Abstract
BackgroundManaging cardiovascular disease (CVD) risk factors, e.g., dyslipidemia in type-2 diabetes mellitus (T2DM) is critically important as CVD is the most common cause of death in T2DM patients. This study aimed to investigate the effect of plant sterols (PS) on lowering both elevated low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG).MethodsIn a double-blind, randomized, placebo-controlled, parallel study, 161 individuals at increased risk of and with established T2DM, consumed low-fat spreads without or with added PS (2 g/d) for 6 weeks after a 2-week run-in period. Increased risk of developing T2DM was defined by the Australian T2DM Risk Assessment Tool (AUSDRISK). Fasting serum/plasma total cholesterol (TC), LDL-C, TG, high-density lipoprotein cholesterol (HDL-C), glucose and insulin were measured at baseline and after 6 weeks. Effects on acute and chronic postprandial blood lipids, glucose and insulin were measured over 4-h in 39 individuals with T2DM following a mixed meal challenge without and with added 2 g/d PS at week 6. The study was registered at clinicaltrials.gov (NCT02288585).ResultsHundred fifty-one individuals completed the study and 138 (57% men, 43% women; 44 with and 94 at risk of T2DM) were included in per protocol analysis. Baseline LDL-C and TG were 3.8 ± 1.0 and 2.5 ± 0.8 mmol/l, respectively. PS intake significantly lowered fasting LDL-C (−4.6%, 95%CI −1.2; −8.0; p = 0.009), TC (−4.2%, 95%CI −1.2; −7.1; p = 0.006) and TG (−8.3%, 95% −1.1, −15.0; p = 0.024) with no significant changes in HDL-C, glucose or insulin. Postprandial lipid (TG, TC, LDL-C, HDL-C, remnant cholesterol), glucose and insulin responses did not differ.ConclusionsIn individuals at risk of and with established T2DM and with elevated TG and LDL-C, 2 g/d of PS results in dual LDL-C plus TG lowering. Postprandial lipid or glycemic responses did not differ between PS and control treatment.
Highlights
Type 2 diabetes mellitus (T2DM) is an independent risk factor for cardiovascular disease (CVD) and individuals with type-2 diabetes mellitus (T2DM) have on average a 2-fold increase in CVD risk compared to those without diabetes[1,2,3]
plant sterols (PS) intake significantly lowered fasting low-density lipoprotein cholesterol (LDL-C) (−4.6%, 95%confidence interval (CI) −1.2; −8.0; p = 0.009), total cholesterol (TC) (−4.2%, 95%CI −1.2; −7.1; p = 0.006) and TG (−8.3%, 95% −1.1, −15.0; p = 0.024) with no significant changes in high-density lipoprotein cholesterol (HDL-C), glucose or insulin
Many individuals at risk of developing or with T2DM have dyslipidemia characterized by lipid and lipoprotein abnormalities such as elevated fasting and non-fasting triglycerides (TG) and TG-rich lipoproteins, e.g., chylomicrons and very-low-density lipoprotein (VLDL), low high-density lipoprotein cholesterol (HDL-C) and often elevated low-density lipoprotein cholesterol (LDL-C) concentrations, in the form of increased small dense LDL particles[2,4]
Summary
Type 2 diabetes mellitus (T2DM) is an independent risk factor for cardiovascular disease (CVD) and individuals with T2DM have on average a 2-fold increase in CVD risk compared to those without diabetes[1,2,3]. Managing CVD risk factors such as dyslipidemia is critically important as Nutrition and Diabetes. Many individuals at risk of developing or with T2DM have dyslipidemia characterized by lipid and lipoprotein abnormalities such as elevated fasting and non-fasting triglycerides (TG) and TG-rich lipoproteins, e.g., chylomicrons and very-low-density lipoprotein (VLDL), low high-density lipoprotein cholesterol (HDL-C) and often elevated low-density lipoprotein cholesterol (LDL-C) concentrations, in the form of increased small dense LDL particles[2,4]. Individuals with established T2DM are advised to use statin therapy to control elevated LDL-C and reduce cardiovascular risk[6]. An additional lowering of elevated TG concentrations can further contribute to reducing residual CVD risk. Managing cardiovascular disease (CVD) risk factors, e.g., dyslipidemia in type-2 diabetes mellitus (T2DM) is critically important as CVD is the most common cause of death in T2DM patients. This study aimed to investigate the effect of plant sterols (PS) on lowering both elevated low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG)
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