Cardiovascular Disease Clinical Trial
Official title:
Impact of Buttermilk on Cholesterol Concentration and Homeostasis
The role of low-density lipoprotein cholesterol (LDL-C) in the pathogenesis of
cardiovascular disease (CVD) and the clinical benefit of lowering LDL-C in high-risk
patients have both been well established. The key contribution of the intestine to whole
body cholesterol homeostasis and thus to regulating plasma cholesterol concentrations has
also been recognized over the last years. It is now clear that cholesterol homeostasis and
hence plasma LDL-C concentrations are maintained by a fine-tuned balance between intestinal
cholesterol absorption and endogenous cholesterol synthesis.
Cholesterol is a highly hydrophobic molecule and for that reason, its absorption is almost
entirely dependent on its solubilizing capacity in bile acid micelles within the intestine.
Recent in vitro studies from our laboratory have shown that buttermilk, a unique by-product
of butter manufacturing resulting from the churning of cream, has a strong inhibitory effect
on cholesterol micelle solubility. This phenomenon is likely due to the presence of unique
milk fat globule membrane (MFGM) fragments present in buttermilk that are produced during
the manufacturing of dairy cream into butter. Most of the work done so far on the subject
has focused on phospholipids purified from MFGM, while overlooking the complex and entire
MFGM mixture of bioactive proteins and polar lipids found in buttermilk. To the best of our
knowledge, no study has yet documented the impact of whole buttermilk on plasma cholesterol
concentration in human.
The general objective of this research project is to investigate for the first time the
impact of buttermilk on plasma cholesterol and other risk factors for CVD in humans. More
specifically, we propose to investigate the impact of buttermilk consumption on plasma LDL-C
and other CVD risk factors as well as on plasma surrogates of cholesterol absorption and
synthesis.
The proposed research will be undertaken as a double-blind randomized cross-over study with
participants being subjected to 2 consecutive treatments of 4 weeks each, in random order,
during which they will consume 45g of buttermilk and a macro- and micronutrient matching
placebo. The treatments will be different in their content of MFGM (present in buttermilk,
absent in placebo). Buttermilk and placebo will be fully characterized and formulated in
ready-to-use pouches, each pouch containing 22.5 g of artificially flavored products that
will have to be mixed in a fixed amount of water for consumption. Participants will have to
consume two pouches every day. Based on a 2500 kcal/day regimen, we have calculated that
these placebo and buttermilk formulation will contribute to approximately 200 kcal (from 5%
and 10%) of the daily energy intake of participants, who will be asked to maintain other
aspects of their nutritional habits constant throughout the study.
Fluctuations in female hormones have been shown to influence metabolic variables. For that
reason, outcomes at the end of each dietary phase will be measured during the follicular
phase of menstrual cycle (day 3 to day 9) in pre-menopausal women. This is another argument
for using a 4-wk intervention, which essentially corresponds to the mean duration of the
menstrual cycle of most women. Pre-menopausal women will start the first diet during the
first week of their menstrual cycle.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Prevention
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