Postprandial triglyceride responses to aerobic exercise and extended-release niacin

Effectiveness of statins vs. exercise on reducing postprandial hypertriglyceridemia in dyslipidemic population: A systematic review and network meta-analysis

BACKGROUND

Individuals at risk of suffering cardiovascular disease (CVD) present with larger increases in blood triglyceride (TG) concentration after a high-fat meal than do healthy individuals. These postprandial hypertriglyceride levels are an independent risk factor for CVD. Prescription of statins and a bout of prolonged exercise are both effective in lowering postprandial hypertriglyceride levels. We aimed to evaluate the comparative effectiveness of statins vs. a bout of aerobic exercise in reducing fasting and postprandial TG (PPTG) concentrations in individuals at high risk of developing CVD.

METHODS

Thirty-seven studies from a systematic literature search of the PubMed, EMBASE, and Cochrane databases were included in this review. The selected studies conducted trials involving statin therapy (n = 20) or a bout of aerobic exercise (n = 19) and measured their impact on PPTG levels as the outcome. Two studies analyzed both treatments and were included in duplicate. The meta-analysis was constructed using a random-effects model to calculate the mean difference (MD). The Student t test was used to compare the data sets for statins vs. exercise.

RESULTS

Overall, statin and exercise interventions showed similar reductions in PPTG levels, with an MD of -0.65 mmol/L for statins (95% confidence interval (95%CI): -0.54 to -0.77; p < 0.001) and -0.46 mmol/L for exercise (95%CI: -0.21 to -0.71; p < 0.01). However, statins lowered fasting TG levels more than exercise (MD = -1.54 mmol/L, 95%CI: -2.25 to -0.83; p = 0.009).

CONCLUSION

Although aerobic exercise is effective in lowering blood TG levels, statins seem to be more efficient, especially in the fasted state. A combination of exercise and statins might reveal a valuable approach to the treatment and prevention of CVD. More studies are required to determine the underlying mechanisms and the possible additive effects of these interventions.

Effect of Prior Exercise on Postprandial Lipemia: An Updated Meta-Analysis and Systematic Review

The purpose of this systematic review was to synthesize the results from current literature examining the effects of prior exercise on the postprandial triglyceride (TG) response to evaluate current literature and provide future direction. A quantitative review was performed using meta-analytic methods to quantify individual effect sizes. A moderator analysis was performed to investigate potential variables that could influence the effect of prior exercise on postprandial TG response. Two hundred and seventy-nine effects were retrieved from 165 studies for the total TG response and 142 effects from 87 studies for the incremental area under the curve TG response. There was a moderate effect of exercise on the total TG response (Cohen's d = -0.47; p < .0001). Moderator analysis revealed exercise energy expenditure significantly moderated the effect of prior exercise on the total TG response (p < .0001). Exercise modality (e.g., cardiovascular, resistance, combination of both cardiovascular and resistance, or standing), cardiovascular exercise type (e.g., continuous, interval, concurrent, or combined), and timing of exercise prior to meal administration significantly affected the total TG response (p < .001). Additionally, exercise had a moderate effect on the incremental area under the curve TG response (Cohen's d = -0.40; p < .0001). The current analysis reveals a more homogeneous data set than previously reported. The attenuation of postprandial TG appears largely dependent on exercise energy expenditure (∼2 MJ) and the timing of exercise. The effect of prior exercise on the postprandial TG response appears to be transient; therefore, exercise should be frequent to elicit an adaptation.

Significance of Postprandial Insulin and Triglycerides to Evaluate the Metabolic Response of Composite Meals Differing in Nutrient Composition – A Randomized Cross-Over Trial

Background and aims

GlucoTRIG, based on postprandial plasma insulin and triglyceride concentrations, has been recently developed as a novel index to determine the postprandial metabolic response to the meals. This study aimed to test GlucoTRIG as a measure for ranking composite meals for their metabolic effects.

Methods

In a randomized cross-over trial, healthy adult volunteers (both males and females; n = 10 for each meal) consumed three is caloric (2000 kj) test meals (meal 1, meal 2, meal 3) of varying macronutrient composition. Postmeal consumption, venous blood samples were collected to determine plasma insulin and plasma triglycerides for estimating the GlucoTRIG value using (Triglycerides_180min × Insulin_180min) - (Triglycerides_0min × Insulin_0min).

Results

The GlucoTRIG values differed significantly (p = 0.0085) across meals. The statistical significance remains even after adjusting for confounding variables such as baseline diet, insulin, and triglycerides. The meal (M3) with a high fiber, low total fat content and containing less refined foods (fruits, beans, vegetables, plain yogurt) exhibited a significantly (p = 0.007) lower GlucoTRIG value (10 ± 7.7) compared to the other two meals, M1 (77 ± 19.8) and M2 (38 ± 12.1) which contained low processed foods, and were relatively high in fat and low in fiber meals. No statistically significant differences were observed between M1 and M2 meal.

Conclusions

GlucoTRIG is a physiologically based index that may be useful to rank composite meals for reducing the risk of metabolic diseases. Further research focusing on the application of GlucoTRIG to foods, meals, and diets is warranted.

ACTRN12619000973112 (Australian New Zealand Clinical Trials Registry, ANZCTR).

