Novel insights into the pathological mechanisms of metabolic related dyslipidemia

Relationship between systemic biomarker of lipid peroxidation 4-hydroxynonenal and lipidomic profile of morbidly obese patients undergoing bariatric surgery

Obesity is characterized by fat accumulation, impaired metabolism and oxidative stress, frequently associated with lipid peroxidation and generation of bioactive 4-hydroxynonenal (4-HNE). This study aimed to evaluate the impact of bariatric surgery-induced weight loss on lipid peroxidation and associated perturbations in lipid profile. Plasma samples of twenty obese individuals before and 6 months after bariatric surgery were collected in addition to samples of ten healthy controls. HILIC-LC-MS/MS platform was used to characterize phospholipid profile, while lipid peroxidation markers 15-F2t-IsoP, 10-F4t-NeuroP and reactive aldehyde 4-HNE were quantified by RP-LC-MS/MS and GC-MS, respectively. Six months post-surgery lipid peroxidation markers decreased significantly and the BMI of morbidly obese patients decreased by 13 on average. Lipidomics analysis, identified 117 phospholipid species from seven classes, and showed obesity-associated lipidome perturbations, particularly in ether-linked phosphatidylethanolamines (PEo). A total of 45 lipid species were found to be significantly altered with obesity, while 10 lipid species correlated with lipid peroxidation markers. Sample pairwise analyses indicated an interesting link between 4-HNE and the amount of two PEos, PEo (38:2) and PEo (36:2). The results indicate that weight loss-induced improvement of redox homeostasis together with changes in lipid metabolites may serve as markers of metabolic improvement. However, further studies are needed to understand the role of obesity-induced oxidative stress on ether lipid biosynthesis and lipidome perturbations, as well as the impact of bariatric surgery on metabolic improvement.

Helicobacter pylori infection increases the risk of dyslipidemia in Chinese diabetic Population: a retrospective cross-sectional study

BACKGROUND

In contemporary times, increased prevalence of Helicobacter pylori (H. pylori) infection and elevated dyslipidemia levels present substantial public health challenges. However, the relationship between H. pylori and dyslipidemia remains inconclusive. No studies have yet conducted a population-based classification to investigate the impact of H. pylori infection on dyslipidemia in individuals with diabetes.

METHODS

A retrospective cohort study was carried out on a total of 60,535 individuals who underwent health check-ups at the Health Examination Center in Taizhou Hospital from 2017 to 2022. Physical measurements, hematological markers and detection of H. pylori were gathered from all patients. The study population was further stratified into diabetic and non-diabetic groups for analysis.

RESULTS

H. pylori infection was found to be an autonomous risk factor for dyslipidemia based on the results of multivariate logistic regression analysis (OR = 1.13, 95% CI: 1.03-1.24). However, no notable effect on dyslipidemia in the non-diabetic group was observed. Furthermore, at the follow-up, the group with persistent negative showed a significantly lower incidence ratio of dyslipidemia compared to the group with persistent infection (P = 0.006). The persistent negative group exhibited a significantly higher rate of improvement in dyslipidemia compared to the new infection group (P = 0.038).

CONCLUSIONS

In the diabetic population, the presence of H. pylori infection heightens the propensity for developing dyslipidemia. Therefore, the implementation of efficient eradication strategies for H. pylori infection could potentially lead to a decrease in the occurrence of dyslipidemia among individuals with diabetes.

Association between blood lipid levels and the risk of liver cancer: a systematic review and meta-analysis

PURPOSE

The association between blood lipid levels and the risk of developing liver cancer remains a subject of ongoing debate. To elucidate this association, we conducted a meta-analysis by systematically incorporating data from all relevant prospective cohort studies.

METHODS

We conducted a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases covering studies published from database inception through July 2023. This study included prospective cohort studies related to lipid profiles (e.g., total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels) that reported hazard ratios (HRs) or relative risks (RRs) with corresponding 95% confidence intervals (95% CIs) to investigate their association with the risk of liver cancer. During the analysis process, we used fixed-effects or random-effects models based on the level of heterogeneity among the studies and obtained pooled risk ratios using these models. To ensure the robustness and reliability of the study findings, we also conducted sensitivity analyses and publication bias analyses.

