Anemia Clinical Trial
Official title:
Role of Intermittent Fasting in Improving High Density Lipoprotein Cholesterol
World Health Organization report notifies of the escalating global burden of cardiovascular diseases (CVD), projecting that it will become the major worldwide cause of death and disability by 2020. The South Asian countries have the highest rates of CVD globally. It is widely acknowledged that South Asians have 40-60% higher risk of CVD linked to mortality, compared with other populations. Multiple human population studies have established the concentration of high density lipoprotein (HDL) cholesterol as an independent, inverse predictor of the risk of having a cardiovascular event. Furthermore, HDLs have several well-documented functions with the potential to protect against cardiovascular disease. This study trial is designed to find out the role of intermittent fasting to improve the dyslipidemia and particularly increase the levels of HDL in general population. Investigators expect that the intermittent fasting will significantly enhance the level of HDL and reduce cardiovascular events in general population.
INTRODUCTION:
Overall lipid profile is important in cardiovascular diseases but particularly serum HDL
levels have long been recognized as an independent inverse prognostic marker of CVD, when the
Framigham study, in 1980s showed that HDL below 40-60mg/dl is of prognostic relevance. A rise
of 1mg/dl in HDL levels is considered to reduce coronary artery disease (CAD) risk to 2-3%.
Even patients with elevated total cholesterol (TC) and LDL, presenting a high HDL are seen to
be protected from atherosclerosis. Multiple human population studies have shown the
concentration of HDL cholesterol as an independent, inverse predictor of the risk of having a
cardiovascular event. Additionally, HDL has several well-documented functions with the
potential to protect against cardiovascular diseases. These include an ability to promote the
efflux of cholesterol from macrophages in the artery wall, inhibit the oxidative modification
of LDL, inhibit vascular inflammation, inhibit thrombosis, promote endothelial repair,
promote angiogenesis, anti-oxidant, enhance endothelial function, improve diabetic control,
and inhibit hematopoietic stem cell proliferation. HDL also exerts direct cardio protective
effect, which are mediated with its interactions with the myocardium.
Various studies have emphasised the high incidence of CVD within the South Asian countries.
The increased risk of cardiovascular events in South Asians at a younger age might be due to
unknown factors affecting plaque rupture, the interaction between prothrombotic factors and
atherosclerosis, or may be due to any undiscovered risk factors. Urbanisation and
westernisation is characterised by a distinct increase in the intake of energy dense foods, a
decrease in physical activity, and a heightened level of psychosocial stress, all of which
promote the development of hyperglycaemia, hypertension, and dyslipidaemia. Most common
dyslipidaemia in South Asians is low HDL-C and high triglycerides. High triglyceride and low
HDL-C levels are metabolically interlinked. This metabolic phenotype is also associated with
increased levels of small LDL particles despite relatively normal levels of LDL-C among South
Asians. This clinical syndrome is accompanied by insulin resistance, a condition frequently
referred to as atherogenic dyslipidemia, which is a common metabolic derangement among Asian.
South Asians not only have lower HDL levels but also have a higher concentration of small,
less-protective HDL particles. One proposed mechanism is presence of dysfunctional HDL
particles. Another potential explanation for the apparent blunted cardioprotection of HDL in
South Asians might be related to HDL particle size. Small particles might be less efficient
in reverse cholesterol transport. In general, HDL particle size tends to be lower in patients
with CHD and those with low HDL-C levels . Alarmingly, an estimated 60-80% of Pakistani
population has been reported to have low HDL. There are a number of non-pharmacological and
pharmacological recommendations for management of low HDL. Non-pharmacological (functional
food) strategies are reported to increase HDL levels around 10-15% and which include regular
exercise , body weight reduction in obese individuals , cessation of cigarette smoking in
smokers and dietary modifications like decrease intake of saturated trans-fatty acids with
increase intake of omega-3 polyunsaturated fatty acids . There are also a number of
pharmacological agents being considered as therapeutic options but the tolerability and
safety issues limit their use in addition to limited success in improving HDL. IF may be a
dietary method to aid in the improvement of the lipid profile in healthy, obese and
dyslipidemia men and women, reducing total cholesterol, LDL, triglycerides and increasing HDL
levels. However, the majority of studies that analyze the IF impacts on the lipid profile and
body weight loss are observational and lack detailed information about diet. Randomized
clinical trials with larger sample size are needed to evaluate the IF effects mainly in
population with dyslipidemia.
HYPOTHESIS:
Intermittent fasting is capable of improving dyslipidemia and particularly enhancement of
serum, HDL which can increase the cardioprotection in high risk general population.
OBJECTIVES:
To evaluate the effect of intermittent fasting on cholesterol levels specifically on HDL.
DATA STORAGE AND MANAGEMENT:
Every participant will be given a code number, all data will be saved according to the code
numbers. Privacy will be maintain of each and every participant. Records will be kept
confidential and used only for scientific purposes by authorized personnel. The hard copies
will be kept in locked cupboards and soft data will be managed in password protected
computers. Data will be stored at institutional level for almost 15 years.
DISSEMINATION OF FINDINGS AND PUBLICATION PLAN:
Investigators expect that Ajwa and intermittent fasting will significantly improve HDL levels
in order to enhance the cardiac protection. This research will help in promoting the
significance of use of functional food and fasting to improve overall health. Investigators
expect at least two publications from this study. The findings of the study will be presented
in international conference and will be published in well reputed journal.
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