Short-term isocaloric fructose restriction lowers apoC-III levels and yields less atherogenic lipoprotein profiles in children with obesity and metabolic syndrome

Atherosclerosis. 2016 Oct;253:171-177. doi: 10.1016/j.atherosclerosis.2016.06.048. Epub 2016 Jul 19.

Abstract

Background and aims: Dietary fructose may play a role in the pathogenesis of metabolic syndrome (MetS). In a recently published study of obese children with MetS, we showed that isocaloric fructose restriction reduced fasting triglyceride (TG) and LDL-cholesterol (LDL-C). In these ancillary analyses, we tested the hypothesis that these effects were also accompanied by improved quantitative and qualitative changes in LDL and HDL subclasses and their apolipoproteins; as well as change in VLDL, particularly apoC-III.

Methods: Obese children with MetS (n = 37) consumed a diet that matched self-reported macronutrient composition for nine days, with the exception that dietary fructose was reduced from 11.7 ± 4.0% to 3.8 ± 0.5% of daily calories and substituted with glucose (in starch). Participants underwent fasting biochemical analyses on Days 0 and 10. HDL and LDL subclasses were analyzed using the Lipoprint HDL and LDL subfraction analysis systems from Quantimetrix.

Results: Significant reductions in apoB (78 ± 24 vs. 66 ± 24 mg/dl) apoC-III (8.7 ± 3.5 vs. 6.5 ± 2.6 mg/dl) and apoE (4.6 ± 2.3 vs. 3.6 ± 1.1 mg/dl), all p < 0.001) were observed. LDL size increased by 0.87 Å (p = 0.008). Small dense LDL was present in 25% of our cohort and decreased by 68% (p = 0.04). Small HDL decreased by 2.7% (p < 0.001) and large HDL increased by 2.4% (p = 0.04). The TG/HDL-C ratio decreased from 3.1 ± 2.5 to 2.4 ± 1.4 (p = 0.02). These changes in fasting lipid profiles correlated with changes in insulin sensitivity.

Conclusions: Isocaloric fructose restriction for 9 days improved lipoprotein markers of CVD risk in children with obesity and MetS. The most dramatic reduction was seen for apoC-III, which has been associated with atherogenic hypertriglyceridemia.

Trial registration: ClinicalTrials.gov NCT01200043.

Keywords: Apolipoproteins; Fructose; HDL subclasses; LDL subclasses; Metabolic syndrome; Obesity; apoC-III.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • African Americans
  • Apolipoprotein C-III / blood*
  • Atherosclerosis
  • Child
  • Diet*
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Fructose / administration & dosage*
  • Glucose / chemistry
  • Hispanic Americans
  • Humans
  • Lipoproteins / metabolism
  • Lipoproteins, HDL / blood
  • Lipoproteins, LDL / blood
  • Lipoproteins, VLDL / blood
  • Male
  • Metabolic Syndrome / blood*
  • Metabolic Syndrome / complications
  • Metabolic Syndrome / diet therapy*
  • Pediatric Obesity / blood*
  • Pediatric Obesity / complications
  • Pediatric Obesity / diet therapy*
  • Triglycerides / blood

Substances

  • Apolipoprotein C-III
  • HDL-triglyceride
  • Lipoproteins
  • Lipoproteins, HDL
  • Lipoproteins, LDL
  • Lipoproteins, VLDL
  • Triglycerides
  • Fructose
  • Glucose

Associated data

  • ClinicalTrials.gov/NCT01200043