded that significant reductions in caloric intake and daily cholesterol compliment the effects of exercise training in postmyocardial infarction patients by increasing substrate protein:fat consumption ratio and by reducing serum cholesterol and triglycerides. These effects are not seen with exercise training alone.     

Dietary intake and changes in lipoprotein lipids in obese, postmenopausal women placed on an American Heart Association Step 1 diet

BACKGROUND: Dietary intake and changes in lipoprotein lipids in obese, postmenopausal women placed on an American Heart Association Step 1 diet. OBJECTIVE: The purpose of this study was to determine the specific dietary factors associated with the commonly observed decrease in HDL-C concentration in obese, postmenopausal women placed on a low-fat diet. DESIGN/SUBJECTS/INTERVENTION: Dietary intake, lipoprotein lipid concentrations, and body weight were measured before and after 10 weeks of instruction in the principles of the American Heart Association (AHA) Step 1 diet in 55 overweight and obese (body mass index=33+/-4 kg/m2), sedentary, postmenopausal women (mean age 59+/-5 years). RESULTS: The percent of energy obtained from total fat, monounsaturated, polyunsaturated, saturated fat, and dietary cholesterol decreased significantly after dietary intervention, while the polyunsaturated:saturated ratio and the percent of energy obtained from total carbohydrate, complex carbohydrate, and simple carbohydrate increased. On average, the women lost a small, but significant, amount of body weight (2%+/-3%, P<.0001). Adherence to the AHA diet reduced total cholesterol (-8%+/-8%), LDL-C (-6%+/-11%), and HDL-C (-16%+/-10%). The only dietary change that predicted decreases in HDL-C concentrations was the increase in the percent of energy from simple sugar (r=-0.32, P<.05). There were no relationships between changes in HDL-C and changes in percent of energy from fat (r=0.16), saturated fat (r=0.07), polyunsaturated fat (r=0.04), or monounsaturated fat (r=0.09). APPLICATIONS/CONCLUSIONS: In postmenopausal women, a dietary reduction in total fat, saturated fat, and cholesterol reduces body weight, total cholesterol, and LDL-C, but substitution of simple sugar for dietary fat may lead to a reduction in HDL-C. Further research is needed to determine which specific simple sugars are contributing to diet-induced reductions in HDL-C in older women placed on a low-fat diet.     

An ad libitum, very low-fat diet results in weight loss and changes in nutrient intakes in postmenopausal women

OBJECTIVES: To determine whether a very low-fat diet (<15% of energy intake) consumed ad libitum during an 8-month period can achieve weight loss of 5% to 10% of initial body weight while still providing adequate intakes of other essential nutrients. DESIGN: Longitudinal, 8-month, ad libitum, free living, very low-fat diet trial. SUBJECTS: Fifty-four of the sixty-four healthy postmenopausal women recruited completed the entire study (age 59+/-8 years, BMI=29.6+/-6.3). Twenty-four of these women used hormone replacement therapy, thirty women did not. INTERVENTION: Weekly sessions aimed at teaching and reinforcing a very low-fat intake diet for eight months. MAIN: outcome measures Body weight, percent body fat, waist-to-hip ratio, resting energy expenditure, respiratory quotient, and nutrient intakes derived from 7-day food records at the beginning and at 2, 4, 6, and 8 months of the study.Statistical analysis performed Repeated measures analysis of variance and Tukey post hoc analysis were used to analyze significant differences in mean data (P<.05). RESULTS: Fat intake decreased from 33.2+/-7.5% to 11+/-4% over the 8-month intervention period (P<.00001). Weight loss was 6.0 kg+/- 4.2 kg (P<.000038), an 8% weight change, and decrease in percent body fat of 2.7%+/-0.2% (P< or =.000046). Weight correlated better with the self-reported fat intake (r=0.321, P<.01) than the energy intake (r=0.263, P<.05) at baseline. Fiber intake increased from 16 g+/-0.6 g to 23 g+/-0.2 g (P<.0005). All micronutrient intakes remained at or above preintervention ranges, except for a decrease in vitamin E intake from 8.1 mg+/-4.0 mg to 3.7 mg+/-1.1 mg (P<.0005) on the very low-fat diet and linoleic acid from 6.3%+/-1.5% to 2.5%+/-0.7% (P<.000001) with no significant reduction in linolenic acid. Hormone replacement was not associated with the amount of weight loss. APPLICATIONS: This study demonstrates that adherence to a very low-fat diet consumed ad libitum causes weight loss in the 5% to 10% range and a reduction of body fat. These reductions, along with the observed decreases in fat intake, are associated with improved health outcomes. Because of the decreased vitamin E and n-3 fatty acid intake, emphasis on foods high in these nutrients may need to be encouraged for those consuming a very low-fat diet.     

