Physician education in hyperlipidemia management: the impact on collaboration.

Collaboration of health care professionals is likely beneficial in modifying patient behavior in the treatment of hyperlipidemia. The purpose of this study was to determine whether limited instruction and demonstration of collaborative management of hyperlipidemia in a continuing medical education (CME) would change physicians' office practices, as determined 1 year later by questionnaire. Collaborative practice was defined as physicians working with other allied health care professionals as a team to increase patients' medication compliance and other behavioral outcomes. A 19-credit hour CME Lipid Disorders Training Program (LDTP) was offered emphasizing the collaborative approach to hyperlipidemia patient management. Physicians (n = 196) were surveyed 1 year after LDTP. The response rate was 52.5%, nonrespondents were similar in locations. About 51% of respondents reported increased collaborative practice; of these respondents, 68% reported saving time, 78% reported improved patient outcomes, 76% improved office efficiency, and 90% increased patient satisfaction. According to self-reporting by these physicians, increased collaboration practices after attending the LDTP course led to improved patient outcomes.

General guidelines for a low-fat diet effective in the management and prevention of nonmelanoma skin cancer.

A dietary intervention trial has shown a significant reduction in occurrence of actinic keratosis and nonmelanoma skin cancer in skin cancer patients who adopt diets in which the percentage of calories from fat is markedly lowered. The purpose of this study was to examine the dietary parameters of a low-fat diet found to be effective in reducing occurrence of skin cancer. Skin cancer patients were taught fat reduction strategies to complement their individual food preferences and life-styles. Diet composition was calculated using standard dietary assessment and nutrient analysis techniques. The dietary intervention was effective in reducing the percentage of calories from fat to 21% by Month 4 and maintaining that level for the remainder of the two-year study. Practical dietary advice with respect to reduction of percentage of calories from fat, along with an increase in the intake of grains, fruits, and vegetables, could make an important contribution to the management and prevention of skin cancer.

Evidence that a low-fat diet reduces the occurrence of non-melanoma skin cancer.

The effect of a low-fat diet on occurrence of non-melanoma skin cancer was examined in a 2-year dietary intervention trial. A total of 101 skin-cancer patients were randomized either to a control group that consumed, on average, 38% of caloric intake as fat, and in which no changes in dietary habits were introduced, or to a low-fat dietary-intervention group, in which patients were instructed to limit their calories from fat to 20% of total caloric intake. Patients were examined at 4-month intervals by dermatologists blinded to their dietary assignments. Nutrient analyses, conducted at each of the 4-month follow-up visits, indicated that the % calories of fat consumed in the intervention group had been reduced to 21% at 4 months and remained below this level throughout the 2-year period. There were no significant differences in total calories consumed, or in mean body weights, between the control and the intervention groups. Nor were there significant group differences in P/S ratios until month 24. Numbers of new skin cancers treated at each examination were analyzed in 8-month periods of the 2-year study. Comparisons of skin-cancer occurrences revealed no significant changes in the control group from baseline values. However, cancer occurrence in the low-fat intervention group declined after the first 8-month period and reached statistical significance by the last 8-month period. Patients in this group had significantly fewer cancers in the last 8-month period than did patients in the control group. In addition, there was a significant reduction in the number of patients developing skin cancer in the last 8-month period, as compared with the first 8-month period, within the low-fat intervention group. There were no significant changes in the control group. These data indicate that a low-fat diet can significantly reduce occurrence of a highly prevalent form of cancer.

Effects of beef and chicken consumption on plasma lipid levels in hypercholesterolemic men.

BACKGROUND: The recommendation to lower saturated fat intake is often interpreted as requiring the elimination of beef to control or lower serum cholesterol levels. The study hypothesis was that the Step I Diet (8% to 10% of energy intake from saturated fatty acids) containing beef would have the same effect on plasma lipid levels of hypercholesterolemic men as a like diet containing chicken. METHODS: Thirty-eight free-living hypercholesterolemic (otherwise healthy) men completed a 13-week dietary intervention study. Subjects consumed their usual diets for 3 weeks, followed by a 5-week stabilization diet (18% of energy intake from saturated fatty acids), before randomization to one of two test diets for 5 weeks. The test diets contained either 85 g of cooked beef (8% fat) or 85 g of cooked chicken (7% fat) per 4184 kJ and had 7% to 8% of energy from saturated fatty acids. All food was supplied during the stabilization and test diets. RESULTS: The beef and chicken test diets both produced significant decreases in average plasma total cholesterol level (0.54 mmol/L [7.6%] for beef and 0.70 mmol/L [10.2%] for chicken) and low-density lipoprotein cholesterol level (0.46 mmol/L [9%] for beef and 0.55 mmol/L [11%] for chicken). Changes in average levels of plasma total cholesterol, high-density lipoprotein cholesterol, triglyceride, and low-density lipoprotein cholesterol were not statistically different (smallest P = .26) between the beef and chicken test diets. The average triglyceride level did not change for either test diet group. CONCLUSIONS: In this short-term study, comparably lean beef and chicken had similar effects on plasma levels of total, low-density lipoprotein, and high-density lipoprotein cholesterol and triglyceride. We concluded that lean beef and chicken are interchangeable in the Step I Diet.

