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High carbohydrate diets, triglyceride-rich lipoproteins, and coronary heart disease risk

      Abstract

      In this study we compared the effects of variations in dietary fat and carbohydrate (CHO) content on concentrations of triglyceride-rich lipoproteins in 8, healthy, nondiabetic volunteers. The diets contained, as a percentage of total calories, either 60% CHO, 25% fat, and 15% protein, or 40% CHO, 45% fat, and 15% protein. They were consumed in random order for 2 weeks, with a 2-week washout period in between. Measurements were obtained at the end of each dietary period of plasma triglyceride, cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, remnant lipoprotein (RLP) cholesterol, and RLP triglyceride concentrations, both after an overnight fast and throughout an 8-hour period (8 a.m. to 4 p.m.) in response to breakfast and lunch. The 60% CHO diet resulted in higher (mean ± SEM) fasting plasma triglycerides (206 ± 50 vs 113 ± 19 mg/dl, p = 0.03), RLP cholesterol (15 ± 6 vs 6 ± 1 mg/dl, p = 0.005), RLP triglyceride (56 ± 25 vs 16 ± 3 mg/dl, p = 0.003), and lower HDL cholesterol (39 ± 3 vs 44 ± 3 mg/dl, p = 0.003) concentrations, without any change in LDL cholesterol concentration. Furthermore, the changes in plasma triglyceride, RLP cholesterol, and RLP triglyceride persisted throughout the day in response to breakfast and lunch. These results indicate that the effects of low-fat diets on lipoprotein metabolism are not limited to higher fasting plasma triglyceride and lower HDL cholesterol concentrations, but also include a persistent elevation in RLPs. Given the atherogenic potential of these changes in lipoprotein metabolism, it seems appropriate to question the wisdom of recommending that all Americans should replace dietary saturated fat with CHO.
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      References

