Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2005) / Chapter Skim
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9. Cholesterol
9. Cholesterol
Pages 542-588
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From page 542... ...
Therefore, neither an Adequate Intake nor a Recommended Dietary Allowance is set for cholesterol. There is much evidence to indicate a positive linear trend between cholesterol intake and low density lipoprotein cholesterol concentration, and therefore increased risk of coronary heart disease (CHD)
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From page 543... ...
cholesterol, but is also bound covalently to fatty acids as cholesteryl esters and to certain proteins. Free cholesterol is an integral component of cell membranes and serves as a precursor for steroid hormones such as estrogen, testosterone, and aldosterone, as well as bile acids.
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From page 544... ...
. The ability of very high intakes of plant sterols to lower plasma cholesterol concentrations by reducing cholesterol absorption may also involve regulation of this transport process (Miettinen and Gylling, 1999)
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From page 545... ...
However, as described below, empirical observations in humans have indicated that increased dietary cholesterol does result in a net increase in plasma LDL cholesterol concentrations, probably as a consequence of reduced hepatic LDL receptor activity. All cells are capable of synthesizing cholesterol in sufficient amounts for their structural and metabolic needs.
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From page 546... ...
(Huisman et al., 1996; Wong et al., 1993) , it is not surprising that plasma cholesterol concentrations are higher in infants fed human milk than in formula-fed infants.
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From page 547... ...
CHOLESTEROL 547 TABLE 9-1 Cholesterol Content in Term Human Milk of Women in the United States Reference n Stage of Lactation Cholesterol Content (mg/L) Picciano et al., 18 612 wk postpartum 1978 (pp)
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From page 548... ...
and in short-term studies with infants and children. Studies in baboons fed breast milk or formulas with or without cholesterol and with varying fat compositions found that early cholesterol intake had little effect on serum cholesterol concentrations in young adults up to about 8 years of age (Mott et al., 1990)
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From page 549... ...
. The available data do not warrant a recommendation with respect to dietary cholesterol intake for infants who are not fed human milk.
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From page 550... ...
550 DIETARY REFERENCE INTAKES TABLE 9-2 Effects of Adding Dietary Cholesterol to Defined Diets with Strict Control of Dietary Intake on Serum Cholesterol Concentration Baseline Dietary Added Dietary Cholesterol Cholesterol Reference n (mg/d)
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From page 551... ...
CHOLESTEROL 551 Change in Serum Total Percent of Cholesterol Calories from (mmol/L) Fat P:S Ratio 0.06 30 0.08 0.10 30 0.08 1.17 30 0.08 0.43 30 0.08 0.59 30 0.08 1.20 30 0.08 0.87 30 0.08 1.71 40 0.76 1.64 40 0.76 1.99 40 0.76 1.47 40 0.88 2.43 40 0.88 2.97 40 0.88 2.53 40 0.88 1.30 40 0.68 0.44 15 0.56 15 0.66 15 0.80 15 0.96 15 1.03 15 1.18 15 1.09 15 1.29 15 1.23 15 1.03 40 0.25 0.74 40 1.7 0.61 41 1.6 0.69 41 1.6 0.75 39 5.4 0.29 39 0.05 0.70 39 0.68 continued
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552 DIETARY REFERENCE INTAKES TABLE 9-2 Continued Baseline Dietary Added Dietary Cholesterol Cholesterol Reference n (mg/d)
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From page 553... ...
CHOLESTEROL 553 Change in Serum Total Percent of Cholesterol Calories from (mmol/L) Fat P:S Ratio 0.36 40 0.70 40 0.41 40 0.80 40 1.3 0.75 40 0.08 0.12 30 2.31 0.27 39 0.5 0.32 40 0.08 0.18 40 0.96 0.96 40 0.93 0.88 40 0.93 0.80 40 0.93 0.13 40 0.93 0.34 39 0.31 0.61 39 0.31 1.05 39 0.31 0.23 35 0.26 0.21 35 4.7 1.56 40 1.9 0.25 40 1.9 0.76 40 1.9 0.67 40 1.9 0.74 0.32 44 2 0.25 44 2 0.70 34 0.2 0.66 34 0.2 2.45 40 0.8 0.93 40 0.8 continued
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From page 554... ...
