Nutritional management of hyperapoB.
Plasma apoB is a more accurate marker of the risk of CVD and type 2 diabetes (T2D) than LDL-cholesterol; however, nutritional reviews targeting apoB are scarce. Here we reviewed eighty-seven nutritional studies and present conclusions in order of strength of evidence. Plasma apoB was reduced in all studies that induced weight loss of 6-12 % using hypoenergetic diets (seven studies; 5440-7110 kJ/d; 1300-1700 kcal/d; 34-50 % carbohydrates; 27-39 % fat; 18-24 % protein). When macronutrients were compared in isoenergetic diets (eleven studies including eight randomised controlled trials (RCT); n 1189), the diets that reduced plasma apoB were composed of 26-51 % carbohydrates, 26-46 % fat, 11-32 % protein, 10-27 % MUFA, 5-14 % PUFA and 7-13 % SFA. Replacement of carbohydrate by MUFA, not SFA, decreased plasma apoB. Moreover, dietary enriching with n-3 fatty acids (FA) (from fish: 1·1-1·7 g/d or supplementation: 3·2-3·4 g/d EPA/DHA or 4 g/d EPA), psyllium (about 8-20 g/d), phytosterols (about 2-4 g/d) or nuts (30-75 g/d) also decreased plasma apoB, mostly in hyperlipidaemic subjects. While high intake of trans-FA (4·3-9·1 %) increased plasma apoB, it is unlikely that these amounts represent usual consumption. Inconsistent data existed on the effect of soya proteins (25-30 g/d), while the positive association of alcohol consumption with low plasma apoB was reported in cross-sectional studies only. Five isoenergetic studies using Mediterranean diets (including two RCT; 823 subjects) reported a decrease of plasma apoB, while weaker evidence existed for Dietary Approaches to Stop Hypertension (DASH), vegetarian, Nordic and Palaeolithic diets. We recommend using a Mediterranean dietary pattern, which also encompasses the dietary components reported to reduce plasma apoB, to target hyperapoB and reduce the risks of CVD and T2D.
1Nutrition Department, Faculty of Medicine,Université de Montréal,Montréal,Québec,Canada.
Valérie
V
Lamantia
4Division of Cardiology,McGill University Health Center,Montréal,Québec,Canada.
Allan
A
Sniderman
1Nutrition Department, Faculty of Medicine,Université de Montréal,Montréal,Québec,Canada.
May
M
Faraj
D000818:Animals; D001055:Apolipoproteins B / Q000097:blood*; D002784:Cholesterol; D008078:Cholesterol, LDL; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D004041:Dietary Fats; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014280:Triglycerides
D001055:Apolipoproteins B; D008078:Cholesterol, LDL; D004041:Dietary Fats; D014280:Triglycerides; D002784:Cholesterol
 CHO carbohydrate;  DASH Dietary Approaches to Stop Hypertension;  FA fatty acid;  HDL-C HDL-cholesterol;  LDL-C LDL-cholesterol;  Lp(a) lipoprotein (a);  MCFA medium-chain fatty acid;  Med diet Mediterranean diet;  RCT randomised controlled trial;  RESMENA Reduction of the Metabolic Syndrome in Navarra-Spain;  T2D type 2 diabetes;  TRL TAG-rich lipoprotein;  VLDL-C VLDL-cholesterol;  hyperapoB hyperapobetalipoproteinaemia;  non-HDL-C non-HDL-cholesterol; ApoB-lipoproteins; Behaviour modification programmes; Cardiometabolic risks; LDL