title: Low-carbohydrate, high-protein, high-fat diet alters small peripheral artery reactivity in metabolic syndrome patients.
abstract: BACKGROUND
  Low carbohydrate diets have become increasingly popular for weight loss. Although they may improve some metabolic markers, particularly in type 2 diabetes mellitus (T2D) or metabolic syndrome (MS), their net effect on vascular function remains unclear.
  
  
  OBJECTIVE
  Evaluate the relation between dietary macronutrient composition and the small artery reactive hyperaemia index (saRHI), a marker of small artery vascular function, in a cohort of MS patients.
  
  
  METHODS
  This cross-sectional study included 160 MS patients. Diet was evaluated by a 3-day food-intake register and reduced to a novel low-carbohydrate diet score (LCDS). Physical examination, demographic, biochemical and anthropometry parameters were recorded, and saRHI was measured in each patient.
  
  
  RESULTS
  Individuals in the lowest LCDS quartile (Q1; 45% carbohydrate, 19% protein, 31% fat) had higher saRHI values than those in the top quartile (Q4; 30% carbohydrate, 25% protein, 43% fat) (1.84±0.42 vs. 1.55±0.25, P=.012). These results were similar in T2D patients (Q1=1.779±0.311 vs. Q4=1.618±0.352, P=.011) and also in all of the MS components, except for low HDLc. Multivariate analysis demonstrated that individuals in the highest LCDS quartile, that is, consuming less carbohydrates, had a significantly negative coefficient of saRHI which was independent of confounders (HR: -0.747; 95%CI: 0.201, 0.882; P=.029).
  
  
  CONCLUSIONS
  These data suggest that a dietary pattern characterized by a low amount of carbohydrate, but reciprocally higher amounts of fat and protein, is associated with poorer vascular reactivity in patients with MS and T2D.
authors.affiliation: Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Institut d'Investigació Sanitària Pere Virgili, IISPV, Faculty of Medicine, Rovira i Virgili University, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain. Electronic address: jordi.merino@urv.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Merino
authors.affiliation: Cardiometabolic Research Institute, Houston, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Kones
authors.affiliation: Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Institut d'Investigació Sanitària Pere Virgili, IISPV, Faculty of Medicine, Rovira i Virgili University, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain.
authors.forename: Raimon
authors.initials: R
authors.lastname: Ferré
authors.affiliation: Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Institut d'Investigació Sanitària Pere Virgili, IISPV, Faculty of Medicine, Rovira i Virgili University, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Plana
authors.affiliation: Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Institut d'Investigació Sanitària Pere Virgili, IISPV, Faculty of Medicine, Rovira i Virgili University, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain.
authors.forename: Josefa
authors.initials: J
authors.lastname: Girona
authors.affiliation: Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Institut d'Investigació Sanitària Pere Virgili, IISPV, Faculty of Medicine, Rovira i Virgili University, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Aragonés
authors.affiliation: Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Institut d'Investigació Sanitària Pere Virgili, IISPV, Faculty of Medicine, Rovira i Virgili University, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain.
authors.forename: Daiana
authors.initials: D
authors.lastname: Ibarretxe
authors.affiliation: Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Institut d'Investigació Sanitària Pere Virgili, IISPV, Faculty of Medicine, Rovira i Virgili University, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Heras
authors.affiliation: Vascular Medicine and Metabolism Unit, Lipids and Atherosclerosis Research Unit, Sant Joan University Hospital, Institut d'Investigació Sanitària Pere Virgili, IISPV, Faculty of Medicine, Rovira i Virgili University, Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Masana
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000503:physiopathology; D003430:Cross-Sectional Studies; D050528:Diet, Carbohydrate-Restricted; D059305:Diet, High-Fat; D004044:Dietary Proteins / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000209:etiology; D008297:Male; D024821:Metabolic Syndrome / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis
chemical_list: D004044:Dietary Proteins
keywords: Dieta baja en hidratos de carbono; Endothelial function; Función endotelial; Low-carbohydrate diet; Metabolic syndrome; Síndrome metabólico