A Study of Fasting and Postprandial Lipid Profile among Patients with and without Diabetes Mellitus in a Tertiary Care Hospital - Kottayam, Kerala

BACKGROUND Type 2 diabetes mellitus (DM) is characterized by insulin resistance which is associated with glucose intolerance, hypertension, dyslipidaemia, a procoagulant state, and an increase in the microvascular and the macrovascular disease. The high cardiovascular mortality which is associated with type 2 DM is due to a prolonged, exaggerated, postprandial state. The abnormal lipid profile in the postprandial state is more significant than the abnormal lipid profile in the fasting state in causing atherosclerotic complications in type 2 diabetes. Very few studies are available on the estimation of the postprandial lipid profile in type 2 diabetes patients. The purpose of this study was to compare fasting and postprandial lipid levels among patients with and without diabetes mellitus and find out the correlation between duration of detection of diabetes mellitus and postprandial lipid levels among patients with diabetes mellitus. METHODS This is a cross sectional analytical study of a study population of 200 subjects including in patients and out patients of wards and diabetic clinic of Government Medical College, Kottayam from April 2017 to March 2018. Data was coded and entered in Microsoft Excel and IBM Statistical Package for Social Sciences (SPSS version 22) for statistical analysis. RESULTS Diabetic patients had impaired fasting and postprandial lipid profiles. Impairment in postprandial lipid profile when compared to non-diabetics was statistically significant. Duration of detection of diabetes and postprandial lipid levels showed weak positive correlation. CONCLUSIONS The postprandial lipid profile in diabetes mellitus patients is significantly deranged compared to fasting state and is an important factor in assessing their cardiovascular risk. Hence, there is a need to stress on postprandial lipid profile estimation in diabetic patients. KEYWORDS Fasting Lipid Profile, Postprandial Lipid Profile, Type 2 Diabetics, Nondiabetics

Eating Dinner Early Improves 24-h Blood Glucose Levels and Boosts Lipid Metabolism after Breakfast the Next Day: A Randomized Cross-Over Trial

Aim To examine whether mild early time-restricted eating (eating dinner at 18:00 vs. at 21:00) improves 24-h blood glucose levels and postprandial lipid metabolism in healthy adults. Methods Twelve participants (2 males and 10 females) were included in the study. In this 3-day (until the morning of day 3) randomized crossover study, two different conditions were tested: eating a late dinner (at 21:00) or an early dinner (at 18:00). During the experimental period, blood glucose levels were evaluated by each participant wearing a continuous blood glucose measuring device. Metabolic measurements were performed using the indirect calorimetry method on the morning of day 3. The study was conducted over three days; day 1 was excluded from the analysis to adjust for the effects of the previous day’s meal, and only data from the mornings of days 2 and 3 were used for the analysis. Results Significant differences were observed in mean 24-h blood glucose levels on day 2 between the two groups (p = 0.034). There was a significant decrease in the postprandial respiratory quotient 30 min and 60 min after breakfast on day 3 in the early dinner group compared with the late dinner group (p < 0.05). Conclusion Despite a difference of only 3 h, eating dinner early (at 18:00) has a positive effect on blood glucose level fluctuation and substrate oxidation compared with eating dinner late (at 21:00).

Postprandial Lipid Metabolism in Normolipidemic Subjects and Patients with Mild to Moderate Hypertriglyceridemia: Effects of Test Meals Containing Saturated Fatty Acids, Mono-Unsaturated Fatty Acids, or Medium-Chain Fatty Acids

Fasting and postprandial hypertriglyceridemia are causal risk factors for atherosclerosis. The prevalence of hypertriglyceridemia is approximately 25–30% and most hypertriglyceridemic patients suffer from mild to moderate hypertriglyceridemia. Data regarding dietary interventions on postprandial triglyceride metabolism of mildly to moderately hypertriglyceridemic patients is, however, sparse. In a randomized controlled trial, eight mildly hypertriglyceridemic patients and five healthy, normolipidemic controls received three separate standardized fat-meals containing either saturated fatty acids (SFA), mono-unsaturated fatty acids (MUFA), or medium-chain fatty acids (MCFA) in a randomized order. Fasting and postprandial lipid parameters were determined over a 10 h period and the (incremental) area under the curve (AUC/iAUC) for plasma triglycerides and other parameters were determined. MCFA do not lead to a significant elevation of postprandial total plasma triglycerides and other triglyceride parameters, while both SFA (patients: p = 0.003, controls: p = 0.03 compared to MCFA) and MUFA (patients: p = 0.001; controls: p = 0.14 compared to MCFA) do lead to such an increase. Patients experienced a significantly more pronounced increase of plasma triglycerides than controls (SFA: patients iAUC = 1006 mg*h/dL, controls iAUC = 247 mg*h/dL, p = 0.02; MUFA: patients iAUC = 962 mg*h/dL, controls iAUC = 248 mg*h/dL, p = 0.05). Replacing SFA with MCFA may be a treatment option for mildly to moderately hypertriglyceridemic patients as it prevents postprandial hypertriglyceridemia.

Mechanisms of Atherosclerosis Induced by Postprandial Lipemia

Postprandial lipemia plays an important role in the formation, occurrence, and development of atherosclerosis, and it is closely related to coronary heart disease and other diseases involving endothelial dysfunction, oxidative stress, inflammation, and other mechanisms. Therefore, it has become a focus area for further research. The studies on postprandial lipemia mainly include TG, TRL, VLDL, CM, and remnant cholesterol. Diurnal triglyceride patterns and postprandial hyperlipidemia are very relevant and are now insufficiently covered. The possible mechanisms between postprandial lipemia and cardiovascular disease have been reviewed in this article by referring to relevant literature in recent years. The research progress on the effects of postprandial lipemia on endothelial function, oxidative stress, and inflammation is highlighted. The intervention of postprandial lipemia is discussed. Non-medicinal intervention such as diet and exercise improves postprandial lipemia. As medicinal intervention, statin, fibrate, ezetimibe, omega-3 fatty acids, and niacin have been found to improve postprandial lipid levels. Novel medications such as pemafibrate, PCSK9, and apoCIII inhibitors have been the focus of research in recent years. Gut microbiota is closely related to lipid metabolism, and some studies have indicated that intestinal microorganisms may affect lipid metabolism as environmental factors. Whether intervention of gut microbiota can reduce postprandial lipemia, and therefore against AS, may be worthy of further study.