The effect of intensive dietary therapy on serum high density lipoprotein cholesterol in patients with type 2 (non-insulin-dependent) diabetes mellitus: A prospective study

Abstract

Summary. Intensive dietary therapy in 57 newly diagnosed Type 2 (non-insulin-dependent) diabetic patients led to an increase, compared with pre-treatment levels, in serum high density lipoprotein (HDL) cholesterol and the HDL/total cholesterol ratio after 3 and 6 months (0.05 < p < 0.1). The increase in HDL cholesterol was related to the degree of weight loss achieved. In 28 patients whose weight decreased by > 10% average body weight during the 6 months, HDL cholesterol rose from 1.22 + 0.06 to 1.36 + 0.06 retool/1 (p < 0.001), whereas patients who lost less weight showed no significant increase in HDL cholesterol. The increase in mean serum HDL-cholesterol levels in female patients was associated with a mean weight reduction of 12.1% average body weight. Patients who were obese at diagnosis lost more weight during the study than non-obese patients (mean 13.2 versus 5.6% average body weight), and showed a significant increase in serum HDL-cholesterol levels. We conclude that intensive dietary therapy may lead to a less atherogenic lipid profile in Type 2 diabetes, particularly in patients who achieve a major weight reduction.Key words: HDL-cholesterol, triglyceride, glucose tolerance, dietary therapy, weight loss, Type 2 diabetes.HDL cholesterol levels are inversely related to the risk of coronary heart disease, and it has been suggested that a low HDL cholesterol or HDL/total cholesterol ratio are major lipid risk factors [1,2]. Several studies have demonstrated that HDL cholesterol levels are reduced in patients with Type 2 diabetes, a condition associated with an increased incidence of atherosclerosis [3][4][5]. It is not clear, however, whether treatment by diet or oral hypoglycaemic drugs influences HDL cholesterol levels.As part of a prolonged prospective study of intensive dietary therapy in Type 2 diabetes [6], we have measured HDL cholesterol and other lipids in 57 newly diagnosed patients before and during 6 months dieting. Patients and MethodsFifty-seven newly diagnosed Type 2 diabetic patients were studied. All had symptoms attributable to hyperglycaemia or glycosuria at diagnosis. Their ages ranged from 43 to 69 years (mean 57 years) and there were 28 males and 29 females. Thirty-four patients were obese (> 110% average body weight) and 23 non-obese (< 110% average body weight) at diagnosis. Twenty-one were known cigarette smokers and 34 were known alcohol consumers. Six patients were known to be taking thiazide diuretics, two to be taking fl-adrenergic blocking agents and two more to be taking both these drugs at time of diagnosis. To our knowledge, they continued on that therapy during the study period. At the time of diagnosis, a 50 g oral glucose tolerance test, with measurement of plasma insulin, was performed. Serum cholesterol, HDL cholesterol and triglyceride levels were measured after a 14-h overnight fast. The patients were then prescribed a diet in which 40%45% of total energy was derived from carbohydrate with exclusion of foods rich in refined sugars. In the majority, the recommended e...

Comparative Study of Lipid Fractions in Type- I and Type- Ii Diabetes in Relation to Its Duration, Severity and Type of Medication

“…Most workers have reported a complete lack of correlation between the duration of diabetes and the serum lipids. 9,10 The findings of the present study were similar except that, the triglycerides showed slight increase with increase in duration of diabetes. It was also found that all lipid fractions profoundly increased with increasing severity of diabetes.…”

Triglyceride‐rich lipoproteins in non‐insulin‐dependent diabetes mellitus: post‐prandial metabolism and relation to premature atherosclerosis

“…Several authors have reported impressive reductions in fasting plasma glucose and TG concentrations in response to weight reduction [175][176][177][178][179][180][181][182][183][184]. The fact that these beneficial metabolic effects already occurred after minor weight reduction while the majority of subjects remained overweight [179,180] emphasizes the therapeutic benefits of weight loss [185][186][187][188].…”

“…The fact that these beneficial metabolic effects already occurred after minor weight reduction while the majority of subjects remained overweight [179,180] emphasizes the therapeutic benefits of weight loss [185][186][187][188]. Although the effect of weight loss on plasma HDL-C levels is not as dramatic as the change in TG metabolism, modest improvements in HDL-C concentrations and HDL-C to LDL-C ratios are commonly observed [176,177]. Weisweiler et al [175] demonstrated that a hypocaloric diet did not only reduce VLDL-TG and apo B concentrations, but also beneficially changed the composition, as indicated by a decreased cholesterol content.…”

Polyunsaturated and Saturated Fat, Cholesterol, and Fatty Add Supplementation

“…At 1 yr, however, plasma TG returned to pretreatment levels, despite persistent improvement in weight and serum glucose concentrations (92). On the other hand, when a weight reduction of 10% is maintained, a sustained improvement in plasma TG, HDL-chol, and HDL-chol to total cholesterol ratio is observed (93). Diabetic patients hospitalized and placed on hypocaloric diets demonstrate even more marked improvement in plasma lipoprotein concentrations.…”

“…Decreases in VLDL-TG were due to decreased synthesis in most patients because the VLDL removal rate and LPL activity were unchanged during a hypocaloric diet (95,96). In most studies, HDL-chol is usually increased in NIDDM when weight loss has been achieved (93,(96)(97)(98), although some investigators have reported no change (94). Treatment of NIDDM with sulfonylurea results in improved glycemic control and reduced TG concentrations (99)(100)(101)(102).…”