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Changes in plasma lipoproteins during low-fat, high-carbohydrate diets: effects of energy intake^1,2,3

¹ From the Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, and the Department of Nutrition, College of Agricultural and Environmental Sciences, University of California at Davis.

Background: Low-fat diets can increase plasma triacylglycerol and reduce HDL cholesterol. Changes in energy intake and body weight can influence the lipoprotein response.

Objective: We sought to prospectively examine the effects of euenergetic and ad libitum dietary fat restriction on plasma lipoproteins in healthy postmenopausal women.

Design: Participants first received a controlled euenergetic diet in which dietary fat was reduced stepwise from 35% to 25% to 15% over 4 mo. Thereafter, participants followed an ad libitum 15%-fat diet for 8 mo; 54 women completed the intervention.

Results: During the controlled euenergetic diet, plasma triacylglycerol increased from 1.70 ± 0.10 to 2.30 ± 0.16 mmol/L, total cholesterol decreased from 5.87 ± 0.13 to 5.53 ± 0.13 mmol/L, LDL cholesterol decreased from 3.41 ± 0.10 to 2.87 ± 0.10 mmol/L, HDL cholesterol decreased from 1.76 ± 0.08 to 1.50 ± 0.08 mmol/L, and apolipoprotein (apo) A-I decreased from 5.11 ± 0.14 to 4.78 ± 0.14 mmol/L (P < 0.0001 for all changes). Hormone replacement therapy did not affect the relative change in HDL cholesterol. Plasma glucose, insulin, hemoglobin A_1C, free fatty acid, and apo B concentrations did not change significantly. During the ad libitum 15%-fat diet, participants lost 4.6 ± 0.4 kg. Plasma triacylglycerol and LDL cholesterol returned to baseline values (1.77 ± 0.12 and 3.31 ± 0.08 mmol/L, respectively), whereas HDL cholesterol and apo A-I remained low (1.40 ± 0.08 and 4.82 ± 0.18 mmol/L, respectively). HDL cholesterol and apo A-I concentrations stabilized in subjects who were not receiving hormone replacement therapy but continued to decline in women who were receiving hormone therapy.

Conclusions: The ad libitum 15%-fat diet resulted in significant weight loss. The euenergetic but not the ad libitum diet caused hypertriacylglycerolemia. HDL cholesterol decreased during both low-fat diets.

Key Words: Low-fat diet • lipoproteins • postmenopausal women • high-carbohydrate diet • lipoprotein response • triacylglycerol • HDL cholesterol • high-density-lipoprotein cholesterol • triglycerides • weight reduction • hormone replacement therapy • apolipoprotein A-I • free fatty acids • glucose • insulin • hemoglobin A_1C

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