Media Releases

Diet That Combines Cholesterol-Lowering Foods Results in Greater Decrease in LDL Than Low-Saturated Fat Diet

August 24, 2011

CHICAGO, IL – Per­sons with high cho­les­terol who received coun­sel­ing regard­ing a diet that com­bined cho­les­terol-low­er­ing foods such as soy pro­tein, nuts and plant sterols over 6 months expe­ri­enced a greater reduc­tion in their low-den­si­ty lipopro­tein cho­les­terol (LDL‑C) lev­els than indi­vid­u­als who received advice on a low-sat­u­rat­ed fat diet, accord­ing to a study in the August 24/31 issue of JAMA.

Efforts have been made to improve the abil­i­ty of con­ven­tion­al dietary ther­a­py to reduce serum cho­les­terol through the inclu­sion of spe­cif­ic foods or food com­po­nents with known cho­les­terol-low­er­ing prop­er­ties, singly or in com­bi­na­tion (dietary port­fo­lio), accord­ing to back­ground infor­ma­tion in the arti­cle. The long-term effect of such diets com­pared with con­ven­tion­al dietary advice has not pre­vi­ous­ly been assessed.

David J. A. Jenk­ins, M.D., of St. Michael’s Hos­pi­tal and the Uni­ver­si­ty of Toron­to, and col­leagues con­duct­ed a mul­ti-cen­ter tri­al to deter­mine whether advice to eat a dietary port­fo­lio con­sist­ing of foods rec­og­nized by the U.S. Food and Drug Admin­is­tra­tion as asso­ci­at­ed with low­er­ing serum cho­les­terol achieved sig­nif­i­cant­ly greater per­cent­age decreas­es in LDL‑C lev­els com­pared with a con­trol diet at 6‑month fol­low-up. The con­trol diet empha­sized high fiber and whole grains but lacked com­po­nents of the port­fo­lio diet, which empha­sized dietary incor­po­ra­tion of plant sterols, soy pro­tein, vis­cous fibers, and nuts. The study includ­ed 351 par­tic­i­pants with hyper­lipi­demia from 4 par­tic­i­pat­ing aca­d­e­m­ic cen­ters acrossCanada(Quebec City,Toronto,Winnipeg, and­Van­cou­ver) ran­dom­ized between June 2007 and Feb­ru­ary 2009 to 1 of 3 treat­ments.

Par­tic­i­pants received dietary advice for 6 months on either the low-sat­u­rat­ed fat ther­a­peu­tic diet (con­trol) or a rou­tine or inten­sive dietary port­fo­lio, for which coun­sel­ing was deliv­ered at dif­fer­ent fre­quen­cies. Rou­tine dietary port­fo­lio involved 2 clin­ic vis­its over 6 months and inten­sive dietary port­fo­lio involved 7 clin­ic vis­its over 6 months.

In the mod­i­fied inten­tion-to-treat analy­sis of 345 par­tic­i­pants, the over­all attri­tion rate was not sig­nif­i­cant­ly dif­fer­ent between treat­ments (18 per­cent for inten­sive dietary port­fo­lio, 23 per­cent for rou­tine dietary port­fo­lio, and 26 per­cent for con­trol).

The researchers found that the change in LDL‑C lev­els from the begin­ning of the study to week 24 in the con­trol diet were ‑3.0 per­cent or ‑8 mg/dL. In the rou­tine and inten­sive dietary port­fo­lio inter­ven­tions, the respec­tive per­cent­age changes were ‑13.1 per­cent or ‑24 mg/dL and ‑13.8 per­cent or ‑26 mg/dL for LDL‑C lev­els.

“Per­cent­age LDL‑C reduc­tions for each dietary port­fo­lio were sig­nif­i­cant­ly more than the con­trol diet. The 2 dietary port­fo­lio inter­ven­tions did not dif­fer sig­nif­i­cant­ly. Among par­tic­i­pants ran­dom­ized to one of the dietary port­fo­lio inter­ven­tions, per­cent­age reduc­tion in LDL‑C on the dietary port­fo­lio was asso­ci­at­ed with dietary adher­ence,” the authors write.

“In con­clu­sion, this study indi­cat­ed the poten­tial val­ue of using rec­og­nized cho­les­terol-low­er­ing foods in com­bi­na­tion. We believe this approach has clin­i­cal appli­ca­tion. A mean­ing­ful 13 per­cent LDL‑C reduc­tion can be obtained after only 2 clin­ic vis­its of approx­i­mate­ly 60-and 40-minute ses­sions. The lim­it­ed 3 per­cent LDL‑C reduc­tion observed in the con­ven­tion­al diet is like­ly to reflect the ade­qua­cy of the base­line diet and there­fore sug­gests that larg­er absolute reduc­tions in LDL‑C may be observed when the dietary port­fo­lio is pre­scribed to patients with diets more reflec­tive of the gen­er­al pop­u­la­tion,” the authors write.

(JAMA. 2011;306[8]:831–839. Avail­able pre-embar­go to the media at

Editor’s Note: Please see the arti­cle for addi­tion­al infor­ma­tion, includ­ing oth­er authors, author con­tri­bu­tions and affil­i­a­tions, finan­cial dis­clo­sures, fund­ing and sup­port, etc.


For more infor­ma­tion or to speak to Dr. Jenk­ins, con­tact:


Paul Can­tin
Asso­ciate Direc­tor, Strate­gic Com­mu­ni­ca­tions,
Uni­ver­si­ty of Toron­to Temer­ty Temer­ty Fac­ul­ty of Med­i­cine