Poor dietary practices and inflammation associated with normal levels of cholesterol in an aging population

Introduction: Hypercholesterolemia is a well established risk factor for coronary heart disease (CHD) in healthy populations. Yet, counterintuitive findings occur in End Stage Renal Disease (ESRD) patients which has generated considerable debate. Previous research findings suggest that normal cholesterol levels may be a sign of malnourishment and associated chronic inflammation. Therefore, the purpose of this study was to determine if a reverse epidemiology effect in cholesterol exists when compared with a dietary behavioral marker and an inflammatory marker. Methods: Lipid profiles, C-reactive protein (CRP) and protein levels were collected from ESRD patients (N=33). Patients were placed in dietary behavior groups based on albumin with < 3.8g/dL considered to have low dietary protein intake. Results: ANCOVA revealed significant differences in LDL particle number (p=.029), VLDL (p=.045), and a trend in triglycerides (p=.055) with normal values associated with poor protein intake and chronic inflammation and therefore more risk for mortality. Discussion: Risk factors in chronically inflamed and malnourished populations are being studied extensively with a reverse epidemiology effect discovered in some studies. A low level of serum albumin indicates poor dietary protein intake and is associated with mortality. Our study demonstrated that higher levels of LDL, LDL particle number and total cholesterol that normally are indicative of increased risk in the general population are associated with higher protein intake and less inflammation and lower risk in ESRD patients. These paradoxical findings with high cholesterol offering a protective effect suggests a nutrition-inflammation complex may be more predictive of cardiovascular outcomes in this population.