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Faecal lipid excretion levels in normal Japanese females on an unrestricted diet and a fat-restricted diet measured by simultaneous analysis of faecal lipids.

Faecal lipid excretion was determined in 16 females on an unrestricted diet and on a fat-restricted diet using a chromatographic method for the simultaneous analysis of faecal lipids. The fat-restricted diet reduced the total quantity of faeces and the amounts of fatty acids, neutral sterols and bile acids excreted were almost halved compared with when on an unrestricted diet. This indicates that dietary fat, fibre and cholesterol affect the amount of faecal bile acid, neutral sterol and fatty acid excretion. The amount of cholesterol/animal sterols excreted and the percentage of primary bile acids were, however, similar for both the fat-restricted and unrestricted diets.

Adult↗

Alternative fat-restricted diets for hypercholesterolemia and combined hyperlipidemia: feasibility, design, subject recruitment, and baseline characteristics of the dietary alternatives study.

UNLABELLED: Dietary recommendations for the treatment of hypercholesterolemia (HC) emphasize stepwise reductions in fat intake, but there is no agreement on what lower limit is desirable or achievable. These recommendations have applied broadly to persons with HC alone, as well as to those with a combined elevation in triglyceride (TG) and cholesterol, even though they may differ in pathophysiological mechanisms and response. In this paper, we describe the design and feasibility of recruiting and randomizing subjects with HC or combined hyperlipidemia (CHL) to an outpatient dietary intervention study of progressively fat-restricted diets. Diets were designed to contain 30, 26, 22, and 18% of calories from fat; 300, 200, 100, and 100 mg cholesterol/day; and a polyunsaturated/saturated fat ratio of approximately 1.0. Triglyceride and low-density-lipoprotein cholesterol (LDL-C) cutpoints were based on the age-specific 75th percentile value. Over 18 months, 8372 men were screened, yielding 320 HC subjects randomized to the four diets and 211 CHL subjects randomized to the first three diets (because of fewer CHL subjects). At baseline, HC and CHL subjects were similar in age, education, lifestyle, dietary intake, and LDL-C, but CHL subjects were heavier, more hyperglycemic, hyperinsulinemic, and hypertensive. CONCLUSIONS: Recruiting a large cohort of HC and CHL subjects from an industrial workforce is feasible in a restricted time frame. CHL subjects demonstrate features of the insulin resistance/hypertension syndrome, differing from HC subjects. CHL is sufficiently common relative to HC (2:3) to permit a comparison of dietary responses between the two conditions. Finally, the randomization of HC and CHL subjects to the diets yielded statistically indistinguishable groups, permitting a test of the efficacy of the alternative diets within each hyperlipidemic (HL) category.

Adult↗

Direct and indirect effects of dietary fibre on plasma lipoproteins in man.

In clinical practice two effects of dietary fibre should be distinguished: A direct, and an indirect effect. An indirect effect of dietary-fibre-rich foods is that they displace from the diet foods high in saturated fat and cholesterol. Thus legumes may displace meat, and whole-wheat bread may displace cookies and cakes. As a result, diets high in fibre-rich foods tend to cause low levels of plasma low-density-lipoprotein (LDL) cholesterol. Direct effects of fibre are those seen in strictly controlled experiments where intake of all other nutrients is forcibly held constant. Under those conditions we and others observed the following effects: Wheat bran fibre does not cause a fall of plasma cholesterol, but may even induce a slight rise. Pectin, both isolated or as a constituent of vegetables and fruits, can lower cholesterol by up to 10%. The fibre of soy beans present in soy protein concentrate does not have a favourable effect on plasma lipoproteins. Addition of fibre-rich foods such as pulses, oats, fruits and vegetables to a conventional lipid-lowering diet caused an extra fall of 10% in plasma cholesterol on top of the 20% fall already caused by the reduction of saturated fats and cholesterol and the increased intake of polyunsaturated fatty acids. The decrease in high-density lipoprotein (HDL) cholesterol caused by the lipid-lowering diet was partly reversed by the addition of plant foods. Extreme high-carbohydrate fat-restricted diets cause a fall in HDL as well as in LDL, and the decrease in HDL cannot be completely prevented by the presence of fibre in the diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary Fats↗

Diet-induced essential fatty acid deficiency in ambulatory patient with type I diabetes mellitus.