Effect of a low-fat diet on the incidence of actinic keratosis.

BACKGROUND: Actinic keratoses are premalignant lesions and are a sensitive and important manifestation of sun-induced skin damage. Studies in animals have shown that dietary fat influences the incidence of sun-induced skin cancer, but the effect of diet on the incidence of actinic keratosis in humans is not known. METHODS: We randomly assigned 76 patients with nonmelanoma skin cancer either to continue their usual diet (control group) or to eat a diet with 20 percent of total caloric intake as fat (dietary-intervention group). For 24 months, the patients were examined for the presence of new actinic keratoses by physicians unaware of their assigned diets. RESULTS: At base line, the mean (+/- SD) percentage of caloric intake as fat was 40 +/- 4 percent in the control group and 39 +/- 3 percent in the dietary-intervention group. After 4 months of dietary therapy the percentage of calories as fat had decreased to 21 percent in the dietary-intervention group, and it remained below this level throughout the 24-month study period. The percentage of calories as fat in the control group did not fall below 36 percent at any time. The cumulative number of new actinic keratoses per patient from months 4 through 24 was 10 +/- 13 in the control group and 3 +/- 7 in the dietary-intervention group (P = 0.001). CONCLUSIONS: In patients with a history of nonmelanoma skin cancer, a low-fat diet reduces the incidence of actinic keratosis.

Development and preparation of lean meat products.

When the effect of food on human lipoprotein levels is tested, or when human consumption of dietary lipids must be controlled or limited, all food needs to be provided under controlled conditions to achieve consistent composition and sensory traits. It is especially important to control the composition of foods, particularly fat and fatty acid content. Because of the inherent biologic variability in the chemical composition of animal tissues (beef in particular), raw materials must be selected carefully and prepared under strict guidelines. In addition, chemical composition should be verified initially and during the production of the product to ensure the accuracy necessary for controlled dietary intake. Furthermore, the meat provided must be easy for the study subject to prepare, be of consistent serving size, and yet be highly palatable to maintain the subject's interest and participation. This article outlines the protocol for developing lean meat products for use in nutrition studies in which fat content must be controlled, especially those studies designed to examine the effect of fat content on human lipoproteins. Preliminary studies, procurement of raw materials, procedures for recipe selection, product preparation, and sampling procedures for verification of chemical composition are described. Our findings indicate that fat intake from beef, chicken, and fish can be controlled for use in nutrition studies.

Diet, nutrition, and heart disease.

Everyone should know his or her cholesterol level. The means are now available for lowering cholesterol in the general population. Such efforts should be coupled with identification of moderate- and high-risk individuals for whom special efforts should be made in cholesterol lowering. The dietary approach outlined by the American Heart Association, which is clearly described in The Living Heart Diet (6), provides the best overall strategy for reducing cholesterol and for battling the epidemic of cardiovascular deaths that represents the No. 1 health problem in our society.

Plasma lipid and lipoprotein response of humans to beef fat, coconut oil and safflower oil.

This study's purpose was to evaluate the fasting human plasma lipid and lipoprotein responses to dietary beef fat (BF) by comparison with coconut oil (CO) and safflower oil (SO), fats customarily classified as saturated and polyunsaturated. Nineteen free-living normolipidemic men aged 25.6 +/- 3.5 yr consumed centrally-prepared lunches and dinners of common foods having 35% fat calories, 60% of which was the test fat. The test fats were isocalorically substituted, and each fed for five weeks in random sequences with intervening five weeks of habitual diets. Plasma total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) concentrations among individuals follows the same relative rank regardless of diet. Triglycerides (TG) concentrations among individuals also maintain their relative rank regardless of diet but in a different order from that of the cholesterols. Plasma TC, HDL-C, and LDL-C responses to BF were significantly lower and TG higher than to CO. As compared to SO, BF produced equivalent levels of TG, HDL-C, and LDL-C and marginally higher TC. Thus, the customary consideration of BF as "saturated" and grouping it with CO appears unwarranted.

Diet and health.

The role of diet in personal health maintenance is important whether a person is trying to stay healthy or to treat diet-related diseases such as hypercholesterolemia, hypertension, diabetes mellitus or obesity. Dietary recommendations include limiting fat to 30% and protein to 20% of total calories, with the remaining 50% coming from carbohydrate. Maintaining dietary changes for long periods is very difficult for many persons. Specific self-management skills may ease the task.

Effects of a low cholesterol eating plan on plasma lipids: results of a three-year community study.

