257864 Poor dietary practices and inflammation associated with normal levels of cholesterol in an aging population

Monday, October 29, 2012

Rodney G. Bowden, PhD , School of Education, Baylor University, Waco, TX
Ronald L. Wilson, MD , Central Texas Nephrology Associates, Waco, TX
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.

Learning Areas:
Chronic disease management and prevention
Clinical medicine applied in public health

Learning Objectives:
1. Describe the term reverse epidemiology as it relates to an aging and malnourished population 2. Analyze the differences in cholesterol values with ESRD patients who have high and low inflammation levels

Keywords: Cholesterol, Chronic (CVD)

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the PI for this study
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.