INDIVIDUAL RESPONSIVENESS TO A CHOLESTEROL-LOWERING DIET IN POSTMENOPAUSAL WOMEN WITH MODERATE HYPERCHOLESTEROLEMIA

Background: The efficacy of the step 1 diet in outpatient women with h ypercholesterolemia has been debated. Methods: Forty-one normotriglyce ridemic women whose low-density lipoprotein (LDL) cholesterol levels w ere 3.62 to 5.17 mmol/L (140 to 200 mg/dL) participated in a two-perio d outpatient diet counseling study that used a 1-month high-fat, high- saturated fatty acid period (Hi-Sat diet) and a 4-month low-fat, low-s aturated fatty acid period (step 1 diet). All women were postmenopausa l and were not taking hormone replacement therapy. Levels of lipids, l ipoproteins, and plasma triglyceride fatty acids were measured five ti mes during the last 2 weeks of each dietary period. Dietary intake was assessed by 7-day food records.Results: The mean reduction in total c holesterol level achieved by the step 1 diet was 0.36 mmol/L (14 mg/ d L). The reduction in total cholesterol level was seen in both LDL chol esterol levels (0.28 mmol/L [11 mg/dL]; P<.005) and high-density lipop rotein cholesterol levels (0.08 mmol/L [3 mg/dL]; P=.08). Although ind ividual LDL responsiveness to diet was normally distributed, there was marked variation in response, which could be explained only partially by compliance (change in saturated fat intake, 10%), change in body w eight (3%), and an interaction between the palmitic acid content of th e plasma and body weight (3%). Conclusions: A step 1 diet lowers total and LDL cholesterol levels in postmenopausal women. A nonsignificant reduction in high-density lipoprotein cholesterol levels was also obse rved. Since some women achieved LDL cholesterol levels low enough to o bviate the need for drug therapy as primary prevention of coronary hea rt disease, dietary therapy should remain the first step in the manage ment of hypercholesterolemia in postmenopausal women.