Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1990. / Vita. Abstract. Includes bibliographical references (leaves 34-38). Also available via the Internet.

Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1993. / Vita. Abstract. Accompanying booklets in pockets. Includes bibliographical references (leaves 110-121). Also available via the Internet.

Cholesterol levels have been shown to be related to the development of coronary heart disease and can be lowered through dietary measures (National Institute of Health, 2003). Dietary counseling alone as well as in conjunction with pharmacotherapy has been demonstrated by research to lower blood cholesterol levels. A problem exists in that dietary counseling is underused for the treatment of hyperlipidemia. The purpose of this study is to identify the different types of dietary counseling and their benefits in the treatment of hyperlipidemia as demonstrated through research. Nursing and interdisciplinary research literature published between 1990 and 2003 regarding dietary intake and hyperlipidemia was reviewed and synthesized. The benefits of dietary counseling were synthesized in relation to the outcome measures of: reduced cholesterol levels according to different types of dietary counseling and diets, cost-effectiveness, synergistic effects with pharmacological and other non-pharmacological treatment, and reduced medication-related adverse affects. Different diets and dietary counseling that significantly reduced cholesterol are reported. Limitations in synthesizing these studies were related to different variables, designs, diets, and client types, as well as the fact most research on dietary counseling is not related specifically to nursing but is interdisciplinary. This study will be significant for nursing practice because nurses are often the health care professionals who counsel the patient prior to discharge, during a routine visit, or in any preventive setting, such as health fairs, clinics, consumer education via media, or other community sites. As benefits are clearly identified, nurses will gain a better appreciation for their role in dietary counseling with patients with hyperlipidemia. Recommendations for nursing education, practice, and research were included in this study based on findings synthesized.

Yang, Nan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (p. 94-117). / Abstracts in English and Chinese. / ACKNOWLEDGMENTS --- p.I / ABSTRACT --- p.II / LIST OF ABBREVIATIONS --- p.VII / TABLE OF CONTENTS --- p.IX / Chapter Chapter 1 --- general introduction / Chapter 1.1 --- Cholesterol and cardiovascular disease --- p.1 / Chapter 1.2 --- Functions of cholesterol and lipoprotein --- p.2 / Chapter 1.3 --- Cholesterol metabolism and regulation in the body --- p.5 / Chapter 1.3.1 --- General process of cholesterol metabolism --- p.5 / Chapter 1.3.2 --- Cholesterol metabolism in liver --- p.6 / Chapter 1.3.2.1 --- The uptake of LDL cholesterol into the liver --- p.6 / Chapter 1.3.2.2 --- Cholesterol synthesis --- p.7 / Chapter 1.3.2.3 --- Synthesis of bile acids --- p.8 / Chapter 1.3.2.4 --- RCT pathway --- p.9 / Chapter 1.3.3 --- Lipids absorption in the intestine lumen --- p.9 / Chapter 1.3.3.1 --- Niemann-Pick Cl like 1(NPC1L1) --- p.10 / Chapter 1.3.3.2 --- ABCG5/8 --- p.10 / Chapter 1.3.3.3 --- Acyl-CoA:cholesterol acyltransferase (ACAT) 2 --- p.11 / Chapter 1.3.4 --- Cholesterol homeostasis --- p.11 / Chapter 1.3.5 --- The regulation of the cholesterol metabolism --- p.11 / Chapter 1.3.5.1 --- The role of SREBP-2 --- p.11 / Chapter 1.3.5.2 --- The role of LXR --- p.13 / Chapter 1.3.5.3 --- Feedback regulation of cholesterol --- p.13 / Chapter 1.4 --- Bile acid metabolism --- p.13 / Chapter 1.4.1 --- The function of bile acid --- p.13 / Chapter 1.4.2 --- Bile acid synthesis --- p.14 / Chapter 1.4.3 --- Enterohepatic circulation of bile --- p.14 / Chapter 1.5 --- Effect of Dietary