Effects of Modifying Triglycerides and Triglyceride-rich Lipoproteins on Cardiovascular Outcomes

Fruits of Wild-Grown Shrubs for Health Nutrition

Cultivated fruits and berries, such as raspberries, strawberries, black currants, cherries, blueberries, are generally recognized sources of antioxidants, vitamins, minerals, and other substances beneficial to human health and well-being. However, there are also wild berries and fruits that are of undoubted interest as food products having valuable medicinal properties due to the presence of phenolic compounds, antioxidants, and vitamins. These fruits have a great potential to be used in functional food making. The present review is dedicated to fruits of wild-grown shrubs Bird cherry (Prunus padus L.), Rowan berry (Sorbus aucuparia L.), Guelder rose (Viburnum opulus L.), Black elderberry (Sambucus nigra L.), and Barberry (Berberis vulgaris L.) The chemical compositions of these wild berries are described as well as their effects on the improvement of human health proved by clinical trials and epidemiological studies. The possibilities of using the fruits of wild-grown shrubs in the preparation of functional foods and examples of their implementation for the manufacturing of dairy, bakery and meat products are considered.

Effects of high-grain diet feeding on fatty acid profiles in milk, blood, muscle, and adipose tissue, and transcriptional expression of lipid-related genes in muscle and adipose tissue of dairy cows

BACKGROUND

High-grain (HG) diets affect lipid metabolism in the liver and mammary tissue of dairy cows, but its effects on muscle and adipose tissue have not been wide evaluated. Thus, the aim of this study is to clarify this issue.

METHODS

Twelve Holstein cows were randomly divided into two groups: conventional diet group (CON, n = 6) and the HG diet group (n = 6). On day 7 of week 4, rumen fluid was sampled to measure pH, milk was sampled to measure components, and blood was sampled to measure biochemical parameters and fatty acid composition. After the experiment, cows were slaughtered to collect muscle and adipose tissue for fatty acid composition and transcriptome analysis.

RESULTS

HG feeding decreased the ruminal pH, milk's fat content and long-chain fatty acid proportion (P < 0.05) and increased the proportion of short- and medium-chain fatty acids in the milk (P < 0.05) as compared with CON diets. The concentrations of blood cholesterol, low-density lipoprotein, and polyunsaturated fatty acids in the HG cows were lower than those in CON cows (P < 0.05). In muscle tissue, HG feeding tended to increase the triacylglycerol (TG) concentration (P < 0.10). Transcriptome analysis revealed changes in the biosynthesis of the unsaturated fatty acids pathway, the regulation of lipolysis in the adipocytes pathway, and the PPAR signalling pathway. In adipose tissue, HG feeding increased the concentration of TG and decreased the concentration of C18:1 cis9 (P < 0.05). At the transcriptome level, the fatty acid biosynthesis pathway, linoleic acid metabolism pathway, and PPAR signalling pathway were activated.

CONCLUSION

HG feeding leads to subacute rumen acidosis and a decreased milk fat content. The fatty acid profiles in the milk and plasma of dairy cows were changed by HG feeding. In muscle and adipose tissue, HG feeding increased TG concentration and up-regulated the expression of genes related to adipogenesis, while down-regulated the expression of genes related to lipid transport. These results complement our knowledge of the fatty acid composition of muscle and adipose tissue in dairy cows and expand our understanding of the mechanisms by which HG diets affect lipid metabolism in muscle and adipose tissue.

Starch-protein interaction effects on lipid metabolism and gut microbes in host

The purpose of this experiment was to investigate the effects of different starch and protein levels on lipid metabolism and gut microbes in mice of different genders. A total of 160 male mice were randomly assigned to sixteen groups and fed a 4 × 4 Latin square design with dietary protein concentrations of 16, 18, 20, and 22%, and starch concentrations of 50, 52, 54, and 56%, respectively. The results of the study showed that different proportions of starch and protein had obvious effects on the liver index of mice, and there was a significant interaction between starch and protein on the liver index (p = 0.005). Compared with other protein ratio diets, 18% protein diet significantly increased the serum TBA concentration of mice (p < 0.001), and different starch ratio diets had no effect on serum TBA concentration (p = 0.442). It was proved from the results of ileal tissue HE staining that the low protein diet and the low starch diet were more favorable. There was a significant interaction between diets with different starch and protein levels on Bacteroidetes, Firmicutes and Proteobacteria abundance in feces of mice (p < 0.001). Compared with 16 and 18% protein ratio diets, both 20 and 22% protein diets significantly decreased the Parabacteroides and Alistipes abundance in feces of mice (p < 0.05), and 52% starch ratio diet significantly decreased the Parabacteroides and Alistipes abundance than 50% starch ratio diet of mice (p < 0.05). There was a significant interaction between diets with different starch and protein levels on Parabacteroides (p = 0.014) and Alistipes (p = 0.001) abundance in feces of mice. Taken together, our results suggest that a low protein and starch diet can alter lipid metabolism and gut microbes in mice.

