Plant sterols (PS) lower total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and inflammatory markers, and decrease risk of atherosclerotic cardiovascular disease (CVD). Exercise increases high density lipoprotein cholesterol (HDL-C) levels and decreases triglycerides (TG) and inflammation, also reducing the risk of CVD. The study objective was to investigate the combined effects of PS and exercise on apolipoproteins (apo) A and B, adiponectin, growth hormone (GH) and ghrelin, in context of previously obtained lipid data. In an 8-wk, placebo-controlled, parallel-arm clinical trial, 84 subjects were randomly assigned to: (1) combination of PS and exercise, (2) exercise, (3) PS, or (4) control group. PS increased (P=0.04) adiponectin values by 15%. ApoA was associated with HDL and apoB with LDL values at baseline. ApoA %change was correlated to HDL %change in the exercise group. ApoB, GH and ghrelin were unchanged. The capability of PS to increase adiponectin values reinforce their role in preventing inflammation, atherosclerosis, and CVD.

The National Cholesterol Education Program Adult Treatment Panel II (NCEP ATP II) unequivocally advocates an initial trial of dietary modification in both primary and secondary prevention prior to the institution of pharmacotherapy. Perhaps the rationale for this delay rests in the inherent, yet unsubstantiated, fear among clinicians that lifestyle change will be compromised in the presence of concurrent pharmacotherapy. However, the question of adherence to diet and exercise interventions following the initiation of lipid-lowering drug therapy has seemingly never been addressed scientifically. / It was therefore hypothesized that pharmacologically-treated patients with untreated hypercholesterolemia started on a program of lifestyle modification would achieve relatively less reduction in dietary fat intake and body weight, and participate less often in physical activity, if a pharmacologic agent was simultaneously prescribed. This was tested by a protocol in which these and related variables were assessed in participants who thought they were taking a lipid-lowering medication at diagnosis, compared to conventional initial treatment of diet and exercise alone. (Abstract shortened by UMI.)

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Localised accumulation of body fat significantly influences the development of obesity related co-morbidities and cardiovascular disease (CVD) risk. Medium chain triglycerides (MCT) have been suggested to modulate body fat distribution. Phytosterols (PS) have demonstrated unequivocal cholesterol-lowering effects. A healthy dietary solution combining MCT and PS could thus become first-line obesity and CVD prevention. The aim of this study was therefore to investigate the effects of a functional oil (FctO) rich in MCT and PS on blood lipid levels and body adiposity, compared to olive oil. Twenty-three hypercholesterolemic, overweight men, were randomly assigned, in a single-blind crossover study, to consume a FctO, or olive oil, incorporated into a 40% fat diet for 6 wks. Blood lipid levels were measured and body composition was assessed. Total and LDL cholesterol were significantly reduced in subjects consuming the FctO versus the control oil. No significant differences for weight or adiposity loss of subjects were observed between the two oils. Results support the cardio-protective role of this FctO.

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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