Improvements in circulating cholesterol, antioxidants, and homocysteine after dietary intervention in an Australian Aboriginal community

Background: Poor nutrition contributes to high rates of coronary heart dise ase among Australian Aboriginal populations. Since late 1993, the Aborigina l community described here has operated a healthy lifestyle program aimed a t reducing the risk of chronic disease. Objective: We evaluated the effectiveness of a community-directed intervent ion program to reduce coronary heart disease risk through dietary modificat ion. Design: Intervention processes included store management policy changes, he alth promotion activities, and nutrition education aimed at high-risk indiv iduals. Dietary advice was focused on decreasing saturated fat and sugar in take and increasing fruit and vegetable intake. Evaluation of the program i ncluded conducting sequential, cross-sectional risk factor surveys at 2-y i ntervals; measuring fasting cholesterol, lipid-soluble antioxidants, and ho mocysteine concentrations; and assessing smoking status. Nutrient intakes w ere estimated from analysis of food turnover in the single community store. Results: There was a significant reduction in the prevalence of hypercholes terolemia (age-adjusted prevalences were 31%, 21%, and 15% at baseline, 2 y , and 4 y, respectively; P<0.001). There were significant increases in plas ma concentrations of a-tocopherol, lutein and zeaxanthin, cryptoxanthin, an d R-carotene across the population. Retinol and lycopene concentrations did not change significantly. Mean plasma homocysteine concentrations decrease d by 3 <mu>mol/L. There was no significant change in smoking prevalence bet ween the 2 follow-up surveys. There was an increase in the density of fresh fruit and vegetables and carotenoids in the food supply at the community s tore. Conclusion: This community-directed dietary intervention program reduced th e prevalence of coronary heart disease risk factors related to diet.