Effect of low and high fat diets on nutrient intakes and selected cardiovascular risk factors in sedentary men and women

Effects of Dietary Supplementation with Mulberry Leaf Powder on the Growth Performance, Lipid Metabolism Parameters, Immunity Indicators, and Gut Microbiota of Dogs

Overfeeding and a lack of exercise are increasingly causing obesity in dogs, which has become a big problem threatening the health of dogs. Therefore, it is necessary to investigate how dietary regulations can help to improve dogs' body conditions and minimize obesity. This study was carried out to investigate the effects of dietary mulberry leaf powder (MLP) supplementation on the growth performance, lipid metabolism parameters, and gut microbiota of Chinese indigenous dogs. Fifteen Chinese indigenous dogs (6.34 ± 0.56 kg) were randomly assigned to three treatment groups and received either the control diet (CON), high-fat diet (HF), or high-fat diet containing 6% Mulberry leaf powder (MLP) for four weeks. The CON group received a basal diet, the HF group received a basal diet supplemented with 10% lard, and the MLP group received a basal diet supplemented with 10% lard and 6% MLP. The trial lasted for four weeks. The growth performance, lipid metabolism parameters, immune globulins, cytokines, and fecal microbiota were measured. Results showed that there was no significant difference in growth performance. The MLP group appeared to have decreased (p < 0.05) the serum level of low-density lipoprotein cholesterol (LDL-C) and apoliprotein-A1(APO-A1) in serum. The MLP group appeared to have higher (p < 0.05) serum immune globulin A (IgA) levels. UPGMA results showed that the MLP group was closer to the CON group than to the HF group. LEfSe analysis showed that dietary supplementation with MLP contributed to an alteration in the genus Alloprevotella, Sarcina, and species belonging to the Bacteroides and Lactobacillus genus. Overall, the dietary supplementation of 6% MLP can improve lipid metabolism conditions and immunity in high-fat-diet-fed dogs, and can alter the gut microbial composition of dogs.

Effect of ketogenic diet versus regular diet on voice quality of patients with Parkinson's disease

Diets that have effects on health problems can vary in their composition. Whilst following a regular diet (RD) a person typically consumes about 30% of calories from fat. Ketogenic diet (KD) is a form of diet whereby a person consumes as much as 90% of calories from fat. KD has been trialed as a treatment for neurological diseases and obesity. Parkinson's disease (PD) is a neurologic disease that impacts the quality of voice. Voice Handicap Index (VHI) is a test that gives information to clinical and physiological assessment about voice. We assessed the impact of KD and RD on voice quality (VQ). Seventy-four patients with PD who reported a voice disorder related to their disease were randomly assigned to the KD or RD groups. We investigated the VHI change of subjects before and 3 months after diet. Sixty-eight PD patients completed the study. Baseline VHI values did not differ significantly between groups. All mean VHI parameters improved in KD group (p˂ 0.001). Currently there are different therapies that address speech and voice disorders in patients with PD. As such KD may be an alternative therapy to improve VQ of patients with PD. A larger sample size is necessary to determine the role and pathophysiology of KD on VQ of PD patients.

Physical Activity and Nutritional Influence on Immune Function: An Important Strategy to Improve Immunity and Health Status

Physical activity (PA) and nutrition are the essential components of a healthy lifestyle, as they can influence energy balance, promote functional ability of various systems and improve immunity. Infections and their associated symptoms are the common and frequent challenges to human health that are causing severe economic and social consequences around the world. During aging, human immune system undergoes dramatic aging-related changes/dysfunctions known as immunosenescence. Clinically, immunosenescence refers to the gradual deterioration of immune system that increases exposure to infections, and reduces vaccine efficacy. Such phenomenon is linked to impaired immune responses that lead to dysfunction of multiple organs, while lack of physical activity, progressive loss of muscle mass, and concomitant decline in muscle strength facilitate immunosenescence and inflammation. In the present review, we have discussed the role of nutrition and PA, which can boost the immune system alone and synergistically. Evidence suggests that long-term PA is beneficial in improving immune system and preventing various infections. We have further discussed several nutritional strategies for improving the immune system. Unfortunately, the available evidence shows conflicting results. In terms of interaction with food intake, PA does not tend to increase energy intake during a short time course. However, overcoming nutritional deficiencies appears to be the most practical recommendation. Through the balanced nutritious diet intake one can fulfill the bodily requirement of optimal nutrition that significantly impacts the immune system. Supplementation of a single nutrient as food is generally not advisable. Rather incorporating various fruits and vegetables, whole grains, proteins and probiotics may ensure adequate nutrient intake. Therefore, multi-nutrient supplements may benefit people having deficiency in spite of sufficient diet. Along with PA, supplementation of probiotics, bovine colostrum, plant-derived products and functional foods may provide additional benefits in improving the immune system.

