To the Editor: The studies of the relationship between nonfasting serum triglyceride levels and heart disease by Dr Nordestgaard and colleagues1 and by Dr Bansal and colleagues2 may be important missing pieces in the diet-heart disease puzzle. Recent large epidemiological studies have contradicted the traditional diet-heart disease hypothesis by finding that fat intake has no association with heart disease, whereas carbohydrate intake, especially the glycemic load of carbohydrate intake, has a positive association with heart disease.3
One possible explanation relates the association between nonfasting triglyceride and heart disease with the finding that reducing dietary fat and increasing dietary carbohydrate cause an increase in nonfasting (and fasting) serum triglyceride level.4 The intended beneficial effect of lowering serum cholesterol by reducing dietary fat intake, therefore, may be negated by the concomitant increase in serum triglyceride level. Alternatively, reducing dietary carbohydrate intake may lower fasting and nonfasting serum triglyceride.5
If dietary carbohydrate has a strong effect on serum triglyceride level and nonfasting triglyceride is associated with heart disease, it is reasonable to study low-carbohydrate diets as a possible intervention to reduce the risk of heart disease. This idea is supported by the finding that, in addition to lowering serum triglyceride, reducing dietary carbohydrate increases high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) particle size, and improves other features of the metabolic syndrome.5 However, such an approach would require high-quality studies before making dietary recommendations.
Financial Disclosures: Dr Yancy reports receiving research grant funding provided by the Robert C. Atkins Foundation to Duke University. Drs Volek and Westman report receiving research grant funding from the Robert C. Atkins Foundation.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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