Assessment of the effect of fat-modified foods on diet quality in adults, 19 to 50 years, using data from the Continuing Survey of Food Intake by Individuals

Fat-reduction strategies and the role of fat-modified foods in the US diet were assessed using a nationally representative survey: the 1996 US Department of Agriculture Continuing Survey of Food Intakes by Individuals. A sample of 878 men and 853 women was included. The sample was divided into low fat and high fat based on the Dietary Guideline's cutoff poin of 30% or less of energy from total fat. The survey sample was further stratified in nonusers, low-users or high-users of fat-modified foods. Approximately 10% of 7,000 foods were classified as fat-modified. There was a 400 to 500 kcal difference in energy intake of individuals consuming low-fat compared with high-fat diets. Adults who were users of fat-modified foods consumed more nutrient-dense diets, with higher intakes of vitamin A, folate, and iron. Not all fat-reduction strategies were equally effective in reducing fat and maintaining nutrient intake. Nonusers of fat-modified foods who consumed a low-fat diet tended to do so by substituting carbohydrate, in part from carbonated beverages, for fat. Both men and women consuming a low-fat diet had lower average BMIs; this difference between individuals consuming low-fat vs high-fat diets was significant for women who were high-users of fat-modified foods. The data suggest that a low-fat diet with high use of fat-modified foods may be one strategy for achieving adequate nutrient intake while maintaining weight in the desirable BMI range of 19 to 25.     

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.     

Structured dietary advice incorporating walnuts achieves optimal fat and energy balance in patients with type 2 diabetes mellitus

OBJECTIVE: A cardioprotective dietary fat profile is recommended for the treatment of type 2 diabetes. The clinical feasibility of advice strategies targeting specific fatty acid intakes and the extent to which they can be achieved by free-living populations needs to be tested. Walnuts, with high n-3 polyunsaturated fatty acid (PUFA) content, may help optimize fatty acid intakes, but regular consumption might increase total fat and energy intakes. This study examined whether advice that refers to a total dietary pattern inclusive of walnuts would result in low-fat energy-controlled diets with optimal dietary fat proportions for patients with type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS: A parallel-design, controlled trial was completed by 55 free-living men and women with established type 2 diabetes mellitus. Participants were randomly assigned to one of three groups: low-fat (general advice), modified low-fat (total diet advice using exchange lists to differentiate PUFA-rich foods), walnut-specific (modified low fat including 30 g walnuts/day). Dietary intakes and clinical outcomes were measured at baseline, and at 3 and 6 months. Dietary goals were: less than 10% of energy from saturated fat, 7% to 10% of energy from PUFA, adequate n-3 PUFA (>or=2.22 g alpha-linolenic acid, >or=0.65 g eicosapentaenoic acid [EPA]+docosahexaenoic acid [DHA]) and n-6 to n-3 ratio less than 10. The proportion of subjects achieving dietary goals and major food sources of fat were determined. RESULTS: At baseline, dietary intakes were not significantly different between groups. No group and few individuals (10%) were consuming adequate PUFA, with meat the main source of dietary fat (22% total dietary fat). At 3 and 6 months, energy and macronutrient intakes were similar among groups. The walnut group, however, was the only group to achieve all fatty acid intake targets (P <.01), and had the greatest proportion of subjects achieving targets ( P <.05). Walnuts were the main source of dietary fat (31%) and n-3 PUFA (50%), while 350 g oily fish/day provided a further 17% n-3 PUFA consumed by this group. CONCLUSIONS: Specific advice for the regular inclusion of walnuts in the context of the total diet helps achieve optimal fat intake proportions without adverse effects on total fat or energy intakes in patients with type 2 diabetes mellitus.     

Dietary-fat intake in the US population.

