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Provident Perspective Volume 4, Issue 3
Provident
News
Provident welcomes our
newest staff members.
· Cassandra
Abel, Lab Assistant
· Esther
Armstrong, RD, LD, Clinical Research Coordinator
· Ana
Diaz, Research Assistant
· Jeanne
Rosone, MLT (ASCP), Lab Manager
· Kristen
Taggart, Research Assistant Congratulations and
welcome to Provident!
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· The
Addison, IL clinic officially opened for business in June.
· Congratulations
to Arianne Orcutt for completing her Bachelor of Arts in Mathematics from DePaul
University.
· Congratulations
also to Rose Hanbury, PhD. Rose has
resigned from Provident to pursue a new business opportunity. She and her husband Bob are building a
business selling custom nightlights and art kits directly to the consumer and
to local area retailers. Take a minute
to visit their website at www.nightlightdesigns.com. Best wishes to Rose and Bob from the Provident team!
Recent and Upcoming
Publications and Presentations
Publications
Maki KC, Carson ML, Miller MP, Kerr Anderson
WH, Turowski M, Reeves MS, Kaden V, Dicklin MR. Hydroxymethylcellulose lowers cholesterol in statin-treated men and
women with primary hypercholesterolemia. Eur
J Clin Nutr (in press).
Toth PP, Maki KC. A commentary on the
implications of the ENHANCE (ezetimibe and simvastatin in hypercholesterolemia
enhances atherosclerosis regression) trial: should ezetimibe move to the “back
of the line” as a therapy for dyslipidemia? J
Clin Lipidol, 2008 (in press).
Maki KC, Dose-response characteristics of high-viscosity
hydroxypropylmethylcellulose in subjects at risk for the development of type 2
diabetes mellitus. Diabetes Technology and Therapeutics (in press).
Voss
AC, Maki KC, Carvey TW, Hustead DS, Alish C, Fix B, Mustad VA. Effect of two carbohydrate-modified tube-Feeding
formulas on metabolic responses in patients with type 2 diabetes. Nutrition, 2008 (in press).
Maki KC, McKenney JM,
Reeves MS, Lubin BC, Dicklin MR. Effects of adding prescription omega-3 fatty
acid ethyl esters to simvastatin (20 mg/day) on lipids and lipoprotein
particles in men and women with mixed dyslipidemia. American Journal of
Cardiology. 2008;102:429-33.
Maki KC, Curry LL, Carakostas MC, Tarka SM,
Reeves MS, Farmer MV, McKenney JM, Toth PD, Schwartz SL, Lubin BC, Dicklin MR,
Boileau AC, Bisognano JD. The hemodynamic effects of rebaudioside A in healthy
adults with normal and low-normal blood pressure. Food and Chemical Toxicology, 2008;46:S40-S46.
Maki KC, Curry LL, Reeves MS, Toth PD,
McKenney JM, Farmer MV, Schwartz SL, Lubin BC, Boileau AC, Dicklin MR,
Carakostas MC, Tarka SM. Chronic consumption of rebaudioside A, a steviol
glycoside, in men and women with type 2 diabetes mellitus. Food and Chemical Toxicology, 2008:46:S47-S53.
Fan
L, Hanbury R, Pandey
SC, and Cohen RS. Dose and time effects of estrogen on expression of
neuron-specific protein and cyclic AMP response element-binding protein and
brain region volume in the medial amygdala of ovariectomized rats. Neuroendocrinology. 2008 (in press, epub
ahead of publication).
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Abstracts/Presentations
The Obesity Society
2008 - Maki KC,
Reeves MS, Farmer M, Yasunaga K, Matsuo N, Katsuragi Y, Komikado M, Tokimitusu
I, Wilder DM, Jones F, Cartwright Y. Effects of daily consumption of a tea
catechin containing beverage on exercise-induced changes in body composition
and fat distribution in overweight and obese adults. Abstract, October 4th,
2008. Poster #369-P.
The Obesity Society
2008 - Maki KC, Reeves MS, Carson ML,
Miller MP, Turowski M, Rains, TM, Anderson K, Papanikolaou Y, Wilder DM.
Dose-response characteristics of high-viscosity hydroxypropylmethylcellulose on
postprandial glucose and insulin concentrations in subjects at risk for the
development of type 2 diabetes mellitus. Abstract, October 4th, 2008. Poster #368-P.
America Dietetic
Association 2008 - Maki KC, Carson
ML, Reeves MS, Herther DC,
Anderson WHK, Miller MP, Dicklin MR.
Effects of hydroxypropylmethylcellulose on fasting lipids in men and women with
primary hypercholesterolemia receiving statin therapy. Tuesday (9:45 am – 11:15
am) October 28th. Oral presentation (session 112).
The Diabetes
Technology Society2008 - Alish CJ, Hustead DS, Maki KC, Reeves MS, Herther DC, Mustad.
Continuous glucose monitoring demonstrates less glycemic variability with a
diabetes-specific nutritional formula compared to a standard formula in patients
with type 2 diabetes. The Diabetes
Technology Society. November 13th-15th, 2008 (Poster).