Determining independence and associations among various cardiovascular disease risk factors in 9-12 years old school-children: a cross sectional study

BACKGROUND

Cardiovascular disease (CVD) risk assessment of children typically includes evaluating multiple CVD risk factors some of which tend to correlate each other. However, in older children and young adolescents, there are little data on the level of independence of CVD risk factors. The purpose of this study was to examine the relationships among various CVD risk factors to determine the level of independence of each risk factor in a sample of 5th-grade public school students.

METHOD

A cross-sectional analysis of 1525 children (856 girls and 669 boys; age: 9-12 years) who participated in baseline CVD risk assessment for the (S)Partners for Heart Health program from 2010 - 2018. Thirteen CVD risk factor variables were used in the analysis and included blood lipids [low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglycerides], resting systolic and diastolic blood pressure (BP); anthropometrics [height, weight, body mass index (BMI), % body fat, waist circumference (WC)]. Additionally, acanthosis nigricans (a marker insulin resistance and diabetes), and cardiorespiratory fitness (VO2 ml/kg) was estimated using the PACER. Descriptive statistics, bivariate Pearson correlations, and principal component analysis were used to determine the relationships among these variables and the independence.

RESULTS

Parallel analysis indicated two components should be extracted. Among the two components extracted, WC, % body fat, and BMI loaded highest on component 1, which explained 34% of the total variance. Systolic BP and diastolic BP loaded predominantly on component 2 and accounted for 17% of the variance. Cardiorespiratory fitness, acanthosis nigricans, HDL, and triglycerides loaded highest on the first component (loadings between 0.42 and 0.57) but still suggest some non-shared variance with this component. Low-density lipoprotein had low loadings on each component. Factor loadings were stable across sex.

CONCLUSION

Among the various CVD risk indicators, measures of adiposity loaded highest on the component that explained the largest proportion of variability in the data reinforcing the importance of assessing adiposity in CVD risk assessment. In addition, blood pressure loaded highest on the second component, suggesting their relative independence when assessing CVD risk. The data also provide support and rationale for determining what CVD risk factors to include- based on resource needs. For example, researchers or public health programs may choose to assess WC instead of lipid profile for cardiovascular related problems if ease of assessment and cost are considerations.

Effects of Diets With Different Protein Levels on Lipid Metabolism and Gut Microbes in the Host of Different Genders

The purpose of this experiment was to investigate the effects of different protein levels on lipid metabolism and gut microbes in mice of different genders. A total of 60 mice (30 female and 30 male) were randomly assigned to six groups and fed female mice with low protein diet (FLP), basal protein diet (FBD), and high protein diet (FHP). Similarly, the male mice fed with low protein diet (MLP), basal protein diet (MBD), and high protein diet (MHP). The low protein diet contained 14% CP, the basal diet contained 20% CP, and the high protein diet contained 26% CP. The results of the study showed that both basal and high protein diets significantly reduced the perirenal adipose tissues (PEAT) index in male mice compared to low protein diet (p < 0.05). For the gut, the FHP significantly increased the relative gut weight compared to the FBD and FLP (p < 0.05). At the same time, the FHP also significantly increased the relative gut length compared with the FBD and FLP (p < 0.05). The MHP significantly increased TC concentration compared with the MLP (p < 0.05), and the MBD tended to increase TC concentration compared with the MLP in serum (p = 0.084). The histomorphology result of the jejunum and ileum showed that a low protein diet was beneficial to the digestion and absorption of nutrients in the small intestine of mice. While different protein levels had no effect on the total number of fecal microbial species in mice, different protein levels had a significant effect on certain fecal microbes in mice, the absolute abundance of Verrucomicrobia in the feces of male mice was significantly higher in both high and basal protein diets than in the low protein diet (p < 0.05). The high protein diet significantly reduced the absolute abundance of Patescibacteria in the feces of female mice compared to both the basal and low protein diets (p < 0.05). The absolute abundance of Patescibacteria in male feces was not affected by dietary protein levels (p > 0.05). Taken together, our results suggest that a low protein diet can alter fat deposition and lipid metabolism in mice, and that it benefited small intestinal epithelial structure and microbes.

