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The Quest for a Cholesterol-decreasing Diet: Should We Subtract, Substitute, or Supplement?
- Thomas A. Pearson, MD, PhD; and
- Rajesh V. Patel, BA
- Columbia University, New York, New York. Requests for Reprints: Thomas A. Pearson, MD, PhD, M.I. Bassett Research Institute, One Atwell Road, Cooperstown, NY 13326.
Recent reports from the National Cholesterol Education Program have documented the continued decrease of serum cholesterol levels in U.S. adults. Using data from the National Health and Nutrition Examination Surveys, the mean cholesterol level for adults, ages 20 to 74 years, was shown to have decreased from 5.69 mmol/L (220 mg/dL) in 1960 to 1962 to 5.30 mmol/L (205 mg/dL) in 1988 to 1991 [1]. This decrease was observed in essentially all race and sex subgroups and was most marked in the past 10 years. Although cholesterol-decreasing drugs have increased in use, it is likely that most of this decrease in cholesterol levels was because of modifications of lifestyle, especially diet. Despite the optimistic data on decreases in population-wide cholesterol levels, it is still estimated that only 49% of U.S. adults have desirable cholesterol levels [2]. Of the remaining, at least 29% (52 million U.S. adults) would require dietary therapy.
Thus, the proportion of patients in the typical internist's office who require dietary counseling for increased serum cholesterol levels is likely to be 30% to 50%. In addition, the public is bombarded with new findings related to nutrition and health, in general, and cholesterol, in particular, creating considerable confusion about what should comprise a cholesterol-decreasing diet. Patients promptly query their physicians about these newest findings, hoping to find the next dietary panacea. Of greater concern, however, is that these new findings may be used indiscriminately by patients instead of in a medically directed program that is integrated into the patient's total health care program.
This issue of Annals contains two research papers and a meta-analysis [3-5] about dietary factors that affect serum cholesterol levels. These papers are representative …
