Cholesterol (diet in hypercholesterolaemia)

NICE state that (1):

• advise people at high risk of or with CVD to eat a diet in which:
  • total fat intake is 30% or less of total energy intake, saturated fats are 7% or less of total energy intake, intake of dietary cholesterol is less than 300 mg/day and where possible saturated fats are replaced by mono-unsaturated and polyunsaturated fats
    
• if a person at high risk of or with CVD:
  • advise them that reducing their saturated fat intake from animal sources also reduces their mono-unsaturated fat levels
  • advise them to replace their saturated and mono-unsaturated fat intake with olive oil, rapeseed oil or spreads based on these oils
  • advise them to use olive oil, rapeseed oil or spreads based on these oils in food preparation
    
    
• if person at high risk of or with CVD to then advise to do all of the following:
  • choose wholegrain varieties of starchy food
  • reduce their intake of sugar and food products containing refined sugars including fructose
  • eat at least 5 portions of fruit and vegetables per day
  • eat at least 2 portions of fish per week, including a portion of oily fish
  • eat at least 4 to 5 portions of unsalted nuts, seeds and legumes per week
• advise pregnant women to limit their oily fish to no more than 2 portions per week and to avoid marlin, shark and swordfish

The National Cholesterol Education Programme (NCEP) Expert Panel on Detection and Treatment of Blood Cholesterol in Adults (Adult Treatment Panel III) recommend a multifaceted lifestyle approach to reduction of risk of coronary heart disease (CHD). This approach is designated therapeutic lifestyle changes (TLC). The targets are more rigorous than those stated by NICE. Essential features are:

• reduced intakes of saturated fats (<7% of total calories) and cholesterol (<200 mg per day)
• therapeutic options for enhancing LDL such as plant stanols/sterols (2g per day) and increased viscous (soluble) fibre (10-25 g per day)
• weight reduction
• increased physical activity

Nutrient Composition of the TLC diet:

* trans fatty acids are another LDL-raising fat that should be kept at a low intake

** carbohydrate should be derived predominantly from foods rich in complex carbohydrates including grains, particularly whole grains, vegetables and fruits

*** daily energy expenditure should include at least moderate physical acitivity (contributing approximately 200 Kcal per day)

Rigorous dietary intervention produced a 12% fall in serum cholesterol in all but 8% of patients referred with a serum cholesterol of 6.5 - 8.0 mmol/l.

Reference:

• (1) NICE (July 2014).Lipid modification Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease
• (2) JAMA 2001 May 16;285(19):2486-97
• (3) Watts GF et al (1993). Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine in St Thomas' Atherosclerosis Regression Study (STARS). Lancet, 339, 563-569.