Effects of spent mushroom Cordyceps militaris supplementation on apparent digestibility, rumen fermentation, and blood metabolite parameters of goats

The objective of this experiment was to study the effects of dried spent mushroom Cordyceps militaris (SMCM) supplementation on digestibility, rumen fermentation, and blood metabolite parameters in goats. When the mushroom production and harvesting was complete, SMCM was collected fresh from a mushroom farm. Four 18-mo-old male crossbred (Thai Native × Anglo Nubian) goats with initial BW of 26.0 ± 1.40 kg were randomly assigned according to a 4 × 4 Latin square design to receive four different levels of SMCM at 0, 100, 200, and 300 g/d. There were quadratic effects (P < 0.06) on apparent digestibility of DM, OM, CP, NDF, and ADF among treatment groups, and greater values for the goats fed SMCM at 100 g/d were observed. A quadratic effect in energy intake (ME, Mcal/kg DM) (P = 0.02), with greater values for the goats fed SMCM at 100 g/d, was also observed. Rumen temperature was similar among groups (P = 0.23), whereas feeding of SMCM linearly decreased (P = 0.001) ruminal pH with increasing SMCM supplementation. Supplementing SMCM linearly decreased plasma concentration of cholesterol (P = 0.01), and there was also a tendency of reduction in plasma concentration of triglyceride (P = 0.10), with greater values for the goats fed SMCM at 100 g/d. There were quadratic effects on plasma of total protein, HgB, and MCHC among treatment groups. However, there were quadratic effects on fecal N (P = 0.04) and nitrogen retention (P = 0.07) based on g/d/animal or percentage of nitrogen retained (P = 0.01) among treatment groups, and greater values for the goats fed SMCM at 100 g/d were observed. Based on this experiment, it could be concluded that supplementing goat diets with SMCM at 100 to 200 g/d results in improved apparent digestibility of nutrients and blood metabolites, suggesting that SMCM has positive functions as a feed additive to improve energy substance metabolism and contribute to glyconeogenesis.

The lipid-lowering effects of Danhong and Huangqi injections: a meta-analysis of clinical controlled trials

Background

Dyslipidaemia is a major risk factor for coronary heart disease (CHD). Danhong and Huangqi injections, two traditional Chinese medicine prescriptions, have been widely studied regarding their lipid-lowering properties. However, the results were inconsistent and inconclusive. Thus, we conducted this meta-analysis of clinical controlled trials to clarify the lipid-lowering effects of Danhong and Huangqi injections.

Methods

The databases including PubMed, Google Scholar, Web of Science, Cochrane Library, Wanfang Database, CNKI and VIP were searched. The following information was obtained from each study: first author, age, gender, ethnicity, health condition, treatment dose, treatment duration, sample size, mean and standard deviation or standard error of lipid variables before and after treatment. The changes in lipid levels from pre- to post-treatment were calculated and compared between the control groups and the treatment groups in this meta-analysis.

Results

Forty-four studies (5021 subjects) and 7 studies (542 subjects) were respectively identified for Danhong and Huangqi injections. Compared with the control groups, Danhong injection yielded a significant reduction in triglycerides (TG) [standardized mean difference (SMD) = − 0.76, 95% confidence interval (CI) = (− 0.91, − 0.61), P <  0.001], total cholesterol (TC) [SMD = − 1.29, 95% CI = (− 1.56, − 1.03), P <  0.001] and low-density lipoprotein cholesterol (LDL-C) [SMD = − 0.76, 95% CI = (− 0.93, − 0.59), P <  0.001], and a significant elevation in high-density lipoprotein cholesterol (HDL-C) [SMD = 0.70, 95% CI = (0.41, 0.98), P <  0.001]. Regarding Huangqi injection, it yielded a significant reduction in TC [SMD = − 1.13, 95% CI = (− 2.09, − 0.16), P = 0.02] and marginally in TG [SMD = − 1.27, 95% CI = (− 2.53, 0.00), P = 0.05] comparing with the control groups.

Conclusions

Danhong injection can effectively decrease the plasma levels of TG, TC and LDL-C, and increase HDL-C levels. Huangqi injection also has significant effects on TG and TC reduction, but not as powerful as Danhong injection.

Electronic supplementary material

The online version of this article (10.1186/s12944-018-0760-2) contains supplementary material, which is available to authorized users.

Effects of Anthocyanin on Serum Lipids in Dyslipidemia Patients: A Systematic Review and Meta-Analysis

Background

Dyslipidemia was present in most of the patients with coronary heart disease. Epidemiological evidence suggests that anthocyanin has some effects on the serum lipid. However, these results are controversial. This study aimed at collecting current clinical evidence and evaluating the effects of anthocyanin supplementation on total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in dialysis patients.

Methods

The search included PubMed, Web of Science, MEDLINE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database (up to July 2015) to identify randomized controlled trials (RCTs) on the association between anthocyanin and serum lipids. RevMan (version 5.2) was used for Meta-analysis. Meta-regression analysis, sensitivity analysis and Egger’s weighted regression tests were performed by using STATA software (version 12.0; StatCorp, College Station, TX, USA).

Results

Six studies (seven arms) involving 586 subjects were included in this meta-analysis. The results showed that anthocyanin supplementation has significant effects on TC [MD = -24.06, 95% CI(-45.58 to -2.64) mg/dL, I² = 93%], TG [MD = -26.14, 95%CI(-40.20 to -3.08) mg/dL, I² = 66%1], LDL-C [MD = -22.10, 95% CI (-34.36 to -9.85) mg/dL, I² = 61%], and HDL-C(MD = 5.58, 95% CI (1.02 to 10.14) mg/dL;I² = 90%).

