Clinical approaches to healthier diet modifications.

There is a strong relation between diet and risk factors for cardiovascular diseases. Generally a high fat consumption will increase the serum cholesterol level. Different fatty acids have different effects on total cholesterol, LDL and HDL lipoproteins and therefore on the risk for cardiovascular diseases. This knowledge was translated into guidelines for a healthy diet and in advices to use less fat. In reality it was not easy for physicians to reach a substantial reduction in total cholesterol by limiting the fat consumption. A recent investigation in Belgium showed that the median reduction obtained by dietary changes through general practitioners was only 3.5%. In medical education not much attention is paid to the communication of the "fat message". In addition, individual patients have frequently multiple risk factors e.g. abdominal obesity, insulin resistance, diabetes, hypertension and a sedentary lifestyle. Therefore in the clinical setting an integrated approach is needed, in which dietary advice is supported by behavioural therapy and suggestions to increase physical activity. Currently there is a debate on the preference of a low fat or a modified fat diet. A low fat diet is rich in carbohydrates and a modified fat diet is rich in mono-unsaturated fatty acids. Recent investigations in diabetic patients are in favour of a modified fat diet. This has the advantage that in practice the possibilities for realizing a low saturated fat diet are increased.