In an attempt to demonstrate whether individuals with average plasma lipids would accept a diet low in saturated fat and cholesterol, members of a community organization were taught the HELP Your Heart Eating Plan. Results of 282 individuals suggest that reduced dietary cholesterol from selected foods could be sustained for up to 36 months. While both plasma cholesterol and triglycerides fell during a year of instruction, both rose to above initial values by 36 months. Overall, the results suggest that adults may be willing to accept a new style of eating temporarily but are not committed to making permanent dietary changes.

Inverse relationship between blood levels of high density lipoprotein subfraction 2 and magnitude of postprandial lipemia.

Triglyceridemic response to a standard oral fat meal was determined in 28 healthy subjects and related to the levels of several lipids, lipoproteins, and apolipoproteins in the post-absorptive plasma. A fatty test meal was administered orally, and postprandial plasma triglyceride levels were determined. In the fasting blood samples, concentrations of apolipoproteins (apo) A-I, A-II, and B were determined by radioimmunoassay, and those of high density lipoprotein (HDL) subfractions HDL2 and HDL3, by zonal ultracentrifugation. The magnitude of triglyceridemic response showed a negative correlation with the plasma levels of HDL2 (r = -0.860, P less than 0.001), HDL-associated cholesterol (r = -0.605, P less than 0.001), and apoA-I (r = -0.459, P less than 0.02). No correlation was found between the triglyceridemic response and the levels of total cholesterol, HDL3, and apoA-II. Triglyceridemic response was correlated positively with fasting triglyceride concentrations (r = 0.450, P less than 0.02) and apoB levels (r = 0.396, P less than 0.03). In two subjects followed for 3 yr, when HDL2 levels rose or fell, the triglyceridemic response decreased or increased, respectively (r = -0.944; r = -0.863). Our data indicate that normolipidemic individuals with high HDL2 levels in the plasma are able to clear alimentary fat at a faster rate than normolipidemic subjects with low HDL2 levels. The pronounced difference in severity and duration of postprandial lipemia among subjects with varying HDL2 levels may help to explain the negative correlation between the risk of atherosclerosis and HDL cholesterol levels.

Selected nutrient intakes of free-living white children ages 6-19 years. The Lipid Research Clinics Program Prevalence Study.

We report energy intake and selected nutrient intakes-protein, fat (total, saturated, and polyunsaturated), carbohydrate (total, starch, and sucrose), and cholesterol-for 1251 white children ages 6-19 years. The data were obtained, by means of a 24-h dietary recall, from children who were randomly selected from the North American populations studied by the Lipid Research Clinics Program. Females (N = 584) consumed about 2000 kcal daily, an intake that remained relatively constant throughout the age groups studied. Males (N = 667) had an energy intake of 2000 kcal/day during childhood that increased to over 3000 kcal/day in adolescence. Energy sources for both sexes were approximately 15% protein, 38% total fat, 15% saturated fat, 6% polyunsaturated fat, 48% total carbohydrate, 19% starch, and 11% sucrose; cholesterol intake averaged about 145 mg/1000 kcal. For both sexes, fat intake increased with age. Compared to females, males ingested greater amounts of cholesterol and total and saturated fat.

The use of the computer in education: focusing on nutrition.

The past few years have brought about renewed recognition of the important interrelationships between diet and disease. The disheartening popularity of food fads and highly questionable products is a signal that the health consumer not only views this as an important area but also has found professional sources of health guidance to be inadequate. With the increasing importance of nutrition as a national health priority, technological advances should be used to translate knowledge of nutrition to the public more efficiently.

Are low-cholesterol diets expensive?

To serve as the basis of cost comparison, USDA "moderate-cost" and "thrifty" menus for one week were modified to meet guidelines for a cholesterol-lowering diet. Prices of individual items on the menus at both cost levels were obtained from two supermarkets and averaged. Items on the moderate-cost, cholesterol-lowering diet were $1.37 less than the USDA menus. At the low-cost level, the modified menus cost 22 cents more. In neither case was the difference significant by the t-test.

A low-cholesterol menu in a steak restaurant.

A twelve-month pilot project was conducted to test public reaction to a special restaurant menu identifying food choices low in cholesterol and saturated fat. The Houston steak house in which the "Help Your Heart" menu was tested prepared foods according to guidelines from dietitians of the Diet Modification Clinic, Baylor College of Medicine. Two newspaper articles, a brief magazine feature, and regularly scheduled radio advertising spots publicized the special menu. At the end of each month of the test period, the number of orders from the special menu was tallied for fourteen randomly selected days. Monthly sales from the special menu ranged from 2.5 to 5.1 per cent, with an overall average of 3.4 per cent. There was no statistically significant change from the mean of the percentage of total sales from the special menu over the months. Despite the relatively low percentage of total sales, restaurant executives were pleased with the results of the study and planned to offer the low-cholesterol menu indefinitely, eventually in an expanded form.