RESULTS

After conducting a systematic search, 12 studies were identified from a total of 11,904 articles and were included in the meta-analysis. These studies included a combined population of 10,765,221 participants, among whom 31,055 cases of liver cancer were reported. The analysis revealed that the pooled HR for the serum TC concentration (highest versus lowest) was 0.45 (95% CI = 0.35-0.58, I2 = 78%). For TGs, the HR was 0.67 (95% CI = 0.46-0.96, I2 = 86%), while for HDL-C, the HR was 0.72 (95% CI = 0.58-0.90, I2 = 65%). The HR for LDL-C was 0.51 (95% CI = 0.23-1.13, I2 = 93%).

CONCLUSION

The findings of this study indicate that serum TC, TG, and HDL-C levels are negatively associated with liver cancer risk, suggesting that higher concentrations of these lipids are associated with a reduced risk of liver cancer. However, no significant association has been found between LDL-C levels and liver cancer risk.

Associations between "Cancer Risk", "Inflammation" and "Metabolic Syndrome": A Scoping Review

BACKGROUND

Individuals with metabolic syndrome exhibit simultaneously pro-thrombotic and pro-inflammatory conditions which more probably can lead to cardiovascular diseases progression, type 2 diabetes mellitus, and some types of cancer. The present scoping review is aimed at highlighting the association between cancer risk, inflammation, and metabolic syndrome.

METHODS

A search strategy was performed, mixing keywords and MeSH terms, such as "Cancer Risk", "Inflammation", "Metabolic Syndrome", "Oncogenesis", and "Oxidative Stress", and matching them through Boolean operators. A total of 20 manuscripts were screened for the present study. Among the selected papers, we identified some associations with breast cancer, colorectal cancer, esophageal adenocarcinoma, hepatocellular carcinoma (HCC), and cancer in general.

CONCLUSIONS

Cancer and its related progression may also depend also on a latent chronic inflammatory condition associated with other concomitant conditions, including type 2 diabetes mellitus, metabolic syndrome, and obesity. Therefore, prevention may potentially help individuals to protect themselves from cancer.

In-hospital and mid-term follow-up of low-density lipoprotein cholesterol and target-goal attainment among patients with acute cerebral infarction: a retrospective study

OBJECTIVE

To investigate the baseline and six-month follow-up data of the main lipid indices as well as low-density lipoprotein cholesterol (LDL-C) target goal attainment in accordance with the current guidelines among patients with acute cerebral infarction (ACI).

METHODS

One thousand ninety-nine patients were consecutively enrolled from January 2021 to December 2022 and divided into ACI, old cerebral infarction (OCI), and control groups. General data [sex, age, body mass index (BMI), medications, smoking status, disease history, etc.], baseline data, and six-month follow-up main laboratory data were collected and analyzed. ACI patients were grouped into dyslipidemia and normal groups according to the lipid management guidelines of the European, American, and Chinese populations. Statistical methods were used to screen for possible predictors of dyslipidemia.

RESULTS

Patients with ACI or OCI had higher total cholesterol (TC) and LDL-C levels than did the control group (all P < 0.05). According to European (94.7%, 89.0% and 13.4%, P < 0.01), American (94.7% vs. 67.7% vs. 45.9%, P < 0.001) and Chinese (85.1% vs. 59.1% vs. 18.6%, P < 0.001) standards, the proportion of dyslipidemia in the ACI group was greater than that in the OCI and control groups. According to European and American standards, increases in BMI and the estimated glomerular filtration rate (eGFR) are predictors of dyslipidemia in ACI patients. According to Chinese standards, increases in BMI, glycated hemoglobin (HbA1c) levels, and eGFRs are independent predictors of dyslipidemia in ACI patients. The 6-month follow-up of the main lipid levels revealed that among the ACI group, TC, LDL-C and triglyceride(TG) levels (4.86 vs. 3.79, P < 0.001; 2.98 vs. 2.01, P < 0.001; 1.46 vs. 1.20, P < 0.001) and the proportion of dyslipidemia decreased significantly in accordance with European/American and Chinese standards (86.8% vs. 64.6%, P = 0.015; 97.2% vs. 84.7%, P = 0.012).

CONCLUSION

These results revealed that lipid management is still not optimal for patients with ACI. More attention should be given to ACI patients with elevated BMI, eGFR, and HbA1c values, which could lead to more individualized lipid management. Although the main lipid levels decreased significantly 6 months after discharge with lipid-lowering therapy, there is still a long way to go to enable more ACI patients to meet the guideline-recommended LDL-C target goal.