Dietary Intake during 56 Weeks of a Low-Fat Diet for Lomitapide Treatment in Japanese Patients with Homozygous Familial Hypercholesterolemia

AIM

Lomitapide is an oral inhibitor of the microsomal triglyceride transfer protein used to treat homozygous familial hypercholesterolemia (HoFH); patients require a low-fat diet to minimize gastrointestinal adverse effects and dietary supplements to prevent nutrient deficiencies. We investigated the diet and nutritional status during lomitapide treatment.

METHODS

Japanese patients with HoFH, who were in a phase 3 trial of lomitapide, were instructed to start low-fat diets with supplements of vitamin E and essential fatty acids 6 weeks before starting lomitapide treatment. Dietary education was conducted by registered dietitians 16 times during the study period, which included a pre-treatment run-in phase (Weeks －6-0), a lomitapide treatment efficacy phase (Weeks 0-26) and a safety phase (Weeks 26-56). Two-day dietary records were collected at each dietary counseling session. Anthropometric and biochemical parameters were measured at Weeks 0, 26 and 56.

RESULTS

Eight patients completed the 56 weeks of lomitapide treatment. Their median energy intakes derived from lipids were 19.2% and 17.9% during the efficacy and safety phases, respectively. "Fats and oils" intakes, and "Fatty meat and poultry" intakes in two patients, were successfully reduced to achieve low-fat diets. Although intakes of energy, fatty acids and fat-soluble vitamins did not differ significantly among phases, body weight, serum fatty acid levels and vitamin E concentrations were decreased at Week 26 as compared with Week 0.

CONCLUSION

HoFH patients can adhere to low-fat diets with ongoing dietary counseling. Instructions about intakes of energy, fatty acids and fat-soluble vitamins, as well as periodic evaluations of nutritional status, are necessary.

Weight loss program is associated with decrease α-tocopherol status in obese adults

BACKGROUND & AIMS

Studies on changes in plasma α-tocopherol levels during body fat reduction in obese persons are not clear. The aim of the present study was to assess factors associated with α-tocopherol status in obese people and to examine changes in α-tocopherol status after a 6-week AntioxObesity weight loss program.

METHODS

The study was conducted in 60 overweight or obese adults, aged 18-54 years old. Food intake data were collected using the 3-day record method and a semi-quantitative food-frequency questionnaire. Anthropometric measurements included: height (H), body weight, waist circumference (WC) and hip circumference (HC), body composition: fat mass (FM) and fat-free mass (FFM), subcutaneous fat (SF) and visceral fat (VF). Lipid profile, α-tocopherol concentration, glutathione peroxidase (GPx) activity, total antioxidant capacity (TAC) in plasma and superoxide dismutase (SOD) activity in erythrocytes were determined.

RESULTS

Energy, fat, and carbohydrate intakes decreased significantly in all subjects (P < 0.001). Body weight, WC, body mass index (BMI), waist-to height ratio (WHtR), and FM, VF and SF decreased significantly during the 6 weeks in all subjects. Plasma α-tocopherol significantly decreased during the program (P = 0.006). No changes were observed for SOD activity, but GPx activity and TAC decreased significantly (P = 0.001; P = 0,023, respectively). Plasma α-tocopherol concentration after 6 weeks of the AntioxObesity program was strongly associated with baseline plasma α-tocopherol, changes in TC, VF and FM. Low α-tocopherol status (<20 μmol/L) was found in 78% of the women and 68% of the men, after 6 weeks of the AntioxObesity program. Men were characterized by a greater decrease in weight, BMI, WC, FM, VF, SF and TAC compared to women.

CONCLUSIONS

A 6-week weight loss program lowered α-tocopherol status in overweight and obese people. Low baseline α-tocopherol status and adiposity in obese adults negatively affected α-tocopherol status after 6 weeks weight loss program. These results, coupled with excessive weight and low α-tocopherol intake, led to the finding that there was an increased risk of oxidative stress diseases in adults on a reduced diet. Long-term dietary restriction program for obese patients should be monitored to avoid α-tocopherol deficiency, and take into account higher dietary α-tocopherol requirements for obese people.