We report a case of symptomatic essential fatty acid deficiency (EFAD) occurring in a free-living individual with type I diabetes mellitus who was voluntarily following a high-carbohydrate, fat-restricted diet. The patient was 43 yr old with type I diabetes for 18 yr and no chronic complications. His self-imposed diet excluded all red meats, fats, and oils. After several months of this diet, the patient developed lethargy and a pruritic, diffuse, scaly, and erythematous rash. Biochemical studies revealed a mildly elevated SGOT and abnormally low levels of linoleic, linolenic, and arachidonic fatty acids. Treatment with linoleic acid supplementation in his diet improved the rash, normalized SGOT, and corrected the fatty acid profile. We conclude that EFAD may occur in a free-living individual after consuming a very-low-fat diet.

Adult↗

Treatment of type IIa hyperlipidemia in childhood by a simplified American Heart Association diet and fiber supplementation.

Thirty-six children identified as having primary type IIa hypercholesterolemia were treated with a diet restricting the intake of saturated fat to 10% of total energy and supplemented with soluble fiber for 8.1 +/- 2.4 (mean +/- SEM) months. In 14 of 36 patients first treated with the American Heart Association "Step-One" diet for 8.0 +/- 1.1 months, total cholesterol level dropped from 257.9 +/- 15.8 mg/dL to 240.6 +/- 10.9 mg/dL; the low-density lipoprotein cholesterol level dropped from 191.8 +/- 17.4 mg/dL to 175.0 +/- 11.7 mg/dL; the high-density lipoprotein cholesterol level dropped from 42.8 +/- 1.94 mg/dL to 41.6 +/- 1.68 mg/dL; and triglyceride concentration rose from 115.9 +/- 13.7 mg/dL to 128.1 +/- 14.1 mg/dL. The 36 patients treated with saturated fat-restrictive diets and supplemental soluble fiber diets had a reduction of total cholesterol levels from 249.2 +/- 7.66 mg/dL to 207.1 +/- 6.31 mg/dL and a low-density lipoprotein cholesterol level reduction from 184.7 +/- 7.55 mg/dL to 142.6 +/- 6.7 mg/dL, a reduction of 18% and 23%, respectively. There was no significant change in high-density lipoprotein cholesterol levels (46.4 +/- 1.9 mg/dL vs 44.3 +/- 2.1 mg/dL) or in triglyceride concentrations (94.2 +/- 7.43 mg/dL vs 102.2 +/- 8.45 mg/dL). In addition, the reduction in serum lipoprotein concentrations resulting from this program was significantly greater than the concentrations resulting from the American Heart Association diet alone. The different responses to these regimens suggest that a simplified diet and soluble fiber supplementation is well tolerated and reduces total and low-density lipoprotein cholesterol levels more effectively than the standard American Heart Association diet in children.

American Heart Association↗

Benign recurrent intrahepatic cholestasis: a long-term follow-up study of two patients.

Two brothers with benign recurrent intrahepatic cholestasis were studied over a period of 6 years. During this period, 11 episodes of cholestasis were observed, with a mean duration of 2.6 months (range: 2 weeks to 6 months). Once, both brothers developed cholestasis simultaneously. There was a prevalence for episodes of cholestasis in wintertime. The postprandial rise in serum sulfated glycolithocholic acid was increased in the patients, and the bile acid pool was enriched with secondary bile acids. In periods prior to cholestasis, the urinary 3 alpha OH-bile acid concentration was often elevated (greater than 50 mumoles per liter) without a clear correlation with the clinical prodromata. However, it could not be used as a predictor of cholestasis. In contrast, the postprandial rise in serum 3 alpha OH-bile acids was always grossly elevated in periods just before cholestasis. An increase both in fecal bile acid excretion as well as secondary bile acids in the bile acid pool indicated an increased spillover of bile acids into the large bowel. Cholestyramine administered directly after the first signs of cholestasis appeared to shorten an episode of cholestasis. On the other hand, withdrawal of cholestyramine in a cholestasis-free period may have resulted in an episode of cholestasis. Neither taurine supplementation for 3 and 7 weeks nor calcium phosphate, which binds sulfated bile acids in vitro, for 3 weeks could prevent an episode of cholestasis, although the latter normalized the bile acid pool composition. There is a rationale for a fat-restricted diet and cholestyramine therapy only as maintenance treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Bile Acids and Salts↗

Colestipol plus nicotinic acid in treatment of heterozygous familial hypercholesterolaemia.

