This paper reviews epidemiological studies on the relationship between diet and high density lipoproteins (HDL), with emphasis on the authors' studies of boys and men from different countries and with different dietary habits. Sera were collected from boys (ages 7 to 9 years) and men (ages 33 to 48 years) in 20 countries, and these were analyzed in one standardized laboratory. In boys, total and HDL cholesterol changed in parallel, from low values in populations in developing countries with lowfat, high-carbohydrate diets to high values in affluent populations. The correlation between HDL and total cholesterol was 0.90 (n = 16 populations). A similar trend was seen in groups of vegetarian and omnivorous boys within one region. Detailed analyses of individual diets of boys in five countries showed a negative relation between carbohydrate intake and HDL cholesterol both for group means (r= −0.99, n = 5) and for individual boys within one country (r= −0.26 to 0.04, n = 109 to 133 boys per country). In these boys, differences in obesity and physical activity were slight, and unrelated to differences in HDL. Total cholesterol rose with saturated fat intake (r= 0.87 for five population means; r= 0.07 to 0.26 within population groups). In adult men, total and HDL cholesterol also tended to rise simultaneously with affluence. However, the relation was much weaker (r= 0.60, n = 13 population groups). In adult men, body mass index was negatively related to the ratio of HDL to total cholesterol both between and within countries and also between and within groups of omnivorous and vegetarian men within one region. We suggest that three partly opposing dietary factors determine an adult population's total cholesterol/HDL cholesterol ratio; namely, the proportion of energy from saturated fat, which raises total cholesterol; the proportion of energy from total fat, which raises HDL cholesterol; and the excess in dietary energy, which produces obesity and in that way lowers HDL cholesterol.
Arteriosclerosis – Wolters Kluwer Health
Published: Nov 1, 1987