Serum cholesterol profiles during treatment of obese outpatients with a very low calorie diet. Effect of initial cholesterol levels.

We studied relative changes of serum cholesterol in obese patients during and after weight loss to determine if they depend on initial cholesterol levels as classified by the National Cholesterol Education Program. Three groups of obese free-living outpatients with desirable (normal) (less than 5.17 mmol/l, n = 26), borderline-high (5.17-6.18 mmol/l, n = 29), and high (greater than 6.21 mmol/l, n = 32) initial total cholesterol completed a 26-week program employing a very low calorie diet. The program involved 12 weeks of supplemented fasting, followed by 6 weeks of refeeding and then 7 weeks consumption of step 1 diet that maintained the new reduced weight. The groups were similar in initial clinical characteristics and they also lost comparable percentages of initial weights. Relative reduction in total cholesterol throughout the study was significantly larger in both borderline-high and high cholesterol groups compared to normal. In patients of borderline-high and high cholesterol groups favourable and significant reduction of total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol, and LDL cholesterol/HDL cholesterol ratios were maintained at the end of the study. The percent decrease in total serum cholesterol at the end of the study positively correlated with the percent of weight loss in patients of the high cholesterol group. We conclude that obese hypercholesterolemic patients have favorable changes in cholesterol profile following weight loss, and that relative reduction of cholesterol levels depend on initial levels. However, specific roles of weight loss, change in diet and/or increased physical activity in observed changes in lipid profiles cannot be determined by this study.