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A substitution model of dietary manipulation is an effective means of optimising lipid profile, reducing C-reactive protein and increasing insulin-like growth factor-1

Published online by Cambridge University Press:  09 March 2007

Adrian H. Heald ,
Cheryl Golding ,
Reena Sharma ,
Kirk Siddals ,
Sara Kirk ,
Clare Lawton ,
Simon Anderson ,
J. Martin Gibson  and
Janet E. Cade
Adrian H. Heald*
Affiliation:
Nutritional Epidemiology Group and
Cheryl Golding
Affiliation:
Nutritional Epidemiology Group and
Reena Sharma
Affiliation:
Department of Diabetes and Endocrinology, Salford Royal Hospitals NHS Trust, Hope Hospital, Stott Lane, Salford M6 8HD, UK
Kirk Siddals
Affiliation:
Department of Diabetes and Endocrinology, Salford Royal Hospitals NHS Trust, Hope Hospital, Stott Lane, Salford M6 8HD, UK
Sara Kirk
Affiliation:
Nutritional Epidemiology Group and
Clare Lawton
Affiliation:
Department of Psychology, University of Leeds, 71–75 Clarendon Road, Leeds, LS2 9P, UK
Simon Anderson
Affiliation:
Department of Diabetes and Endocrinology, Salford Royal Hospitals NHS Trust, Hope Hospital, Stott Lane, Salford M6 8HD, UK
J. Martin Gibson
Affiliation:
Department of Diabetes and Endocrinology, Salford Royal Hospitals NHS Trust, Hope Hospital, Stott Lane, Salford M6 8HD, UK
Janet E. Cade
Affiliation:
Nutritional Epidemiology Group and
*
*Corresponding author: Dr Adrian Heald, fax +44 161 787 5989, email, [email protected]
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Abstract

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There are two key methods in which fat intake may be manipulated; the ‘substitution model’ and the ‘reduction model’. However insufficient information is known about the mechanisms of dietary fat reduction in individuals who have successfully reduced their fat intake, to be clear as to which strategy offers the greatest chance of success. Our objective was to ascertain the most effective dietary intervention for improving cardiovascular risk profile. Eighty female volunteers (high fat consumers) were recruited. Each subject was randomly allocated into one of the following groups. Substitution of high-fat foods was made with reduced-fat products, by the reduction of high-fat foods, by a combination of substitution and reduction strategies, or no advice was given. Each intervention lasted 3 months. Anthropometric measures and fasting blood samples were taken at baseline and follow-up. The substitution intervention resulted in weight loss (mean −1.4 (95% CI −2.4, −0.2) kg) and reduced percentage body fat (mean −1.3 (95% CI −2.0, −0.5)%). There was no significant weight change with the other interventions. Fasting triacylglycerols (−0.2 (SEM 0.07) mM; P=0.04), cholesterol and C-reactive protein (CRP) levels (0.8 (SEM 0.2) mg/l; P=0.04) fell with the substitution intervention, but not with the other interventions. Insulin-like growth factor-1 increased with both substitution and reduction (P=0.02). There was no significant change in fasting insulin or glucose with any intervention. The substitution model of dietary intervention is effective even over a relatively short interval of time in reducing fasting total cholesterol, triacylglycerols and CRP. Although the group size for the present study was small and involved females only, it has significant implications for population intervention strategies.

Keywords

Dietary interventionsSubstitution modelCardiovascular risk factorsLipidsC-reactive protein
Type
Research Article
Information
British Journal of Nutrition , Volume 92 , Issue 5 , November 2004 , pp. 809 - 818
Copyright
Copyright © The Nutrition Society 2004

