The effect of a lipid-lowering diet on plasma lipids and lipoproteins in mildly hypercholesterolaemic subjects: a potential role for occasional treats

The aim of the study was to compare the effect of a lipid-lowering diet containing chocolate confectionery with an equivalent diet that is chocolate-free. In a parallel design trial, 42 free-living subjects (19 men and 23 women), aged 46.9 yr, mildly hypercholesterolemic (6.9 mmol/L) were allocated to an American Heart Association/National Cholesterol Education Program Step 1 diet that included chocolate confectionery or an identical regimen containing no chocolate. Blood samples for the analysis of plasma lipids were obtained initially, then at 6 and 12 weeks after dietary therapy. Both groups of subjects showed a trend toward a reduction in saturated fat, with those allowed chocolate reaching borderline significance (P < 0.057). Plasma cholesterol and low density lipoprotein cholesterol concentrations were significantly lower (P < 0.03) whereas plasma triacylglycerol was significantly higher (P < 0.02) in the control group compared with the chocolate group. High density lipoprotein cholesterol was reduced in both groups. Subgroup analysis on patients with the apo E3/E3 phenotype showed that the response was identical between the control and chocolate groups. The inclusion of a modest amount of chocolate confectionery did not detract from the response of a lipid-lowering diet.