Hyperlipidemias: Klein S

Klein S, Burke LE, Bray GA, Blair S, Allison DB, Pi-Sunyer X, Hong Y, Eckel RH, Anonymous00031. · No affiliation provided · Circulation. · Pubmed #15509809 links to  free full text

Abstract: Obesity adversely affects cardiac function, increases the risk factors for coronary heart disease, and is an independent risk factor for cardiovascular disease. The risk of developing coronary heart disease is directly related to the concomitant burden of obesity-related risk factors. Modest weight loss can improve diastolic function and affect the entire cluster of coronary heart disease risk factors simultaneously. This statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism reviews the relationship between obesity and the cardiovascular system, evaluates the effect of weight loss on coronary heart disease risk factors and coronary heart disease, and provides practical weight management treatment guidelines for cardiovascular healthcare professionals. The data demonstrate that weight loss and physical activity can prevent and treat obesity-related coronary heart disease risk factors and should be considered a primary therapy for obese patients with cardiovascular disease.

Klein S. · Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA. · Obes Res. · Pubmed #11707565 No free full text.

Abstract: Intentional weight loss improves many of the medical complications associated with obesity. Moreover, many of these beneficial effects have a dose-dependent relationship with the amount of weight lost and begin after only modest weight losses of 5% to 10% of initial body weight. There is no conclusive evidence that weight loss decreases mortality in obese people. The therapeutic effect of weight loss on risk factors for cardiovascular disease (insulin resistance and diabetes, dyslipidemia, and hypertension) has received the most attention in clinical trials. The hazard of developing coronary heart disease is directly related to the concomitant burden of risk factors. Modest weight loss can affect the entire cluster of risk factors simultaneously. Both negative energy balance and weight loss improve insulin sensitivity and glycemic control in obese patients with type 2 diabetes. Most studies have found that weight loss decreases serum triglyceride, total cholesterol, and low-density lipoprotein cholesterol concentrations and increases serum high-density lipoprotein cholesterol concentration. Regain of weight leads to relapse in triglyceride and cholesterol concentrations. Weight loss, independent of sodium restriction, decreases systolic and diastolic blood pressure. Dietary intervention is the cornerstone of weight-loss therapy. Most diets proposed for losing weight vary in two principal dimensions: energy content and macronutrient composition. Manipulation of food macronutrient content, energy density, and portion size can help decrease energy intake and facilitate weight loss.

Weiss EP, Fields DA, Mittendorfer B, Haverkort MA, Klein S. · Division of Geriatrics and Nutritional Science, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO 63110, USA. · Metabolism. · Pubmed #18803956 No free full text.

Abstract: Postprandial lipemia test (PPLT) results are predictive of cardiovascular disease risk. However, their reproducibility must be established before they can be clinically useful. Therefore, we investigated PPLT reproducibility by testing 9 men and women (body mass index, 20-41 kg/m(2); age, 21-40 years) on 4 separate occasions (n = 36 PPLTs total) separated by 1 week. Furthermore, because PPLTs are time consuming, we assessed the validity of an abbreviated PPLT. During the PPLT, venous blood was obtained before and every hour for 8 hours after a high-fat meal, which consisted of ice cream and heavy cream (approximately 800 kcal, 71% fat calories). Total and triglyceride-rich lipoprotein (TRL) triglyceride concentrations were measured in plasma. Total area under the curve (AUC) for total triglycerides was highly reproducible (within-subject coefficient of variation, 8%; intraclass correlation coefficient, 0.82); however, reproducibility was low for total triglyceride incremental AUC and both total and incremental TRL triglyceride AUCs (within-subject coefficients of variation, 20%-31%; intraclass correlation coefficients, 0.28-0.54). Four-hour lipemic responses were highly predictive of 8-hour responses (R(2) = 0.89-0.96, P <or= .0001). In conclusion, PPLTs are highly reproducible when lipemic responses are determined as the total AUC for total triglycerides. However, large variability in incremental AUC and TRL triglyceride responses may preclude their clinical utility. Furthermore, abbreviated 4-hour PPLTs are a valid surrogate for longer tests and may make PPLTs more feasible in a clinical setting.

Reeds DN, Mittendorfer B, Patterson BW, Powderly WG, Yarasheski KE, Klein S. · Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA. · Am J Physiol Endocrinol Metab. · Pubmed #12746213 links to  free full text

Abstract: Hypertriglyceridemia is common in individuals with human immunodeficiency (HIV) infection, but the mechanisms responsible for increased plasma triglyceride (TG) concentrations are not clear. We evaluated fatty acid and VLDL-TG kinetics during basal conditions and during a glucose infusion that resulted in typical postprandial plasma glucose and insulin concentrations in six men with HIV-dyslipidemia [body mass index (BMI): 28 +/- 2 kg/m2] and six healthy men (BMI: 26 +/- 2 kg/m2). VLDL-TG secretion and palmitate rate of appearance (Ra) in plasma were measured by using stable-isotope-labeled tracer techniques. Basal palmitate Ra and VLDL-TG secretion rates were greater (P < 0.01 for both) in men with HIV-dyslipidemia (1.04 +/- 0.07 micromol palmitate x kg-1 x min-1 and 5.7 +/- 0.6 micromol VLDL-TG x l plasma-1 x min-1) than in healthy men (0.67 +/- 0.08 micromol palmitate. kg-1 x min-1 and 3.0 +/- 0.5 micromol VLDL-TG x l plasma-1 x min-1). Basal VLDL-TG plasma clearance was lower in men with HIV-dyslipidemia (13 +/- 1 ml/min) than in healthy men (19 +/- 2 ml/min; P < 0.05). Glucose infusion decreased palmitate Ra (by approximately 50%) and the VLDL-TG secretion rate (by approximately 30%) in both groups, but the VLDL-TG secretion rate remained higher (P < 0.05) in subjects with HIV-dyslipidemia. These findings demonstrate that increased secretion of VLDL-TG and decreased plasma VLDL-TG clearance, during both fasting and fed conditions, contribute to hypertriglyceridemia in men with HIV-dyslipidemia. Although it is likely that increased free fatty acid release from adipose tissue contributes to the increase in basal VLDL-TG concentration, other factors must be involved, because insulin-induced suppression of lipolysis and systemic fatty acid availability did not normalize the VLDL-TG secretion rate.

Kane JM, Barrett EJ, Casey DE, Correll CU, Gelenberg AJ, Klein S, Newcomer JW. · Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA. · J Clin Psychiatry. · Pubmed #15554755 No free full text.

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