Plasma lipid metabolites as potential biomarkers for identifying individuals at risk of obesity-induced metabolic complications

Lipidomics studies have indicated an association between obesity and lipid metabolism dysfunction. This study aimed to evaluate and compare cardiometabolic risk factors, and the lipidomic profile in adults and older people. A cross-sectional study was conducted with 72 individuals, divided into two sex and age-matched groups: obese (body mass index-BMI ≥ 30 kg/m2; n = 36) and non-obese (BMI < 30 kg/m2; n = 36). The lipidomic profiles were evaluated in plasma using 1H nuclear magnetic resonance (1H-NMR) spectroscopy. Obese individuals had higher waist circumference (p < 0.001), visceral adiposity index (p = 0.029), homeostatic model assessment insulin resistance (HOMA-IR) (p = 0.010), and triacylglycerols (TAG) levels (p = 0.018). 1H-NMR analysis identified higher amounts of saturated lipid metabolite fragments, lower levels of unsaturated lipids, and some phosphatidylcholine species in the obese group. Two powerful machine learning (ML) models-k-nearest neighbors (kNN) and XGBoost (XGB) were employed to characterize the lipidomic profile of obese individuals. The results revealed metabolic alterations associated with obesity in the NMR signals. The models achieved high accuracy of 86% and 81%, respectively. The feature importance analysis identified signal at 1.50-1.60 ppm (-CO-CH2-CH2-, Cholesterol and fatty acid in TAG, Phospholipids) to have the highest importance in the two models.

Lipidome, central carbon metabolites, and sleep rhythm in coronary heart disease with nontraditional risks: An exploratory pilot study

Aims

Altered lipid, energy metabolism and sleep disorders had been linked with coronary heart disease (CHD), however, the metabolic signatures and sleep rhythm in non-obstructive coronary atherosclerosis-CHD remain unclear. This pilot study aims to investigate the lipidome and central carbon metabolites profiles and associated sleep characteristics among CHD patients without traditional risk factors.

Methods

From January to July 2021, 15 CHD patients and 15 healthy controls were randomly selected from the cardiology unit of Zhongshan Hospital, Shanghai. A total of 464 lipids and 45 central carbon metabolites (CCM) were quantified in blood plasma. Metabolic signatures were selected through orthogonal projections to latent structures discriminant analysis (OPLS-DA) and principal component analysis (PCA) was conducted to link the profiles of identified metabolites with CHD risk, sleep patterns, cardiometabolic traits and cardiac electrophysiologic parameters.

Results

Using OPLS-DA, we identified 40 metabolites (variable influence on projection >1) that were altered in CHD patients, with 38 lipids, including 25 triacylglycerols (TAGs), 8 diacylglycerols (DAGs), being elevated and two CCM metabolites (i.e., succinic acid and glycolic acid) being reduced. Using PCA, four principal components (PCs) were identified and associated with increased risk of CHD. Specifically, one standard unit increasement in the PC that was characterized by high levels of DAG (18:1) and low succinic acid and the PC that was characterized by high levels of two sphingomyelins [SM (26:0) and SM (24:0)] was associated with 21% [odds ratio (OR) = 1.21, 95% CI: 1.02,1.43] and 14% (OR = 1.14,1.02,1.29) increased risk of CHD, respectively. Further regression analyses confirmed that the identified metabolites and the four PCs were positively associated with TG and ALT. Interestingly, glycolic acid was negatively associated with sleep quality and PSQI. Participants with night sleep mode tended to have a high level of the identified lipids, especially FFA (20:4).

Conclusion

In the present pilot study, our findings provide clues on alterations of lipid and energy metabolism in CHD patients without traditional risk factors, with multiple triacylglycerols and diacylglycerols metabolites seemingly elevated and certain nonlipids metabolites (e.g., succinic acid and glycolic acid) decreased in cases. Considering the limit sample size, further studies are warranted to confirm our results.

Twelve-Week Safety and Potential Lipid Control Efficacy of Coffee Cherry Pulp Juice Concentrate in Healthy Volunteers

Coffee cherry pulp, a major waste product from coffee manufacturing, contains polyphenols with antioxidant activity. However, its clinical safety and health benefits are unclear. This randomized, double-blinded, placebo-controlled trial evaluated the safety and potential efficacy of coffee cherry pulp juice concentrate. A total of 61 participants were randomly divided into a study group (n = 30), receiving the juice, and a control group (n = 31), receiving a placebo drink of 14 g twice daily for 12 weeks. Adverse symptoms, changes in body weight, hematological and biochemical parameters, vital signs, and heart function were evaluated using subject diaries, interviews, blood and urine tests, and electrocardiograms. The results showed no intervention-related adverse events. Body weight, liver, renal function, complete blood counts, blood glucose, urinalysis, and electrocardiograms were not significantly altered throughout the study. Consuming the juice for at least 8 weeks significantly decreased cholesterol and LDL levels. The glucose levels were maintained significantly better than those of the placebo group. The findings suggest that continuously consuming 28 g/day of coffee pulp juice concentrate for 12 weeks is safe in healthy volunteers. Future studies could employ a dose of ≤28 g/day to investigate the efficacy of this novel food, especially for preventing dyslipidemia and diabetes.

