Induction of Hypertriglyceridemia by a Low-Fat Diet HENRY GINSBERG,* JERROLD M. OLEFSKY,f GEORGE KIMMERLING,* PHYLLIS CRAPO, AND GERALD M. REAVEN§ Department of Medicine, Stanford University School of Medicine and Veterans Hospital, Palo Alto, California ABSTRACT. We have studied the effects of moderate dietary fat restriction on plasma triglyceride, cholesterol, glucose, and insulin response in 27 subjects. Compared with a control diet (45% fat, 40% carbohydrate [CHO], 15% protein) the low fat (higher CHO) diet (30% fat, 55% CHO, 15% protein) produced a 41% increase in fasting triglyceride level (155 ± 17 to 219 ± 23 mg%) with no change in fasting plasma cholesterol level. Furthermore, this increase in triglyceride levels; induced by the higher CHO content of the low fat diet, was seen in 26 out of
P
REVIOUS studies (1-3) have indicated that fat-free diets which are very high in carbohydrate, can lead to significant elevation of fasting plasma triglyceride levels, and have suggested that the degree of triglyceride elevation is proportional to the insulin response elicited by the diet (3, 4). More recently, we have reported that increasing carbohydrate consumption to only 55% of daily calories leads to a significant increase in postprandial plasma insulin concentrations (5), suggesting that even a moderate increase in dietary carbohydrate may result in hypertriglyceridemia. Given the fact that hypertriglyceridemia (plasma triglyceride levels >150 mg%) was
Received August 11, 1975. Supported in part by NHLI NIH Grant no. HL08506, GCRC Grant no. FR70, and by the Veterans Administration. * Dr. Ginsberg was a Resident Clinical Associate, MRIS #3412, Veterans Administration. Present address: Naval Regional Medical Center, San Diego, California. t Dr. Olefsky is a Clinical Investigator, MRIS #6488, Veterans Administration. | Dr. Kimmerling was a Resident Clinical Associate, MRIS #4932, Veterans Administration. § Dr. Reaven is a Medical Investigator, MRIS #7363, Veterans Administration. Reprints: Gerald M. Reaven, M.D., Veterans Administration Hospital, 3801 Miranda Ave., Palo Alto, Calif. 94304.
Administration
27 subjects. Postprandial triglyceride, glucose, and insulin levels were also higher on the low fat (higher CHO) diet. Since hypertriglyceridemia is a significant risk factor for the development of coronary heart disease, and since our data indicate that the moderate increase in dietary CHO associated with a low fat diet will elevate plasma triglyceride levels, we believe that more caution is necessary before recommending the wide-spread use of low fat diets for heart disease prevention. (/ Clin Endocrinol Metab 42: 729, 1976)
present in approximately one-third of otherwise healthy male inhabitants (30-60 years of age) of a city in California (6), and the evidence suggesting that plasma triglyceride level is an independent risk factor in the development of arteriosclerotic heart disease (7-11), it seemed that investigation of the effect of a moderate increase in dietary carbohydrate on plasma triglyceride response would be prudent. Materials and Methods Twenty-four male and three female subjects were investigated while in the Stanford Clinical Research Center. The nature of these studies was explained to the participants, and informed consent was obtained from all subjects. The group had a mean ( ± S E ) age of 47 ± 2 years (range 20 to 59 years) and a mean (±SE) relative weight of 0.99 ± .05 (range 0.78 to 1.26). No subject had a fasting plasma glucose level greater than 110 mg%. Pre-study outpatient fasting plasma triglyceride concentrations ranged from 53-471 mg%, while fasting plasma cholesterol levels varied from 149-290 mg%. Nine patients had elevated plasma triglyceride levels (>150 mg%), while triglyceride levels were normal (
P
REVIOUS studies (1-3) have indicated that fat-free diets which are very high in carbohydrate, can lead to significant elevation of fasting plasma triglyceride levels, and have suggested that the degree of triglyceride elevation is proportional to the insulin response elicited by the diet (3, 4). More recently, we have reported that increasing carbohydrate consumption to only 55% of daily calories leads to a significant increase in postprandial plasma insulin concentrations (5), suggesting that even a moderate increase in dietary carbohydrate may result in hypertriglyceridemia. Given the fact that hypertriglyceridemia (plasma triglyceride levels >150 mg%) was
Received August 11, 1975. Supported in part by NHLI NIH Grant no. HL08506, GCRC Grant no. FR70, and by the Veterans Administration. * Dr. Ginsberg was a Resident Clinical Associate, MRIS #3412, Veterans Administration. Present address: Naval Regional Medical Center, San Diego, California. t Dr. Olefsky is a Clinical Investigator, MRIS #6488, Veterans Administration. | Dr. Kimmerling was a Resident Clinical Associate, MRIS #4932, Veterans Administration. § Dr. Reaven is a Medical Investigator, MRIS #7363, Veterans Administration. Reprints: Gerald M. Reaven, M.D., Veterans Administration Hospital, 3801 Miranda Ave., Palo Alto, Calif. 94304.
Administration
27 subjects. Postprandial triglyceride, glucose, and insulin levels were also higher on the low fat (higher CHO) diet. Since hypertriglyceridemia is a significant risk factor for the development of coronary heart disease, and since our data indicate that the moderate increase in dietary CHO associated with a low fat diet will elevate plasma triglyceride levels, we believe that more caution is necessary before recommending the wide-spread use of low fat diets for heart disease prevention. (/ Clin Endocrinol Metab 42: 729, 1976)
present in approximately one-third of otherwise healthy male inhabitants (30-60 years of age) of a city in California (6), and the evidence suggesting that plasma triglyceride level is an independent risk factor in the development of arteriosclerotic heart disease (7-11), it seemed that investigation of the effect of a moderate increase in dietary carbohydrate on plasma triglyceride response would be prudent. Materials and Methods Twenty-four male and three female subjects were investigated while in the Stanford Clinical Research Center. The nature of these studies was explained to the participants, and informed consent was obtained from all subjects. The group had a mean ( ± S E ) age of 47 ± 2 years (range 20 to 59 years) and a mean (±SE) relative weight of 0.99 ± .05 (range 0.78 to 1.26). No subject had a fasting plasma glucose level greater than 110 mg%. Pre-study outpatient fasting plasma triglyceride concentrations ranged from 53-471 mg%, while fasting plasma cholesterol levels varied from 149-290 mg%. Nine patients had elevated plasma triglyceride levels (>150 mg%), while triglyceride levels were normal (
