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Comparison of Low-Fat Meal and High-Fat Meal on Postprandial Lipemic Response in Non-Obese Men according to the –1131T>C Polymorphism of the Apolipoprotein A5 (APOA5) Gene (Randomized Cross-Over Design)

Yonsei University Research Institute of Science for Aging (J.Y.K., O.Y.K., S.J.K., Y.J., J.H.L.)
Division of Cardiology, Cardiovascular Genome Center, Yonsei Medical Institute (Y.J.)
Dept. of Food & Nutrition, College of Human Ecology (J.H.L.)
Yonsei University, R&D Center, Maeil Dairy Industry Co., Ltd. (S.-S.Y.), Seoul, KOREA
Nutrition and Genomics Laboratory, JM-USDA-HNRCA, Tufts University, Boston, Massachusetts (J.M.O.)

Address reprint requests to: Jong Ho Lee, Ph.D., R.D., Department of Food & Nutrition, College of Human Ecology, Yonsei University, 134, Shinchon-Ding, Sudaemun-Gu, Seoul, 120-749, KOREA. E-mail: jhleeb{at}yonsei.ac.kr

	ABSTRACT

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS ACKNOWLEDGMENTS REFERENCES

 
Objective: The purpose of this study was to compare low-fat (LF) meal and high-fat (HF) meal on the postprandial lipemic responses according to the –1131T>C polymorphism of the APOA5 gene in a population usually consuming a LF diet and having a high frequency of the variant allele at the APOA5 –1131T>C SNP.

Methods: This study was conducted using a cross-over design and 49 non-obese healthy men (42.8 ± 0.7 yrs, 23.9 ± 0.25 kg/m²) participated in the meal tolerance test. They were randomly assigned to consume one of two types of experimental enteral formulae (LF vs HF) with a seven-day interval. Blood samples were collected at 0, 2, 3, 4 and 6h after ingestion and analyzed for total and chylomicron TG, glucose, insulin and free fatty acid.

Results: No differences were found in anthropometic parameter, calorie and macronutrient intakes and total energy expenditure between TT (n = 23) and TC + CC (n = 26) men. Fasting total TG were higher in TC + CC men than TT men, but fasting chylomicron TG were not significantly different between TT men and C carriers, TT subjects had no significant differences in postprandial responses of total TG and chylomicron TG and postprandial mean changes of chylomicron TG between LF and HF meal. On the other hand, C carriers had delayed peak time of total TG compared to TT subject and higher postprandial response and mean changes of chylomicron TG at HF meal compared to LF meal.

Conclusion: The capacity to clear chylomicron-TG or hydrolyze TG might become a rate-limiting factor on HF diet in TC + CC men resulting in higher postprandial triglyceridemia. Therefore, HF diet for C carriers of the APOA5 gene may be one of important CVD risk factors.

Key words: APOA5, C carrier, high fat meal, postprandial lipemic response

	INTRODUCTION

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According to the 2001 Korean National Health and Nutrition Survey [1], average calorie intake of adults (30–49 yr) is 2196 kcal/d, with 66% of energy as carbohydrate (CHO), 19% as fat and 15% as protein. The proportion of energy consumed from fat is much lower than that of most Western countries and carbohydrate still contributes to most of the energy consumption. Recently, there has been concern that low-fat (LF), high-CHO diets may not confer the anticipated benefits for cardiovascular disease (CVD) risk [2] because of their potential hypertriglyceridemic effects. At this regard, results from epidemiological studies [3] show that CHO-induced hypertriglyceridemia can be a long-lasting phenomenon. In fact, serum triglyceride (TG) concentrations in Korean men are on average high at 144 mg/dl despite the relative low mean serum total cholesterol (192 mg/dl) and LDL-cholesterol (114 mg/dl) [1,4].