554 DIETARY REFERENCE INTAKES TABLE 9-2 Continued Baseline Dietary Added Dietary Cholesterol Cholesterol Reference n (mg/d)
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From page 555... ...
CHOLESTEROL 555 Change in Serum Total Percent of Cholesterol Calories from (mmol/L) Fat P:S Ratio 0.88 20 0.7 0.42 31 1 0.47 40 0.32 0.72 40 0.32 0.13 40 0.8 0.70 40 0.8 0.05 40 2.5 0.26 40 2.5 1.19 40 0.93 0.28 40 0.82 0.25 42 0.46 0.5 42 0.16 0.58 31 2.1 0.39 31 0.64 0.26 30 1.5 0.14 27 0.89 0.16 27 0.93 0.29 28 0.87 0.06 31 0.21 0.35 31 0.25 0.50 39 0.81 0.76 36 0.28 0.16 28 0.89 0.41 28 0.86
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From page 556... ...
556 DIETARY REFERENCE INTAKES TABLE 9-3 Effects of Adding Dietary Cholesterol to Self-Selected Diets with Strict Control of Dietary Intake on Serum Cholesterol Concentration Baseline Added Dietary Dietary Cholesterol Cholesterol Reference n (mg/d)
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From page 557... ...
CHOLESTEROL 557 Change in Serum Total Percent of Cholesterol Calories (mmol/L) from Fat P:S Ratio 0.09 0.05 40 0.16 38 0.03 38 0.49 38 0.00 38 0.75 41 0.62 41 0.40 40 1.47 38 0.17 0.48 46 0.5 0.61 46 0.5 0.27 35 0.62 0.13 26 0.8 0.12 35 0.6 0.16 35 1.45 0.13 35 0.27 0.02 41 0.37 0.04 36 0.85 0.06 29 0.6 0.19 29 0.6 0.36 29 0.6 continued
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From page 558... ...
and change in serum total cholesterol (TC) concentration.
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From page 559... ...
and change in serum cholesterol (TC) concentration.
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From page 560... ...
reported that the majority of the increase in serum total cholesterol concentration with increased cholesterol intake was due to an increase in LDL cholesterol concentration. The incremental serum cholesterol response to a given amount of dietary cholesterol appears to diminish as baseline serum cholesterol intake increases (Hopkins, 1992)
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From page 561... ...
points to the possibility that more common variants of these genes may contribute to variation in cholesterol absorption and dietary cholesterol response in the general population. There are numerous other candidate genes that could modulate plasma lipid and lipoprotein response to dietary cholesterol by affecting cholesterol absorption, cellular cholesterol homeostasis, and plasma lipoprotein metabolism.
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From page 562... ...
. More recently, in a study of 10,802 healthconscious men and women in the United Kingdom, a univariate relationship of cholesterol intake to ischemic heart disease mortality was observed (Mann et al., 1997)
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From page 563... ...
. The lack of consistency in observations relating dietary cholesterol intake to clinical cardiovascular disease and CHD endpoints may be due to many factors, including the limited ability to detect such effects (e.g., due to relatively small increases in LDL cholesterol concentration and inaccuracies in dietary intake data)
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From page 564... ...
564 DIETARY REFERENCE INTAKES TABLE 9-4 Dietary Cholesterol and Coronary Heart Disease (CHD) Reference Study Design Diet Information Kromhout and Men, 4059 y Dietary history de Lezenne 14 cases Coulander, 1984 857 controls Cohort, 10-y follow-up McGee et al., 1984 456 cases 24-h recall 6,632 controls Adjusted for age Cohort, 10-y follow-up Kushi et al., 1985 Men Dietary history 110 cases Adjusted for age 891 controls and cohort Cohort, 20-y follow-up McGee et al., 1985 8,006 men 24-h recall Cohort, 10-y Adjusted for age follow-up Posner et al., 1991 Men 4555 y 24-h recall Cohort, 16-y Multivariate follow-up analysis Tzonou et al., 1993 Men and women Dietary history 329 cases 570 controls Case-control Tell et al., 1994 Men and women, Food frequency 4564 y questionnaire Cohort Watts et al., 1994 50 men Dietary history 26 lipid-lowering diet 24 usual care Intervention
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From page 565... ...