The tangled web of dyslipidemia and cancer: Is there any association?

Cancer is a primary cause of mortality around the world and imposes a significant physiological, psychological, and financial burden on patients. Lipids regulate cell cycle progression and affect cell proliferation, migration, and apoptosis. Therefore, alterations in serum lipid levels might contribute to carcinogenesis. In this article, we review the relationships between triglyceride (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels and different types of cancer. Then, we examine the association between cancer and familial hypercholesterolemia. Finally, we evaluate the impact of statins on different types of cancer. Increased total cholesterol has been reported to increase cellular proliferation and angiogenesis in tumors and inhibit apoptosis. Increased LDL-C has been reported to induce inflammation and increase susceptibility to oxidative damage. HDL-C has anti-oxidation, anti-inflammatory, and antiproliferative properties. Increased levels of serum TG can induce oxidative stress and a chronic inflammatory state and therefore contribute to the proliferation and progression of cancer cells. Statins decrease downstream products of cholesterol synthesis that are crucial in cell proliferation and growth. Thus, lipid components can have prognostic value in cancer and management of serum lipid levels through lifestyle changes and medical therapy can be beneficial in cancer prevention and treatment.

High-normal liver enzyme levels in early pregnancy predispose the risk of gestational hypertension and preeclampsia: A prospective cohort study

Background

Gestational hypertension (GH) and preeclampsia (PE) are severe adverse gestational complications. Previous studies supported potential link between elevated liver enzyme levels and GH and PE. However, given the transient physiological reduction of liver enzyme levels in pregnancy, little is known whether the associations of the high-normal liver enzyme levels in early pregnancy with GH and PE exist in pregnant women.

Methods

Pregnant women in this study came from a sub-cohort of Shanghai Preconception Cohort, who were with four liver enzyme levels examined at 9–13 gestational weeks and without established liver diseases, hypertension and preeclampsia. After exclusion of pregnant women with clinically-abnormal liver enzyme levels in the current pregnancy, associations of liver enzyme levels, including alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT), with GH and PE status were assessed by multivariable log-binomial regression. Population attributable fraction was measured to estimate the fractions of GH and PE that were attributable to the high-normal liver enzyme levels.

Results

Among 5,685 pregnant women 160 (2.8%) and 244 (4.3%) developed GH and PE, respectively. After adjustment for potential covariates, higher ALP, ALT and GGT levels were significantly associated with the risk of GH (adjusted risk ratio (aRR):1.21 [95% confidence interval, 1.05–1.38]; 1.21 [1.05–1.38]; and 1.23 [1.09–1.39]), as well as the risk of PE(1.21 [1.13–1.29]; 1.15 [1.03–1.28]; 1.28 [1.16–1.41]), respectively. The cumulative population attributable fraction of carrying one or more high-normal liver enzyme levels (at 80th percentile or over) was 31.4% for GH and 23.2% for PE, respectively.

Conclusion

Higher ALT, ALP and GGT levels within the normal range in early pregnancy are associated with increased risk of GH and PE. The documented associations provide new insight to the role of hepatobiliary function in GH and PE pathogenesis.

Effects of exercise training in hypoxia versus normoxia on fat-reducing in overweight and/or obese adults: A systematic review and meta-analysis of randomized clinical trials

Objective: Fat loss theory under various oxygen conditions has been disputed, and relevant systematic review studies are limited. This study is a systematic review and meta-analysis to assess whether hypoxic exercise training (HET) leads to superior fat-reducing compared with normoxic exercise training (NET).

Methods: We searched PubMed, Web of Science, CNKI, ProQuest, Google Scholar, Cochrane Library, and EBSCOhost from inception to June 2022 for articles comparing the effects of hypoxic and normoxic exercise on body composition indicators, glycometabolism, and lipometabolism indicators in obese and overweight adults. Only randomized controlled trials (RCTs) were included. The effect sizes were expressed as standardized mean difference (SMD) and 95% confidence intervals (CI). Between-study heterogeneity was examined using the I² test and evaluated publication bias via Egger’s regression test. The risk of bias assessment was performed for each included trial using Cochrane Evaluation Tool second generation. The meta-analysis was performed by using R 4.1.3 and RevMan 5.3 analytic tools.

