Cardiovascular Disease Clinical Trial
Official title:
Milk Consumption and the Metabolic Syndrome in Menopausal Women
Cardiovascular disease (CVD) represents the first cause of mortality in industrialized
countries such as Canada and the United States. In that regard, it is being increasingly
recognized that a significant proportion of CVD events may be attributable to the presence
of a cluster of metabolic and physiological perturbations defined as the metabolic syndrome
(MetS). The National Cholesterol Education Program- Adult Treatment Panel III (NCEP-ATP III)
has recently proposed a clinical definition to identify individuals with the MetS. This
definition is based on the presence of at least three of the following five characteristics:
1- abdominal obesity, 2- hypertriglyceridemia, 3- reduced plasma HDL-C levels, 4- high blood
pressure, 5- high fasting blood glucose levels. Recent data have suggested that the MetS
based on this definition was associated with a 2 to 5 fold increase in the risk of CVD in
men as well as in women. These are alarming figures since it has been suggested that as much
as 35 to 45% of female aged > 65 years in the US may have the MetS. It is therefore
imperative to develop new preventive strategies that will be efficacious in attenuating the
impact of the MetS on the progressing rates of CVD in women. In that context, there is
accumulating evidence to suggest that milk and dairy products may beneficially modify
several components of the MetS. However, most of the available data to date are based on
observational studies or interventional studies with minimal nutritional control. Thus,
metabolically controlled studies that document the impact of milk consumption on
cardiovascular risk factors associated with the MetS in women defined a priori as having the
MetS are utterly lacking.
The purpose of this study was to investigate the impact of milk consumption on features of
the MetS in menopausal women presenting one or more features of the MetS.
The proposed research will be undertaken as a randomized, cross-over, nutritionally
controlled study, with participants being subjected to two 6-week isocaloric diets separated
by a 4-week washout period. No stratification was considered since the population recruited
will be relatively homogeneous. The experimental diet (designed as 'Milk') will be
formulated so that the percentage of daily calories from fat (30%), saturated fat (10%),
carbohydrates (55%) and proteins (15%) will conform to most of the dietary recommendations
of the American Heart Association and the NCEP for primary prevention of CVD, with the
exception of saturated fats (slight excess) and fibers (slight deficit). The cholesterol
content of the experimental diet will not exceed 200 mg/day. The only source of dairy
products during the experimental phase will be from 2% fat milk. We have chosen to use 2%
fat milk because this is the most frequently consumed dairy product in Canada. Two percent
fat milk also goes through minimal processing compared to milk or to other dairy products
such as yogurt and cheese. Thus, bioactive components in milk are more likely to be retained
in the 2% fat milk than in other more extensively processed products. The energy intake from
milk will represent 20% of the consumed kcal/day. Based on a reasonable 2000 kcal/day
regimen, a 20% intake attributable to 2% fat milk will correspond to 400 day/kcal, which
will be derived from a 'daily dose' of 3 portions of milk/day. This dose has been shown to
be effective in previous uncontrolled studies. The Control diet will be virtually identical
in terms of menus, calories and macronutrient composition, with the exception that milk will
be formally excluded from the regimen. The energy intake and changes in macronutrient
composition attributable to the milk component in the experimental diet will be compensated
in the control diet by modifying the protein, carbohydrate and lipid component of the
various recipes.
A 4-week stabilization run-in period will precede the randomization of participants. During
this run-in period, participants will be asked and instructed to comply to the NCEP-ATP III
prudent diet. They will be asked to maintain their body weight constant during this period.
Milk consumption will be adapted during this period to comply to the recommendations of
NCEP-ATP III. The washout period between the two experimental diets will last 4 weeks and
will also consist of NCEP-ATP III recommended diet. It must be stressed that foods will not
be provided during the run-in and wash-out periods. These periods are imposed to minimize
the inter- and intra-individual variability before and between the experimental phases.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Open Label, Primary Purpose: Prevention
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