Abstract
We conducted this cross-sectional population study with a healthy multi-ethnic urban population (n = 577) in Malaysia, combining nutritional assessments with cardiometabolic biomarkers defined by lipid, atherogenic lipoproteins, inflammation and insulin resistance. We found diametrically opposing associations of carbohydrate (246·6 ± 57·7 g, 54·3 ± 6·5%-TEI) and fat (total = 64·5 ± 19·8 g, 31·6 ± 5·5%-TEI; saturated fat = 14·1 ± 2·7%-TEI) intakes as regards waist circumference, HDL-C, blood pressure, glucose, insulin and HOMA2-IR as well as the large-LDL and large-HDL lipoprotein particles. Diets were then differentiated into either low fat (LF, <30% TEI or <50 g) or high fat (HF, >35% TEI or >70 g) and low carbohydrate (LC, <210 g) or high carbohydrate (HC, >285 g) which yielded LFLC, LFHC, HFLC and HFHC groupings. Cardiometabolic biomarkers were not significantly different (P > 0.05) between LFLC and HFLC groups. LFLC had significantly higher large-LDL particle concentrations compared to HFHC. HOMA-IR2 was significantly higher with HFHC (1·91 ± 1·85, P < 0·001) versus other fat-carbohydrate combinations (LFLC = 1·34 ± 1·07, HFLC = 1·41 ± 1·07; LFHC = 1·31 ± 0·93). After co-variate adjustment, odds of having HOMA2-IR >1.7 in the HFHC group was 2.43 (95% CI: 1·03, 5·72) times more compared to LFLC while odds of having large-LDL <450 nmol/L in the HFHC group was 1.91 (95% CI: 1·06, 3·44) more compared to latter group. Our data suggests that a HFHC dietary combination in Malaysian adults is associated with significant impact on lipoprotein particles and insulin resistance.
Highlights
The rising global burden of diet-related non-communicable diseases (NCDs) impacts health equity and economic productivity in developing countries, as mortality from NCDs occur during the middle life years[1,2,3]
Given this gap in the knowledge between dietary consumption patterns and cardiovascular disease (CVD) risk in the Malaysian population, we designed and undertook the Malaysia Lipid Study (MLS) to address key questions related to dietary macronutrients’ consumption and their association with CVD and diabetes. This cross-sectional study goes beyond the traditional metabolic syndrome (MetS) parameters, to elucidate other overlapping risk factors such as insulin resistance and vasculopathy assessed through the lipoprotein subclasses of which small dense LDL particles have been shown to be a better predictor for CVD than plasma LDL-C14–16
The reported prevalence of MetS in Malaysia is 27·5%, whereas we found prevalence of 16·3% in the MLS population; a lower trend which may be explained by our study’s exclusion criteria at recruitment of those previously diagnosed with diabetes, hypertension and hypercholesterolemia[32]
Summary
The rising global burden of diet-related non-communicable diseases (NCDs) impacts health equity and economic productivity in developing countries, as mortality from NCDs occur during the middle life years[1,2,3]. Www.nature.com/scientificreports and United Kingdom opt to adopt these strategies to lower the risk of CVD9,10 Despite these recommendations, the evidence base for dietary guidelines in general has been challenged, in relation to their potential CVD risk reduction efficacy, especially those recommendations targeting saturated fats, as the global pandemic of NCDs continues unabated with CVD as the largest contributor to mortality[4,11,12]. The recently published 18-country PURE prospective cohort study including Malaysia, highlights high carbohydrate intake rather than total fat or saturated fat were related to higher mortality risk from CVDs13 Given this gap in the knowledge between dietary consumption patterns and CVD risk in the Malaysian population, we designed and undertook the Malaysia Lipid Study (MLS) to address key questions related to dietary macronutrients’ consumption and their association with CVD and diabetes. This cross-sectional study goes beyond the traditional metabolic syndrome (MetS) parameters, to elucidate other overlapping risk factors such as insulin resistance and vasculopathy assessed through the lipoprotein subclasses of which small dense LDL particles have been shown to be a better predictor for CVD than plasma LDL-C14–16
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