A Meta-Analysis of Microbial Therapy Against Metabolic Syndrome: Evidence From Randomized Controlled Trials

Background and aims: Metabolic syndrome (MetS), accompanied with significant intestinal dysbiosis, causes a great public health burden to human society. Here, we carried out a meta-analysis to qualify randomized controlled trials (RCTs) and to systematically evaluate the effect of microbial therapy on MetS. Methods and results: Forty-two RCTs were eligible for this meta-analysis after searching the PubMed, Cochrane, and Embase databases. Pooled estimates demonstrated that treatment with microbial therapy significantly reduced the waist circumference (WC) (SMD = -0.26, 95% CI -0.49, -0.03), fasting blood glucose (FBG) (SMD = -0.35, 95% CI -0.52, -0.18), total cholesterol (TC) (SMD = -0.36, 95% CI -0.55, -0.17), low-density lipoprotein cholesterol (LDL-C) (SMD = -0.42, 95% CI -0.61, -0.22), and triacylglycerol (TG)(SMD = -0.38, 95% CI -0.55, -0.20), but increased the high-density lipoprotein cholesterol (HDL-C) (SMD = 0.28, 95% CI.03, 0.52). Sensitivity analysis indicated that after eliminating one study utilizing Bifidobacteriumlactis, results became statistically significant in diastolic blood pressure (DBP) (SMD = -0.24, 95% CI -0.41, -0.07) and in Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (SMD = -0.28, 95% CI -0.54, -0.03), while the body mass index (BMI) showed significant difference after eliminating one study utilizing oat bran (SMD = -0.16, 95% CI -0.31, -0.01). There was still no significant effect in systolic blood pressure (SBP) and in hemoglobin A1c (HbA1c%). Conclusion: In patients with MetS, the conditioning with microbial therapy notably improves FBG, TC, TG, HDL-C, LDL-C, WC, BMI (except for the study using oat bran), HOMA-IR, and DBP (except for the Study using Bifidobacteriumlactis), however, with no effect in SBP and in HbA1c%.

High-Intensity Interval Exercise Performance and Short-Term Metabolic Responses to Overnight-Fasted Acute-Partial Sleep Deprivation

People practicing high-intensity interval exercise (HIIE) fasted during the morning hours under a lack of sleep. Such a habit may jeopardize the health benefits related to HIIE and adequate sleep. Fifteen habitually good sleeper males (age 31.1 ± 5.3 SD year) completed on a treadmill two isocaloric (500 kcal) HIIE sessions (3:2 min work:rest) averaged at 70% VO2reserve after 9-9.5 h of reference sleep exercise (RSE) and after 3-3.5 h of acute-partial sleep deprivation exercise (SSE). Diet and sleep patterns were controlled both 1 week prior and 2 days leading up to RSE and SSE. HIIE related performance and substrate utilization data were obtained from the continuous analysis of respiratory gases. Data were analyzed using repeated measures ANOVA with the baseline maximum oxygen uptake (VO2max) and body fat percentage (BF%) as covariates at p < 0.05. No difference was observed in VO2max, time to complete the HIIE, VE, RER, CHO%, and FAT% utilization during the experimental conditions. Whether attaining an adequate amount of sleep or not, the fasted HIIE performance and metabolism were not affected. We propose to practice the fasted HIIE under adequate sleep to receive the pleiotropic beneficial effects of sleep to the human body.

Acute partial sleep deprivation and high-intensity interval exercise effects on postprandial endothelial function

PURPOSE

Acute-total and chronic-partial sleep deprivation increase the risks for cardiovascular disease (CVD). Cardiovascular function assessed by flow mediated dilation (FMD) is reduced after sleep deprivation. High-intensity interval exercise (HIIE) improves postprandial FMD. Sleep-deprived individuals may practice HIIE followed by a high-fat breakfast. This study investigated the acute-partial sleep deprivation (APSD) and HIIE interaction on postprandial FMD.

METHODS

Fifteen healthy males (age 31 ± 5 years) participated in: (a) reference sleep (~ 9.5 h) with no HIIE (RS), (b) RS and HIIE (RSX), and (c) APSD and HIIE (SSX). HIIE was performed in 3:2 min intervals at 90% and 40% of VO₂ reserve. FMD was assessed the night before (D1), the morning of the next day (D2), 1 h (1hrPE) and 4 h post HIIE (4hrPE).

RESULTS

FMD% change was lower at RS compared to both RSX (F_1,14 = 23.96, p < 0.001, η² = 0.631) and SSX (F_1,14 = 4.8, p = 0.47, η² = 0.253) at 1hrPE. RSX and SSX did not differ at 1hrPE (F_1,14 = 0.2, p = 0.889, η² = 0.001), but SSX elicited greater FDM responses. Absolute FMD change was lower at RS compared to both RSX (F_1,14 = 21.5, p < 0.001, η² = 0.606) and SSX (F_1,14 = 7.01, p = 0.019, η² = 0.336) at 1hrPE. RSX and SSX did not differ at 1hrPE (F_1,14 = .03, p = 0.858, η² = 0.002), but SSX elicited greater FDM responses.

CONCLUSIONS

HIIE short-term effects on cardiovascular function remain cardioprotective even after an acute-partial sleep deprivation.

Whey protein consumption following fasted exercise reduces early postprandial glycaemia in centrally obese males: a randomised controlled trial

Purpose

Acute submaximal exercise and whey protein supplementation have been reported to improve postprandial metabolic and appetite responses to a subsequent meal independently. We aimed to examine the combination of these strategies on postprandial responses to a carbohydrate-rich breakfast.

Methods

Twelve centrally obese males (age 41 ± 3 years, waist circumference 123.4 ± 2.9 cm), completed three trials in a single-blind, crossover design. Participants rested for 30 min (CON) or completed 30 min low–moderate-intensity treadmill walking (51 ± 1% \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\dot{V}O}}_{\text{2peak}}$$\end{document}V˙O2peak) followed immediately by ingestion of 20 g whey protein (EX + PRO) or placebo (EX). After 15 min, a standardised breakfast was consumed and blood, expired gas and subjective appetite were sampled postprandially. After 240 min, an ad libitum lunch meal was provided to assess energy intake.

