Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: A meta-analysis

Shaomei Yu-Poth, Guixiang Zhao, Terry D. Etherton, Mary Naglak, Satya Jonnalagadda, Penny Margaret Kris-Etherton

Research output: Contribution to journalArticle

442 Citations (Scopus)

Abstract

Background: Plasma lipid and lipoprotein responses have been variable in dietary intervention studies. Objective: The objective of this study was to evaluate the effects of the National Cholesterol Education Program's Step I and Step II dietary interventions on major cardiovascular disease risk factors using meta-analysis. Design: MEDLINE was used to select 37 dietary intervention studies in free-living subjects published from 1981 to 1997. Results: Step I and Step II dietary interventions significantly decreased plasma lipids and lipoproteins. Plasma total cholesterol (TC), LDL cholesterol, triacylglycerol, and TC:HDL cholesterol decreased by 0.63 mmol/L (10%), 0.49 mmol/L (12%), 0.17 mmol/L (8%), and 0.50 (10%), respectively, in Step I intervention studies, and by 0.81 mmol/L (13%), 0.65 mmol/L (16%), 0.19 mmol/L (8%), and 0.34 (7%), respectively, in Step II intervention studies (P < 0.01 for all). HDL cholesterol decreased by 7% (P = 0.05) in response to Step II but not to Step I dietary interventions. Positive correlations between changes in dietary total and saturated fatty acids and changes in TC and LDL and HDL cholesterol were observed (r = 0.59, 0.61, and 0.46, respectively; P < 0.001). Multiple regression analyses showed that for every 1% decrease in energy consumed as dietary saturated fatty acid, TC decreased by 0.056 mmol/L and LDL cholesterol by 0.05 mmol/L. Moreover, for every 1-kg decrease in body weight, triacylglycerol decreased by 0.011 mmol/L and HDL cholesterol increased by 0.011 mmol/L. Exercise resulted in greater decreases in TC, LDL cholesterol, and triacylglycerol and prevented the decrease in HDL cholesterol associated with low-fat diets. Conclusion: Step I and Step II dietary interventions have multiple beneficial effects on important cardiovascular disease risk factors.

Original languageEnglish (US)
Pages (from-to)632-646
Number of pages15
JournalAmerican Journal of Clinical Nutrition
Volume69
Issue number4
StatePublished - Apr 1 1999

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Meta-Analysis
Cardiovascular Diseases
HDL Cholesterol
Cholesterol
Education
LDL Cholesterol
Lipoproteins
Fatty Acids
Lipids
Fat-Restricted Diet
MEDLINE
Triglycerides
Body Weight
Regression Analysis
low density lipoprotein triglyceride

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

@article{bb3dbf54947343deb37539d2353ce0e8,
title = "Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: A meta-analysis",
abstract = "Background: Plasma lipid and lipoprotein responses have been variable in dietary intervention studies. Objective: The objective of this study was to evaluate the effects of the National Cholesterol Education Program's Step I and Step II dietary interventions on major cardiovascular disease risk factors using meta-analysis. Design: MEDLINE was used to select 37 dietary intervention studies in free-living subjects published from 1981 to 1997. Results: Step I and Step II dietary interventions significantly decreased plasma lipids and lipoproteins. Plasma total cholesterol (TC), LDL cholesterol, triacylglycerol, and TC:HDL cholesterol decreased by 0.63 mmol/L (10{\%}), 0.49 mmol/L (12{\%}), 0.17 mmol/L (8{\%}), and 0.50 (10{\%}), respectively, in Step I intervention studies, and by 0.81 mmol/L (13{\%}), 0.65 mmol/L (16{\%}), 0.19 mmol/L (8{\%}), and 0.34 (7{\%}), respectively, in Step II intervention studies (P < 0.01 for all). HDL cholesterol decreased by 7{\%} (P = 0.05) in response to Step II but not to Step I dietary interventions. Positive correlations between changes in dietary total and saturated fatty acids and changes in TC and LDL and HDL cholesterol were observed (r = 0.59, 0.61, and 0.46, respectively; P < 0.001). Multiple regression analyses showed that for every 1{\%} decrease in energy consumed as dietary saturated fatty acid, TC decreased by 0.056 mmol/L and LDL cholesterol by 0.05 mmol/L. Moreover, for every 1-kg decrease in body weight, triacylglycerol decreased by 0.011 mmol/L and HDL cholesterol increased by 0.011 mmol/L. Exercise resulted in greater decreases in TC, LDL cholesterol, and triacylglycerol and prevented the decrease in HDL cholesterol associated with low-fat diets. Conclusion: Step I and Step II dietary interventions have multiple beneficial effects on important cardiovascular disease risk factors.",
author = "Shaomei Yu-Poth and Guixiang Zhao and Etherton, {Terry D.} and Mary Naglak and Satya Jonnalagadda and Kris-Etherton, {Penny Margaret}",
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Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors : A meta-analysis. / Yu-Poth, Shaomei; Zhao, Guixiang; Etherton, Terry D.; Naglak, Mary; Jonnalagadda, Satya; Kris-Etherton, Penny Margaret.