Reduction of serum estradiol in postmenopausal women given free access to low-fat high-carbohydrate diet.

The short-term effects of a low-fat (less than 10% of cal) high-fiber (35-45 g.1000 kcal-1.day-1) diet on estradiol levels were studied in 13 postmenopausal women under residential conditions with cafeteria food service. During this diet study (mean +/- SE duration 22 +/- 4.6 days), body weight declined from 84.9 +/- 6.4 to 82.3 +/- 6.0 kg (P less than 0.001). Serum cholesterol and low-density and high-density lipoprotein cholesterol also fell significantly, whereas triglycerides remained constant. Serum estradiol fell from 18.1 +/- 3.6 to 9.4 +/- 2.4 pg/ml (P less than 0.05). This study demonstrates that serum estradiol levels are reduced in normal to over-weight postmenopausal women given free access to a low-fat high-fiber diet. Most of these women were in negative caloric balance during the study, suggesting that short-term changes in caloric balance may affect estrogen synthesis in postmenopausal women prior to a large decrease in fat mass.     

Diet intervention methods to reduce fat intake: nutrient and food group composition of self-selected low-fat diets

A multicentered pilot study was conducted to test an intervention protocol designed to reduce fat intake to 15% of energy intake. Eligible subjects were postmenopausal women with stage II breast cancer whose baseline fat intake was more than 30% of energy intake. The low-fat diet intervention protocol consisted of bi-weekly individual counseling sessions with emphasis on substitution of lower-fat foods for high-fat foods and maintenance of nutritional adequacy. Nutrient intakes were calculated from 4-day food records collected at baseline and after 3 months of diet intervention. Mean daily fat intake for the 17 patients on the low-fat diet dropped significantly from 38.4 +/- 4.3% of energy intake at baseline to 22.8 +/- 7.8% at 3 months (p less than .001). A 25% reduction in mean energy intake, from 1,840 +/- 419 kcal at baseline to 1,365 +/- 291 kcal at 3 months, was accompanied by significant increases in protein and carbohydrate as percent of energy intake. A mean weight loss of 2.8 kg and a 7.7% reduction in serum cholesterol were observed; both changes were significant at the p less than .01 level. Absolute intakes of zinc and magnesium were significantly reduced. However, mean intake on the low-fat diet for 14 vitamins and minerals, including zinc and magnesium, exceeded two-thirds of the 1989 Recommended Dietary Allowances (RDAs). When expressed as nutrient density (i.e., amount of nutrient per 1,000 kcal), increases were observed for all micronutrients. These results support the hypothesis that a nutritionally adequate low-fat diet can be successfully implemented in a highly motivated, free-living population.     

Responses of inflammatory markers to a low-fat, high-carbohydrate diet: effects of energy intake