A perspective on vegetarian dietary patterns and risk of metabolic syndrome

The vegetarian dietary pattern is traditionally a plant-based diet that includes fruits, vegetables, cereals, legumes, nuts, vegetable oils, soya, and possibly dairy products and/or eggs. Vegetarians and other populations who follow a plant-based dietary pattern enjoy longevity. Specifically, vegetarian dietary patterns have been associated with a lower risk for developing IHD, type 2 diabetes, hypertension, specific cancers, lower all-cause mortality and reduction in cause-specific mortality. The prevalence of the metabolic syndrome (MetS) in the USA is approximately 20 % and is currently increasing in developing countries in line with the obesity epidemic. The health care costs associated with the MetS are on a magnitude of 1.6 overall compared with healthy individuals, which makes it an important public health problem. Current evidence from several cross-sectional and case-control studies shows an association between consumption of a vegetarian dietary pattern and a reduced prevalence or risk of developing the MetS. There is a need for further research to be conducted, particularly prospective cohort studies to evaluate the effect of vegetarian dietary patterns on reducing the incidence of the MetS and, clinical trials should be designed to explore vegetarian dietary patterns for the reversal of the MetS in high-risk populations. This research could contribute to reduce the societal and economic burdens associated with the disorder.

Vegetarian diet and cholesterol and TAG levels by gender

OBJECTIVE

The present study assessed the effects of vegetarian and omnivorous diets on HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), TAG and the ratio of HDL-C to total cholesterol (TC) by gender.

DESIGN

HDL-C, LDL-C, TAG and HDL-C:TC were compared among three diet groups (vegan, ovo-lacto vegetarian and omnivorous). Multivariate linear regression analysis was performed to examine factors significantly and independently associated with vegetarian status and to estimate the β value of lipid profiles for the diet groups. Settings A cross-sectional study. Data were obtained from the Taiwanese Survey on the Prevalence of Hyperglycemia, Hyperlipidemia and Hypertension (TwSHHH).

SUBJECTS

The study comprised included 3257 men and 3551 women.

RESULTS

After adjusting for confounders, vegan and ovo-lacto vegetarian diets lowered LDL-C levels (β=-10.98, P=0.005 and β=-7.12, P=0.025, respectively) in men compared with omnivorous diet. There was a significant association between HDL-C and vegan diet (β=-6.53, P=0.004). In females, the β values of HDL-C, TAG and HDL-C:TC were -5.72 (P<0.0001), 16.51 (P=0.011) and -0.02 (P=0.012) for vegan diet, and -4.86 (P=0.002), 15.09 (P=0.008) and -0.01 (P=0.026) for ovo-lacto vegetarian diet, when compared with omnivorous diet.

CONCLUSIONS

Vegan diet was associated with lower HDL-C concentrations in both males and females. Because the ovo-lacto vegetarian diet was effective in lowering LDL-C, it may be more appropriate for males.

Impact of health counselling on cardiovascular disease risk in middle aged men: influence of socioeconomic status

BACKGROUND

The inverse association between socioeconomic status and cardiovascular disease is well documented. We examined whether the impact of health counselling on cardiovascular risk factors in middle-aged men differed according to socioeconomic status.

METHODS

We used data from a community based study assessing the risk for cardiovascular disease among middle-aged men in Helsinki, Finland. Traditional cardiovascular disease risk factors were measured and cardiovascular disease risk was assessed by a modified risk tool used in the North Karelia project (CVD Risk Score). Those men with increased risk for cardiovascular disease at their baseline visit in 2006 received lifestyle counselling. After two years these high-risk men were invited to a follow-up visit. The same measurements and risk assessments were repeated.

RESULTS

Based on the CVD Risk Score there were significant differences between the groups at baseline (p = 0.001) and at follow-up (p<0.001) with the highest scores in the lowest educational group. There were no significant differences in traditional cardiovascular risk factors according to educational attainment between groups either at baseline or at follow-up. Baseline lifestyle characteristics differed between the groups regarding use of soft fat (p = 0.019). All groups responded positively to lifestyle counselling.

CONCLUSIONS

The present study showed that lifestyle counselling is feasible in high-risk middle-aged men and lifestyle intervention works in all educational groups. Interestingly the traditional risk factors did not show improvement, but the risk score improved. From a practical point of view our findings stress the importance of using risk score calculators in health counselling instead of looking at individual cardiovascular disease risk factors.

