Reduction of plasma triglycerides by diet in subjects with chronic renal failure

Abstract

The response of plasma triglyceride levels to changes in the composition of meal formula diets was studied in 12 subjects who had moderate to severe chronic renal failure. Fasting hypertriglyceridemia (greater than 150 mg/100 ml) was present in seven of 12 subjects. Fasting plasma triglyceride levels decreased in all subjects in response to a reduction in the proportion of carbohydrate (from 50 to 35% of total daily calories) and an increase in the poly-unsaturated to saturated fat ratio (from 0.2 to 2.0) in an isocaloric diet. Fasting plasma cholesterol and postprandial triglyceride levels were unchanged. Both the triglyceride production rate and the insulin response were significantly lower on a diet in carbohydrate and higher in polyunsaturated fat. These data indicate that hypertriglyceridemia occurs in subjects with moderate to severe chronic renal failure, and that dietary modification promptly reduces triglycerides levels over an 11 day period. A long term study on a dietary program incorporating these changes is indicated to determine whether this effect is sustained.

Hypertriglyceridemia and Lipoprotein Lipase Activity in Experimental Uremia

“…There is agreement that hypertriglyceridemia in CRF is associated with a defect in VLDL-TG removal from plasma [4][5][6][7]. If these abnormalities are due to a reduction in LPL activity, two criteria must be satisfied.…”

“…Elevated plasma triglyceride (TG) levels occur fre quently in patients with chronic renal failure (CRF) [1][2][3], and measurement of very low density lipoprotein (VLDL)-TG turnover rates in both man [4,5] and animal [6.7] have shown that hypertriglyceridemia is secondary to a defect in VLDL-TG removal from plasma. Although it has been suggested that the defect in VLDL-TG removal is second ary to a decrease in lipoprotein lipase (LPL) activity [3,4,7], recent observations have raised questions as to the adequacy of this explanation.…”

Lipid and Carbohydrate Metabolism in Uremia

“…Furthermore, the individual triglyceride changes during the dietary treatment were not influenced by pretreatment status in relation to impairments of lipid metabolism or renal function. In uremic patients (on a normal protein intake and carbohydrate-reduced formula diet) a drastic increase in P/S ratio has earlier been shown to cause a marked decrease in serum triglycerides, however (41). In nonuremic patients, as well as in healthy subjects, the relative content of palmitic or linoleic acids (43), as well as the inclusion of large amounts of sucrose in the diet (9), influence serum triglyceride values, liver triglyceride synthesis and on the relative fatty acid composition of serum lecithin, respectively.…”

Uremia and the Liver. III. Uremia and Hepatic Metabolism of Carbohydrates, Lipids and Proteins

“…Increased VLDL hepatic synthesis in uremia appears unlikely for the following reasons: (a) diminished rates of hepatic triglyceride production were found by San Felippo et al [34] and Cattran et al [35] in uremic patients; (b) in creased hepatic de novo synthesis of fatty acids is improb able since the rate-limiting enzymes for hepatic fatty acids synthesis (acetyl CoA carboxylase) and for hepatic chol esterol synthesis (HMG CoA reductase) have been found to be decreased [36][37][38]; (c) the responsibility of hyperinsulinemia in creating hyperlipoproteinemia is highly questionable [38]. It is still probable that increased free fatty acid delivery to the liver stimulates hepatic triglycer ide synthesis.…”