References

Anonymous (1994) Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 344, 1383–1389.Google Scholar
Astrup, A, Buemann, B, Western, P, Toubro, S, Raben, A & Christensen, NJ (1994) Obesity as an adaptation to a high-fat diet: evidence from a cross-sectional study. Am J Clin Nutr 59, 350–355.CrossRefGoogle ScholarPubMed
Astrup, A, Grunwald, GK, Melanson, EL, Saris, WH & Hill, JO (2000) The role of low-fat diets in body weight control: a meta-analysis of ad libitum dietary intervention studies. Int J Obes Relat Metab Dis 24, 1545–1552.CrossRefGoogle ScholarPubMed
Bingham, SA (1987) The dietary assessment of individuals; methods, accuracy, new techniques and recommendations. Nutr Abstr Rev 57, 705–742.Google Scholar
Blundell, JE, Burley, VJ, Cotton, JR & Lawton, CL (1993) Dietary fat and the control of energy intake: evaluating the effects of fat on meal size and post-meal satiety. Am J Clin Nutr 57, Suppl. 5772S–777S.CrossRefGoogle Scholar
Calvert, C, Cade, JE, Woodhouse, A, Barrett, J & UKWCS, Steering Group (1996) Food frequency questionnaire (FFQ) interpretation and analysis: issues for the UK Women's Cohort Study. Proc Nutr Soc 56, 17A.Google Scholar
Caputo, FA & Mattes, RD (1992) Human dietary responses to covert manipulations of energy, fat, and carbohydrate in a midday meal. Am J Clin Nutr 56, 36–43.CrossRefGoogle Scholar
Cooling, J & Blundell, JE (2000) Lean male high- and low-fat phenotypes – different routes for achieving energy balance. Int J Obesity 24, 1561–1566.CrossRefGoogle ScholarPubMed
Crawley, H (1988) Food Portion Sizes. London: H.M. Stationery Office.Google Scholar
Cruickshank, JK, Heald, AH & Anderson, S et al. (2001) Epidemiology of the insulin-like growth factor system in three ethnic groups. Am J Epidemiol 154, 504–513.CrossRefGoogle ScholarPubMed
De Castro, JM (1994) Methodology, correlation analysis, and interpretation of diet diary records of the food and fluid intake of free-living humans. Appetite 23, 179–192.CrossRefGoogle Scholar
Department of HealthDepartment of Health (1999) Saving Lives: Our Healthier Nation. London: The Stationery Office.Google Scholar
DiClemente, CC & Prochaska, JO (1998) Toward a comprehensive, transtheoretical model of change: stages of change and addictive behaviors. In Treating Addictive Behaviors. 2nd ed. 3 – 24 [ Miller, WR and Heather, N, editors ] New York: Plenum Press.CrossRefGoogle Scholar
Dittmar, M (2003) Reliability and variability of bioimpedance measures in normal adults: effects of age, gender, and body mass. Am J Phys Anthropol 122, 361–370.CrossRefGoogle ScholarPubMed
Downs, JR, Clearfield, M, Weis, S, Whitney, E, Shapiro, DR, Beere, PA, Langendorfer, A, Stein, EA, Kruyer, W & Gotto, AM Jr (1998) Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 279, 1615–1622.Google ScholarPubMed
Festa, A, D'Agostino, R Jr, Howard, G, Mykkanen, L, Tracy, RP & Haffner, SM (2000) Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 102, 42–47.CrossRefGoogle ScholarPubMed
Festa, A, D'Agostino, R Jr, Williams, K, Karter, AJ, Mayer-Davis, EJ, Tracy, RP & Haffner, SM (2001) The relation of body fat mass and distribution to markers of chronic inflammation. Int J Obes Relat Metab Disord 25, 1407–1415.CrossRefGoogle ScholarPubMed
Fidanza, F, Puddu, V, Imbimbo, AB, Menotti, A & Keys, A (1970) Coronary heart disease in seven countries. VII. Five-year experience in rural Italy. Circulation 41, Suppl 4. I63–I75.CrossRefGoogle ScholarPubMed
Foltin, RW, Rolls, BJ, Moran, TH, Kelly, TH, McNelis, AL & Fischman, MW (1992 a) Caloric, but not macronutrient, compensation by humans for required-eating occasions with meals and snack varying in fat and carbohydrate. Am J Clin Nutr 55, 331–342.CrossRefGoogle Scholar
Foltin, RW, Rolls, BJ, Moran, TH, Kelly, TH, McNelis, AL & Fischman, MW (1992 b) Caloric, but not macronutrient, compensation by humans for required-eating. Erratum. Am J Clin Nutr 56, 954.Google Scholar
Gorbach, SL, Morrill-LaBrode, A & Woods, MN et al. (1990) Changes in food patterns during a low-fat dietary intervention in women. J Am Diet Assoc 90, 802–809.CrossRefGoogle ScholarPubMed
