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Williams O, Ting T, Matthews L, Block G, Block T, Teresi J, Eimicke J, Kong J, Silver S, Ravenell J, Mallaiah J, Jammalamadaka S, Nelson LM, Karmally W, Hankerson S. Community Health workers United to Reduce Colorectal cancer and cardiovascular disease among people at Higher risk (CHURCH): study protocol for a randomized controlled trial. Trials 2024; 25:283. [PMID: 38671470 PMCID: PMC11046862 DOI: 10.1186/s13063-024-08110-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polyps removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk. DESIGN AND METHODS We aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-month follow-up, and Life Simple7 (LS7)-a cardiovascular disease (CVD) risk score-at 6 months and 1 year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed-methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. DISCUSSION Church-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction. TRIAL REGISTRATION NCT05174286; clinicaltrials.gov; August 31st, 2023.
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Affiliation(s)
- Olajide Williams
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Tina Ting
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Lisa Matthews
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Gladys Block
- NutritionQuest and Turnaround Health, Berkeley, CA, USA
| | - Torin Block
- NutritionQuest and Turnaround Health, Berkeley, CA, USA
| | - Jeanne Teresi
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Joseph Eimicke
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Jian Kong
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Stephanie Silver
- Division of Medicine, Data Coordinating Center Unit, Columbia University Irving Medical Center, Stroud Center at New York State Psychiatric Institute, 622 West 168th Street, New York, NY, 10032, USA
| | - Joseph Ravenell
- New York University Grossman School of Medicine, Manhattan, NY, USA
| | - Janhavi Mallaiah
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Soujanya Jammalamadaka
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Laura Maudene Nelson
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Wahida Karmally
- Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
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2
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Williams O, Ting T, Matthews L, Block G, Block T, Teresi J, Eimicke J, Kong J, Silver S, Ravenell J, Mallaiah J, Jammalamadaka S, Nelson LM, Karmally W, Hankerson S. Community Health workers United to Reduce Colorectal cancer and cardiovascular disease among people at Higher risk (CHURCH): study protocol for a randomized controlled trial. Res Sq 2024:rs.3.rs-3797889. [PMID: 38659874 PMCID: PMC11042434 DOI: 10.21203/rs.3.rs-3797889/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: Colorectal cancer (CRC) is the second most lethal cancer in the United States (U.S.) with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, AAs are the least likely to undergo CRC screening, have precancerous colorectal polys removed, and have CRC detected at stages early enough for curative excision. In addition, compelling evidence links inflammatory dietary patterns to increased CRC and cardiovascular disease risk. Studies show that AA churches can successfully engage in health promotion activities including those related to cancer control. The current study seeks to leverage church-placed Community Health Workers (CHWs) to increase CRC screening and reduce CRC risk. Design and Methods: We aim to (1) increase guideline concordant CRC screening uptake using church-placed CHWs trained in screening with a validated instrument, Brief Intervention using Motivational Interviewing, and Referral to Treatment (SBIRT); and (2) reduce dietary risk factors (inflammatory dietary patterns) linked to CRC. The latter will be addressed by culturally adapting an existing, web-based lifestyle program called Alive!. Using a Hybrid Type 1 Implementation-Effectiveness cluster randomized design, we will randomize 22 AA churches into either the dual intervention arm (CHW-led SBIRT intervention plus Alive!) or a usual care arm comprised of CRC prevention educational pamphlets and a list of CRC screening sites. We will recruit 440 subjects and evaluate the effects of both arms on screening uptake (colonoscopy, fecal DNA) (primary outcome) and dietary inflammation score (secondary outcome) at 6-months follow up, and Life Simple7 (LS7) - a cardiovascular disease (CVD) risk score - at 6 months and 1-year (secondary outcome). Finally, guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR), we will conduct a mixed- methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. Discussion: Church-placed CHWs are trusted influential connectors between communities and health systems. Studies have shown that these CHWs can successfully implement health prevention protocols in churches, including those related to cancer control, making them potentially important community mediators of CRC screening uptake and CRC/CVD risk reduction. Trial registration: NCT05174286.
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Driggin E, Cohen LP, Gallagher D, Karmally W, Maddox T, Hummel SL, Carbone S, Maurer MS. Nutrition Assessment and Dietary Interventions in Heart Failure: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:1623-1635. [PMID: 35450580 PMCID: PMC9388228 DOI: 10.1016/j.jacc.2022.02.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 12/19/2022]
Abstract
Despite the high prevalence of nutrition disorders in patients with heart failure (HF), major HF guidelines lack specific nutrition recommendations. Because of the lack of standardized definitions and assessment tools to quantify nutritional status, nutrition disorders are often missed in patients with HF. Additionally, a wide range of dietary interventions and overall dietary patterns have been studied in this population. The resulting evidence of benefit is, however, conflicting, making it challenging to determine which strategies are the most beneficial. In this document, we review the available nutritional status assessment tools for patients with HF. In addition, we appraise the current evidence for dietary interventions in HF, including sodium restriction, obesity, malnutrition, dietary patterns, and specific macronutrient and micronutrient supplementation. Furthermore, we discuss the feasibility and challenges associated with the implementation of multimodal nutrition interventions and delineate potential solutions to facilitate addressing nutrition in patients with HF.
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Affiliation(s)
- Elissa Driggin
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
| | - Laura P Cohen
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Dympna Gallagher
- Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York, USA
| | - Wahida Karmally
- Columbia University Irving Medical Center, New York, New York, USA
| | - Thomas Maddox
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Scott L Hummel
- Ann Arbor Veterans Affairs Health System, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; Virginia Commonwealth University Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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Tanriover B, Lingvay I, Ahmed F, Sandikci B, Mohan S, Cremers S, Karmally W, Mohan P, Newhouse J, Ragunathan S, AbdulRahim N, Ariyamuthu VK, Ratner LE, Cohen DJ. Insulin Sensitivity After Living Donor Nephrectomy. Transplant Proc 2021; 53:1858-1864. [PMID: 34246476 DOI: 10.1016/j.transproceed.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/01/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The kidney is essential for glucose and insulin metabolism. Living kidney donors (LKDs) experience a reduction in glomerular filtration rate of 25 to 30 mL/min after donor nephrectomy. Little is known about the effect of glomerular filtration rate decline on insulin sensitivity in LKDs. METHODS We conducted a prospective pilot study on 9 LKDs (N = 9) who underwent dynamic metabolic testing (mixed meal tolerance test) to measure proxies of insulin sensitivity (homeostatic model assessment of insulin resistance, the area under curve [AUC] for insulin/glucose ratio, and Matsuda insulin sensitivity index) before and 3 months after donor nephrectomy. The primary outcome was the change in insulin sensitivity indices (delta [post-nephrectomy - pre-nephrectomy]). RESULTS Four of the donors had a body mass index (BMI) between 32.0 and 36.7 predonation. Post-donor nephrectomy, compared with prenephrectomy values, median insulin AUC increased from 60.7 to 101.7 hr*mU/mL (delta median 33.3, P = .04) without significant change in median glucose AUC levels from 228.9 to 209.3 hr*mg/dL (delta median 3.2, P = .77). There was an increase in the median homeostatic model assessment of insulin resistance from 2 to 2.9 (delta median 0.8, P = .03) and the AUC insulin/glucose ratio from 30.9 to 62.1 pmol/mmol (delta median 17.5, P = .001), whereas the median Matsuda insulin sensitivity index decreased from 5.9 to 2.9 (delta median -2, P = .05). The changes were more pronounced in obese (BMI >32) donors. CONCLUSION LKDs appear to have a trend toward a decline in insulin sensitivity post-donor nephrectomy in the short term, especially in obese donors (BMI >32). Further investigation with a larger sample size and longer follow-up is needed.
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Affiliation(s)
- Bekir Tanriover
- Division of Nephrology, University of Arizona College of Medicine, Tucson, Arizona.
| | - Ildiko Lingvay
- Division of Endocrinology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Firas Ahmed
- Department of Radiology, Columbia University Medical Center, New York, New York
| | | | - Sumit Mohan
- Division of Nephrology, Columbia University Medical Center, New York, New York
| | - Serge Cremers
- Biomarkers Core Laboratory, Columbia University Medical Center, New York, New York
| | - Wahida Karmally
- Biomarkers Core Laboratory, Columbia University Medical Center, New York, New York
| | - Prince Mohan
- Division of Nephrology, Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey Newhouse
- Division of Endocrinology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sneha Ragunathan
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Nashila AbdulRahim
- Division of Nephrology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Lloyd E Ratner
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - David J Cohen
- Division of Nephrology, Columbia University Medical Center, New York, New York
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Kalra D, Vijayaraghavan K, Sikand G, Desai NR, Joshi PH, Mehta A, Karmally W, Vani A, Sitafalwalla SJ, Puri R, Duell PB, Brown A. Prevention of atherosclerotic cardiovascular disease in South Asians in the US: A clinical perspective from the National Lipid Association. J Clin Lipidol 2021; 15:402-422. [PMID: 33846108 DOI: 10.1016/j.jacl.2021.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 12/24/2022]
Abstract
It is now well recognized that South Asians living in the US (SAUS) have a higher prevalence of atherosclerotic cardiovascular disease (ASCVD) that begins earlier and is more aggressive than age-matched people of other ethnicities. SA ancestry is now recognized as a risk enhancer in the US cholesterol treatment guidelines. The pathophysiology of this is not fully understood but may relate to insulin resistance, genetic and dietary factors, lack of physical exercise, visceral adiposity and other, yet undiscovered biologic mechanisms. In this expert consensus document, we review the epidemiology of ASCVD in this population, enumerate the challenges faced in tackling this problem, provide strategies for early screening and education of the community and their healthcare providers, and offer practical prevention strategies and culturally-tailored dietary advice to lower the rates of ASCVD in this cohort.
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Affiliation(s)
- Dinesh Kalra
- Division of Cardiology, Rush University Medical Center, 1620W. Harrison St, Kellogg Suite 320, Chicago, IL 60612, United States.
| | | | - Geeta Sikand
- University of California Irvine School of Medicine, Irvine, CA, United States
| | - Nihar R Desai
- Yale School of Medicine, New Haven, CT, United States
| | - Parag H Joshi
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Anurag Mehta
- Emory University School of Medicine, Atlanta, GA, United States
| | - Wahida Karmally
- Columbia University Irving Medical Center, New York, NY, United States
| | - Anish Vani
- New York University Langone Health, New York, NY, United States
| | | | - Raman Puri
- Lipid Association of India, New Delhi, India
| | - P Barton Duell
- Oregon Health and Science University, Portland, OR, United States
| | - Alan Brown
- Advocate Lutheran General Hospital, Park Ridge, IL, United States
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6
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Hummel SL, Rosenblum HR, Cornellier ML, Karmally W, Maurer MS. Reply: Calorie Intake, Post Discharge Outcomes in Heart Failure, and Food Insecurity. JACC Heart Fail 2020; 8:1052-1053. [PMID: 33272383 DOI: 10.1016/j.jchf.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022]
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7
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Massad S, Gebre-Medhin M, Dary O, Abdalla M, Holleran S, Karmally W, Bordelois P, Khammash U, Deckelbaum RJ. Micronutrient status of Palestinian school children following salt and flour fortification: a cross-sectional study. BMC Nutr 2020; 6:38. [PMID: 32864153 PMCID: PMC7448451 DOI: 10.1186/s40795-020-00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 07/30/2020] [Indexed: 12/02/2022] Open
Abstract
Background In 1996 and in 2006, Palestine initiated salt iodization and multiple micronutrient fortification of wheat flour, respectively as a strategy to prevent deficiencies of these nutrients. In 2009, we assessed the impact of these interventions on the health and nutritional status of schoolchildren residing in the West Bank. Methods We surveyed a sample of 22 schools run by the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the Palestinian Government. We randomly selected students from the first (mean age 6.7 years [SD 0.5]), sixth (11.8 years [0.6]), and ninth grades (14.8 years [0.6]). Data were obtained from 1484 (99%) of 1500 students planned for enrollment. Results Our results suggest that iodine intake appears adequate and there was essentially no iodine deficiency. As to the status of other micronutrients, the main nutritional micronutrient risks for schoolchildren in the West Bank continue to be low serum levels of iron, zinc, and vitamin B-12; folate levels were seemingly high. The overall prevalence of anemia was 9.6%, but there were pockets of anemia in certain districts. Almost 42% of the anemia in our sample was explained by iron deficiency. There were significant differences in iron deficiency between girls and boys, 29.5% vs. 15.7%, respectively (p = 0.0001). There were no cases of lead toxicity in the studied sample. Conclusions Wheat flour and salt fortification has had a major influence on improving the micronutrient status of Palestinian children, for some but not all micronutrients. The recommended key blood and biochemical parameters to be incorporated in the surveillance system are iron, zinc, and vitamin B12.