composition on the blood cholesterol --- p.15 / Chapter 1.5.1 --- Dietary cholesterol --- p.15 / Chapter 1.5.2 --- Dietary protein --- p.15 / Chapter 1.5.2.1 --- Research history of dietary protein on the cholesterol --- p.15 / Chapter 1.5.2.2 --- Dietary casein --- p.17 / Chapter 1.5.2.3 --- Soy protein --- p.18 / Chapter 1.5.2.4 --- Buckwheat protein --- p.18 / Chapter 1.5.2.5 --- Mechanism of dietary protein on the cholesterol --- p.18 / Chapter 1.5.3 --- Dietary fiber --- p.18 / Chapter 1.5.4 --- Other functional components in the diet --- p.19 / Chapter 1.5.4.1 --- Phytosterol --- p.19 / Chapter 1.5.4.2 --- Dietary flavonoids --- p.21 / Chapter 1.6 --- Chemical composition of Tartary buckwheat --- p.22 / Chapter 1.6.1 --- Buckwheat protein --- p.22 / Chapter 1.6.2 --- Dietary fiber --- p.23 / Chapter 1.6.3 --- Phytosterols --- p.23 / Chapter 1.6.4 --- Flavonoids --- p.23 / Chapter Chapter 2 --- Effect of Tartary Buckwheat Flour on Blood Cholesterol Level in Male Hamsters / Chapter 2.1 --- Introduction --- p.25 / Chapter 2.2 --- Objective --- p.27 / Chapter 2.3 --- Materials and methods --- p.27 / Chapter 2.3.1 --- Hamsters --- p.27 / Chapter 2.3.2 --- Diets --- p.28 / Chapter 2.3.3 --- "Determination of plasma lipid, lipoproteins" --- p.30 / Chapter 2.3.4 --- Determination of cholesterol concentration in organs --- p.31 / Chapter 2.3.5 --- Determination of fecal neutral and acidic sterols output --- p.31 / Chapter 2.3.6 --- "Western blotting of liver SREBP-2, LDLR, HMGR, LXR and CYP7A1 proteins" --- p.36 / Chapter 2.3.7 --- "Real-Time PCR Analysis of mRNA or Liver SREBP-2, LDLR, HMGR, and CYP7A1 and Small Intestine NPC1L1, ABCG5, ABCG8, ACAT2, and MTP" --- p.37 / Chapter 2.3.8 --- Intestinal ACAT2 activity measurement --- p.37 / Chapter 2.3.9 --- Statistics --- p.39 / Chapter 2.4 --- Results --- p.40 / Chapter 2.4.1 --- Nutritional composition of different flours --- p.40 / Chapter 2.4.2 --- "Growth, food intake and relative organ weights" --- p.44 / Chapter 2.4.3 --- Effect of different flour diets on the plasma lipid profile --- p.44 / Chapter 2.4.4 --- Effect of different flour diets on organ cholesterol of hamsters --- p.44 / Chapter 2.4.5 --- Cholesterol balance and excretion of fecal neutral and acidic Sterols --- p.44 / Chapter 2.4.6 --- "Effect of different flour diets on hepatic SREBP-2, HMGR, LDLR and CYP7A1 immunoreactive mass" --- p.51 / Chapter 2.4.7 --- "Effect of different flour diets on intestinal ABCG5, ABCG8, NPC1L1, MTP, and ACAT2 immunoreactive mass" --- p.54 / Chapter 2.4.8 --- Effect of different diet group on intestinal ACAT activity --- p.54 / Chapter 2.5 --- Discussion --- p.57 / Chapter 2.6 --- Summary --- p.61 / Chapter Chapter 3 --- Effect of DefattedTartary Buckwheat Protein Extract on Blood Cholesterol Level in Male Hamsters / Chapter 3.1 --- Introduction --- p.62 / Chapter 3.2 --- Objective --- p.63 / Chapter 3.3 --- Materials and methods --- p.63 / Chapter 3.3.1 --- Hamsters --- p.63 / Chapter 3.3.2 --- Diets --- p.63 / Chapter 3.3.3 --- "Determination of plasma lipid, lipoproteins" --- p.66 / Chapter 3.3.4 --- Determination of cholesterol concentration in organs and fecal neutral and acidic sterols output --- p.66 / Chapter 3.3.5 --- "Western blotting of liver SREBP-2, LDLR, HMGR and CYP7A1 proteins" --- p.66 / Chapter 3.3.6 --- "Real-Time PCR Analysis of mRNA or Liver SREBP-2, LDLR, HMGR, and CYP7A1 and Small Intestine NPC1L1, ABCG5, ABCG8, ACAT2, and MTP" --- p.66 / Chapter 3.3.7 --- Intestinal ACAT2 activity measurement --- p.67 / Chapter 3.3.8 --- Protein digestibility determination --- p.67 / Chapter 3.3.9 --- Statistics --- p.67 / Chapter 3.4 --- Results --- p.68 / Chapter 3.4.1 --- Diet composition --- p.68 / Chapter 3.4.2 --- "Growth, food intake, fecal excretion" --- p.72 / Chapter 3.4.3 --- Relative organ weights and organ cholesterol concentration --- p.72 / Chapter 3.4.4 --- Effect of different defatted protein