Thriteen patients with heterozygous familial hypercholesterolaemia (FH) were sequentially treated with: a low-cholesterol, fat-restricted diet; diet and colestipol; and diet and colestipol and nicotinic acid. Concentrations of plasma cholesterol decreased from 415 +/- 69 mg/dl on diet alone to 327 +/- 54 mg/dl on colestipol and fell to 246 +/- 49 mg/dl on the combined drug regimen. Plasma concentrations of LDL cholesterol declined 24% on colestipol; the subsequent addition of nicotinic acid resulted in a further 31% fall so that values on the combined drug regimen were 47% below those seen on diet alone. HDL cholesterol levels were similar on both the diet (40 mg/dl) and colestipol (43 mg/dl) treatment periods but increased to 53 mg/dl on the combined drug regimen. Treatment resulted in significant decreases in the LDL:HDL ratio which fell from 8.4 on diet to 3.3 on the colestipol plus nicotinic acid regimen. In most patients with heterozygous FH, combined use of a bile acid sequestrant and nicotinic acid affords the opportunity to maintain a normal lipid profile. Prolonged use of this regimen may reduce the incidence of premature coronary atherosclerosis which naturally occurs in these patients.

Adult↗

Excessive hypertriglyceridemia and pancreatitis in pregnancy. Association with deficiency of lipoprotein lipase.

Acute pancreatitis verified at laparotomy occurred in the 37th week in 1 of 4 women who developed excessive hypertriglyceridemia (type V hyperlipoproteinemia) during pregnancy. The hypertriglyceridemia was associated with and possibly caused by deficiency of lipoprotein lipase, measured as the NaCl sensitive component of post-heparin lipase activity. A severely fat-restricted diet controlled the hypertriglyceridemia in 1 of the patients, followed during a second pregnancy.

Adult↗

Faecal osmolality and electrolyte concentrations in chronic diarrhoea: do they provide diagnostic clues?

Osmolality, pH, and electrolyte concentrations in faecal fluid were measured in 23 patients referred to our department because of diarrhoeal disorders. The aim of the study was to ascertain whether such measurements could provide valuable diagnostic information in patients with diarrhoea. The patients were studied on a fat-restricted diet (70 g fat/day) and during fasting. Osmolality, pH, and concentrations of electrolytes in faecal water showed wide variations but were within normal ranges in most of the patients. The patients were grouped into secretory and osmotic diarrhoea on the basis of: 1) current assumptions on the pathogenesis of diarrhoea in different disorders; 2) persistence versus resolution of diarrhoea during fasting (resolution = decrease of stool mass to less than 200 g/24 h); and 3) an osmotic gap (measured osmolality -2 X (Na + K]. The accordance between these three ways of grouping was very incomplete. It is concluded that measurements of faecal fluid osmolality and electrolyte concentrations are of little value as diagnostic procedures in chronic diarrhoea. Determination of the osmotic gap and/or of the decrease of stool mass during fasting may help to elucidate the pathogenesis of diarrhoea in different disorders but does not seem diagnostically useful. Three patients turned out to be laxative abusers, and laxative ingestion should always be considered in chronic unsettled diarrhoea.

Adult↗

Gallbladder dynamics in response to various meals: is dietary fat restriction necessary in the management of gallstones?