Conclusion

Anthocyanin supplementation significantly reduces serum TC, TG, and LDL-C levels in patients with dyslipidemia, and increases HDL-C. Further rigorously designed RCTs with larger sample sizes are needed to confirm the effectiveness of anthocyanin supplementation for dyslipidemia, especially hypo high density lipoprotein cholesterolemia.

Triglyceride Treatment in the Age of Cholesterol Reduction

Cholesterol reduction has markedly reduced major cardiovascular disease (CVD) events and shown regression of atherosclerosis in some studies. However, CVD has for decades also been associated with increased levels of circulating triglyceride (TG)-rich lipoproteins. Whether this is due to a direct toxic effect of these lipoproteins on arteries or whether this is merely an association is unresolved. More recent genetic analyses have linked genes that modulate TG metabolism with CVD. Moreover, analyses of subgroups of hypertriglyceridemic (HTG) subjects in clinical trials using fibric acid drugs have been interpreted as evidence that TG reduction reduces CVD events. This review will focus on how HTG might cause CVD, whether TG reduction makes a difference, what pathophysiological defects cause HTG, and what options are available for treatment.

Systematic review and meta-analysis of randomised controlled trials testing the effects of vitamin C supplementation on blood lipids

BACKGROUND & AIMS

Randomised controlled trials (RCTs) in humans revealed contradictory results regarding the effect of vitamin C supplementation on blood lipids. We aimed to conduct a systematic review and meta-analysis of RCTs investigating the effect of vitamin C supplementation on total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triglycerides and to determine whether the effects are modified by the participants' or intervention characteristics.

METHODS

Four databases (PubMed, Embase, Scopus and Cochrane Library) were searched from inception until August 2014 for RCTs supplementing adult participants with vitamin C for ≥ 2 weeks and reporting changes in blood lipids.

RESULTS

Overall, vitamin C supplementation did not change blood lipids concentration significantly. However, supplementation reduced total cholesterol in younger participants (≤52 years age) (-0.26 mmol/L, 95% CI: -0.45, -0.07) and LDL-C in healthy participants (-0.32 mmol/L, 95% CI: -0.57, -0.07). In diabetics, vitamin C supplementation reduced triglycerides significantly (-0.15 mmol/L, 95% CI: -0.30, -0.002) and increased HDL-C significantly (0.06 mmol/L, 95% CI: 0.02, 0.11). Meta-regression analyses showed the changes in total cholesterol (β: -0.24, CI: -0.36, -0.11) and in triglycerides (β: -0.17, CI: -0.30, -0.05) following vitamin C supplementation were greater in those with higher concentrations of these lipids at baseline. Greater increase in HDL-C was observed in participants with lower baseline plasma concentrations of vitamin C (β: -0.002, CI: -0.003, -0.0001).

CONCLUSIONS

Overall, vitamin C supplementation had no significant effect on lipid profile. However, subgroup and sensitivity analyses showed significant reductions in blood lipids following supplementation in sub-populations with dyslipidaemia or low vitamin C status at baseline. PROSPERO Database registration: CRD42014013487, http://www.crd.york.ac.uk/prospero/.

Influence of glucose-lowering rate on CKMB and myoglobin serum levels in type-2 diabetes patients with coronary heart disease

OBJECTIVE

To analyze the level of creatine kinase isoenzyme (CKMB), myoglobin, to explore the influence of different glucose-lowering rate on cardiac enzyme in type 2 diabetes mellitus patients with coronary heart disease (T2DMC), to search for the rational glucose-lowering rate.

METHODS

A total number of 293 type 2 diabetic patients who were hospitalized in the First Affiliated Hospital of Harbin Medical University from May 2008 to December 2009 were recruited. Two groups were divided according to the coronary angiography. 142 subjects of type 2 diabetes mellitus (T2DM) and 151 subjects of T2DMC received intensive glucose therapy. After CKMB and myoglobin being measured, variation and correlation factors were evaluated.

RESULTS

In T2DM group, the level of CKMB was significantly lower at follow-up than that before intensive therapy. Then, we got four subgroups according to the glucose-lowering rate. In T2DM group, when the fasting or postprandial glucose-lowering rate was no more than 6 mmolL(-1)d(-1), the level of CKMB and myoglobin were significantly lower than that before intensive therapy (P<0.05). When the fasting glucose-lowering rate is faster than 6 mmolL(-1)d(-1), the level of CKMB is significantly higher after intensive therapy than that before glucose-lowering (P<0.05). In T2DMC group, when the fasting or postprandial glucose-lowering rate was not more than 4 mmolL(-1)d(-1), the level of CKMB and myoglobin was significantly lower than that before intensive therapy (P<0.05, P<0.01). When the fasting glucose-lowering rate was faster than 4 mmolL(-1)d(-1), the level of CKMB and myoglobin was significantly higher at follow-up than that before intensive therapy (P<0.05). Before intensive therapy, high density lipoprotein cholesterol (HDL-C) has a negative linear regression relationship with CKMB (P<0.01). Low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) and glycosylated hemoglobin A1c (HbA1c) have a positive linear regression relationship with CKMB (P<0.05). HDL-C has a negative linear regression relationship with myoglobin (P<0.01). LDL-C and TG have a positive linear regression relationship with myoglobin (P<0.01).