Different dietary strategies for weight loss in obesity: role of energy and macronutrient content

Obesity is a chronic disorder caused by an imbalance of the energy metabolism with high associated burdens. Therefore, huge efforts are being currently devoted in studying new types of hypoenergetic diets and their composition, in order to characterise more specific, long-lasting and safe slimming protocols. A number of investigations are trying to determine the specific influence of the macronutrient distribution in energy-restricted diets on the management of excessive body weight. In this context, very-low-energy diets supplying between 1670 and 3350 kJ (400 and 800 kcal)/d have been beneficial in short-term treatments causing a weight loss of 300-500 g/d. Such strategies place more emphasis on energy restriction than on the macronutrient composition of the diet prescription. Weight loss produced by either low-carbohydrate or low-fat moderately energy-restricted diets ranges from 0.5 to 1.0 kg/week, while diets with high or moderately high protein content have also been applied in weight-reducing programmes by inducing losses of 0.2-0.4 kg/week. Other factors that determine weight loss by dieting are sex, age, initial body weight, race, genetics, regional fat deposition, etc, which must be taken into account to explain the variability in the outcomes of different low-energy diets. Therefore, more research is needed about the impact of diets with different fuel substrates and foods on the characteristics of the weight-loss process.

Residual cardiovascular risk despite optimal LDL cholesterol reduction with statins: the evidence, etiology, and therapeutic challenges

This review captures the existence, cause, and treatment challenges of residual cardiovascular risk (CVR) after aggressive low-density lipoprotein cholesterol (LDL-C) reduction. Scientific evidence implicates low high-density lipoprotein cholesterol (HDL-C) and high triglycerides (TG) in the CVR observed after LDL-C lowering. However, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) lipid trial with fenofibrate, the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE) study with torcetrapib, and the recently terminated Atherothrombosis Intervention in Metabolic Syndrome with Low HDL Cholesterol/High Triglyceride and Impact on Global Health Outcomes (AIM-HIGH) study with niacin, do not clearly attribute risk reduction value to HDL-C/TG modulation. The optimum approach to long-term lipid-modifying therapies for CVR reduction remains uncertain. Consequently, absolute risk modulation via lifestyle changes remains the centerpiece of a strategy addressing the physiologic drivers of CVR associated with HDL-C/TG, especially in the context of diabetes/metabolic syndrome.

High-density lipoprotein therapy: is there hope?

OPINION STATEMENT

The treatment of lipid abnormalities generally has focused on low-density lipoprotein cholesterol (LDL-C) reduction based on extensive clinical trials and the National Cholesterol Education Program Adult Treatment Panel III guidelines. Unfortunately, it has become increasingly clear that a significant percentage of patients continue to have cardiovascular events despite being on LDL-C-lowering medications and having LDL-C levels below 100 mg/dL. Numerous epidemiologic studies have associated low high-density lipoprotein cholesterol (HDL-C) levels with increased risk of cardiovascular disease (CVD). Furthermore, recent data show that up to 55% of patients hospitalized for CVD have low HDL-C levels (<40 mg/dL) on admission, suggesting a possible target for further reducing CVD. Low HDL-C also is part of the atherogenic phenotype associated with obesity, glucose intolerance, and hypertension, termed the metabolic syndrome, and often is seen in patients with insulin resistance states. In general, the first line of therapy for increasing HDL-C in patients with levels below 40 mg/dL is lifestyle modification with smoking cessation, exercise, weight loss, and diet modifications. The pharmacologic treatment of isolated low HDL-C in patients without coronary disease is controversial but should be considered in those with a strong family history of CVD. In patients with coronary artery disease and isolated low HDL-C, statins remain the first-line therapy and should be instituted after lifestyle modifications, with the goal of increasing HDL-C above 40 mg/dL. If concomitant hypertriglyceridemia is present, a fibrate or niacin should be considered. Although statins do offer some HDL-C-raising properties, they tend to have modest effects. If treatment goals have not been achieved with either lifestyle changes or statin therapy, then the next agent of choice is niacin. Among the various HDL-C-raising therapies, niacin continues to be the most potent therapeutic option available. There are several novel HDL-C therapies in the research pipeline; however, only one class of medications is relatively close to clinical use, the cholesteryl ester transferase protein (CETP) inhibitors. Although one of the CETP inhibitors, torcetrapib, has received much negative attention from a large randomized trial showing increased mortality associated with its use, the overall class of therapeutic agents may still hold some benefit. Currently, two new CETP inhibitors without the off-target effects of torcetrapib are undergoing clinical research. Overall, the use of HDL-C-modifying agents likely will increase over the next decade.

