Fasting and Postprandial Lipid and Lipoprotein Metabolism in Healthy Young Men

Despite many previous studies, controversy remains concerning the effects of dietary cholesterol on plasma cholesterol concentrations. In addition, the focus of previous studies has been fasting lipid and lipoprotein concentrations; there are no published studies with postprandial measurements. We studied the effects of four levels of dietary cholesterol intake on fasting lipid, lipoprotein, and apoprotein levels, as well as postprandial lipid levels, in a group of young, healthy men who were otherwise eating a low-fat, American Heart Association step 1 diet. Twenty young, healthy men completed a randomized, four-way crossover design study to test the effects of an American Heart Association step 1 diet containing 0, 1, 2, or 4 eggs per day. Dietary cholesterol ranged from 128 to 858 mg cholesterol per day. Each diet was eaten for 8 weeks, with a break between diets. Three fasting blood samples were obtained at the end of each diet period. In addition, blood samples were obtained just before and 2, 4, and 6 hours after ingestion of a standard lunch containing the various amounts of egg cholesterol. We also obtained blood 4 and 8 hours after the subjects ingested a standard, high-fat formula. Fasting plasma total cholesterol concentrations increased by 1.47 mg/dL (0.038 mmol/L) for every 100 mg dietary cholesterol added to the diet (/<.001). Low-density lipoprotein (LDL) cholesterol increased in parallel. Responsiveness varied but appeared to be normally distributed. Fasting plasma apoprotein B concentrations increased approximately 10% between the 0and 4-egg diets and were correlated with Despite many carefully controlled metabolic studies and detailed reviews of the available data, much controversy still exists regarding the effect of dietary cholesterol on plasma lipids and lipoproteins. The uncertainty regarding the potential for dietary cholesterol to raise plasma cholesterol concentrations derives in part from the lack of adequate dietary control in some studies, the extreme levels of dietary cholesterol used in other studies, and the variability in other diet components. Differences in the protocols used to study the effects of dietary cholesterol Received September 28, 1993; revision accepted January 12, 1994. From the Departments of Medicine (H.N.G., W.K., M.S., A.R.T., W.S.B.) and Pediatrics (S.H., S.C.R., RJ.D., R.R.), Columbia University College of Physicians and Surgeons, New York, NY. Reprint requests to Henry N. Ginsberg, MD, Department of Medicine, P&S 9-510, College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032. changes in total and LDL cholesterol concentrations. Although there was a trend toward a greater response in men with an apoprotein E4 allele, this was not statistically significant. Fasting plasma cholesteryl ester transfer protein levels were higher only on the 4-egg diet, and changes in cholesteryl ester transfer protein levels between the 0and 4-egg diets correlated with changes in total and LDL cholesterol. There were no differences in the postlunch or post-fat-formula responses of plasma lipids across the diets. Incubation of the 4-hour postlunch serum with J774 macrophages did not affect cell cholesteryl ester content at any level of dietary cholesterol. Cellular free cholesterol levels were slightly higher on each of the egg-containing diets versus the 0-egg diet. In summary, increases in dietary cholesterol resulted in linear increases in fasting total and LDL cholesterol in young, healthy men. The increases were less than expected based on previous studies, and this may have been due to the low saturated fat content of the background diet and/or the young age of the study group. Dietary cholesterol had no effect on postprandial plasma lipids either in response to the varying doses of cholesterol or after a standard high-fat meal. Increasing dietary cholesterol did not appear to result in an increased atherogenic potential of postprandial serum, as assessed by effects on cultured macrophages. (Artaiosder Thrombosis. 1994;14:576-586.)