The recommended diet plan by health regulatory bodies focuses on improving the health & lifestyle of the general population. Diet therapy can work effectively in high cholesterol patients in reducing the risk of cardiovascular disorders. However, people respond differently to the dietary modifications due to the difference in genetic makeup, compliance with the guidelines, or maybe lack of knowledge needed to make nutritional changes. Therefore, a study conducted to measure the compliance of patients to the recommended diet therapy, which included home-delivered meals, snacks, and telephonic diet education, is represented below. Reduction in low-density lipoprotein (LDL), cholesterol, and body weight were used as primary outcomes to measure the decreased risk of coronary heart disease. ^[1]

Thirty-five male and postmenopausal females with established CHD were enrolled from the great Boston area for the eight weeks dietary and lifestyle modification study. LifeSpring Nutrition, Inc funded the research and later approved by the Human Investigation Review Committee of New England Medical Center. Subjects suffering from diabetes, uncontrolled angina or hypertension, or another current, severe diseases were not part of the study. Twenty-one men and 14 women with a mean age of 62 years and mean BMI 31.5 kg/m2 continued to administer their medication dosages during the eight weeks. Out of them, 29 continued to take HMGCoA reductase for controlling cholesterol levels. ^[1]

The registered dietician instructed diet therapy on the telephone to the patients. The menu consisted of 67% carbohydrate, 16% protein, 17% fat, 4% saturated fat, 5% monounsaturated fat, 128 mg cholesterol, and 25 g fiber.^[1]

The outcomes of the study were measured using lipid profiles, anthropometric measures, food measures, adherence to the diet plan, and quality of life at a period of four weeks. Mean compliance calculated as a percentage of food energy consumed to the percentage of food energy found- was found to be 91% and 88% at four and eight weeks, respectively. The major changes observed after eight weeks of therapy were:

• Reduction in weight (-3.7 kg)
• Decreased waist circumference (-2.0 inches)
• Reduced hip circumference (-1.3 inches)
• Reduction in body mass index (-1.21 kg/m2)
• Decreased total cholesterol (-0.17 mmol/dL, -7.0 mg/dL)
• Reduced LDL cholesterol (-0.19 mmol/dL, -7.5 mg/dL)

High-density lipoprotein or triglycerides did not respond to significant changes with the therapy. Significant improvement in the quality of life was reported using this diet plan in patients with CHD. ^[1]

Nutrition labeling is an integral part of packaged food items, which is regulated by the Food Drug & Administration (FDA). The nutrition panel provided on the packet consisted of the following information:

• Serving size information
• Calorie information
• Percent daily value (calculated based on a 2000-calorie diet)
• Nutrition information
• A footnote comprising recommended daily value based on 2000- & 2500-calorie diet

Patients able to extract useful information from the nutrition labels are what expected by the dietician while recommending the low-carbohydrate food items. The healthcare regulation bodies such as the National Cholesterol Education Program and the American Heart Association recommend specific dietary guidelines on the label expecting patients can read them well off. ^[2]

The problem arises when people with low literacy rates and numeracy skills could not be able to calculate their intake nutrition value. The studies on the comprehension of food labels by the patients have been conducted to help FDA in improving nutrition labels. ^[2]

Method: The sample consisted of a wide variety of patients (18 to 80 years aged) from a primary care clinic. Non-English speaking or patients having vision & psychiatric disorders were excluded from the study. The tests used to measure the patients understanding are:

Questionnaire: To assess the patient’s behavior of nutrition label usage

Rapid Estimate of Adult Literacy in Medicine (REALM): To measure the health literacy of the patient.

Wide Range Achievement Test (WRAT-3): To measure the mathematical skills of the subjects

Nutrition Label Survey(NLS): To evaluate patients understanding of current labels

NLS consisted of 24 questions. The first 12 were an open-ended question where patients were asked to calculate the total carbohydrate or calorie content for the food items purchased from a local grocery store. The second 12 questions asked for determining which items consist of more nutrition value. Half of the survey questions included “low-carb” mentioned products.

The analysis of the data revealed a low comprehension of labels by the patients. It is expected from flat literacy rate patients to find difficulty in depicting the information, but highly educating subjects were also not able to read the label properly. Hence, the FDA needs to focus on making the food labels more user-friendly so that patients can adhere to the stated guidelines.^[2]

The following diet plan consists of the recommendations only for patients suffering from type 2 hyperlipoproteinemia. The therapy is not intended for ordinary people who wish to lose fats or lower down cholesterol levels. Moreover, it should be strictly followed under the recommendation of a doctor only. The meal suggestions focus on the two concepts:

A high P/S ratio: This can be obtained by consuming vegetable oils and margarine, having a high percentage of polyunsaturated fat, and restricting the use of saturated fats. Safflower oil, corn oil, or safflower margarine are unique items for providing polyunsaturated fat in the diet. Olives and peanuts do not significantly affect the P/S ratio; hence, they can be used in the dishes.

• Restrict the cooked meat to only a maximum of 9 ounces per day. It’s better to use fish and poultry without skin as it lowers the fat naturally.
• Restrict beef, lamb, ham, and pork to 3 ounces of the stated day limit. Consume the specified meat only three times per week
• Take 3 tsp of polyunsaturated fat for every 3 ounces of cooked meat.

Cholesterol consumption restricted to 300 milligrams per day: An average American takes 600 milligrams of cholesterol per day. Avoid consuming egg yolk or baked food prepared with egg yolk, shellfish, dairy products containing fat, butter & whole milk, and organ meats such as heart, brain, kidney, liver, and sweetbreads.^[3]

No limits to the use of polyunsaturated fats; use as you desire!

Buying and cooking meat, fish & poultry

Use fish and chicken in place of meat as often as possible. Choose the cuts which are lean, trimmed, and ground as they have more muscle than fat. Avoid the meats where fat is distributed throughout (marbled) and can not be removed.

Use conventional cooking methods, i.e., barbecuing, pan, and oven broiling, to cook meat, fish, or poultry. To drain the fat from roasted or baked chicken, it can be placed on a rack. Add the permitted vegetable oils in your dishes as per your taste.^[3]

Several studies have reported that adhering to the recommended dietary guidelines can significantly improve health, especially of CHD patients. Restrict the consumption of unsaturated fats and increase the intake of fibers helps in improving the cholesterol levels and hence reduces the risk of diseases attached to the high cholesterol. A dietary plan has been discussed above for the patients suffering from CHD, which promises the stated weight loss, reduced waist circumference, decreased bad cholesterol, and improved the quality of life. However, the plan is not recommended for diabetic patients or the ones suffering from vision and psychiatric disorders. Another problem faced by the majority of people is reading and extracting the useful information from the nutrition labels attached to the packaged items. The educated people were also not able to calculate the accurate carbohydrate and calories as per the studies, which recommends the FDA to focus more on the packaging. The labels should be more comfortable in the language, which can be understood by an ordinary person. After this, the article focused on the diet plan and meal suggestions for patients suffering from type 2 hyperlipoproteinemia

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