Clinical approaches to healthier diet modifications

There is a strong relation between diet and risk factors for cardiovascular diseases. Generally a high fat consumption will increase the serum cholest erol level. Different fatty acids have different effects on total cholester ol, LDL and HDL lipoproteins and therefore on the risk for cardiovascular d iseases. This knowledge was translated into guidelines for a healthy diet a nd in advices to use less fat. In reality it was not easy for physicians to reach a substantial reduction in total cholesterol by limiting the fat con sumption. A recent investigation in Belgium showed that the median reductio n obtained by dietary changes through general practitioners was only 3.5%. In medical education not much attention is paid to the communication of the "fat message". In addition, individual patients have frequently multiple r isk factors e.g. abdominal obesity, insulin resistance, diabetes, hypertens ion and a sedentary lifestyle. Therefore in the clinical setting an integra ted approach is needed, in which dietary advice is supported by behavioural therapy and suggestions to increase physical activity. Currently there is a debate on the preference of a low fat or a modified fat diet. A low fat d iet is rich in carbohydrates and a modified fat diet is rich in mono-unsatu rated fatty acids. Recent investigations in diabetic patients are in favour of a modified fat diet. This has the advantage that in practice the possib ilities for realizing a low saturated fat diet are increased.