Lessons from coronary intravascular ultrasound on the importance of raising high-density lipoprotein cholesterol

Technological advances have enhanced our ability to visualize the entire extent of atherosclerosis within the artery wall. Intravascular ultrasound has enabled characterization of the impact of medical therapies on progression of coronary atherosclerosis. Despite use of established anti-atherosclerotic therapy, cardiovascular disease still remains the leading cause of morbidity and mortality. There is an ongoing need to develop new therapeutic strategies to achieve more effective reduction in cardiovascular risk. Raising high-density lipoprotein cholesterol continues to receive attention as a therapeutic strategy. The relationship between high-density lipoprotein and progression of atherosclerosis and its implications for clinical practice are reviewed here.

Influence of exercise on nutritional requirements

There is no consensus on the best diet for exercise, as many variables influence it. We propose an approach that is based on the total energy expenditure of exercise and the specific macro- and micronutrients used. di Prampero quantified the impact of intensity and duration on the energy cost of exercise. This can be used to determine the total energy needs and the balance of fats and carbohydrates (CHO). There are metabolic differences between sedentary and trained persons, thus the total energy intake to prevent overfeeding of sedentary persons and underfeeding athletes is important. During submaximal sustained exercise, fat oxidation (FO) plays an important role. This role is diminished and CHO's role increases as exercise intensity increases. At super-maximal exercise intensities, anaerobic glycolysis dominates. In the case of protein and micronutrients, specific recommendations are required. We propose that for submaximal exercise, the balance of CHO and fat favors fat for longer exercise and CHO for shorter exercise, while always maintaining the minimal requirements of each (CHO: 40% and fat: 30%). A case for higher protein (above 15%) as well as creatine supplementation for resistance exercise has been proposed. One may also consider increasing bicarbonate intake for exercise that relies on anaerobic glycolysis, whereas there appears to be little support for antioxidant supplementation. Insuring minimal levels of substrate will prevent exercise intolerance, while increasing some components may increase exercise tolerance.

HDL-C and LDL-C: their role in stroke pathogenesis and implications for treatment

Elevated serum low-density lipoprotein cholesterol (LDL-C) and low serum high-density lipoprotein cholesterol (HDL-C) are risk factors for atherosclerotic ischemic stroke. The National Cholesterol Education Panel and the American Heart Association have released guidelines for the treatment of dyslipidemia that stress LDL-C reduction using HMG CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors (statins) and are applicable to individuals who have had or are at a high risk of having a stroke. Treatment of low HDL-C is a secondary goal of these guidelines and can be best achieved by using extended-release niacin (alone or in combination with statins) and fibrates. Early and aggressive treatment of dyslipidemia is an important component of a multimodality approach to stroke prevention.

Targeting residual risk: the rationale for the use of non-HDL cholesterol

There is a wealth of epidemiological and clinical data linking low-density lipoprotein cholesterol (LDLc) with atherosclerotic cardiovascular disease. Numerous primary and secondary prevention trials have demonstrated that reduction in LDLc leads to significant decrease in cardiovascular event rates. However, patients continue to be at significant risk for recurrent events despite aggressive LDLc lowering, reflecting a substantial residual risk. Numerous parameters like apolipoprotein B, LDL particle size, number and non-high density lipoprotein cholesterol (non-HDLc) measurement have been used to assess and address this high residual risk. Herein, we discuss the rationale and the evidence supporting the use of non-HDLc. We also discuss therapeutic options and provide a practical approach to residual risk reduction from a primary care perspective.

Mediterranean diet and metabolic syndrome: the evidence

Background

The Mediterranean diet has long been related to a lower cardiovascular disease risk; however, more recent evidences also indicate that it has a favourable effect on adiposity and type 2 diabetes.

Design

Review of the available literature in relation to Mediterranean diet and metabolic syndrome.

