Virta Health, 501 Folsom Street, San Francisco, CA, 94105, USA.
Indiana University Health Arnett, Lafayette, IN, USA.
Cardiovasc Diabetol. 2020 Dec 8;19(1):208. doi: 10.1186/s12933-020-01178-2.
We have previously reported that in patients with type 2 diabetes (T2D) consumption of a very low carbohydrate diet capable of inducing nutritional ketosis over 2 years (continuous care intervention, CCI) resulted in improved body weight, glycemic control, and multiple risk factors for cardiovascular disease (CVD) with the exception of an increase in low density lipoprotein cholesterol (LDL-C). In the present study, we report the impact of this intervention on markers of risk for atherosclerotic cardiovascular disease (CVD), with a focus on lipoprotein subfraction particle concentrations as well as carotid-artery intima-media thickness (CIMT).
Analyses were performed in patients with T2D who completed 2 years of this study (CCI; n = 194; usual care (UC): n = 68). Lipoprotein subfraction particle concentrations were measured by ion mobility at baseline, 1, and 2 years and CIMT was measured at baseline and 2 years. Principal component analysis (PCA) was used to assess changes in independent clusters of lipoprotein particles.
At 2 years, CCI resulted in a 23% decrease of small LDL IIIb and a 29% increase of large LDL I with no change in total LDL particle concentration or ApoB. The change in proportion of smaller and larger LDL was reflected by reversal of the small LDL subclass phenotype B in a high proportion of CCI participants (48.1%) and a shift in the principal component (PC) representing the atherogenic lipoprotein phenotype characteristic of T2D from a major to a secondary component of the total variance. The increase in LDL-C in the CCI group was mainly attributed to larger cholesterol-enriched LDL particles. CIMT showed no change in either the CCI or UC group.
Consumption of a very low carbohydrate diet with nutritional ketosis for 2 years in patients with type 2 diabetes lowered levels of small LDL particles that are commonly increased in diabetic dyslipidemia and are a marker for heightened CVD risk. A corresponding increase in concentrations of larger LDL particles was responsible for higher levels of plasma LDL-C. The lack of increase in total LDL particles, ApoB, and in progression of CIMT, provide supporting evidence that this dietary intervention did not adversely affect risk of CVD.
我们之前曾报道，在 2 型糖尿病（T2D）患者中，持续进行能够诱导营养性酮症的极低碳水化合物饮食（连续护理干预，CCI）超过 2 年，可改善体重、血糖控制以及心血管疾病（CVD）的多种危险因素，但低密度脂蛋白胆固醇（LDL-C）水平升高除外。在本研究中，我们报告了这种干预对动脉粥样硬化性心血管疾病（CVD）风险标志物的影响，重点关注脂蛋白亚组分颗粒浓度以及颈动脉内膜中层厚度（CIMT）。
本研究分析了完成 2 年该研究的 T2D 患者（CCI；n=194；常规护理（UC）：n=68）的数据。在基线、1 年和 2 年时通过离子迁移率测量脂蛋白亚组分颗粒浓度，在基线和 2 年时测量 CIMT。采用主成分分析（PCA）评估脂蛋白颗粒独立簇的变化。
在 2 年时，CCI 导致小 LDL IIIb 降低 23%，大 LDL I 增加 29%，而 LDL 颗粒总浓度或 ApoB 无变化。小和大 LDL 比例的变化反映了在 CCI 参与者中，小 LDL 亚类表型 B 逆转（占比 48.1%）以及代表 T2D 致动脉粥样硬化脂蛋白表型的主成分（PC）从总方差的主要成分转移到次要成分。CCI 组 LDL-C 的增加主要归因于胆固醇富集的大 LDL 颗粒。CCI 和 UC 组的 CIMT 均无变化。
在 2 型糖尿病患者中，进行 2 年极低碳水化合物饮食结合营养性酮症，可降低糖尿病血脂异常中常见升高的小 LDL 颗粒水平，这是 CVD 风险增加的标志物。大 LDL 颗粒浓度的相应增加导致 LDL-C 水平升高。总 LDL 颗粒、ApoB 以及 CIMT 进展均无增加，为这种饮食干预不会对 CVD 风险产生不利影响提供了支持证据。
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