Macro partitioning
Individualized dietary advice to lower blood total cholesterol in free-living subjects produces a modest reduction of approximately 5.3% after six months, with more intensive diets achieving greater reductions (up to 8.5% at 3 months).
To lower cholesterol, individualized dietary advice works, but the effect is modest (around 5%) in real-world settings due to adherence issues. More intensive diets (Step 2: <7% saturated fat, <200mg cholesterol) are significantly more effective than basic Step 1 diets. Focus on reducing saturated fats and increasing polyunsaturated fats, and recognize that consistent, moderate changes are better than none, even if they don't achieve the 10-15% reductions seen in controlled metabolic ward studies.
The percentage reduction in blood total cholesterol attributable to dietary advice after at least six months of intervention was 5.3% (95% confidence interval 4.7% to 5.9%). Including both short and long duration studies, the effect was 8.5% at 3 months and 5.5% at 12 months.
Why this rating
Systematic overview of 19 randomized controlled trials provides high-quality aggregate evidence, though real-world adherence is a limiting factor.
Source
Systematic review of dietary intervention trials to lower blood total cholesterol in free-living subjects Commentary: Dietary change, cholesterol reduction, and the public health---what does meta-analysis add?
Jenny Tang et al. · BMJ · 1998
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