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Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO and from the Department of Medicine and Biochemistry & Molecular Biology, University of Calgary, Alberta, Canada
* To whom correspondence should be addressed. E-mail: mooradad{at}slu.edu.
One of the factors contributing to the increased risk of developing premature atherosclerosis is low plasma concentrations of high-density lipoprotein (HDL) cholesterol. Multiple potential mechanisms account for the cardioprotective effects of HDL and its main protein apolipoprotein A-I (apo A-I). The low plasma concentrations of HDL could be the result of increased fractional clearance and reduced expression of apo A-I. To this end, nutrients play an important role in modulating both the fractional clearance rate, as well as the rate of apo A-I gene expression. Since medical nutrition therapy constitutes the cornerstone of management of dyslipidemias, it is essential to understand the mechanisms underlying the changes in HDL level in response to alterations in dietary intake. In this review we will discuss the effect of select nutrients on serum HDL cholesterol (HDLc) and apo A-I levels. Specifically, we will review the literature on the effect of carbohydrates, fatty acids, ketones, as well as some of the nutrient-related metabolites, such as glucosamine and the prostanoids, on apo A-I gene expression. Because there are multiple mechanisms involved in the regulation of serum HDLc levels, changes in gene transcription do not necessarily correlate with clinical observations on serum levels of HDLc.
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