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Affiliation(s)
- Salwa Massad
- Juzoor for Health and Social Development, Ramallah, 970 Palestine
| | - Mehari Gebre-Medhin
- Department of Women's and Children's Health, Pediatrics, University Hospital, SE-751 85 Uppsala, Sweden
| | - Omar Dary
- USAID Bureau of Global Health, Washington, DC USA
| | - Marwah Abdalla
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - Steve Holleran
- Institute of Human Nutrition, Columbia University, New York, NY 10032 USA
| | - Wahida Karmally
- Irving Institute for Clinical and Translational Research, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - Paula Bordelois
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - Umaiyeh Khammash
- Juzoor for Health and Social Development, Ramallah, 970 Palestine
| | - Richard J Deckelbaum
- Institute of Human Nutrition, Columbia University, New York, NY 10032 USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032 USA
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Kris-Etherton PM, Stewart PW, Ginsberg HN, Tracy RP, Lefevre M, Elmer PJ, Berglund L, Ershow AG, Pearson TA, Ramakrishnan R, Holleran SF, Dennis BH, Champagne CM, Karmally W. The Type and Amount of Dietary Fat Affect Plasma Factor VIIc, Fibrinogen, and PAI-1 in Healthy Individuals and Individuals at High Cardiovascular Disease Risk: 2 Randomized Controlled Trials. J Nutr 2020; 150:2089-2100. [PMID: 32492148 PMCID: PMC7398773 DOI: 10.1093/jn/nxaa137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/12/2019] [Accepted: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Factor VIIc, fibrinogen, and plasminogen activator inhibitor 1 (PAI-1) are cardiovascular disease (CVD) risk factors and are modulated, in part, by fat type and amount. OBJECTIVE We evaluated fat type and amount on the primary outcomes: factor VIIc, fibrinogen, and PAI-1. METHODS In the Dietary Effects on Lipoproteins and Thrombogenic Activity (DELTA) Trial, 2 controlled crossover feeding studies evaluated substituting carbohydrate or MUFAs for SFAs. Study 1: healthy participants (n = 103) were provided with (8 wk) an average American diet [AAD; designed to provide 37% of energy (%E) as fat, 16% SFA], a Step 1 diet (30%E fat, 9% SFA), and a diet low in SFA (Low-Sat; 26%E fat, 5% SFA). Study 2: participants (n = 85) at risk for CVD and metabolic syndrome (MetSyn) were provided with (7 wk) an AAD, a step 1 diet, and a high-MUFA diet (designed to provide 37%E fat, 8% SFA, 22% MUFA). RESULTS Study 1: compared with AAD, the Step 1 and Low-Sat diets decreased mean factor VIIc by 1.8% and 2.6% (overall P = 0.0001), increased mean fibrinogen by 1.2% and 2.8% (P = 0.0141), and increased mean square root PAI-1 by 0.0% and 6.0% (P = 0.0037), respectively. Study 2: compared with AAD, the Step 1 and high-MUFA diets decreased mean factor VIIc by 4.1% and 3.2% (overall P < 0.0001), increased mean fibrinogen by 3.9% and 1.5% (P = 0.0083), and increased mean square-root PAI-1 by 2.0% and 5.8% (P = 0.1319), respectively. CONCLUSIONS Replacing SFA with carbohydrate decreased factor VIIc and increased fibrinogen in healthy and metabolically unhealthy individuals and also increased PAI-1 in healthy subjects. Replacing SFA with MUFA decreased factor VIIc and increased fibrinogen but less than carbohydrate. Our results indicate an uncertain effect of replacing SFA with carbohydrate or MUFA on cardiometabolic risk because of small changes in hemostatic factors and directionally different responses to decreasing SFA. This trial was registered at https://clinicaltrials.gov/ct2/show/NCT00000538?term=NCT00000538&rank=1 as NCT00000538.
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Affiliation(s)
- Penny M Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA,Address correspondence to PMK-E (e-mail: )
| | - Paul W Stewart
- Department of Biostatistics, Collaborative Studies Coordinating Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Henry N Ginsberg
- Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Russell P Tracy
- Colchester Research Facility, University of Vermont, Colchester, VT, USA
| | - Michael Lefevre
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA,Present address for ML: Department of Nutrition, Dietetics and Food Sciences, Utah State University, 9815 Old Main Hill, Logan, UT 84322-9815
| | - Patricia J Elmer
- Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN, USA,Present address for PJE: Portland, OR
| | - Lars Berglund
- Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA,Present address for LB: Clinical and Translational Science Center, UC-Davis, School of Medicine, Sacramento, CA
| | - Abby G Ershow
- Division of Heart and Vascular Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA,Present address for AGE: Office of Dietary Supplements, National Institutes of Health, Bethesda, MD
| | - Thomas A Pearson
- The Mary Imogene Bassett Research Institute, Cooperstown, NY, USA,School of Public Health, State University of New York at Albany, Albany, NY, USA,Columbia University College of Physicians and Surgeons, New York, NY, USA,Department of Community and Preventive Medicine, University of Rochester, Rochester, NY, USA,Present address for TAP: Department of Epidemiology, University of Florida, Gainesville, FL
| | - Rajasekhar Ramakrishnan
- Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Stephen F Holleran
- Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Barbara H Dennis
- Department of Biostatistics, Collaborative Studies Coordinating Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Present address for BHD: Chapel Hill, NC
| | - Catherine M Champagne
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Wahida Karmally
- Department of Medicine, Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - for the DELTA Investigators
GinsbergHenryMDPrincipal Investigator12RamakrishnanRajasekharDSc12KarmallyWahidaDrPH RD, CDE12BerglundLarsMD, PhD12SiddiquiMalihaMS, RD12ChenNiem-TzuMS12HolleranSteveBS12JohnsonColleenRD12HolemanRoberta12ChirgwinKaren12StennettKellye12GangaLencey12TowolawaiTajsudeenMBA12MyersMinnieBS12NgaiColleenBS12FontenezNelsonBS12JonesJeffBS12RodriguezCarmen12UsecheNorma12LefevreMichaelPhD13RoheimPaul SMDCo-Principal Investigators13
Deceased RyanDonnaMD13MostMarlenePhD, RD13ChampagneCatherinePhD, RD13WilliamsonDonaldPhD13TulleyRichardPhD13BrockRickyRN13BodinDeonneBS, MT13KennedyBettyMPA13BarkateMichelleMS, RD13FoustElizabethBS13YorkDeshoinBS13Kris-EthertonPennyPhD, RDPrincipal Investigator14JonnalagaddaSatyaPhD14DerrJanicePhD14Farhat-WoodAbirMS14MustadVikkiePhD14MeakerKateMS14MillsEdwardPhD14TilleyMary-AnnMS, RD14Smiciklas-WrightHelenPhD14Sigman-GrantMadeleinePhD, RD14YuShaomeiMS, PhD14GuinardJean-XavierPhD14SechevichPamelaMS14ReddyC ChannaPhD14MastroAndrea MPhD14CooperAllen DMD14ElmerPatriciaPhDPrincipal Investigator15FolsomAaronMD15Van HeelNancyMS, RD15WoldChristineRD15FritzKayMA, RD15SlavinJoannePhD15JacobsDavidPhD15DennisBarbaraPhDFirst Principal Investigator16StewartPaulPhDSecond Principal Investigator16DavisCPhD16HoskingJamesPhD16AndersonNancyMSPH16BlackwellSusanBS16MartinLynnMS16BryanHopeMS16StewartW BrianBS16AbolafiaJeffreyMA16FoleyMalachyBS16ZienConroyBA16LeuSzu-YunMS16YoungbloodMarstonMPH16GoodwinThomasMAT16MilesMonica16WehbieJennifer16PearsonThomasMD, PhD17ReedRobertaPhD17TracyRussellPhD18CornellElaineBS18StewartKentPhD19PhillipsKatherinePhD19McGeeBernestinePhD, RD20WilliamsBrendaBS20BeecherGaryPhD21HoldenJoanneMS21DavisCarolBS21ErshowAbbyScD22GordonDavidMD, PhD22ProschanMichaelPhD22RifkindBasilMD, FRCP22Deceased
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9
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Bilgen F, Chen P, Poggi A, Wells J, Trumble E, Helmke S, Teruya S, Catalan T, Rosenblum HR, Cornellier ML, Karmally W, Maurer MS, Hummel SL. Insufficient Calorie Intake Worsens Post-Discharge Quality of Life and Increases Readmission Burden in Heart Failure. JACC Heart Fail 2020; 8:756-764. [PMID: 32653445 DOI: 10.1016/j.jchf.2020.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the relationship between calorie intake and post-discharge outcomes in hospitalized patients with heart failure (HF). BACKGROUND Malnutrition increases adverse outcomes in HF, and dietary sodium restriction may inadvertently worsen nutritional intake. METHODS In a dietary intervention trial, baseline nutritional intake in HF inpatients was estimated using the Block Food Frequency Questionnaire (FFQ), and the Nutritional Risk Index (NRI) was calculated. Insufficient calorie intake was defined as <90% of metabolic needs, and a 15-point micronutrient deficiency score was created. Adjusted linear, logistic, and negative binomial regression were used to evaluate associations between insufficient calorie intake and quality of life (using the Kansas City Cardiomyopathy Questionnaire Clinical Summary [KCCQ-CS]), readmission risk, and days rehospitalized over 12 weeks. RESULTS Among 57 participants (70 ± 8 years of age; 31% female; mean body mass index 32 ± 8 kg/m2); median sodium and calorie intake amounts were 2,987 mg/day (interquartile range [IQR]: 2,160 to 3,540 mg/day) and 1,602 kcal/day (IQR: 1,201 to 2,142 kcal/day), respectively; 11% of these patients were screened as malnourished by the NRI. All patients consuming <2,000 mg/day sodium had insufficient calorie intake; this group also more frequently had dietary micronutrient and protein deficiencies. At 12 weeks, patients with insufficient calorie intake had less improvement in the KCCQ-CS score (β = -14.6; 95% confidence interval [CI]: -27.3 to -1.9), higher odds of readmission (odds ratio: 14.5; 95% CI: 2.2 to 94.4), and more days rehospitalized (incident rate ratio: 31.3; 95% CI: 4.3 to 229.3). CONCLUSIONS Despite a high prevalence for obesity and rare overt malnutrition, insufficient calorie intake was associated with poorer post-discharge quality of life and increased burden of readmission in patients with HF. Inpatient dietary assessment could improve readmission risk stratification and identify patients for nutritional intervention. (Geriatric Out of Hospital Randomized Meal Trial in Heart Failure [GOURMET-HF] NCT02148679).
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Affiliation(s)
| | - Peiyu Chen
- University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Stephen Helmke
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Sergio Teruya
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | | | | | | | - Wahida Karmally
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Mathew S Maurer
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Scott L Hummel
- University of Michigan, Ann Arbor, Michigan; Columbia University, New York, New York.
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Abstract
Epidemiology has long suggested that diet plays a major role in determining risk for atherosclerotic cardiovascular disease. A small number of important randomized controlled trials support this contention. We have to recognize that dietary patterns also constitute a large part of ethnic identity. In our increasingly connected world of international mobility and influence, lipidologists face new challenges in counseling patients with diverse nutritional preferences. In this JCL roundtable, we discuss Hispanic, South Asian, and Mediterranean dietary patterns and their association with atherosclerotic risk. Culturally acceptable ways are suggested to mitigate the atherogenic aspects of Hispanic and South Asian diets and to reinforce their heart healthy aspects. The Mediterranean diet provides a model for ameliorating risk, but one should understand how it is practiced in its native countries compared with its adaptations abroad.