OBJECTIVE: This article looks at the food group choices by individuals grouped based on fat intake, saturated fat intake, and use of lowfat foods. METHODS: Food consumption data from USDA's National Food Consumption Surveys (NFCS) and the Continuing Survey of Food Intakes by Individuals (CSFII) were used to look at changes in the mean energy, percent calories from fat and saturated-fat and total-fat intakes over time. USDA's 1995 CSFII data were used to evaluate the diets of individuals grouped based on percent calories from fat and use of low-fat foods. Individuals six to 50 years old who had complete food intake records were included and five age-gender classifications were used. RESULTS: The percent of calories from total fat and saturated fat have steadily declined over the last 30 years, and the amount of fat in the diet has increased from 1989 to 1995. Those whose diets met the Dietary Guidelines Recommendations for fat and saturated fat had lower fat intakes. Except for adult males, those with low-fat diets had higher intakes of total-food amount. Also, lower saturated-fat intakes were associated with lower energy intakes. In general, high-fruit-and-grain-products consumption were seen in groups with low-fat intake. For those who included low-fat foods in their diets and also had low-fat intakes, rice and pasta were the major foods of choice for calories. Fried potatoes were one of the main sources of calories for high-fat groups. CONCLUSION: The study showed individuals whose diets included low-fat foods are more likely to have a diet that meets the dietary guidelines recommendations for fat and saturated fat.     

Lack of energy compensation over 4 days when white button mushrooms are substituted for beef

Increasing intake of low energy density (ED) foods in place of high ED foods has been proposed as a strategy for preventing or treating obesity. This study investigated how substituting mushrooms for beef in a test lunch affected energy intake, fat intake, palatability, appetite, satiation and satiety in normal weight, overweight and obese adults. Each subject consumed a total of eight test lunches in our lab over two consecutive weeks. The order of presentation of four consecutive meat lunches and four consecutive mushroom lunches was randomized. Energy content of meat and mushroom lunches varied (783 kcal versus 339 kcal), while volume was held constant. Energy intakes were significantly higher during meat lunches than mushroom lunches (730+/-7.9 kcal versus 310+/-5.8 kcal). Subjects exhibited only partial compensation (11.4+/-12.0%) for this difference over 4 days. Total daily energy intake and fat intake were significantly greater in the meat condition than in the mushroom condition, while ratings of palatability, appetite, satiation and satiety did not differ significantly. These results suggest that substituting low ED foods for high ED foods in otherwise similar recipes can be an effective method for reducing daily energy and fat intake.     

Impact of Adopting Lower-Fat Food Choices on Energy and Nutrient Intakes of American Adults

Objective To evaluate the energy and nutrient intake of free-living men and women who choose foods consistent with different fat-reduction strategies.Design For each year of the Continuing Survey of Food Intake by Individuals from 1989 through 1991, food codes were used to sort respondents by type of milk; type of meats; and type of cheese, yogurt, salad dressing, cake, and pudding (ie, full-fat or fat-modified products) consumed.Subjects A nationally representative sample of 3,313 men and 3,763 women who completed 3-day intake records and consumed either a reduced-fat or full-fat food from at least 1 of the 3 fat-reduction strategy categories.Statistical analysis performed Analysis of variance with the Scheffé test was used to analyze differences in energy and nutrient intake between exclusive users, mixed users, and nonusers of each strategy or combined strategies.Results Regardless of fat-reduction strategy, men and women who used them reported significantly lower intakes of total fat (up to 18 g lower), saturated fat (up to 12 g lower), cholesterol (up to 75 ing lower) and energy compared with nonusers. Exclusive users of single strategies met or approached recommendations of the National Cholesterol Education Program for total fat, saturated fat, and cholesterol intake; micronutrient intake varied depending on the strategy used. Skim milk users had the most favorable micronutrient intake, whereas lean meat users reported inadequate intake of zinc (men 6396 and women 59% of the Recommended Dietary Allowances [RDAs]) and female users of fat-modified products reported inadequate intakes of vitamin E (64% of RDA) and zinc (65% of RDA). Multiple-strategy users achieved National Cholesterol Education Program goals and reported adequate micronutrient intakes and significantly lower energy intake. Mixed users of fat-modified products compared with nonusers of any fat-modified products had adequate micronutrient intake and lower intakes of total fat (32% vs 36% of energy for men and 32% vs 35% of energy for women) and saturated fat (11% vs 13% of energy for men and 11% vs 12% of energy for women). In addition, nonusers of any fat-modified strategy had the highest cholesterol and energy intake and the lowest intake of. many micrbnutrients.Applications A variety of fat-reduction strategies can be implemented to reduce energy, total fat, saturated fat, and cholesterol intake. Some of the strategies were associated with an inadequate micronutrient intake, so additional dietary guidance is needed to ensure that all nutrient requirements are met. Furthermore, people who do not use any fat-reduction strategy or those who exclusively use lean meats or fat-modified products would benefit from understanding how to balance their food choices. J Am Diet Assoc. 1999;99:177–183.     

