Strawberry milky-white blood donor's plasma: signaling uncontrolled diabetic lipemia

Intake of a fatty meal before donating blood can lead to an increased level of plasma triglyceride concentration for several hours. This may cause either turbid and or “milky-white” appearance of their venous plasma samples. We, however, report a peculiar case about a male blood donor from India, whose plasma appeared to be “strawberry milky-white” in colour. On inquiry, he gave a history of poorly controlled diabetes mellitus type-II. Further, this was affirmed by his high blood glucose concentration [nearly 326 mg/dL] and HbA1c [13.7%] respectively. Moreover, his plasma triglyceride concentration was elevated up to 376 mg/dL. His treatment was started at our hospital and the strawberry colour of his plasma, dramatically recovered to normal straw-colour after achieving a fairly good glycemic control with the insulin therapy.     

Postprandial lipemia as a cardiometabolic risk factor

High levels of fasting circulating triglycerides (TG) represent an independent risk factor for cardiovascular disease. In western countries, however, people spend most time in postprandial conditions, with continuous fluctuation of lipemia due to increased levels of TG-rich lipoproteins (TRLs), including chylomicrons (CM), very low density lipoproteins (VLDL), and their remnants. Several factors contribute to postprandial lipid metabolism, including dietary, physiological, pathological and genetic factors. The presence of coronary heart disease, type 2 diabetes, insulin resistance and obesity is associated with higher postprandial TG levels compared with healthy conditions; this association is present also in subjects with normal fasting TG levels. Increasing evidence indicates that impaired metabolism of postprandial lipoproteins contributes to the pathogenesis of coronary artery disease, suggesting that lifestyle modifications as well as pharmacological approaches aimed at reducing postprandial TG levels might help to decrease the cardiovascular risk.     

Consumption of diets with different type of fat influences triacylglycerols-rich lipoproteins particle number and size during the postprandial state

Background and aims

Previous evidence suggests that dietary fat could influence the composition and size of triacylglycerols-rich lipoproteins (TRL). In a controlled intervention study on healthy subjects, we evaluated the influence of 3 dietary interventions, with different types of fat on postprandial TRL particle size and number.

Methods and results

Volunteers followed three different diets for four weeks each, according to a randomized crossover design. Western diet: 15% protein, 47% carbohydrates (CHO), 38% fat (22% saturated fatty acid (SFA)); Mediterranean diet: 15% protein, 47% CHO, 38% fat (24% monounsaturated fatty acid (MUFA)); high CHO enriched with ALNA diet: 15% protein, 55% CHO, <30% fat (8% polyunsaturated fatty acid (PUFA)). After a 12-h fast, volunteers consumed a breakfast with 1 g fat and 7 mg cholesterol per kg body weight and a fat composition similar to that consumed in each of the diets: Butter meal: 35% SFA; Olive oil meal: 36% MUFA; Walnut meal: 16% PUFA, 4% α-linolenic acid. Tryglicerides (TG) in TRL (large and small TRL) were determined by ultracentrifugation and size and number of lipoprotein particles were measured with Nuclear Magnetic Resonance Spectroscopy at different time points. The olive oil meal reduced the number of total TRL postprandial particles compared with the other meals (P = 0.002). Moreover, the olive oil meal also increased the TRL particle size compared with the walnut meal (P = 0.001).

Conclusion

Our data showed that short-term intake of the Mediterranean diet and the acute intake of an olive oil meal lead to the formation of a reduced number and higher-size TRL particle compared with other fat sources. These novel findings have implications for understanding the postprandial lipoprotein mechanisms, and could favour the lower cardiovascular risk in Mediterranean countries.     

