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Does Dietary Cholesterol Matter?

Current Atherosclerosis Reports volume 18, Article number: 68 (2016) Cite this article

Abstract

An ongoing dispute in the nutrition field is whether dietary cholesterol contributes significantly to elevated serum cholesterol and to atherosclerotic disease. Carefully controlled metabolic studies have shown that high-cholesterol intakes cause moderate increases in serum cholesterol levels. It is been difficult to verify this in population studies because of confounding factors. Nonetheless, meta-analysis of controlled studies documents a cholesterol-raising action of dietary cholesterol. Most of this effect occurs in low-density lipoproteins (LDLs), but the cholesterol content of other lipoproteins can be increased as well. Moreover, population studies strongly suggest that dietary cholesterol is atherogenic beyond any rise in LDL concentrations. It must be emphasized that dietary cholesterol is only one of several dietary factors influencing serum cholesterol levels. Others include saturated fatty acids, trans fatty acids, soluble fiber, and total caloric intake. To achieve substantial serum cholesterol lowering, favorable changes in all of these factors must be combined. To maximize cardiovascular risk reduction, a lifetime of a healthy diet is needed. Reduced cholesterol intake is only one of several factors required to achieve such a diet. In addition, reduction of cholesterol absorption can enhance serum cholesterol lowering. This can be attained by the addition of plant sterols or plant stanols to the diet or by use of ezetimibe, a cholesterol absorption blocker. By combining dietary cholesterol reduction with other cholesterol-lowering modalities, it should be possible to substantially reduce atherosclerosis throughout life short of using cholesterol-lowering drugs that act systemically.

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Affiliations

  1. Center for Human Nutrition and Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9052, USA

    Scott M. Grundy

  2. Veterans Affairs Medical Center, 4500 S. Lancaster Road, Dallas, TX, 75216, USA

    Scott M. Grundy

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  1. Scott M. Grundy
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Correspondence to Scott M. Grundy.

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Grundy, S.M. Does Dietary Cholesterol Matter?. Curr Atheroscler Rep 18, 68 (2016). https://doi.org/10.1007/s11883-016-0615-0

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  • DOI: https://doi.org/10.1007/s11883-016-0615-0

Keywords

  • Dietary cholesterol
  • Cholesterol absorption
  • Eggs
  • Low-density lipoproteins
  • Plant sterols
  • Plant stanols
  • Ezetimibe