CONCLUSIONS

T2DM patients, no matter with CHD or not, all have a rational fasting glucose-lowering rate; the fasting glucose-lowering rate is more susceptible to myocardial damage anticipation than the postprandial glucose-lowering rate.

Prevalence of lipid abnormalities and attainment of normal lipid levels among patients with dyslipidaemia: a pooled analysis of observational studies from five Asian countries

AIMS

Guidelines emphasise the importance of low-density lipoprotein cholesterol (LDL-C) goals for cardiovascular risk reduction. Given the importance of association between high-density lipoprotein (HDL-C) and triglycerides (TG) normal levels and cardiovascular risk, there is an additional need to further evaluate diverse dyslipidaemic populations.

METHODS

A retrospective longitudinal observational study of patients aged ≥ 35 years on lipid-modifying therapy (LMT) for ≥ 12 months was conducted from patient records pooled from five Asian countries (Malaysia, Korea, Hong Kong, Thailand and Philippines). The prevalence of lipid abnormalities and goal attainment was assessed 12 months before and after LMT initiation.

RESULTS

Among 3256 patients (mean age - 58.6 years, 50.4% men), 65.4% were high-risk patients and 88% were on statin therapy. At baseline 94.7% of all patients had at least one abnormal lipid value elevated, LDL-C (86.2%) being the most prevalent. Non-smokers [OR (95% CI): 1.42 (1.08-1.87)], non-diabetics [2.35 (1.96-2.82)], non-cardiovascular disease patients [1.77 (1.42-2.21)] and those from Korea [2.56 (1.83-3.59)] were more likely to attain LDL-C goals. On the contrary, women [0.82 (0.68-0.98)], subjects with FRS > 20% [0.56 (0.41-0.77)] those from Malaysia [0.55 (0.39-0.77)] and the Philippines [0.18 (0.12-0.28)] were less likely to reach LDL-C goals. Fewer characteristics were independently associated with reaching normal levels of HDL-C and TG and attaining at least two normal lipid levels.

CONCLUSIONS

While current LMT reduced the prevalence of dyslipidaemia, a third of patients still failed to achieve target/normal levels. We highlight country differences and the importance of improving therapy to attain multiple lipid goals/normal levels.

Attainment of normal lipid levels among high cardiovascular risk patients: pooled analysis of observational studies from the United Kingdom, Sweden, Spain and Canada

BACKGROUND

Although low-density lipoprotein cholesterol (LDL-C) is the primary lipid target for cardiovascular disease (CVD) risk reduction, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) have also emerged as risk factors. This study evaluated attainment of goal/normal lipid levels in current clinical practice among high-risk patients following lipid-modifying therapy (LMT).

METHODS

Data for patients aged ≥35years and on LMT for ≥12months were identified from electronic medical records (United Kingdom and Sweden) and extracted from medical charts (Canada and Spain). High CVD risk was defined according to the Adult Treatment Panel III guidelines. An index period was defined, from January 1995-July 2008, during which patients received an initial LMT prescription. Prevalence of lipid abnormalities was assessed 12months before and after the index date. Multivariate logistic regressions evaluated predictors of attaining goal/normal lipid levels.

RESULTS

Among 12,768 high-risk patients, 75% had elevated LDL-C, 37% low HDL-C, and 30% elevated TG before LMT. Despite therapy (97% statins only), 23% had elevated LDL-C, 36% low HDL-C, 16% elevated TG, and 17% had ≥2 abnormal lipid levels. Framingham risk score >20% (Odds Ratio, 95% confidence interval: 0.37,0.31-0.43), diabetes (0.75,0.64-0.88), hypertension (1.26,1.09-1.46), current smoker (0.82,0.70-0.95) and increased body mass index (0.95,0.94-0.96) were associated with the likelihood of attaining ≥2 normal lipid levels (vs. LDL-C goal only).

CONCLUSION

Current approaches to lipid management improve LDL-C goal attainment; however, control of multiple lipid risk factors remains poor. Patients may benefit from more comprehensive approaches to lipid management, which treat multiple lipid abnormalities, as suggested in clinical guidelines.

