1. Diet lower in carbohydrates seems to lead to increased LDL particle size. However, the effect of diet on LDL particle size is controversial. 2. When carbohydrate intake is high and comparable between groups, the effects of fatty acids like saturated fat, monounsaturated fat, and polyunsaturated fat on LDL particle size are also controversial. 3. When on a low carbohydrate diet high in red meat, replacing saturated fat with monounsaturated fat increases LDL particle size.

1. The effect of diet on LDL particle
size and LDL particle number
(LDL-P)
[Updated April 2015]
Registered dietitian, M.Sc, MBA
Reijo Laatikainen
www.twitter.com/pronutritionist
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2. Effect of diet on LDL particle size
is much more controversial than
some low carbohydrate diet
proponents claim
Favouring carbohydrate
restriction and/or higher SFA
intake
Dreon 1998
Krauss 2006
Kratz 2002
Egert 2011
Guay 2012
2
Favouring MUFA or PUFA
Wilkinson 2005
Mangravite 2013
Damasceno 2013 (nuts)
Hernández-Alonso 2015 (nuts)

3. 1. Diet lower in carbs seems to
lead to increased LDL particle
size.
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4. High intake of SFA ↓ amount of smallest
LDL particles, no effect in other particle
groups (in the context of low-carb diet)
Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS, Williams PT Separate effects of reduced
carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr. 2006
May;83(5):1025-31;.

5. Main driver of smaller (=worse) LDL
particles (=LDL pattern B) was higher
carb intake, not SFA content
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Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS, Williams PT Separate effects of reduced
carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr. 2006
May;83(5):1025-31;.
N= 178,
Interventions,
3-4 weeks in
weight stable
situation

6. Carbohydrate restriction increased
LDL-particle size vs low fat diet. In
other words both fat quality and
carbohydrate quantity changed.
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Dreon DM, Fernstrom HA, Campos H, Blanche P, Williams PT, Krauss RM. Change in dietary
saturated fat intake is correlated with change in mass of large low-density-lipoprotein particles in
men. Am J Clin Nutr. 1998 May;67(5):828-36.
“The results indicate significant associations of
dietary saturated fat intake with plasma LDL-
particle distributions. Change in dietary saturated
fat was associated positively with mass of larger
LDL particles and with peak LDL particle diameter
and
LDL flotation rate.”
N=103, interventions 6 weeks

7. Very short feeding study: Diet higher
in fat (37E%) increases LDL particle
size and LDL-C vs low fat diet (25E%)
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Guay V, Lamarche B, Charest A, Tremblay AJ, Couture P. Effect of short-term low- and high-fat
diets on low-density lipoprotein particle size in normolipidemic subjects. Metabolism. 2012
Jan;61(1):76-83.
“Compared with the low-fat diet, plasma cholesterol, LDL
cholesterol, and high-density lipoprotein cholesterol were
significantly increased … following the 3-day high-fat diet.The
high-fat diet was also associated with a significant increase in
LDL particle size (255.0 vs 255.9 Å;P = .01) and a significant
decrease in the proportion of small LDL particle (<255.0 Å)
(50.7% vs 44.6%, P = .01).”
N=12, interventions , 3 days, crossover, nonobese healthy men with
normal plasma lipid profile.

8. 2. When carbohydrate intake is
rather high and comparable
between the groups, effects of
fatty acids are controversial.
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9. Very high intake of PUFAs and lower
intake of SFA increased particle size
when carbohydrate intake was around
40%E
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Wilkinson P, Leach C, Ah-Sing EE, Hussain N, Miller GJ, Millward DJ, Griffin BA. Influence of
alpha-linolenic acid and fish-oil on markers of cardiovascular risk in subjects with an atherogenic
lipoprotein phenotype. Atherosclerosis. 2005 Jul;181(1):115-24.
,,
Sunflower + fish oil
Sunflower + fish oil
Fat intake increased in all groups
by 4-5 E% (carb intake ↓ 2-3 E%)
Fat intake increased in all groups
by 4-5 E% (carb intake ↓ 2-3 E%)
N=57

10. No difference in between low fat and
high MUFA diet (Diet higher in fat but
not a “real” low carb study)
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Egert S, Kratz M, Kannenberg F, Fobker M, Wahrburg U. Effects of high-fat and low-fat diets rich
in monounsaturated fatty acids on serum lipids, LDL size and indices of lipid peroxidation in
healthy non-obese men and women when consumed under controlled conditions. Eur J Nutr.
2011 Feb;50(1):71-9
“In conclusion, a low-fat and a high-fat diet, both
rich in MUFA, had similar effects on serum lipids
and lipoproteins, LDL size and indices of lipid
peroxidation in metabolically healthy, young and
non-obese men and women.”
N=25, interventions 4 weeks

