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  • 1.  

    Most evidence supports the notion that these dietary constituents adversely affect serum lipids and lipoprotein levels (Grundy and Denke, 1990; Kris-Etherton et al., 1988). However, additional mechanisms have also been proposed, since dietary saturated fat and cholesterol correlate with coronary disease incidence even after adjustment for serum cholesterol levels (Shekelle et al., 1981). Two mechanisms proposed have been the effect of dietary saturated fat on blood pressure (Puska et al., 1983) and the ability of high-fat diets to increase blood-clotting factors (Hornstra, 1990; Marckmann et al., 1993).

  • 2.  

    These organizations include the National Academy of Sciences/National Research Council (National Research Council, 1989), the U.S. Surgeon General (U.S. Department of Health and Human Services, 1988), the U.S. Department of Agriculture (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 1995), the American Heart Association, and the National Cholesterol Education Program (Carleton et al., 1991).

  • 3.  

    The present discussion of strategies assumes that both quantitative dietary changes (i.e., reduction in calories, fat, and cholesterol) and qualitative dietary changes (i.e., replacement with alternative foodstuffs that do not increase coronary risk) are needed.

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