RR of CHD intake and risk of CHD 300 1.0 529 0.99 Mean cholesterol intake (mg/d) No association between cholesterol Men Women intake and CHD Cases 345 322 Controls 350 292 Cholesterol intake was positively associated with carotid artery wall thickness Mean cholesterol intake (mg/d)
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From page 566... ...
566 DIETARY REFERENCE INTAKES TABLE 9-4 Continued Reference Study Design Diet Information Ascherio et al., Men 4075 y Food frequency 1996 734 cases questionnaire Cohort, 6-y Multivariate follow-up analysis (including fiber intake) Esrey et al., 1996 52 cases, 3059 y 24-h recall 3,873 controls Multivariate 40 cases, 6079 y analysis 581 controls Cohort, 12-y follow-up Hu et al., 1997 80,082 women, Food frequency 3459 y questionnaire Cohort, 14-y Multivariate follow-up analysis Mann et al., 1997 Men and women, Food frequency 1679 y questionnaire Prospective Adjusted for age, observation sex, smoking, and social class Pietinen et al., Smoking men, Food frequency 1997 5069 y questionnaire Cohort, 6.1-y Multivariate follow-up analysis
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From page 567... ...
Cholesterol intake was not Age (y) 3059 6079 significantly associated with CHD Cases 427 423 mortality Controls 416 355 Quintile of RR of A positive but nonsignificant cholesterol intake CHD association between cholesterol 1 1.00 intake and risk of CHD 2 1.19 3 1.14 4 1.32 5 1.25 Tertile of IHD death Increased IHD mortality with cholesterol intake rate ratio increased cholesterol intake 1st 100 2nd 181 3rd 353 Median cholesterol RR of coronary No association between cholesterol intake (mg/d)
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From page 568... ...
Cancer As shown in Tables 9-5 through 9-8, no consistent significant associations have been established between dietary cholesterol intake and cancer, including lung, breast, colon, and prostate. Several case-control studies have suggested that a high consumption of cholesterol may be associated with an increased risk of lung cancer (Alavanja et al., 1993; Byers et al., 1987; Goodman et al., 1988; Hinds et al., 1983; Jain et al., 1990)
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From page 569... ...
This effect of added cholesterol is highly variable among individuals and is considerably attenuated at higher baseline cholesterol intakes. The LDL cholesterol concentration increase would predict approximately a 1 to 2 percent increase in CHD, with possibly offsetting effects of increased HDL cholesterol concentration.
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From page 570... ...
570 DIETARY REFERENCE INTAKES TABLE 9-5 Dietary Cholesterol and Risk of Lung Cancer Reference Study Design Dietary and Other Information Hinds et al., Men Dietary history 1983 188 cases Adjusted for smoking, age, 294 controls ethnicity, and Case-control occupational exposure Heilbrun et al., Men 24-h recall 1984 109 cases Adjusted for age and 7,420 controls smoking Cohort, 15-y follow-up Byers et al., Men and women Food frequency 1987 450 cases questionnaire 902 controls Adjusted for age and Case-control smoking Goodman et al., Men and women Dietary history 1988 336 cases Adjusted for age, 865 controls ethnicity, and pack Case-control years of smoking Jain et al., Men and women Dietary history 1990 839 cases Adjusted for cumulative 772 controls cigarette smoking Case-control Knekt et al., Men Dietary history 1991 117 cases Adjusted for age, 4,421 controls smoking, and Cohort, 20-y energy intake follow-up
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From page 571... ...
1.0 1.0 Mean cholesterol Significant positive association intake (mg/d) Men Women between lung cancer risk Cases 385 249 and cholesterol intake in Controls 332 245 men, but not in women Quartile of OR for lung cancer cholesterol intake Men Women 1 (low)
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From page 572... ...