The potential atherogenicity of CHO-induced fasting hypertriglyceridemia is the subject of current debate [2,5–8]. Conversely, increased consensus appears to exist about the atherogenicity of high postprandial TG concentrations and its role as an independent predictor of early atherosclerosis [9] and CVD [10]. Changes in postprandial TG responses are likely to be more marked following a brief intervention period than after long periods of diet intervention, during which adaptive processes may counterbalance the initial effects [11]. Therefore, the study of two acute dietary interventions [high CHO (LF) and high fat (HF) diets] in subjects traditionally consuming high CHO intake, may help to reveal the mechanisms underlying the atherogenic risk of HF diets as well as to bring up the differences in postprandial lipemia responses according to meals containing different fat contents. Moreover, this approach provides an appropriate framework to explore interindividual differences in TG responses associated with polymorphisms at candidate genes involved in TG metabolism. One such gene is the apolipoprotein A5 (APOA5), which has been shown to be involved in TG metabolism in both fasting and postprandial states in Korean men [12] and in other populations around the world [13,14]. Several common polymorphisms have been reported and, specifically, the presence of the APOA5 (–1131T>C) SNP, has been associated with higher plasma TG concentrations and it may be a significant factor contributing to higher CVD risk independently of common environmental factors such as calorie and CHO intakes, BMI (body mass index), cigarette and alcohol intake [12]. Moreover, the frequency of the C allele in Koreans was 0.28, much greater than that reported in Caucasian (0.081 [15]. Conversely, the common S19W polymorphism that has been associated with high TG in Whites does not appear to be present in Chinese populations [13,17].

Therefore, the present study was designed to investigate effects of the APOA5 –1131T>C SNP on the postprandial responses of total and chylomicron TG, glucose, insulin and free fatty acids (FFA) to acute dietary challenges from traditional Korean LF diet to Western type HF diets in a population usually consuming a LF diet and having a high frequency of the variant allele at the APOA5 –1131T>C SNP.

	MATERIALS AND METHODS

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Subject Information
Study subjects were recruited from volunteers who responded to an advertisement for a nutrition study conducted by the Clinical Nutrition Research Team at Yonsei University in 2003. The subject selection criteria demanded that participants have a BMI less than 30 kg/m² and have the normal range on the glucose tolerance test and electrocardiograms. Excluded was anyone who had experienced weight changes within the past 6 months, was taking medication, or had any type of disease such as diabetes mellitus (DM), cardiovascular disease (CVD) including coronary heart disease, stroke, peripheral vascular disease or cancer. Finally forty-nine men were selected as study participants (age: 28–55 years and BMI: 18.9–29.9 kg/m²). Written informed consent was obtained from all of the study subjects and the protocol was approved by the Ethical Committee of Yonsei University. Subjects were asked to refrain from doing strenuous exercise or drinking alcoholic beverages 24 hours prior to the meal tolerance test. They were also instructed to avoid eating or drinking anything except water during the experimental period.

Study Design and Meal Tolerance Test
The 49 test subjects took the meal tolerance test under a double blind randomized cross-over design. On the first day of the experiment, participants were randomly assigned to consume one of two types of experimental enteral formulae differing only in the amount of fat and carbohydrate (LF formula: 20.2% of total calorie from fat and 64.6% from carbohydrate vs HF formula: 50.0% from fat and 34.6% from carbohydrate). After a seven-day interval, they consumed the kind of formulae that was not eaten on the first day. On both days, the 6-hr postprandial lipemia response test was conducted starting at 8:30 AM after an overnight fast of more than 12 hours. Each of ingested formulae contained 500 kcal, which was usually taken as breakfast by Korean.

APOA5 Genotyping
Genomic DNA was extracted from 5 ml of whole blood using a commercially available DNA isolation kit (WIZARD® Genomic DNA purification kit, Promega Corp., Madison, WI, U.S.A) according to the manufacturer’s protocol. –1131T>C genotyping was performed by SNP-IT^TM assays using single primer extension technology (SNPstream 25K^TM System, Orchid Biosystems, New Jersey, USA). The results of yellow and/or blue color developments were analyzed with a microplate reader and the final genotype calls were made with QCReview^TM program.

