Step I and Step II Diets
AHA Scientific Position
The American Heart Association and the National Cholesterol Education Program developed the Step I and Step II diets to treat high blood cholesterol, or hypercholesterolemia (hi"per-ko-les"ter-ol-E'me-ah). The main aim is to lower LDL ("bad") cholesterol to reduce the risk of coronary heart disease, which causes heart attack. The guidelines help patients sets goals for reducing saturated fat and cholesterol in their diet. At the same time, they promote good nutrition. The composition of these diets is shown below.
What are recommended amounts of total fat and saturated fat in grams?
What are the differences between the American Heart Association Diet, the Step I and Step II Diets?
The initial dietary recommendations for patients on Step I are similar to those the American Heart Association advocates for the public. The only difference is that Step I is carried out in a medical setting. For those patients who haven't reduced their fat and cholesterol intake before treatment, Step I is a starting point. For those already at the Step I goals, the Step II diet goals are even lower for saturated fat and cholesterol. Also, patients with a high-risk cholesterol level (240 mg/dL and higher) or who've had a heart attack should start with the Step II diet goals. These dietary changes should be carried out along with regular physical activity in all patients and weight reduction in those who are overweight.
We updated our dietary guidelines in October 2000 and dropped the "Step I" and "Step II" designations. However, the revised guidelines retain the principles of the Step I and Step II diets. They put more emphasis on foods than on percentages of food components, such as fat. New major guidelines offer goals for the general population in these four areas:
The guidelines also consider the special needs of children and older people. Please see "Dietary Guidelines for Healthy American Adults" and "Dietary Guidelines for Healthy Children" in this Guide for more information.
For people at higher risk, the new dietary goals are similar to those formerly called "Step II." The guidelines offer dietary therapy for subgroups of people with specific medical conditions and risk factors such as these:
The NCEP further modified its dietary recommendations in the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel 3), released in May 2001.
Related AHA publications:
Summary of the Third Report of the NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), (on NHLBI Web site) | AHA Scientific Statement: AHA Dietary Guidelines: Revision 2000, #71-0193 Circulation. 2000;102:2284-2299; Stroke. 2000;31:2751-2766 | AHA Conference Proceedings: Summary of the Scientific Conference on Dietary Fatty Acids and Cardiovascular Health, #71-0200 Circulation. 2001;103:1034-1039
AHA Scientific Statements:
AHA Dietary Guidelines: Revision 2000
Fatty Acids Conference Summary
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