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February 12, 1996

Efficacy of the National Cholesterol Education Program Step I Diet: A Randomized Trial Incorporating Quick-Service Foods

Author Affiliations

From the Chicago (Ill) Center for Clinical Research (Dr Davidson, Mss Kong and Drennan, and Mr Story), and the Department of Nutritional Sciences, University of Toronto (Ontario) (Dr Anderson).

Arch Intern Med. 1996;156(3):305-312. doi:10.1001/archinte.1996.00440030105013

Objective:  To determine the effect of incorporating quick-service meals into a Step I diet on the achievement of the National Cholesterol Education Program (NCEP) guidelines and on the blood lipid response of hyperlipidemic subjects (as possibly, the achievement of, and adherence to, dietary goals may be assisted by the inclusion of familiar foods, instead of their exclusion).

Methods:  This was a randomized, parallel design study in free-living subjects. Hypercholesterolemic men and women (low-density lipoprotein cholesterol [LDL-C] level, 3.36 to 5.69 mmol/L [130 to 220 mg/dL]) who were consuming a high-fat diet (>33% of total calories from fat) were randomly assigned to either a traditional NCEP Step I diet (n=44) or an NCEP Step I diet with the incorporation of frequent quick-service meals (NCEP-QS, n=45).

Results:  After 8 weeks of treatment, both groups similarly reduced their reported dietary intakes of energy (approximately 30%), total percent fat (approximately 8%), percent saturated fat (approximately 3%), and cholesterol (approximately 38% to 28%). Both groups also experienced a decrease in the levels of total serum cholesterol (NCEP Step I diet, 8%; NCEP-QS Step I diet, 3%) and LDL-C (NCEP Step I diet, 10%; NCEP-QS Step I diet, 4%). However, compared with the group receiving the NCEP-QS Step I diet, the subjects who were consuming the NCEP Step I diet showed a significantly greater reduction in their total serum cholesterol and LDL-C levels over time (P<.05). Weight loss was significantly correlated (P<.001) with the decrease in the total serum cholesterol and LDL-C levels for all subjects combined.

Conclusions:  Hyperlipidemic subjects who were consuming an NCEP Step I diet, with or without the incorporation of quick-service meals, experienced a significant decrease in their total serum cholesterol and LDL-C levels, body weight, and reported fat intake. The beneficial responses in lipid levels were modestly mitigated in the quick-service diet group.(Arch Intern Med. 1996;156:305-312)

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