In: American Journal of Clinical Nutrition, Vol. 69, No. 4, 01.04.1999, p. 632-646.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors

T2 - A meta-analysis

AU - Yu-Poth, Shaomei

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N2 - Background: Plasma lipid and lipoprotein responses have been variable in dietary intervention studies. Objective: The objective of this study was to evaluate the effects of the National Cholesterol Education Program's Step I and Step II dietary interventions on major cardiovascular disease risk factors using meta-analysis. Design: MEDLINE was used to select 37 dietary intervention studies in free-living subjects published from 1981 to 1997. Results: Step I and Step II dietary interventions significantly decreased plasma lipids and lipoproteins. Plasma total cholesterol (TC), LDL cholesterol, triacylglycerol, and TC:HDL cholesterol decreased by 0.63 mmol/L (10%), 0.49 mmol/L (12%), 0.17 mmol/L (8%), and 0.50 (10%), respectively, in Step I intervention studies, and by 0.81 mmol/L (13%), 0.65 mmol/L (16%), 0.19 mmol/L (8%), and 0.34 (7%), respectively, in Step II intervention studies (P < 0.01 for all). HDL cholesterol decreased by 7% (P = 0.05) in response to Step II but not to Step I dietary interventions. Positive correlations between changes in dietary total and saturated fatty acids and changes in TC and LDL and HDL cholesterol were observed (r = 0.59, 0.61, and 0.46, respectively; P < 0.001). Multiple regression analyses showed that for every 1% decrease in energy consumed as dietary saturated fatty acid, TC decreased by 0.056 mmol/L and LDL cholesterol by 0.05 mmol/L. Moreover, for every 1-kg decrease in body weight, triacylglycerol decreased by 0.011 mmol/L and HDL cholesterol increased by 0.011 mmol/L. Exercise resulted in greater decreases in TC, LDL cholesterol, and triacylglycerol and prevented the decrease in HDL cholesterol associated with low-fat diets. Conclusion: Step I and Step II dietary interventions have multiple beneficial effects on important cardiovascular disease risk factors.

AB - Background: Plasma lipid and lipoprotein responses have been variable in dietary intervention studies. Objective: The objective of this study was to evaluate the effects of the National Cholesterol Education Program's Step I and Step II dietary interventions on major cardiovascular disease risk factors using meta-analysis. Design: MEDLINE was used to select 37 dietary intervention studies in free-living subjects published from 1981 to 1997. Results: Step I and Step II dietary interventions significantly decreased plasma lipids and lipoproteins. Plasma total cholesterol (TC), LDL cholesterol, triacylglycerol, and TC:HDL cholesterol decreased by 0.63 mmol/L (10%), 0.49 mmol/L (12%), 0.17 mmol/L (8%), and 0.50 (10%), respectively, in Step I intervention studies, and by 0.81 mmol/L (13%), 0.65 mmol/L (16%), 0.19 mmol/L (8%), and 0.34 (7%), respectively, in Step II intervention studies (P < 0.01 for all). HDL cholesterol decreased by 7% (P = 0.05) in response to Step II but not to Step I dietary interventions. Positive correlations between changes in dietary total and saturated fatty acids and changes in TC and LDL and HDL cholesterol were observed (r = 0.59, 0.61, and 0.46, respectively; P < 0.001). Multiple regression analyses showed that for every 1% decrease in energy consumed as dietary saturated fatty acid, TC decreased by 0.056 mmol/L and LDL cholesterol by 0.05 mmol/L. Moreover, for every 1-kg decrease in body weight, triacylglycerol decreased by 0.011 mmol/L and HDL cholesterol increased by 0.011 mmol/L. Exercise resulted in greater decreases in TC, LDL cholesterol, and triacylglycerol and prevented the decrease in HDL cholesterol associated with low-fat diets. Conclusion: Step I and Step II dietary interventions have multiple beneficial effects on important cardiovascular disease risk factors.

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