Alternative fat-restricted diets for hypercholesterolemia and combined hyperlipidemia: feasibility, design, subject recruitment, and baseline characteristics of the dietary alternatives study.

Walden, Carolyn E.; McCann, Barbara S.; Retzlaff, Barbara M.; Dowdy, Alice; Hanson, Madelyn S.; Fish, Brian; Fitzpatrick, Virginia; Follette, William C.; Parker, Donald E.; Gey, George O.

doi:10.1080/07315724.1991.10718169

Cited by 23 publications

(7 citation statements)

References 28 publications

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“…It would be expected in stratifying subjects in this manner that there would be one‐fourth as many individuals with CHL as HC (0.25 × 0.25= 0.0625). We were surprised to discover that for every four individuals identified with HC there were 2.6 individuals with CHL (320 HC subjects, 211 CHL subjects) where one would be expected (21). This observation means that in this hypercholesterolemic cohort, hypertriglyceridemia is over‐represented nearly three‐fold.…”

Section: Dietary Alternatives Study (Das)mentioning

confidence: 98%

“… Design of the Dietary Alternatives Study in which 531 HC or CHL subjects were randomized into one of four (HC) or three (CHL) diets of increasing fat restriction (21). Hypothesis test analyses were performed at one year (22).…”

Section: Dietary Alternatives Study (Das)mentioning

confidence: 99%

“…The first was performed in a cohort of 531 male Boeing employees to test the effect of four different levels of increasing fat restriction and carbohydrate augmentation. The second study tested the effect of the National Cholesterol Education Program (NCEP) Step II Diet for the equivalency of its effect on lowering LDL cholesterol in women versus men and conjoint effects on other lipoproteins (21–25). The first study is known as the Dietary Alternatives Study (DAS), and the second study is referred to as the Boeing employees Fat Intervention Trial (BeFIT).…”

mentioning

confidence: 99%

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

Knopp

Retzlaff

Walden

et al. 2000

Proc Soc Exp Biol Med

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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...

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Section: Dietary Alternatives Study (Das)mentioning

confidence: 98%

Section: Dietary Alternatives Study (Das)mentioning

confidence: 99%

mentioning

confidence: 99%

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

Knopp

Retzlaff

Walden

et al. 2000

Proc Soc Exp Biol Med

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“…The impact of social support on dietary adherence was examined in the Dietary Alternatives Study (DAS) (Walden, McCann, & Retzlaff, 1991). The DAS reported the positive effects of reduced fat and reduced cholesterol diets on married, hyperlipidemic and hypercholesterolemic men (Walden, McCann, Retzlaff, 1991).…”

Section: Dietary Adherence and Fat Preferencementioning

confidence: 99%

“…The DAS reported the positive effects of reduced fat and reduced cholesterol diets on married, hyperlipidemic and hypercholesterolemic men (Walden, McCann, Retzlaff, 1991). A subgroup of the DAS participants who had completed both spouse support variables and food records at each assessment were selected to examine the role of social support on the consumption and maintenance of a low-fat diet (Bovbjerg et al, 1995).…”

Section: Dietary Adherence and Fat Preferencementioning

confidence: 99%

"The Impact of a Low-Fat Diet and the Use of Fat Substitutes on Fat Preferences Among Overweight Women Seeking Weight Loss Treatment"

Kalupa¹

2003

PsycEXTRA Dataset

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Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. , 1999). The current study evaluated the impact of dietary fat modification on fat preference in three weight loss groups. The impact of changes in fat preference on shortterm adherence to a 6-week weight loss program was assessed. Sixty-one otherwise, healthy overweight women (BMI 25-37 kg/m2) between the ages of 18-60 were randomly assigned to one of three brief, 6-week weight loss programs. All three groups were asked to reduce dietary intake to 1800 kilocalories per day, but one group was asked to maintain fat at 36%, and two additional groups were asked to consume 20-25% of kilocalories in fat. One low-fat group was instructed to use fat substitutes and the other was instructed to avoid substitutes. It was hypothesized that decreased fat intake and sensory exposure to fat would cause a decrease in preference for high fat foods. Excellent adherence was observed with over 91% of participants completing treatment. In addition, guidelines regarding kilocalories, respective fat intake, fat substitute use were followed. Taste changes that occurred were subtle and did not affect on short-term dietary adherence. More time on the prescribed fat levels might be required to induce a change in fat preference. Differential changes in fat preference following dietary fat modification were expected, but not observed in the current investigation. However, results suggest that a modified 6-week Behavior Choice program might be a viable treatment option for women in this age and weight category (BMI < 37 kg/m2). However, adherence to low-fat diets remains a challenge. Hedonic responses to food may be important to understand the adherence problem. When compared to bland-tasting foods, nutritionally-equivalent foods that are flavorful are more satiating (Rolls, 1995;Warwick et al., 1993). Two previous studies that examined the sensory impact of dietary fat modification reported conflicting results (Mattes, 1993;Guinard et al., 1999).The current study evaluated the impact of dietary fat modification on fat preference in three weight loss groups. The impact of changes in fat preference on shortterm adherence to a 6-week weight loss program was assessed. Sixty-one otherwise, healthy overweight women (BMI 25-37 kg/m 2 ) be...

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Long-term Cholesterol-Lowering Effects of 4 Fat-Restricted Diets in Hypercholesterolemic and Combined Hyperlipidemic Men

Knopp¹

1997

JAMA

129

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Alternative fat-restricted diets for hypercholesterolemia and combined hyperlipidemia: feasibility, design, subject recruitment, and baseline characteristics of the dietary alternatives study.

Cited by 23 publications

References 28 publications

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

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

"The Impact of a Low-Fat Diet and the Use of Fat Substitutes on Fat Preferences Among Overweight Women Seeking Weight Loss Treatment"

Long-term Cholesterol-Lowering Effects of 4 Fat-Restricted Diets in Hypercholesterolemic and Combined Hyperlipidemic Men

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