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Affiliation(s)
| | - Heather Rasmussen
- Department of Nutrition and Health Sciences, University of Nebraska, Lincoln, NE, USA
| | - Wahida Karmally
- Special Research Scientist, Columbia University, New York, NY, USA
| | - John R Guyton
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
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11
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Hummel SL, Bilgen F, Chen P, Rosenblum H, Poggi A, Cornellier ML, Catalan T, Teruya S, Helmke S, Karmally W, Maurer M. INSUFFICIENT CALORIC INTAKE IS ASSOCIATED WITH POOR QUALITY OF LIFE AND READMISSION BURDEN POST-DISCHARGE IN OLDER PATIENTS WITH HEART FAILURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Marolt C, Miller A, Carlozzi NE, Karmally W, Helmke S, Teruya S, Wells J, Trumble E, Maurer MS, Hummel SL. Assessing Barriers to Healthy Eating in Hospitalized Older Adults With Heart Failure: Psychometric Properties of Two Questionnaires. J Card Fail 2020; 26:223-226. [DOI: 10.1016/j.cardfail.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
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13
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Reyes-Soffer G, Sztalryd C, Horenstein RB, Holleran S, Matveyenko A, Thomas T, Nandakumar R, Ngai C, Karmally W, Ginsberg HN, Ramakrishnan R, Pollin TI. Effects of APOC3 Heterozygous Deficiency on Plasma Lipid and Lipoprotein Metabolism. Arterioscler Thromb Vasc Biol 2019; 39:63-72. [PMID: 30580564 DOI: 10.1161/atvbaha.118.311476] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective- Apo (apolipoprotein) CIII inhibits lipoprotein lipase (LpL)-mediated lipolysis of VLDL (very-low-density lipoprotein) triglyceride (TG) and decreases hepatic uptake of VLDL remnants. The discovery that 5% of Lancaster Old Order Amish are heterozygous for the APOC3 R19X null mutation provided the opportunity to determine the effects of a naturally occurring reduction in apo CIII levels on the metabolism of atherogenic containing lipoproteins. Approach and Results- We conducted stable isotope studies of VLDL-TG and apoB100 in 5 individuals heterozygous for the null mutation APOC3 R19X (CT) and their unaffected (CC) siblings. Fractional clearance rates and production rates of VLDL-TG and apoB100 in VLDL, IDL (intermediate-density lipoprotein), LDL, apo CIII, and apo CII were determined. Affected (CT) individuals had 49% reduction in plasma apo CIII levels compared with CCs ( P<0.01) and reduced plasma levels of TG (35%, P<0.02), VLDL-TG (45%, P<0.02), and VLDL-apoB100 (36%, P<0.05). These changes were because of higher fractional clearance rates of VLDL-TG and VLDL-apoB100 with no differences in production rates. CTs had higher rates of the conversion of VLDL remnants to LDL compared with CCs. In contrast, rates of direct removal of VLDL remnants did not differ between the groups. As a result, the flux of apoB100 from VLDL to LDL was not reduced, and the plasma levels of LDL-cholesterol and LDL-apoB100 were not lower in the CT group. Apo CIII production rate was lower in CTs compared with CCs, whereas apo CII production rate was not different between the 2 groups. The fractional clearance rates of both apo CIII and apo CII were higher in CTs than CCs. Conclusions- These studies demonstrate that 50% reductions in plasma apo CIII, in otherwise healthy subjects, results in a significantly higher rate of conversion of VLDL to LDL, with little effect on direct hepatic uptake of VLDL. When put in the context of studies demonstrating significant protection from cardiovascular events in individuals with loss of function variants in the APOC3 gene, our results provide strong evidence that therapies which increase the efficiency of conversion of VLDL to LDL, thereby reducing remnant concentrations, should reduce the risk of cardiovascular disease.
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Affiliation(s)
- Gissette Reyes-Soffer
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Carol Sztalryd
- Maryland School of Medicine, University of Maryland, Baltimore (C.S., R.B.H., T.I.P.)
- Baltimore VA Medical Center, VA Research Service, Geriatric Research, Education and Clinical Center and VA Maryland Health Care System (C.S., T.I.P.)
| | - Richard B Horenstein
- Maryland School of Medicine, University of Maryland, Baltimore (C.S., R.B.H., T.I.P.)
| | - Stephen Holleran
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Anastasiya Matveyenko
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Tiffany Thomas
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Renu Nandakumar
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Colleen Ngai
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Wahida Karmally
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Henry N Ginsberg
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Rajasekhar Ramakrishnan
- From the Columbia University Vagelos College of Physicians and Surgeons, New York (G.R.-S., S.H., A.M., T.T., R.N., C.N., W.K., H.N.G., R.R.)
| | - Toni I Pollin
- Maryland School of Medicine, University of Maryland, Baltimore (C.S., R.B.H., T.I.P.)
- Baltimore VA Medical Center, VA Research Service, Geriatric Research, Education and Clinical Center and VA Maryland Health Care System (C.S., T.I.P.)
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Rhodes KS, Williams L, Welstead L, Karmally W, Alexander L, Sutton L. Effective Treatment for Acute Pancreatitis Depends on Underlying Etiologies. J Acad Nutr Diet 2019; 119:560-561. [PMID: 30905428 DOI: 10.1016/j.jand.2019.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Katherine S Rhodes
- Cardiovascular Dietitian, Michigan Medicine, Cardiovascular Medicine at Domino's Farms, Ann Arbor, MI
| | - Lauren Williams
- Risk Evaluation to Achieve Cardiovascular Health (REACH) Clinic, Cook Children's Endocrinology Clinic, Cook Children's Medical Center, Fort Worth, TX
| | - Lori Welstead
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL
| | | | - Lori Alexander
- ENCORE Lipid Center of Excellence, Jacksonville Center for Clinical Research, Jacksonville, FL
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Nandakumar R, Matveyenko A, Thomas T, Pavlyha M, Ngai C, Holleran S, Ramakrishnan R, Ginsberg HN, Karmally W, Marcovina SM, Reyes-Soffer G. Effects of mipomersen, an apolipoprotein B100 antisense, on lipoprotein (a) metabolism in healthy subjects. J Lipid Res 2018; 59:2397-2402. [PMID: 30293969 DOI: 10.1194/jlr.p082834] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 09/25/2018] [Indexed: 01/17/2023] Open
Abstract
Elevated lipoprotein (a) [Lp(a)] levels increase the risk for CVD. Novel treatments that decrease LDL cholesterol (LDL-C) have also shown promise for reducing Lp(a) levels. Mipomersen, an antisense oligonucleotide that inhibits apoB synthesis, is approved for the treatment of homozygous familial hypercholesterolemia. It decreases plasma levels of LDL-C by 25% to 39% and lowers levels of Lp(a) by 21% to 39%. We examined the mechanisms for Lp(a) lowering during mipomersen treatment. We enrolled 14 healthy volunteers who received weekly placebo injections for 3 weeks followed by weekly injections of mipomersen for 7 weeks. Stable isotope kinetic studies were performed using deuterated leucine at the end of the placebo and mipomersen treatment periods. The fractional catabolic rate (FCR) of Lp(a) was determined from the enrichment of a leucine-containing peptide specific to apo(a) by LC/MS. The production rate (PR) of Lp(a) was calculated from the product of Lp(a) FCR and Lp(a) concentration (converted to pool size). In a diverse population, mipomersen reduced plasma Lp(a) levels by 21%. In the overall study group, mipomersen treatment resulted in a 27% increase in the FCR of Lp(a) with no significant change in PR. However, there was heterogeneity in the response to mipomersen therapy, and changes in both FCRs and PRs affected the degree of change in Lp(a) concentrations. Mipomersen treatment decreases Lp(a) plasma levels mainly by increasing the FCR of Lp(a), although changes in Lp(a) PR were significant predictors of reductions in Lp(a) levels in some subjects.
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Affiliation(s)
- Renu Nandakumar
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | - Tiffany Thomas
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Marianna Pavlyha
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Colleen Ngai
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Stephen Holleran
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | - Henry N Ginsberg
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Wahida Karmally
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Santica M Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, WA
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16
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Sloan RP, Shapiro PA, McKinley PS, Bartels M, Shimbo D, Lauriola V, Karmally W, Pavlicova M, Choi CJ, Choo T, Scodes JM, Flood P, Tracey KJ. Aerobic Exercise Training and Inducible Inflammation: Results of a Randomized Controlled Trial in Healthy, Young Adults. J Am Heart Assoc 2018; 7:e010201. [PMID: 30371169 PMCID: PMC6201415 DOI: 10.1161/jaha.118.010201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/17/2018] [Indexed: 12/31/2022]
Abstract
Background Consensus panels regularly recommend aerobic exercise for its health-promoting properties, due in part to presumed anti-inflammatory effects, but many studies show no such effect, possibly related to study differences in participants, interventions, inflammatory markers, and statistical approaches. This variability makes an unequivocal determination of the anti-inflammatory effects of aerobic training elusive. Methods and Results We conducted a randomized controlled trial of 12 weeks of aerobic exercise training or a wait list control condition followed by 4 weeks of sedentary deconditioning on lipopolysaccharide (0, 0.1, and 1.0 ng/mL)-inducible tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), and on toll-like receptor 4 in 119 healthy, sedentary young adults. Aerobic capacity by cardiopulmonary exercise testing was measured at study entry (T1) and after training (T2) and deconditioning (T3). Despite a 15% increase in maximal oxygen consumption, there were no changes in inflammatory markers. Additional analyses revealed a differential longitudinal aerobic exercise training effect by lipopolysaccharide level in inducible TNF -α ( P=0.08) and IL-6 ( P=0.011), showing T1 to T2 increases rather than decreases in inducible (lipopolysaccharide 0.1, 1.0 versus 0.0 ng/mL) TNF- α (51% increase, P=0.041) and IL-6 (42% increase, P=0.11), and significant T2 to T3 decreases in inducible TNF- α (54% decrease, P=0.007) and IL-6 (55% decrease, P<0.001). There were no significant changes in either group at the 0.0 ng/mL lipopolysaccharide level for TNF- α or IL-6. Conclusions The failure to support the primary hypotheses and the unexpected post hoc findings of an exercise-training-induced proinflammatory response raise questions about whether and under what conditions exercise training has anti-inflammatory effects. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01335737.
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Affiliation(s)
- Richard P. Sloan
- Division of Behavioral MedicineDepartment of PsychiatryColumbia University Medical CenterNew YorkNY
- New York State Psychiatric InstituteNew YorkNY
| | - Peter A. Shapiro
- Division of Consultation/Liaison PsychiatryDepartment of PsychiatryColumbia University Medical CenterNew YorkNY
| | - Paula S. McKinley
- Division of Behavioral MedicineDepartment of PsychiatryColumbia University Medical CenterNew YorkNY
| | - Matthew Bartels
- Department of Rehabilitation MedicineColumbia University Medical CenterNew YorkNY
| | - Daichi Shimbo
- Department of MedicineColumbia University Medical CenterNew YorkNY
| | - Vincenzo Lauriola
- Division of Behavioral MedicineDepartment of PsychiatryColumbia University Medical CenterNew YorkNY
| | - Wahida Karmally
- Irving Institute for Clinical and Translational ResearchColumbia University Medical CenterNew YorkNY
| | - Martina Pavlicova
- Department of BiostatisticsMailman School of Public HealthColumbia University Medical CenterNew YorkNY
| | | | | | | | - Pamela Flood
- Department of AnesthesiologyColumbia University Medical CenterNew YorkNY
| | - Kevin J. Tracey
- The Feinstein Institute for Medical ResearchNorthwell HealthManhassettNY
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Massad SG, Khalili M, Karmally W, Abdalla M, Khammash U, Mehari GM, Deckelbaum RJ. Metabolic Syndrome among Refugee Women from the West Bank, Palestine: A Cross-Sectional Study. Nutrients 2018; 10:nu10081118. [PMID: 30126177 PMCID: PMC6115782 DOI: 10.3390/nu10081118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 11/17/2022] Open
Abstract
This study was carried out among Palestinian refugee women in the West Bank to provide data on the prevalence of metabolic syndrome (MetS) and its correlates. Data were obtained from a cross-sectional study of 1694 randomly selected refugee women from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) health centers throughout the West Bank during June and July 2010. In this cohort, 30% of the refugee women were overweight, 39% were obese, and 7% were extremely obese. Based on World Health Organization (WHO) criteria, the age-adjusted prevalence of MetS was 19.8%. The results of the binary logistic regression analysis indicated that older age and younger marital age were significantly associated with an increased likelihood of MetS in the women. The high prevalence of obesity and MetS mandates the implementation of national policies for its prevention, notably by initiating large-scale community intervention programs for 5.2 million refugees in Palestine, Jordan, Lebanon, and Syria, to tackle obesity and increase the age at marriage.
