Hans-Christian Heitkamp1. 1. Institut für Sportmedizin, Fakultät Naturwissenschaften, Universität Paderborn, Warburgerstr. 100, 33098, Paderborn, Deutschland. hansh@mail.upb.de.
Abstract
BACKGROUND: New European and American guidelines for nutrition in hypercholesterolemia coincided with a lowered target value for LDL(Low density lipoprotein)-cholesterol. METHODS: Guidelines, their development and supporting meta-analyses were searched in Medline/PubMed and Cochrane database and analyzed for the influence of fat, carbohydrates and protein on reduction of LDL-cholesterol as well as the differences between European and American guidelines. RESULTS: In contrast to European guidelines, American guidelines increasingly refrain from controlling fat in nutrition, based on studies on the influence of nutrition on LDL-cholesterol and saturated fat; instead, monosaccharides and disaccharides are to be reduced from 15% to 10% of total calories for avoidance of high LDL-cholesterol and a non-alcoholic fatty liver. In predisposed persons the ratio of triglycerides to HDL-cholesterol should be checked when controlling LDL-cholesterol, an early indicator of type 2 diabetes mellitus and non-alcoholic fatty liver disease. Substituting animal fat with plant fat hardly influences LDL-cholesterol. Whole fat milk should be consumed as a source of protein. The nutritional pattern is more important than single components. CONCLUSION: Fat content in nutrition is increasingly less important in hypercholesterolemia but the reduction of monosaccharides and disaccharides gains importance.
BACKGROUND: New European and American guidelines for nutrition in hypercholesterolemia coincided with a lowered target value for LDL(Low density lipoprotein)-cholesterol. METHODS: Guidelines, their development and supporting meta-analyses were searched in Medline/PubMed and Cochrane database and analyzed for the influence of fat, carbohydrates and protein on reduction of LDL-cholesterol as well as the differences between European and American guidelines. RESULTS: In contrast to European guidelines, American guidelines increasingly refrain from controlling fat in nutrition, based on studies on the influence of nutrition on LDL-cholesterol and saturated fat; instead, monosaccharides and disaccharides are to be reduced from 15% to 10% of total calories for avoidance of high LDL-cholesterol and a non-alcoholic fatty liver. In predisposed persons the ratio of triglycerides to HDL-cholesterol should be checked when controlling LDL-cholesterol, an early indicator of type 2 diabetes mellitus and non-alcoholic fatty liver disease. Substituting animal fat with plant fat hardly influences LDL-cholesterol. Whole fat milk should be consumed as a source of protein. The nutritional pattern is more important than single components. CONCLUSION: Fat content in nutrition is increasingly less important in hypercholesterolemia but the reduction of monosaccharides and disaccharides gains importance.
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