Double-blind, randomized feedback control fails to improve the hypocholestrolemic effect of a plant-based low-fat diet in patients with moderately elevated total cholesterol levels

• Published in: European journal of clinical nutrition 2004, Vol.58 (10), p.1402-1409
• Main Authors: Koebnick, C, Plank-Habibi, S, Wirsam, B, Gruendel, S, Hahan, A, Meyer-Kleine, C, Leitzmann, C, Zunft, H.J.F
• Format: Article
• Language: English
• Subjects: blood lipids; cholesteremic effect; cholesterol; cholesterol metabolism; dairy products; diet; diet-related diseases; energy intake; fat intake; feedback control; human diseases; hypercholesterolemia; low fat diet; men; nutritional intervention; triacylglycerols; vegetarian diet; women
• ISSN: 0954-3007; 1476-5640

Objective: To determine whether the cholesterol-lowering effect of a plant-based low-fat diet can be improved by a flexible control design that controls the extent of fat reduction based on the individual response of blood cholesterol. Design: Randomized, double-blind intervention study. Setting: A hotel in Prerow, Germany. Subjects: A total of 32 participants (21 female and 11 male participants) with total cholesterol level > 5.7 mmol/l. Intervention: The control group consumed a plant-based low-fat diet with constantly 20% of energy as fat; the intervention group received a diet with either 20 or 15% of energy as fat, depending on the serum cholesterol response of the preceding week. A flexible control design based on the individual cholesterol response during a run-in period of 1 week was used within a low-fat intervention. Results: During the run-in period, the consumption of a plant-based low-fat diet led to a reduction in total cholesterol by 18 +/- 6 mmol/l (P < 0.001), in LDL cholesterol by 19 +/- 9 mmol/l (P < 0.001) and triglycerides by 13 +/- 3 mmol/l (P < 0.001). During the feedback control period, an additional reduction in total cholesterol by 13 +/- 8 ( P < 0.001) and in LDL cholesterol by 17 +/- 11 (P < 0.001) was observed compared to 15 +/- 15 and 7 +/- 18 in the control group. The effect of an additional feedback control was only marginal and not statistically significant compared to the effect of the low-fat diet alone. Conclusions: On a level of fat intake already reduced to 20% of energy, the use of a feedback control to adapt the fat content of the diet depending on the individual serum cholesterol response was not more effective in reducing blood cholesterol levels than a plant-based low-fat diet alone.