Inflammation modifies the effects of a reduced-fat low-cholesterol diet on lipids: results from the DASH-sodium trial.
BACKGROUND
Inflammatory mediators regulate key aspects of lipid metabolism. We hypothesized that inflammation could diminish the cholesterol-lowering effect of a reduced-fat/low-cholesterol diet.


RESULTS
After a 2-week run-in period on a control diet (37% total fat, 16% saturated fat), 100 participants were randomized to the control or DASH diet (27% total fat, 6% saturated fat) for 12 weeks. Median C-reactive protein (CRP) at baseline was 2.37 mg/L (interquartile range, 1.20, 3.79). The DASH diet, net of control, had no effect on CRP. Overall, there were significant net reductions in total (-0.34 mmol/L), LDL (-0.29 mmol/L), and HDL (-0.12 mmol/L) cholesterol from the DASH diet (each, P<0.001) and little change in triglycerides (+0.05 mmol/L, P=0.21). Baseline CRP was strongly associated with lipid responsiveness to the DASH diet. Total and LDL cholesterol were reduced to a greater degree in those with a "low" (below median) compared with a "high" (above median) baseline CRP (total, -9.8% versus -3%; P for interaction=0.006; LDL cholesterol, -11.8% versus -3%; P for interaction=0.009). Reductions in HDL cholesterol (-8.8%) were similar in persons with low versus high CRP. Triglycerides were increased in those with a high CRP but not in those with a low CRP (19.8% versus +0%; P for interaction=0.019).


CONCLUSIONS
In this study, the presence of increased CRP was associated with less total and LDL cholesterol reduction and a greater increase in triglycerides from a reduced-fat/low-cholesterol diet. These findings document an additional mechanism by which inflammation might increase cardiovascular disease risk.
Erlinger
Thomas P
TP
Department of Medicine, the Johns Hopkins University School of Medicine, Baltimore, Md, USA. terlinge@jhmi.edu
Miller
Edgar R
ER
Charleston
Jeanne
J
Appel
Lawrence J
LJ
D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D002791:Cholesterol, Dietary; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D018592:Cross-Over Studies; D004041:Dietary Fats; D005260:Female; D005526:Food, Formulated; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000378:metabolism*; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012044:Regression Analysis; D012964:Sodium / Q000378:metabolism*; D014280:Triglycerides / Q000097:blood
D015415:Biomarkers; D002791:Cholesterol, Dietary; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004041:Dietary Fats; D008055:Lipids; D014280:Triglycerides; D002097:C-Reactive Protein; D002784:Cholesterol; D012964:Sodium