The effect of dietary cholesterol on plasma cholesterol levels has been an area of considerable debate. In 1972, the American Heart Association recommended that dietary cholesterol intake should average less than 300mgperday as part of a 'heart-healthy,' plasma cholesterol-lowering diet. Since that initial recommendation, a number of other public health dietary recommendations in the United States have endorsed the 300 mg daily limit. Interestingly, few dietary recommendations from other countries contain a dietary cholesterol limitation. The evidence for a relationship between dietary cholesterol and plasma cholesterol indicates that the effect is relatively small, and that on average a change of 100 mg per day in dietary cholesterol intake results in a 0.057 mmoll-1 (2.2mgdl-1) change in plasma cholesterol concentrations. Studies have also shown that the majority of individuals are resistant to the plasma cholesterol-raising effects of dietary cholesterol 'nonresponders' and have less than the predicted response. In contrast, a segment of the population (estimated to be between 15 and 25%) is sensitive to dietary cholesterol 'responders' and exhibits a greater than expected plasma cholesterol response to a change in dietary cholesterol intake. To date, there are no defined physiological or clinical characteristics to differentiate responders from nonre-sponders, but studies suggest that the apoE phenotype plays a role, as does the clinical condition of combined hyperlipidemia. Data also suggest that sensitivity to dietary cholesterol is associated with sensitivity to dietary fat, and that overall adiposity may also play a role. Although on a population basis the plasma cholesterol response to dietary cholesterol is relatively small, and in most epidemiological analyses not related to hypercholesterolemia, some individuals are sensitive to dietary cholesterol changes and, if hypercholester-olemic, would experience plasma cholesterol reduction with dietary cholesterol restrictions. For the majority, however, dietary cholesterol restrictions have little effect on plasma cholesterol levels.
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