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Generally, people with low levels of high-density lipoprotein (HDL) in blood are more likely to get heart disease than those who have normal or high levels. Dietary fat, whether the harmful type (saturated) or beneficial type (unsaturated) raises HDL levels. Dietary carbohydrate lowers HDL. The investigators are doing this research study to find out why the amount of HDL in a person's blood is affected by dietary unsaturated fat and carbohydrate. The investigators will trace the ability of the HDL in a person's blood to take up cholesterol, get bigger, and then leave the blood by passing into the liver. The investigators want to know if dietary unsaturated fat improves the ability of HDL to do this compared to dietary carbohydrate.
The investigators will study the kinetics of multiple types of high-density lipoprotein (HDL) in humans under two strictly controlled dietary conditions, high unsaturated fat and high carbohydrate, in 20 individuals with low HDL cholesterol and overweight or obesity. The participants will be given the controlled diets for 4 weeks in a randomized crossover design. They will be admitted to the Brigham & Women's Hospital Center for Clinical Investigation (CCI) the morning of Day 28 when they will be infused intravenously with a stable isotope tracer, trideuterated (D3), leucine for 10 minutes as a bolus. Blood will be sampled in the hospital through 24 hours, and thereafter at the ambulatory clinical center throughout 94 hours. HDL subtypes will be prepared in Dr. Sacks's laboratory at Harvard School of Public Health (HSPH) and analyzed for content of lipids and proteins, and for incorporation of the tracer into apolipoprotein A-I, the principal protein of HDL. These data will be studied by interactive modeling to a multi-compartment model of human HDL physiology that best fits the observed data. The model will yield HDL metabolic rates during unsaturated fat and carbohydrate-rich diets which will be tested for statistical significance.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| High Fat and Low Carbohydrate Diet | Experimental |
| |
| Low Fat and High Carbohydrate Diet | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Low Fat and High Carbohydrate Diet | Behavioral | Low Fat and High Carbohydrate Diet |
|
| Measure | Description | Time Frame |
|---|---|---|
| high-density lipoprotein (HDL) cholesterol | To determine how dietary unsaturated fat when it replaces carbohydrate affects HDL metabolism. | Diet Periods I and II-Days 28-32 |
| Measure | Description | Time Frame |
|---|---|---|
| To study HDL with apoE | Diet Periods I and II-Days 28-32 |
| Measure | Description | Time Frame |
|---|---|---|
| Provide guidance for interpreting effects of unsaturated fats on reverse cholesterol transport | Diet Periods I and II-Days 28-32 |
Inclusion Criteria:
Exclusion Criteria:
Hematocrit <33
Low-density Lipoprotein (LDL) cholesterol >190 mg/dl
HDL cholesterol <20 mg/dl, to exclude those with rare genetic HDL deficiency syndromes
Fasting Triglycerides >500 mg/dl to exclude those with risk of pancreatitis
ApoE genotypes, E2E2, E2E4, and E4E4.
Lipid lowering medications
Hormone replacement therapy
Other medicines that affect plasma lipid levels: e.g. beta blockers, certain psychiatric medicines including Alprazolam, Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam, Oxazepam, Prazepam, Aripiprazole, Chlorpromazine, Chlorprothixene, Clozapine, Flupenthixol, Fluphenazine, Haloperidol, Loxapine, Mesoridazine, Methotrimeprazine, Molindone, Olanzapine, Perphenazine, Pimozide, Pipotiazine, Prochlorperazine, Promazine, Promethazine, Quetiapine, Risperidone, Sulpiride, Thioridazine, Thiothixene, Trifluoperazine, Ziprasidone.
Thyrotrophin-stimulating hormone: <0.5 or >5.0
alanine aminotransferase : 1.5 x uln or 60 IU/L
Aspartate transaminase: 1.5 x uln or 60 IU/L
Bilirubin: outside upper limit. (>1.2 mg/dL)
Creatinine: outside upper limit (>1.00 mg/dL)
Diabetes by history
Diabetes by fasting or post-challenge glycemia according to ADA guidelines:
Will not eat the provided diet and abstain from alcoholic beverages.
Women who are pregnant
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| Name | Affiliation | Role |
|---|---|---|
| Frank M Sacks, MD | Harvard University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Harvard T. H. Chan School of Public Health | Boston | Massachusetts | 02215 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30944249 | Derived | Morton AM, Furtado JD, Mendivil CO, Sacks FM. Dietary unsaturated fat increases HDL metabolic pathways involving apoE favorable to reverse cholesterol transport. JCI Insight. 2019 Apr 4;4(7):e124620. doi: 10.1172/jci.insight.124620. eCollection 2019 Apr 4. | |
| 29467335 | Derived | Morton AM, Koch M, Mendivil CO, Furtado JD, Tjonneland A, Overvad K, Wang L, Jensen MK, Sacks FM. Apolipoproteins E and CIII interact to regulate HDL metabolism and coronary heart disease risk. JCI Insight. 2018 Feb 22;3(4):e98045. doi: 10.1172/jci.insight.98045. eCollection 2018 Feb 22. |
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| ID | Term |
|---|---|
| D050177 | Overweight |
| D002318 | Cardiovascular Diseases |
| ID | Term |
|---|---|
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D001835 | Body Weight |
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| ID | Term |
|---|---|
| D018752 | Diet, Fat-Restricted |
| D004032 | Diet |
| D050528 | Diet, Carbohydrate-Restricted |
| ID | Term |
|---|---|
| D004035 | Diet Therapy |
| D044623 | Nutrition Therapy |
| D013812 | Therapeutics |
| D009747 | Nutritional Physiological Phenomena |
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| High Fat and Low Carbohydrate Diet | Behavioral | High Fat and Low Carbohydrate Diet |
|
|
| D012816 |
| Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D000066888 |
| Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |