Our dietary guidelines were revised in 2000 and built upon the Step I diet, emphasizing the importance of a diet low in saturated and trans-fat, and rich in fruits, vegetables, whole grains, fat-free and low-fat dairy products, and lean meat, fish and poultry. (In June 2006, we released new Dietary Recommendations.) 

History

The Step I and Step II diets were created by the National Heart, Lung, and Blood Association’s National Cholesterol Education Program (NCEP). The American Heart Association endorsed them. Both diets were designed to reduce risk of cardiovascular disease by reducing high blood cholesterol levels.

The Step I diet restricted total fat to no more than 30 percent of total calories, saturated fat to no more than 10 percent of total calories, and cholesterol to less than 300 mg/day.  It was intended as the starting point for patients who had high cholesterol levels.

The Step II diet goals were lower for saturated fat (less than 7 percent) and cholesterol (less than 200 mg/day).  They were intended for people already at the Step I goals or for patients with a high-risk cholesterol level (240 mg/dL or higher) or who had had a heart attack.

For people at high risk or who have known cardiovascular disease, we have adopted the Therapeutic Lifestyle Changes (TLC) diet. This is the “next generation” of the Step II diet recommended in May 2001. That's when the NCEP released new guidelines for cholesterol management in its Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]).  (For more information about this diet, see below.)

ATP III continues to recommend the Step I diet for the general public.

For people at higher risk, the new (TLC) dietary goals offer dietary therapy for subgroups of people with specific medical conditions and risk factors such as these:

• high LDL cholesterol or other lipid disorders
• coronary heart disease or other cardiovascular disease
• diabetes mellitus, insulin resistance or metabolic syndrome

In May 2001 the NCEP released new guidelines for cholesterol management.  These new guidelines are in the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]).  The American Heart Association accepted and endorsed this report and began incorporating these recommendations into its materials on dietary and lifestyle change for people with high blood cholesterol.

ATP III recommends that therapy for elevated cholesterol begin with more intensive life-habit intervention to lower cholesterol and reduce the risk for developing heart disease and having a heart attack. This approach is referred to as the “Therapeutic Lifestyle Changes (TLC)” diet. It’s targeted to people whose LDL cholesterol is above the goal level for their category of risk for heart disease. These are the essential components of TLC:

* Trans fatty acids also raise LDL and should be kept at a low intake.

1. The 25–35% fat recommendation allows for increased intake of unsaturated fat in place of carbohydrates in people with the metabolic syndrome or diabetes.
2. Carbohydrate should come mainly from foods rich in complex carbohydrates.  These include grains (especially whole grains), fruits and vegetables.
3. Daily energy expenditure should include at least moderate physical activity (contributing about 200 Kcal a day).
4. Options include adding 10–25 grams of viscous (soluble) fiber; 2 g/day of plant-derived sterols or stanols.  Soy protein may be used as a replacement for some animal products.

Related AHA publications:

• Easy Food Tips for Heart-Healthy Eating (also in Spanish)
• "How Can I Cook Healthfully?", "How Do I Follow a Low-Fat Diet?" and "How Can I Manage My Weight?" in Answers By Heart kit (also in Spanish kit)
• "What About Eating Out?", "How Do I Read Food Labels?", "How Do I Change Recipes?" and "Why Should I Lose Weight?" in Answers By Heart kit

Related AHA Scientific Statements
Diet/Nutrition