J. Lipid Res.
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Journal of Lipid Research, Vol. 43, 264-273, February 2002
Copyright © 2002 by Lipid Research, Inc.

Efficacy of a Therapeutic Lifestyle Change/Step 2 diet in moderately hypercholesterolemic middle-aged and elderly female and male subjects

Alice H. Lichtensteina, Lynne M. Ausmana, Susan M. Jalberta, Montserrat Vilella-Bacha, Matti Jauhiainenb, Sandra McGladderyc, Arja T. Erkkiläd, Christian Ehnholmb, Jiri Frohlichc, and Ernst J. Schaefera
a Cardiovascular Nutrition Research Program and Lipid Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston MA
b Department of Molecular Medicine, National Public Health Institute, Helsinki, Finland
c Atherosclerosis Specialty Laboratory, Department of Pathology & Laboratory Medicine, UBC, Vancouver BC, Canada
d Department of Clinical Nutrition, University of Kuopio, Kuopio, Finland

Correspondence to: Alice H. Lichtenstein, at Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111., lichtenstein{at}hnrc.tufts.edu (E-mail)

Lifestyle modification to decrease cardiovascular disease (CVD) risk has recently been reaffirmed by both the National Cholesterol Education Program and American Heart Association (AHA). Using a randomized crossover design, the Therapeutic Lifestyle Change (TLC)/Step 2 diet relative to a typical Western diet was assessed in 36 moderately hypercholesterolemic subjects in a clinical setting under isoweight conditions. Mean lipoprotein and apolipoprotein levels (fasting and non-fasting), fatty acid profiles, parameters of HDL metabolism, and glucose homeostasis were determined. Relative to the Western diet, the TLC/Step 2 diet resulted in 11% and 7% lower LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C), respectively, with no significant change in TG levels or total cholesterol-HDL-C ratio. Similar responses were observed in the non-fasting state. Linoleic (18:2n-6c) and {alpha}-linolenic (18:3n-3) acids increased at the expense of oleic acid (18:1n-9c) in the cholesteryl ester, TG, and phospholipid subfractions. The dietary changes had no significant effect on fractional esterification rate of HDL, phospholipid transfer protein (PLTP), or cholesterol ester transfer protein activities, or glucose and insulin levels. Female and male subjects responded similarly.

The TLC/Step 2 diet resulted in a decrease in some CVD risk factors and no apparent adverse effects in others. — Lichtenstein, A. H., L. M. Ausman, S. M. Jalbert, M. Vilella-Bach, M. Jauhiainen, S. McGladdery, A. T. Erkkilä, C. Ehnholm, J. Frohlich, and E. J. Schaefer. Efficacy of a Therapeutic Lifestyle Change/Step 2 diet in moderately hypercholesterolemic middle-aged and elderly female and male subjects. J. Lipid Res. 2002. 43: 264–273.

Supplementary key words: therapeutic lifestyle change diet, Step 2 diet, saturated fat, cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fatty acids, diet, hypercholesterolemia


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