Published Online
on July 7, 2003

A more recent version of this article appeared on July 15, 2003

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Submitted on February 10, 2003
Revised on April 10, 2003
Accepted on April 11, 2003

Inflammation Modifies the Effects of a Reduced-Fat Low-Cholesterol Diet on Lipids. Results From the DASH-Sodium Trial

Thomas P. Erlinger MD, MPH^*, Edgar R. Miller III MD, PhD, Jeanne Charleston RN, and Lawrence J. Appel MD, MPH

From the Department of Medicine, the Johns Hopkins University School of Medicine (T.P.E., E.R.M., L.J.A.), and the Department of Epidemiology (T.P.E., E.R.M., J.C., L.J.A.) and International Health (L.J.A.), the Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.

^* To whom correspondence should be addressed. E-mail: terlinge{at}jhmi.edu.

Background--Inflammatory mediators regulate key aspects of lipid metabolism. We hypothesized that inflammation could diminish the cholesterol-lowering effect of a reduced-fat/low-cholesterol diet.

Methods and Results--After a 2-week run-in period on a control diet (37% total fat, 16% saturated fat), 100 participants were randomized to the control or DASH diet (27% total fat, 6% saturated fat) for 12 weeks. Median C-reactive protein (CRP) at baseline was 2.37 mg/L (interquartile range, 1.20, 3.79). The DASH diet, net of control, had no effect on CRP. Overall, there were significant net reductions in total (-0.34 mmol/L), LDL (-0.29 mmol/L), and HDL (-0.12 mmol/L) cholesterol from the DASH diet (each, P<0.001) and little change in triglycerides (+0.05 mmol/L, P=0.21). Baseline CRP was strongly associated with lipid responsiveness to the DASH diet. Total and LDL cholesterol were reduced to a greater degree in those with a "low" (below median) compared with a "high" (above median) baseline CRP (total, -9.8% versus -3%; P for interaction=0.006; LDL cholesterol, -11.8% versus -3%; P for interaction=0.009). Reductions in HDL cholesterol (-8.8%) were similar in persons with low versus high CRP. Triglycerides were increased in those with a high CRP but not in those with a low CRP (19.8% versus +0%; P for interaction=0.019).

Conclusions--In this study, the presence of increased CRP was associated with less total and LDL cholesterol reduction and a greater increase in triglycerides from a reduced-fat/low-cholesterol diet. These findings document an additional mechanism by which inflammation might increase cardiovascular disease risk.

Key words: inflammation • lipids • cholesterol • diet

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