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Lipid Effects of a Moderate Fat vs. Low Fat Diet among Free Living Individuals with Metabolic Syndrome: DMetS Extension Arthi Thirumalai, M.D. Alice Dowdy.

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Presentation on theme: "Lipid Effects of a Moderate Fat vs. Low Fat Diet among Free Living Individuals with Metabolic Syndrome: DMetS Extension Arthi Thirumalai, M.D. Alice Dowdy."— Presentation transcript:

1 Lipid Effects of a Moderate Fat vs. Low Fat Diet among Free Living Individuals with Metabolic Syndrome: DMetS Extension Arthi Thirumalai, M.D. Alice Dowdy M.S., Brian Fish, B.S., Robert H. Knopp, M.D., Pathmaja Paramsothy, M.D. M.S.

2 Global Purpose To understand what diet is best and most feasible to decrease CVD risk factors among people with metabolic syndrome (MetS)

3 Objectives Determine if the lipid improvements noted with a moderate fat, moderate carbohydrate diet vs. low fat, high carbohydrate diet can be sustained under free-living conditions Determine if free living people with MetS can adhere to prescribed diets on their own

4 The Problem: Metabolic Syndrome 30% of Americans have MetS 2 fold risk for CVD Poor diet results in MetS Weight loss is the ideal treatment but success rate is low Refs: Grundy SM et al. Circulation. 2004;109: , Lutsey P et al. Circulation. 2008;117: Gami AS et al. J Am Coll Cardiol. 2007;49:

5 Metabolic Syndrome Triglycerides 150 mg/dL PLUS 2 of: HDL-C < 40 (men), < 50 mg/dL (women) Blood Pressure 130/85 (or on antihypertensive meds) Fasting Glucose > 100 mg/dL Abdominal Obesity Waist circumference >102 cm (men), > 88 cm (women)

6 Current Dietary Recommendations Total fat 20-35%, total carbohydrate 45-65% <10% saturated fat Negligible trans fat Insulin Resistant Populations such as those with MetS are not adequately addressed What type of fats is unclear Source: Dietary Guidelines for Americans, 2010

7 Maintaining free-living diets No studies investigating the effects of a truly free- living diet on lipid effects or feasibility in MetS Either employed food-exchange models or studied ad libitum diets in non-MetS patients High drop-out rates: 12-40% High tendency to not achieve dietary targets

8 Diets for Dyslipidemia in Metabolic Syndrome (DMetS) Study Design: Double blinded, randomized, X-over Intervention: Moderate Fat (MF) = 40% fat, 45% carbohydrate Low fat (LF) = 20% fat, 65% carbohydrate Both diets 15% protein, 8% saturated fat, g/day of fiber Primary Lipid Outcome: Δ Non-HDL cholesterol from baseline Also evaluated inflammatory markers, endothelial function, glycemic indices

9 Exclusion Criteria LDL-C > 190 mg/dL Triglyceride > 500 mg/dL BP > 150/95 mmHg mean 2 visits Use of lipid lowering rx other than statins Moderate or high doses of thiazides or beta blockers previous 4 weeks Use of plant sterols previous 4 weeks Use of diabetes rx or fasting glucose level > 140 mg/dL Hospitalization for CHD within 6 months

10 Summary Lipid Changes

11 DMetS: Results Summary o First randomized controlled feeding study comparing LF vs. MF diet in MetS o MF diet improves the atherogenic dyslipidemia of MetS compared with LF diet o No significant difference in inflammatory markers, insulin sensitivity, or endothelial function

12 Study Design Extension period: -63 subjects (32 LF, 31 MF) -Weekly dietary sessions and counselling -Food records collected using 24 hour dietary recall

13 Statistical methods Hypothesis 1: Subjects will be able to sustain their diet during the extension period as measured by lipid effects Paired T-Tests Hypothesis 2: The difference in effects of MF vs LF diets on atherogenic dyslipidemia of MetS will be maintained during the extension period Unpaired T-Tests

14 RESULTS Baseline characteristics Lipid outcomes Primary outcome: non-HDLc from end of controlled feeding to end of free-living extension period Secondary outcomes: Total cholesterol, triglycerides, HDLc, LDLc, Apo-B, Apo-A1 Adherence rates

