Predictors of plasma triglyceride elevation in patients participating in a coronary atherosclerosis treatment program

Rat chromosome 8 confers protection against dyslipidemia caused by a high-fat/low-carbohydrate diet

BACKGROUND/AIMS

Recent studies have highlighted the importance of gene by diet interactions in contributing to risk factors of metabolic syndrome. We used a consomic rat panel, in which a chromosome of the Brown Norway (BN) strain is introgressed onto the background of the Dahl salt-sentitive (SS) strain, to test the hypothesis that these animals will be useful for dissecting gene by diet interactions involved in metabolic syndrome.

METHODS

We placed the parental SS and BN strains on a low-fat/high-carbohydrate (LF) or high-fat/low-carbohydrate (HF) diet for 22 weeks and measured several indices of metabolic syndrome. We then investigated the effect of diet in eight consomic rat strains.

RESULTS

We show that the HF diet resulted in significantly increased levels of fasting plasma cholesterol and triglycerides in the SS strain, with no effect in the BN. Both strains responded to the HF diet with slight increases in body weight. SSBN8 was the only consomic strain that resembled that of the BN, with low levels of fasting cholesterol and triglycerides even on the HF diet.

CONCLUSIONS

These results indicate that BN chromosome 8 harbors a gene or genes that confer protection against dyslipidemia caused by the HF diet.

Nutrition in the genomics era: cardiovascular disease risk and the Mediterranean diet

The effect of dietary changes on phenotypes (i.e., plasma lipid measures, body weight and blood pressure) differs significantly between individuals. This phenomenon has been more extensively researched in relation to changes in dietary fat and plasma lipid concentrations for the prevention of cardiovascular disease (CVD) compared to other pathological conditions. Although common knowledge associates low fat diets with reductions in total and plasma LDL cholesterol, the clinical evidence shows dramatic inter-individual differences in response that are partially due to genetic factors. The discovery of the cardioprotective and other healthy properties of the Mediterranean diet has popularized the consumption of Mediterranean products such as olive oil. Molecular, clinical, and epidemiological studies have begun to shed some light about how various components of this diet may protect the cardiovascular system and to decrease the risk of other diseases such as cancer. However, it is also possible that the right combination of genetic, cultural, socioeconomic factors is needed to achieve full benefit. It has been proposed that the Mediterranean diet may be closer to the ancestral foods that were part of human development and our metabolism may have evolved to work optimally on such a diet rather than with the current diets richer in saturated fat and highly refined and processed foods. Therefore, it is possible that alleles that are associated with increase disease risk may be silenced in the presence of that more ancestral and traditional diet and lifestyle. This knowledge may provide the basis for successful public health as well individual approaches for disease prevention.

Dietary carbohydrate's effects on lipogenesis and the relationship of lipogenesis to blood insulin and glucose concentrations

The process by which dietary carbohydrate is transformed into fat in the human body is termedde novolipogenesis. New methods for the measurement of this process in humans are available and have been used to investigate the role of the carbohydrate form (fed as a liquid or solid), the level of processing of carbohydrate in foods, and the role of lipogenesis in the control of liver triacylglycerol secretion. The present paper will discuss how research results are affected by both the physical state of the carbohydrate in the diet and by the metabolic state of individual research subjects. Of interest is the relationship between the glycemic index of a food (or indicators of a food's glycemic index) and that food's ability to stimulate lipogenesis in humans. Given the increasing prevalence of obesity worldwide, future scientific emphasis will expand methods to quantitate the lipogenic potential of specific foods and dietary patterns and investigate how the metabolic state of insulin resistance affects lipogenesis and/or contributes to obesity.