BACKGROUND: Inflammation contributes to atherogenesis. Dietary fats may be proinflammatory. OBJECTIVE: The objective was to determine whether energy intake modulates the effects of low-fat, high-carbohydrate intakes on inflammatory markers. DESIGN: Twenty-two healthy postmenopausal women with a mean (+/-SD) age of 61 +/- 11 y, who were not receiving hormone replacement therapy, were fed eucaloric diets to reduce their fat intake from 35% to 15% of energy. Next, the women consumed a 15%-fat ad libitum diet under free-living conditions. Serum highly sensitive C-reactive protein, interleukin 6, HDL serum amyloid A, and adiponectin concentrations were measured at the end of the eucaloric and ad libitum low-fat, high-carbohydrate intakes. RESULTS: The eucaloric diet decreased adiponectin from 16.3 +/- 2.1 to 14.2 +/- 2.0 mg/L (P < 0.05) and increased triacylglycerol from 131 +/- 11 to 164 +/- 14 mg/dL (P < 0.01). The ad libitum low-fat diet caused 6 kg weight loss and decreased highly sensitive C-reactive protein from 4.3 +/- 0.6 to 2.5 +/- 0.5 mg/L (P < 0.01), decreased HDL serum amyloid A from 10.3 +/- 1.8 to 5.7 +/- 1.3 mg/L (P < 0.001), increased adiponectin from 14.2 +/- 2.0 to 16.3 +/- 1.7 mg/L (P < 0.05), and decreased triacylglycerol from 164 +/- 14 to 137 +/- 15 mg/dL (P < 0.05). CONCLUSION: During the eucaloric phase, the low-fat, high-carbohydrate diet exerted unfavorable effects on the inflammatory markers. In contrast, the ad libitum low-fat, high-carbohydrate intake caused weight loss and affected inflammatory markers favorably. Thus, the energy content of a low-fat, high-carbohydrate diet determines changes in inflammatory markers.     

Response to a diet low in total fat in women with postmenopausal breast cancer: a pilot study

A feasibility study was instituted to determine if women with postmenopausal breast cancer would follow a low-fat diet (20% of kcal) for at least four months. Nineteen women, whose baseline food intake was 1,504 +/- 420 kcal with 56 +/- 16 g of fat, reported a decrease in fat intake to 21 +/- 6 g after two months of dietary intervention. Serum concentrations of cholesterol, HDL cholesterol, and estradiol were significantly reduced by the fifth month on the diet. We conclude that self-selected patients can adhere to a low-fat diet, and that serum cholesterol may serve as an indicator of dietary compliance.     

Effect of dietary fat and cholesterol on plasma lipids and lipoprotein fractions in normolipidemic men

In a controlled feeding situation, male subjects were assigned to one of four treatment groups: low fat (31% of total kcal)/low cholesterol (193 mg/d) (LFLC), low fat/usual cholesterol (504 mg/d) (LFUC), usual fat (46% of total kcal)/low cholesterol (UFLC) and usual fat/usual cholesterol (UFUC) intake. For the first 2 wk of the 10-wk study all subjects consumed the UFUC diet. Subjects consumed experimental diets during wk 3-7 and resumed their customary intake during wk 8-10. Plasma total, high-density-lipoprotein (HDL), low-density-lipoprotein and very-low-density-lipoprotein cholesterol and triglycerides were determined weekly. A significant effect (P less than 0.05) of dietary fat on plasma total and HDL cholesterol was observed between the end of wk 2 and 7. Low fat intake resulted in 17 +/- 2 mg/dL lower total cholesterol and 10 +/- 1 mg/dL lower HDL cholesterol than the usual fat intake. Plasma lipids were not affected either by dietary cholesterol or by any interaction of dietary fat with cholesterol.     

Influence of type and amount of dietary lipid on plasma lipid concentrations in endurance athletes

Changes in plasma total cholesterol, triglyceride, and lipoprotein concentrations were assessed in three male endurance cyclists who consumed isoenergetic diets for 28-day periods in which carbohydrate, polyunsaturated fat, or saturated fat contributed about 50% of the daily energy intake. Dietary cholesterol was similar among the diets. Maximal aerobic capacity was maintained at 62 ml O2/(kg X min). Body weights were held within 3% of admission levels. The polyunsaturated fat diet significantly (p less than 0.05) reduced mean fasting plasma total cholesterol in comparison to the saturated fat and carbohydrate diets (160 versus 254 and 243 mg/dl, respectively). Similarly, the polyunsaturated fat diet depressed (p less than 0.05) mean plasma triglycerides relative to the saturated fat and carbohydrate diets (37 versus 62 and 79 mg/dl, respectively). No significant dietary effects were seen on high-density lipoprotein cholesterol. The observed changes in plasma total cholesterol were not significantly different than the values predicted by the Keys' equation, delta CHL = 1.35(2 delta S-delta P) + 1.5 delta Z. We conclude that under controlled conditions in which physical activity is constant l) dietary lipid differences influence fasting serum lipid and lipoprotein concentrations among men with high energy expenditures, and 2) the Keys' equation gives useful predictions of changes in plasma total cholesterol among vigorous men consuming different types and amounts of dietary lipid.     