Plasma NOV/CCN3 levels are closely associated with obesity in patients with metabolic disorders

OBJECTIVE

Evidence points to a founder of the multifunctional CCN family, NOV/CCN3, as a circulating molecule involved in cardiac development, vascular homeostasis and inflammation. No data are available on the relationship between plasma NOV/CCN3 levels and cardiovascular risk factors in humans. This study investigated the possible relationship between plasma NOV levels and cardiovascular risk factors in humans.

METHODS

NOV levels were measured in the plasma from 594 adults with a hyperlipidemia history and/or with lipid-lowering therapy and/or a body mass index (BMI) >30 kg/m(2). Correlations were measured between NOV plasma levels and various parameters, including BMI, fat mass, and plasma triglycerides, cholesterol, glucose, and C-reactive protein. NOV expression was also evaluated in adipose tissue from obese patients and rodents and in primary cultures of adipocytes and macrophages.

RESULTS

After full multivariate adjustment, we detected a strong positive correlation between plasma NOV and BMI (r = 0.36 p<0.0001) and fat mass (r = 0.33 p<0.0005). According to quintiles, this relationship appeared to be linear. NOV levels were also positively correlated with C-reactive protein but not with total cholesterol, LDL-C or blood glucose. In patients with drastic weight loss induced by Roux-en-Y bariatric surgery, circulating NOV levels decreased by 28% (p<0.02) and 48% (p<0.0001) after 3 and 6 months, respectively, following surgery. In adipose tissue from obese patients, and in human primary cultures NOV protein was detected in adipocytes and macrophages. In mice fed a high fat diet NOV plasma levels and its expression in adipose tissue were also significantly increased compared to controls fed a standard diet.

CONCLUSION

Our results strongly suggest that in obese humans and mice plasma NOV levels positively correlated with NOV expression in adipose tissue, and support a possible contribution of NOV to obesity-related inflammation.

Effect of high-intensity interval exercise on basal triglyceride metabolism in non-obese men

A single bout of high-intensity interval aerobic exercise has been shown to produce the same or greater metabolic benefits as continuous endurance exercise with considerably less energy expenditure, but whether this applies to very low density lipoprotein (VLDL) metabolism is not known. We sought to examine the effect of a single bout of high-intensity interval aerobic exercise on basal VLDL-triglyceride (TG) kinetics 14 and 48 h after exercise cessation to determine the acute and time-dependent effects of this type of exercise on VLDL-TG metabolism. Eight healthy sedentary men (age, 23.6 ± 6.1 years; body mass index, 23.1 ± 2.2 kg·m(-2), peak oxygen consumption (V̇O2peak), 36.3 ± 5.5 mL·kg(-1)·min(-1)) participated in three stable isotopically labeled tracer infusion studies: (i) 14 h and (ii) 48 h after a single bout of high-intensity aerobic interval exercise (60% and 90% of V̇O2peak in 4 min intervals for a total of 32 min; gross energy expenditure ∼500 kcal) and (iii) after an equivalent period of rest, in random order. Fasting plasma VLDL-TG concentration was 20% lower at 14 h (P = 0.046) but not at 48 h (P = 1.000) after exercise compared with the resting trial. VLDL-TG plasma clearance rate increased by 21% at 14 h (P < 0.001) but not at 48 h (P = 0.299) after exercise compared with rest, whereas hepatic VLDL-TG secretion rate was not different from rest at any time point after exercise. We conclude that high-intensity interval exercise reduces fasting plasma VLDL-TG concentrations in non-obese men the next day by augmenting VLDL-TG clearance, just like a single bout of continuous endurance exercise. This effect is short-lived and abolished by 48 h after exercise.

Acute effects of exercise and calorie restriction on triglyceride metabolism in women

PURPOSE

The mechanisms by which exercise reduces fasting plasma triglyceride (TG) concentrations in women and the effect of negative energy balance independent of muscular contraction are not known.The aim of this study was to evaluate the effects of equivalent energy deficits induced by exercise or calorie restriction on basal VLDL-TG metabolism in women.

METHODS

Eleven healthy women (age = 23.5 ± 2.7 yr, body mass index = 21.6 ± 1.4 kg·m-2; mean ± SD) underwent a stable isotopically labeled tracer infusion study to determine basal VLDL-TG kinetics after performing, in random order, three experimental trials on the previous day: (i) a single exercise bout (brisk walking at 60% of peak oxygen consumption for 123 ± 18 min, with a net energy expenditure of 2.06 ± 0.39 MJ, ∼500 kcal), (ii) dietary energy restriction of 2.10 ± 0.41 MJ, and (iii) a control day of isocaloric feeding and rest (zero energy balance).

RESULTS

Fasting plasma VLDL-TG concentration was approximately 30% lower after the exercise trial compared with the control trial (P < 0.001), whereas no significant change was detected after the calorie restriction trial (P = 0.297 vs control). Relative to the control condition, exercise increased the plasma clearance rate of VLDL-TG by 22% (P = 0.001) and reduced hepatic VLDL-TG secretion rate by approximately 17% (P = 0.042), whereas hypocaloric diet had no effect on VLDL-TG kinetics (P > 0.2).

