Hypercholesterolemia, the presence of high levels of cholesterol in the blood, is one of the major risk factor for cardiovascular disease (CVD). Plasma cholesterol level is the result of intestinal cholesterol absorption and hepatic cholesterol synthesis, also biliary excretion and cellular use (Lecerf and Lorgeril, 2011). Lipoprotein is a compound found in the bloodstream containing a core of lipids with a shell composed of protein, phospholipid, and cholesterol. A normal lipoprotein profile is a total cholesterol level less than 200 mg/dl, LDL cholesterol less than 130 mg/dl, HDL cholesterol is more than 40 mg/dl and triglyceride level less than 150 mg/dl (NCEP-ATP III, 2001).
For decades, dietary cholesterol is believed as one of the major risk factors that contribute to the cardiovascular diseases. Previously, in Dietary Guidelines for Americans (DGA) 2010, dietary cholesterol was limited to less than 300 mg per day. The same amount is also adopted in Indonesia (BPOM, 2016) until today. However, in the latest Dietary Guidelines for Americans 2015-2020, dietary cholesterol is no longer included in the list of specific foods that should be limited. The added sugars, sodium, saturated fats and trans fats remain on the list of food components that should be reduced. Generally, foods that are higher in dietary cholesterol are also higher in saturated fats. But there are also some foods that are higher in cholesterol but not in saturated fats, such as egg yolk, shrimps, brains and liver (Almatsier, 2007). According to the latest recommendation, this kind of foods can be consumed without any specific restriction. However, not all countries have implemented the same recommendation in their dietary guidelines (FAO, 2017). This exclusion of dietary cholesterol is also not yet applied in Indonesia.
There have been numerous researches conducted about cholesterol, but only limited studies related to the association between dietary cholesterol and plasma cholesterol. Most of the intervention studies used eggs as the dietary source of cholesterol. According to a review study done by Zulkarnain (2018), so far no strong scientific evidence support the association between dietary cholesterol intake with high level of plasma cholesterol (hypercholesterolemia). However, the new recommendation from USDA about the exclusion of dietary cholesterol from the specific food restriction should be carefully considered before being implemented in other countries. Some people clearly are more hyper-responsive to dietary cholesterol than others. Furthermore, need to educate the society about the source of food containing dietary cholesterol with low saturated fats and trans fat, because a lot of food that contain high cholesterol also contain high saturated fats and trans fats. Foods that contains high cholesterol but low saturated fat could be broad field for intervention studies to see the effect of dietary cholesterol in plasma cholesterol level. More extensive studies on hyper-responders, the systematic review and meta-analyses to determine the association between dietary cholesterol and plasma cholesterol level are still needed for future research especially for the local population, before the exclusion of dietary cholesterol from the specific food restrictions is ready to be implemented in other countries, particularly in Indonesia.
(This article also has been published in The 1st Conference Technology on Biosciences and Social Sciences 2016)
Almatsier, S. 2007. Editor. Penuntun Diet Instalasi Gizi RS Cipto Mangunkusumo dan Asosiasi Dietisien Indonesia. PT. Gramedia Pustaka Utama. Jakarta.
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