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Among healthy subjects, replacement of saturated fat with carbohydrates resulted in reductions of TC and LDL-C across sex and ethnicity 114. Triglyceride concentrations tended to be lower with the MUFA diet, but were significantly higher with the high carbohydrate diet.
Of note, the dietary lipid responses varied on the basis of baseline lipid profiles, but they did not differ by metabolic syndrome or insulin resistance status 103.
Mixed results have been reported in diabetic patients with respect to the effects of dietary carbohydrates on plasma lipids 115. A recent systematic analysis of 17 clinical trials among obese subjects reported that low-carbohydrate diets were associated with significant decreases in TG and increases in HDL-C, without impacting LDL-C 121.
Studies replacing saturated fat with carbohydrates have investigated the impact of carbohydrate intake on LDL particle size, which has been associated with CVD endpoints 125-129.
Individuals with pattern B have a higher proportion of small dense LDL particles, and thus more likely to have atherogenic dyslipidemia.
The amount of dietary carbohydrates was associated with a decrease in LDL particle size and an increase in LDL density, contributing to the atherogenic dyslipidemia 132.
Of note, proportions of saturated vs. One third of these individuals converted to pattern B on this diet. Thus, it was suggested that reduced fat consumption replaced with an increased intake of carbohydrates modifies lipid and lipoprotein profiles towards atherogenic dyslipidemia.
On the other hand, reductions in dietary carbohydrate, even in the context of a diet high in saturated fat, have been associated with increases in large and medium LDL particles, and decreases in small, dense LDL particles 135.
Another study in overweight men provided a more detailed view with respect to the effects of varying carbohydrates and saturated fat, as well as weight loss, on lipid profiles 135.
In this study, comparing low-carbohydrate diets with a high vs. A 9-month intervention study in overweight and obese adults reported significantly increased LDL particle size after a low-carbohydrate diet, whereas there was no difference after a low-fat diet 139.
Of note the change in body weight was similar between these two groups.
A Mediterranean-style diet with reduced energy intake from carbohydrate and fat but with increases in MUFA intake and increased energy intake from protein has been shown to reduce small LDL 140. Therefore, beneficial effects of a high or a low carbohydrate diet on cardiovascular health remain to be clarified.
Different kinds of sugar impact differentially on the lipid profile and its contribution to atherogenic dyslipidemia. Fructose is known to increase TG levels and impair insulin sensitivity, and has been shown, in several recent studies, to more adversely impact LDL particle subclass profile than glucose.
In a 10-wk study among overweight and obese individuals, indices of postprandial TG 23-h area under the curve, TG exposure and postprandial peak, but not fasting TG increased after fructose, but not after glucose intake 141. Of note, fructose also increased small dense LDL particles.
High fructose corn syrup HFCS has become a major source of fructose intake, and a recent study investigated whether there are differences in the lipid profile after consumptions of HFCS, glucose, or fructose alone 142.
These changes were comparable to the ones seen with fructose, but were greater than those seen with glucose 142.