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.     

Caloric, but not macronutrient, compensation by humans for required-eating occasions with meals and snack varying in fat and carbohydrate.

Six subjects participated in a residential study assessing the effects of covert macronutrient and energy manipulations during three required-eating occasions (breakfast, lunch, and afternoon snack) on total macronutrient and energy intakes. Overall, energy content of the occasions varied between approximately 3000 and approximately 7000 kJ (approximately 700 and approximately 1700 kcal) with the majority of the differential derived from either fat or carbohydrate (CHO). Each condition (high, medium, and low fat; high, medium, and low CHO; and no required eating) was examined for 2 d. Subjects compensated for the energy content of the required occasions such that only under the low-CHO condition (11,297 +/- 3314 kJ) was total daily energy intake lower than that observed in the absence of required occasions (13,297 +/- 1356 kJ). Only total energy intake under the high-fat condition (12,326 +/- 2548 kJ) was significantly different from its matched CHO condition (high-CHO condition: 14,665 +/- 2686 kJ). In contrast to the clear evidence for caloric compensation, there were no differential effects of condition on macronutrient intake, ie, there was no macronutrient compensation.     

High dietary calcium reduces body fat content,digestibility of fat,and serum vitamin D in rats

OBJECTIVE: This study investigated which aspect of energy balance was responsible for the decrease in body fat content of rats fed a high-calcium, high-dairy protein diet. RESEARCH METHODS AND PROCEDURES: Male Wistar rats were fed a control diet (25% kcal fat, 14% kcal protein from casein, 0.4% by weight calcium) or high-calcium diet (25% kcal fat, 7% kcal protein from nonfat dry milk, 7% kcal protein from casein, 2.4% calcium) for 85 days. Body weights, digestible energy intakes, energy expenditures, rectal temperatures, body composition, and serum glucose, insulin, free fatty acids, triglycerides, and 1,25-dihydroxyvitamin D were measured. RESULTS: Rats fed high-calcium diet gained significantly less weight than controls and had 29% less carcass fat. Gross energy intake was not significantly different between groups, but digestible energy was 90% of gross energy in the high-calcium diet compared with 94% in the control diet because of increased fecal excretion of dietary lipid. The difference in digestible energy intake accounted for differences in carcass energy. Body temperatures and energy expenditures of the rats were not different. The high-calcium diet reduced serum triglycerides by 23% and serum 1,25-dihydroxyvitamin D by 86%. DISCUSSION: These results confirm that a high-calcium diet decreases body weight and fat content due to a lower digestible energy intake caused by increased fecal lipid and a nonsignificant reduction in gross energy intake.     

Incorporating Fat-Modified Foods Into a Food Frequency Questionnaire Improves Classification of Fat Intake

Objective To determine the extent to which incorporating fat-modified foods into a food frequency questionnaire influences the agreement of energy and nutrient estimates with estimates obtained from food records.Design Subjects completed four 2-day food records at 3-month intervals. At the end of the recording period, a food frequency questionnaire was administered to assess usual daily intake during the preceding year. Subjects/setting One hundred and three subjects selected from a population-based sample of adults participating in the Beaver Dam Eye Study.Statistical analyses performed Subjects were categorized into three groups on the basis of their frequency of consumption of fat-modified foods. For each group, correlations were calculated between food record estimates and estimates obtained from the original food frequency questionnaire, the original with a low-fat option, and the fat-modified questionnaire.Results For persons categorized as high consumers of fat-modified foods, incorporating questions regarding the consumption of these products resulted in higher correlations with food record estimates (original vs fat-modified version) for percentage of energy from total fat (.32 vs .47), saturated fat (.20 vs .41), oleic acid (.32 vs .50), and linoleic acid (.40 vs .46). High consumers differed in several characteristics that could be associated with disease risk (eg, higher ratios of serum total cholesterol to high-density lipoprotein cholesterol).Conclusions Failure to account for the consumption of fat-modified foods in epidemiologic studies may result in misclassification of fat exposures. Because patterns of misclassification could be different for those at risk for disease, results of epidemiologic studies could be biased if these foods are excluded. Thus, incorporating fat-modified foods into food frequency questionnaires will improve the ability of researchers to correctly classify fat exposures and to evaluate potentially important relationships between fat intake and disease risk. J Am Diet Assoc. 1997; 97: 860–866.     

