Abstract 1613: Predictors of Lipid Lowering Response to Weight Loss in Familial Hyperlipidemias
Objective: to identify predictors of lipid response to weight reduction in overweight and obese subjects with familial hyperlipidemias.
Methods: Familial dyslipidemias included; genetically defined familial hypercholesterolemia (FH), clinically defined familial combined hyperlipidemia (FCH) and familial hypertriglyceridemia (FHTG), body mass index >25 kg/m2, steady weight (± kg in the last 3 months) and absence of lipid lowering drugs including sterols in the previous 5 weeks. Each participant’s caloric prescription represented a deficit of 600 kcal per day as calculated from the person’s resting energy expenditure and activity level. The nutrient goals were: 30% fat, 15% protein, and 55% carbohydrates. Subjects were followed by an expert nutritionist every 2–3 weeks. Anthropometric data, a validated food-frequency questionnaire including 134 items and biochemical analysis including lipids, apolipoproteins and non-cholesterol sterols were performed at baseline, 3 months and 6 months. A positive lipid response was considered with reductions >10% in LDL cholesterol or non-HDL cholesterol for FH and FCH respectively, and >20% in triglycerides in subjects with FHTG.
Results: 68 patients were included in the study, 11 subjects discontinued before the 3 month visit and were excluded. Among the remaining subjects, 44 subjects lost at least 2% of body weight. This subgroup was uniformly distributed among the hyperlipemia groups. The frequency of lipid lowering responders to weight reduction was significantly lower in FH (13.3%) than in FCH (60%) and FHTG (66.7%) (p=0.002). Independent predictors of a positive response to weight loss were: baseline glucose, triglycerides and the absence of a mutation in the LDL receptor gene (LDLR). The odds ratio to be a responder was 6.11 (confidence interval 1.52–24.5, p=0.011) for subjects with baseline triglicerides over 250 mg/dL; 4.64 (CI 1.24 –17.4, p=0.023), and 10.6 (CI 2.01–56.3, p=0.005).
Conclusions: in overweight and obese subjects with familial hiperlipidemias those FCH and FHTG subjects with triglycerides >250 mg/dL or blood glucose >100 mg/dL obtained the greatest lipid benefit from weight loss. The LDLR gene study could help to identify subjects with a different lipid response to weight loss.