Correlates of maintenance of a low-fat diet among women in the Women's Health Trial.

BACKGROUND. The Women's Health Trial (WHT) was a feasibility study for a randomized controlled trial designed to test the hypothesis that a reduction in dietary fat reduces breast cancer incidence among women age 45 to 69. Between 1984 and 1988, 2,064 women participated in its two phases. METHODS. A follow-up study of 525 women who were randomized to receive the WHT dietary intervention program was conducted to assess maintenance of the diet 1 year on average after the trial ended. Among 448 participants, the mean percentage of energy from fat as measured by a food frequency questionnaire was 40.0% at baseline, 26.3% at the end of the trial, and 27.7% at follow-up. Based on 408 women with complete data, a recursive model was estimated, describing the influence of baseline characteristics of the women on attendance at intervention program sessions, adherence to the diet during the trial, and long-term maintenance of the diet after the trial ended. The effects of women's experiences during the trial on adherence and long-term maintenance were investigated as well. RESULTS. Attendance at the educational sessions was strongly related to adherence to the diet during the trial (P less than 0.001), and adherence was the most important predictor of long-term maintenance (P less than 0.001). The percentage of energy from dietary fat at baseline was an important correlate of both adherence (P less than 0.001) and long-term maintenance (P less than 0.001). College-educated women were more likely to adhere to the diet during the trial (P less than 0.001). Feelings of deprivation adversely affected long-term maintenance (P less than 0.01), primarily through their effect on adherence during the trial (P = 0.01). Costliness of the diet in time and money negatively influenced long-term maintenance (P less than 0.05). Development of a distaste for fat encouraged adherence (P = 0.06). CONCLUSIONS. The low-fat dietary pattern established during the WHT was maintained for as long as 20 months after the trial ended. A recursive model was useful in analyzing the process and correlates of long-term maintenance of dietary behavior change. Both predisposing variables and women's experiences while on a low-fat diet were associated with long-term maintenance. The results suggest that feelings of deprivation should be avoided, perhaps by use of low-fat substitutes, by those attempting to lower their dietary fat and that more research is needed on the development of a distaste for fat among individuals who adopt low-fat diets.     

The effects of diet and exercise training on growth,body composition and blood lipid levels in rats

Adult male Sprague-Dawley rats were fed ad libitum either a high-fat diet or a low-fat diet. Half of the animals from each dietary group were submitted to an exercise regimen consisting of 2 hour swimming bouts, on alternate days for either 4 (Phase I) or 10 (Phase II) weeks. Body weight and food intake were measured weekly, and serum cholesterol levels as well as body composition were determined at the end of the treatment. High-fat diet fed animals ate significantly more food (Phase I 14%, Phase II 15%) weighed more (Phase I 9.5%, Phase II 18.2%) and had more body fat (Phase I 5.1%, Phase II 9.7%) than the low-fat fed controls. Total serum cholesterol (total-C) was greater in high-fat diet animals (Phase I 9 mg/dl, Phase II 30 mg/dl) due to higher levels of cholesterol in all lipoprotein fractions. Exercised animals in both diet groups weighed less (Phase I 13%, Phase II 20%) and had significantly lower levels of body fat (Phase I 4.5%, Phase II 8.2%) than their sedentary counterparts, yet food intake was similar in the two groups. Total-C was less in the exercised animals due to less circulating low density lipoprotein cholesterol (LDL-C) (Phase I 24 mg/dl, Phase II 41 mg/dl) and very low density lipoprotein cholesterol (VLDL-C) (Phase II 4 mg/dl, Phase II 21 mg/dl). Rats exercised for 10 weeks had significantly greater high density lipoprotein cholesterol (HDL-C) (14 mg/dl) than did their sedentary counterparts. The increased HDL-C/total-C ratio observed in both phases was due to the reduction of total-C associated with exercise. Treatments in Phase II had a greater effect on the variables studied than in Phase I, suggesting that time is an important consideration for diet and exercise studies. These results indicate that diet and exercise have independent effects on growth, body composition and serum cholesterol.     