15 Baseline characteristics VariableLow FatModerate FatP (MF vs LF) Age (years) Women56%48%0.62 White race88%90%>0.99 BMI (kg/m2)30.3 (4.09)30.3 (4.93)0.98 Waist Circumference (cm)108 (14.8)105 (18.5)0.44 % meeting MetS definition of HTN 34%29%0.62 Triglycerides (mg/dL)* 232 [187,269]181 [138,216]0.02* HDL Cholesterol (mg/dL)38.9 (6.86)40.7 (8.27)0.35 Total Cholesterol (mg/dL)203 (32.2)189 (31.3)0.09 Non-HDL Cholesterol (mg/dL)* 164 (29.9) 148 (30.2)0.04* LDL Cholesterol (mg/dL)117 (31.6)110 (26.9)0.37 Apolipoprotein B (mg/dL)113 (20.7) 106 (16.9) 0.14 Apolipoprotein A-I (mg/dL) 120 (15.3)123 (18.6) 0.46 Glucose (mg/dL)99.7 (8.88)102 (9.67)0.44

16 Non-HDLc Baseline Mean (SD) End of extension period Mean (SD) Change during study period Mean (SD) Difference between diets Mean (SE) [95% CI] Low Fat164 (29.9)165 (32.6)1.66 (22.7) p=0.683 Moderate Fat148 (30.2) 156 (27.9)7.97 (25.7) p=0.095 (MF vs. LF) [6.11] [-18.5, 5.91] p=0.306

17 Total cholesterol Baseline Mean (SD) End of extension period Mean (SD) Change during study period Mean (SD) Difference between diets Mean (SE) [95% CI] Low Fat203 (32.2) 207 (32.4) 4.16 (20.8) p=0.268 Moderate Fat184 (31.3) 198 (29.3) 8.90 (26.3) p=0.069 P value (MF vs. LF) [5.97] [-16.7,7.19] p=0.430

18 Triglycerides Baseline Mean (SD) End of extension period Mean (SD) [median for skewed items] Change during study period Mean (SD) Difference between diets Mean (SE) [95% CI] Low Fat234 (67.8) 264 (186) [218] 30.1 (170) p=0.324 Moderate Fat190 (83.8) 215 (103) [192] 25.6 (104) p=0.179 P value (MF vs. LF) 4.45 [35.5] [-66.6,75.5] p=0.901

19 LDLc Baseline Mean (SD) End of extension period Mean (SD) Change during study period Mean (SD) Difference between diets Mean (SE) [95% CI] Low Fat117 (31.6) 113 (36.4) (22.0) p=0.279 Moderate Fat110 (26.9) 113 (28.8) 2.90 (26.1) p=0.541 P value (MF vs. LF) [6.08] [-19.3,4.96] p=0.242

20 HDLc Baseline Mean (SD) End of extension period Mean (SD) Change during study period Mean (SD) Difference between diets Mean (SE) [95% CI] Low Fat38.9 (6.86) 41.4 (9.46) 2.50 (5.92) p=0.023 Moderate Fat40.7 (8.27) 41.6 (7.77) (5.38) p=0.341 P value (MF vs. LF) 1.56 [1.43] [-1.29,4.42] p=0.277

21 Apo-B Baseline Mean (SD) End of extension period Mean (SD) Change during study period Mean (SD) Difference between diets Mean (SE) [95% CI] Low Fat113 (20.7)114 (18.8) (14.1) p=0.970 Moderate Fat 106 (16.9)109 (19.7) 2.73 (13.3) p=0.270 P value (MF vs. LF) [3.51] [-9.86,4.20] p=0.423

22 Apo-A1 Baseline Mean (SD) End of extension period Mean (SD) Change during study period Mean (SD) Difference between diets Mean (SE) [95% CI] Low Fat 120 (15.3)134 (14.9)13.8 (12.1) p<0.001 Moderate Fat 123 (18.6)131 (16.8) 7.70 (12.3) p=0.002 P value (MF vs. LF) 6.07 [3.12] [-0.178,12.3] p=0.057

23 Adherence % calories from carbohydrate Mean (SD) [rec] % calories from protein Mean (SD) [rec] % calories from fat Mean (SD) [rec] Low Fat (9.60) [65] (5.55) [15] (8.50) [20] Moderate Fat (9.92) [45] (5.37) [15] (8.30) [40]

24 Conclusions First study looking at lipid outcomes in MetS patients at weight stability, under truly free-living conditions Significantly lower drop out rate compared to prior studies Able to sustain the benefits noted during controlled feeding phase, even under free-living conditions No significant difference between the two diets in lipid outcomes likely related to not achieving carbohydrate and fat goals in 2 diets

25 Acknowledgements DMetS participants Northwest Lipid Research Clinic Staff University of Washington CRC Staff Alice Dowdy and Brian Fish Dr. Robert H. Knopp, original PI for DMetS, who passed away on 5/30/10 Dr. Pathmaja Paramsothy, PI and phenomenal mentor!

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