社区糖尿病一体化管理对糖化血红蛋白和血脂的影响研究

目的:评价社区糖尿病一体化管理对糖尿病患者糖化血红蛋白和血脂异常的控制效果,为糖尿病患者社区管理个体化方案提供依据.方法:将已管理的糖尿病患者随即分为实验组138例和常规管理组139例,常规管理组按照传统模式管理,由社区公共卫生医生按组定期随访,患者自主就诊;实验组在此基础上,采用"公共卫生医生-全科医生-专科医生"一体化无缝式管理模式,随访1年,比较两组患者糖化血红蛋白和血脂指标的变化.结果:与常规管理组比较,干预后实验组的平均糖化血红蛋白(HbAlc)比对照组低0.89%;血清三酰甘油(TG)明显下降,差异有统计学意义(P ＜0.01).血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)没有明显变化(P ＞0.05).结论:一体化管理模式在降低HbAlc和TG方面存在更明显的优势.     

The Influence of Visceral Fat on the Postprandial Lipemic Response in Men with Paraplegia

Background: Postprandial lipemia (PPL) is associated with vascular dysfunction and may be an etiologic factor in the progression of atherogenic cardiovascular disease.

Objective: In 10 men with paraplegia and 10 able-bodied men, the magnitude of the PPL responses and the relationship of abdominal adiposity and the PPL responses were determined.

Methods: Anthropometrics, dual energy x-ray absorptiometry, and abdominal ultrasonography were performed to determine visceral fat and total body fat. A fasting lipid profile was performed. A high-fat milkshake (1.3 g fat/kg body mass) was administered with serum collected at baseline and at 2, 4, and 6 hours after the test meal for subsequent measurement of triglyceride. The triglyceride response was determined by the area under the triglyceride curve.

Results: No significant differences were noted between the groups in fasting lipid values or in measures of visceral fat. Total body fat tended to be higher in men with paraplegia than in able-bodied men (34.9 ± 10.0 vs. 27.3 ± 6.7%, p = 0.07). No significant difference between the groups was observed in triglyceride response. In men with paraplegia, visceral fat was strongly associated with the triglyceride (r = 0.8, p = 0.005), fasting low-density lipoprotein (r = 0.66, p = 0.04), and triglyceride responses (r = 0.80, p = 0.005); a significant relationship was not found between fasting high-density lipoprotein and any measure of adiposity. In men with paraplegia, triglyceride response was positively related to all measures of abdominal adiposity.

Conclusion: Visceral abdominal fat was related to delayed triglyceride clearance after a fat load, which may contribute to coronary heart disease (CHD) risk and progression of vascular disease in men with paraplegia.     

Double-Blind Controlled Study on the Effects of Dietary Diacylglycerol on Postprandial Serum and Chylomicron Triacylglycerol Responses in Healthy Humans

Objective: The effects of dietary diacylglycerol (DG) on postprandial lipemia in healthy humans were investigated.

Methods: Forty normolipidemic male volunteers ingested fat emulsions containing either DG oil or triacylglycerol (TG) oil, at different doses: 10 g (n = 13), 20 g (n = 10) and 44 g (n = 17). Two test emulsions were given at seven-days intervals in random order. Fatty acid compositions of the test oils had been adjusted to be equal. Fasting and postprandial serum lipid concentrations in each group and plasma lipoprotein lipids in the 20 g-fat ingestion group were measured during the postprandial intervals.

Results: When DG emulsion was ingested, serum TG concentrations were significantly lower (p < 0.05) in the late postprandial phase, i.e., 4 hours, 6 hours as compared to the TG emulsion. The magnitude of postprandial lipemia (the area bounded by the curve above the fasting concentration) after ingestion of 44 g-DG emulsion was significantly less than that of 44 g-TG emulsion (6.54 ± 5.12 and 8.45 ± 7.54 mmol · h/L, mean ± SD, respectively). Chylomicron TG, cholesterol, and phospholipid concentrations at 4 hours after ingestion of DG emulsion were significantly lower (p < 0.05) than those after the ingestion of TG emulsion at the same time point. No marked differences were observed for VLDL, LDL and HDL lipids between the test emulsions.

Conclusion: In the usual range of fat intake (10–44 g), postprandial response after ingestion of DG emulsion was significantly less than that after ingestion of TG emulsion in healthy human subjects.     

