Reduction of Plasma Cholesterol Levels in Normal Men on an American Heart Association Step 1 Diet or a Step 1 Diet with Added Monounsaturated Fat

Abstract

The design of diets to achieve optimal changes in plasma lipid levels is controversial. In a randomized, double-blind trial involving 36 healthy young men, we evaluated the effects on plasma lipid levels of both an American Heart Association Step 1 diet (in which 30 percent of the total calories were consumed as fat: 10 percent saturated, 10 percent monounsaturated, and 10 percent polyunsaturated fats, with 250 mg of cholesterol per day) and a monounsaturated fat—enriched Step 1 diet (with 38 percent of the calories consumed as fat: 10 percent saturated, 18 percent monounsaturated, and 10 percent polyunsaturated fats, with 250 mg of cholesterol per day). The effects of these diets were then compared with those of an average American diet, in which 38 percent of the total calories were consumed as fat: 18 percent saturated, 10 percent monounsaturated, and 10 percent polyunsaturated fats, with 500 mg of cholesterol per day. The men consumed the average American diet for 10 weeks before random assignment to one of the two Step 1 diets or to continuation of the average diet for an additional 10 weeks. Caloric intake was adjusted to maintain a constant body weight. As compared with the mean (±SD) change in the plasma total cholesterol level in the group that followed the average American diet throughout the study (−0.05±0.36 mmol per liter), there were statistically significant reductions (P<0.025) in the plasma total cholesterol level in the group on the Step 1 diet (−0.37±0.27 mmol per liter) and in the group on the monounsaturated fat—enriched Step 1 diet (−0.46±0.36 mmol per liter). There were parallel reductions in the plasma low-density lipoprotein cholesterol levels in these two groups. Neither the plasma triglyceride levels nor the high-density lipoprotein cholesterol concentrations changed significantly with any diet. We conclude that enrichment of the Step 1 diet with monounsaturated fat does not alter the beneficial effects of the Step 1 diet on plasma lipid concentrations. (N Engl J Med 1990; 322:574–9.). © 1990, Massachusetts Medical Society. All rights reserved.