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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.

Recommended Intake as Percent of Total Calories
Nutrient* Step I Diet Step II Diet
Total Fat 30% or less 30% or less
Saturated 7-10% less than 7%
Polyunsaturated Up to 10% Up to 10%
Monounsaturated Up to 15% Up to 15%
Carbohydrate 55% or more 55% or more
Protein Approximately 15% Approximately 15%
Cholesterol Less than 300 mg per day Less than 200 mg per day
Total Calories To achieve and maintain desired weight To achieve and maintain desired weight
* Calories from alcohol not included.

What are recommended amounts of total fat and saturated fat in grams?

Calorie Level Total Fat Step I Diet
Saturated Fat
Step II Diet
Saturated Fat
  (grams) (grams) (grams)
1200 40 or less 9-13 less than 9
1500 50 or less 12-17 less than 12
1800 60 or less 14-20 less than 14
2000 67 or less 16-22 less than 16
2200 73 or less 17-24 less than 17
2500 83 or less 19-28 less than 19
3000 100 or less 23-33 less than 23

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:

  • overall healthy eating pattern
  • appropriate body weight
  • desirable cholesterol profile
  • desirable blood pressure

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:

  • high LDL cholesterol or other lipid disorders
  • coronary heart disease or other cardiovascular disease
  • diabetes mellitus and insulin resistance
  • congestive heart failure
  • kidney disease

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:

  • An Eating Plan for Healthy Americans... American Heart Association Diet
  • Understanding and Controlling Cholesterol
  • 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


Detailed Research

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



The American Heart Association has identified six key risk factors people can treat or modify to reduce their risk of a heart attack. Addressing these risk factors can have immediate benefits to your overall health and well being.
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