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Reduction of small dense LDL and Il-6 after intervention with Plantago psyllium in adolescents with obesity: a parallel, double blind, randomized clinical trial

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Abstract

Obesity can lead children and adolescents to an increased cardiovascular disease (CVD) risk. A diet supplemented with Plantago psyllium has been shown to be effective in reducing LDL-C and IL-6 in adolescents. However, there are no studies that have explored small-dense LDL (sdLDL) or HDL subclasses. The aim of this study was to evaluate the impact of a fiber dietary intervention on LDL and HDL subclasses in adolescents with obesity. In this parallel, double blind, randomized clinical trial, the participants were assigned to Plantago psyllium or placebo (10g/day for 7 weeks). We randomized 113 participants, and evaluated and analyzed 100 adolescents (50 in each group), 15 to 19 years with a body mass index of 29–34. We measured biochemical markers LDL and HDL subclasses using the Lipoprint system (Quantimetrix) and IL-6 by ELISA. Post-treatment there was a decrease in sdLDL between the groups 2.0 (0–5.0) vs 1 (0–3.0) mg/dl (p = 0.004), IL-6 median 3.32 (1.24–5.96) vs 1.76 (0.54–3.28) pg/ml, p <0.0001. There were no differences in HDL subclasses and no adverse effects were reported in either group.

Conclusions: Small dense LDL and IL-6 reduced in adolescents with obesity when consuming Plantago psyllium. This may be an early good strategy for the reduction of cardiovascular disease risk in this vulnerable population.

Trial registration: ISRCTN # 14180431. Date assigned 24/08/2020

What is Known:

• Supplementing the diet with Plantago psyllium lowers LDL-C levels.

What is New:

• First evidence that soluble fiber supplementation like Plantago psyllium decreases small dense LDL particles in association with lowered IL-6, reducing the risk of cardiovascular disease in obese adolescents.

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Availability of data and material

Data and material available by request to Ma. Eugenia Garay-Sevilla (megaray@ugto.mx).

Code availability

Not applicable.

Abbreviations

AI:

Atherogenic index

BMI:

Body mass index

CETP:

Cholesteryl ester transfer protein

CHO:

Carbohydrates

CVD:

Cardiovascular disease

FA:

Fatty acid

GLUT-4:

Glucose transporter type 4

HDL:

High-density lipoproteins

IL-6:

Interleukin-6

IQR:

Interquartile range

IR:

Insulin resistance

LCAT:

Lecithin cholesterol acyltransferase

LDL:

Low-density lipoprotein

RRCT:

Remnant reverse cholesterol transport

SCFA:

Short chain fatty acids

SdLDL:

Small dense low density lipoprotein

VLDL:

Very low-density lipoproteins

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Funding

University of Guanajuato (DAIP 211/2019 and 195/2020), Mining Company Santa María de la Paz, SLP, México, Touro-University California, Vallejo Ca. USA.

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Authors and Affiliations

  1. Department of Medical Science, Division of Health Science, University of Guanajuato, Campus León, Guanajuato, Mexico

    Alma Patricia González, Anaisa Flores-Ramírez, Karla Paola Gutiérrez-Castro, Claudia Luévano-Contreras, Armando Gómez-Ojeda & Ma Eugenia Garay-Sevilla

  2. High Specialty Medical Unit, Hospital of Gynecology and Pediatrics # 48, Mexican Institute of Social Security, León, Mexico

    Alma Patricia González & Gloria Patricia Sosa-Bustamante

  3. Glycation, Oxidation and Disease Laboratory, Dept. of Research, College of Osteopathic Medicine, Touro University California, Vallejo, CA, USA

    Russell Caccavello & Alejandro Gugliucci

  4. Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Mexico

    Juan Carlos Barrera-de León

  5. University of Guadalajara, Guadalajara, Mexico

    Juan Carlos Barrera-de León

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  1. Alma Patricia González
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  9. Ma Eugenia Garay-Sevilla
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Contributions

All authors contributed to the study conception and design; material preparation, data collection, and analysis were performed by Alma Patricia González, Anaisa Flores Ramírez, Karla Paola Gutiérrez Castro, Claudia Luévano Contreras, Russell Caccavello, Ma Eugenia Garay-Sevilla, and Alejandro Gugliucci]; the first draft of the manuscript was written by Alma Patricia González mentored by Ma Eugenia Garay-Sevilla and Alejandro Gugliucci, and all authors gave their input. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Ma Eugenia Garay-Sevilla or Alejandro Gugliucci.

Ethics declarations

Ethics approval

Ethics approval for this study was provided by the Locals Ethics Committees [University of Guanajuato (CIBIUG-P40-2017) and the Mexican Institute of Social Security, (R-2018-1002-052)] ISRCTN # 14180431.

Consent to participate

Written informed consent was obtained from the parents, and from all individual participants included in the study.

Consent for publication

All adolescents and their parents gave consent for the publication of their data anonymously if is necessary.

Conflicts of interest

The authors declare no competing interests.

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Communicated by Peter de Winter

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González, A.P., Flores-Ramírez, A., Gutiérrez-Castro, K.P. et al. Reduction of small dense LDL and Il-6 after intervention with Plantago psyllium in adolescents with obesity: a parallel, double blind, randomized clinical trial. Eur J Pediatr 180, 2493–2503 (2021). https://doi.org/10.1007/s00431-021-04064-5

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