Insulin-like growth factor I and low-density-lipoprotein cholesterol in women during high- and low-fat feeding.

In vitro studies suggest that insulin-like growth factor I (IGF-I) may modulate hepatic production and peripheral utilization of lipoproteins. We measured blood concentrations of IGF-I; total, high-density-lipoprotein, and low-density-lipoprotein (LDL) cholesterol; and apolipoproteins in 18 women with above average cholesterol after high- and low-fat diet periods. Total cholesterol fell 6% (P less than 0.02) during the low-fat diet because of reduced concentrations of LDL cholesterol (P less than 0.01). Serum concentrations of IGF-I were inversely correlated with total and LDL cholesterol and apolipoprotein B during both high-fat (r = -0.676, P less than 0.005; r = -0.745, P less than 0.001; and r = -0.504, P less than 0.04, respectively) and low-fat (r = -0.656, P less than 0.005; r = -0.757, P less than 0.001; and r = -0.695, P less than 0.001, respectively) diets. IGF-I increased with reduced fat intake in obese subjects only. Thus, IGF-I may contribute to the regulation of LDL cholesterol in mildly hypercholesterolemic women but may not mediate the beneficial response to reduced fat intake.     

Prospective, randomized, controlled comparison of the effects of low-fat and low-fat plus high-fiber diets on serum lipid concentrations.

Previous studies examining the hypocholesterolemic effects of high-soluble-fiber diets have not been designed to control for dietary fat intake. Serum cholesterol reductions may therefore be accounted for by differences in consumption of fat. Moderately hypercholesterolemic, nonobese, Caucasian men and women, 30-50 y old were randomly assigned to low-fat, low-fat plus high-fiber, or usual-diet groups and followed for 12 mo. At 12 mo the high-fiber group consumed significantly more soluble fiber than both the low-fat and usual-diet groups (P = 0.0063 and P = 0.0001); the high-fiber group did not differ from the low-fat group in quantity of dietary fat consumed. The high-fiber group experienced a greater average reduction (13%) in serum cholesterol than did the low-fat (9%) and usual-diet (7%) groups. After adjustment for relevant covariates, the reduction in the high-fiber group was significantly greater than that in the low-fat group (P = 0.0482). Supplementation with soluble fiber reduces serum cholesterol beyond the reduction observed with low-fat diet alone.     

Dietary intervention in breast cancer patients: effects on food choice.

Effects of dietary intervention on food choice were studied in 240 women aged 50-65 years who had been operated for a stage I-II breast cancer. Following surgery, the women participated in a dietary history interview and were then randomized to one of two groups. The intervention group (n = 121) received individual dietary counselling aimed at reducing dietary fat intake to 20-25% energy (E%), whereas no dietary advice was given to women in the control group (n = 119). For the 52% of the women in the intervention group that completed the study the total fat intake decreased from 36 to 23 E% (P less than or equal to 0.01) and from 37 to 34 E% (P less than or equal to 0.01) for the control group. There were significant reductions in the intake of table fat, high-fat milk products, pork and sausages (containing greater than 11% fat), eggs, rice, pasta, cakes and chocolate for the intervention group. Concurrently the intake of vegetables, fruits, potatoes, bread, cereals, low-fat milk products, low-fat meat, sausages and fish increased significantly. For the control group there was a significant decrease in the consumption of total milk products, total meats, rice, pasta, cakes, and butter intake while the consumption of vegetables, fruits, cereals and fish increased (P less than or equal to 0.01). Reduction of high-fat foods and increases of carbohydrate-rich foods were more pronounced for the intervention group than for the control group. Formal education influenced dietary changes, and dietary counselling should therefore ideally be adapted to education level. This study showed that dietary counselling can bring about significant changes in consumption of high-fat foods for at least a 2-year period for women operated for breast cancer.     