Results

During EX + PRO, post-breakfast peak blood glucose was reduced when compared with EX and CON (EX + PRO: 7.6 ± 0.4 vs EX: 8.4 ± 0.3; CON: 8.3 ± 0.3 mmol l⁻¹, p ≤ 0.04). Early postprandial glucose AUC_0–60 min was significantly lower under EX + PRO than EX (p = 0.011), but not CON (p = 0.12). Over the full postprandial period, AUC_0–240 min during EX + PRO did not differ from other trials (p > 0.05). Peak plasma insulin concentrations and AUC_0–240 min were higher during EX + PRO than CON, but similar to EX. Plasma triglyceride concentrations, substrate oxidation and subjective appetite responses were similar across trials and ad libitum energy intake was not influenced by prior fasted exercise, nor its combination with whey protein supplementation (p > 0.05).

Conclusion

Following fasted low–moderate-intensity exercise, consuming whey protein before breakfast may improve postprandial glucose excursions, without influencing appetite or subsequent energy intake, in centrally obese males.

Trial registration number

NCT02714309.

Effects of statin therapy and exercise on postprandial triglycerides in overweight individuals with hypercholesterolaemia

AIMS

To determine the effects of statins on postprandial lipaemia (PPL) and to study if exercise could enhance statin actions.

METHODS

Ten hypercholesteraemic (blood cholesterol 204 ± 36 mg dL^-1 ; low-density lipoprotein-cholesterol 129 ± 32 36 mg dL^-1 ) overweight (body mass index 30 ± 4 kg m^-2 ), metabolic syndrome individuals chronically medicated with statins (>6 months) underwent 5-hour PPL tests in 4 occasions in a randomized order: (i) substituting their habitual statin medication by placebo for 96 hours (PLAC trial); (ii) taking their habitual statin medicine (STA trial); (iii) placebo combined with a bout of intense aerobic exercise (EXER+PLAC trial); and (iv) combining exercise and statin medicine (EXER+STA trial).

RESULTS

Before the fat meal, statin withdrawal (i.e. PLAC and EXER+PLAC) increased blood triglycerides (TG; 24%), low-density lipoprotein-cholesterol (31%) and total cholesterol (19%; all P < .05) evidencing treatment compliance. After the meal, statin withdrawal increased 5-hour postprandial TG (PPTG) compared to its matched trials (94% higher PLAC vs STA and 45% higher EXER+PLAC vs EXER+STA; P < .05). EXER+PLAC trial did not lower PPTG below PLAC (i.e. incremental AUC of 609 ± 152 vs 826 ± 190 mg dL^-1 5 h; P = .09). Adding exercise to statin did not result in larger reductions in PPTG (i.e. EXER+STA vs STA incremental area under the curve of 421 ± 87 vs 421 ± 84 mg dL^-1 5 h; P = .99).

CONCLUSION

In hypercholesteraemic metabolic syndrome individuals, chronic statin therapy blunts the elevations in TG after a fat meal (i.e. incremental area under the curve of PPTG) reducing the cardiovascular risk associated to their atherogenic dyslipidaemia. However, a single bout of intense aerobic exercise before the high fat meal, does not reduce PPTG but also does not interfere with the effects of statin treatment.

Nicotinic acid promotes sleep through prostaglandin synthesis in mice

Nicotinic acid has been used for decades for its antiatherogenic properties in humans. Its actions on lipid metabolism intersect with multiple sleep regulatory mechanisms, but its effects on sleep have never been documented. For the first time, we investigated the effects of acute systemic administration of nicotinic acid on sleep in mice. Intraperitoneal and oral gavage administration of nicotinic acid elicited robust increases in non-rapid-eye movement sleep (NREMS) and decreases in body temperature, energy expenditure and food intake. Preventing hypothermia did not affect its sleep-inducing actions suggesting that altered sleep is not secondary to decreased body temperature. Systemic administration of nicotinamide, a conversion product of nicotinic acid, did not affect sleep amounts and body temperature, indicating that it is not nicotinamide that underlies these actions. Systemic administration of monomethyl fumarate, another agonist of the nicotinic acid receptor GPR109A, fully recapitulated the somnogenic and thermoregulatory effects of nicotinic acid suggesting that they are mediated by the GPR109A receptor. The cyclooxygenase inhibitor indomethacin completely abolished the effects of nicotinic acid indicating that prostaglandins play a key role in mediating the sleep and thermoregulatory responses of nicotinic acid.

The repeatability of the abbreviated (4-h) Oral Fat Tolerance Test and influence of prior acute aerobic exercise

PURPOSE

The Oral Fat Tolerance Test (OFTT) is regarded as a repeatable measure used to assess postprandial triglyceride (TAG) levels, with higher levels observed in cardio-metabolic disorders. Acute aerobic exercise intervention before OFTT reduces the TAG response, but the repeatability of this effect is unknown. The aim of this study was to determine the repeatability of the abbreviated 4-h OFTT with and without immediate prior aerobic exercise.

METHODS

On four separate days, healthy adult male participants underwent two 4-h OFTT (n = 10) and another two 4-h OFTT with 1-h of standardised moderate intensity aerobic exercise performed immediately before meal ingestion (n = 11). The OFTT meal composition included 75.4 g total fat, 21.7 g carbohydrate and 13.7 g protein. Venous blood was sampled at baseline and hourly up to 4 h after the OFTT meal ingestion, and TAG area under the curve (AUC) was calculated.

RESULTS

Nonparametric Bland-Altman analysis of 4-h TAG AUC revealed that 9 of 10 repeat measurements fell within ±15 % of the median TAG AUC for the OFTT. By contrast, two of 11 repeat measurements fell within ±15 % of the median TAG AUC for the OFTT undertaken with 1-h prior aerobic exercise.