An estimated 20 million Americans have gallstones the majority asymptomatic. Yet traditionally many are often placed on low-fat or fat-free diets, presumably to reduce the risk of biliary colic. To assess the gallbladder dynamics in response to various meals, we studied 15 subjects (ages 21-54), each on 4 separate days. After an overnight fast, each subject was given, at random, either a breakfast containing greater than 30 g fat, less than 15 g fat, totally free of fat, or an infusion of C-terminal octapeptide of cholecystokinin. Gallbladder ejections at regular time intervals were measured using real time ultrasonography and the sum of cylinders technic corrected for the gallbladder shape. Considerable variability in the gallbladder dynamics and time response was noted with all the stimuli. However, among various meals, there were no statistically significant differences in the mean maximum ejection fraction or the mean maximum ejection time (p greater than 0.10). The mean maximum ejection fraction after cholecystokinin was somewhat greater (0.01 less than p less than 0.05) than that after meals, but the mean maximum ejection time was similar (p greater than 0.10). We conclude that the gallbladder dynamics in response to various meals are independent of a meal's fat content. Since the passage of gallstones into the cystic or common duct (biliary colic) is a random event unrelated to the type of food, fat-restricted diets offer no significant therapeutic advantage in the management of the large population with asymptomatic gallstones.

Adult↗

Body weight and low-density lipoprotein cholesterol changes after consumption of a low-fat ad libitum diet.

OBJECTIVE: To assess the effects of a diet restricted in fat, saturated fat, and cholesterol, under weight-maintenance and ad libitum conditions on body weight and plasma lipid levels in hypercholesterolemic subjects. DESIGN: Dietary intervention study. SETTING AND PARTICIPANTS: Twenty-seven free-living, healthy middle-aged and elderly men (n = 13, age range, 41 to 81 years) and women (n = 14, age range, 52 to 79 years) with moderate hypercholesterolemia (low-density lipoprotein cholesterol [LDL-C] > or = 3.36 mmol/L [130 mg/dL]) participated in the study. INTERVENTION: Subjects underwent three dietary phases. First, subjects were provided with a diet similar to the average US diet (baseline diet; 35.4% total fat, 13.8% to 14.1% saturated fat, and 30 to 35 mg/1000 kJ [128 to 147 mg/1000 kcal] cholesterol). During the second dietary phase, subjects consumed a low-fat diet (15.1% total fat, 5.0% saturated fat, 17 mg/1000 kJ [73 mg/1000 kcal] cholesterol). During the baseline and low-fat diet phases, which lasted 5 to 6 weeks each, the energy intake was adjusted to keep body weight constant. During the third diet phase (low-fat ad libitum diet) subjects were given the same low-fat diet for 10 to 12 weeks, but could adjust their intake between 66% and 133% of the energy required to maintain body weight. MAIN OUTCOME MEASURES: Body weight and plasma lipid levels. RESULTS: Consumption of the low-fat diet under weight-maintenance conditions had significant lowering effects on plasma total cholesterol (TC), LDL-C, and high-density lipoprotein cholesterol (HDL-C) levels (mean change, -12.5%, -17.1%, and -22.8%, respectively). This diet significantly increased plasma triglyceride levels (+47.3%) and the TC/HDL-C ratio (+14.6%). In contrast, consumption of the low-fat ad libitum diet was accompanied by significant weight loss (3.63 kg), by a mean decrease in LDL-C (124.3%), and by mean triglyceride levels and TC/HDL-C ratio that were not significantly different from values obtained at baseline. CONCLUSIONS: Our results indicate that a low-fat ad libitum diet promotes weight loss and LDL-C lowering without adverse effects on triglycerides or the TC/HDL-C ratio in middle-aged and elderly men and women with moderate hypercholesterolemia.

Aged↗

Lipidomic Profiling Reveals Differential Behaviors of Individual Free Fatty Acids During Altered Metabolic States in Rats.

We used lipidomic analyses to investigate how individual free fatty acids (FFAs) behave differently in metabolic states altered by diet and by antibiotic treatment (ABX) that depletes gut bacteria. Wistar rats were fed either a low-fat or high-fat purified diet, or standard chow with or without antibiotics for two weeks (n = 8-10). Blood samples were then collected before and after meals. Individual FFAs were quantified and grouped based on distinct postprandial response patterns across dietary and treatment conditions. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), key ω-3 FFAs, exhibited postprandial shifts suggestive of suppressed adipocyte lipolysis following meals. Fatty acids in the high-fat diet (HFD) elevated postprandial FFA levels, masking the meal-induced suppression of lipolysis observed with chow or low-fat diet (LFD). Some FFAs, including medium-chain saturated species, remained unaffected by meals. We further evaluated the impact of diet and ABX on baseline (pre-meal) concentrations of FFAs. Certain FFAs were altered by purified diets compared to standard chow. Notably, EPA and DHA were selectively depleted under HFD conditions, likely due to enhanced catabolic activity. In conclusion, lipidomic profiling revealed divergent behaviors among individual FFAs, reflecting distinct metabolic processes and regulatory mechanisms under altered metabolic states.

