Women and men with hypercholesterolemia respond similarly to an American Heart Association step 1 diet.

OBJECTIVE: To compare serum lipid level responses of women and men with hypercholesterolemia to an American Heart Association (AHA) step 1 diet. DESIGN: Sixty-three women and 99 men with varying degrees of hypercholesterolemia were instructed on an AHA step 1 diet. Subjects were followed up on a biweekly basis with individual visits and group classes for 8 weeks. SETTING: Outpatient clinic facility of the Metabolic Research Group, University of Kentucky, Lexington. SUBJECTS/SAMPLES: Through community cholesterol screenings, we recruited 76 women and 108 men aged 30 to 70 years who were within 80% to 130% of their ideal body weight. Serum cholesterol levels were between 5.17 mmol/L and 8.99 mmol/L and serum triglyceride levels when subjects were fasting were less than 5.08 mmol/L. Sixty-three women and 99 men completed the study. INTERVENTION: Subjects followed an AHA step 1 diet (30% of energy from fat, 50 to 60% of energy from carbohydrate, 10 to 20% of energy from protein, and less than 300 mg cholesterol per day) for 8 weeks. MAIN OUTCOME MEASURES: Serum lipid levels, nutrient intake, and body weight. STATISTICAL ANALYSES PERFORMED: Subjects were divided into three groups according to initial serum cholesterol levels (mild = 5.17 to 6.17 mmol/L; moderate = 6.20 to 6.95 mmol/L; severe = > or = 6.98 mmol/L). Within-individual changes in nutrient intakes, body weights, and serum lipid levels were analyzed using dependent t tests. Between-group comparisons were made using analysis of variance (ANOVA). When significant differences were found using ANOVA, differences between groups were evaluated with the Tukey test. RESULTS: All subjects tolerated the diet well and average dietary adherence was good, as assessed by a food frequency questionnaire and analysis of 3-day diet records. Serum total cholesterol levels decreased 9.2% overall for women (P < .001) and 7.2% for men (P < .001); serum low-density lipoprotein cholesterol levels decreased 9.2% for women and 9.8% for men; and serum high-density lipoprotein cholesterol levels decreased 3.6% for women and 2.8% for men. Mean serum triglyceride levels decreased significantly for women but not for men. No significant differences were found in the responses of women and men in the corresponding groups. Women and men with higher initial serum cholesterol values showed significantly greater hypocholesterolemic responses to diet than those with lower initial serum cholesterol values. APPLICATIONS/CONCLUSIONS: The findings of this study confirm the beneficial role of dietary intervention for reducing atherogenic serum lipid levels in women and men.

Nutrition and health implications of dry beans: a review.

The nutrient composition of dry beans makes them ideally suited to meet two major dietary recommendations for good health--increased intake of starches and complex carbohydrates and decreased consumption of fat. Dry beans supply protein, complex carbohydrate, fiber and essential vitamins and minerals to the diet, yet are low in fat and sodium and contain no cholesterol. Both protective and therapeutic effects of bean intake have been documented. The antinutritional effects of dry beans, while minor, are of interest to nutrition professionals. Dry beans are an excellent way to increase dietary fiber consumption and most individuals can incorporate beans into their diet without difficulty if they do so gradually. Including dry beans in a health-promoting diet is especially important in meeting the major dietary recommendations to reduce risk for chronic diseases such as coronary heart disease, diabetes mellitus, obesity and cancer.

Management of obesity in diabetes mellitus.

A primary goal of treatment in obese individuals with NIDDM is weight loss and maintenance. Obesity is a precipitating factor for the development of NIDDM in individuals who are genetically at risk. A variety of weight-loss regimens are available to match the specific needs and lifestyles of individuals. Hypocaloric high-fiber diets have been found to be effective in achieving weight loss, as well as aiding in glycemic and lipid control. Very low calorie diets, administered under medical supervision, are useful for obese NIDDM patients with 18-55 kilograms of weight to lose. Lifestyle education appears to be an important element of any successful weight loss program.

Hypocholesterolemic effects of different bulk-forming hydrophilic fibers as adjuncts to dietary therapy in mild to moderate hypercholesterolemia.

Hypercholesterolemia is a significant risk factor for coronary heart disease, and the hypocholesterolemic effects of psyllium are well established. This placebo-controlled, parallel study compared psyllium with methylcellulose, calcium polycarbophil, and placebo as dietary adjuncts in treating mild to moderate hypercholesterolemia. Of 163 men and women recruited with serum cholesterol levels above 5.17 mmol/L (200 mg/dL), 105 completed 8 weeks of an American Heart Association step I diet and then augmented the diet with one of the fiber supplements for 8 additional weeks. Incremental differences from placebo for low-density lipoprotein cholesterol were -8.8% for psyllium, -3.2% for methylcellulose (not significant), and +8.7% for calcium polycarbophil; and for total cholesterol the differences were -4.3% for psyllium (not significant), -1.4% for methylcellulose (not significant), and +5.9% for calcium polycarbophil. Compliance was 94% to 96%, and only mild gastrointestinal side effects were observed. In managing mild to moderate hypercholesterolemia, methylcellulose and calcium polycarbophil provide little or no additional benefit, while psyllium significantly enhances the American Heart Association diet effects.

High-fiber diet for diabetes. Safe and effective treatment.

Persons with diabetes are at increased risk for cardiovascular disease. Maintaining normal lipid levels is, therefore, a key goal in diabetes management. A high-carbohydrate, high-fiber diet provides effective, positive, and safe treatment for diabetes and lowers the associated risk for coronary artery disease.

New perspectives in nutrition management of diabetes mellitus.

Diet remains the cornerstone in the management of diabetes mellitus. A prudent nutrition plan reduces the exaggerated risk for atherosclerotic heart disease and metabolic complications of diabetes by improving lipid and glycemic control. The current consensus diabetes diet recommends 55 to 60 percent of energy as carbohydrate, 12 to 20 percent as protein, and less than 30 percent fat. Total cholesterol intake should be less than 300 mg per day. Fiber appears to have distinct benefits in improving glucose and lipid levels; therefore, an intake of up to 40 g per day or 15 to 25 g/1,000 kcal of food is recommended. Other considerations in meal planning for diabetes include alternative sweeteners, salt intake, alcohol consumption, and vitamin and mineral needs. Individualized and flexible nutrition plans, designed within established guidelines, promote adherence. Persons with diabetes can change their eating patterns and closely adhere to a diet plan if the entire health care team is enthusiastic, supportive, and instructive.