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Books and Book Chapters
· The
book Therapeutic Lipidology edited by Drs. Michael Davidson, Peter Toth and Kevin Maki is
available for purchase at Amazon.com
· Maki KC.
High-viscosity hydroxypropylmethylcellulose (HV-HPMC) a promising agent for metabolic
risk factor management. ACS Press, 2008
(in press).
  ·
Maki KC, Matsuo N, Dicklin MR. Clinical studies evaluating the benefits
of diacylglycerol for managing excess adiposity. In: Katsuragi Y, Yasukawa T, Matsuo N,
Flickinger BD, Tokimitusu I, and Matlock MG. (eds) Chapter 10. Diacylglycerol Oil, AOCS Press, 2nd ed. 2008.
· Maki, KC and Dicklin M. How well do various lipids
and lipoprotein measures predict cardiovascular disease morbidity and mortality.
In: Toth PP, Sica D. (eds). Clinical
Challenges in Lipid Disorders. Oxford: Clinical Publishing. June, 2008.
· Huth
PJ, Rains TM, Yang Yifan, Philips
SM. Current and emerging role of whey protein on muscle accretion. In: Onwulata CI and Huth PJ. (eds) Chapter
13. Whey Processing, Functionality and
Health Benefits. Wiley-Blackwell. 2008.
Shai I, Schwarzfuchs
D, Henkin Y, Shahar DR, Witkow S, et al.
Weight loss with a
low-carbohydrate,
N Engl J Med 2008;359:229-241.
Methods: This dietary intervention, randomized,
controlled trial was designed to compare the safety and effectiveness of three
types of popular weight loss diets: (1) a low-fat, restricted-calorie (based
on the American Heart Association guidelines1); (2) a moderate fat, restricted-calorie,
Results: Overall,
subjects were 95.4% adherent to
their diet following one year and 84.6% at two years (assessed by a validated
food-frequency questionnaire). Analysis
of self-administered dietary questionnaires indicated that all groups had
significant reductions from baseline daily energy intakes (p < 0.05), but
there were no significant differences among the three diets. Dietary
compositions were as expected; the low-fat diet group consumed lower amounts of
saturated fat than the low-carbohydrate group, while the low-carbohydrate group
consumed fewer grams of carbohydrates and higher amounts of protein, total fat,
saturated fat, and total cholesterol than both other diet groups (p < 0.05
for all comparisons). The
Mediterranean-diet group consumed the highest ratio of monounsaturated to
saturated fatty acids and had a higher dietary fiber intake than the
low-carbohydrate group (p < 0.05 for all comparisons). The low-carbohydrate group had the highest
percentage of participants with detectable urinary ketones (8.3% vs. 4.8 and
2.8% in the low-fat and Mediterranean diet groups, respectively, p =
0.04).
All
groups lost weight, but the low-carbohydrate and
There
were no significant differences between the lipid responses of the low-fat and
Mediterranean diet groups. High-density
lipoprotein cholesterol concentration increased in all diet groups, and to a
significantly greater extent in the low-carbohydrate group compared to the
low-fat group (8.4 vs. 6.3 mg/dL at 24 months, p = 0.01). Triglyceride reductions were also
significantly larger at 24 months with the low-carbohydrate diet compared to
the low-fat diet (-23.7 vs. -2.8 mg/dL, p = 0.03), as was the relative
reduction in the ratio of total cholesterol to high-density lipoprotein
cholesterol (-20% in the low-carbohydrate group vs. -12% in the low-fat group, p =
0.01). The change in this ratio was
intermediate for the Mediterranean diet group (17%). There were no significant differences between
or within diet groups in low-density lipoprotein cholesterol changes.
While
both the Mediterranean diet and low-carbohydrate diet groups showed significant
reductions from baseline in high-sensitivity-C-reactive protein (changes of
-0.9 and -1.3 g/L, respectively, compared to -0.5 g/L in the low-fat diet group),
there were no significant differences among the three groups. High-molecular weight adiponectin increased
significantly in all diet groups and circulating leptin decreased significantly
in all diet groups, but there were no significant differences among the three
diet groups in these changes.
Of the 36
subjects with diabetes, only participants in the Mediterranean diet group experienced
a significant reduction in fasting plasma glucose concentration (-32.8 mg/dL
vs. +12.1 mg/dL in the low-fat diet group, p < 0.001). Subjects without diabetes had no significant
changes in glucose concentration. Insulin levels decreased significantly in subjects with and without
diabetes in all diet groups and there were no significant differences among
groups. The HOMA-IR decreased
significantly more in subjects with diabetes assigned to the Mediterranean diet
than those in the low-fat diet group (-2.3 vs. -0.3, p = 0.04). Glycosylated hemoglobin in participants with
diabetes decreased in all groups (-0.4, -0.5, and -0.9% for low-fat,
Conclusions: The
results from this trial suggest that both
the Mediterranean diet and the
low-carbohydrate diet may be safe and effective alternatives to a low-fat
diet. In addition to producing weight
loss, the low-carbohydrate diet had a more favorable net effect on the fasting
lipid profile and the Mediterranean diet appeared to have some advantages for
subjects with diabetes. These
differences suggest that personal dietary preferences and metabolic goals
should be considered when selecting a weight loss plan.
