BackgroundThe prevalence of abdominal obesity and type 2 diabetes mellitus (T2DM) is a public health challenge. New solutions need to be developed to help patients implement lifestyle changes.ObjectiveThe objective of the study was to evaluate a fully automated Web-based intervention designed to help users improve their dietary habits and increase their physical activity.MethodsThe Accompagnement Nutritionnel de l’Obésité et du Diabète par E-coaching (ANODE) study was a 16-week, 1:1 parallel-arm, open-label randomized clinical trial. Patients with T2DM and abdominal obesity (n=120, aged 18-75 years) were recruited. Patients in the intervention arm (n=60) had access to a fully automated program (ANODE) to improve their lifestyle. Patients were asked to log on at least once per week. Human contact was limited to hotline support in cases of technical issues. The dietetic tool provided personalized menus and a shopping list for the day or the week. Stepwise physical activity was prescribed. The control arm (n=60) received general nutritional advice. The primary outcome was the change of the dietary score (International Diet Quality Index; DQI-I) between baseline and the end of the study. Secondary endpoints included changes in body weight, waist circumference, hemoglobin A1c (HbA1c) and measured maximum oxygen consumption (VO2 max).ResultsThe mean age of the participants was 57 years (standard deviation [SD] 9), mean body mass index was 33 kg/m² (SD 4), mean HbA1c was 7.2% (SD 1.1), and 66.7% (80/120) of participants were women. Using an intention-to-treat analysis, the DQI-I score (54.0, SD 5.7 in the ANODE arm; 52.8, SD 6.2 in the control arm; P=.28) increased significantly in the ANODE arm compared to the control arm (+4.55, SD 5.91 vs -1.68, SD 5.18; between arms P<.001). Body weight, waist circumference, and HbA1c changes improved significantly in the intervention.ConclusionsAmong patients with T2DM and abdominal obesity, the use of a fully automated Web-based program resulted in a significant improvement in dietary habits and favorable clinical and laboratory changes. The sustainability of these effects remains to be determined.Trial RegistrationClinicalTrials.gov NCT02343107; http://clinicaltrials.gov/ct2/show/NCT02343107 (Archived by WebCite at http://www.webcitation.org/6uVMKPRzs)

Objective-Low high-density lipoprotein (HDL) cholesterol levels are frequently observed in familial hypercholesterolemia (FH) and might be associated with functional alterations of HDL particles that may influence their efficaciousness in the reverse cholesterol transport pathway. Methods and Results-We evaluated key steps of the reverse cholesterol transport, ie, cellular free cholesterol efflux, cholesteryl ester transfer protein-mediated cholesteryl ester (CE) transfer from HDL to apolipoprotein B-containing lipoproteins, and hepatic HDL-CE uptake, in patients displaying FH (nϭ12) and in healthy normolipidemic control subjects (nϭ12). Large HDL2 particles isolated from FH patients displayed a reduced capacity to mediate free cholesterol efflux via both scavenger receptor-BI-and ABCG1-dependent pathways. A significant inverse relationship between scavenger receptor-BI-dependent HDL2 efflux capacity and carotid intima-media thickness (rϭϪ0.473; Pϭ0.0186), as well as between ABCG1-dependent HDL2 efflux capacity and carotid intima-media thickness (rϭϪ0.485; Pϭ0.0212), was detected. We also observed an elevated cholesteryl ester transfer protein-mediated CE transfer from HDL2 and HDL3 particles to low-density lipoprotein and a reduced capacity of HDL particles to deliver CEs to the liver. Conclusion-We demonstrated that the centripetal movement of cholesterol from peripheral tissues, including the vessel wall, to feces is defective in FH, thereby emphasizing its atherogenicity. Key Words: ABC transporter Ⅲ lipoproteins Ⅲ macrophages Ⅲ metabolism Ⅲ receptors F amilial hypercholesterolemia (FH) is a common inherited dominant autosomal disorder caused by mutations in the gene encoding the low-density lipoprotein (LDL) receptor. 1 These mutations lead to a reduced number of functional LDL receptors, resulting in diminished cellular uptake of LDL particles, LDL accumulation, and increased plasma levels of total cholesterol, LDL cholesterol, and premature atherosclerosis. 2,3 Within the arterial wall, macrophages take up modified LDL through a variety of scavenger receptors, mainly scavenger receptor (SR)-A and CD36, accumulate cholesteryl esters (CEs), and are progressively converted into lipid-rich foam cells that represent the hallmark of the atherosclerotic plaque. 4 Excess cholesterol in macrophages is eliminated via the process of reverse cholesterol transport (RCT), a pathway by which cholesterol from peripheral tissues is transported to the liver for biliary excretion. 5 During the past few years, the atheroprotective role of RCT has been clearly demonstrated in humans. 6 The first step in this pathway is the efflux of cholesterol from cells to extracellular acceptors, such as high-density lipoprotein (HDL) and apolipoprotein AI (apoAI). Cellular cholesterol efflux to lipid-free or lipid-poor apoAI occurs through a transporter belonging to the ATP binding cassette (ABC) family, ABCA1, 7 whereas free cholesterol efflux to mature HDL particles involves both ABCG1 8 and SR-BI. 9 The low HDL cholesterol levels...