Results

Several components of Mediterranean diet patterns have been inversely related with body mass index. They are considered to be modulators of insulin resistance, can exert beneficial effects on blood pressure, improve atherogenic dyslipidemia or attenuate the inflammatory burden associated with metabolic syndrome. Furthermore, a lower prevalence of metabolic syndrome has been associated with dietary patterns rich in fruits and vegetables, nuts, olive oil, legumes and fish, moderate in alcohol and low in red meat, processed meat, refined carbohydrates and whole-fat dairy products.

Conclusions

There is much evidence suggesting that the Mediterranean diet could serve as an anti-inflammatory dietary pattern, which could help to fight diseases related to chronic inflammation, including metabolic syndrome.

Dyslipidemia in type 2 diabetes mellitus

Dyslipidemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. The characteristic features of diabetic dyslipidemia are a high plasma triglyceride concentration, low HDL cholesterol concentration and increased concentration of small dense LDL-cholesterol particles. The lipid changes associated with diabetes mellitus are attributed to increased free fatty acid flux secondary to insulin resistance. The availability of multiple lipid-lowering drugs and supplements provides new opportunities for patients to achieve target lipid levels. However, the variety of therapeutic options poses a challenge in the prioritization of drug therapy. The prevalence of hypercholesterolemia is not increased in patients with diabetes mellitus, but mortality from coronary heart disease increases exponentially as a function of serum cholesterol levels, and lowering of cholesterol with statins reduces diabetic patients' relative cardiovascular risk. Although drug therapy for dyslipidemia must be individualized, most people with diabetes mellitus are candidates for statin therapy, and often need treatment with multiple agents to achieve therapeutic goals.

High density lipoprotein cholesterol: an evolving target of therapy in the management of cardiovascular disease

Since the pioneering work of John Gofman in the 1950s, our understanding of high density lipoprotein cholesterol (HDL-C) and its relationship to coronary heart disease (CHD) has grown substantially. Numerous clinical trials since the Framingham Study in 1977 have demonstrated an inverse relationship between HDL-C and one’s risk of developing CHD. Over the past two decades, preclinical research has gained further insight into the nature of HDL-C metabolism, specifically regarding the ability of HDL-C to promote reverse cholesterol transport (RCT). Recent attempts to harness HDL’s ability to enhance RCT have revealed the complexity of HDL-C metabolism. This review provides a detailed update on HDL-C as an evolving therapeutic target in the management of cardiovascular disease.

Obesity-related changes in high-density lipoprotein metabolism

Obesity is associated with a 3-or-more-fold increase in the risk of fatal and nonfatal myocardial infarction (1,2,3,4,5,6). The American Heart Association has reclassified obesity as a major, modifiable risk factor for coronary heart disease (7). The increased prevalence of premature coronary heart disease in obesity is attributed to multiple factors (8,9,10). A principal contributor to this serious morbidity is the alterations in plasma lipid and lipoprotein levels. The dyslipidemia of obesity is commonly manifested as high plasma triglyceride levels, low high-density lipoprotein cholesterol (HDLc), and normal low-density lipoprotein cholesterol (LDLc) with preponderance of small dense LDL particles (7,8,9,10). However, there is a considerable heterogeneity of plasma lipid profile in overweight and obese people. The precise cause of this heterogeneity is not entirely clear but has been partly attributed to the degree of visceral adiposity and insulin resistance. The emergence of glucose intolerance or a genetic predisposition to familial combined hyperlipidemia will further modify the plasma lipid phenotype in obese people (11,12,13,14,15).

Increasing apoA-I production as a target for CHD risk reduction

Dyslipidemia leading to coronary heart diseases (CHD) enables venues to prevent or treat CHD by other strategies than only lowering serum LDL cholesterol (LDL-C) concentrations, which is currently the most frequently targeted change. Unlike LDL-C, elevated high-density lipoprotein cholesterol (HDL-C) concentrations may protect against the development of CHD as demonstrated in numerous large-scale epidemiological studies. In this review we describe that besides elevating serum HDL-C concentrations by increasing alpha-HDL particles, approaches to elevate HDL-C concentrations by increasing pre-beta HDL particle concentrations seems more attractive. Besides infusion of apoA-I(Milano), using apoA-I mimetics, or delipidation of alpha-HDL particles, elevating de novo apoA-I production may be a suitable target to functionally increase pre-beta HDL particle concentrations. Therefore, a detailed description of the molecular pathways underlying apoA-I synthesis and secretion, completed with an overview of known effects of pharmacological and nutritional compounds on apoA-I synthesis will be presented. This knowledge may ultimately be applied in developing dietary intervention strategies to elevate apoA-I production and serum HDL-C concentrations and consequently lower CHD risk.