The -250G/A polymorphism in the hepatic lipase gene promoter influences the postprandial lipemic response in healthy men

Background and aimThe −250G/A promoter polymorphism of the hepatic lipase gene has been associated with changes in the activity of the enzyme. We investigated whether this polymorphism modifies the postprandial response of triacylglycerol-rich lipoproteins (TRL) in young normolipemic males.Methods and resultsFifty-one healthy apolipoprotein (apo) E3/E3 male volunteers (30 G/G and 21 carriers of the A allele) underwent a vitamin A fat-loading test and blood samples were drawn every hour until the 6th, and every 2 h and 30 min until the 11th. Total plasma cholesterol and triacylglycerols (TG), as well as cholesterol, TG and retinyl palmitate (RP) in TRL, isolated by ultracentrifugation, were determined.Carriers of the A allele showed a higher response (P = 0.008), a higher area under the curve (AUC; P = 0.022) and a lower RP peak time (P = 0.029) in small TRL during the postprandial response, as well as a lower peak time in total plasma TG levels (P = 0.034) and large TRL-TG (P = 0.033) than subjects who were homozygous for the G allele.ConclusionOur data indicate that the presence of the A allele in the −250G/A promoter polymorphism of the hepatic lipase gene is associated with a higher postprandial lipemic response.     

The relationship between the postprandial lipemic response and lipid composition in persons with spinal cord injury

Objective

To determine the influence of lipid concentration, lipid particle size, and total abdominal fat (TAF) on postprandial lipemic response (PPLr) in persons with spinal cord injury (SCI).

Methods

Thirty-five persons with SCI (17 paraplegia, 18 tetraplegia) and 18 able-bodied (AB) individuals participated. Following a 10-hour fast, blood was drawn for lipids, apolipoprotein (apo) A1 and B concentrations, and low-density (LSP) and high-density (HSP) lipoprotein particle sizes. A high-fat milkshake was consumed (∼1.3 g fat/kg). Blood was drawn at 2, 4, and 6 hours to determine PPLr, (triglyceride (TG) area under the curve). TAF and visceral (VF) fat were measured by ultrasonography; total body fat (TBF) by dual-energy X-ray absorptiometry. Differences between the groups were determined by independent sample t-tests. Pearson correlation coefficients determined the relationship among PPLr and lipids, and TAF.

Results

There were no significant differences in fasting TG, low-density lipoprotein (LDL), apoB, TAF, or PPLr values between the groups. In SCI, PPLr significantly correlated with: apoB (r = 0.63, P < 0.01, LSP (r = 0.57, P < 0.01), and TAF (r = 0.36, P < 0.01). After controlling for age and duration of injury, PPLr significantly correlated with apoB (r = 0.66, P = 0.001), TBF (r = 0.45, P = 0.03), VF (r = 0.66, P = 0.02), and TAF (r = 0.56, P = 0.007).

Conclusions

Although concentrations of LDL cholesterol and apoB were not different between SCI and AB groups, LSP, apoB, and TAF correlated with PPLr in persons with SCI. ApoB was associated with a greater PPLr in those with motor complete SCI, after controlling for age and duration of injury.     

三佳康乐鸡蛋降血脂降血糖作用研究

以鸡蛋为载体，利用生物富集技术，在蛋黄中富集具有保健功能的特殊物质，使鸡蛋产生良好的防病治病作用。研究结果表明，使用三佳康乐鸡蛋蛋黄（10．67g／kg）连续灌胃21天，可使高脂血症大鼠TG．TC值的异常升高显著降低，用同等剂量的普通鸡蛋蛋黄在相同的实验条件下没有降TG．TC的作用。三佳康乐鸡蛋蛋黄（10．67g／kg）连续灌胃10天，可使正常小鼠淀粉负荷后1．5．3h的血糖明显下降，对四氧嘧啶糖尿病小鼠血糖异常升高也有一定的降低作用，同时可使糖尿病小鼠多饮多尿多食症状得到缓解，说明用生物富集技术后的鸡蛋能够使高脂血症大鼠血脂升高得到改善，能够增加正常小鼠淀粉负荷后的糖耐量能力，降低糖尿病小鼠血糖值。