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Ernst J. Schaefer, MD; Alice H. Lichtenstein, DSc; Stefania Lamon-Fava, MD, PhD; Judith R. McNamara, MT; Mary M. Schaefer, PhD; Helen Rasmussen, RD; Jose M. Ordovas, PhD

JAMA. 1995;274(18):1450-1455.

Abstract
Objective.
—To assess the effects of a diet restricted in fat, saturated fat, and cholesterol, under weight-maintenance and ad libitum conditions on body weight and plasma lipid levels in hypercholesterolemic subjects.

Design.
—Dietary intervention study.

Setting and Participants.
—Twenty-seven free-living, healthy middle-aged and elderly men (n=13, age range, 41 to 81 years) and women (n=14, age range, 52 to 79 years) with moderate hypercholesterolemia (low-density lipoprotein cholesterol [LDL-C] 3.36 mmol/L [130 mg/dL]) participated in the study.

Intervention.
—Subjects underwent three dietary phases. First, subjects were provided with a diet similar to the average US diet (baseline diet; 35.4% total fat, 13.8% to 14.1% saturated fat, and 30 to 35 mg/1000 kJ [128 to 147 mg/1000 kcal] cholesterol). During the second dietary phase, subjects consumed a low-fat diet (15.1% total fat, 5.0% saturated fat, 17 mg/1000 kJ [73 mg/1000 kcal] cholesterol). During the baseline and low-fat diet phases, which lasted 5 to 6 weeks each, the energy intake was adjusted to keep body weight constant. During the third diet phase (low-fat ad libitum diet) subjects were given the same low-fat diet for 10 to 12 weeks, but could adjust their intake between 66% and 133% of the energy required to maintain body weight.

Main Outcome Measures.
—Body weight and plasma lipid levels.

Results.
—Consumption of the low-fat diet under weight-maintenance conditions had significant lowering effects on plasma total cholesterol (TC), LDL-C, and highdensity lipoprotein cholesterol (HDL-C) levels (mean change, -12.5%, -17.1%, and -22.8%, respectively). This diet significantly increased plasma triglyceride levels (+47.3%) and the TC/HDL-C ratio (+14.6%). In contrast, consumption of the low-fat ad libitum diet was accompanied by significant weight loss (-3.63 kg), by a mean decrease in LDL-C (-24.3%), and by mean triglyceride levels and TC/HDL-C ratio that were not significantly different from values obtained at baseline.

Conclusions.
—Our results indicate that a low-fat ad libitum diet promotes weight loss and LDL-C lowering without adverse effects on triglycerides or the TC/HDL-C ratio in middle-aged and elderly men and women with moderate hypercholesterolemia.

(JAMA. 1995;274:1450-1455)

Author Affiliations
From the Lipid Metabolism Laboratory (Drs E. Schaefer, Lichtenstein, Lamon-Fava, M. Schaefer, and Ordovas, and Ms McNamara), Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University; the Division of Endocrinology, Diabetes, Metabolism, and Molecular Medicine, New England Medical Center (Dr E. Schaefer); and the Department of Medicine, Tufts University School of Medicine, Boston, Mass (Dr E. Schaefer).

Footnotes
Reprint requests to the Lipid Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington St, Boston, MA 02111 (Dr E. Schaefer).

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