Effects of Nutritional Status on Cholesterol Levels

Background: Hypercholesterolemia is an established risk-factor for heart disease in healthy populations. Discussion has occurred regarding the role cholesterol plays in chronic disease populations with poor dietary behaviors with some studies reporting a reverse epidemiology effect. The purpose of this study was to determine the effects of poor dietary behavior on cholesterol levels in End-Stage Renal Disease patients. Methods: Cholesterol and protein intake were collected from hemodialysis patients (N=105) after a 12-hour fast. Patients were placed into dietary groups based on albumin levels (>3.8 g/dL considered normal dietary protein intake). Results: After controlling for diabetes ANCOVA revealed reverse epidemiology trends in LDL particle size (p=.037) with fewer small and dense LDL particles in the poor protein intake group; LDL particle number (p=.0001) with less LDL particle numbers in the poor protein intake group and HDL (p=.035) with higher values in the poor protein intake group. Significant differences without a reverse epidemiology effect occurred in total cholesterol (p=.022) and LDL (p=.0001) with higher levels in the poor protein group. Conclusions: Risk-factors in a malnourished and diseased population are being studied with a reverse epidemiology effect discovered in some studies. A low level of albumin indicates poor protein intake and is associated with mortality. Our study found that reverse epidemiology trends in cholesterol with normal values associated with higher risk, increased morbidity and mortality in dialysis patients. These finding may be explained by malnutrition and may suggest dietary behavior may play a more significant role than cholesterol level alone in dialysis patients.