Telephone Counseling Helps Maintain Long-Term Adherence to a High-Vegetable Dietary Pattern ,
John P. PierceVicky A. NewmanLoki NatarajanShirley W. FlattWael K. Al‐DelaimyBette J. CaanJennifer A. EmondSusan FaerberEllen B. GoldRoman HájekKathryn HollenbachLovell A. JonesNjeri KaranjaSheila KealeyLisa MadlenskyJames R. MarshallCheryl RitenbaughCheryl L. RockMarcia L. StefanickCynthia A. ThomsonL WassermanBarbara A. Parker
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Telephone counseling
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Mediterranean Diet
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Dietary fiber (DF), found in whole fruits, vegetables, and whole grains (WG), is considered a nutrient of concern in the US diet and increased consumption is recommended. The present study was designed to highlight this critical importance of the difference between WG, high-fiber WG, and sources of fiber that are not from WG. The study is based on the two-day diets reported consumed by the nationally representative sample of Americans participating in What We Eat In America, the dietary component of the National Health and Nutrition Examination Survey from 2003-2010. Foods consumed were classified into tertiles of DF and WG and the contribution of fiber by differing levels of WG content were examined. Foods containing high amounts of WG and DF only contributed about 7% of total fiber intake. Overall, grain-based foods contributed 54.5% of all DF consumed. Approximately 39% of DF came from grain foods that contained no WG, rather these foods contained refined grains, which contain only small amounts of DF but are consumed in large quantities. All WG-containing foods combined contributed a total of 15.3% of DF in the American diet. Thus, public health messaging needs to be changed to specifically encourage consumption of WG foods with high levels of DF to address both recommendations.
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The aim of this article is to review the definitions and regulations for dietary fiber and whole grains worldwide and to discuss barriers to meeting recommended intake levels. Plant foods, such as whole grains, that are rich in dietary fiber are universally recommended in dietary guidance. Foods rich in dietary fiber are recommended for all, but dietary recommendations for whole grains and dietary fiber depend on definitions and regulations. Official recommendations for dietary fiber in the United States and Canada are denoted by dietary reference intakes (DRIs), which are developed by the Institute of Medicine. An adequate intake (AI) for dietary fiber was based on prospective cohort studies of dietary fiber intake and cardiovascular disease risk that found 14 grams of dietary fiber per 1000 kilocalories protected against cardiovascular disease (CVD). This value was used to set AIs for dietary fiber across the life cycle based on recommended calorie intakes. Actual intakes of dietary fiber are generally about half of the recommended levels. Recommendations for whole grain intake are equally challenging, as definitions for whole grain foods are needed to set recommendations. The 2005 Dietary Guidelines for Americans recommended that half of all grain servings be whole grains, but usual intakes are generally less than 1 serving per day, rather than the recommended 3 servings per day. Scientific support for whole grain recommendations is based on the same prospective cohort studies and links to CVD protection used to inform dietary fiber guidance. Thus, dietary fiber is a recommended nutrient and whole grains are a recommended dietary pattern in dietary guidance in North America and around the world. Challenges for attaining recommended intakes of dietary fiber and whole grains include low-carbohydrate diets, low-gluten diets, and public health recommendations to avoid processed foods.
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Mediterranean Diet
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We tested whether partial replacement with mono‐or poly‐unsaturated fats improves coronary vascular dysfunction induced by a high saturated fat diet. We fed C57BL6 male mice high saturated fats (60% lard) for 12 weeks before substituting half of the fat with poly‐[n‐3 menhaden oil: MO or n‐6 safflower oil: SO] or mono‐unsaturated fat [olive oil: OO] for 4 weeks. After 16 weeks weight and basal glucose were elevated and glucose tolerance was reduced in lard fed compared to normal mice (4% fat). Substitution with MO but not SO or OO restored basal glucose and glucose tolerance to normal. Responses to insulin, acetylcholine (ACh) and sodium nitroprusside (SNP) were evaluated in isolated pressurized coronary arteries. Insulin–induced relaxation was attenuated in coronary arteries from mice fed a high saturated fat diet and improved with MO, OO and SO modified diets. There was a modest reduction in relaxation to ACh in mice fed high fat diet, which was not improved with any modification of diet (MO, OO or SO). SNP responses were not altered by high saturated fat diet. We conclude that short‐term enrichment of high saturated fat diet with mono‐and poly‐unsaturated fats selectively improves insulin vasoreactivity despite persistent abnormal glucose tolerance with SO and OO enriched diets. Even when glucose tolerance was restored to normal with MO, ACh‐induced relaxation was not improved in coronary arteries.
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Preprandial and postprandial serum lipids after meals of saturated or unsaturated fat were measured in 44 men, and blood sludging in 20 men, half of whom showed a behavior pattern (A) associated with proneness to clinical coronary artery disease. The average plasma cholesterol and both fasting and postprandial triglyceride values were higher (P<0.001) in men showing pattern A, regardless of whether a saturated or unsaturated fat was given. Seven of ten men with pattern A showed severe sludging after a meal of saturated fat, five of these seven also showed sludging after a meal of unsaturated fat. Sludging was virtually absent in the noncoronary-prone group. It was concluded that substitution of an unsaturated fat for a saturated fat carries no benefit under the circumstances tested.
