Which dietary modifications are used in the treatment of low HDL cholesterol (hypoalphalipoproteinemia)?

Updated: May 21, 2021
  • Author: Vibhuti N Singh, MD, MPH, FACC, FSCAI; Chief Editor: George T Griffing, MD  more...
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Diets that are very low in fat are associated with low high-density lipoprotein (HDL) cholesterol levels. However, because no data are available that show a reduction in the risk of coronary heart disease (CHD) upon raising HDL cholesterol levels, no particular dietary interventions are needed for this specific purpose. In fact, increasing the fat content of a patient's diet is not recommended. Dietary management should follow the NCEP guidelines for lowering frequently associated low-density lipoprotein (LDL) cholesterol, which is the primary target in lipid management [3, 4, 5, 6] ; lowering LDL levels has been demonstrated to reduce CHD morbidity and mortality in multiple randomized clinical trials.

  • The NCEP has recommended a therapeutic lifestyle-change diet, which should be incorporated in the treatment of all patients. The following are recommendations:

    • Patients should reduce their intake of saturated fats to less than 7% of their total calorie (energy) intake. Their cholesterol intake should be reduced to less than 200 mg/d. Trans fatty acids (the HDL-lowering, LDL-raising fats) should be kept to a minimum. Polyunsaturated fats should constitute up to 10% of total energy intake, and monounsaturated fats, up to 20% of total energy intake. Total fat intake, therefore, should be in the range of 25-35% of total energy intake.

    • Carbohydrates (complex carbohydrates from grains, whole grains, fruits, and vegetables) should constitute 50-60% of total energy intake.

    • Patients should consume 20-30 g/d of fiber.

    • The protein content should be approximately 15% of total energy intake.

    • In order to maintain a desirable body weight and to prevent weight gain, the total amount of energy consumed must be balanced in terms of energy intake and expenditure.

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