. Serum cholesterol concentrations increase with increased dietary cholesterol (Figures 9-1 and 9-2)
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From page 573... ...
There is much evidence to indicate a positive linear trend between cholesterol intake and low density lipoprotein cholesterol concentration, and therefore increased risk of coronary heart disease (CHD)
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From page 574... ...
Dietary guidance for minimizing cholesterol intake is provided in Chapter 11. RESEARCH RECOMMENDATIONS · Studies are needed to identify possible mechanisms whereby early nutritional experiences, such as dietary cholesterol, affect the atherosclerotic
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From page 575... ...
RR of breast cancer No association between < 130 1.00 cholesterol intake and 130233 1.33 risk of breast cancer 233415 0.79 > 415 0.70 Mean cholesterol intake (mg/d) RR of breast cancer No association between 204 1.00 cholesterol intake and 262 1.06 breast cancer 325 1.02 345 1.07 436 0.91 Quintile of cholesterol intake RR of breast cancer No association between 1 1.00 cholesterol intake and 2 0.84 risk of breast cancer 3 0.85 4 0.85 5 1.09 Cholesterol intake (mg/d)
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From page 576... ...
576 DIETARY REFERENCE INTAKES TABLE 9-7 Dietary Cholesterol and Risk of Colon Cancer Reference Study Design Dietary and Other Information Willett et al., Women Food frequency 1990 Cohort, 6-y questionnaire follow-up Adjusted for age and total energy intake Sandler et al., Men and women Food frequency 1993 236 cases questionnaire 409 controls Adjusted for age, Case-control alcohol intake, body mass index, and calories Giovannucci Men Food frequency et al., 1994 205 cases questionnaire Cohort, 6-y Adjusted for age and follow-up total energy intake Le Marchand 698 male case- Food frequency et al., 1997 control pairs questionnaire 494 female case- Multivariate analysis control pairs Case-control Pietinen et al., Male smokers Food frequency 1999 Cohort, 8-y questionnaire follow-up Multivariate analysis aRR = relative risk, OR = odds ratio.
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From page 577... ...
adenomas cholesterol intake and < 156 1.0 risk of colorectal 156189 0.78 adenomas 190227 0.73 228289 0.89 > 289 0.99 Quintile/median No association between cholesterol intake (mg/d) RR of colon cancer cholesterol intake and 1/198 1.0 risk of colon cancer 2/262 1.27 3/313 0.99 4/369 1.07 5/467 1.07 Quartile of cholesterol OR for colorectal cancer Cholesterol intake intake from eggs Men Women (limited to cholesterol 1 (low)
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From page 578... ...
that contribute to the wide interindividual variation in LDL cholesterol response to dietary cholesterol also need to be delineated. · Studies are needed to better define the relation between dietary cholesterol intakes and LDL cholesterol concentrations over a broad range of cholesterol intakes, from very low to high.
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From page 579... ...
in cholesterol intake Cases 341 between prostate Controls 351 cancer cases andcontrols Tertile of cholesterol intake OR for prostate cancer No significant association 1 1.00 between cholesterol 2 0.97 intake and risk of 3 0.60 prostate cancer Anderson JT, Grande F, Keys A
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From page 580... ...
1972. Prospective study of serum cholesterol levels during first year of life.
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From page 581... ...
1992. Rela tion of infant feeding to adult serum cholesterol concentration and death from ischaemic heart disease.
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From page 582... ...
1997. Dietary fat intake and the risk of coronary heart disease in women.
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From page 583... ...
2000. Egg consumption and coronary heart disease: An epidemiologic overview.
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1995. Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: The Seven Countries Study.
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1992. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease.
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From page 586... ...
1997. Intake of fatty acids and risk of coronary heart disease in a cohort of Finnish men.
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From page 587... ...
1999. Associations of fat and cholesterol intake with serum lipid levels and cardio vascular disease: The EURODIAB IDDM Complications Study.
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From page 588... ...
1963. Egg yolk and serum-cholesterol levels: Impor tance of dietary cholesterol intake.
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