Issue 118 Item 10 Standard Diet and Exercise Have No Significant Effect on Lipds

That, when compared to intensive exercise and aggressive diet changes. Compared with intensive exercise and aggressive diet changes, standard diet and exercise recommendations have no significant effect on plasma lipid levels in dyslipidemic patients, according to the results of a pilot study.

Dr. Lyne Lalonde from the University of Montreal, and colleagues randomized 47 patients with dyslipidemia to one of four treatment regimens. The regimens included standard lifestyle recommendations from the National Cholesterol Education Program (NCEP) step 1 diet and regular exercise; the NCEP step 1 diet plus supervised aerobic exercise; or the NCEP step 2 diet, with or without supervised aerobic exercise program.

In the NCEP step 1 diet, patients get 55% of their total energy intake from carbohydrates, and up to 30% from fat. In addition, saturated fat intake is reduced to less than 10% of total calories and dietary cholesterol to less than 300 mg/day. In the NCEP step 2 diet, saturated far intake is further reduced to 7% of total caloric intake and cholesterol intake to less than 200 mg/day.

At baseline and 3 months after treatment, the researchers measured dietary intake, time on treadmill, and health-related quality of life. Forty-one patients completed the trial.

At follow-up, the researchers observed no significant changes in any of the measures among patients randomized to the standard lifestyle recommendations.

However, patients in the other groups experienced weight loss (from 1.7 kg to 3.7 kg), reductions in total cholesterol (by 4% to 6%), reduction in LDL cholesterol (6%) and a lowering of mean systolic blood pressure (from 7.3 mm Hg to 8.8 mm Hg), the researchers found.

Patients in the supervised exercise program also significantly improved their exercise capacity, they add. These patients also reported a significantly greater improvement in health-related quality of life compared with other patients, according to the report in the July issue of Preventive Medicine.

"These improvements in cardiovascular disease risk factors in the more intense groups translates into a 3% to 6% absolute reduction of the estimated 10-year cardiovascular disease risk, whereas this risk remained stable in the step 1 group," the researchers note. "This represents a relative risk reduction varying from 15% to 27% over baseline for the more intensive interventions, compared with only 6% for the step 1 diet group."

Dr. Lalonde and colleagues conclude that "more intensive lifestyle interventions may be associated with improvement in cardiovascular health and quality of life. Further studies should be done to identify interventions that are both effective and attractive for the majority." Prev Med 2002;35:16-24.