CONCLUSIONS

The 4-h OFTT is a repeatable test of postprandial TAG responses in healthy men. However, aerobic exercise performed immediately before OFTT considerably increases the variability of TAG AUC. These findings have implications for interpretation of research studies investigating exercise intervention performed immediately before OFTT. Future studies should also investigate the repeatability of exercise performed 8-24 h before OFTT.

Metabolic Reponses to a physical exercise session in women with excess body mass: randomized clinical trial

Background

There are various factors that influence the effect of physical exercise on the lipid profile, among them the body mass index and calorie expenditure of the exercise are some of the main factors. To test the hypothesis that a physical exercise session based on caloric expenditure may acutely modify the glycemia and lipid values of women with excess body mass.

Methods

The study included 66 women, randomly divided into two groups, control and experimental, with BMI of 29 ± 4.4 kg/m² vs 29 ± 4.3 kg/m² (p = 0.45) sedentary and aged 23 ± 3.8 vs 24 ± 3.5 years, respectively (p = 0.25). After 12 h fasting, the volunteers underwent the first blood collection. The experimental group was submitted to a physical exercise session corresponding to energy expenditure of 250Kcal, of light intensity based the Borg Rating of Perceived Exertion (RPE), 12 h after the first blood collection. The control and experimental group volunteers underwent a second blood collection 24 h after the first. Glycemia, insulin status and lipid profile were measured and Homa IR and Homa-beta were calculated. The t-test for independent and dependent samples was used, and a level of significance of 5% was adopted.

Results

Physical exercise changed the glycemic response in both the intragroup analysis (before = 96 ± 6.6 mg/dL vs after = 92 ± 6.6 mg/dL), (p = 0.01), and in the intergroup analysis (control = Δ 0.9 ± 6.1 vs experimental = Δ -4.1 ± 6.3) (p = 0.02). No changes were shown for the Homa IR, Homa Beta and Insulin indexes. When the lipid profiles were evaluated, differences in HDL were shown in the intragroup analysis (before = 89 ± 10.5 mg/dL vs. after = 91 ± 10.3 mg/dL) (p = 0.04). For the other parameters (LDL, TG, Total Cholesterol, TG/HDL), no changes were shown.

Conclusion

In women with excess body weight, a low intensity exercise session diminished the glycemia, but did not change the lipid response.

Trial registration

NCT03170973. Retrospectively registered.

The effect of exercise intensity and excess postexercise oxygen consumption on postprandial blood lipids in physically inactive men

Reductions in postprandial lipemia have been observed following aerobic exercise of sufficient energy expenditure. Increased excess postexercise oxygen consumption (EPOC) has been documented when comparing high- versus low-intensity exercise. The contribution of EPOC energy expenditure to alterations in postprandial lipemia has not been determined. The purpose of this study was to evaluate the effects of low- and high-intensity exercise on postprandial lipemia in healthy, sedentary, overweight and obese men (age, 43 ± 10 years; peak oxygen consumption, 31.1 ± 7.5 mL·kg^-1·min^-1; body mass index, 31.8 ± 4.5 kg/m²) and to determine the contribution of EPOC to reductions in postprandial lipemia. Participants completed 4 conditions: nonexercise control, low-intensity exercise at 40%-50% oxygen uptake reserve (LI), high-intensity exercise at 70%-80% oxygen uptake reserve (HI), and HI plus EPOC re-feeding (HI+EERM), where the difference in EPOC energy expenditure between LI and HI was re-fed in the form of a sports nutrition bar (Premier Nutrition Corp., Emeryville, Calif., USA). Two hours following exercise participants ingested a high-fat (1010 kcals, 99 g sat fat) test meal. Blood samples were obtained before exercise, before the test meal, and at 2, 4, and 6 h postprandially. Triglyceride incremental area under the curve was significantly reduced following LI, HI, and HI+EERM when compared with nonexercise control (p < 0.05) with no differences between the exercise conditions (p > 0.05). In conclusions, prior LI and HI exercise equally attenuated postprandial triglyceride responses to the test meal. The extra energy expended during EPOC does not contribute significantly to exercise energy expenditure or to reductions in postprandial lipemia in overweight men.

Nicotinic acid timed to feeding reverses tissue lipid accumulation and improves glucose control in obese Zucker rats[S]

Nicotinic acid (NiAc) is a potent inhibitor of lipolysis, acutely reducing plasma free fatty acid (FFA) concentrations. However, a major FFA rebound is seen during rapid NiAc washout, and sustained exposure is associated with tolerance development, with FFAs returning to pretreatment levels. Our aim was to find a rational NiAc dosing regimen that preserves FFA lowering, sufficient to reverse nonadipose tissue lipid accumulation and improve metabolic control, in obese Zucker rats. We compared feeding-period versus fasting-period NiAc dosing for 5 days: 12 h subcutaneous infusion (programmable, implantable mini-pumps) terminated by gradual withdrawal. It was found that NiAc timed to feeding decreased triglycerides in liver (-47%; P < 0.01) and heart (-38%; P < 0.05) and reduced plasma fructosamine versus vehicle. During oral glucose tolerance test, plasma FFA levels were reduced with amelioration of hyperglycemia and hypertriglyceridemia. Furthermore, timing NiAc to feeding resulted in a general downregulation of de novo lipogenesis (DNL) genes in liver. By contrast, NiAc timed to fasting did not reduce tissue lipids, ameliorate glucose intolerance or dyslipidemia, or alter hepatic DNL genes. In conclusion, NiAc dosing regimen has a major impact on metabolic control in obese Zucker rats. Specifically, a well-defined NiAc exposure, timed to feeding periods, profoundly improves the metabolic phenotype of this animal model.