CONCLUSION

(i) Exercise-induced hypotriglyceridemia in women manifests through a different mechanism (increased clearance and decreased secretion of VLDL-TG) than that previously described in men (increased clearance of VLDL-TG only), and (ii) exercise affects TG homeostasis by eliciting changes in VLDL-TG kinetics that cannot be reproduced by an equivalent diet-induced energy deficit, indicating that these changes are independent of the exercise-induced negative energy balance but instead are specific to muscular contraction.

Food combinations for cholesterol lowering

Reducing elevated LDL-cholesterol is a key public health challenge. There is substantial evidence from randomised controlled trials (RCT) that a number of foods and food components can significantly reduce LDL-cholesterol. Data from RCT have been reviewed to determine whether effects are additive when two or more of these components are consumed together. Typically components, such as plant stanols and sterols, soya protein, β-glucans and tree nuts, when consumed individually at their target rate, reduce LDL-cholesterol by 3-9 %. Improved dietary fat quality, achieved by replacing SFA with unsaturated fat, reduces LDL-cholesterol and can increase HDL-cholesterol, further improving blood lipid profile. It appears that the effect of combining these interventions is largely additive; however, compliance with multiple changes may reduce over time. Food combinations used in ten 'portfolio diet' studies have been reviewed. In clinical efficacy studies of about 1 month where all foods were provided, LDL-cholesterol is reduced by 22-30 %, whereas in community-based studies of >6 months' duration, where dietary advice is the basis of the intervention, reduction in LDL-cholesterol is about 15 %. Inclusion of MUFA into 'portfolio diets' increases HDL-cholesterol, in addition to LDL-cholesterol effects. Compliance with some of these dietary changes can be achieved more easily compared with others. By careful food component selection, appropriate to the individual, the effect of including only two components in the diet with good compliance could be a sustainable 10 % reduction in LDL-cholesterol; this is sufficient to make a substantial impact on cholesterol management and reduce the need for pharmaceutical intervention.

Attainment of normal lipid levels among patients on lipid-modifying therapy in Hong Kong

INTRODUCTION

Although low-density lipoprotein cholesterol (LDL-C) is the primary lipid target for coronary heart disease (CHD) risk reduction, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) have also emerged as CHD risk factors. The objective of this study was to evaluate attainment of lipid goals and normal levels following lipid-modifying therapy (LMT) and its predictors in a representative sample of Chinese patients from Hong Kong.

METHODS

Using longitudinal data collected from patient medical records, the study identified 706 patients who initiated LMT from January 2004 to December 2006 and had full lipid panels 12 months before and after therapy. LDL-C goals and normal levels of HDL-C and TG were defined according to the National Cholesterol Education Program Adult Treatment Panel 3 guidelines. Patients with previous CHD, diabetes, and 10-year CHD risk > 20% were classified as high risk. Multiple logistic regressions evaluated predictors of normal lipid-level attainment.

RESULTS

Among 706 patients (mean age 64.6 years, 58.6% male), 71.7% had elevated LDL-C, 32.4% had low HDL-C, and 24.9% had elevated TG before LMT. Despite therapy (91.2% statins only), 22.7% had elevated LDL-C, 31.9% had low HDL-C, 12.3% had elevated TG, and 13.9% had multiple abnormal lipid levels. The strongest predictors of attaining ≥ 2 normal lipid levels included male gender (odds ratio [OR]: 2.11 [1.12 to 4.01]), diabetes (OR: 0.43 [0.23 to 0.78]), obesity (OR: 0.91 [0.86 to 0.97]), and CHD risk > 20% (OR: 0.33 [0.15 to 0.71]).

CONCLUSIONS

Current approaches to lipid management in Hong Kong, primarily using statins, considerably improve attainment of LDL-C goal. However, a large proportion of patients do not achieve normal HDL-C levels and control of multiple lipid parameters remains poor. Patients could benefit from a more comprehensive approach to lipid management that treats all three lipid risk factors, as suggested in clinical guidelines.

Triglycerides and cardiovascular risk

In 1996 a meta-analysis was published showing that an increase in plasma triglyceride (TG) levels was associated with an increase in CHD risk, even after adjustment for high density lipoprotein cholesterol (HDL-C) levels. Very recently, two studies were published that further extent the early observation and showed the importance of nonfasting plasma triglyceride (TG) levels in the prediction of risk on coronary heart disease (CHD). In the current review we have summarized all available evidence obtained in clinical studies showing that treatment guidelines should reconsider to include nonfasting TG in their risk assessments as nonfasting TG levels may better predict CVD risk.

