Impact of a 2-year trial of nutritional ketosis on indices of cardiovascular disease risk in patients with type 2 diabetes.

Autor: Athinarayanan SJ; Virta Health, 501 Folsom Street, San Francisco, CA, 94105, USA., Hallberg SJ; Virta Health, 501 Folsom Street, San Francisco, CA, 94105, USA.; Indiana University Health Arnett, Lafayette, IN, USA.; Indiana University, School of Medicine, Indianapolis, IN, USA., McKenzie AL; Virta Health, 501 Folsom Street, San Francisco, CA, 94105, USA., Lechner K; Department of Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany.; DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich, Germany., King S; School of Medicine, University of California, San Francisco, CA, 94143, USA., McCarter JP; Abbott Diabetes Care, Alameda, CA, 94502, USA.; Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA., Volek JS; Virta Health, 501 Folsom Street, San Francisco, CA, 94105, USA.; Department of Human Sciences, The Ohio State University, Columbus, OH, USA., Phinney SD; Virta Health, 501 Folsom Street, San Francisco, CA, 94105, USA., Krauss RM; School of Medicine, University of California, San Francisco, CA, 94143, USA. Ronald.Krauss@ucsf.edu.
Jazyk: angličtina
Zdroj: Cardiovascular diabetology [Cardiovasc Diabetol] 2020 Dec 08; Vol. 19 (1), pp. 208. Date of Electronic Publication: 2020 Dec 08.
DOI: 10.1186/s12933-020-01178-2
Abstrakt: Background: We have previously reported that in patients with type 2 diabetes (T2D) consumption of a very low carbohydrate diet capable of inducing nutritional ketosis over 2 years (continuous care intervention, CCI) resulted in improved body weight, glycemic control, and multiple risk factors for cardiovascular disease (CVD) with the exception of an increase in low density lipoprotein cholesterol (LDL-C). In the present study, we report the impact of this intervention on markers of risk for atherosclerotic cardiovascular disease (CVD), with a focus on lipoprotein subfraction particle concentrations as well as carotid-artery intima-media thickness (CIMT).
Methods: Analyses were performed in patients with T2D who completed 2 years of this study (CCI; n = 194; usual care (UC): n = 68). Lipoprotein subfraction particle concentrations were measured by ion mobility at baseline, 1, and 2 years and CIMT was measured at baseline and 2 years. Principal component analysis (PCA) was used to assess changes in independent clusters of lipoprotein particles.
Results: At 2 years, CCI resulted in a 23% decrease of small LDL IIIb and a 29% increase of large LDL I with no change in total LDL particle concentration or ApoB. The change in proportion of smaller and larger LDL was reflected by reversal of the small LDL subclass phenotype B in a high proportion of CCI participants (48.1%) and a shift in the principal component (PC) representing the atherogenic lipoprotein phenotype characteristic of T2D from a major to a secondary component of the total variance. The increase in LDL-C in the CCI group was mainly attributed to larger cholesterol-enriched LDL particles. CIMT showed no change in either the CCI or UC group.
Conclusion: Consumption of a very low carbohydrate diet with nutritional ketosis for 2 years in patients with type 2 diabetes lowered levels of small LDL particles that are commonly increased in diabetic dyslipidemia and are a marker for heightened CVD risk. A corresponding increase in concentrations of larger LDL particles was responsible for higher levels of plasma LDL-C. The lack of increase in total LDL particles, ApoB, and in progression of CIMT, provide supporting evidence that this dietary intervention did not adversely affect risk of CVD.
Databáze: MEDLINE
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