Citations:
1Krauss RM, Eckel RH, Howard B, et al.
AHA Dietary Guidelines: revision 2000; a statement for healthcare professionals
from the Nutrition Committee of the American Heart Association. Circulation
2000;102:2284-2299.
2Willett WC, Skerrett PJ. Eat, drink,
and be healthy: The Harvard Medical School guide to healthy eating.
3Atkins RC. Dr. Atkins’ new diet
revolution.
Dr.
Maki’s Commentary: The results from this study confirm those from
previous trials in several respects. They demonstrate that either a moderate-fat (Mediterranean) diet or a
higher-fat, low-carbohydrate diet (Atkins) are effective alternatives to a
traditional low-fat diet for weight loss and weight loss maintenance. The results from this study are consistent
with those from a trial we conducted1 in which we compared a
low-fat, portion-controlled diet to a reduced glycemic load diet (The South
Beach Diet) that was similar to the Mediterranean diet used in this trial.
The
influences of different diets on the cardiovascular risk profile are also of
interest. An often expressed concern is
that the higher intakes of saturated fat and cholesterol associated with lower
carbohydrate diets will increase total and low-density lipoprotein cholesterol
levels. This does not appear to be the
case. The low-density lipoprotein
cholesterol level does not appear to be increased on a low-carbohydrate diet compared
with a low-fat diet, despite higher consumption of saturated fat and cholesterol. However, Krauss and colleagues showed that
higher saturated fat intake in the context of a low carbohydrate diet is
associated with a higher level of low-density lipoprotein cholesterol when
compared to a similarly low carbohydrate diet with a lower intake of saturated
fat.2 Additional research is
warranted to explore the mechanisms responsible for the large decline in
low-density lipoprotein cholesterol associated with a low carbohydrate, low
saturated fat/cholesterol diet compared with a typical American diet.
What are
the implications of these results for clinical practice? First, it appears that individuals can be
successful losing weight and maintaining weight loss on a range of
macronutrient intakes, although the amount of weight loss after 24 months was
modest in all groups. Therefore, a
patient’s personal preference should be taken into account when weight loss
counseling occurs. Some people prefer a
lower fat diet and some prefer a lower carbohydrate diet and patients should
not be pushed to follow a diet that is substantially different from their
personal preferences.
Second,
for individuals with insulin resistance and/or glucose intolerance, moderate
carbohydrate restriction seems to be a reasonable approach. Reducing carbohydrate intake has been
consistently associated with lower levels of triglycerides and a more favorable
total/high-density lipoprotein cholesterol ratio. There is also some reason to believe that
moderate restriction of carbohydrate intake may reduce demand on the pancreas
for insulin secretion. This might slow
the development of beta-cell dysfunction, although clinical trials are needed
to test this hypothesis.
Finally,
in my view, some legitimate concerns remain regarding the use of very low
carbohydrate diets. Data from population
studies suggest that higher intakes of whole grains, nuts and fruits are
associated with lower mortality and reduced incidence rates for cancer,
diabetes and heart disease. Such foods
can be incorporated into moderately carbohydrate restricted diets (40% of
energy or more), but their intakes are necessarily limited on very low
carbohydrate diets. Furthermore, intakes
of foods that have been associated with increased risks for cancer, diabetes
and heart disease, such as high-fat and processed meats tend to be higher on
such diets. Therefore, while I feel that
many individuals with obesity, insulin resistance or dyslipidemia may benefit
from some reduction in carbohydrate intake, with greater emphasis on
unsaturated fats and proteins,3 I remain uncomfortable with diets
that contain less than roughly 40% of energy from carbohydrate.
Citations:
1Maki KC, Rains TM, Kaden VM, Raneri KR, Davidson MH. Effects of
a reduced-glycemic-load diet on body weight, body composition, and cardiovascular
disease risk markers in overweight and obese adults. Am J Clin Nutr 2007;85:724-734. 2Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS, Williams PT. Separate effects of reduced carbohydrate intake and
weight loss on atherogenic dyslipidemia. Am J Clin Nutr
2006;83:1025-1031.
3Furtado
JD, Campos H, Appel LJ, Miller
ER, Laranjo
N, Carey VJ, Sacks FM. Effect
of protein, unsaturated fat, and carbohydrate intakes on plasma apolipoprotein
B and VLDL and LDL containing apolipoprotein C-III: results from the OmniHeart
Trial. Am J Clin Nutr 2008;87:1623-1630.
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Provident has a team of research professionals
with extensive experience in the design and conduct of clinical trials to
evaluate pharmaceuticals, medical and functional foods, dietary supplements and
medical devices.
For
more information, visit our web site: http://www.providentcrc.com.
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