Lifestyle Changes: Effect of Diet, Exercise, Functional Food, and Obesity Treatment on Lipids and Lipoproteins

Abstract

The role of lipids and lipoproteins as risk factors for cardiovascular disease (CVD) is well established. Although CVD remains as the leading cause of mortality in adults, there is a decreasing trend in overall CVD mortality rate over the last two to three decades. This reduction in CVD mortality is largely driven by decreases in coronary heart disease mortality rate. Lifestyle changes remain the cornerstone of management of lipid and lipoprotein disorders and obesity, and are warranted in primary as well as secondary prevention settings. Lifestyle changes recommended for those with high cholesterol levels include adopting a diet low in saturated and trans fatty acids, incorporating functional foods rich in bioactive substances such as fiber, antioxidants, plant sterols and stanols, exercising regularly, and maintaining a healthy weight. Based on a large body of evidence, current dietary guidelines uniformly recommend reducing intakes of saturated and trans fatty acids with replacement by increasing intake of mono- and polyunsaturated fatty acids. Precision medicine options such as personal preferences regarding food choices and long-term dietary strategies are needed to improve the overall lipid profile. Given the complexity of the individual lifestyle choices, it is not surprising that a substantial heterogeneity regarding outcomes has been observed across studies, underscoring the challenge of accurately assessing effects of lifestyle changes, including diet- or physical activity-based interventions, on the lipid profile and cardiovascular risk. Many factors likely contribute to the variability in observations, including presence of substantial heterogeneity in study settings and designs, publication biases, issues related to self-reported measures of dietary intakes as well as adherence measurements to study diet. Further, there are a limited number of studies focused on certain types of diet or dietary composition including functional foods or exercise modality. Thus, while existing data offers some insights into fruitful interventions, there is a need to undertake well-designed, controlled, adequately powered, large-scale studies to bring more insights into the role of individual components of lifestyle changes in modifying cardiovascular risk factors and mortality. For complete coverage of all areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.