Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Dr Knopp and colleagues1state that "aggressive fat restriction compared
with moderate fat restriction offers no further benefits in a number of parameters
and adverse effects in others." This conclusion is misleading, since Knopp
et al did not assess heart disease but only changes in lipid levels. In the
Lifestyle Heart Trial,2reducing fat intake
to 10% of energy consumed and dietary cholesterol to 10 mg/d resulted in a
37% decrease in low-density lipoprotein (LDL) after 1 year compared with only
6% in the control group on a Step II diet (and compared with 5%-13% in the
lowest-fat category of the study by Knopp et al). Thus, "aggressive fat restriction"
clearly offers further benefits in reducing LDL.
Ornish D. Serum Lipids After a Low-Fat Diet. JAMA. 1998;279(17):1345-1346. doi:10.1001/jama.279.17.1345