Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

Double-blind, randomized feedback control fails to improve the hypocholesterolemic effect of a plant-based low-fat diet in patients with moderately elevated total cholesterol levels

European Journal of Clinical Nutrition volume 58, pages 1402–1409 (2004)Cite this article

Abstract

Objective: To determine whether the cholesterol-lowering effect of a plant-based low-fat diet can be improved by a flexible control design that controls the extent of fat reduction based on the individual response of blood cholesterol.

Design: Randomized, double-blind intervention study.

Setting: A hotel in Prerow, Germany.

Subjects: A total of 32 participants (21 female and 11 male participants) with total cholesterol level>5.7 mmol/l.

Intervention: The control group consumed a plant-based low-fat diet with constantly 20% of energy as fat; the intervention group received a diet with either 20 or 15% of energy as fat, depending on the serum cholesterol response of the preceding week. A flexible control design based on the individual cholesterol response during a run-in period of 1 week was used within a low-fat intervention.

Results: During the run-in period, the consumption of a plant-based low-fat diet led to a reduction in total cholesterol by 18±6 mmol/l (P<0.001), in LDL cholesterol by 19±9 mmol/l (P<0.001) and triglycerides by 13±3 mmol/l (P<0.001). During the feedback control period, an additional reduction in total cholesterol by 13±8 (P<0.001) and in LDL cholesterol by 17±11 (P<0.001) was observed compared to 15±15 and 7±18 in the control group. The effect of an additional feedback control was only marginal and not statistically significant compared to the effect of the low-fat diet alone.

Conclusions: On a level of fat intake already reduced to 20% of energy, the use of a feedback control to adapt the fat content of the diet depending on the individual serum cholesterol response was not more effective in reducing blood cholesterol levels than a plant-based low-fat diet alone.

Sponsorship: Institute of Micro-Ecology, Herborn; the Stoll VITA Foundation, Waldshut; ALBAT+WIRSAM Software, Linden; Reformhaus Technical College, Oberstedten; Kölln Flocken Werke, Elmshorn, all in Germany.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  • Ansell B (2002): Future directions in lipid therapies. Adv. Ther. 19, 61–72.

    Article  CAS  Google Scholar 

  • Cheung ST (2000): Possible dangers in a low fat diet: some evidence reviewed. Nutr. Health 14, 271–280.

    Article  CAS  Google Scholar 

  • D. A. CH (2000): DGfE, Österreichische Gesellschaft für Ernährung SGfE, Schweizerische Vereinigung für Ernährung). Reference values for nutrient intake [German: Referenzwerte für die Nährstoffzufuhr], Frankfurt am Main: Umschau.

  • Dallongeville J, Lussier-Cacan S & Davignon J (1992): Modulation of plasma triglyceride levels by apoE phenotype: a meta-analysis. J. Lipid Res. 33, 447–454.

    CAS  PubMed  Google Scholar 

  • Day D (2001): Population-based screening with the Coronary Heart Disease Risk Factor Calculator. Adv. Ther. 18, 21–32.

    Article  CAS  Google Scholar 

  • Donohoe GG, Salomaki A, Lehtimaki T, Pulkki K & Kairisto V (1999): Rapid identification of apolipoprotein E genotypes by multiplex amplification refractory mutation system PCR and capillary gel electrophoresis. Clin. Chem. 45, 143–146.

    CAS  PubMed  Google Scholar 

  • Dreon DM, Fernstrom HA, Miller B & Krauss RM (1995): Apolipoprotein E isoform phenotype and LDL subclass response to a reduced-fat diet. Arterioscler. Thromb. Vasc. Biol. 15, 105–111.

    Article  CAS  Google Scholar 

  • Dumesnil JG, Turgeon J, Tremblay A, Poirier P, Gilbert M, Gagnon L, St-Pierre S, Garneau C, Lemieux I, Pascot A, Bergeron J & Despres JP (2001): Effect of a low-glycaemic index–low-fat–high protein diet on the atherogenic metabolic risk profile of abdominally obese men. Br. J. Nutr. 86, 557–568.

    Article  CAS  Google Scholar 

  • Dunn-Emke S, Weidner G & Ornish D (2001): Benefits of a low-fat plant-based diet. Obes. Res. 9, 731.

    Article  CAS  Google Scholar 

  • Erkkila AT, Sarkkinen ES, Lindi V, Lehto S, Laakso M & Uusitupa MI (2001): APOE polymorphism and the hypertriglyceridemic effect of dietary sucrose. Am. J. Clin. Nutr. 73, 746–752.