Anthropometric Parameters and Blood Pressure
Body weight and height were measured in the morning, with the subjects in light clothing and shoeless. Body mass index (BMI) was calculated as body weight in kilograms divided by height in meters squared. Waist and hip circumference were combined into the waist to hip ratio (WHR) as an indication of the index of body fat distribution. Blood pressure was read from the left arm while the subjects remained seated. An average of three measurements was recorded for each subject.

Blood Collection
Venous blood samples were obtained from the forearm and collected into plain or EDTA-treated tubes at 0 h (baseline) and at 2, 3, 4 and 6 h after eating the enteral formulae. Tubes were immediately placed on ice until they arrived at the analytical laboratory (within 1–3 hrs) and stored at –70°C (for glucose, insulin, FFA and total TG) and at 4°C (for chylomicron TG) until analysis.

Serum Lipid Profile and Apolipoprotein AI and B
Fasting serum concentrations of total cholesterol and TG were measured using commercially available kits on a Hitachi 7150 Autoanalyzer (Hitachi Ltd. Tokyo, Japan). After precipitation of serum chylomicron, low-density lipoprotein (LDL) and VLDL with dextran sulfate-magnesium, high-density lipoprotein (HDL) cholesterol left in the supernatant was measured using an enzymatic method. LDL cholesterol was estimated indirectly using the Friedewald formula for subjects with serum TG concentrations <4.52 mol/l (400 mg/ml). Postprandial TG concentration was also measured using the same methods that were used to measure serum TG.

Serum apolipoprotein AI and B were determined by turbidometry at 340 nm using a specific antiserum (Roche, Switzerland).

Glucose, Insulin and FFA Assessment
Blood glucose was measured based on a glucose oxidase method using the Beckman Glucose Analyzer (Beckman Instruments, Irvine, CA). Insulin was measured by radioimmuno-assay using commercial kits from the Immuno Nucleo Corporation (Stillwater, MN). FFA was analyzed using a Hitachi 7150 autoanalyzer (Hitachi Ltd, Tokyo Japan). Postprandial responses of glucose, insulin and FFA to the fat challenge were calculated using the trapezoidal method as area under curve (AUC).

Chylomicron TG Assessment
To collect chylomicron TG, 1.006 g/ml density solution was added to plasma. Centrifugation was carried out in a Beckman 50.4 Ti rotor at 14,000 rpm, 40 for 30 minutes using a Beckman LE8 ultracentrifuge. 1 ml of the chylomicron was carefully removed from the top of each tube using a drawn out glass pipette. After separating the chylomicron from the plasma, chylomicron TG was measured using commercially available kits on a Hitachi 7150 Autoanalyzer (Hitachi Ltd. Tokyo, Japan).

Assessment of Food Intake and Physical Activity Level
Usual food intake was assessed with a 24-h recall method and a semi-quantitative food frequency questionnaire. Nutrient intake data were calculated as mean values from the same data base referred in National Rural Living Science Institute (6th ed, 2000). Total energy expenditure (kcal/day) was calculated from activity patterns including basal metabolic rate, physical activity for 24 hours [18], and specific dynamic action of food. Basal metabolic rate for each subject was calculated with the Harris-Benedict equation [19].

Statistical Analysis
We used SPSS version 11.0 for Windows (Statistical Package for the Social Science, SPSS Ins., Chicago, IL, U.S.A.) for all our statistical analyses. To investigate differences between variables according to apoA5 genotype (TT n = 23, TC or CC n = 26) and the effect of dietary switch from a LF to a HF meal in each genotype group, we performed independent t-test. We also performed analysis of variance (ANOVA) for repeated measures from general linear model (GLM) to find the interaction between genotype and diet during postprandial responses of total TG, chylomicron TG, glucose, FFA and insulin. Each variable was examined for normal distribution and those variables that deviated significantly from the normal distribution were log-transformed. For descriptive purposes, mean values were presented on untransformed and unadjusted variables. Results were expressed as mean ± SE. A two tailed value of P < 0.05 was considered statistically significant.