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Affiliation(s)
- Salwa G Massad
- Institute of Human Nutrition, Columbia University, New York, NY 10032, USA.
| | - Mohammed Khalili
- United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jerusalem 972, Palestine.
| | - Wahida Karmally
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, New York, NY 10032, USA.
| | - Marwah Abdalla
- Institute of Human Nutrition, Columbia University, New York, NY 10032, USA.
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.
| | - Umaiyeh Khammash
- Juzoor for Health and Social Development, Ramallah 970, Palestine.
| | - Gebre-Medhin Mehari
- Department of Women's and Children's Health, Pediatrics, University Hospital, SE-751 85 Uppsala, Sweden.
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18
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Hummel SL, Karmally W, Gillespie BW, Helmke S, Teruya S, Wells J, Trumble E, Jimenez O, Marolt C, Wessler JD, Cornellier M, Maurer MS. Home-Delivered Meals Postdischarge From Heart Failure Hospitalization. Circ Heart Fail 2018; 11:e004886. [PMID: 30354562 PMCID: PMC6205816 DOI: 10.1161/circheartfailure.117.004886] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background In patients with heart failure (HF), malnutrition and dietary sodium excess are common and may worsen outcomes. No prior studies have provided low-sodium, nutritionally complete meals following HF hospitalization. Methods and Results The GOURMET-HF study (Geriatric Out-of-Hospital Randomized Meal Trial in Heart Failure) randomized patients discharged from HF hospitalization to 4 weeks of home-delivered sodium-restricted Dietary Approaches to Stop Hypertension meals (DASH/SRD; 1500 mg sodium/d) versus usual care. The primary outcome was the between-group change in the Kansas City Cardiomyopathy Questionnaire summary score from discharge to 4 weeks postdischarge. Additional outcomes included changes in the Kansas City Cardiomyopathy Questionnaire clinical summary score and cardiac biomarkers. All patients were followed 12 weeks for death/all-cause readmission and potential diet-related adverse events (symptomatic hypotension, hyperkalemia, acute kidney injury). Sixty-six patients were randomized 1:1 at discharge to DASH/SRD versus usual care (age, 71±8 years; 30% female; ejection fraction, 39±18%). The Kansas City Cardiomyopathy Questionnaire summary score increased similarly between groups (DASH/SRD 46±23-59±20 versus usual care 43±19-53±24; P=0.38), but the Kansas City Cardiomyopathy Questionnaire clinical summary score increase tended to be greater in DASH/SRD participants (47±22-65±19 versus 45±20-55±26; P=0.053). Potentially diet-related adverse events were uncommon; 30-day HF readmissions (11% versus 27%; P=0.06) and days rehospitalized within that timeframe (17 versus 55; P=0.055) trended lower in DASH/SRD participants. Conclusions Home-delivered DASH/SRD after HF hospitalization appeared safe in selected patients and had directionally favorable effects on HF clinical status and 30-day readmissions. Larger studies are warranted to clarify the effects of postdischarge nutritional support in patients with HF. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02148679.
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Affiliation(s)
- Scott L. Hummel
- University of Michigan, Ann Arbor, MI
- Ann Arbor Veterans Affairs Health System, Ann Arbor, MI
| | | | | | | | | | | | - Erika Trumble
- Ann Arbor Veterans Affairs Health System, Ann Arbor, MI
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Williams L, Rhodes KS, Karmally W, Welstead LA, Alexander L, Sutton L. Familial chylomicronemia syndrome: Bringing to life dietary recommendations throughout the life span. J Clin Lipidol 2018; 12:908-919. [DOI: 10.1016/j.jacl.2018.04.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/03/2018] [Accepted: 04/22/2018] [Indexed: 12/12/2022]
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Badjatia N, Cremers S, Claassen J, Connolly ES, Mayer SA, Karmally W, Seres D. Serum glutamine and hospital-acquired infections after aneurysmal subarachnoid hemorrhage. Neurology 2018; 91:e421-e426. [PMID: 29959259 DOI: 10.1212/wnl.0000000000005902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/27/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To understand nutritional and inflammatory factors contributing to serum glutamine levels and their relationship to hospital-acquired infections (HAIs) after aneurysmal subarachnoid hemorrhage (SAH). METHODS A prospective observational study of patients with SAH who had measurements of daily caloric intake and C-reactive protein, transthyretin, tumor necrosis factor α receptor 1a (TNFαR1a), glutamine, and nitrogen balance performed within 4 preset time periods during the 14 days after SAH. Factors associated with glutamine levels and HAIs were analyzed with multivariable regression. HAIs were tracked daily for time-to-event analyses. Outcome 3 months after SAH was assessed by the Telephone Interview for Cognitive Status and modified Rankin Scale. RESULTS There were 77 patients with an average age of 55 ± 15 years. HAIs developed in 18 (23%) on mean SAH day 8 ± 3. In a multivariable linear regression model, negative nitrogen balance (p = 0.02) and elevated TNFαR1a (p = 0.04) were independently associated with higher glutamine levels during the study period. The 14-day mean glutamine levels were lower in patients who developed HAI (166 ± 110 vs 236 ± 81 μg/mL, p = 0.004). Poor admission Hunt and Hess grade (p = 0.04) and lower glutamine levels (p = 0.02) predicted time to first HAI. Low 14-day mean levels of glutamine were associated with a poor recovery on the Telephone Interview for Cognitive Status score (p = 0.03) and modified Rankin Scale score (p = 0.04) at 3 months after injury. CONCLUSIONS Declining glutamine levels in the first 14 days after SAH are influenced by inflammation and associated with an increased risk of HAI.
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Affiliation(s)
- Neeraj Badjatia
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY.
| | - Serge Cremers
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Jan Claassen
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - E Sander Connolly
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Stephan A Mayer
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Wahida Karmally
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - David Seres
- From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
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Hummel SL, Karmally W, Gillespie BW, Helmke ST, Teruya S, Wessler JD, Wells JM, Jimenez O, Trumble E, Cornellier M, Marolt C, Maurer MS. Geriatric Out-of-Hospital Randomized Meal Trial in Heart Failure (GOURMET-HF) Pilot Randomized Trial: Primary Results. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reyes-Soffer G, Pavlyha M, Ngai C, Thomas T, Hollearn S, Ramakrishnan R, Karmally W, Nandakumar R, Ginsberg H. Mipomersen treatment decreases lipoprotein (a) plasma levels by increasing its fractional clearance from plasma. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Thomas T, Zhou H, Karmally W, Ramakrishnan R, Holleran S, Liu Y, Jumes P, Wagner JA, Hubbard B, Previs SF, Roddy T, Johnson-Levonas AO, Gutstein DE, Marcovina SM, Rader DJ, Ginsberg HN, Millar JS, Reyes-Soffer G. CETP (Cholesteryl Ester Transfer Protein) Inhibition With Anacetrapib Decreases Production of Lipoprotein(a) in Mildly Hypercholesterolemic Subjects. Arterioscler Thromb Vasc Biol 2017; 37:1770-1775. [PMID: 28729361 PMCID: PMC5567403 DOI: 10.1161/atvbaha.117.309549] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/04/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Lp(a) [lipoprotein (a)] is composed of apoB (apolipoprotein B) and apo(a) [apolipoprotein (a)] and is an independent risk factor for cardiovascular disease and aortic stenosis. In clinical trials, anacetrapib, a CETP (cholesteryl ester transfer protein) inhibitor, causes significant reductions in plasma Lp(a) levels. We conducted an exploratory study to examine the mechanism for Lp(a) lowering by anacetrapib. APPROACH AND RESULTS We enrolled 39 participants in a fixed-sequence, double-blind study of the effects of anacetrapib on the metabolism of apoB and high-density lipoproteins. Twenty-nine patients were randomized to atorvastatin 20 mg/d, plus placebo for 4 weeks, and then atorvastatin plus anacetrapib (100 mg/d) for 8 weeks. The other 10 subjects were randomized to double placebo for 4 weeks followed by placebo plus anacetrapib for 8 weeks. We examined the mechanisms of Lp(a) lowering in a subset of 12 subjects having both Lp(a) levels >20 nmol/L and more than a 15% reduction in Lp(a) by the end of anacetrapib treatment. We performed stable isotope kinetic studies using 2H3-leucine at the end of each treatment to measure apo(a) fractional catabolic rate and production rate. Median baseline Lp(a) levels were 21.5 nmol/L (interquartile range, 9.9-108.1 nmol/L) in the complete cohort (39 subjects) and 52.9 nmol/L (interquartile range, 38.4-121.3 nmol/L) in the subset selected for kinetic studies. Anacetrapib treatment lowered Lp(a) by 34.1% (P≤0.001) and 39.6% in the complete and subset cohort, respectively. The decreases in Lp(a) levels were because of a 41% reduction in the apo(a) production rate, with no effects on apo(a) fractional catabolic rate. CONCLUSIONS Anacetrapib reduces Lp(a) levels by decreasing its production. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00990808.
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Affiliation(s)
- Tiffany Thomas
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Haihong Zhou
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Wahida Karmally
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Rajasekhar Ramakrishnan
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Stephen Holleran
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Yang Liu
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Patricia Jumes
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - John A Wagner
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Brian Hubbard
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Stephen F Previs
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Thomas Roddy
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Amy O Johnson-Levonas
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - David E Gutstein
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Santica M Marcovina
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Daniel J Rader
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Henry N Ginsberg
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - John S Millar
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Gissette Reyes-Soffer
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.).