extracts on the plasma lipid profile --- p.76 / Chapter 3.4.5 --- Cholesterol Balance and Excretion of Fecal Neutral and Acidic Sterols --- p.76 / Chapter 3.4.6 --- "Apparent protein digestibility in casein, TBP, WP and RP diet groups" --- p.77 / Chapter 3.4.7 --- "Effect of different defatted protein extracts on hepatic SREBP-2, HMGR, LDLR and CYP7A1 immunoreactive mass" --- p.83 / Chapter 3.4.8 --- "Effect of different defatted protein extracts on intestinal ABCG5, ABCG8, NPC1L1, MTP, and ACAT2 immunoreactive mass" --- p.83 / Chapter 3.5 --- Discussion --- p.87 / Chapter 3.6 --- Summary --- p.91 / Chapter Chapter 4 --- Conclusion --- p.92 / References --- p.94

The National Cholesterol Education Program Adult Treatment Panel guidelines specify that dietary intervention is the cornerstone of treatment for hypercholesterolemia. Self-monitoring is a strategy used to achieve self-direction in adopting and maintaining a cholesterol-lowering dietary pattern. The Cholesterol Saturated Fat Index (CSI) illustrates the atherogenic potential of food. Given that saturated fat and dietary cholesterol are the two major dietary components known to raise serum cholesterol, a CSI Scorecard was developed and pilot tested as a dietary self-monitoring tool. Twelve nutritionists scored the same five food records with known CSI scores, the reference data. The food records represented CSI scores from the 10th, 25th, 50th, 75th, and 90th percentiles from a pool of 400 usual diet food records. Two-tailed, one-sample t-tests demonstrated that the CSI Scorecard scores were not statistically significant at only the 25th and 75th percentiles. Therefore, in three of five food record percentiles, nutritionists’ CSI scores differed from the corresponding reference CSI scores. Small sample size and years of experience may have been factors influencing the results. Comments from the nutritionists’ critique forms were incorporated into the revision of the CSI Scorecard. Twelve participants scored their four-day food records using the booklet. The Spearman’s rho correlation of the CSI Scorecard derived CSI scores to the reference CSI scores was r_S=.8 (p<.05). These preliminary results and comments from the formative evaluation meetings suggested that the CSI Scorecard deserves further validity testing with a larger sample of subjects. The CSI Scorecard appeared to show promise as a dietary self-monitoring tool that would facilitate increased self-direction in the adoption of a cholesterol-lowering diet. / Master of Science

Thesis (M.Sc. (Chemical Pathology)) --University of Limpopo, 2013 / Objectives: The present study investigated how the serum lipids responded to a high-fat meal in black South African subjects with different APOE genotypes, a population that until recently was reported to be consuming a traditional diet of low fat and high carbohydrates. Methods: Sixty students (males and females) of the University of Limpopo, Turfloop Campus were successfully genotyped using Restriction Fragment Length Polymorphism (RFLP) and grouped into four APOE genotype groups; ε2, ε2/ε4, ε3 and ε4. Only thirty-three subjects volunteered to participate in the oral fat-tolerance test (OFTT), but two were excluded for having abnormal total cholesterol (6.05 mmol/l) and LDL cholesterol (3.12 mmol/l) so only 31 subjects were left. The numbers per group were ε2=5, ε2/ε4=8, ε3=9 and ε4=9. After an overnight fast blood was drawn for measurements of baseline serum parameters. Subjects were administered a high fat meal 30 minutes after the baseline blood sample was drawn. Blood was drawn at intervals of 20, 40, 60, 120, 180, 240, 300 and 360 minutes for measurements of postprandial serum parameter levels. Serum parameters measured were triglyceride, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, glucose and insulin. Results Mean levels of serum lipids at baseline in mmol/l were as follows; group 