Sex differences in the effects of 12 weeks sprint interval training on body fat mass and the rates of fatty acid oxidation and VO2max during exercise

BACKGROUND

The purpose of this study was to examine whether very short duration, very high intensity sprint interval training (SIT) leads to loss of body fat mass in association with improvements to VO2max and fatty acid oxidation, and to assess the extent of sex dimorphism in these physiological responses.

METHODS

A total of 24 men and 17 women (mean (SEM) age: 39 (±2) years; body mass index 24.6 (0.6)) completed measurements of the maximal rate of oxygen uptake (VO2max) and fatty acid oxidation (FATmax). Body fat and lean mass were measured by dual emission x-ray absorptiometry, and fasting blood lipid, glucose and insulin profiles were assessed before and after training. SIT consisted of 4×20 s sprints on a cycle ergometer at approximately 175% VO2max, three times per week for 12 weeks.

RESULTS

Fat mass decreased by 1.0 kg, although men lost statistically significantly more fat than women both when expressed in Kg and as % body fat. VO2max increased by around 9%, but women improved VO2max significantly more than men. FATmax improved by around 13%, but fasting plasma glucose, insulin, total triglyceride, total cholesterol and high-density lipoprotein (HDL) did not change after training, while low-density lipoprotein decreased by 8% (p=0.028) and the HDL:Total Cholesterol ratio improved by 6%. There were no sex differences in these metabolic responses to training.

CONCLUSIONS

These results show lower body fat %, and higher rates of fatty acid oxidation and VO2max after 12 weeks of training for just 4 min per week. Notably, women improved VO2max more than men, while men lost more fat than women.

Niacin Alternatives for Dyslipidemia: Fool's Gold or Gold Mine? Part I: Alternative Niacin Regimens

Niacin was the first drug demonstrating lowered cholesterol prevents coronary heart disease (CHD) events, with two clinical CHD outcome studies establishing a cardioprotective niacin regimen: 1 g thrice daily with meals. Though cardioprotective, skin toxicity limits niacin's use, fostering several variations to improve tolerability. One of these, an extended-release (ER) alternative, proved immensely successful commercially, dominating clinical practice despite departing from the established regimen in several critical ways. Hence, improved tolerability may have come at the cost of diminished efficacy, posing a conundrum: Does it still help the population at risk for CHD to broaden a drug's acceptance by "watering it down"? This question is crucial at this stage now that the ER alternative failed to recapitulate the benefits of the established cardioprotective niacin regimen in two trials of the alternative approach: AIM-HIGH and HPS2-THRIVE. Part I of this review discusses how vastly the ER alternative departs from the established cardioprotective regimen, why that is important physiologically, and how it may explain the findings of AIM-HIGH and HPS2-THRIVE. Given important gaps left by statin therapy, the established cardioprotective niacin regimen remains an important evidence-based therapy for the statin intolerant or statin averse.

Paraoxonase responses to exercise and niacin therapy in men with metabolic syndrome

Our purpose was to characterize changes in paraoxonase 1 (PON1) activity and concentration after single aerobic exercise sessions conducted before and after 6 weeks of niacin therapy in men with metabolic syndrome (MetS). Twelve men with MetS expended 500 kcal by walking at 65% of VO2max before and after a 6-week regimen of niacin. Niacin doses were titrated by 500 mg/week from 500 to 1500 mg/day and maintained at 1500 mg/day for the last 4 weeks. Fasting blood samples were collected before and 24 hours after each exercise session and analyzed for PON1 activity, PON1 concentration, myeloperoxidase (MPO), apolipoprotein A1, oxidized low-density lipoprotein (oLDL), lipoprotein particle sizes and concentrations. PON1 activity, PON1 concentration, MPO, and oLDL were unaltered following the independent effects of exercise and niacin (P > 0.05 for all). High-density lipoprotein particle size decreased by 3% (P = 0.040) and concentrations of small very low-density lipoprotein increased (P = 0.016) following exercise. PON1 activity increased 6.1% (P = 0.037) and PON1 concentrations increased 11.3% (P = 0.015) with the combination of exercise and niacin. Exercise and niacin works synergistically to increase PON1 activity and concentration with little or no changes in lipoproteins or markers of lipid oxidation.

Postprandial lipemia as a cardiometabolic risk factor

High levels of fasting circulating triglycerides (TG) represent an independent risk factor for cardiovascular disease. In western countries, however, people spend most time in postprandial conditions, with continuous fluctuation of lipemia due to increased levels of TG-rich lipoproteins (TRLs), including chylomicrons (CM), very low density lipoproteins (VLDL), and their remnants. Several factors contribute to postprandial lipid metabolism, including dietary, physiological, pathological and genetic factors. The presence of coronary heart disease, type 2 diabetes, insulin resistance and obesity is associated with higher postprandial TG levels compared with healthy conditions; this association is present also in subjects with normal fasting TG levels. Increasing evidence indicates that impaired metabolism of postprandial lipoproteins contributes to the pathogenesis of coronary artery disease, suggesting that lifestyle modifications as well as pharmacological approaches aimed at reducing postprandial TG levels might help to decrease the cardiovascular risk.

