DIETS FOR DYSLIPIDEMIA IN THE METABOLIC SYNDROME

代谢综合征血脂异常的饮食

• 批准号: 7257033
• 负责人: ROBERT Henry KNOPP
• 金额: $ 75.21万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-15 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7257033
• 关键词: Apolipoproteins B; Apoprotein (B); Blood Vessels; Body Weight; Body Weight decreased; Carbohydrates; Cholesterol; Condition; Consensus; Coronary heart disease; Counseling; Crossover Design; Diet; Dietary Fats; Drops; Dyslipidemias; Elements; Elevation; Eligibility Determination; Endothelium; Epidemic; Exercise; Fasting; Fat-Restricted Diet; Fatty acid glycerol esters; Food; Glucose; High Density Lipoproteins; Hypertriglyceridemia; Inflammation; Inflammatory; Insulin; Intake; Life; Lipids; Lipoproteins; Low-Density Lipoproteins; Measures; Mediating; Metabolic; Metabolic syndrome; Nutritionist; Obesity; Observational Study; Persons; Physiological; Plant Roots; Plasma; Proteins; Randomized; Rate; Recommendation; Research; Research Design; Research Personnel; Solutions; Standards of Weights and Measures; Stress; Testing; Triglycerides; Tumor Necrosis Factor-alpha; Universities; Vascular Cell Adhesion Molecule-1; Washington; Week; Weight; Woman; adiponectin; base; brachial artery; carbohydrate metabolism; cardiovascular risk factor; cysteine rich protein; cytokine; design; feeding; human TNF protein; hypercholesterolemia; improved; indexing; intercellular cell adhesion molecule; men; programs; response; saturated fat; vascular inflammation

DESCRIPTION (provided by applicant): The metabolic syndrome (MetS) is comprised of a constellation of cardiovascular risk factors rooted in the current epidemic of obesity. Two of the defining features of MetS are high triglycerides and low HDL, i.e. the dyslipidemia of MetS. Standard hygienic recommendations for this dyslipidemia are weight loss and exercise, but at weight stability, there is no consensus on the dietary fat and carbohydrate proportions best suited for the dyslipidemia or the associated impaired vascular reactivity of MetS. Diets higher in fat, lower in carbohydrate may be more beneficial in MetS. Weight-loss studies show that higher fat, lower carbohydrate intakes are associated with lower triglyceride levels in obese persons, but lipoprotein, inflammatory and vascular responses to dietary perturbation in weight stability (the usual physiological state) have not been studied prospectively. Standard low fat, high carbohydrate diets in dyslipidemic persons yield 1/3rd of the LDL lowering of persons with simple hypercholesterolemia. Such persons are also less sensitive to higher saturated fat feeding. Consistent with these findings are lower rates of coronary disease in persons ingesting higher fat diets in observational studies. These observations plus physiological reasoning suggest the following hypothesis: Higher fat intake is more beneficial than conventional fat restricted diet in MetS for; 1) managing dyslipidemia, 2) reducing inflammatory stress and 3) correcting endothelium-mediated vascular reactivity, an immediate index of atherosclerotic stress. The study will compare the lipoprotein and vascular effects of two diets distinct in fat and carbohydrate content in a randomized, 4-week, crossover, feeding study design, using food prepared in the metabolic kitchen of the University of Washington GCRC. Diets will contain 40en% fat. 45en% carbohydrate or 20en% fat. 65en% carbohydrate with equivalent protein (15en%) and saturated fat (8en%). Weight will remain stable. Eligibility criteria are triglyceride >150mg/dl and any two other criteria of MetS. Seventy-two men and women will be randomized to yield 60 finished subjects at a 20% drop out rate. Weight and other vital signs will be measured twice weekly when food is picked-up from the GCRC. Lipoprotein lipids will be measured at 0, 3 and 4 weeks. Apoproteins B and A-l, LDL buoyancy, glucose, insulin, adiponectin, inflammatory cytokines and flow-mediated brachial artery reactivity will be measured at 0 and 4 weeks. A 4-month extension will continue the second diet assignment under dietician counseling with repeat testing. Expected results: 40en% fat diet in MetS subjects will yield improvements in non-HDL-C, other lipoprotein and glycemic variables, inflammation and brachial reactivity compared to 20en% fat. This study will be the first to demonstrate dietary benefit for dyslipidemia, inflammation and vascular stress in MetS at stable weight.

描述（由申请人提供）：代谢综合征（METS）由植根于当前肥胖症流行的心血管危险因素组成。 MetS的两个定义特征是高甘油三酸酯和低HDL，即MetS的血脂异常。这种血脂异常的标准卫生建议是减肥和运动，但是在体重稳定性下，饮食中脂肪和碳水化合物比例尚无共识，最适合于血脂异常或相关的Mets血管反应性受损。脂肪含量更高，碳水化合物较低的饮食对大都会的饮食可能更有益。减肥研究表明，肥胖者中较高的脂肪，较低的碳水化合物摄入量与较低的甘油三酸酯水平有关，但是脂肪蛋白，炎症性和血管反应对体重稳定性的饮食扰动（通常的生理状态）尚未被前瞻性研究。血脂性患者的标准低脂，高碳水化合物饮食产生1/3的LDL降低，患有简单的高胆固醇血症。此类人对更高的饱和脂肪进食也不太敏感。与这些发现一致的是在观察性研究中摄入较高脂肪饮食的人的冠状动脉疾病率较低。这些观察结果以及生理推理提出了以下假设：较高的脂肪摄入比大都会的常规脂肪限制饮食更有益； 1）管理血脂异常，2）减少炎症应激和3）纠正内皮介导的血管反应性，这是动脉粥样硬化应激的直接指数。这项研究将比较在华盛顿GCRC大学代谢厨房中制备的食物，比较了随机的，为期4周，跨越的喂养研究设计，两种饮食在脂肪和碳水化合物含量上不同的脂质蛋白和血管作用。饮食将含有40％的脂肪。 45en％碳水化合物或20EN％脂肪。 65EN％碳水化合物，等效蛋白（15EN％）和饱和脂肪（8en％）。体重将保持稳定。资格标准是甘油三酸酯> 150mg/dl和MetS的其他两个标准。 72名男女将被随机分配，以20％的辍学率产生60名成品受试者。从GCRC获取食物时，重量和其他生命体征将每周两次测量。脂蛋白脂质将在0、3和4周测量。载脂蛋白B和A-L，LDL浮力，葡萄糖，胰岛素，脂联素，炎性细胞因子和流动介导的臂动脉反应性将在0和4周时测量。 4个月的延长将继续在营养师咨询下继续进行第二次饮食分配，并重复测试。预期的结果：与20EN％的脂肪相比，Mets受试者的40％脂肪饮食将在非HDL-C，其他脂蛋白和血糖变量，炎症和臂反应性方面产生改善。这项研究将是第一个证明血脂异常，炎症和血管应激的饮食良好，体重稳定。