Lipoprotein Subclass Changes in Three Healthy Heart Diets: The OmniHeart trial

Rosie A Jones

Background: Diet is a key modifiable factor for improving suboptimal lipoprotein profiles and reducing cardiovascular disease (CVD) risk. Dietary patterns like the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean Diet have shown positive effects on lipoprotein profiles. However, limited research exists on the impact of different healthy diets on lipoprotein subclass profiles. This study aims to compare the nuclear magnetic resonance (NMR)-measured 112 lipoprotein profiles of a typical western diet with three healthy dietary patterns - a carbohydrate-rich diet (CARB), similar to the DASH diet; a protein-rich diet (PROT); and an unsaturated-rich diet (USFA) similar to Mediterranean diet. Additionally, this study seeks to explore individual variations in lipoproteins subclasses in response to each healthy dietary pattern. Method and Results: Plasma samples from 156 Individuals who completed >2 dietary patterns in the OmniHeart Trial were analysed for 112 lipoprotein subclass profiles. The Friedman’s test with post-hoc analysis showed that all healthy dietary patterns led to reduction in overall lipoprotein subclasses that are known to be associated with atherogenic risk. This reduction included large and medium size low-density lipoprotein subclasses (L1-L3), all intermediate-density lipoprotein (IDL) subclasses, as well as total plasma cholesterol, triglycerides, apolipoprotein-B100, apo-B100/apo-A1 ratio and LDL-cholesterol (p<0.05). However, additional variations in lipoproteins subclasses that were specific to each diet were also observed. The PROT diet showed a decrease small-sized and dense LDL (L4 and L5), large to medium-sized very low-density lipoprotein (VLDL) subclasses (L1-L4), and large-sized HDL (L1) subclasses. Conversely, the CARB diet exhibited an increase in smaller-sized and denser LDL (L6), along with a decrease in large-sized HDL (H1) and an increase in smaller-sized HDL (H4) subclasses. The USFA diet led to decreases in LDL (L4) and overall VLDL subclasses, while increasing LDL (L5 and L6) and HDL (H4) subclasses (p < 0.05). The linear mixed effect models showed the cholesterol status of individuals has an impact on these changes of lipoproteins. Latent Profile Analysis showed the majority of individuals displayed a consistent and homogenous lipoprotein response pattern to each diet (> 95%), of which 10 individuals showed a non-coherent response. Specifically, six individuals only responded to specific diets, one showed significantly improved lipoprotein responses to all three diets, one less beneficial but improved lipoprotein changes and a further two individuals did not show a positive response to all three diets. Conclusion: All three healthy dietary patterns showed beneficial effects on various lipoproteins, particularly those associated with atherogenic risk. The changes in lipoproteins were found to be more pronounced after adjusting for cholesterol status. Furthermore, inter-individual variations in lipoproteins response to healthy diets were evident. These observed variations highlight the complexity of individual responses to dietary interventions. Keywords: Lipoprotein, lipoprotein subclass, metabonomic, cardiovascular disease, plasma, NMR, diet, carbohydrate-rich, protein-rich, unsaturated fat-rich, saturated fat, OmniHeart.

Lipoprotein Subclass Changes in Three Healthy Heart Diets: The OmniHeart trial

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