Exercise and dietary-mediated reductions in postprandial lipemia

Postprandial hyperlipemia produces long-term derangements in lipid/lipoprotein metabolism, vascular endothelial dysfunction, hypercoagulability, and sympathetic hyperactivity which are strongly linked to atherogenesis. The purpose of this review is to (1) provide a qualitative analysis of the available literature examining the dysregulation of postprandial lipid metabolism in the presence of obesity, (2) inspect the role of adiposity distribution and sex on postprandial lipid metabolism, and (3) examine the role of energy deficit (exercise- and/or energy restriction-mediated), isoenergetic low-carbohydrate diets, and omega-3 (n-3) fatty acid supplementation on postprandial lipid metabolism. We conclude from the literature that central adiposity primarily accounts for sex-related differences in postprandial lipemia and that aerobic exercise attenuates this response in obese or lean men and women to a similar extent through potentially unique mechanisms. In contrast, energy restriction produces only mild reductions in postprandial lipemia suggesting that exercise may be superior to energy restriction alone as a strategy for lowering postprandial lipemia. However, isoenergetic very low-carbohydrate diets and n-3 fatty acid supplementation reduce postprandial lipemia indicating that macronutrient manipulations reduce postprandial lipemia in the absence of energy restriction. Therefore, interactions between exercise/energy restriction and alterations in macronutrient content remain top priorities for the field to identify optimal behavioral treatments to reduce postprandial lipemia.

Effect of prior exercise on postprandial lipemia: an updated quantitative review

Reducing postprandial triglycerides (TG) can lower the risk for cardiovascular disease. The purpose of this study was to perform a meta-analytic review of the literature to estimate the effect of prior exercise on postprandial lipemia. A total of 121 effects were found from 76 studies for the total TG response and 70 effects from 44 studies for the incremental area under the curve (iAUC) TG response. The weighted mean effect was moderate for the total TG response, Cohen's d = −0.60 ( P < 0.0001), and for the iAUC response, Cohen's d = −0.59 ( P < 0.0001). Moderator analysis revealed women exhibited a larger reduction ( P < .01) in the total TG response following exercise ( d = −0.96) than men ( d = −0.57); high-intensity interval training induced a larger reduction ( P < .05) in the iAUC response ( d = −1.49) than aerobic ( d = −0.58) or resistance ( d = −0.13) exercise, and participants maintaining an energy deficit following exercise exhibited a greater reduction in the iAUC response ( d = −0.67) compared with participants in energy balance ( d = −0.28). We conclude that prior acute exercise reduces postprandial lipemia, with the magnitude of effect influenced by sex, type of exercise, and energy deficit following exercise.

Postprandial hypertriglyceridemia and cardiovascular disease: current and future therapies

Exaggerated postprandial hypertriglyceridemia is a risk factor for cardiovascular disease. This metabolic abnormality is principally due to overproduction and/or decreased catabolism of triglyceride-rich lipoproteins (TRLs) and is a consequence of pathogenic genetic variations and other coexistent medical conditions, particularly obesity and insulin resistance. Accumulation of TRL in the postprandial state promotes the formation of small, dense low-density lipoproteins, as well as oxidative stress, inflammation, and endothelial dysfunction, all of which compound the risk of cardiovascular disease. The cardiovascular benefits of lifestyle modification (weight loss and exercise) and conventional lipid-lowering therapies (statins, fibrates, niacin, ezetimibe, and n-3 fatty acid supplementation) could involve their favorable effects on TRL metabolism. New agents, such as dual peroxisome-proliferator-activated receptor α/δ agonists, diacylglycerol, inhibitors of diacylglycerol acyltransferase 1 and microsomal triglyceride transfer protein, antisense oligonucleotides for apolipoprotein B-100 and apolipoprotein C-III, and incretin-based therapies, may enhance the treatment of postprandial lipemia, but their efficacy needs to be tested in clinical end point trials. Further work is required to develop a simple clinical protocol for investigating postprandial lipemia, as well as internationally agreed management guidelines for this type of dyslipidemia.

The latest on the effect of prior exercise on postprandial lipaemia

This review examines the effect of prior exercise on postprandial triacylglycerol (pTAG) concentrations, an independent risk factor for cardiovascular diseases. Numerous studies have shown that a single bout of exercise reduces pTAG concentrations; however, several modulators such as exercise energy expenditure/deficit, mode of exercise (aerobic/resistance/high intensity/intermittent exercise or combinations), type of meal (moderate or high fat), time frame between exercise and meal and target group may individually or in conjunction influence this effect. On the other hand, at least for aerobic exercise, training reduces pTAG concentrations transiently (~2 days); therefore, exercise sessions should be frequent enough to maintain this clinically significant improvement. For the healthy population, it seems that a subject's preference and ability determine which type of exercise to undertake to attenuate pTAG concentrations; an energy expenditure of ~30 kJ/kg of body mass (or ~2-2.5 MJ) not combined with a corresponding increase in energy intake is required; for resistance or intermittent exercise, for those following a moderate rather than a high-fat diet, and for those with obesity (expressed as kJ/kg of body mass), a smaller energy expenditure is probably sufficient. More studies are needed to investigate dose-response/plateau effects, as well as the threshold of energy expenditure in those with diabetes mellitus and other high-risk populations. Finally, investigation of the underlying mechanisms may be clinically helpful in individualizing the appropriate intervention.

The effect of aerobic exercise intensity on attenuation of postprandial lipemia is dependent on apolipoprotein E genotype

OBJECTIVE

To investigate the effect of aerobic exercise intensity on postprandial lipemia according to allelic variants of the apolipoprotein E gene.

METHODS

Three groups of 10 healthy men each were formed based genotyping of the APOE gene, rested or performed 500 Kcal tests in a random sequence separated by a minimum 48 h interval, as follows: (a) no exercise (control), (b) intense intermittent exercise, (c) moderate continuous exercise. Each test series was completed 30-min before ingestion of a high-fat meal (1 g fat/kg). Venous blood was collected before and at 1, 2, 3 and 4 h after the high-fat meal. Postprandial lipemia was assessed using the area under the curve approach as well as the kinetic profile of mean lipid variables. Statistical significance was adopted at P ≤ 0.05 level.

