Physiology in Medicine: update on lifestyle determinants of postprandial triacylglycerolemia with emphasis on the Mediterranean lifestyle

Abstract

Maraki MI, Sidossis LS. Update on lifestyle determinants of postprandial triacylglycerolemia with emphasis on the Mediterranean lifestyle. Am J Physiol Endocrinol Metab 309: E440 -E449, 2015. First published July 7, 2015; doi:10.1152/ajpendo.00245.2015.-This review updates the effect of lifestyle on plasma triacylglycerols (TAG) in the postprandial state, commonly reported as postprandial lipemia (PPL), an independent risk factor for cardiovascular diseases (CVD). Numerous studies have shown that Mediterranean diet may reduce PPL. However, most of these studies were focused on the type of fat (i.e., monounsaturated fat from olive oil), and the other components of the Mediterranean lifestyle were neglected. Physical activity, an integral part of this lifestyle, is widely investigated on its own and shown to reduce PPL. In addition, preliminary results of studies examining other Mediterranean "ingredients", such as legumes, fish, and herbs, showed additional benefits; however, data on the long-term effects are limited. More studies are needed to confirm short-term results and investigate the effects of the whole Mediterranean lifestyle on PPL and whether these effects mediate its protective role on CVD. Moreover, investigation of the effects in nonhealthy populations and the underlying mechanisms would be clinically helpful in individualizing the appropriate intervention.triglycerides; olive; physical activity; diet; lipid metabolism FREE-LIVING HUMANS spend most of their time in a nonfasting, postprandial state; however, routine health screening is performed in the fasting state. Regarding lipids [mainly triacylglycerols (TAG) and their carriers, TAG-rich lipoproteins (TRL)], the most profound changes are taking place in the postprandial state, i.e., the hours after the consumption of dietary fat. TAG and TRL metabolism in the postprandial state are schematically shown in Fig. 1.Recent evidence suggests that elevated levels of plasma TAG in the postprandial state, commonly reported as postprandial lipemia (PPL) or nonfasting TAG, is associated with increased risk for atherosclerosis, independently of other known cardiovascular disease (CVD) risk factors (32, 61). In addition, TAG-TRL remnants [i.e., chylomicrons and VLDL with reduced amount or depleted of TAG after the action of lipoprotein lipase (LPL)] may penetrate the arterial wall and may be taken up by monocytes, forming foam cells. Several epidemiological studies have shown that CVD patients have increased levels of postprandial TRL (62), while VLDL remnants have also be found in atheromatique plaques. In addition, reduced TRL catabolism is associated with changes in the size of other lipoproteins (e.g., formation of HDL 3 and LDL 3 ; Fig. 2) that are thought to be atherogenic (66, 74), as well as oxidative stress, endothelium dysfunction, and inflammation (40, 87), thereby increasing CVD risk. Recent detailed reviews have highlighted the clinical importance of PPL (12, 37). Therefore, interventions that improve postprandial TAG and TRL metabolism may be ...

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