Grande, F, Anderson, JT & Keys, A (1970) Comparison of effects of palmitic and stearic acids in the diet on serum cholesterol in man. Am J Clin Nutr 23, 1184–1193.CrossRefGoogle ScholarPubMed
Greene, GW & Rossi, SR (1998) Stages of change for reducing dietary fat intake over 18 months. J Am Diet Assoc 98, 529–534.CrossRefGoogle ScholarPubMed
Heald, AH, Anderson, SG, Ivison, F, Laing, I, Gibson, JM & Cruickshank, JK (2003 a) C-reactive protein and the insulin-like growth factor (IGF)-system in relation to risk of cardiovascular disease in different ethnic groups. Atherosclerosis 170, 79–86.CrossRefGoogle ScholarPubMed
Heald, AH, Cade, JE, Cruickshank, JK, Anderson, S, White, A & Gibson, JM (2003 b) The influence of dietary intake on the insulin-like growth factor (IGF) system across three ethnic groups: a population-based study. Public Health Nutr 6, 175–181.CrossRefGoogle ScholarPubMed
Heald, AH, Cruickshank, JK & Riste, LK et al. (2001) Close relation of fasting insulin-like growth factor binding protein-1 (IGFBP-1) with glucose tolerance and cardiovascular risk in two populations. Diabetologia 44, 333–339.Google ScholarPubMed
Hellenius, ML, Brismar, KE, Berglund, BH & de Faire, U (1995) Effects on glucose tolerance, insulin secretion, insulin-like growth factor 1 and its binding protein, IGFBP-1, in a randomized controlled diet and exercise study in healthy, middle-aged men. J Intern Med 238, 121–130.CrossRefGoogle Scholar
Hill, JO, Seagle, HM, Johnson, SL, Smith, S, Reed, GW, Tran, ZV, Cooper, D, Stone, M & Peters, JC (1998) Effects of 14 d of covert substitution of olestra for conventional fat on spontaneous food intake. Am J Clin Nutr 67, 1178–1185.CrossRefGoogle ScholarPubMed
Holland, B, Welch, AA, Unwin, ID, Buss, DH, Paul, AA & Southgate, DAT (1991) McCance and Widdowson's The Composition of Foods. 5th ed. Cambridge and London: Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food.Google Scholar
Hooper, L, Summerbell, CD, Higgins, JP, Thompson, RL, Capps, NE, Smith, GD, Riemersma, RA & Ebrahim, S (2001) Dietary fat intake and prevention of cardiovascular disease. BMJ 322, 757–763.CrossRefGoogle ScholarPubMed
Jackson, SL, Golding, C, Greenwood, DC, Cade, JE & Hirst, SE (2002) Development of a new cut-off point to distinguish between high-fat and medium-fat consumers using the Dietary Instrument for Nutrition Education questionnaire. Proc Nutr Soc 61, 138A.Google Scholar
Janssen, JAMJL, Stolk, RP, Pols, HAP, Grobbee, DE & Lamberts, SWJ (1998) Serum total IGF-I, free IGF-I and IGFBP-1 levels in an elderly population. Arterioscler Thromb Vasc Biol 18, 277–282.CrossRefGoogle Scholar
Kaaks, R, Bellati, C, Venturelli, E, Rinaldi, S, Secreto, G, Biessy, C, Pala, V, Sieri, S & Berrino, F (2003) Effects of dietary intervention on IGF-I and IGF-binding proteins, and related alterations in sex steroid metabolism: the Diet and Androgens (DIANA) Randomised Trial. Eur J Clin Nutr 57, 1079–1088.CrossRefGoogle Scholar
Keenan, DP, Achterberg, C, Kris-Etherton, PM, AbuSabha, R, Von Eye, A (1996) Use of qualitative and quantitative methods to define behavioral fat-reduction strategies and their relationship to dietary fat reduction in the patterns of dietary change study. J Am Diet Assoc 96, 1245–1250 1253.CrossRefGoogle ScholarPubMed
Keys, A (1975) Coronary heart disease – the global picture. Atherosclerosis 22, 149–192.CrossRefGoogle ScholarPubMed
Kristal, AR, White, E, Shattuck, AL, Curry, S, Anderson, GL, Fowler, A & Urban, N (1992) Long-term maintenance of a low-fat diet: durability of fat-related dietary habits in the Women's Health Trial. J Am Diet Assoc 92, 553–559.CrossRefGoogle ScholarPubMed
Lawton, CL, Delargy, HJ, Smith, FC, Hamilton, V & Blundell, JE (1998) A medium-term intervention study on the impact of high- and low-fat snacks varying in sweetness and fat content: large shifts in daily fat intake but good compensation for daily energy intake. Br J Nutr 80, 49–61.CrossRefGoogle ScholarPubMed
Lloyd, HM, Paisley, CM & Mela, DJ (1995) Barriers to the adoption of reduced-fat diets in a UK population. J Am Diet Assoc 95, 316–322.CrossRefGoogle Scholar