RESULTS

The main results show that, in the moderate continuous exercise, total postprandial cholesterolemia was higher in ɛ4 than in ɛ2 carriers, whereas under intense intermittent exercise, total and LDL cholesterolemia were higher in ɛ4 than in ɛ2 and ɛ3 carriers. There was no difference in the lipemic profile of the subjects across APOE genotypes at baseline.

CONCLUSION

Moderate and intense exercise were effective in attenuating PPL in both ɛ2 and ɛ3 subjects, with ɛ2 subjects being more susceptible to the lipid lowering effect of moderate training than ɛ3 subjects. Carriers of the ɛ4 allele, however, showed no attenuation of postprandial lipemia.

Extended-release niacin acutely suppresses postprandial triglyceridemia

OBJECTIVE

Postprandial triglyceridemia predicts cardiovascular events. Niacin might lower postprandial triglycerides by restricting free fatty acids. Immediate-release niacin reduced postprandial triglycerides, but extended-release niacin failed to do so when dosed the night before a fat challenge. The study aims were to determine whether extended-release niacin dosed before a fat challenge suppresses postprandial triglycerides and whether postprandial triglycerides are related to free fatty acid restriction.

METHODS

A double-blinded, placebo-controlled, random-order crossover experiment was performed, in which healthy volunteers took 2 g extended-release niacin or placebo 1 hour before heavy cream. We sampled blood over 12 hours and report triglycerides and free fatty acid as means ± standard deviation for incremental area under the curve (AUC) and nadir.

RESULTS

By combining 43 fat challenges from 22 subjects, postprandial triglycerides incremental AUC was +312 ± 200 mg/dL*h on placebo versus +199 ± 200 mg/dL*h on extended-release niacin (33% decrease, P=.02). The incremental nadir for free fatty acid was -0.07 ± 0.15 mmol/L on placebo versus -0.27 ± 0.13 mmol/L on extended-release niacin (P<.0001), and free fatty acid incremental AUC decreased from +2.9 ± 1.5 mmol/L*h to +1.5 ± 1.5 mmol/L*h on extended-release niacin (20% decrease, P=.0015). The incremental AUC for triglycerides was strongly related to the post-dose decrease in free fatty acid (r = +0.58, P=.0007).

CONCLUSIONS

Given right before a fat meal, even a single dose of extended-release niacin suppresses postprandial triglyceridemia. This establishes that postprandial triglycerides suppression is an acute pharmacodynamic effect of extended-release niacin, probably the result of marked free fatty acid restriction. Further study is warranted to determine whether mealtime dosing would augment the clinical efficacy of extended-release niacin therapy.

Postprandial dyslipidaemia and diabetes: mechanistic and therapeutic aspects

PURPOSE OF REVIEW

There has been a resurgence of interest in the role of triglyceride-rich lipoproteins in the development of atherosclerosis and cardiovascular disease, and this is particularly relevant to diabetes mellitus and the postprandial state.

RECENT FINDINGS

Recent evidence suggests that insulin resistance in diabetes induces postprandial dyslipidemia by increasing the enterocytic production of chylomicrons and their remnant particles, but an impaired clearance capacity is also involved. Postprandial dyslipidaemia in diabetes induces oxidative stress, inflammation and endothelial dysfunction and this may be compounded by dysglycaemia. New guidelines for managing hypertriglyceridaemia in diabetes have been published, first-line therapies being improved glycaemic control, treatment of other secondary causes of dyslipidaemia and statin therapy, followed by judicious use of fibrates, n-3 fatty acids or niacin. A new role for incretin-based therapies in regulating dyslipidaemia has been identified.

SUMMARY

Postprandial dyslipidaemia is a pivotal mechanism whereby diabetes can induce and accelerate atherosclerosis. Regulating the plasma concentrations of triglyceride-rich lipoproteins may decrease the cardiovascular complications of diabetes. The mechanisms of action of incretin-based treatments on dyslipidaemia and endothelial dysfunction need further investigation. The efficacy of new therapies targeted at postprandial dysmetabolism in diabetes need to be confirmed, against best current levels of care, in clinical endpoint trials.

The influence of intense intermittent versus moderate continuous exercise on postprandial lipemia

INTRODUCTION

Postprandial lipemia is characterized by an increased concentration of circulating lipids after fat intake and is an independent risk factor for cardiovascular disease. Exercise is known to reduce postprandial lipemia and its negative clinical outcomes.

OBJECTIVE

This study investigated the effect of intense intermittent versus moderate continuous exercise using the same energy expenditure in postprandial lipemia.

MATERIALS AND METHODS

Twenty healthy men (aged 21.5 ± 3.5 years) performed a random sequence of either rest or 500 Kcal tests separated by a minimum 48 h interval as follows: (a) no exercise (control), (b) intense intermittent exercise, or (c) moderate continuous exercise. Each test series was completed 30 min before ingestion of a high-fat meal (1 g fat/kg). Venous blood was collected before and at 1, 2, 3 and 4 hours after the high-fat meal. Postprandial lipemia was assessed using the area under the curve approach as well as a kinetic profile of mean lipid variables. Statistical significance was tested at the p<0.05 level.

RESULTS

With both statistical approaches, intense intermittent and moderate continuous exercises were both effective in reducing postprandial triglycerides; however, only intense intermittent exercise reduced the levels of postprandial very low density lipoprotein. Intense intermittent and continuous exercise produced lower levels of insulinemia using the area under the curve analysis only.

CONCLUSION

Intense intermittent or continuous exercise with an energy expenditure of 500 kcal completed 30 min before ingestion of high-fat meal reduced postprandial lipid levels to different levels in physically active men. Understanding these relevant differences will enable clinicians to provide the best exercise prescription for patients.