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Millar JS, Lassman ME, Thomas T, Ramakrishnan R, Jumes P, Dunbar RL, deGoma EM, Baer AL, Karmally W, Donovan DS, Rafeek H, Wagner JA, Holleran S, Obunike J, Liu Y, Aoujil S, Standiford T, Gutstein DE, Ginsberg HN, Rader DJ, Reyes-Soffer G. Effects of CETP inhibition with anacetrapib on metabolism of VLDL-TG and plasma apolipoproteins C-II, C-III, and E. J Lipid Res 2017; 58:1214-1220. [PMID: 28314859 PMCID: PMC5454510 DOI: 10.1194/jlr.m074880] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/16/2017] [Indexed: 01/30/2023] Open
Abstract
Cholesteryl ester transfer protein (CETP) mediates the transfer of HDL cholesteryl esters for triglyceride (TG) in VLDL/LDL. CETP inhibition, with anacetrapib, increases HDL-cholesterol, reduces LDL-cholesterol, and lowers TG levels. This study describes the mechanisms responsible for TG lowering by examining the kinetics of VLDL-TG, apoC-II, apoC-III, and apoE. Mildly hypercholesterolemic subjects were randomized to either placebo (N = 10) or atorvastatin 20 mg/qd (N = 29) for 4 weeks (period 1) followed by 8 weeks of anacetrapib, 100 mg/qd (period 2). Following each period, subjects underwent stable isotope metabolic studies to determine the fractional catabolic rates (FCRs) and production rates (PRs) of VLDL-TG and plasma apoC-II, apoC-III, and apoE. Anacetrapib reduced the VLDL-TG pool on a statin background due to an increased VLDL-TG FCR (29%; P = 0.002). Despite an increased VLDL-TG FCR following anacetrapib monotherapy (41%; P = 0.11), the VLDL-TG pool was unchanged due to an increase in the VLDL-TG PR (39%; P = 0.014). apoC-II, apoC-III, and apoE pool sizes increased following anacetrapib; however, the mechanisms responsible for these changes differed by treatment group. Anacetrapib increased the VLDL-TG FCR by enhancing the lipolytic potential of VLDL, which lowered the VLDL-TG pool on atorvastatin background. There was no change in the VLDL-TG pool in subjects treated with anacetrapib monotherapy due to an accompanying increase in the VLDL-TG PR.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Joseph Obunike
- New York City College of Technology, CUNY, Brooklyn, NY 11201
| | - Yang Liu
- Merck & Co., Inc., Kenilworth, NJ 07033
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Reyes-Soffer G, Pavlyha M, Ngai C, Thomas T, Holleran S, Ramakrishnan R, Karmally W, Nandakumar R, Fontanez N, Obunike J, Marcovina SM, Lichtenstein AH, Matthan NR, Matta J, Maroccia M, Becue F, Poitiers F, Swanson B, Cowan L, Sasiela WJ, Surks HK, Ginsberg HN. Effects of PCSK9 Inhibition With Alirocumab on Lipoprotein Metabolism in Healthy Humans. Circulation 2016; 135:352-362. [PMID: 27986651 PMCID: PMC5262523 DOI: 10.1161/circulationaha.116.025253] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/07/2016] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Alirocumab, a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), lowers plasma low-density lipoprotein (LDL) cholesterol and apolipoprotein B100 (apoB). Although studies in mice and cells have identified increased hepatic LDL receptors as the basis for LDL lowering by PCSK9 inhibitors, there have been no human studies characterizing the effects of PCSK9 inhibitors on lipoprotein metabolism. In particular, it is not known whether inhibition of PCSK9 has any effects on very low-density lipoprotein or intermediate-density lipoprotein (IDL) metabolism. Inhibition of PCSK9 also results in reductions of plasma lipoprotein (a) levels. The regulation of plasma Lp(a) levels, including the role of LDL receptors in the clearance of Lp(a), is poorly defined, and no mechanistic studies of the Lp(a) lowering by alirocumab in humans have been published to date. Methods: Eighteen (10 F, 8 mol/L) participants completed a placebo-controlled, 2-period study. They received 2 doses of placebo, 2 weeks apart, followed by 5 doses of 150 mg of alirocumab, 2 weeks apart. At the end of each period, fractional clearance rates (FCRs) and production rates (PRs) of apoB and apo(a) were determined. In 10 participants, postprandial triglycerides and apoB48 levels were measured. Results: Alirocumab reduced ultracentrifugally isolated LDL-C by 55.1%, LDL-apoB by 56.3%, and plasma Lp(a) by 18.7%. The fall in LDL-apoB was caused by an 80.4% increase in LDL-apoB FCR and a 23.9% reduction in LDL-apoB PR. The latter was due to a 46.1% increase in IDL-apoB FCR coupled with a 27.2% decrease in conversion of IDL to LDL. The FCR of apo(a) tended to increase (24.6%) without any change in apo(a) PR. Alirocumab had no effects on FCRs or PRs of very low-density lipoproteins-apoB and very low-density lipoproteins triglycerides or on postprandial plasma triglycerides or apoB48 concentrations. Conclusions: Alirocumab decreased LDL-C and LDL-apoB by increasing IDL- and LDL-apoB FCRs and decreasing LDL-apoB PR. These results are consistent with increases in LDL receptors available to clear IDL and LDL from blood during PCSK9 inhibition. The increase in apo(a) FCR during alirocumab treatment suggests that increased LDL receptors may also play a role in the reduction of plasma Lp(a). Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01959971.
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Affiliation(s)
- Gissette Reyes-Soffer
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.).
| | - Marianna Pavlyha
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Colleen Ngai
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Tiffany Thomas
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Stephen Holleran
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Rajasekhar Ramakrishnan
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Wahida Karmally
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Renu Nandakumar
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Nelson Fontanez
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Joseph Obunike
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Santica M Marcovina
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Alice H Lichtenstein
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Nirupa R Matthan
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - James Matta
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Magali Maroccia
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Frederic Becue
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Franck Poitiers
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Brian Swanson
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Lisa Cowan
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - William J Sasiela
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Howard K Surks
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.)
| | - Henry N Ginsberg
- From Columbia University College of Physicians and Surgeons, New York (G.R.-S., M.P., C.N., T.T., S.H., R.R., W.K., R.N., N.F., H.N.G.); The City University of New York (J.O.); Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle (S.M.M.); Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (A.H.L., N.R.M.); Sanofi, Bridgewater, NJ (J.M., B.S., L.C., H.K.S.); Umanis, Levallois-Perret, France (M.M.); Sanofi, Montpellier, France (F.B.); Sanofi, Paris, France (F.P.); and Regeneron Pharmaceuticals, Inc., Tarrytown, NY (W.J.S.).
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Van Horn L, Carson JAS, Appel LJ, Burke LE, Economos C, Karmally W, Lancaster K, Lichtenstein AH, Johnson RK, Thomas RJ, Vos M, Wylie-Rosett J, Kris-Etherton P. Recommended Dietary Pattern to Achieve Adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e505-e529. [DOI: 10.1161/cir.0000000000000462] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In 2013, the American Heart Association and American College of Cardiology published the “Guideline on Lifestyle Management to Reduce Cardiovascular Risk,” which was based on a systematic review originally initiated by the National Heart, Lung, and Blood Institute. The guideline supports the American Heart Association’s 2020 Strategic Impact Goals for cardiovascular health promotion and disease reduction by providing more specific details for adopting evidence-based diet and lifestyle behaviors to achieve those goals. In addition, the
2015–2020 Dietary Guidelines for Americans
issued updated evidence relevant to reducing cardiovascular risk and provided additional recommendations for adopting healthy diet and lifestyle approaches. This scientific statement, intended for healthcare providers, summarizes relevant scientific and translational evidence and offers practical tips, tools, and dietary approaches to help patients/clients adapt these guidelines according to their sociocultural, economic, and taste preferences.
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Reyes-Soffer G, Moon B, Hernandez-Ono A, Dionizovik-Dimanovski M, Dionizovick-Dimanovski M, Jimenez J, Obunike J, Thomas T, Ngai C, Fontanez N, Donovan DS, Karmally W, Holleran S, Ramakrishnan R, Mittleman RS, Ginsberg HN. Complex effects of inhibiting hepatic apolipoprotein B100 synthesis in humans. Sci Transl Med 2016; 8:323ra12. [PMID: 26819195 DOI: 10.1126/scitranslmed.aad2195] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mipomersen is a 20mer antisense oligonucleotide (ASO) that inhibits apolipoprotein B (apoB) synthesis; its low-density lipoprotein (LDL)-lowering effects should therefore result from reduced secretion of very-low-density lipoprotein (VLDL). We enrolled 17 healthy volunteers who received placebo injections weekly for 3 weeks followed by mipomersen weekly for 7 to 9 weeks. Stable isotopes were used after each treatment to determine fractional catabolic rates and production rates of apoB in VLDL, IDL (intermediate-density lipoprotein), and LDL, and of triglycerides in VLDL. Mipomersen significantly reduced apoB in VLDL, IDL, and LDL, which was associated with increases in fractional catabolic rates of VLDL and LDL apoB and reductions in production rates of IDL and LDL apoB. Unexpectedly, the production rates of VLDL apoB and VLDL triglycerides were unaffected. Small interfering RNA-mediated knockdown of apoB expression in human liver cells demonstrated preservation of apoB secretion across a range of apoB synthesis. Titrated ASO knockdown of apoB mRNA in chow-fed mice preserved both apoB and triglyceride secretion. In contrast, titrated ASO knockdown of apoB mRNA in high-fat-fed mice resulted in stepwise reductions in both apoB and triglyceride secretion. Mipomersen lowered all apoB lipoproteins without reducing the production rate of either VLDL apoB or triglyceride. Our human data are consistent with long-standing models of posttranscriptional and posttranslational regulation of apoB secretion and are supported by in vitro and in vivo experiments. Targeting apoB synthesis may lower levels of apoB lipoproteins without necessarily reducing VLDL secretion, thereby lowering the risk of steatosis associated with this therapeutic strategy.
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Affiliation(s)
- Gissette Reyes-Soffer
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
| | - Byoung Moon
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Antonio Hernandez-Ono
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | | | | | - Jhonsua Jimenez
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Joseph Obunike
- Biological Sciences Department, New York City College of Technology, 300 Jay Street, Brooklyn, NY 11201, USA
| | - Tiffany Thomas
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Colleen Ngai
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Nelson Fontanez
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Daniel S Donovan
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Wahida Karmally
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Stephen Holleran
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Rajasekhar Ramakrishnan
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | | | - Henry N Ginsberg
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
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28
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Wessler JD, Cohen LP, Rosenblum H, Karmally W, Maurer MS, Hummel SL. Salt Taste Sensitivity in Acute Decompensated Heart Failure. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Greenlee H, Ogden Gaffney A, Aycinena AC, Koch P, Contento I, Karmally W, Richardson JM, Shi Z, Lim E, Tsai WY, Santella RM, Blaner WS, Clugston RD, Cremers S, Pollak S, Sirosh I, Crew KD, Maurer M, Kalinsky K, Hershman DL. Long-term Diet and Biomarker Changes after a Short-term Intervention among Hispanic Breast Cancer Survivors: The ¡Cocinar Para Su Salud! Randomized Controlled Trial. Cancer Epidemiol Biomarkers Prev 2016; 25:1491-1502. [PMID: 27461049 DOI: 10.1158/1055-9965.epi-15-1334] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/29/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Among Hispanic breast cancer survivors, we examined the long-term effects of a short-term culturally based dietary intervention on increasing fruits/vegetables (F/V), decreasing fat, and changing biomarkers associated with breast cancer recurrence risk. METHODS Spanish-speaking women (n = 70) with a history of stage 0-III breast cancer who completed treatment were randomized to ¡Cocinar Para Su Salud! (n = 34), a culturally based 9-session program (24 hours over 12 weeks, including nutrition education, cooking classes, and food-shopping field trips), or a control group (n = 36, written dietary recommendations for breast cancer survivors). Diet recalls, fasting blood, and anthropometric measures were collected at baseline, 6, and 12 months. We report changes between groups at 12 months in dietary intake and biomarkers using 2-sample Wilcoxon t tests and generalized estimating equation (GEE) models. RESULTS At 12 months, the intervention group compared with the control group reported higher increases in mean daily F/V servings (total: +2.0 vs. -0.4; P < 0.01), and nonsignificant decreases in the percentage of calories from fat (-2.2% vs. -1.1%; P = 0.69) and weight (-2.6 kg vs. -1.5 kg; P = 0.56). Compared with controls, participants in the intervention group had higher increases in plasma lutein (+20.4% vs. -11.5%; P < 0.01), and borderline significant increases in global DNA methylation (+0.8% vs. -0.5%; P = 0.06). CONCLUSIONS The short-term ¡Cocinar Para Su Salud! program was effective at increasing long-term F/V intake in Hispanic breast cancer survivors and changed biomarkers associated with breast cancer recurrence risk. IMPACT It is possible for short-term behavioral interventions to have long-term effects on behaviors and biomarkers in minority cancer patient populations. Results can inform future study designs. Cancer Epidemiol Biomarkers Prev; 25(11); 1491-502. ©2016 AACR.
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Affiliation(s)
- Heather Greenlee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
| | | | - A Corina Aycinena
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.,Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York
| | - Pam Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York
| | - Isobel Contento
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York
| | - Wahida Karmally
- Irving Institute for Clinical and Translational Research, Columbia University, New York, New York
| | - John M Richardson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Zaixing Shi
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Emerson Lim
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Wei-Yann Tsai
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Regina M Santella
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.,Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - William S Blaner
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Robin D Clugston
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Serge Cremers
- Irving Institute for Clinical and Translational Research, Columbia University, New York, New York
| | - Susan Pollak
- Irving Institute for Clinical and Translational Research, Columbia University, New York, New York
| | - Iryna Sirosh
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Katherine D Crew
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Matthew Maurer
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kevin Kalinsky
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Dawn L Hershman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
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Aycinena AC, Jennings KA, Gaffney AO, Koch PA, Contento IR, Gonzalez M, Guidon E, Karmally W, Hershman D, Greenlee H. ¡Cocinar Para Su Salud! Development of a Culturally Based Nutrition Education Curriculum for Hispanic Breast Cancer Survivors Using a Theory-Driven Procedural Model. Health Educ Behav 2016; 44:13-22. [PMID: 27179286 DOI: 10.1177/1090198116642236] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We developed a theory-based dietary change curriculum for Hispanic breast cancer survivors with the goal of testing the effects of the intervention on change in dietary intake of fruits/vegetables and fat in a randomized, clinical trial. Social cognitive theory and the transtheoretical model were used as theoretical frameworks to structure curriculum components using the Nutrition Education DESIGN Procedure. Formative assessments were conducted to identify facilitators and barriers common to Hispanic women and test the degree of difficulty and appropriateness of program materials. Focus groups provided valuable insight and informed preimplementation modifications to the dietary program. The result was a systematically planned, evidence-based, culturally tailored dietary intervention for Hispanic breast cancer survivors, ¡Cocinar Para Su Salud! (Cook for Your Health!). The methodology described here may serve as a framework for the development of future dietary interventions among diverse and minority populations. Short- and long-term study results will be reported elsewhere.
