Abstract
The occurrence of Metabolic Syndrome (MS) represents an independent risk factor for developing cardiovascular disease states in patients suffering from type 2 diabetes mellitus. Moreover, both the size of LDL particles and liver dysfunction identified as non alcoholic fatty liver disease (NAFLD) represent important biomarkers for the development of cardiometabolic risk in patients with MS. Here we studied the effect of bergamot polyphenolic fraction (BPF) in patients with MS and NAFLD. 107 patients were enrolled at the San Raffaele IRCCS (Rome). All of them showed ultrasonografic evidences of NAFLD and at least three out of five previous identified criteria for the diagnosis of MS. Patients were divided into two groups: one receiving placebo and the second receiving BPF 650 mg twice a day for 120 consecutive days. In the group receiving BPF 650 mg twice a day, a significant reduction of fasting plasma glucose, serum LDL cholesterol and triglycerides alongside with an increase of HDL cholesterol was found. This effect was accompanied by significant reduction of both ultrasonographic and metabolic biomarkers of NAFLD. Moreover, a significant reduction of small dense LDL particles, as detected via proton NMR Spectroscopy, was found after BPF treatment. In conclusion, our data confirm the beneficial effect of bergamot-extract in patients with MS an effect highlighted by significant reduction of small dense LDL particles and by improvement of NAFLD biomarkers. This suggests a potential preventive role of bergamot derivatives in reducing cardiometabolic risk.
Highlights
Evidence has been collected showing that the occurrence of metabolic syndrome (MS) is associated to increased risk of developing cardiovascular diseases and type 2 diabetes [1]
Besides imbalanced glycemic control has been associated with parameters of vascular damage [3], increasing hyperglycemia in type 2 diabetes does not contribute to the cardiovascular risk to the same extent as it does in type 1 diabetes [4], pointing to the importance of nonglycemic related risk factors belonging to the MS
We found that bergamot-derived polyphenolic fraction (BPF) produces significant reduction of serum cholesterol, triglycerides and fasting glucose in hyperlipemic patients [26] [27], an effect which occurs at multilevels including an enhanced metabolism of lipoproteins at the hepatic level [28]
Summary
Evidence has been collected showing that the occurrence of metabolic syndrome (MS) is associated to increased risk of developing cardiovascular diseases and type 2 diabetes [1]. Numerous studies demonstrated an increased cardiovascular risk in patients with MS prior to the development of overt hyperglycemia [5] [6]. Patients with type 2 diabetes or MS have an increased cardiovascular risk despite optimal control of other risk factors as low-density lipoprotein cholesterol (LDL-C) [7]. In the context of the shortcomings of commonly assessed risk factors in individuals with features of the MS, the characterization and sub-classification of LDL and high-density lipoprotein HDL particles emerged as a tool that may offer a better risk prediction. A decrease of HDL associated with an increase in small, dense LDL particles (sdLDL), class III and IV, is closely associated with an increased cardiovascular risk, independently of the traditional risk factors both in patients with [8]-[10] and without [11]-[13] diabetes or MS. Individual LDL particle profiles normally cluster into two patterns of LDL size distribution: the majority of profiles demonstrates a predominance of large or medium sized LDL particles (LDL pattern A), whereas a substantial minority exhibits the LDL pattern B with a higher proportion of smaller LDL particles [14]
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