Thread by @realDaveFeldman

🧵 New paper on comparing advanced lipid testing (NMR) with body fat (adiposity) - ht @nicknorwitz

High adiposity associates with:
- ⬆️ #ApoB & #LDL-C
- ⬆️ #triglycerides
- ⬆️ levels of all fatty acids

How does this relate to #LEM? Let's unpack... /1

nature.com/articles/s4385…

2/ "Adiposity-related hypertriglyceridemia is mainly driven by increased numbers of triglyceride-rich VLDLs (which carry the largest proportion of triglycerides in blood). Concurrently, the cholesterol in these lipoproteins also seem to be higher at higher adiposity levels."

3/ And these next sentences are key -- take special note of the underlined text...

4/ So of course, an increase in remnants (particularly VLDL) result in higher overall levels of ApoB.

This is why I can never repeat enough times the problematic nature of looking at ApoB in isolation.

For more on this, see my article here: cholesterolcode.com/thoughts-regar…

5/ The Lipid Energy Model (#LEM) posits we may be seeing these patterns due to a lack of delivery by these VLDL of their triglyceride cargo.

Whereas with #LMHRs may be demonstrating the opposite -- trafficking a lot of TG via VLDL at a higher rate of delivery.

6/ This would explain why #LMHRs would have very high fasting ApoB given they have high turnover of VLDL, thus more LDL particles and cholesterol as a result.

This would also explain why VLDL and TG itself would be lower in a fasted state given the higher turnover itself.

7/ Regardless, this highlights exactly why study on #LMHRs are so crucial given our data on populations with high ApoB/LDL are typically confounded as we see in this study by collinearity to another disease state.

Hence the importance of research such as our #LMHRstudy.