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Previous observations in normolipidemic individuals have indicated that the increase in LDL cholesterol (C) resulting from substitution of dietary saturated fat for carbohydrate or unsaturated fat is primarily due to higher plasma levels of large cholesterol-enriched LDL particles, with minimal effects on smaller LDL, as well as apolipoprotein (apo) B and total-C/HDL-C ratio. In the present study, we tested whether similar effects of saturated fat are observed in individuals with atherogenic dyslipidemia characterized by a preponderance of small LDL particles (LDL phenotype B). Fifty-three phenotype B participants consumed a baseline diet (55% carbohydrate, 15% protein, 30% fat, 8% saturated fat) for 3 weeks, after which they were randomized to either a moderate carbohydrate, high saturated fat diet (HSF; 39% carbohydrate, 25% protein, 36% fat, 18% saturated fat) or a moderate carbohydrate, low saturated fat diet (LSF; 37% carbohydrate, 25% protein, 37% fat, 9% saturated fat) for 3 weeks. The difference in saturated fat was derived primarily from dairy sources. Plasma lipids and lipoproteins were measured after the baseline and randomized diets. Compared to the LSF diet, participants who consumed the HSF diet had a greater percent increase in total-C (p<0.0001), LDL-C (p=0.0002), total-C/HDL-C ratio (p=0.0004) and apoB (p<0.0001) from the baseline diet, with no significant differences in HDL-C or apoAI. The HSF group had a greater percent increase in medium (p=0.05) and small (p=0.02) LDL particle concentrations from baseline compared to the LSF group, with no differences in large and very small LDL. There were also no significant differences in large and small HDL subclasses. The activities of both hepatic lipase (p=0.05) and cholesteryl ester transfer protein (p=0.04) were increased in the HSF group compared to the LSF group. Because medium and small LDL particles have been found to be more highly associated with CVD risk than larger LDL particles, the present results, in conjunction with our previous findings, suggest that adverse effects of very high saturated fat intake on CVD risk may be greater in phenotype B individuals than in those with normal lipoprotein profiles.
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Dyslipidemia
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Intra-aortic insertion of magnesium-aluminum-zinc wire was used to induce experimental aortic thrombosclerosis in rabbits fed kennel chow and in rabbits fed chow supplemented with cholesterol, with and without additions of saturated or unsaturated fat. In the absence of cholesterol supplement, no spontaneous atherosclerosis developed and no excess lipid appeared in the thrombosclerotic plaque, regardless of supplementations with saturated or unsaturated fat. In the presence of cholesterol supplement, both spontaneous atherosclerosis and thromboatherosclerosis were noted. Additional supplementations with saturated or unsaturated fat did not ameliorate either lesion. Rabbits ingesting cholesterol plus unsaturated fat exhibited no less hypercholesteremia, spontaneous atherosclerosis, and thromboatherosclerosis than did rabbits on any other regimen. The results are discussed with reference to the effect of oral unsaturated fat on bile acid and cholesterol within the intestinal lumen.
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Background Previous studies have shown that increases in LDL-cholesterol resulting from substitution of dietary saturated fat for carbohydrate or unsaturated fat are due primarily to increases in large cholesterol-enriched LDL, with minimal changes in small, dense LDL particles and apolipoprotein B. However, individuals can differ by their LDL particle distribution, and it is possible that this may influence LDL subclass response. Objective The objective of this study was to test whether the reported effects of saturated fat apply to individuals with atherogenic dyslipidemia as characterized by a preponderance of small LDL particles (LDL phenotype B). Methods Fifty-three phenotype B men and postmenopausal women consumed a baseline diet (55%E carbohydrate, 15%E protein, 30%E fat, 8%E saturated fat) for 3 weeks, after which they were randomized to either a moderate carbohydrate, very high saturated fat diet (HSF; 39%E carbohydrate, 25%E protein, 36%E fat, 18%E saturated fat) or low saturated fat diet (LSF; 37%E carbohydrate, 25%E protein, 37%E fat, 9%E saturated fat) for 3 weeks. Results Compared to the LSF diet, consumption of the HSF diet resulted in significantly greater increases from baseline (% change; 95% CI) in plasma concentrations of apolipoprotein B (HSF vs. LSF: 9.5; 3.6 to 15.7 vs. -6.8; -11.7 to -1.76; p = 0.0003) and medium (8.8; -1.3 to 20.0 vs. -7.3; -15.7 to 2.0; p = 0.03), small (6.1; -10.3 to 25.6 vs. -20.8; -32.8 to -6.7; p = 0.02), and total LDL (3.6; -3.2 to 11.0 vs. -7.9; -13.9 to -1.5; p = 0.03) particles, with no differences in change of large and very small LDL concentrations. As expected, total-cholesterol (11.0; 6.5 to 15.7 vs. -5.7; -9.4 to -1.8; p<0.0001) and LDL-cholesterol (16.7; 7.9 to 26.2 vs. -8.7; -15.4 to -1.4; p = 0.0001) also increased with increased saturated fat intake. Conclusions Because medium and small LDL particles are more highly associated with cardiovascular disease than are larger LDL, the present results suggest that very high saturated fat intake may increase cardiovascular disease risk in phenotype B individuals. This trial was registered at clinicaltrials.gov (NCT00895141). Trial registration Clinicaltrials.gov NCT00895141.
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