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Total cholesterol and HDL cholesterol did not show any specific change. However, HDL cholesterol particle size and LDL size increased slightly. The effect of this diet on particle size is of interest, but the number of study patients is small, and possible variation in the diet and diet compliance are unclear. Long-term follow-up and larger numbers of patients are needed for more definitive information. Of note, plasma homocysteine concentrations and C-reactive protein increased in the short-duration study. The 1 long-term study comparing the Atkins diet with various low-fat diets for 1 year showed that with the Atkins diet, homocysteine concentrations, C-reactive protein, and lipoprotein(a) all increased. 5 This study also showed that with a high-fat diet, LDL cholesterol and TG levels increased, HDL levels decreased, and the cholesterol-to-HDL ratio became abnormal, all suggesting that this diet may have important long-term limitations.
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