The nature and level of dietary protein is liable to influence cholesterol and essential fatty acid (EFA) metabolism. Dietary vegetable protein, particularly the undigested fraction, decreases intestinal cholesterol absorption, increases the faecal excretion of steroids, and enhances the catabolism of cholesterol-carrying lipoproteins by increasing the activity or number of LDL receptors. However, the hypocholesterolemic effect of protein may be due to the presence of non-protein components and hence the purity degree of the selected protein, and the concomitant addition or not of cholesterol. Dietary proteins with different amino acid composition may modulate the secretion of hormones (e.g. glucagon and insulin), which in turn may modify the activity of enzymes responsible for cholesterol metabolism (e.g. HMG-CoA reductase, 7alpha-hydroxylase, lecithin: cholesterol acyl transferase) and polyunsaturated fatty acid synthesis (e.g. Delta5 and Delta6-desaturases). PUFA affect membrane fluidity and the synthesis of eicosanoids: prostaglandins and leukotrienes. Protein deficiency affects severely the PUFA amounts, particularly arachidonic and EPA acids which are precursors of prostaglandins, thromboxanes and leukotrienes, and the possible consequences of their diminution may be an underlying cause of some of the common clinical symptoms in protein malnutrition, such as hair loss, dry scaly dermatitis and increased water permeability. Protein deficiency may thus increase the EFA requirement and precipitate marginal EFA deficiency. The dietary protein level may also influence the efficiency of antioxidant system and/or the release of reactive oxygen species. Tissue lipid peroxidation could be markedly enhanced by feeding low-protein diets, probably due to a depressed efficiency of antioxidative enzyme activities.
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