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viii CHAPTER 1. GENERAL INTRODUCTION I Dissertation organization 2 References 3 CHAPTER 2. LITERATURE REVIEW 4 Part I. Primary prevention of atherosclerosis in young adults using dietary interventions 4 Prevalence of atherosclerosis and associated diseases in the United States 4 Importance of early prevention of atherosclerosis 4 Onset of atherosclerosis in adolescence 5 Atherosclerosis is difficult to reverse 6 Hypercholesterolemia a major risk factor of atherosclerosis 7 Role of hypercholesterolemia in the pathogenesis of atherosclerosis 8 Dietary approaches to lower cholesterol in the general population 11 Phytosterols effective cholesterol-lowering agents 12 Evidence of phytosterol effectiveness in lowering serum cholesterol 12 Plant sterols and stanols: structure, dietary intakes, and absorption 13 Hypocholesterolemic mechanism of phytosterols 16 Potential adverse effects of phytosterol consumption 18 Research directions 19 References 19 Part n. Primary prevention of obesity in young adults using educational interventions 26 Prevalence of overweight and obesity in the United States 26 Weight change patterns in adulthood 28 Health and economic consequences of obesity 30 Obesity treatment: success and limitations 33 Dietary interventions 34 Pharmacotherapy 35 Obesity prevention: success and limitations 37 Evidence of the nutrition knowledge-behavior association 39 Nutrition education is a cornerstone of prevention interventions 40 Nutrition education: definition, goals, and research directions 41 Fundamentals of nutrition education 41 Determinants of the information quality 42 Selecting a target audience for primary prevention of obesity 43 Receiver input 43

Primary prevention of atherosclerosis and obesity in young adults using dietary and educational interventions