Dietary cholesterol and the optimal diet for reducing risk of atherosclerosis

The importance of dietary cholesterol in the incidence of hypercholesterolemia in the population remains a topic of scientific debate. Analysis of the results from over 30 years of cholesterol feeding studies (n = 128) in more than 2750 patients indicate that for the majority of individuals modest changes in dietary cholesterol have little if any effect on plasma lipoprotein cholesterol levels. Data demonstrate that on average a change in cholesterol intake of 100 mg/day results in a change in plasma total cholesterol of 0.07 mmol/L (2.5 mg/dL). The studies also show that the extent of response to dietary cholesterol is independent of the amount of dietary fat and of the baseline plasma cholesterol level. In contrast, the dose adjusted plasma cholesterol response to a dietary cholesterol challenge is affected by the type of dietary fat and the baseline dietary cholesterol intake. Based on these data a reduction in dietary cholesterol intake from 450 to 300 mg/day will, on average, lower plasma cholesterol levels by 0.10 mmol/L (3.7 mg/dL). This decrease is modest and highly variable due to significant interindividual heterogeneity of responses. It is estimated that one-third of the population is sensitive to dietary cholesterol whereas two-thirds are resistant to plasma cholesterol changes. In comparison, a 1% decrease in energy intake from saturated fat decreases plasma cholesterol 0.08 mmol/L (3 mg/dL). Consumption of products marketed as 'No cholesterol' with high total and saturated fat clearly does not contribute to the optimal diet for reducing plasma cholesterol levels of risk of atherosclerosis.