Responses of blood lipids and lipoproteins to extended-release niacin and exercise in sedentary postmenopausal women

Niacin and exercise positively alter blood lipids and lipoproteins via different mechanisms. However, the effects of niacin combined with exercise on blood lipid and lipoprotein profiles have not been investigated in sedentary postmenopausal women. The current study examined the responses of blood lipids and lipoproteins to niacin and exercise in 18 sedentary postmenopausal women, who underwent four conditions: no-niacin rest, no-niacin exercise, niacin rest, and niacin exercise. Participants ingested 1,000 mg/day of extended-release niacin for 4 weeks during the niacin condition. As an exercise treatment, participants performed a single bout of exercise on a treadmill at 60% heart rate reserve until 400 kcal were expended. Extended-release niacin without the exercise intervention significantly (p < .001) increased high-density lipoprotein cholesterol and high-density lipoprotein-2 cholesterol by 12.4% and 33.3%, respectively, and decreased the total cholesterol to high-density lipoprotein cholesterol ratio by 14.8%. Thus, 4 weeks of 1,000 mg/day of extended-release niacin can improve the blood lipid and lipoprotein profiles in sedentary postmenopausal women.

In vivo efficacy of acyl CoA: diacylglycerol acyltransferase (DGAT) 1 inhibition in rodent models of postprandial hyperlipidemia

Postprandial serum triglyceride concentrations have recently been identified as a major, independent risk factor for future cardiovascular events. As a result, postprandial hyperlipidemia has emerged as a potential therapeutic target. The purpose of this study was two-fold. Firstly, to describe and characterize a standardized model of postprandial hyperlipidemia in multiple rodent species; and secondly, apply these rodent models to the evaluation of a novel class of pharmacologic agent; acyl CoA:diacylglycerol acyltransferase (DGAT) 1 inhibitors. Serum triglycerides were measured before and for 4h after oral administration of a standardized volume of corn oil, to fasted C57BL/6, ob/ob, apoE(-/-) and CD-1 mice; Sprague-Dawley and JCR/LA-cp rats; and normolipidemic and hyperlipidemic hamsters. Intragastric administration of corn oil increased serum triglycerides in all animals evaluated, however the magnitude and time-course of the postprandial triglyceride excursion varied. The potent and selective DGAT-1 inhibitor A-922500 (0.03, 0.3 and 3 mg/kg, p.o.), dose-dependently attenuated the maximal postprandial rise in serum triglyceride concentrations in all species tested. At the highest dose of DGAT-1 inhibitor, the postprandial triglyceride response was abolished. This study provides a comprehensive characterization of the time-course of postprandial hyperlipidemia in rodents. In addition, the ability of DGAT-1 inhibitors to attenuate postprandial hyperlipidemia in multiple rodent models, including those that feature insulin resistance, is documented. Exaggerated postprandial hyperlipidemia is inherent to insulin-resistant states in humans and contributes to the substantially elevated cardiovascular risk observed in these patients. Therefore, by attenuating postprandial hyperlipidemia, DGAT-1 inhibition may represent a novel therapeutic approach to reduce cardiovascular risk.

Niacin: a re-emerging pharmaceutical for the treatment of dyslipidaemia

Dyslipidaemias, particularly those characterized by the 'atherogenic profile' of high low-density lipoprotein-cholesterol and triglycerides and low high-density lipoprotein-cholesterol, are the major modifiable risk factor for atherosclerosis. The search for drugs to favourably alter such lipid profiles, reducing the associated morbidity and mortality, remains a major research focus. Niacin (nicotinic acid) is the most effective agent available for increasing high-density lipoprotein-cholesterol, but its use is associated with side effects that negatively affect patient compliance: these appear to arise largely as a result of production of prostaglandin D(2) and its subsequent activation of the DP(1) receptor. Desire to reduce the side effects (and improve pharmacokinetic parameters) has led to the development of a number of agonists that have differing effects, both in terms of clinical potency and the severity of adverse effects. The recent discovery of the niacin G-protein-coupled receptor HM74A (GPR109A) has clarified the distinction between the mechanism whereby niacin exerts its therapeutic effects and the mechanisms responsible for the generation of side effects. This has allowed the development of new drugs that show great potential for the treatment of dyslipidaemia. However, recent advances in understanding of the contribution of prostaglandin metabolism to vascular wall health suggest that some of the beneficial effects of niacin may well result from activation of the same pathways responsible for the adverse reactions. The purpose of this review is to emphasize that the search for agonists that show higher tolerability must take into account all aspects of signalling through this receptor.

Independent and combined effects of aerobic exercise and pharmacological strategies on serum triglyceride concentrations: a qualitative review

Elevated fasting and postprandial serum triglyceride concentrations are associated with cardiovascular disease morbidity and mortality. Aerobic exercise reduces serum triglyceride concentrations in the presence or absence of weight loss. Although pharmacological interventions are often used in combination with aerobic exercise to achieve target triglyceride concentrations, information on the combined effects of aerobic exercise and lipid-modifying agents on serum triglycerides is limited. This review examines the independent and combined effects of both interventions on serum fasting and postprandial triglyceride concentrations from the available literature. Reductions in serum triglycerides after aerobic exercise are associated with an increase in skeletal muscle lipoprotein lipase activity and a decrease in hepatic triglyceride and very-low-density lipoprotein (VLDL) synthesis and secretion. Lipid-modifying agents such as niacin, omega-3 fatty acids, and statins also decrease fasting and postprandial triglycerides by increasing lipoprotein lipase (LPL) activity and/or decreasing VLDL synthesis. When combined, lipid-modifying agents may reduce fasting and postprandial triglyceride secretion to an extent in which aerobic exercise cannot provide any additional benefit. These observations indicate that aerobic exercise and pharmacological strategies reduce serum triglycerides by similar mechanisms, which may attenuate the triglyceride-lowering capacity of the concordant treatment.