	RESULTS

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Frequency of the APOA5 –1131T>C Polymorphism
In these subjects, we identified 23 men homozygous for the T allele (TT), 18 heterozygous for the C allele (TC) and 8 homozygous for C allele at the APOA5 –1131T>C SNP. Calculated frequency of the C allele was 0.35, and the genotype distributions did not deviate significantly from the Hardy-Weinberg proportions (p = 0.60).

During the postprandial period, TT subjects showed significant differences in TG concentrations at 0h, 2h, 3h, 4h and 6h as compared with TC or CC subjects (Table 1). However, there were no significant differences in the TG concentrations between TC groups and CC subjects. In addition, there were no significant differences in age (p = 0.248), BMI (p = 0.394) waist circumferences (p = 0.201), waist to hip ratio (p = 0.357), systolic blood pressure (p = 0.561), diastolic blood pressure (p = 0.806), cigarettes smoking (p = 0.463) and alcohol consumption (p = 0.405) among 3 genotype groups. Therefore, we combined the TC and CC groups and compared postprandial metabolism between TT subjects and carriers of the C allele (TC + CC).

View larger version (23K): [in this window] [in a new window]   Fig. 1. Postprandial response of in-total TG and chylomicron-TG in the TT homozygotes (solid lines, n = 23) and carriers of the C allele (dotted lines, n = 26) on LF (O) and HF (•) liquid meals. P1: p-value, time effect, P2: p-value, genotype effect, P3: p-value, diet effect, P4: p-value, genotype by diet interaction.

Comparison of Postprandial FFA, Glucose and Insulin between Carriers of the C Allele and TT Subjects on LF and HF Liquid Meal Ingestion
Table 4 presents fasting and postprandial responses of serum FFAs, glucose and insulin after ingestion of the different fat liquid meals between TT and TC + CC subjects. We observed the time effects and diet effects in FFAs and insulin responses; in each genotype group, FFAs at 2h, 3h and 4h time point, insulin at 2h time point and AUC of insulin were higher after HF liquid meal ingestion compare with LF liquid meal ingestion. However there were no significant time effects, genotype effects and genotype by diet interaction on all postprandial glucose response.

	DISCUSSION

The impaired clearance of total TG and chylomicron-TG in carriers of the C allele as compared to TT men following a HF meal may relate to a decrease in APOA5 function [20,21]. Plasma lipoprotein lipase (LPL) activity is known to be inversely related to AUC of postprandial TG [22,23]. Lower expression of APOA5 may impact on the catabolism of TG-rich lipoprotein (TRL) through a mechanism involving impaired LPL-mediated lipolytic conversion of TRLs, thereby stimulating remnant formation and hepatic clearance as shown in hyperlipemic mice [21]. In addition, differences in postprandial responses to meals especially in C carriers might be the result of both the acute effects of the amount of the experimental fat load as well as the chronic effects of the usual diets consumed by the participants [6]. In the present study, there were no significant differences in macronutrient intakes of the habitual diets consumed by either TT or TC + CC subjects. Thus, the postprandial differences observed in this study, probably reflects the acute transition from LF meal to HF meal in men with C allele could be more atherogenic than TT men [6].

This polymorphism did not affect mean changes of total TG and chylomicron-TG from baseline in the postprandial state when dietary fat intake was low. However, during a HF meal, the capacity to clear chylomicron-TG or hydrolyze TG might become a rate-limiting factor in men with TC + CC resulting in higher postprandial lipemia. With regard to the potential clinical implications of the present results, it is of interest that our LF experimental meal is close to the current population-wide guidelines emphasizing diets low in fat and high in complex CHO. Conversely, our HF experimental meal corresponding to the current Western style diet may indicate that atherogenic risk can be higher in those subjects carrying the C allele.

