ABSTRACT. The effect on lipoprotein metabolism of a 2-week modified fast and an im- mediately ensuing 3-week period on a vegetarian diet was studied under ...
Upsala J Med Sci 90:73-83, 1985
Changes in Lipoprotein Metabolism during a Supplemented Fast and an Ensuing Vegetarian Diet Period H.Lithell,' A. Bruce,' I.-B. Gustafsson,' N.-J.Hoglund,' B. Karlstrom,' K. L j ~ n g h a l lK. , ~ Sjolin,' I. Werner' and B. Vessby'
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'Department of Geriatrics, Uppsala University, Uppsala, 2The Swedish National Food Administration, Uppsala and 3Department of Dermatology, University Hospital, Uppsala, Sweden
ABSTRACT T h e e f f e c t on lipoprotein metabolism o f a 2-week modified fast and a n immediately ensuing 3-week p e r i o d o n a vegetarian d i e t was studied u n d e r metabolic w a r d conditions in 21 non-obese female a n d 6 male patients. T h e v e r y low calorie d i e t induced reductions o f t h e cholesterol concentration in all serum lipoprotein classes.
In t h e female patients, who were a l l normolipoproteinaemic,
t h e t r i g l y c e r i d e s in serum showed a s l i g h t increase during t h e fast, r e f l e c t i n g small changes in v e r y low ( V L D L ) a n d low d e n s i t y lipoprotein t r i g l y c e r i d e s . T h i s may p r o b a b l y b e explained p a r t l y by simultaneous significant reductions o f b o t h t h e adipose tissue a n d skeletal muscle tissue lipoprotein lipase activities (LPLA). admission,
In contrast, in t h e male patients who h a d a h i g h e r V L D L level a t
t h e V L D L t r i g l y c e r i d e s decreased w i t h o u t s i g n i f i c a n t changes o f
high d e n s i t y lipoprotein ( H D L ) cholesterol a n d o f LPLA in muscle. T h e female patients, whose weights were stable during t h e vegetarian diet, ended up w i t h a lower H D L cholesterol t h a n a t t h e s t a r t o f t h e t r i a l .
This
effect was p r o b a b l y p a r t l y d u e t o t h e high content o f polyunsaturated f a t t y acids in t h e vegetarian diet. It i s concluded t h a t t h e changes o f lipoprotein metabolism during supple-
mented f a s t i n g a r e q u a n t i t a t i v e l y a n d qualitatively d i f f e r e n t in several respects in females a n d males.
INTRODUCTION T h e r e p o r t e d effects o f low-calorie diets o n t h e lipoprotein p a t t e r n have v a r i e d considerably.
F o r example decreased (241
I
unchanged ( 2 8 ) a n d in-
creased (22) levels o f high d e n s i t y lipoprotein (HDL) cholesterol have a l l been 5 t -858571
73
f o u n d during t h i s treatment. T h e r e i s a need f o r elucidation o f t h e reasons f o r these discrepancies.
We have c a r r i e d o u t a n investigation o n t h e effects o f a
supplemented fast a n d a n e n s u i n g p e r i o d o n a vegetarian d i e t o n t h e clinical condition in patients w i t h d i f f e r e n t diseases ( 1 2 ) .
T h e p r e s e n t r e p o r t deals
w i t h t h e lipoprotein changes t h a t were observed in t h i s g r o u p o f non-obese females a n d males u n d e r metabolic w a r d conditions during t h e supplemented fast.
In addition, analyses of l i p o p r o t e i n lipase activities gave a n o p p o r t u n i t y
f o r mode o f action studies. Some aspects o f t h e changes t h a t o c c u r r e d during
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t h e period o n t h e vegetarian d i e t a r e also r e p o r t e d a n d discussed.
MATERIALS A N D METHODS Subjects Twenty-seven patients, 21 females a n d 6 males, were studied. T w o subjects (one female,
one male) deteriorated clinically during t h e f a s t i n g period a n d
i n t e r r u p t e d t h e treatment trial.