1[TG=0.69(0.55-0.81), TCHOL=3.10±0.29, HDL-C=1.12±0.32, LDLC= 1.67±0.28]; group 2 [TG=0.61(0.53-1.00), TCHOL=2.98±0.53, HDLC= 1.20±0.37, LDL-C=1.43±0.37]; group 3 [TG=0.67(0.28-0.86), TCHOL=2.96±0.54, HDL-C=1.22±0.30, LDL-C=1.46±0.47]; group 4 [TG=0.76(0.51-1.16), TCHOL=3.27±0.51, HDL-C=1.12±0.17, LDLC= 1.79±0.47]. There was no significant difference in the mean levels of baseline triglyceride, total cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol between the APOE groups hence no significant difference in the response to a fatty meal. Conclusions There was no significant change in serum lipid concentrations after a fatty meal in individuals with different APOE genotypes in a population that consume a traditional diet of low fat and high carbohydrates. Due to the small sample size, the results should be interpreted with caution. A larger study is recommended to ascertain the role of APOE genotypes on serum lipid response to a fatty meal in Black South African population.

One hundred and seventy male and female volunteers employed at Hubbell Lighting Inc., Christiansburg, Virginia were studied to determine the effectiveness of two alternative educational strategies for lowering elevated blood cholesterol by modifying the diet. Initially three hundred and twenty-eight employees were weighed and tested for elevated total blood cholesterol via a finger-stick procedure using a Reflotron. Two hundred of these employees had elevated total blood cholesterol readings (2: 200 mg/dl) and were invited to participate in the study. The one hundred and seventy employees who consented to participate were divided into plant and office populations and then each of these two subpopulations was then randomized by sex into one of three experimental groups: individuals receiving worksite classes, those who received information on diet and blood cholesterol mailed to their homes, or a control group. Prior to the baseline blood cholesterol test, subjects completed and returned a pre-test questionnaire used to obtain demographic data and assess baseline knowledge, dietary practices and health-relevant attitudes such as self-efficacy, perceived susceptibility to heart disease, and perceived social support. Subjects also completed a three-day food record on the first and eighth week of the study as well as a post-test questionnaire identical to the pre-test questionnaire prior to the second blood cholesterol test which was performed during the tenth week of the study. No significant differences were observed over the experimental period in body weight. knowledge, dietary practices, and health relevant attitudes. Significant differences were observed for the dependent measure of change in blood cholesterol with a group and education level effect identified between subjects receiving worksite classes vs. the control group (p = .0284**) and subjects with only a grade school level education vs. all other education levels (p = .0021 **). Overall. subjects reduced total blood cholesterol levels by 18 mg/dl or 9% with the mean reduction for white and blue-collar groups receiving worksite classes (23 mg/dl or 11% and 19 mg/dl or 9%) significantly greater than the mean reduction for the control groups (13 mg/dl or 6% and 14 mg/dl or 7%). Subjects with only a grade school education reduced their cholesterol levels more than subjects at all other educational levels. The mean reduction in blood cholesterol for subjects receiving information mailed to the home about diet and blood cholesterol was less than the mean reduction for subjects in groups receiving the worksite classes. However. ANOV A revealed that there was no statistically significant difference between these two groups. Since, the mailed home approach is less costly for the employer, these findings suggest that while the two educational interventions may be similar in terms of effectiveness, the mailed home approach is more cost-effective. / Master of Science