Results: A total of 19 RCTs with 444 subjects were analyzed according to the inclusion and exclusion criteria. Among them, there were 14 English literature and five Chinese literature. No significant difference in body composition (SMD -0.10, 95% CI -0.20 to -0.01), glycometabolism and lipid metabolism (SMD -0.01, 95% CI -0.13 to -0.10) has been observed when comparing the HET and NET groups. We only found low heterogeneity among trials assessing glycometabolism and lipometabolism (I² = 20%, p = 0.09), and no publication bias was detected.

Conclusion: The effects of HET and NET on fat loss in overweight or obese people are the same. The application and promotion of HET for fat reduction need further exploration.

IL-38 in modulating hyperlipidemia and its related cardiovascular diseases

Hyperlipidemia is confirmed to be associated with several health problems that include the combination of diabetes mellitus, obesity, and hypertension, ie, metabolic syndrome. Although the lipid-lowering therapy is an effective treatment in hyperlipidemia and its related cardiovascular diseases (CVDs), the persistence of high atherosclerotic risk is notable which could not be simply explained as a phenomenon of hyperlipidemia. Concerning on this notion, it is imperative to identify novel biomarkers which could monitor treatment and predict adverse cardiovascular events. It is demonstrated that the chronic inflammatory response caused by immune cells is a characteristic of hyperlipidemia and atherosclerosis. Notably, among several inflammatory related cytokines, interleukin 38 (IL-38), as a member of the IL-1 family, plays an important role in anti-inflammatory response by binding with its receptor which inhibits the downstream signaling pathways. In addition, IL-38 suppresses the expression of inflammatory factors mainly through the mitogen-activated protein kinase (MAPK). At the cellular level, IL-38 could inhibit the CD4 positive T lymphocyte into T-helper 17 (Th-17) lymphocyte which further enhances the immunosuppressive activity of the T-regulatory lymphocyte (T-reg) to inhibit the inflammatory response. Consistently, IL-38 is shown to be strongly correlated to development of hyperlipidemic related CVDs. In this review, the roles of IL-38 in the development of hyperlipidemia are fully summarized. Furthermore, a theoretical basis for further in-depth research of IL-38 for treatment of hyperlipidemia is also provided.

Effects of Body Mass Index, Waist Circumference, Waist-to-Height Ratio and Their Changes on Risks of Dyslipidemia among Chinese Adults: The Guizhou Population Health Cohort Study

This study aimed to assess the effects of different anthropometric indices and their changes on the risk of incident dyslipidemia among the Chinese population. From the Guizhou population health cohort study, 2989 Chinese adults without dyslipidemia at baseline were followed up. Anthropometric parameters including waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), and their changes in the latter two indices, and serum lipids were tested after at least 8 h fasting. Hazard ratio (HR), adjusted hazard ratio (aHR), and 95% confidential interval (CI) were calculated to estimate the association between anthropometric parameters and dyslipidemia risk using multivariate Cox regression. A total of 2089 (69.98%) new dyslipidemia cases were identified over an average follow-up of 7.0 years. Baseline BMI (aHR = 1.12, 95%CI 1.01, 1.23) and WHtR (aHR = 1.06, 95%CI 1.00, 1.13) were positively associated with higher risks of incident dyslipidemia but not WC. Each 5.0 kg/m² increment of BMI or 0.05-unit increment of WHtR was significantly associated with 43% or 25% increased risk of incident dyslipidemia, respectively. The aHRs (95%CI) of incident dyslipidemia for subjects maintaining or developing general obesity were 2.19 (1.53, 3.12) or 1.46 (1.22, 1.75), and 1.54 (1.23, 1.82) or 1.30 (1.06, 1.60) for subjects maintaining or developing abdominal obesity, respectively. Linear trends for aHRs of BMI, WHtR change, and BMI change were observed (p for trend: 0.021, <0.001, <0.001, respectively). BMI, WHtR, and their changes were closely associated with the incidence of dyslipidemia for Chinese adults. Loss in BMI and WHtR had protective effects on incident dyslipidemia, whereas gain of BMI or WHtR increased the dyslipidemia risk. Interventions to control or reduce BMI and WHtR to the normal range are important for the early prevention of dyslipidemia, especially for participants aged 40 years or above, male participants, and urban residents with poor control of obesity.