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Margo A. Denke, MD

Arch Intern Med. 1994;154(17):1977-1982.

Abstract
Background
The efficacy of the step 1 diet in outpatient women with hypercholesterolemia has been debated.

Methods
Forty-one normotriglyceridemic women whose low-density lipoprotein (LDL) cholesterol levels were 3.62 to 5.17 mmol/L (140 to 200 mg/dL) participated in a twoperiod outpatient diet counseling study that used a 1-month high-fat, high-saturated fatty acid period (Hi-Sat diet) and a 4-month low-fat, low-saturated fatty acid period (step 1 diet). All women were postmenopausal and were not taking hormone replacement therapy. Levels of lipids, lipoproteins, and plasma triglyceride fatty acids were measured five times during the last 2 weeks of each dietary period. Dietary intake was assessed by 7-day food records.

Results
The mean reduction in total cholesterol level achieved by the step 1 diet was 0.36 mmol/L (14 mg/ dL). The reduction in total cholesterol level was seen in both LDL cholesterol levels (0.28 mmol/L [11 mg/dL]; P<.005) and high-density lipoprotein cholesterol levels (0.08 mmol/L [3 mg/dL]; P=.08). Although individual LDL responsiveness to diet was normally distributed, there was marked variation in response, which could be explained only partially by compliance (change in saturated fat intake, 10%), change in body weight (3%), and an interaction between the palmitic acid content of the plasma and body weight (3%).

Conclusions
A step 1 diet lowers total and LDL cholesterol levels in postmenopausal women. A nonsignificant reduction in high-density lipoprotein cholesterol levels was also observed. Since some women achieved LDL cholesterol levels low enough to obviate the need for drug therapy as primary prevention of coronary heart disease, dietary therapy should remain the first step in the management of hypercholesterolemia in postmenopausal women.

(Arch Intern Med. 1994;154:1977-1982)

Author Affiliations
From the Center for Human Nutrition and the Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas.

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