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31
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Millar JS, Reyes-Soffer G, Jumes P, Dunbar RL, deGoma EM, Baer AL, Karmally W, Donovan DS, Rafeek H, Pollan L, Tohyama J, Johnson-Levonas AO, Wagner JA, Holleran S, Obunike J, Liu Y, Ramakrishnan R, Lassman ME, Gutstein DE, Ginsberg HN, Rader DJ. Anacetrapib lowers LDL by increasing ApoB clearance in mildly hypercholesterolemic subjects. J Clin Invest 2016; 126:1603-4. [PMID: 27035815 DOI: 10.1172/jci87364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Reyes-Soffer G, Millar JS, Ngai C, Jumes P, Coromilas E, Asztalos B, Johnson-Levonas AO, Wagner JA, Donovan DS, Karmally W, Ramakrishnan R, Holleran S, Thomas T, Dunbar RL, deGoma EM, Rafeek H, Baer AL, Liu Y, Lassman ME, Gutstein DE, Rader DJ, Ginsberg HN. Cholesteryl Ester Transfer Protein Inhibition With Anacetrapib Decreases Fractional Clearance Rates of High-Density Lipoprotein Apolipoprotein A-I and Plasma Cholesteryl Ester Transfer Protein. Arterioscler Thromb Vasc Biol 2016; 36:994-1002. [PMID: 26966279 DOI: 10.1161/atvbaha.115.306680] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/22/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Anacetrapib (ANA), an inhibitor of cholesteryl ester transfer protein (CETP) activity, increases plasma concentrations of high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I (apoA)-I, apoA-II, and CETP. The mechanisms responsible for these treatment-related increases in apolipoproteins and plasma CETP are unknown. We performed a randomized, placebo (PBO)-controlled, double-blind, fixed-sequence study to examine the effects of ANA on the metabolism of HDL apoA-I and apoA-II and plasma CETP. APPROACH AND RESULTS Twenty-nine participants received atorvastatin (ATV) 20 mg/d plus PBO for 4 weeks, followed by ATV plus ANA 100 mg/d for 8 weeks (ATV-ANA). Ten participants received double PBO for 4 weeks followed by PBO plus ANA for 8 weeks (PBO-ANA). At the end of each treatment, we examined the kinetics of HDL apoA-I, HDL apoA-II, and plasma CETP after D3-leucine administration as well as 2D gel analysis of HDL subspecies. In the combined ATV-ANA and PBO-ANA groups, ANA treatment increased plasma HDL-C (63.0%; P<0.001) and apoA-I levels (29.5%; P<0.001). These increases were associated with reductions in HDL apoA-I fractional clearance rate (18.2%; P=0.002) without changes in production rate. Although the apoA-II levels increased by 12.6% (P<0.001), we could not discern significant changes in either apoA-II fractional clearance rate or production rate. CETP levels increased 102% (P<0.001) on ANA because of a significant reduction in the fractional clearance rate of CETP (57.6%, P<0.001) with no change in CETP production rate. CONCLUSIONS ANA treatment increases HDL apoA-I and CETP levels by decreasing the fractional clearance rate of each protein.
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Affiliation(s)
- Gissette Reyes-Soffer
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - John S Millar
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Colleen Ngai
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Patricia Jumes
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Ellie Coromilas
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Bela Asztalos
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Amy O Johnson-Levonas
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - John A Wagner
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Daniel S Donovan
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Wahida Karmally
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Rajasekhar Ramakrishnan
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Stephen Holleran
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Tiffany Thomas
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Richard L Dunbar
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Emil M deGoma
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Hashmi Rafeek
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Amanda L Baer
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Yang Liu
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Michael E Lassman
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - David E Gutstein
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Daniel J Rader
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
| | - Henry N Ginsberg
- From the Columbia University, New York, NY (G.R.-S., C.N., E.C., D.S.D., W.K., R.R., S.H., T.T., H.N.G.); University of Pennsylvania, Philadelphia (J.S.M., R.L.D., E.M.d., A.L.B., D.J.R.); Merck & Co., Inc., Kenilworth, NJ (P.J., A.O.J.-L., J.A.W., Y.L., M.E.L., D.E.G.); Tufts University School of Medicine, Boston, MA (B.A.); and Drexel Neurological Associates, Philadelphia, PA (H.R.)
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Greenlee H, Gaffney AO, Aycinena AC, Koch P, Contento I, Karmally W, Richardson JM, Lim E, Tsai WY, Crew K, Maurer M, Kalinsky K, Hershman DL. ¡Cocinar Para Su Salud!: Randomized Controlled Trial of a Culturally Based Dietary Intervention among Hispanic Breast Cancer Survivors. J Acad Nutr Diet 2015; 115:S42-S56.e3. [PMID: 25911520 DOI: 10.1016/j.jand.2015.02.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is a need for culturally relevant nutrition programs targeted to underserved cancer survivors. OBJECTIVE Our aim was to examine the effect of a culturally based approach to dietary change on increasing fruit/vegetable (F/V) intake and decreasing fat intake among Hispanic breast cancer survivors. DESIGN Participants were randomized to Intervention and Control groups. Diet recalls, detailed interviews, fasting blood, and anthropometric measures were collected at baseline, 3, 6, and 12 months. PARTICIPANTS/SETTING Hispanic women (n=70) with stage 0 to III breast cancer who completed adjuvant treatment and lived in New York City were randomized between April 2011 and March 2012. INTERVENTION The Intervention group (n=34) participated in ¡Cocinar Para Su Salud!, a culturally based nine-session (24 hours over 12 weeks) intervention including nutrition education, cooking classes, and food-shopping field trips. The Control group (n=36) received written dietary recommendations for breast cancer survivors. MAIN OUTCOME MEASURES Change at 6 months in daily F/V servings and percent calories from total fat were the main outcome measures. STATISTICAL ANALYSES Linear regression models adjusted for stratification factors and estimated marginal means were used to compare changes in diet from baseline to 3 and 6 months. RESULTS Baseline characteristics were the following: mean age 56.6 years (standard deviation 9.7 years), mean time since diagnosis 3.4 years (standard deviation 2.7 years), mean body mass index (calculated as kg/m(2)) 30.9 (standard deviation 6.0), 62.9% with annual household income ≤$15,000, mean daily servings of all F/V was 5.3 (targeted F/V 3.7 servings excluding legumes/juices/starchy vegetables/fried foods), and 27.7% of daily calories from fat. More than 60% in the Intervention group attended seven or more of nine classes, with overall study retention of 87% retention at 6 months. At month 6, the Intervention group compared with Control group reported an increase in mean servings of F/V from baseline (all F/V: +2.0 vs -0.1; P=0.005; targeted F/V: +2.7 vs +0.5; P=0.002) and a nonsignificant decrease in percent calories from fat (-7.5% vs -4.4%; P=0.23) and weight (-2.5 kg vs +3.8 kg; P=0.22). CONCLUSIONS ¡Cocinar Para Su Salud! was effective at increasing short-term F/V intake in a diverse population of Hispanic breast cancer survivors.
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Millar JS, Reyes-Soffer G, Jumes P, Dunbar RL, deGoma EM, Baer AL, Karmally W, Donovan DS, Rafeek H, Pollan L, Tohyama J, Johnson-Levonas AO, Wagner JA, Holleran S, Obunike J, Liu Y, Ramakrishnan R, Lassman ME, Gutstein DE, Ginsberg HN, Rader DJ. Anacetrapib lowers LDL by increasing ApoB clearance in mildly hypercholesterolemic subjects. J Clin Invest 2015; 125:2510-22. [PMID: 25961461 DOI: 10.1172/jci80025] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/13/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Individuals treated with the cholesteryl ester transfer protein (CETP) inhibitor anacetrapib exhibit a reduction in both LDL cholesterol and apolipoprotein B (ApoB) in response to monotherapy or combination therapy with a statin. It is not clear how anacetrapib exerts these effects; therefore, the goal of this study was to determine the kinetic mechanism responsible for the reduction in LDL and ApoB in response to anacetrapib. METHODS We performed a trial of the effects of anacetrapib on ApoB kinetics. Mildly hypercholesterolemic subjects were randomized to background treatment of either placebo (n = 10) or 20 mg atorvastatin (ATV) (n = 29) for 4 weeks. All subjects then added 100 mg anacetrapib to background treatment for 8 weeks. Following each study period, subjects underwent a metabolic study to determine the LDL-ApoB-100 and proprotein convertase subtilisin/kexin type 9 (PCSK9) production rate (PR) and fractional catabolic rate (FCR). RESULTS Anacetrapib markedly reduced the LDL-ApoB-100 pool size (PS) in both the placebo and ATV groups. These changes in PS resulted from substantial increases in LDL-ApoB-100 FCRs in both groups. Anacetrapib had no effect on LDL-ApoB-100 PRs in either treatment group. Moreover, there were no changes in the PCSK9 PS, FCR, or PR in either group. Anacetrapib treatment was associated with considerable increases in the LDL triglyceride/cholesterol ratio and LDL size by NMR. CONCLUSION These data indicate that anacetrapib, given alone or in combination with a statin, reduces LDL-ApoB-100 levels by increasing the rate of ApoB-100 fractional clearance. TRIAL REGISTRATION ClinicalTrials.gov NCT00990808. FUNDING Merck & Co. Inc., Kenilworth, New Jersey, USA. Additional support for instrumentation was obtained from the National Center for Advancing Translational Sciences (UL1TR000003 and UL1TR000040).
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Badjatia N, Monahan A, Carpenter A, Zimmerman J, Schmidt JM, Claassen J, Connolly ES, Mayer SA, Karmally W, Seres D. Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage. Neurology 2015; 84:680-7. [PMID: 25596503 DOI: 10.1212/wnl.0000000000001259] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To analyze the impact of inflammation and negative nitrogen balance (NBAL) on nutritional status and outcomes after subarachnoid hemorrhage (SAH). METHODS This was a prospective observational study of SAH patients admitted between May 2008 and June 2012. Measurements of C-reactive protein (CRP), transthyretin (TTR), resting energy expenditure (REE), and NBAL (g/day) were performed over 4 preset time periods during the first 14 postbleed days (PBD) in addition to daily caloric intake. Factors associated with REE and NBAL were analyzed with multivariable linear regression. Hospital-acquired infections (HAI) were tracked daily for time-to-event analyses. Poor outcome at 3 months was defined as a modified Rankin Scale score ≥ 4 and assessed by multivariable logistic regression. RESULTS There were 229 patients with an average age of 55 ± 15 years. Higher REE was associated with younger age (p = 0.02), male sex (p < 0.001), higher Hunt Hess grade (p = 0.001), and higher modified Fisher score (p = 0.01). Negative NBAL was associated with lower caloric intake (p < 0.001), higher body mass index (p < 0.001), aneurysm clipping (p = 0.03), and higher CRP:TTR ratio (p = 0.03). HAIs developed in 53 (23%) patients on mean PBD 8 ± 3. Older age (p = 0.002), higher Hunt Hess (p < 0.001), lower caloric intake (p = 0.001), and negative NBAL (p = 0.04) predicted time to first HAI. Poor outcome at 3 months was associated with higher Hunt Hess grade (p < 0.001), older age (p < 0.001), negative NBAL (p = 0.01), HAI (p = 0.03), higher CRP:TTR ratio (p = 0.04), higher body mass index (p = 0.03), and delayed cerebral ischemia (p = 0.04). CONCLUSIONS Negative NBAL after SAH is influenced by inflammation and associated with an increased risk of HAI and poor outcome. Underfeeding and systemic inflammation are potential modifiable risk factors for negative NBAL and poor outcome after SAH.