Nutrigenetics, plasma lipids, and cardiovascular risk

Cardiovascular disease (CVD) results from complex interactions between genetic and environmental factors. The evidence supports that gene-environment interactions modulate plasma lipid concentrations and potentially CVD risk. Several genes (eg, apolipoprotein A-I and A-IV, apolipoprotein E, and hepatic lipase) are providing proof-of-concept for the application of genetics in the context of personalized nutrition for CVD prevention. The spectrum of candidate genes has been expanding to incorporate those involved in intracellular lipid metabolism and especially those transcription factors (ie, peroxisome proliferator activator receptors) that act as sensors of nutrients in the cell (eg, polyunsaturated fatty acids) to trigger metabolic responses through activation of specific sets of genes. However, current knowledge is still very limited and so is the potential benefit of its application to clinical practice. Thinking needs to evolve from simple scenarios (eg, one single dietary component, a single nucleotide polymorphism and risk factor) to more realistic situations involving multiple interactions. One of the first situations where personalized nutrition is likely to be beneficial is in patients with dyslipidemia who require special intervention with dietary treatment. This process could be more efficient if the recommendations were carried out based on genetic and molecular knowledge. Moreover, adherence to dietary advice may increase when it is supported with information based on nutritional genomics, and a patient believes the advice is personalized. However, a number of important changes in the provision of health care are needed to achieve the potential benefits associated with this concept, including a teamwork approach with greater integration among physicians, food and nutrition professionals, and genetic counselors.

Genetic variation and lipid metabolism: modulation by dietary factors

Cardiovascular diseases (CVD) result from complex interactions between genetic and environmental factors. The evidence supports that gene-environment interactions modulate plasma lipid concentrations and potentially CVD risk. The findings from studies examining gene-diet interactions and lipid metabolism have been promising. Several loci (eg, APOA1, APOE, LIPC) are providing proof of concept for the application of genetics in the context of personalized nutrition for CVD prevention. The spectrum of candidate genes has been expanding to incorporate those involved in intracellular lipid metabolism (eg, iPPARs, CYP7A1). However, the practical application of these findings is not ready for prime time. There is a compelling need for replication using a higher level of scientific evidence. Moreover, we need to evolve from the simple scenarios examined nowadays (ie, one single dietary component, SNP, and risk factor) to more realistic situations involving multiple interactions. In summary, there is need for both large population studies and well-standardized intervention studies.

SINGLE NUCLEOTIDE POLYMORPHISMS THAT INFLUENCE LIPID METABOLISM: Interaction with Dietary Factors

Cardiovascular disease (CVD) risk is the result of complex interactions between genetic and environmental factors. During the past few decades, much attention has focused on plasma lipoproteins as CVD risk factors. The current evidence supports the concept that gene-environment interactions modulate plasma lipid concentrations and potentially CVD risk. The findings from studies examining gene-diet interactions and lipid metabolism have been highly promising. Several loci (i.e., APOA1, APOA4, APOE, and LIPC) are providing proof-of-concept for the potential application of genetics in the context of personalized nutritional recommendations for CVD prevention. However, the incorporation of these findings to the clinical environment is not ready for prime time. There is a compelling need for replication using a higher level of scientific evidence. Moreover, we need to evolve from the simple scenarios examined nowadays (i.e., one single dietary component, single nucleotide polymorphism, and risk factor) to more realistic situations involving interactions between multiple genes, dietary components, and risk factors. In summary, there is need for both large population studies and well-standardized intervention studies.

Sugars, hypertriglyceridemia, and cardiovascular disease

Short-term studies consistently show that raising the carbohydrate content of the diet increases serum triacylglycerol concentrations. As compared with starches, sugars (particularly sucrose and fructose) tend to increase serum triacylglycerol concentrations by approximately 60%. The magnitude of the effect depends on other aspects of the diet, including the total amount of carbohydrate and the types of fat, carbohydrate, and fiber, but definitive studies to describe the dose-response relations are not available. Longer-term studies show that some high-carbohydrate diets are not associated with increased fasting serum triacylgycerol concentrations. However, sedentary subjects with upper-body and visceral obesity who have the metabolic syndrome tend to be at higher risk for hypertriglyceridemia in response to high-sucrose and high-carbohydrate diets; moderate weight loss mitigates the effect. Hyperinsulinemia or insulin resistance may play a role in promoting higher rates of VLDL synthesis and hypertriglyceridemia in obesity, but the mechanisms remain unclear. The effect of fructose in promoting triacylglycerol synthesis is independent of insulinemia, however. In terms of the long-term effects of diets high in sugars on the risk of cardiovascular disease, available epidemiologic evidence indicates no association of sugars or total carbohydrate intake per se, but high dietary glycemic load is associated with higher serum triacylglycerol concentrations and greater risk of coronary heart disease in women. Studies are needed to delineate the independent effects of dietary sugars and glycemic load on serum triacylglycerol concentrations in lean and obese men and women and to determine whether the elevations in fasting and fed concentrations of serum triacylglycerol with high-carbohydrate and high-sugars diets are associated with increased risk of cardiovascular disease.