Association between extended-release niacin treatment and glycemic control in patients with type 2 diabetes mellitus: analysis of an administrative-claims database

The aim of the study was to evaluate trends in antihyperglycemic agents (AHAs) use in patients with type 2 diabetes mellitus (T2DM) newly initiating extended-release niacin (ERN) compared with other lipid-modifying therapy (LMT). United States administrative-claims data identified adults with T2DM on AHAs who received a new prescription for ERN or another LMT between January 2001 and June 2003 (index date), and these adults were followed for 12 months. Inclusion criteria were (1) stable T2DM as defined by International Classification of Diseases, Ninth Revision, codes and also receiving at least 2 AHA prescriptions 12 to 24 months before initiating ERN or LMT treatment and (2) at least 2 prescriptions within 12 months before the onset of ERN or LMT. Trends in AHA prescriptions 12 months before (baseline) and after (follow-up) index date were defined as (1) no change (ie, stable T2DM), (2) increased (ie, worsening T2DM), or (3) reduced (ie, improved T2DM). Among 3799 patients with T2DM, 392 (10.3%) were treated with ERN and 3407 (89.7%) were treated with other LMT. In the ERN cohort, 82.1% of patients experienced no change in AHA prescriptions between baseline and follow-up compared with 79.4% of patients in the LMT cohort (P = .20); 13% of the ERN cohort and 16% of the LMT cohort (P = .17) experienced a dose increase or the addition of another AHA; and 5% of both cohorts were prescribed fewer AHAs or switched to a lower dose (P = .92). Treatment with ERN (vs other types of LMT) did not significantly increase AHA use, implying that T2DM status did not worsen in this cohort.

Lipid trajectories as predictors of depressive symptoms: the Young Finns Study

OBJECTIVE

The aim of this study was to identify common trajectories of lipid levels across childhood and early adulthood life span.

DESIGN

The sample was a subpopulation of 824 young adults (3 to 9 years of age at baseline in 1980) of the ongoing population-based prospective Cardiovascular Risk in Young Finns Study. Lipid levels were determined in 1980, 1983, 1986, and 2001.

MAIN OUTCOME MEASURES

Depressive symptoms were assessed using a modified version of Beck's Depression Inventory (Beck, 1967) in 1992 and 2001.

RESULTS

The 2 triglycerides trajectories (steeply vs. moderately increasing) were differently related to depressive symptoms in adulthood. The trajectory showing steep increase over time was associated with higher level of depressive symptoms (M 2.18, 95% CI [2.08, 2.28] vs. 1.99, [1.95, 2.04]). This relationship persisted after adjustments for various risk factors. These triglycerides trajectories accounted for part of the association between high body mass index and depressive symptoms.

CONCLUSION

A pattern of steeply increasing triglyceride levels throughout childhood and adulthood may be associated with increased the risk of depressive symptoms in adulthood. This pattern may also be one link between obesity and depressive symptoms.

Nibbling versus feasting: which meal pattern is better for heart disease prevention?

Dietary interventions that limit saturated fat, cholesterol, and energy are generally implemented as the first line of therapy to reduce the risk of coronary heart disease (CHD). Another form of diet therapy that may be effective in protecting against CHD is altering meal frequency without limiting energy. Meal-frequency regimens are classified into two major forms: 1) feasting, i.e., consuming all energy needs in one meal/day, and 2) nibbling, i.e., consuming all energy needs in three, six, nine, 12, or 17 regimented meals/day. Whether one meal pattern, feasting or nibbling, is more effective at improving indicators of CHD risk than the other, remains unresolved. Moreover, whether a dose-dependent relationship exists between biomarker improvement and the number of meals consumed per day also remains unknown. The objective of the present review was to determine which meal pattern, nibbling or feasting, is more effective at improving key indicators of CHD risk in normal-weight and obese, non-diabetic individuals.

Prescription omega-3-acid ethyl esters for the treatment of very high triglycerides

Triglyceride (TG) levels can increase for numerous reasons, including a sedentary lifestyle, an unhealthy diet, especially one rich in refined carbohydrates, and comorbidities. According to the National Cholesterol Education Program (NCEP), the normal TG level is < 150 mg/dL. Patients with very high TG (VHTG) levels (> or = 500 mg/dL) should be promptly managed and treated to reach lipid treatment goals, as determined by the NCEP. Lowering TG levels is the primary management goal in these patients, while lowering low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol levels are secondary goals. Therapeutic lifestyle changes are often recommended initially for patients with elevated TGs; however, concomitant drug therapy is often required. Data show that intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) can significantly decrease serum TGs, along with plasma concentrations of certain lipoproteins. Omega-3-acid ethyl esters are available by prescription or as dietary supplements. Clinical trials in adult patients with VHTGs show that four 1 g capsules of prescription omega-3 fatty acids, which contain 465 mg of EPA and 375 mg of DHA per capsule, can effectively decrease TG levels by up to 45%, and is generally well tolerated.