In the fasting state, differences in serum TG levels between TT and TC + CC men may relate to VLDL-TG because fasting levels of chylomicron-TG in carriers of the C allele were similar to those in TT homozygotes. The peak concentration of the serum total TG after the HF meal occurred later in carriers of the C allele (at 4h), as compared with TT men (at 2h), and the level at 6h was still significantly higher than the fasting value in C carriers. An exaggerated and prolonged lipemic response after the HF meal in carriers of the C allele might be partly due to the expanded fasting TG pool, because chylomicrons compete with VLDL for the same rate-limiting enzyme (LPL) in the hydrolysis of their core TG [24,25]. However, this is unlikely to be the sole explanation for the difference in postprandial lipemia between TT and TC + CC men after HF meal ingestion.

In addition, the higher postprandial triglyceridemia on the HF meal can be also explained by a higher rate of production of TRLs [26]. The postprandial suppression of plasma FFA concentration was less pronounced in HF meal than LF meal in this study. The higher FFA concentrations after HF meal versus LF meal might have served as a substrate for hepatic TG synthesis and contribute to the higher total TG concentration during the late postprandial period. Thus, a possible explanation for the prolonged and higher postprandial triglyceridemia in carriers of the C allele on the HF meal might be due to delayed clearance of chylomicron-TG, higher production of TG-rich protein and delayed catabolism of TRLs [26].

In postprandial response, serum concentrations of FFA were higher (2h, 3h and 4h) and serum insulin concentration (2 h) and AUC were lower after the HF meal ingestion in both TT and TC + CC men. In the postprandial state, the release of FFA into the circulation is determined by the activity of intracellular hormone sensitive lipase (HSL) and the extent to which LPL-derived fatty acids are not entrapped in muscle and adipose tissues [27]. In the postprandial state, about 25–54% of LPL-derived fatty acids are known to be internalized into adipocytes, whereas the remainder stays in the blood compartment [28]. Therefore, the FFA response observed after the HF meal could reflect an impairment of the normal postprandial suppression of HSL by insulin and/or a greater ‘spillover’ of fatty acids from the action of LPL [6].

In summary, our results indicated that the response of postprandial lipemia to a HF experimental meal differs between TT and TC + CC men, showing C carriers displaying higher triglyceridemia on the HF meal possibly due to delayed clearance of chylomicron-TG, higher production of TG-rich protein and delayed catabolism of TG-rich lipoproteins [25]. However, no allele-related differences were observed during the postprandial period following the consumption of the experimental LF meal. Since prolonged and exaggerated postprandial lipemia has been associated with accelerated atherogenesis [24], HF diet for C carriers of the APOA5 (–1131T>C) gene may be an important factor contributing to their greater CVD risk. However, these results may be a transient effect of a HF meal in subjects consuming usually high CHO diet. Therefore, a controlled intervention study on a larger number of subjects during a longer period would be required to confirm our results. Such a study would help to improve our understanding of the mechanisms responsible for the substantial inter-individual variability on the effects of diets with different contents of fat on atherogenic risk in C carrier of APOA5 (–1131T>C).

	ACKNOWLEDGMENTS

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This study was partly supported by the National Research Laboratory project ‘2005-01572’, Ministry of Science and Technology, Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (02-PJ1-PG1-CH15-0001, 00-PJ3-PG6-GN-01-0001), Korea Science and Engineering Foundation (R01-2003-0000-11709-0) and by grants from NIH/NHLBI # HL54776, and contracts 53-K06-5-10 and 58-1950-9-001 from the US Department of Agriculture Research Service.

Experimental liquid meals were provided by R&D Center, Maeil Diary Industry Co., Ltd, Seoul, Korea.

Received April 26, 2005. Accepted December 21, 2005.

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TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS ACKNOWLEDGMENTS REFERENCES

 

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