Reverse epidemiological findings in lipids among malnourished patients

Introduction: Reverse epidemiology is a term associated with counterintuitive effects associated with normal cholesterol levels but increased rates of cardiovascular morbidity and mortality along with high levels of inflammation and malnutrition. Therefore the purpose of this study was to determine if reverse epidemiological effects occurred with cholesterol in a systemically inflamed and malnourished group. Methods Lipid-profiles and serum albumin levels were collected from End-Stage Renal Disease (ESRD) patients (N=130) who were recruited from dialysis clinics. Patients donated 20 milliliters of blood after fasting. Patients were placed in an albumin group (>3.8 g/dL) or a hypoalbumin group (<3.8 g/dL) with low albumin being used as a proxy measure for a malnutrition-inflammation complex. Results: ANOVA revealed significant differences in LDL levels (p=.001), large LDL (p=.0001), LDL particle size (p=.038), and HDL (p=.045), with each variable reporting a reverse epidemiology effect with less risk (though cholesterol lipoprotein levels are high) associated with the hypoalbumin (more malnourished and inflamed) group. Total cholesterol was significantly different between groups (p=.050) but did not demonstrate a reverse epidemiology effect. LDL particle number, VLDL, large VLDL, and triglycerides were not significantly different. Discussion: Our study demonstrated a reverse epidemiological effect (increased risk with normal cholesterol values) with LDL, large LDL, LDL particle size and HDL agreeing with the few database studies on this subject. Findings that emerged with triglycerides suggested a trend towards a reverse epidemiological effect as well, but were not statistically significant. These are novel findings suggesting a reverse epidemiological effect can occur in ESRD patients.