Sugars, hypertriglyceridemia, and cardiovascular disease

Discussion in 'Health and medical' started by Matti Narkia, Oct 21, 2003.

  1. Matti Narkia

    Matti Narkia Guest

    In the abstract of a new study

    Fried SK, Rao SP.
    Sugars, hypertriglyceridemia, and cardiovascular disease.
    Am J Clin Nutr. 2003 Oct;78(4):873S-880S.
    PMID: 14522752 [PubMed - in process]
    http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=14522752&dopt=Abstract

    Fried et al write:

    "Short-term studies consistently show that raising the carbohydrate
    content of the diet increases serum triacylglycerol concentrations.
    As compared with starches, sugars (particularly sucrose and
    fructose) tend to increase serum triacylglycerol concentrations by
    approximately 60%. The magnitude of the effect depends on other
    aspects of the diet, including the total amount of carbohydrate and
    the types of fat, carbohydrate, and fiber, but definitive studies to
    describe the dose-response relations are not available. Longer-term
    studies show that some high-carbohydrate diets are not associated
    with increased fasting serum triacylgycerol concentrations. However,
    sedentary subjects with upper-body and visceral obesity who have the
    metabolic syndrome tend to be at higher risk for
    hypertriglyceridemia in response to high-sucrose and high-
    carbohydrate diets; moderate weight loss mitigates the effect.
    Hyperinsulinemia or insulin resistance may play a role in promoting
    higher rates of VLDL synthesis and hypertriglyceridemia in obesity,
    but the mechanisms remain unclear. The effect of fructose in
    promoting triacylglycerol synthesis is independent of insulinemia,
    however. In terms of the long-term effects of diets high in sugars
    on the risk of cardiovascular disease, available epidemiologic
    evidence indicates no association of sugars or total carbohydrate
    intake per se, but high dietary glycemic load is associated with
    higher serum triacylglycerol concentrations and greater risk of
    coronary heart disease in women. Studies are needed to delineate the
    independent effects of dietary sugars and glycemic load on serum
    triacylglycerol concentrations in lean and obese men and women and
    to determine whether the elevations in fasting and fed
    concentrations of serum triacylglycerol with high-carbohydrate and
    high-sugars diets are associated with increased risk of
    cardiovascular disease."

    Remark: In the abstract the authors write.

    "In terms of the long-term effects of diets high in sugars
    on the risk of cardiovascular disease, available epidemiologic
    evidence indicates no association of sugars or total carbohydrate
    intake per se, but high dietary glycemic load is associated with
    higher serum triacylglycerol concentrations and greater risk of
    coronary heart disease in women."

    Still, the epidemilogical study

    Hu FB, Stampfer MJ, Manson JE, Rimm E, Colditz GA, Speizer FE, Hennekens CH,
    Willett WC.
    Dietary protein and risk of ischemic heart disease in women.
    Am J Clin Nutr. 1999 Aug;70(2):221-7.
    PMID: 10426698 [PubMed - indexed for MEDLINE]
    http://www.ajcn.org/cgi/content/full/70/2/221

    suggests that replacing carbohydrates with protein may be
    associated with a lower risk of ischemic heart disease. A cople of citations
    from the abstract:

    "... Our data do not support the hypothesis that a high protein
    intake increases the risk of ischemic heart disease. In contrast, our
    findings suggest that replacing carbohydrates with protein may be
    associated with a lower risk of ischemic heart disease. ...

    [...]

    "... Our findings strongly reject the hypothesis that a high protein
    intake, including animal protein, is associated with an increased
    risk of ischemic heart disease. On the contrary, our results suggest
    that a diet with a relatively high protein and low carbohydrate
    content may reduce the risk. These results are consistent with
    results of controlled feeding studies that suggest improvements in
    plasma lipid profiles when carbohydrates are replaced with proteins."

    Another epidemilogical study by Hu et al,

    Hu FB, Stampfer MJ, Manson JE, Rimm E, Colditz GA, Rosner BA, Hennekens CH,
    Willett WC.
    Dietary fat intake and the risk of coronary heart disease in women.
    N Engl J Med. 1997 Nov 20;337(21):1491-9.
    PMID: 9366580 [PubMed - indexed for MEDLINE]
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9366580&dopt=Abstract

    suggests that replacing carbohydrates in the diet with either monounsaturated
    or polyunsaturated fat is ssociated with reduced risk of CHD. A citation from
    the abstract:

    "... RESULTS: Each increase of 5 percent of energy intake from
    saturated fat, as compared with equivalent energy intake from
    carbohydrates, was associated with a 17 percent increase in the risk
    of coronary disease (relative risk, 1.17; 95 percent confidence
    interval, 0.97 to 1.41; P=0.10). As compared with equivalent energy
    from carbohydrates, the relative risk for a 2 percent increment in
    energy intake from trans unsaturated fat was 1.93 (95 percent
    confidence interval, 1.43 to 2.61; P<0.001); that for a 5 percent
    increment in energy from monounsaturated fat was 0.81 (95 percent
    confidence interval, 0.65 to 1.00; P=0.05); and that for a 5 percent
    increment in energy from polyunsaturated fat was 0.62 (95 percent
    confidence interval, 0.46 to 0.85; P= 0.003). Total fat intake was
    not signficantly related to the risk of coronary disease (for a 5
    percent increase in energy from fat, the relative risk was 1.02; 95
    percent confidence interval, 0.97 to 1.07; P=0.55). ..."


    --
    Matti Narkia
     
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