Effect of short-term Pritikin diet therapy on the metabolic syndrome

The Pritikin Program (Aventura, FL) involves the use of a very-low-fat, low-sodium, high-fiber diet and exercise to decrease the risk of coronary heart disease (CHD). This study evaluated the effect of short-term Pritikin therapy on the metabolic risk factors for CHD in patients with the metabolic syndrome. Sixty-seven subjects who had the metabolic syndrome and attended the Pritikin Longevity Center & Spa for 12-15 days were studied. Short-term Pritikin therapy improved most CHD risk factors: body mass index decreased by 3% (P<.001); systolic and diastolic blood pressure, and serum glucose and low-density lipoprotein cholesterol concentrations decreased by 10%-15% (P<.001); serum triglyceride concentration decreased by 36% (P<.001); and 37% of subjects no longer met National Cholesterol Education Program criteria for the metabolic syndrome. Serum high-density lipoprotein cholesterol, however, decreased by 3% (P<.05). These data demonstrate that brief treatment with a very-low-fat, low-sodium, high-fiber diet and regular exercise simultaneously improves multiple CHD risk factors in patients with the metabolic syndrome.

Snack chips fried in corn oil alleviate cardiovascular disease risk factors when substituted for low-fat or high-fat snacks

BACKGROUND

The perception that all high-fat snacks are unhealthy may be wrong.

OBJECTIVE

We aimed to assess whether replacing low-fat and high-fat snacks with snacks rich in polyunsaturated fatty acids (PUFAs) and low in saturated and trans fatty acids would improve cardiovascular health.

DESIGN

Thirty-three adults participated in a randomized crossover trial of 3 controlled feeding phases of 25 d each in which a different type of snack was provided: low-fat (30.8% of energy from fat, 5.2% of energy from PUFAs), high-PUFA (36.3% of energy from fat, 9.7% of energy from PUFAs), or high-fat (37.9% of energy from fat, 5.8% of energy from PUFAs) snack.

RESULTS

Each diet reduced LDL- and total cholesterol concentrations, but reductions were greater with the low-fat and the high-PUFA diets than with the high-fat diet: LDL cholesterol (11.8% and 12.5% compared with 8.8%, respectively; P = 0.03 and 0.01), total cholesterol (10.5% and 10.7% compared with 7.9%, respectively; P = 0.03 and 0.02). The high-PUFA diet tended to reduce triacylglycerol concentrations (9.4%; P = 0.06), and this change was greater than that with the low-fat (P = 0.028) and high-fat (P = 0.0008) diets.

CONCLUSIONS

These data show that snack type affects cardiovascular health. Consuming snack chips rich in PUFA and low in saturated or trans fatty acids instead of high-saturated fatty acid and trans fatty acid or low-fat snacks leads to improvements in lipid profiles concordant with reductions in cardiovascular disease risk.

Nicotinic acid and other therapies for raising high-density lipoprotein

PURPOSE OF REVIEW

The purpose of this review is to describe the high-density-lipoprotein-raising effect of nicotinic acid and the clinical effects of treatment on cardiovascular diseases, particularly in combination with statins. Other treatments for raising high-density lipoprotein, including changes in lifestyle, other drugs and infusions of 'synthetic' (reconstituted) high-density lipoprotein will be summarized.

RECENT FINDINGS

Treatment of atherosclerotic cardiovascular disease with nicotinic acid and statin results in a pronounced increase of protective high-density lipoprotein cholesterol and reduces morbidity/mortality. Addition of prolonged-release nicotinic acid to ongoing treatment with statin raises high-density lipoprotein cholesterol and induces regression of atherosclerosis that otherwise would progress during statin treatment. Several new high-density lipoprotein-raising drugs in clinical trials are reported. New proposed mechanisms for the broad-spectrum lipid effects of nicotinic acid are described.

SUMMARY

Low plasma concentration of high-density lipoprotein is an important risk factor for atherosclerotic cardiovascular disease. Nicotinic acid has the uncomfortable but harmless side effect of flush. Prolonged-release nicotinic acid gives rise to less flush than immediate-release nicotinic acid. Treatment with nicotinic acid and statin targets the two independent lipid risk factors of low high-density lipoprotein and high low-density lipoprotein and has clinical benefits in secondary prevention of atherosclerotic cardiovascular disease.