While the relationship between elevated total serum cholesterol levels and the risk for coronary heart disease (CHD) has been evident for a number of years, relatively few studies attempting to attain reductions in total serum cholesterol have utilized specific behavioral protocols. This study was conducted with 16 middle aged men (mean age = 46.4 years) with elevated total serum cholesterol (TSC) levels (x = 233 mg/dl). Multiple measures of TSC were taken. After an extended baseline phase, participants were randomly assigned to treatment conditions. One group ("Simple") received a cholesterol reduction class only (designed to stress the National Cholesterol Education Program's (NCEP) Step One Diet) and the other group ("Intensive’) received the cholesterol reduction class in addition to weekly cholesterol feedback, specific dietary feedback (shown graphically) and individually tailored goals. Dietary information was collected by individual food diaries. The results indicated that both groups reduced their TSC level (9.60% Intensive and 5.52% Simple) with no statistically significant difference between the groups. Both groups made changes in their diet yet, neither group completely met the guidelines set by the NCEP. However, there was some evidence for greater dietary adherence to the Step One diet and reaching risk (categorization) reduction goals for men in the intensive condition. Additional research has shown more intensive interventions led to substantially greater reductions (14%-16%) in TSC and dietary change. These results and prior research suggest that modest reductions in TSC can be achieved by less intensive programs that follow and/or slightly enhance the NCEP program, but that greater reductions in TSC (and reductions in CHD risk) may require programs with more intensive procedures. / Master of Science

The effectiveness of biweekly feedback regarding blood total cholesterol (TCH) to assist dietary adherence and lower blood TCH levels was assessed in a mixed population of healthy and cardiac diseased subjects (S) engaging in an unsupervised mall walking program. Based upon screening with a portable lipid analyzer (and with their physician's permission) 36 S’s (x age=63, 83% females) with TCH levels between 200-300 mg/dl were randomized to control (CG) or experimental groups (EG). The CG received instruction regarding the National Cholesterol Education Program's Step 1 low-fat, low-cholesterol diet at 0, 2, 4, 6 weeks and completed 3-day food records at 0, 4, 8 weeks. In addition to this instruction, the EG received graphic feedback regarding their TCH at 0, 2, 4, and 6 weeks. Both groups had a goal of a 10% reduction in TCH. By 8 weeks, the CG increased TCH by 2.2 mg/dl (1%) from 240.2 ± 24.8 to 242.4 ± 40.0 mg/dl while the EG decreased TCH by 11.8 mg/dl (5%) from 239.9 ± 22.6 to 228.1 ± 26.8 mg/dl. Repeated measures ANOVA showed a trend toward a lowering of TCH in the EG (time*group) [FC1,34)=3.39, p=.07]. A one-way repeated measures ANOVA for TCH within the EG between 0 and 8 weeks was significant [F(4,64)=3.14, p=.02]. Goal attainment was statistically greater in the experimental group [z=2.12: p=.0017]). Food record two-way ANOVAS revealed no significant differences between groups over time on dietary intake of fats or dietary cholesterol. Using one-way ANOVAs the experimental group demonstrated a significant pattern of initial decreases from food record 1 to food record 2 which Was maintained at food record 3. A recently reported study conducted in a structured cardiovascular exercise program (Burkett, Southard, Herbert, & Walberg, 1990) showed statistical significance over a 16 week trial period using this feedback technique. The results of the present study suggest that the findings of Burkett, et al. may be generalizable to populations participating in an unsupervised mall walking program. / Master of Science