Marckmann, P, Sandstrom, B & Jespersen, J (1994) Low-fat, high-fiber diet favorably affects several independent risk markers of ischemic heart disease: observations on blood lipids, coagulation, and fibrinolysis from a trial of middle-aged Danes. Am J Clin Nutr 59, 935–939.CrossRefGoogle ScholarPubMed
Matthews, DR, Hosker, JB, Rudenski, AS, Naylor, BA, Treacher, DF & Turner, RC (1985) Homeostasis model assessment: insulin resistance and beta cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412–419.CrossRefGoogle ScholarPubMed
Pao, CI, Farmer, PK, Begovic, S, Goldstein, S, Wu, GJ & Phillips, LS (1992) Expression of hepatic insulin-like growth factor-I and insulin-like growth factor binding protein-1 genes is transcriptionally regulated in streptozotocin-diabetic rats. Mol Endocrinol 6, 969–977.Google Scholar
Phillips, LS, Goldstein, S & Pao, CI (1991) Nutrition and somatomedin. XXVI. Molecular regulation of IGF-I by insulin in cultured rat hepatocytes. Diabetes 40, 1525–1530.CrossRefGoogle ScholarPubMed
Pirozzo, S, Summerbell, C, Cameron, C & Glasziou, P (2003) Should we recommend low fat diets for obesity? Obes Rev 4, 83–90.CrossRefGoogle ScholarPubMed
Rallidis, LS, Paschos, G, Liakos, GK, Velissaridou, AH, Anastasiadis, G & Zampelas, A (2003) Dietary alpha-linolenic acid decreases C-reactive protein, serum amyloid A and interleukin-6 in dyslipidaemic patients. Atherosclerosis 167, 237–242.CrossRefGoogle ScholarPubMed
Ridker, PM, Buring, JE, Cook, NR & Nader, Rifai N (2003) C-Reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation 107, 391–397.CrossRefGoogle Scholar
Ridker, PM, Hennekens, H, Buring, JE & Rifai, N (2000) C-reactive protein and other markers of inflammation in prediction of cardiovascular disease in women. Circulation 342, 836–843.Google Scholar
Roe, L, Strong, C, Whiteside, C, Neil, A & Mant, D (1994) Dietary intervention in primary care: validity of the DINE method for diet assessment. Fam Pract 11, 375–381.CrossRefGoogle ScholarPubMed
Sandhu, MS, Heald, AH, Gibson, JM, Cruickshank, JK, Dunger, DB & Wareham, NJ (2002) Circulating concentrations of insulin-like growth factor-I and development of glucose intolerance: a prospective observational study. Lancet 359, 1740–1745.CrossRefGoogle ScholarPubMed
Sever, PS, Dahlof, B & Poulter, NR et al. (2003) Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 361, 1149–1158.CrossRefGoogle ScholarPubMed
Shepherd, J, Cobbe, SM, Ford, I, Isles, CG, Lorimer, AR, MacFarlane, PW, McKillop, JH & Packard, CJ (1995) Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 333, 1301–1307.CrossRefGoogle ScholarPubMed
Stephenson, J & Imrie, J (1998) Why do we need randomised controlled trials to assess behavioural interventions? BMJ 316, 611–613.CrossRefGoogle ScholarPubMed
Vaessen, N, Heutink, P, Janssen, JA, Witteman, JC, Testers, L, Hofman, A, Lamberts, SW, Oostra, BA, Pols, HA & van Duijn, CM (2001) A polymorphism in the gene for IGF-I: functional properties and risk for type 2 diabetes and myocardial infarction. Diabetes 50, 637–642.CrossRefGoogle ScholarPubMed
Walker, KZ, O'Dea, K, Johnson, L, Sinclair, AJ, Piers, LS, Nicholson, GC & Muir, JG (1996) Body fat distribution and non-insulin-dependent diabetes: comparison of a fiber-rich, high-carbohydrate, low-fat (23%) diet and a 35% fat diet high in monounsaturated fat. Am J Clin Nutr 63, 254–260.CrossRefGoogle Scholar
Westwood, M, Gibson, JM, Davies, AJ, Young, RJ & White, A (1994) The phosphorylation pattern of insulin-like growth factor binding protein-1 in normal plasma is different from that in amniotic fluid and changes during pregnancy. J Clin Endocrinol Metab 79, 1735–1741.Google ScholarPubMed
White, E, Shattuck, AL, Kristal, AR, Urban, N, Prentice, RL, Henderson, MM, Insull, W Jr, Moskowitz, M, Goldman, S, Woods, MN (1992) Maintenance of a low-fat diet: follow-up of the Women's Health Trial. Cancer Epidemiol Biomarkers Prev 1, 315–323.Google ScholarPubMed
Wood, DA, Durrington, P, McInnes, G, Poulter, N, Rees, A & Wray, R (1998) Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 80, S1–S29.Google Scholar