11. High MUFA diet reduced slightly LDL
particle size vs diet high in SFA (carbs
at level of 40%E)
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Egert S, Kratz M, Kannenberg F, Fobker M, Wahrburg U. Effects of high-fat and low-fat diets rich
in monounsaturated fatty acids on serum lipids, LDL size and indices of lipid peroxidation in
healthy non-obese men and women when consumed under controlled conditions. Eur J Nutr.
2011 Feb;50(1):71-9
“The MUFA-rich diets significantly decreased the
size of the predominant LDL fraction.”
N=25
*) Diet high in SFA diet lasted only 1 week

12. High MUFA/PUFA diet slightly reduced
LDL particle size vs diet high in SFA
(in the context of high-carb diet)
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Kratz M1, Gülbahçe E, von Eckardstein A, Cullen P, Cignarella A, Assmann G, Wahrburg U.
Dietary mono- and polyunsaturated fatty acids similarly affect LDL size in healthy men and
women. J Nutr. 2002 Apr;132(4):715-8.
.
”In conclusion, changing the quality of dietary fat
from saturated to unsaturated fat slightly reduced
the LDL peak particle diameter, with no significant
difference between diets rich in MUFA, (n-6)-PUFA
and (n-3)-PUFA”
N=56, interventions 4 weeks

13. 3. When low carbohydrate diet is
high in red meat, replacing
saturated fat for MUFA increases
LDL particle size
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14. Low SFA, high MUFA diet reduced
LDP-P and small dense LDL particles
(low carb, high read meat context)
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Mangravite LM, Chiu S, Wojnoonski K, Rawlings RS, Bergeron N, Krauss RM. Changes in
atherogenic dyslipidemia induced by carbohydrate restriction in men are dependent on dietary
protein source. J Nutr. 2011 Dec;141(12):2180-5.
=LDL-P
High SFA (3 weeks) Low SFA (3 weeks)

15. 4. High intake of trans fat seem to
reduce LDL particle size
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16. Margarine lowest in trans fat has quite
similar effects as butter. High trans fat
intake reduced LDL particle size
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Mauger JF, Lichtenstein AH, Ausman LM, Jalbert SM, Jauhiainen M, Ehnholm C, Lamarche B.
Effect of different forms of dietary hydrogenated fats on LDL particle size. Am J Clin Nutr. 2003
Sep;78(3):370-5.
N=36, 5 weeks

17. The higher the TFA content of
margarine, the more deleterious effect
on LDL particle size
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Mauger JF, Lichtenstein AH, Ausman LM, Jalbert SM, Jauhiainen M, Ehnholm C, Lamarche B.
Effect of different forms of dietary hydrogenated fats on LDL particle size. Am J Clin Nutr. 2003
Sep;78(3):370-5.
” In conclusion, data from the present study support
the concept that consumption of trans fatty acids
has a deleterious effect on LDL particle size, thus
further contributing to the overall effect of trans fatty
acids on cardiovascular disease”

18. 5. Mediterranean diet
supplemented with nuts increased
LDL size and reduced LDL-P.
Extra virgin oil did NOT have this
favourable effect.
.
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19. Med diet enriched with nuts (high in
PUFA and MUFA) improved LDL
particle profile. Predimed subcohort
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Damasceno NR e tal. Mediterranean diet supplemented with nuts reduces waist circumference
and shifts lipoprotein subfractions to a less atherogenic pattern in subjects at high cardiovascular
risk. Atherosclerosis. 2013 Oct;230(2):347-53.
N=169, intervention
52 weeks
Only long term study
available

20. 6. Isolated effect of nuts
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21. Increased consumption of pistachio
nuts → decrease in small LDL particles
(in the context of high-carb diet)
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Hernández-Alonso P, Salas-Salvadó J, Baldrich-Mora M, Mallol R2, Correig X, Bulló M..
Effect of pistachio consumption on plasma lipoprotein subclasses in pre-diabetic subjects. Nutr
Metab Cardiovasc Dis. 2015 Apr;25(4):396-402.
” Small low-density lipoprotein particles (sLDL-P)
significantly decreased after pistachio consumption
compared to the nut-free diet (P = 0.023)”
N=55, 4-month cross over interventions, prediabetic subjects

22. Conclusion
• Many studies are very short, typically 3-4 weeks
• Replacing carbohydrates with fat seems to increase LDL particle size
• There is conflicting and limited evidence on the effects of fatty acid
classes (MUFA/PUFA vs SFA) on LDL particle size and LDL-P
• Trans fat seems to decrease LDL particle size. Currently available
margarines in most European countries are very low in trans fat
• Mediterranean diet improved LDL particle size in Predimed study when
enriched with nuts (high in MUFA and PUFA). Nuts may have beneficial
effect on LDL particle size
• Hard end point RCTs are needed to evaluate if changes LDL-particle
size translate into real clinical benefits
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23. What about apoB, non-HDL-
cholesterol, LDL, HDL and HDL
when going low carb?
Visit my other slide deck
http://www.slideshare.net/pronutritionist/repla
cing-carbohydrate-with-different-fats-effects-
in-apo-b-non-hdl-and-ldl
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24. Wellcome aboard!
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Reijo Laatikainen, RD, MBA
Images bought and licensed from BigStockPhoto. Snapshots from papers and sites referred to.
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