Changes in fat synthesis influenced by dietary macronutrient content

DE NOVO: lipogenesis is the biological process by which C2 precursors of acetyl-CoA are synthesized into fatty acids. In human subjects consuming diets higher in fat (> 30 % energy), lipogenesis is down regulated and extremely low; typically < 10 % of the fatty acids secreted by the liver. This percentage will increase when dietary fat is reduced and replaced by carbohydrate, although the extent of carbohydrate-induced lipogenesis is dependent on the type of carbohydrate (monosaccharide v. polysaccharide) and the form in which the carbohydrate is fed (liquid meals, solid less-processed food). Clearly, massive overconsumption of carbohydrate can also increase lipogenesis. A second related phenomenon that occurs when dietary fat is reduced is hypertriacylglycerolaemia. This rise in blood triacylglycerol concentration could be due to increased de novo lipogenesis or to reduced clearance of lipid from the blood. The present paper will review the metabolic mechanisms leading to the elevations in blood triacylglycerol concentration that occur with dietary fat reduction. Studies considered will be those investigating fatty acid synthesis in subjects chronically fed low-fat high-carbohydrate diets and studies in which data were obtained in both the fasted and fed states. Also summarized will be data from subjects who had consumed diets of different carbohydrate types, as well as the most recent data from postprandial studies investigating factors that affect the magnitude of the rise in blood lipids following a meal. Given the changing availability of carbohydrate in the food supply, it will be important to understand how the balance of fat and carbohydrate in the diet influences lipogenesis, and the relative contribution of the process of de novo lipogenesis to the escalating incidence of obesity observed around the world.

Carbohydrate-induced hypertriglyceridemia: modifying factors and implications for cardiovascular risk

High-carbohydrate/low-fat, isocaloric diets have repeatedly been shown to increase plasma triglyceride concentrations. The present review addresses recent developments relevant to several important unresolved issues. These include the type of dietary carbohydrate that is most likely to induce hypertriglyceridemia, predictors of individual susceptibility, modifiable physiologic factors that may mitigate the plasma triglyceride response, underlying metabolic mechanisms that are responsible for increased plasma triglycerides, and implications of altered serum lipid profiles for atherogenic risk. Although some progress has been made in this field, the central public health issue - the net effect on cardiovascular risk - remains unresolved.

Effect of dietary carbohydrate on triglyceride metabolism in humans

When the content of dietary carbohydrate is elevated above the level typically consumed (>55% of energy), blood concentrations of triglycerides rise. This phenomenon, known as carbohydrate-induced hypertriglyceridemia, is paradoxical because the increase in dietary carbohydrate usually comes at the expense of dietary fat. Thus, when the content of the carbohydrate in the diet is increased, fat in the diet is reduced, but the content of fat (triglycerides) in the blood rises. The present article will review studies of carbohydrate-induced hypertriglyceridemia, highlighting data obtained in fasted subjects habituated to high carbohydrate diets, data obtained from subjects in the fed state, and metabolic studies investigating fatty acid and triglyceride synthesis in subjects consuming diets of different carbohydrate content. The available data have been recently expanded by new methodologies, such as the use of stable isotopes, to investigate the metabolism of sugars in humans in vivo. Given the significant increase in body weight observed in the American population over the past decade and the changing availability of carbohydrate in the food supply, future studies of carbohydrate-induced hypertriglyceridemia promise to provide important information of how the macronutrient composition of the diet can influence health.