title: Vitamin E tocotrienol supplementation improves lipid profiles in chronic hemodialysis patients.
abstract: OBJECTIVE
  Chronic hemodialysis patients experience accelerated atherosclerosis contributed to by dyslipidemia, inflammation, and an impaired antioxidant system. Vitamin E tocotrienols possess anti-inflammatory and antioxidant properties. However, the impact of dietary intervention with Vitamin E tocotrienols is unknown in this population.
  
  
  METHODS
  A randomized, double-blind, placebo-controlled, parallel trial was conducted in 81 patients undergoing chronic hemodialysis. Subjects were provided daily with capsules containing either vitamin E tocotrienol-rich fraction (TRF) (180 mg tocotrienols, 40 mg tocopherols) or placebo (0.48 mg tocotrienols, 0.88 mg tocopherols). Endpoints included measurements of inflammatory markers (C-reactive protein and interleukin 6), oxidative status (total antioxidant power and malondialdehyde), lipid profiles (plasma total cholesterol, triacylglycerols, and high-density lipoprotein cholesterol), as well as cholesteryl-ester transfer protein activity and apolipoprotein A1.
  
  
  RESULTS
  TRF supplementation did not impact any nutritional, inflammatory, or oxidative status biomarkers over time when compared with the baseline within the group (one-way repeated measures analysis of variance) or when compared with the placebo group at a particular time point (independent t-test). However, the TRF supplemented group showed improvement in lipid profiles after 12 and 16 weeks of intervention when compared with placebo at the respective time points. Normalized plasma triacylglycerols (cf baseline) in the TRF group were reduced by 33 mg/dL (P=0.032) and 36 mg/dL (P=0.072) after 12 and 16 weeks of intervention but no significant improvement was seen in the placebo group. Similarly, normalized plasma high-density lipoprotein cholesterol was higher (P<0.05) in the TRF group as compared with placebo at both week 12 and week 16. The changes in the TRF group at week 12 and week 16 were associated with higher plasma apolipoprotein A1 concentration (P<0.02) and lower cholesteryl-ester transfer protein activity (P<0.001).
  
  
  CONCLUSIONS
  TRF supplementation improved lipid profiles in this study of maintenance hemodialysis patients. A multi-centered trial is warranted to confirm these observations.
authors.affiliation: Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA.
authors.forename: Zulfitri A Mat
authors.initials: ZA
authors.lastname: Daud
authors.affiliation: Great Lake Dialysis Clinic, LLC, Detroit, MI, USA.
authors.forename: Boniface
authors.initials: B
authors.lastname: Tubie
authors.affiliation: Great Lake Dialysis Clinic, LLC, Detroit, MI, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Sheyman
authors.affiliation: Great Lake Dialysis Clinic, LLC, Detroit, MI, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Osia
authors.affiliation: Great Lake Dialysis Clinic, LLC, Detroit, MI, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Adams
authors.affiliation: Great Lake Dialysis Clinic, LLC, Detroit, MI, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Tubie
authors.affiliation: Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA.
authors.forename: Pramod
authors.initials: P
authors.lastname: Khosla
mesh_terms: D000368:Aged; D000975:Antioxidants / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D053480:Cholesterol Ester Transfer Proteins / Q000097:blood; D019587:Dietary Supplements; D004311:Double-Blind Method; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D008055:Lipids / Q000097:blood*; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008824:Michigan; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects; D006435:Renal Dialysis; D013997:Time Factors; D024508:Tocotrienols / Q000627:therapeutic use*; D016896:Treatment Outcome; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D000975:Antioxidants; D015415:Biomarkers; C506642:CETP protein, human; D053480:Cholesterol Ester Transfer Proteins; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D008055:Lipids; D024508:Tocotrienols; D014815:Vitamins; D008315:Malondialdehyde; D002097:C-Reactive Protein
keywords: end-stage renal disease; hemodialysis; lipid profiles; nutrition intervention; tocotrienol-rich fraction; vitamin