    Article  CAS  Google Scholar 

  • Federal Institute for Health Protection of Consumers and Veterinary Medicine (1999): The German Food Code and Nutrient Data Base (BLS II.3): conception, structure and documentation of the data base blsdat. Berlin, Germany: BgVV Publications.

  • Gibney MJ (1999): Optimal macronutrient balance. Proc. Nutr. Soc. 58, 421–425.

    Article  CAS  Google Scholar 

  • Gimeno E, Fito M, Lamuela-Raventos RM, Castellote AI, Covas M, Farre M, de La Torre-Boronat MC & Lopez-Sabater MC (2002): Effect of ingestion of virgin olive oil on human low-density lipoprotein composition. Eur. J. Clin. Nutr. 56, 114–120.

    Article  CAS  Google Scholar 

  • Grande F, Anderson JT, Chlouverakis C, Proja M & Keys A (1965): Effect of dietary cholesterol on man's serum lipids. J. Nutr. 87, 52–62.

    Article  CAS  Google Scholar 

  • Hegsted DM, McGandy RB, Myers ML & Stare FJ (1965): Quantitative effects of dietary fat on serum cholesterol in man. Am. J. Clin. Nutr. 17, 281–295.

    Article  CAS  Google Scholar 

  • Hermansen K, Dinesen B, Hoie LH, Morgenstern E & Gruenwald J (2003): Effects of soy and other natural products on LDL:HDL ratio and other lipid parameters: a literature review. Adv. Ther. 20, 50–78.

    Article  CAS  Google Scholar 

  • Hoffmann I, Groeneveld MJ, Boeing H, Koebnick C, Golf S, Katz N & Leitzmann C (2001): Giessen Wholesome Nutrition Study: relation between a health-conscious diet and blood lipids. Eur. J. Clin. Nutr. 55, 887–895.

    Article  CAS  Google Scholar 

  • Johnson RK & Kennedy E (2000): The 2000 Dietary Guidelines for Americans: what are the changes and why were they made? The Dietary Guidelines Advisory Committee. J. Am. Diet. Assoc. 100, 769–774.

    Article  CAS  Google Scholar 

  • Koebnick C, Heins UA, Hoffmann I, Dagnelie PC & Leitzmann C (2001): Folate status during pregnancy in women is improved by long-term high vegetable intake compared with the average western diet. J. Nutr. 131, 733–739.

    Article  CAS  Google Scholar 

  • Lefevre M, Ginsberg HN, Kris-Etherton PM, Elmer PJ, Stewart PW, Ershow A, Pearson TA, Roheim PS, Ramakrishnan R, Derr J, Gordon DJ & Reed R (1997): ApoE genotype does not predict lipid response to changes in dietary saturated fatty acids in a heterogeneous normolipidemic population. The DELTA Research Group. Dietary effects on lipoproteins and thrombogenic activity. Arterioscler. Thromb. Vasc. Biol. 17, 2914–2923.

    Article  CAS  Google Scholar 

  • Lopez-Miranda J, Ordovas JM, Mata P, Lichtenstein AH, Clevidence B, Judd JT & Schaefer EJ (1994): Effect of apolipoprotein E phenotype on diet-induced lowering of plasma low density lipoprotein cholesterol. J. Lipid. Res. 35, 1965–1975.

    CAS  PubMed  Google Scholar 

  • Mensink RP & Katan MB (1992): Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler. Thromb. 12, 911–919.

    CAS  Google Scholar 

  • Ordovas JM (1999): The genetics of serum lipid responsiveness to dietary interventions. Proc. Nutr. Soc. 58, 171–187.

    Article  CAS  Google Scholar 

  • Ordovas JM & Galluzzi JR (1999): Genetic predictors of plasma lipid response to diet intervention. Curr. Atheroscler. Rep. 1, 196–203.

    Article  CAS  Google Scholar 

  • Ornish D (1998): Serum lipids after a low-fat diet. JAMA 279, 1345–1346.

    Article  CAS  Google Scholar 

  • Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ & Gould KL (1990): Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 336, 129–133.

    Article  CAS  Google Scholar 

  • Pasternak R (2002): Adult Treatment Panel II versus Adult Treatment Panel III: what has changed and why? Am. J. Cardiol. 89, 3C–7C.

    Article  Google Scholar 

  • Poppitt SD, Keogh GF, Mulvey TB, McArdle BH, MacGibbon AK & Cooper GJ (2002): Lipid-lowering effects of a modified butter-fat: a controlled intervention trial in healthy men. Eur. J. Clin. Nutr. 56, 64–71.

    Article  CAS  Google Scholar 

  • Sabate J (2003): The contribution of vegetarian diets to health and disease: a paradigm shift? Am. J. Clin. Nutr. 78, 502S–507S.