        • Nestel P.J.
        Relationship between plasma triglycerides and removal of chylomicrons.
        J Clin Invest. 1964; 43: 943-949
        • Wilson D.E.
        • Chan I.-F.
        • Buchi K.N.
        • Horton S.C.
        Postchallenge plasma lipoprotein retinoids.
        Metabolism. 1985; 34: 551-558
        • Ahrens E.H.
        • Hirsch Jr, J.
        • Oette K.
        • Farquhar J.W.
        • Stein Y.
        Carbohydrate-induced and fat-induced lipemia.
        Trans Assoc Am Physicians. 1961; 74: 134
        • Farquhar J.W.
        • Frank A.
        • Gross R.C.
        • Reaven G.M.
        Glucose, insulin and triglyceride responses to high and low carbohydrate diets in man.
        J Clin Invest. 1966; 45: 1648-1656
        • Coulston A.M.
        • Liu G.C.
        • Reaven G.M.
        Plasma glucose, insulin, and lipid responses to high-carbohydrate low-fat diets in normal humans.
        Metabolism. 1983; 32: 52-56
        • Chen Y.D.I.
        • Swami S.
        • Skowronski R.
        • Coulston A.M.
        • Reaven G.M.
        Effect of variations in dietary fat and carbohydrate intake on postprandial lipemia in patients with non-insulin dependent diabetes mellitus.
        J Clin Endocrinol Metab. 1993; 76: 347-351
        • Chen Y.D.I.
        • Coulston A.M.
        • Zhou M.Y.
        • Wang T.
        • Reaven G.M.
        Why do low-fat high-carbohydrate diets accentuate postprandial lipemia in patients with NIDDM?.
        Diabetes Care. 1995; 18: 10
        • Jeppesen J.
        • Schaaf P.
        • Jones C.
        • Zhou M.Y.
        • Chen Y.D.I.
        • Reaven G.M.
        Effects of low-fat, high-carbohydrate diets on risk factors for ischemic heart disease in post-menopausal women.
        Am J Clin Nutr. 1997; 65: 1027-1033
        • Mensink R.P.
        • Katan M.B.
        Effect of dietary fatty acids on serum lipids and lipoproteins.
        Arterioscler Thromb. 1992; 12: 911-919
        • Gardner C.D.
        • Kraemer H.C.
        Monounsaturated versus polyunsaturated dietary fat and serum lipids-meta-analysis.
        Arterioscler Thromb Vasc Biol. 1995; 15: 1917-1925
        • Simons L.A.
        • Dyer T.
        • Simons J.
        • Bernstein L.
        • Mock P.
        • Poonia N.S.
        • Balasubramaniam S.
        • Baron D.
        • Branson J.
        • Morgan J.
        • Roy P.
        Chylomicrons and chylomicron remnants in coronary artery disease.
        Atherosclerosis. 1987; 65: 181-189
        • Simpson H.S.
        • Williamson C.M.
        • Olivercrona T.
        • Pringle S.
        • Maclean J.
        • Lorimer A.R.
        • Bonnefous F.
        • Bogaievsky Y.
        • Packard C.J.
        • Shepherd J.
        Postprandial lipemia, fenofibrate and coronary artery disease.
        Atherosclerosis. 1990; 85: 193-202
        • Groot P.H.
        • van Stiphout W.A.
        • Krauss X.H.
        • Jansen H.
        • van Tol A.
        • van Ramshorst E.
        • Chin-On S.
        • Hofman A.
        • Cresswell S.R.
        • Havekes L.
        Postprandial lipoprotein metabolism in normolipidemic men with and without coronary artery disease.
        Arterioscler Thromb. 1991; 11: 653-662
        • Patsch J.R.
        • Miesenbock G.
        • Hopferweiser T.
        • Muhlberger V.
        • Knapp E.
        • Dunn J.K.
        • Gotto Jr, A.M.
        • Patsch W.
        Relation of triglyceride metabolism and coronary artery disease studies in the postprandial state.
        Arterioscler Thromb. 1992; 12: 1336-1345
        • Karpe F.
        • Bard J.M.
        • Steiner G.
        • Carlson L.A.
        • Fruchart J.C.
        • Hamsten A.
        HDLs and alimentary lipemia.
        Arterioscler Thromb. 1993; 13: 11-22
        • Jeppesen J.
        • Chen Y.D.I.
        • Zhou M.Y.
        • Schaaf P.
        • Coulston A.
        • Reaven G.M.
        Postprandial triglyceride and retinal ester responses to oral fat.
        Am J Clin Nutr. 1995; 61: 787-791
        • Jeppesen J.
        • Chen Y.D.I.
        • Zhou M.Y.
        • Wang T.
        • Reaven G.M.
        Effect of variations in oral fat and carbohydrate load on postprandial lipemia.
        Am J Clin Nutr. 1995; 62: 1201-1205
        • Nakajima K.
        • Saito T.
        • Tamura A.
        • Suzuki M.
        • Nakano T.
        • Adachi M.
        • Tanaka A.
        • Tada N.
        • Nakamura H.
        • Campos E.
        • Havel R.J.
        Cholesterol in remnant-like lipoproteins in human serum monoclonal anti-apoB-100 and anti apoA-1 immunoaffinity mixed gels.
        Clin Chim Acta. 1993; 223: 53-71
        • Watanabe N.
        • Taniguichi T.
        • Taketoh H.
        • Kitagawa Y.
        • Namura H.
        • Yoneda N.
        • Kurimoto Y.
        • Yamada S.
        • Ishikawa Y.
        Elevated remnant-like lipoprotein particles in impaired glucose tolerance and type 2 diabetic patients.
        Diabetes Care. 1999; 22: 152-156
        • Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
        Report of the expert committee on the diagnosis and classification of diabetes millitus.
        Diabetes Care. 1998; 21: S5-S22
        • Nakajima K.
        • Okazaki M.
        • Tanaka A.
        • et al.
        Separation and determination of remnant-like particles in serum from diabetes patients using monocional antibodies to apoB-100 and apo A-1.
        J Clin Ligand Assay. 1996; 19: 177-183
        • Leary E.T.
        • Wang T.
        • Baker D.J.
        • Cilla D.D.
        • Zhong J.
        • Warnick G.R.
        • Nakajima K.
        • Havel R.J.
        Evaluation of an immunoseparation method for quantitative measurement of remnant-like particle-cholesterol in serum and plasma.
        Clin Chem. 1998; 44: 2490-2498
        • Hulley S.B.
        • Rosenman R.H.
        • Bawol R.D.
        • Brand R.J.
        Epidemiology as a guide to clinical decisions. The association between triglyceride and coronary heart disease.
        N Engl J Med. 1980; 302: 1383-1389
        • Criqui M.H.
        • Heiss G.
        • Cohn R.R.
        • Cowan L.D.
        • Suchindran C.M.
        • Bangdiwala S.
        • Kritchevsky S.
        • Jacobs D.R.
        • O’Grady H.K.
        • Davis C.E.
        Plasma triglyceride level and mortality from coronary heart disease.
        N Engl J Med. 1993; 328: 1220-1225
        • Miller G.J.
        • Miller N.E.
        Plasma-high-density-lipoprotein concentration and development of ischaemic heart-disease.
        Lancet. 1975; 1: 16-19
        • Gordon T.
        • Kannel W.B.
        • Castelli W.P.
        • Dawber T.R.
        Lipoproteins, cardiovascular disease, and death.
        Arch Intern Med. 1981; 141: 1128-1131
        • Assmann G.
        • Schultz H.
        • von Eckardstein A.
        Hypertriglyceridemia and elevated lipoprotein (a) are risk factors for major coronary events in middle-aged men.
        Am J Cardiol. 1996; 77: 1179-1184
        • Austin M.A.
        • Hokanson J.E.
        • Edwards K.L.
        Hypertriglyceridemia as a cardiovascular risk factor.
        Am J Cardiol. 1998; 81: 7B-12B
        • Zilversmit D.B.
        Atherogenesis.
        Circulation. 1979; 60: 473-485