Effect of carbohydrate restriction and fatty acids on LDL particle size and LDL particle number

(LDL-P)

[Updated September 2014]

Registered dietitian, M.Sc, MBAReijo Laatikainen

www.twitter.com/pronutritionist

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1. Low carb and fat modification context

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Effect of saturated fatty acids on LDL particle size depends on what study you pick, but diet higher in fat per se usually leads to somewhat larger LDL particles

Favouring carbohydrate restriction and/or higher SFA intake on the basis of at least one marker of LDL particle size

Dreon 1998Krauss 2006Kratz 2002Egert 2011

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Favouring MUFA or PUFA on the basis of at least one marker of LDL particle size

Wilkinson 2005 Mangravite 2013

In one trial high intake of SFA reduced number of smallest LDL particles (Low carb context)

Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS, Williams PT Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr. 2006 May;83(5):1025-31;.

In the study, main driver of smaller (=worse) LDL particles (=LDL pattern B) was higher carb intake

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Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS, Williams PT Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr. 2006 May;83(5):1025-31;.

N= 178, Interventions,3-4 weeks in weight stable situation

Carbohydrate restriction increased LDL-particle size vs low fat diet. This was not a head to head study SFA vs MUFA/PUFA

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Dreon DM, Fernstrom HA, Campos H, Blanche P, Williams PT, Krauss RM. Change in dietary saturated fat intake is correlated with change in mass of large low-density-lipoprotein particles in men. Am J Clin Nutr. 1998 May;67(5):828-36.

“The results indicate significant associations of dietary saturated fat intake with plasma LDL-particle distributions. Change in dietary saturated fat was associated positively with mass of larger LDL particles and with peak LDL particle diameter andLDL flotation rate.”

N=103, interventions 6 weeks

High MUFA or PUFA diet slightly reduced LDL particle size (high carb context)

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Kratz M1, Gülbahçe E, von Eckardstein A, Cullen P, Cignarella A, Assmann G, Wahrburg U. Dietary mono- and polyunsaturated fatty acids similarly affect LDL size in healthy men and women. J Nutr. 2002 Apr;132(4):715-8..

”In conclusion, changing the quality of dietary fat from saturated to unsaturated fat slightly reduced the LDL peak particle diameter, with no significant difference between diets rich in MUFA, (n-6)-PUFA and (n-3)-PUFA”

N=56, interventions 4 weeks

High MUFA intake reduced LDL particle size vs SFA (higher fat context, not “real” low carb study)

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Egert S, Kratz M, Kannenberg F, Fobker M, Wahrburg U. Effects of high-fat and low-fat diets rich in monounsaturated fatty acids on serum lipids, LDL size and indices of lipid peroxidation in healthy non-obese men and women when consumed under controlled conditions. Eur J Nutr. 2011 Feb;50(1):71-9

High SFA (2 weeks) High MUFA (4 weeks)

”The MUFA-rich diets significantly decreased the size of the predominant LDL fraction (- 0.48 nm; P< 0.001 for time).”

PUFA as ~30 E% (!) (sunflower oil or flax seed oil) had beneficial effect on particle size. Sunflower oil + fish oil reduced small LDL particles most

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Wilkinson P, Leach C, Ah-Sing EE, Hussain N, Miller GJ, Millward DJ, Griffin BA. Influence of alpha-linolenic acid and fish-oil on markers of cardiovascular risk in subjects with an atherogenic lipoprotein phenotype. Atherosclerosis. 2005 Jul;181(1):115-24.

,,

Flax seed oil (n-3; 19 E %

open circles)

Sunflower oil (n-6; 24

E%, (dashed line)

Sunflower + fish oil

Sunflower + fish oil

Flax seed oil (n-3; 19 E % open

circles)

Sunflower oil (n-6; 24 E%,

dashed line)

Fat intake increased in all groups by 4-5 E% (carb intake ↓ 2-3 E%)

Fat intake increased in all groups by 4-5 E% (carb intake ↓ 2-3 E%)

N=57

Low SFA, high MUFA diet reduced LDP-P and small dense LDL particles (low carb, high beef context)

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Mangravite LM, Chiu S, Wojnoonski K, Rawlings RS, Bergeron N, Krauss RM. Changes in atherogenic dyslipidemia induced by carbohydrate restriction in men are dependent on dietary protein source. J Nutr. 2011 Dec;141(12):2180-5.

=LDL-P

High SFA (3 weeks) Low SFA (3 weeks)

2. Margarine vs butter

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“Largest LDL peak particle size was observed after consumption of the butter-enriched diet” (high carb context)

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Mauger JF, Lichtenstein AH, Ausman LM, Jalbert SM, Jauhiainen M, Ehnholm C, Lamarche B.Effect of different forms of dietary hydrogenated fats on LDL particle size. Am J Clin Nutr. 2003 Sep;78(3):370-5.

N=36, 5 weeks

Higher the TFA content of margarine, the more deleterious effect on LDL particle size

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Mauger JF, Lichtenstein AH, Ausman LM, Jalbert SM, Jauhiainen M, Ehnholm C, Lamarche B.Effect of different forms of dietary hydrogenated fats on LDL particle size. Am J Clin Nutr. 2003 Sep;78(3):370-5.

” In conclusion, data from the present study support the concept that consumption of trans fatty acids has a deleterious effect on LDL particle size, thus further contributing to the overall effect of trans fatty acids on cardiovascular disease”

3. Mediterranean diet context

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Mediterranean diet enriched with nuts (high in PUFA and MUFA) improved LDL particle size. Predimed subcohort

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Damasceno NR e tal. Mediterranean diet supplemented with nuts reduces waist circumference and shifts lipoprotein subfractions to a less atherogenic pattern in subjects at high cardiovascular risk. Atherosclerosis. 2013 Oct;230(2):347-53.

N=169, intervention 52 weeks

Conclusion • Many studies are very short, typically 3-4 weeks

• Replacing carbohydrates with fat seems to increase LDL particle size

• There is conflicting and limited evidence on the effects of fatty acid classes (MUFA/PUFA vs SFA) on LDL particle size and LDL-P

• Trans fat seems to decrease LDL particle size. Currently available margarines in Western Europe are very low in trans fat

• Mediterranean diet improved LDL particle size in Predimed study when enriched with nuts (high in MUFA and PUFA)

• Hard end point RCTs are needed to evaluate if changes LDL-particle size translate into real clinical benefits

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What about apoB, non-HDL-cholesterol, LDL, HDL and HDL

when going low carb?

Visit my other slide deck

http://www.slideshare.net/pronutritionist/replacing-carbohydrate-with-different-fats-

effects-in-apo-b-non-hdl-and-ldl

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Reijo Laatikainen, RD, MBA

Images bought and licensed from BigStockPhoto. Snapshots from papers and sites referred to.

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