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A very-low-fat diet is not associated with improved lipoprotein profiles in men with a predominance of large, low-density lipoproteins^1,2,3

Background: We found previously that men with a predominance of large LDL particles (phenotype A) consuming high-fat diets (40–46% fat) show less lipoprotein benefits of low-fat diets (20–24% fat) than do men with a high-risk lipoprotein profile characterized by a predominance of small LDL (phenotype B). Furthermore, one-third of men with phenotype A consuming a high-fat diet converted to phenotype B with a low-fat diet.

Objective: We investigated effects of further reduction in dietary fat in men with persistence of LDL subclass phenotype A during both high- and low-fat diets.

Design: Thirty-eight men who had shown phenotype A after 4–6 wk of both high- and low-fat diets consumed for 10 d a 10%-fat diet (2.7% saturates) with replacement of fat with carbohydrate and no change in cholesterol content or ratio of polyunsaturates to saturates.

Results: In 26 men, phenotype A persisted (stable A group) whereas 12 converted to phenotype B (change group). LDL cholesterol did not differ from previous values for 20–24%-fat diets in either group, whereas in the change group there were higher concentrations of triacylglycerol and apolipoprotein B; greater mass of HDL, large LDL-I, small LDL-III and LDL-IV, and HDL₃; lower concentrations of HDL cholesterol, apolipoprotein A-I; and lower mass of large LDL-I and HDL₂.

Conclusions: There is no apparent lipoprotein benefit of reduction in dietary fat from 20–24% to 10% in men with large LDL particles: LDL-cholesterol concentration was not reduced, and in a subset of subjects there was a shift to small LDL along with increased triacylglycerol and reduced HDL-cholesterol concentrations.

Key Words: Lipoproteins • low-fat diet • LDL subclasses • HDL • men • coronary artery disease • LDL phenotype

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