    Article  CAS  Google Scholar 

  • Sabate J, Haddad E, Tanzman JS, Jambazian P & Rajaram S (2003): Serum lipid response to the graduated enrichment of a Step I diet with almonds: a randomized feeding trial. Am. J. Clin. Nutr. 77, 1379–1384.

    Article  CAS  Google Scholar 

  • Sarkkinen E, Korhonen M, Erkkila A, Ebeling T & Uusitupa M (1998): Effect of apolipoprotein E polymorphism on serum lipid response to the separate modification of dietary fat and dietary cholesterol. Am. J. Clin. Nutr. 68, 1215–1222.

    Article  CAS  Google Scholar 

  • Savolainen MJ, Rantala M, Kervinen K, Jarvi L, Suvanto K, Rantala T & Kesaniemi YA (1991): Magnitude of dietary effects on plasma cholesterol concentration: role of sex and apolipoprotein E phenotype. Atherosclerosis 86, 145–152.

    Article  CAS  Google Scholar 

  • Schaefer EJ (2002): Lipoproteins, nutrition, and heart disease. Am. J. Clin. Nutr. 75, 191–212.

    Article  CAS  Google Scholar 

  • Schaefer EJ, Lamon-Fava S, Ausman LM, Ordovas JM, Clevidence BA, Judd JT, Goldin BR, Woods M, Gorbach S & Lichtenstein AH (1997): Individual variability in lipoprotein cholesterol response to National Cholesterol Education Program Step 2 diets. Am. J. Clin. Nutr. 65, 823–830.

    Article  CAS  Google Scholar 

  • US Department of Agriculture & US Department of Health and Human Services (2000): Nutrition and your Health: Dietary Guidelines for the Americans. Washington, DC (Home and Garden Bulletin No 232): US Government Printing Office.

  • Weggemans RM, Zock PL, Urgert R & Katan MB (1999): Differences between men and women in the response of serum cholesterol to dietary changes. Eur. J. Clin. Invest. 29, 827–834.

    Article  CAS  Google Scholar 

  • Wirsam B, Hahn A, Uthus EO & Leitzmann C (1997): Fuzzy sets and fuzzy decision making in nutrition. Eur. J. Clin. Nutr. 51, 286–296.

    Article  CAS  Google Scholar 

  • Wirsam B & Uthus EO (1996): The use of fuzzy logic in nutrition. J. Nutr. 126, 2337S–2341S.

    Article  CAS  Google Scholar 

  • Zunft HJ, Luder W, Harde A, Haber B, Graubaum HJ & Gruenwald J (2001): Carob pulp preparation for treatment of hypercholesterolemia. Adv. Ther. 18, 230–236.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This project was supported by the Institute of Micro-Ecology, Herborn; the Stoll VITA Foundation, Waldshut; ALBAT+WIRSAM Software, Linden; Reformhaus Technical College, Oberstedten; Kölln Flocken Werke, Elmshorn, all in Germany. We are grateful to the staff of the hotel ‘Haus Linden’ for all their efforts. We also thank the study participants for their excellent compliance.

Author information

Authors and Affiliations

  1. German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany

    C Koebnick, S Gruendel & H J F Zunft

  2. Institute for Nutritional Science, University of Giessen, Giessen, Germany

    S Plank-Habibi & C Leitzmann

  3. Albat+Wirsam Software AG, Linden, Germany

    B Wirsam

  4. Institute of Nutritional Science, University of Potsdam, Potsdam, Germany

    S Gruendel & H J F Zunft

  5. Institute of Nutritional Science, University of Hanover, Hanover, Germany

    A Hahn

  6. Centre for Human Genetics, Linden, Germany

    C Meyer-Kleine

Authors
  1. C Koebnick
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Plank-Habibi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B Wirsam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Gruendel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C Meyer-Kleine
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C Leitzmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H J F Zunft
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Guarantor: C Koebnick.

Contributors: SPH, BW, AH, CL, HJFZ and CK contributed to the design of the study. SPH, BW, CL and HJFZ were available for the participants during the study period in the study center. CK and SPH were responsible for the statistical analysis and interpretation of the data. CMK contributed to the laboratory analysis. All authors contributed to the conduct of the study, data collection and writing of the manuscript.

Corresponding author

Correspondence to C Koebnick.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koebnick, C., Plank-Habibi, S., Wirsam, B. et al. Double-blind, randomized feedback control fails to improve the hypocholesterolemic effect of a plant-based low-fat diet in patients with moderately elevated total cholesterol levels. Eur J Clin Nutr 58, 1402–1409 (2004). https://doi.org/10.1038/sj.ejcn.1601984

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601984

Keywords

This article is cited by

Search

Advanced search

Quick links