Dietary treatment for familial hypercholesterolemia—differential effects of dietary soy protein according to the apolipoprotein E phenotypes

Abstract

Familial hypercholesterolemia, one form of type IIa hyperlipidemia, usually responds poorly to standard low-lipid diets. To define the responsiveness to a soy-protein diet in this disease, one homozygous and twenty heterozygous type IIa patients were submitted to a 4-wk traditional hypocholesterolemic diet followed by 4 wk in which animal protein was substituted with texturized soy protein. Soy was then withdrawn for a further 4 wk. No significant changes in plasma lipids were observed during low-lipid diets. The soy diet, however, caused a marked decrease in total (-20.8%) and low-density-lipoprotein (-25.8%) cholesterol and in apolipoprotein B (-14.1%). The plasma cholesterol reduction was higher in patients with apolipoprotein E3/E3 or E3/E4 vs an almost negligible effect on E3/E2. These results confirm that soy-protein diets can lower cholesterol in type IIa patients with familial disease. Data on the sensitivity of patients with different apo-E isoforms agree with recent hypotheses suggesting that soy proteins may activate B,E receptors.

Effects of Soy Protein Isolate (SPI) and Casein on the Postprandial Lipemia in Normolipidemic Men.

“…These factors are all known to affect the metabolism of TG-rich lipoproteins. Previous studies also reported that soybean protein decreased the fasting plasma lipid concentration when lipids levels of subjects were elevated by dietary or genetic factors, or by chronic diseases (high fat intake, familial hypercholesterolemia (17,33), renal disease (34), nephrotic syndrome (34,35)). In this study, however, all the subjects were normolipidemic, and the fasting levels of plasma lipids and apolipo proteins were not affected by SPI or casein intake.…”

“…Decreased levels of TC, TG and LDL-C are believed to be associated with a decreased risk of CAD. Several mechanisms have been proposed whereby soybean protein reduces plasma TC: (1) it raises LDL receptor activity (14)(15)(16)(17); (2) it reduces intestinal bile acid and cholesterol absorption (18)(19)(20); (3) it raises lipoprotein lipase (LPL) activity (21); and (4) it alters insulin levels (22). In the postprandial state, intestine-derived chylomicrons are hydrolyzed by LPL and converted to cholesterol-rich chylomicron remnants .…”

“…Soybean protein, compared to casein, raises hepatic LDL receptor activity (14)(15)(16)(17), alters insulin level (22) and raises LPL activity (21). These factors are all known to affect the metabolism of TG-rich lipoproteins.…”

The realization of a project aimed at reducing the plasmatic lipid level in a large Italian population improves the mean calcium daily intake: the Brisighella Study

“…Moreover, in 1980, 22.5% of older men and 21.5% of older women (9.5% and 8.3%, respectively, after NEP in 1986 ± 1989) had a multiple de®cit in food intake of calcium, vitamin D and magnesium. These daily intakes were calculated from data obtained by the 7-day questionnaires: this dietary record seems to be accurate as long as the subjects are willing to cooperate, as also shown in some controlled clinical trials (Gaddi et al, 1990). It meets the characteristics required by the nutritional habit survey in populations (Dwyer, 1994), particularly for the simplicity of the descriptive part and the accuracy of the quantitative part, avoiding typical disadvantages related ot the use of a 24 h recall (day-to-day variations of food consumption and other bias sources; Dwyer, 1994;Bingham et al, 1988;Block, 1982).…”

Homozygous Familial Hypercholesterolemia: Case report and Review of Literature

“…. Antonio gaddi et al 23 showed that Soy protein decreased TC (-20.8%) and LDL (-25.8%) levels in patients suffering from FH. But Cochrane reviews stated that, no conclusions can be made about the effectiveness of a cholesterol-lowering diet, or any of the other dietary interventions suggested for FH, due to the lack of adequate data.…”