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Affiliation(s)
- Neeraj Badjatia
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY.
| | - Aimee Monahan
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Amanda Carpenter
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Jacqueline Zimmerman
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - J Michael Schmidt
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Jan Claassen
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - E Sander Connolly
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Stephan A Mayer
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Wahida Karmally
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
| | - David Seres
- From the Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology (N.B.), University of Maryland School of Medicine, Baltimore; and the Neurological Institute of New York (A.M., A.C., J.Z., J.M.S., J.C., E.S.C., S.A.M.), Institute of Human Nutrition (W.K.), and Division of Preventive Medicine and Nutrition, Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY
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Greenlee H, Gaffney AO, Aycinena AC, Koch P, Contento I, Karmally W, Richardson JM, Lim E, Tsai WY, Crew K, Maurer M, Kalinsky K, Hershman DL. ¡Cocinar Para Su Salud!: Randomized Controlled Trial of a Culturally Based Dietary Intervention among Hispanic Breast Cancer Survivors. J Acad Nutr Diet 2015; 115:709-723.e3. [PMID: 25578926 DOI: 10.1016/j.jand.2014.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 10/29/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is a need for culturally relevant nutrition programs targeted to underserved cancer survivors. OBJECTIVE Our aim was to examine the effect of a culturally based approach to dietary change on increasing fruit/vegetable (F/V) intake and decreasing fat intake among Hispanic breast cancer survivors. DESIGN Participants were randomized to Intervention and Control groups. Diet recalls, detailed interviews, fasting blood, and anthropometric measures were collected at baseline, 3, 6, and 12 months. PARTICIPANTS/SETTING Hispanic women (n=70) with stage 0 to III breast cancer who completed adjuvant treatment and lived in New York City were randomized between April 2011 and March 2012. INTERVENTION The Intervention group (n=34) participated in ¡Cocinar Para Su Salud!, a culturally based nine-session (24 hours over 12 weeks) intervention including nutrition education, cooking classes, and food-shopping field trips. The Control group (n=36) received written dietary recommendations for breast cancer survivors. MAIN OUTCOME MEASURES Change at 6 months in daily F/V servings and percent calories from total fat were the main outcome measures. STATISTICAL ANALYSES Linear regression models adjusted for stratification factors and estimated marginal means were used to compare changes in diet from baseline to 3 and 6 months. RESULTS Baseline characteristics were the following: mean age 56.6 years (standard deviation 9.7 years), mean time since diagnosis 3.4 years (standard deviation 2.7 years), mean body mass index (calculated as kg/m²) 30.9 (standard deviation 6.0), 62.9% with annual household income ≤$15,000, mean daily servings of all F/V was 5.3 (targeted F/V 3.7 servings excluding legumes/juices/starchy vegetables/fried foods), and 27.7% of daily calories from fat. More than 60% in the Intervention group attended seven or more of nine classes, with overall study retention of 87% retention at 6 months. At month 6, the Intervention group compared with Control group reported an increase in mean servings of F/V from baseline (all F/V: +2.0 vs -0.1; P=0.005; targeted F/V: +2.7 vs +0.5; P=0.002) and a nonsignificant decrease in percent calories from fat (-7.5% vs -4.4%; P=0.23) and weight (-2.5 kg vs +3.8 kg; P=0.22). CONCLUSIONS ¡Cocinar Para Su Salud! was effective at increasing short-term F/V intake in a diverse population of Hispanic breast cancer survivors.
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Reyes-Soffer G, Dionizovik M, Jimenez J, Obunike J, Holleran S, Ramakrishnan R, Karmally W, Fontanez N, Thomas T, Donovan D, Morey R, Mittleman R, Chin W, Baker B, Ginsberg HN. Abstract 634: Treatment with Mipomersen Reduces Levels of ApoB-Containing Lipoproteins by Increasing Fractional Removal of VLDL and LDL-apoB Without Reducing VLDL-apob Secretion. Arterioscler Thromb Vasc Biol 2014. [DOI: 10.1161/atvb.34.suppl_1.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Mipomersen (MIPO), a second generation antisense oligonucleotide, targets apoB mRNA, thereby inhibiting apolipoprotein B (apoB) synthesis. In humans, MIPO reduces plasma levels of low density lipoprotein-cholesterol (LDL-C), and plasma triglycerides (TG). We hypothesized that these changes are due to reduced assembly and secretion of very low density lipoproteins (VLDL) and lower production of LDL.
Methods:
Healthy volunteers (HVs) (9M, 8F), mean age 43.5 ± 14.2 yr, completed a single-blind, fixed-sequence, phase I study. They received sc-placebo injections once weekly for 3-wks followed by 200mg sc-MIPO injections once weekly for 7-9 wks. Stable isotope turnover studies were performed after each treatment. Blood samples were collected over 48-hrs to determine fractional catabolic rates (FCRs) and production rates (PRs) of apoB in VLDL, IDL, and LDL, and of TG in VLDL. Rates of de novo lipogenesis (DNL) were also measured.
Results:
MIPO treatment resulted in significant reductions in plasma LDL-C (45%), TG (29%), and apoB (40%). VLDL, IDL, and LDL apoB levels fell by 29%, 25%, and 42%, respectively. These changes were associated with increases in FCRs of VLDL apoB (42%) and LDL apoB (30%), and by reductions in PRs of IDL apoB (15%) and LDL apoB (27%). The PR of VLDL apoB was unaffected. The FCR of VLDL-TG increased 46% without change in PR. DNL did not change.
Conclusion:
In summary, 7 wks of MIPO significantly reduced levels of all apoB-lipoproteins in HVs by increasing the FCRs of VLDL and LDL apoB. The absence of a reduction in VLDL apoB secretion is consistent with many studies in isolated hepatocytes demonstrating both intracellular degradation and secretion of newly synthesized apoB. Thus, if MIPO submaximally inhibited apoB synthesis in this study, the liver could have compensated by increasing the efficiency of VLDL assembly and secretion. The basis of increases in VLDL and LDL FCRs requires further investigation.
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Affiliation(s)
| | | | | | - Joseph Obunike
- Biology/Physiology, New York City College of Technology, New York, NY
| | | | | | - Wahida Karmally
- Irving Institute for Clinical and Translational Rsch, Columbia Univ Med Cntr, New York, NY
| | - Nelson Fontanez
- Preventive Medicine and Nutrition, Columbia Univ Med Cntr, New York, NY
| | | | | | | | | | - Wai Chin
- Biostatistics, Genzyme Corp, Cambridge, MA
| | - Brenda Baker
- Clinical Development, ISIS Pharmaceuticals, Carlsbad, CA
| | - Henry N Ginsberg
- Preventive Medicine and Nutrition, Columbia Univ Med Cntr, New York, NY
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Greenlee H, Gaffney AO, Aycinena AC, Koch P, Contento I, Karmally W, Richardson J, Lim E, Tsai WY, Crew K, Maurer M, Kalinsky K, Hershman DL. Abstract B02: ¡Cocinar Para Su Salud!: Long-term effects of a short-term culturally based dietary intervention among Hispanic breast cancer survivors. Cancer Prev Res (Phila) 2013. [DOI: 10.1158/1940-6215.prev-13-b02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Guidelines for cancer survivors from the American Cancer Society and the American Institute for Cancer Research recommend a diet high in fruits and vegetables and low in energy dense foods, with the goal of improving cancer outcomes. However, few effective and culturally relevant resources exist to assist minority cancer survivors, including Hispanics, in meeting and maintaining these dietary recommendations. We tested the effects of ¡Cocinar Para Su Salud! (Cook For Your Health!), a short-term (9-week) culturally-based dietary intervention, on increasing fruit/vegetable (F/V) intake and decreasing dietary fat intake over 12 months among Hispanic breast cancer survivors.
Methods: Eligible women included those with a prior diagnosis of stage 0-III breast cancer, completion of adjuvant treatment (hormonal therapy allowed), Hispanic and able to speak Spanish. At baseline, women completed three 24-hour diet recalls, detailed interviews, provided fasting blood and anthropometric measures. Subjects were randomized to: A) the control arm (dietary recommendation booklet for breast cancer survivors), or B) the ¡Cocinar Para Su Salud! program, a 9-week culturally-based dietary intervention using group nutrition education, cooking classes and food shopping field trips to promote behavior change. The intervention was developed via a collaboration between academic and NYC-based community partners. All study activities were conducted in Spanish. Participants were followed for 12 months via monthly phone interviews and clinic visits (3, 6 and 12 months). The primary outcome was change at 6 months in daily F/V servings and % calories from fat. Month 12 outcomes are reported here. Change in dietary intake was analyzed using 2-sample t-tests.
Results: From April 2011 to March 2012, 70 women were randomized (n=36 control, n=34 intervention). Baseline characteristics: mean age 56.6 yrs (SD 9.7), mean time since diagnosis 3.4 yrs (SD 2.7), mean body mass index (BMI) 30.6 kg/m2 (SD 5.4), and 63% had an annual household income <$15,000. At baseline, women reported average daily intake of 5.3 servings of all F/V (3.1 servings of F/V targeted by the intervention, which excluded legumes/juices/starchy vegetables/fried foods) and 27.7% of daily calories from fat. 64% of women in the intervention arm attended ≥7/9 classes. Retention rates were 87% at month 6 and 83% at month 12. At month 6, the intervention group compared to controls reported a significant increase in mean servings of F/V from baseline (all F/V: +2.0 vs. -0.1, P=0.005; targeted F/V: +2.6 vs. +0.1, P<0.001), but a non-significant decrease in % calories from fat (-7.3% vs. -4.5%, P=0.26) and weight (-2.5 kg vs. +2.6 kg, P=0.2). Changes in F/V intake were maintained at month 12: the intervention group compared to controls reported a significant increase in mean servings of F/V from baseline (all F/V: +2.0 vs. -0.4, P=0.006; targeted F/V: +1.9 vs. -0.3, P=0.001). Although the non-significant trend in weight loss in the intervention arm compared to controls was maintained at month 12 (-2.1 kg vs. +2.5 kg, P=0.3), the decrease in % calories from fat was not maintained (-2.2% vs. -1.1%, P=0.69).
Conclusions: ¡Cocinar Para Su Salud! is an effective program to increase fruit/vegetable intake among a diverse group of urban Hispanic breast cancer survivors. The benefit of the 9-week intervention was sustained at 12 months.
Citation Format: Heather Greenlee, Ann Ogden Gaffney, Ana Corina Aycinena, Pam Koch, Isobel Contento, Wahida Karmally, John Richardson, Emerson Lim, Wei Yann Tsai, Katherine Crew, Matthew Maurer, Kevin Kalinsky, Dawn L. Hershman. ¡Cocinar Para Su Salud!: Long-term effects of a short-term culturally based dietary intervention among Hispanic breast cancer survivors. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B02.
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Affiliation(s)
| | | | | | - Pam Koch
- 3Columbia University Teachers College, New York, NY
| | | | | | | | - Emerson Lim
- 1Columbia University Medical Center, New York, NY,
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Jackness C, Karmally W, Febres G, Conwell IM, Ahmed L, Bessler M, McMahon DJ, Korner J. Very low-calorie diet mimics the early beneficial effect of Roux-en-Y gastric bypass on insulin sensitivity and β-cell Function in type 2 diabetic patients. Diabetes 2013; 62:3027-32. [PMID: 23610060 PMCID: PMC3749351 DOI: 10.2337/db12-1762] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Marked improvement in glycemic control occurs in patients with type 2 diabetes mellitus shortly after Roux-en-Y gastric bypass surgery (RYGB) and before there is major weight loss. The objective of this study was to determine whether the magnitude of this change is primarily due to caloric restriction or is unique to the surgical procedure. We studied eleven subjects who underwent RYGB and fourteen subjects mean-matched for BMI, HbA1c, and diabetes duration who were admitted to our inpatient research unit and given a very low-calorie diet (VLCD) of 500 kcal/day with a macronutrient content similar to that consumed by patients after RYGB. Frequently sampled intravenous glucose tolerance tests were performed before and after interventions. Both groups lost an equivalent amount of weight over a mean study period of 21 days. Insulin sensitivity, acute insulin secretion after intravenous glucose administration, and β-cell function as determined by disposition index improved to a similar extent in both groups. Likewise, changes in fasting glucose and fructosamine levels were similar. Based on these data, VLCD improves insulin sensitivity and β-cell function just as well as RYGB in the short term.