Stages of change and the intake of dietary fat in African-American women: improving stage assignment using the Eating Styles Questionnaire

OBJECTIVE: To develop an algorithm for determining the stage of change for dietary fat intake in African-American women. DESIGN: We examined the relationships between stage of change, dietary fat intake, and associated eating behaviors and developed an assessment tool for placing subjects in their appropriate stage of change. SUBJECTS: Working class and middle-income African-American women in Nashville, Tenn; 174 in study 1 and 208 in study 2. STATISTICAL ANALYSES: Fat and fiber intake by stage of change was examined using multivariate analysis of variance. Hierarchical cluster analysis was performed using Ward's method. RESULTS: A significant difference in fat intake was noted between women trying to change their intake and those not trying to change in study 1 (P < .001) and study 2 (P < .03). Of those trying to change, only 34% (study 1) and 9% (study 2) of subjects reported fat intakes below the Healthy People 2000 goal of 30% of energy from fat. In study 1, cluster analysis identified 14 groups of foods that significantly separated subjects into not trying, noncompliant, and compliant categories. Compliant subjects ate out less; ate fewer snack foods and less chicken, meat, and fat; and ate more fruits, vegetables, breakfast foods, and low-fat products. These results led to development of the Eating Styles Questionnaire (study 2), which facilitated more appropriate placement of the noncompliant group in stages of change for dietary fat intake. APPLICATIONS/CONCLUSIONS: These data support the stage construct of the Transtheoretical Model for dietary fat reduction in African-American women. Moreover, the Eating Styles Questionnaire (ESQ) can improve determination of stage of change for this group of women. The ESQ can be used to diagnose the eating styles that contribute to a high-fat intake and help in the design of interventions to lower fat intakes.     

Nutrient contributions of dairy foods in the United States, Continuing Survey of Food Intakes by Individuals, 1994-1996, 1998

OBJECTIVE: This study was designed to quantify the impact of dairy foods on nutrient intakes in the United States. SUBJECTS: Data were from 17959 respondents to the 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals (CSFII).Statistical analyses Nutrient intakes were quantified by quartile of dairy food intake. Also, dairy intakes were compared in people who met vs did not meet intake recommendations for select nutrients. Finally, the direct contribution of dairy foods/ingredients to calcium and lipid intakes was determined. SAS and SUDAAN software were used. Data were weighted. Energy intake was a covariable in regression models. RESULTS: Intake of all micronutrients examined, except vitamin C, was higher with increasing quartile of total dairy and milk intake, controlling for energy intake. Calcium was the only micronutrient positively associated with cheese intake. Fat intake either did not differ or was lower among people in quartile 2, 3, or 4 vs quartile 1 of total dairy and milk intake, whereas fat was higher as quartile of cheese intake increased. Dietary cholesterol was lower as intakes of any of the dairy categories increased; the opposite was true for saturated fat. Dairy foods/ingredients directly contributed an average of 51% of dietary calcium, 19% of total fat, 32% of saturated fat, and 22% of cholesterol. CONCLUSIONS: Total dairy and milk intakes were associated with higher micronutrient intakes without adverse impact on fat or dietary cholesterol. Results reinforce the strong nutritional profile of dairy-rich diets, although results with saturated fat and with cheese suggest that it would be useful to modify product composition and/or eating patterns to optimize nutritional contributions of dairy products.     