Animals↗

Effects of dietary butter fat on fecal bile acid excretion in patients with Crohn's disease on elemental diet.

The excretion rate of fecal bile acids was determined by gas-liquid chromatography in nine patients with Crohn's disease and six healthy volunteers under two dietary conditions with different amounts of fat: during nasoduodenal tube feeding with a fat-restricted elemental diet containing approximately 1.5 g/day of fat, and during the addition of 50 g/day of butterfat by peroral administration. The fecal bile acid excretion rate on the elemental diet was significantly greater in the patients with Crohn's disease than in the healthy controls. With ingestion of the additional fat, the excretion rate was significantly increased in the patients with Crohn's disease, but not significantly changed in the healthy controls. The bile acid excretion rate in Crohn's disease correlated with fecal fat excretion, but not with either fecal weight or disease activity. These studies show that the amount of dietary fat represents an important consideration in the evaluation of bile acid malabsorption in Crohn's disease.

Adolescent↗

High-fat and low-fat fermented milk and cheese intake, proteomic signatures, and risk of all-cause and cause-specific mortality.

PURPOSE: This study aimed to examine the associations between the intake of high- and low-fat fermented dairy (cheese and fermented milk), their proteomic profiles, and mortality risk. METHODS: This cohort study included 25,187 participants (mean age 57.7 years, 60.9% females). Fermented dairy intake was assessed by a modified diet history method. In a random subset of this cohort (n&#x2009;=&#x2009;4359), we constructed proteomic signatures for fermented dairy intake using 136 candidate plasma proteins. RESULTS: During 23.5 years of follow-up, 9742 participants died. High-fat cheese (>&#x2009;20% fat) intake was inversely associated with risk of all-cause mortality (HR for an increment of 20&#xa0;g/day, 0.97; 95% CI, 0.96-0.99, P&#x2009;<&#x2009;0.001) and cardiovascular disease mortality (HR, 0.96; 95% CI, 0.93-0.99, P&#x2009;=&#x2009;0.006). Low-fat cheese intake showed an inverse association with all-cause mortality (HR, 0.98; 95% CI, 0.96-1.00, P&#x2009;=&#x2009;0.047). Low-fat fermented milk intake was inversely associated with all-cause mortality (HR for an increment of 250&#xa0;g/day, 0.91; 95% CI, 0.85-0.97, P&#x2009;=&#x2009;0.006), while high-fat fermented milk (>&#x2009;2.5% fat) showed null association. A total of 42, 26, 0, and 39 proteins were identified for the signature of high-fat cheese, low-fat cheese, high-fat fermented milk, and low-fat fermented milk, respectively. Inverse associations with all-cause mortality were observed for all three signatures with identified proteins. The identified proteins were involved in biological pathways related to immune response and inflammation. CONCLUSION: Our study indicated that consuming high-fat cheese, low-fat cheese, and low-fat fermented milk was linked to survival benefits. Plasma proteins improve our understanding of the health effects of fermented dairy.

Humans↗

Early lesion development in the aortas of rabbits fed low-fat, cholesterol-free, semipurified casein diet.

The initial endothelial morphological alterations and the development of raised, lipid-containing lesions in rabbit aortas were examined after 1 and 3 months on a casein-enriched, semipurified, cholesterol-free diet. The alterations were compared with those in rabbits fed soy-protein in the place of casein and with age-matched, chow-fed, control animals. Using immunohistochemistry macrophages, T-lymphocytes, and smooth muscle cells were identified in the lesions, and an expression of leukocyte adhesion molecules, VCAM-1, ICAM-1 and, occasionally, E-selectin was seen in sections of the aortas of casein-fed rabbits. The initial alterations in the endothelium appear to include evidence of endothelial injury and white blood cell adhesion. No evidence of extracellular liposome formation was observed. This model of atherogenesis is consistent with endothelial injury being an important component of diet-induced atherogenesis and has similarities to human atherosclerosis.

Animals↗