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Affiliation(s)
- Clifton Jackness
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Wahida Karmally
- Irving Institute for Clinical and Translational Research, Columbia University, New York, New York
| | - Gerardo Febres
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Irene M. Conwell
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Leaque Ahmed
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Marc Bessler
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Donald J. McMahon
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Judith Korner
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Corresponding author: Judith Korner,
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Korner J, Conroy R, Febres G, McMahon DJ, Conwell I, Karmally W, Aronne LJ. Randomized double-blind placebo-controlled study of leptin administration after gastric bypass. Obesity (Silver Spring) 2013; 21:951-6. [PMID: 23512892 PMCID: PMC3689870 DOI: 10.1002/oby.20433] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/10/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Obese individuals have high levels of circulating leptin and are resistant to the weight-reducing effect of leptin administration at physiological doses. Although Roux-en-Y gastric bypass (RYGB) is an effective weight loss procedure, there is a plateau in weight loss and most individuals remain obese. This plateau may be partly due to the decline in leptin resulting in a state of relative leptin insufficiency. The main objective of this study was to determine whether leptin administration to post-RYGB patients would promote further weight reduction. DESIGN AND METHODS This was a randomized, double-blind, placebo-controlled cross-over study of 27 women who were at least 18 months post-RYGB and lost on average 30.8% of their presurgical body weight. Subjects received either leptin or placebo via subcutaneous injection twice daily for 16 weeks, then crossed over to receive the alternate treatment for 16 weeks. RESULTS Weight change after 16 weeks of placebo was not significantly different from that after 16 weeks of leptin. No changes were observed in percent fat mass, resting energy expenditure, thyroid hormones, or cortisol levels. CONCLUSION Contrary to our hypothesis, we did not observe a significant effect of leptin treatment on body weight in women with relative hypoleptinemia after RYGB.
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Affiliation(s)
- Judith Korner
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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Reyes-Soffer G, Ngai CI, Lovato L, Karmally W, Ramakrishnan R, Holleran S, Ginsberg HN. Effect of combination therapy with fenofibrate and simvastatin on postprandial lipemia in the ACCORD lipid trial. Diabetes Care 2013; 36:422-8. [PMID: 23033246 PMCID: PMC3554305 DOI: 10.2337/dc11-2556] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Action to Control Cardiovascular Risk in Diabetes lipid study (ACCORD Lipid), which compared the effects of simvastatin plus fenofibrate (FENO-S) versus simvastatin plus placebo (PL-S) on cardiovascular disease outcomes, measured only fasting triglyceride (TG) levels. We examined the effects of FENO-S on postprandial (PP) lipid and lipoprotein levels in a subgroup of ACCORD Lipid subjects. RESEARCH DESIGN AND METHODS We studied 139 subjects (mean age of 61 years, 40% female, and 76% Hispanic or black) in ACCORD Lipid, from a total 529 ACCORD Lipid subjects in the Northeast Clinical Network. PP plasma TG, apolipoprotein (apo)B48, and apoCIII were measured over 10 h after an oral fat load. RESULTS The PP TG incremental area under the curve (IAUC) above fasting (median and interquartile range [mg/dL/h]) was 572 (352-907) in the FENO-S group versus 770 (429-1,420) in the PL-S group (P = 0.008). The PP apoB48 IAUC (mean ± SD [μg/mL/h]) was also reduced in the FENO-S versus the PL-S group (23.2 ± 16.3 vs. 35.2 ± 28.6; P = 0.008). Fasting TG levels on the day of study were correlated with PP TG IAUC (r = 0.73 for FENO-S and r = 0.62 for PL-S; each P < 0.001). However, the fibrate effect on PP TG IAUC was a constant percentage across the entire range of fasting TG levels, whereas PP apoB48 IAUC was only reduced when fasting TG levels were increased. CONCLUSIONS FENO-S lowered PP TG similarly in all participants compared with PL-S. However, levels of atherogenic apoB48 particles were reduced only in individuals with increased fasting levels of TG. These results may have implications for interpretation of the overall ACCORD Lipid trial, which suggested benefit from FENO-S only in dyslipidemic individuals.
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Hsu WC, Boyko EJ, Fujimoto WY, Kanaya A, Karmally W, Karter A, King GL, Look M, Maskarinec G, Misra R, Tavake-Pasi F, Arakaki R. Pathophysiologic differences among Asians, native Hawaiians, and other Pacific Islanders and treatment implications. Diabetes Care 2012; 35:1189-98. [PMID: 22517940 PMCID: PMC3329855 DOI: 10.2337/dc12-0212] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- William C Hsu
- Asian American Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA.
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Badjatia N, Monahan A, Carpenter A, Friedman L, Zimmerman J, Schmidt JM, Claassen J, Lee K, Connolly S, Mayer S, Karmally W, Seres D. Impact of Underfeeding and Protein Catabolism on Hospital-Acquired Infections after Subarachnoid Hemorrhage (S19.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s19.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gibson CD, Karmally W, McMahon DJ, Wardlaw SL, Korner J. Randomized pilot study of cabergoline, a dopamine receptor agonist: effects on body weight and glucose tolerance in obese adults. Diabetes Obes Metab 2012; 14:335-40. [PMID: 22074059 PMCID: PMC3290696 DOI: 10.1111/j.1463-1326.2011.01534.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Dopaminergic hypofunction and hyperprolactinaemia have been implicated in the pathogenesis of obesity and glucose intolerance. The aim of this pilot study was to determine the efficacy of cabergoline, a dopamine receptor agonist, on body weight and glucose tolerance in obese non-diabetic persons with normal plasma prolactin levels. METHODS This 16-week double blind, placebo-controlled pilot study randomized non-diabetic obese adults (body mass index 30-42 kg/m(2) ) to placebo or cabergoline (0.25 mg twice weekly for 4 weeks followed by 0.5 mg twice weekly for the next 12 weeks). Of 40 subjects enrolled, 29 completed 16 weeks: 16 randomized to placebo and 13 to cabergoline. All subjects were counselled on a 500 kcal/day calorie deficit diet. A 75-g oral glucose tolerance test was performed at baseline and at 16 weeks. RESULTS As expected, prolactin levels decreased after cabergoline (p < 0.001). Weight loss was similar after placebo compared with cabergoline treatment: 1.0 vs. 1.2% body weight, respectively. Fasting glucose levels did not differ between groups after treatment, however, 90-min postprandial glucose and insulin decreased in the cabergoline group only (p = 0.029). HOMA-IR (homeostasis model of assessment) increased by 40% after placebo and 1.5% after cabergoline treatment. CONCLUSIONS This pilot study suggests that cabergoline therapy may improve glucose tolerance independent of weight loss, however, a larger, longer term study of dopamine receptor agonist therapy in obese individuals is warranted to confirm this finding.
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Affiliation(s)
- Charlisa D. Gibson
- Department of Medicine, New York Obesity Research Center, St. Luke’s-Roosevelt Hospital Center New York, New York
| | - Wahida Karmally
- Irving Institute for Clinical and Translational Research, Columbia University, New York, New York
| | - Donald J. McMahon
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Sharon L. Wardlaw
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Judith Korner
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
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Wheeler ML, Dunbar SA, Jaacks LM, Karmally W, Mayer-Davis EJ, Wylie-Rosett J, Yancy WS. Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010. Diabetes Care 2012; 35:434-45. [PMID: 22275443 PMCID: PMC3263899 DOI: 10.2337/dc11-2216] [Citation(s) in RCA: 204] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Lindsay M. Jaacks
- School of Public Health, Nutritional Epidemiology, The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Wahida Karmally
- Irving Institute for Clinical and Translational Research, Columbia University, New York, New York
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - William S. Yancy
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
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Nicklas TA, Karmally W, O'Neil CE. Nutrition professionals are obligated to follow ethical guidelines when conducting industry-funded research. ACTA ACUST UNITED AC 2012; 111:1931-2. [PMID: 22117671 DOI: 10.1016/j.jada.2011.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Indexed: 11/30/2022]
Abstract
Although disclosure of all funding sources, including those from industry, is mandatory for publication, it is no longer adequate. Given the skepticism surrounding industry-funded research, we need guidelines for communication with funding organizations and publication venues, and we need to safeguard and preserve research and scientific integrity.
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Affiliation(s)
- Theresa A Nicklas
- Baylor College of Medicine, Department of Pediatrics, Houston, TX, USA
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Berryman CE, Preston AG, Karmally W, Deckelbaum RJ, Kris-Etherton PM. Effects of almond consumption on the reduction of LDL-cholesterol: a discussion of potential mechanisms and future research directions. Nutr Rev 2011; 69:171-85. [DOI: 10.1111/j.1753-4887.2011.00383.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kris-Etherton PM, Karmally W, Ramakrishnan R. Almonds lower LDL cholesterol. J Am Diet Assoc 2009; 109:1521-1523. [PMID: 19699825 DOI: 10.1016/j.jada.2009.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Indexed: 05/28/2023]
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Reyes-Soffer G, Holleran S, Karmally W, Ngai CI, Chen NT, Torres M, Ramakrishnan R, Blaner WS, Berglund L, Ginsberg HN, Tuck C. Measures of postprandial lipoproteins are not associated with coronary artery disease in patients with type 2 diabetes mellitus. J Lipid Res 2009; 50:1901-9. [PMID: 19429886 DOI: 10.1194/jlr.m900092-jlr200] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Individuals with type 2 diabetes mellitus (DM) characteristically have elevated fasting and postprandial (PP) plasma triglycerides (TG). Previous case-control studies indicated that PPTG levels predict the presence of coronary artery disease (CAD) in people without DM; however, the data for patients with DM are conflicting. Therefore, we conducted a case-control study in DM individuals, 84 with (+) and 80 without (-) CAD. Our hypothesis was that DM individuals with or without CAD would have similar PPTG levels, but CAD+ individuals would have more small d<1.006 g/L lipoprotein particles. Several markers of PP lipid metabolism were measured over 10 h after a fat load. PP lipoprotein size and particle number were also determined. There was no significant difference in any measure of PP lipid metabolism between CAD+ and CAD-, except for apoB48, which was actually higher in CAD-. We followed 69 CAD- participants for a mean 8.7 years; 33 remained free of any cardiovascular event. There were no PP differences at baseline between these 33 who remained CAD- and either the 36 original CAD- who subsequently developed CAD or the original CAD+ group.PP measurements of TG-rich lipoproteins do not predict the presence of CAD in individuals with DM.
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Affiliation(s)
- Gissette Reyes-Soffer
- Departments of Medicine, Columbia University Medical Center, New York, NY 10032, USA
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Lu G, Thomas-Geevarghese A, Anuurad E, Raghavan S, Minolfo R, Ormsby B, Karmally W, El-Sadr WM, Albu J, Berglund L. Relationship of postprandial nonesterified fatty acids, adipokines, and insulin across gender in human immunodeficiency virus-positive patients undergoing highly active antiretroviral therapy. Metab Syndr Relat Disord 2009; 7:199-204. [PMID: 19320559 DOI: 10.1089/met.2008.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Metabolic derangements are common in human immunodeficiency virus (HIV)-positive subjects undergoing antiretroviral therapy, but little is known about postprandial conditions. METHODS We investigated the relationship between leptin, adiponectin, nonesterified fatty acids (NEFA), and insulin in response to a day-long meal pattern and evaluated gender differences in HIV-positive men (n = 12) and women (n = 13) undergoing highly active antiretroviral therapy (HAART). RESULTS For both men and women, a significant decrease in postprandial NEFA levels was observed following breakfast (0.53 vs. 0.22 mmol/L, P < 0.001, baseline and at 3 hours, respectively), whereas day-long postprandial leptin and adiponectin levels showed small nonsignificant oscillations. In contrast to NEFA and adiponectin, postprandial leptin levels were significantly higher among women compared to men (P < 0.05). Postprandial NEFA levels correlated positively with fasting insulin levels (r(2) = 0.25, P = 0.016), and the postbreakfast decrease in NEFA levels correlated significantly with the postbreakfast increase in insulin levels (r(2) = 0.17, P = 0.038). No significant association between postprandial adipokines and insulin was observed. CONCLUSIONS In HAART-treated, HIV-infected men and women, levels of NEFA, but not adipokines, showed significant postprandial variation. Furthermore, food intake resulted in significant NEFA suppression in proportion to the food-stimulated insulin increase.
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Affiliation(s)
- Guijing Lu
- Department of Medicine, University of California Davis, Sacramento, California 95817, USA
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