Methods to increase fruit and vegetable intake with and without a decrease in fat intake: compliance and effects on body weight in the nutrition and breast health study

Dietary patterns that involve a decrease in fat and an increase in fruit and vegetable (FV) intake have been suggested to decrease cancer risks. In this study, intervention methods to selectively modify dietary fat and/or FV intakes were developed. Compliance to the diets and the effects on body weight are shown, because both of these dietary changes can impact on and be confounded by changes in energy intake. A total of 122 women with a family history of breast cancer were randomized onto one of four diets for 12 mo. Counseling methods were devised to increase amount and variety of FV consumed with or without a decrease in fat intake using modified exchange list diets. Women on the low-fat and combination low-fat/high-FV diet arms decreased their fat intakes to approximately 16% of energy. Women on the high-FV and the combination low-fat/high-FV diet arms increased FV intakes to approximately 11 servings/day. Despite counseling efforts to maintain baseline energy intakes, mean body weight increased significantly by 6 pounds in women in the high-FV diet arm and decreased significantly by 5 pounds in women in the low-fat diet arm. Percent body fat also was increased in the high-FV diet arm and decreased in the low-fat diet arm. Body weight and percent body fat in the combination diet arm did not change significantly. Control of energy intake, therefore, appears to have been achieved only when the addition of FV to the diet was balanced by a decrease in fat intake and both dietary components were enumerated daily. Maintenance of energy intake, therefore, did not appear to be attained intrinsically when individuals were counseled to make changes in the composition of their diets.     

Dietary habits of elderly persons with diabetes.

The dietary habits and nutrient intakes of a group of 151 persons with diabetes were compared with those of a group without diabetes in a random postal survey of 3,000 individuals aged 65 years and older residing in Adelaide, South Australia. A semiquantitative food frequency questionnaire was used. The response rate was 77%. Only 64% of individuals with diabetes reported following a diabetic diet at the time of the survey, and only 6% were consuming a high-carbohydrate, low-fat diet (greater than or equal to 50% energy intake from carbohydrate and less than or equal to 30% from fat). The dietary habits of elderly persons with diabetes suggested an awareness of the need to limit simple sugars; however, adherence to the latest recommendations concerning dietary fat and fiber was poor. Individuals with diabetes had lower intakes of refined carbohydrate but were just as likely as those without diabetes to eat high-fat foods, and they ate eggs and cheese more frequently. Those with diabetes were no more likely than those without diabetes to consume the recommended complex-carbohydrate and fiber-rich foods. The extent of adherence to current dietary recommendations for the management of diabetes was found to be independent of sex, age, occupational status, educational attainment, marital status, living arrangements (alone vs with a spouse), and source of income.     

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.     

Caloric compensation for lunches varying in fat and carbohydrate content by humans in a residential laboratory

Two groups of three subjects participated in a residential study that assessed the effects of varying the macronutrient and caloric content of a required lunch meal on subsequent food choice and intake. Lunches contained 431 or 844 kcal, with the caloric differential created by manipulating the calories derived from either fat or carbohydrate (CHO). Each lunch condition (high-fat, high-CHO, low-fat, and low-CHO) was examined for 3 consecutive days. Subjects controlled their own patterns of food intake and could consume any item or number of items at any time during the day or night. There were no significant differences in total daily caloric intake across conditions, indicating that subjects compensated for the caloric content of the lunch regardless of the macronutrient content. Total daily caloric intake under the high-fat and high-CHO conditions was 2824 +/- 151 (mean +/- SEM) and 2988 +/- 187 kcal, respectively, whereas intake under the low-fat and low-CHO conditions was 2700 +/- 131 and 2890 +/- 247 kcal, respectively.     

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.     

Dietary fat:carbohydrate ratio and obesity in middle-aged men

Nutrient intakes from 7-d diet records were compared with hydrostatically determined body composition in 155 sedentary obese men aged 30-59 y. Percent body fats ranged from 18.6 to 40.3. The men ate (mean +/- SD) 2570 +/- 514 kcal/d: 15.6 +/- 2.6% from protein, 40.7 +/- 5.7% from fat, 37.5 +/- 6.9% from carbohydrate, and 6.2 +/- 6.0% from alcohol. Percent body fat correlated positively (p less than 0.05) with g/1000 kcal intake of total, saturated, and monounsaturated fatty acids and negatively with carbohydrates and plant protein. Total calories, number of meals, and distribution of calories were unrelated to percent body fat, total weight, or fat-free mass. The higher proportion of fat and carbohydrate in the diet may contribute to obesity in men. The modest caloric intake of these men and the lack of correlation between percent body fat and total calories suggest that calorie differences are not the major cause of the variations in obesity in these men.