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Severely dysregulated disposal of postprandial triacylglycerols exacerbates hypertriacylglycerolemia in HIV lipodystrophy syndrome^1,2,3,4

¹ From the Translation Metabolism Unit, Division of Diabetes, Endocrinology and Metabolism (RVS, KR, DI, and AB), the Section of Atherosclerosis (HJP and JG), Department of Medicine, the Department of Pediatrics (FJ), and the US Department of Agriculture, Agriculture Research Service, Children's Nutrition Research Center (RVS and FJ), Baylor College of Medicine, Houston, TX, and the Endocrine Service, Ben Taub General Hospital, Houston, TX (RVS and AB)

Background: The pathogenesis of hypertriacylglycerolemia, a characteristic feature of HIV lipodystrophy syndrome (HLS), is incompletely understood. One mechanism is accelerated lipolysis in the fasted state, but the severity of the hypertriacylglycerolemia suggests that additional underlying abnormalities may exist in the disposal of dietary fat.

Objective: Our objective was to investigate abnormalities in dietary fat disposal in the pathogenesis of hypertriacylglycerolemia in HLS.

Design: We studied 6 nondiabetic men with HLS and 6 men without HIV matched for age and body mass index as control subjects for 8 h after consumption of an isocaloric meal containing 2 g labeled [¹³C₃]tripalmitin. Chylomicron-triacylglycerol disposal was estimated from labeled [¹³C₁]palmitate in the plasma chylomicron fraction, and [¹³C₁]palmitate oxidation was estimated from the ¹³CO₂ enrichment in the breath and CO₂ production, over 8 h after the meal.

Results: HLS patients had significantly elevated concentrations of fasting plasma triacylglycerols in both chylomicron ( + SE: 100.3 ± 49.5 compared with 29.2 ± 2.2 mg/dL; P < 0.01) and VLDL (82.4 ± 39.0 compared with 10.8 ± 2.8 mg/dL; P < 0.01) fractions. Chylomicron-triacylglycerol-derived [¹³C₁]palmitate disposal was markedly lower in the HLS patients (3.09 ± 0.41 compared with 6.42 ± 0.18 mmol [¹³C₁]palmitate/8 h; P < 0.001) in the 8-h postmeal period. Further, HLS patients had lowered storage of chylomicron-triacylglycerols (0.74 ± 0.38 compared with 5.05 ± 0.16 mmol; P < 0.0001) and elevated plasma [¹³C₁]palmitate concentrations (2.01 ± 0.27 compared with 1.18 ± 0.16 mmol; P < 0.05) 8 h after the meal.

Conclusions: Patients with HLS have key defects that markedly impair postprandial disposal and storage of chylomicron-triacylglycerols. These defects contribute significantly to hypertriacylglycerolemia in HLS.

Key Words: Lipoprotein lipase • lipolysis • fat oxidation • cholesteryl ester

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