Effects of low-fat and/or high-fruit-and-vegetable diets on plasma levels of 8-isoprostane-F2alpha in the Nutrition and Breast Health study

Dietary patterns that involve both a decrease in fat and an increase in fruit and vegetable (FV) intake may decrease cancer risks. In this study, a total of 122 premenopausal women with a family history of breast cancer were randomized into one of four diets for 12 mo: nonintervention, low-fat (15% of energy from fat), high-FV(9 servings/d), and combination low-fat/high-FV Fasting blood samples were obtained at baseline and after 3, 6, and 12 mo. Levels of 8-isoprostane-F2a in plasma were deter-mined by immunoassay kits. Statistical analyses indicated that levels of 8-isoprostane-F2a decreased significantly with time in the low-fat arm, which is the only intervention that resulted in weight loss; there were no significant changes in the other three diet arms. It is unlikely that this is due to changes in levels of blood lipids because there was little change overtime in plasma total cholesterol, high-density lipoprotein,low-density lipoprotein (LDL), or triglyceride levels in any diet arm, although mean LDL did decrease slightly in women who reduced fat intake after adjustment for change in body mass index (BMI). Levels of baseline 8-isoprostane-F2a were significantly higher in obese women than in overweight or normal weight women, and change in BMI was significantly correlated with change in 8-isoprostane-F2a levels. These results indicate that low-fat diets or high-FV diets are unlikely to affect plasma levels of 8-isoprostane-F2a in healthy,premenopausal women who do not lose weight during dietary change.     

Relationships of dietary fat consumption to serum total and low-density lipoprotein cholesterol in hispanic preschool children

BACKGROUND. Studies of the relationship between dietary fat intake and serum lipids in young children have yielded inconclusive results. We studied this relationship in 108 Hispanic children ages 4-5 years. METHODS. Four 24-hr recalls approximately 3 months apart and two Willett semiquantitative food frequency questionnaires approximately 6 months apart were obtained by interviewing the children's mothers. Diet measures were averaged for the multiple administrations of each of these instruments. RESULTS. Based on the 24-hr recalls, children in the highest tertile of total fat consumption (36.2% of total calories) compared with the lowest tertile (30.2% of total calories) had mean total serum cholesterol of 4.32 mmol/liter (167 mg/dl) vs 3.91 mmol/liter (151 mg/d) (test for linear trend across tertiles, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.74 mmol/liter (106 mg/dl) vs 2.29 mmol/liter (89 mg/dl) (test for linear trend, P less than 0.01). Children in the highest tertile of saturated fat consumption (14.6% of total calories) compared with the lowest tertile (11.2% of total calories) had mean total serum cholesterol of 4.39 mmol/liter (170 mg/dl) vs 3.97 mmol/liter (154 mg/dl) (test for linear trend, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.80 mmol/liter (108 mg/dl) vs 2.35 mmol/liter (91 mg/dl) (test for linear trend, P less than 0.01). These relationships remained significant when calorie-adjusted nutrient intakes were examined and after adjustment in multiple linear regression models for age, sex, and body mass index, with the exception of the association of calorie-adjusted total fat with total serum cholesterol level (P = 0.07). Similar results were obtained using the Willett questionnaires. CONCLUSIONS. These findings indicate that dietary fat, particularly saturated fat consumption, is an important correlate of blood lipid levels in preschool children. These are also the first reported data indicating that the Willett questionnaire, as a method for measuring the atherogenic components of diet, has criterion-related validity in young children.     