T h e mean age of t h e women was 46 years a n d
o f t h e men 41 y e a r s ( r a n g e s 24-64 a n d 23-55, psoriasis w i t h a r t h r i t i s , deformans,
respectively). E i g h t patients h a d
4 h a d rheumatoid a r t h r i t i s ,
one h a d s p o n d y l a r t h r i t i s
one h a d l u p u s erythematosus disseminatus,
4 h a d pustulosis pal-
maris e t plantaris, 3 h a d atopic eczema, 3 h a d acne rosacea a n d 3 h a d a nonspecific a r t h r i t i s . None o f t h e p a t i e n t s was febrile. One was b e i n g t r e a t e d w i t h corticosteroids in a low, constant dose. Treatment w i t h o t h e r anti-inflammatory d r u g s was k e p t constant t h r o u g h o u t t h e treatment period. F o r f u r t h e r informat i o n concerning t h e clinical conditions a n d o t h e r details see ( 1 2 ) .
Experimental Procedure T h e whole s t u d y was c a r r i e d o u t u n d e r metabolic w a r d conditions.
During
t h e f i r s t d a y t h e o r d i n a r y hospital d i e t was given. A f t e r t h e second day's t e s t t h e patients were g i v e n t h e vegetarian d i e t a t a low e n e r g y level (5.0 MJ/day) f o r 2 days.
T h e y t h e n fasted f o r 11 days, during which time o n l y vegetarian
beverages a n d h e r b a l teas were g i v e n (0.9 MJIday). A f t e r t h e fast was b r o k e n t h e e n e r g y i n t a k e was g r a d u a l l y increased during t h e f i r s t 3 d a y s ( 1 . 1 ,
1.7
a n d 2 . 6 M J / d a y ) , a f t e r which it was a d j u s t e d according t o t h e patient's b o d y weight ( 1 5 0 a n d 1 3 0 k J / k g b o d y w e i g h t f o r males a n d females respectively) aiming a t a stable b o d y weight during t h e last 2 weeks. O n admission, clinical examinations a n d laboratory tests were performed o n t h e f i r s t a n d second days. A l l studies made o n admission were repeated a t t h e
74
e n d o f t h e fast a n d a t t h e e n d o f t h e vegetarian d i e t period. A l l tests were c a r r i e d o u t in t h e morning a f t e r a n o v e r n i g h t fast.
Diets D u r i n g t h e f a s t i n g period vegetarian beverages a n d herbal teas were g i v e n e v e r y 2 t o 3 hours. T h e beverages were made f r o m d i f f e r e n t r o o t vegetables, s u c h as beetroot, c a r r o t s a n d potatoes, a n d from b l u e b e r r i e s a n d strawberries. A 7-day
menu was used t h r o u g h o u t t h e vegetarian d i e t period. T h e com-
position o f t h e food was calculated from food tables (13). T h e f a t content a n d
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composition were analysed as described earlier (27). fish,
egg,
m i l k ) was excluded,
A l l animal p r o t e i n (meat,
w h i c h made t h e d i e t r a t h e r low in p r o t e i n
content (Table 1). T h e e n e r g y d e r i v e d f r o m f a t a n d carbohydrates was p e r centually similar t o t h a t in o r d i n a r y Swedish food ( T a b l e 1). T h e vegetarian d i e t was based o n f r e s h vegetables, r o o t vegetables, millets, lentils a n d buckwheat. Sunflower oil ( w i t h a high content o f polyunsaturated f a t t y acids) was used in d r e s s i n g s etc. T h e average r a t i o o f polyunsaturated t o saturated f a t t y acids (PIS-ratio)
+
was 4.3
0.3
(mean + SD).
No e x t r a salt o r s u g a r was
allowed. T h e o n l y simple c a r b o h y d r a t e s available were in t h e b e r r i e s a n d f r u i t s t h a t were included; these were permitted in a controlled a n d limited amount. T h e average f i b r e content was 21.5
+
1.9 g/4.2 MJ.
Table 1
Contents o f Protein,
F a t a n d Carbohydrates Calculated p e r 1 . O MJ in Grams
.
a n d as Per C e n t o f Total E n e r g y (E%)
Ordinary Swedish diet*
Vegan d i e t content
-
E%
content
E%
Swedish nutrition recommendat ion E%
5.5+0.5
9
7.6
13
10-15
Fat
10.5+0.5 -
42
10.3
40
