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Low-fat, high-sugar diet and lipoprotein profiles

12 Sir Francis Wyatt Place Newport News, VA 23606-3660 E-mail: Wbgrant{at}norfolk.infi.net

Dear Sir:

The recent paper by Dreon et al (1) reported that a very-low-fat diet is not associated with improved lipoprotein profiles in men. The dietary nutrient data presented in their Table 1 show that at the same time that the percentage of energy from fat decreased from 31.8% to 10.4%, that from carbohydrates increased from 52.1% to 75.7%, with half of the carbohydrate energy derived from simple sugars. Only near the end of the paper did Dreon et al mention that potential differences in metabolic effects of complex compared with simple sugars need to be considered.

Another way of assessing the effect of fat and carbohydrates on IHD is to consider the dietary profiles of several countries along with their IHD mortality rates. Presented in Table 1 are consumer food supply data that were obtained from the Food and Agriculture Organization (7) and 1986 IHD mortality rates that were obtained from the World Health Organization (8). The simple sugars category is approximated by sweeteners, lactose, and 50% of the fruit energy.

What is readily apparent from Table 1 is that there is no relation between the fraction of the diet derived from total carbohydrates and IHD mortality rates, and little relation between grams of fat and IHD mortality rates. However, there is a hint that there is a relation between the fraction of the diet derived from simple carbohydrates and IHD mortality rates. In the data presented in Table 1, lactose has the highest correlation with IHD mortality. The linear regression results for lactose are r = 0.97 (P = 0.006) for males and r = 0.95 (P = 0.014) for females. Lactose has long been associated with IHD mortality rates for men and older women according to the ecologic approach (9, 10), although no case-control or cohort studies have been conducted to confirm this finding. In addition, sweeteners have recently been associated with IHD mortality for women between the ages of 35 and 64 y (10).

REFERENCES

1. Dreon DM, Fernstrom HA, Williams PT, Krauss RM. A very-low-fat diet is not associated with improved lipoprotein profiles in men with a predominance of large, low-density lipoproteins. Am J Clin Nutr 1999;69:411–8.[Abstract/Free Full Text]
2. Reiser S. Health implications of food carbohydrates: heart disease and diabetes. In: Lineback DR, Inglett GE, eds. Food carbohydrates. Westport, CT: AVI Publishing Co, Inc, 1982;11:170–205.
3. Albrink MJ, Ullrich MD. Interaction of dietary sucrose and fiber on serum lipids in healthy young men fed high carbohydrate diets. Am J Clin Nutr 1986;43:419–28.[Abstract/Free Full Text]
4. Yudkin J, Eisa O, Kang SS, Meraji S, Bruckdorfer KR. Dietary sucrose affects plasma high density lipoprotein cholesterol concentration in young men. Ann Nutr Metab 1986;30:261–6.[Medline]
5. Archer SL, Liu K, Dyer AR, et al. Relationship between changes in dietary sucrose and high density lipoprotein cholesterol: The CARDIA Study. Ann Epidemiol 1998;8:433–8.[Medline]
6. Jeppesen J, Hein HO, Suadicani P, Gyntelberg F. Triglyceride concentration and ischemic heart disease. Circulation 1998;97:1029–36.[Abstract/Free Full Text]
7. Food and Agriculture Organization of the United Nations. Food balance sheets. Rome: FAO, 1996.
8. World Health Organization. World health statistics annual. Geneva: WHO, 1992.
9. Segall JJ. Epidemiological evidence for the link between dietary lactose and atherosclerosis. In: Colaco CA, ed. The glycation hypothesis of atherosclerosis. Austin, TX: Landes Bioscience, 1997:185–209.
10. Grant WB. Milk and other dietary influences on coronary heart disease. Altern Med Rev 1998;3:281–94.[Medline]

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