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Serum Lipids After a Low-Fat Diet

DeaN Ornish, MD
JAMA. 1998;279(17):1345-1346. doi:10.1001/jama.279.17.1345.
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To the Editor.—Dr Knopp and colleagues1state that "aggressive fat restriction compared with moderate fat restriction offers no further benefits in a number of parameters and adverse effects in others." This conclusion is misleading, since Knopp et al did not assess heart disease but only changes in lipid levels. In the Lifestyle Heart Trial,2reducing fat intake to 10% of energy consumed and dietary cholesterol to 10 mg/d resulted in a 37% decrease in low-density lipoprotein (LDL) after 1 year compared with only 6% in the control group on a Step II diet (and compared with 5%-13% in the lowest-fat category of the study by Knopp et al). Thus, "aggressive fat restriction" clearly offers further benefits in reducing LDL.


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