Changes in plasma lipoproteins during low-fat, high-carbohydrate diets: effects of energy intake

BACKGROUND: Low-fat diets can increase plasma triacylglycerol and reduce HDL cholesterol. Changes in energy intake and body weight can influence the lipoprotein response. OBJECTIVE: We sought to prospectively examine the effects of euenergetic and ad libitum dietary fat restriction on plasma lipoproteins in healthy postmenopausal women. DESIGN: Participants first received a controlled euenergetic diet in which dietary fat was reduced stepwise from 35% to 25% to 15% over 4 mo. Thereafter, participants followed an ad libitum 15%-fat diet for 8 mo; 54 women completed the intervention. RESULTS: During the controlled euenergetic diet, plasma triacylglycerol increased from 1.70 +/- 0.10 to 2.30 +/- 0.16 mmol/L, total cholesterol decreased from 5.87 +/- 0.13 to 5.53 +/- 0. 13 mmol/L, LDL cholesterol decreased from 3.41 +/- 0.10 to 2.87 +/- 0.10 mmol/L, HDL cholesterol decreased from 1.76 +/- 0.08 to 1.50 +/- 0.08 mmol/L, and apolipoprotein (apo) A-I decreased from 5.11 +/- 0.14 to 4.78 +/- 0.14 mmol/L (P < 0.0001 for all changes). Hormone replacement therapy did not affect the relative change in HDL cholesterol. Plasma glucose, insulin, hemoglobin A(1C,) free fatty acid, and apo B concentrations did not change significantly. During the ad libitum 15%-fat diet, participants lost 4.6 +/- 0.4 kg. Plasma triacylglycerol and LDL cholesterol returned to baseline values (1.77 +/- 0.12 and 3.31 +/- 0.08 mmol/L, respectively), whereas HDL cholesterol and apo A-I remained low (1.40 +/- 0.08 and 4.82 +/- 0.18 mmol/L, respectively). HDL cholesterol and apo A-I concentrations stabilized in subjects who were not receiving hormone replacement therapy but continued to decline in women who were receiving hormone therapy. CONCLUSIONS: The ad libitum 15%-fat diet resulted in significant weight loss. The euenergetic but not the ad libitum diet caused hypertriacylglycerolemia. HDL cholesterol decreased during both low-fat diets.     

Very low-fat (12%) and high monounsaturated fat (35%) diets do not differentially affect abdominal fat loss in overweight, nondiabetic women

Studies in women with type 2 diabetes demonstrated adverse effects on body fat distribution of a low-fat diet relative to a high monounsaturated fat diet. We performed a randomized 12-wk parallel design study of two 6000-kJ diets: 35% energy from fat (high monounsaturated fat diet, HIMO), or 12% energy from fat (very low-fat diet, VLF) to determine whether this also occurred in nondiabetic women. Body fat distribution, fasting plasma glucose, blood pressure, and fasting serum lipids were measured at wk 0 and 12 in 62 women (BMI > 27 kg/m(2)). Weight loss (9.5 +/- 2.4 vs. 9.4 +/- 3.4 kg, VLF vs. HIMO) and total fat loss (6.1 +/- 2.4 vs. 6.3 +/- 2.7 kg, VLF vs. HIMO) did not differ in the groups. There was a diet x menopausal status interaction in lean mass changes (P = 0.005) such that in premenopausal women, HIMO produced a lower loss of lean mass than the low-fat diet (0.4 +/- 2.3 vs. 2.9 +/- 2.7 kg, P = 0.006) with the opposite but nonsignificant effect seen in postmenopausal women. There was a greater decrease in total plasma cholesterol in women who consumed VLF compared with those who consumed HIMO (0.82 +/- 0.0.51 vs. 0.50 +/- 0.48 mmol/L, P < 0.001 for time, P < 0.05 for diet effect). This was also true for the change in HDL cholesterol (0.18 +/- 0.23 vs. 0.04 +/- 0.19 mmol/L, VLF and HIMO, respectively, P < 0.001 for time, P < 0.05 for diet effect). The LDL/HDL ratio was reduced in both groups with no effect of diet (0.16 +/- 0.51 vs. 0.16 +/- 0.45, VLF and HIMO, respectively, P < 0.05). In conclusion, weight, total fat mass, and regional fat mass loss did not differ in the 2 groups of women but there was an apparent preservation of lean mass in premenopausal women consuming HIMO.