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Vitamin E tocotrienol supplementation improves lipid profiles in chronic hemodialysis patients

Authors Daud ZAM, Tubie B, Sheyman M, Osia R, Adams J, Tubie S, Khosla P

Received 18 July 2013

Accepted for publication 10 October 2013

Published 28 November 2013 Volume 2013:9 Pages 747—761

DOI https://doi.org/10.2147/VHRM.S51710

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Zulfitri A Mat Daud,1 Boniface Tubie,2 Marina Sheyman,2 Robert Osia,2 Judy Adams,2 Sharon Tubie,2 Pramod Khosla1

1Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA; 2Great Lake Dialysis Clinic, LLC, Detroit, MI, USA

Purpose: Chronic hemodialysis patients experience accelerated atherosclerosis contributed to by dyslipidemia, inflammation, and an impaired antioxidant system. Vitamin E tocotrienols possess anti-inflammatory and antioxidant properties. However, the impact of dietary intervention with Vitamin E tocotrienols is unknown in this population.
Patients and methods: A randomized, double-blind, placebo-controlled, parallel trial was conducted in 81 patients undergoing chronic hemodialysis. Subjects were provided daily with capsules containing either vitamin E tocotrienol-rich fraction (TRF) (180 mg tocotrienols, 40 mg tocopherols) or placebo (0.48 mg tocotrienols, 0.88 mg tocopherols). Endpoints included measurements of inflammatory markers (C-reactive protein and interleukin 6), oxidative status (total antioxidant power and malondialdehyde), lipid profiles (plasma total cholesterol, triacylglycerols, and high-density lipoprotein cholesterol), as well as cholesteryl-ester transfer protein activity and apolipoprotein A1.
Results: TRF supplementation did not impact any nutritional, inflammatory, or oxidative status biomarkers over time when compared with the baseline within the group (one-way repeated measures analysis of variance) or when compared with the placebo group at a particular time point (independent t-test). However, the TRF supplemented group showed improvement in lipid profiles after 12 and 16 weeks of intervention when compared with placebo at the respective time points. Normalized plasma triacylglycerols (cf baseline) in the TRF group were reduced by 33 mg/dL (P=0.032) and 36 mg/dL (P=0.072) after 12 and 16 weeks of intervention but no significant improvement was seen in the placebo group. Similarly, normalized plasma high-density lipoprotein cholesterol was higher (P<0.05) in the TRF group as compared with placebo at both week 12 and week 16. The changes in the TRF group at week 12 and week 16 were associated with higher plasma apolipoprotein A1 concentration (P<0.02) and lower cholesteryl-ester transfer protein activity (P<0.001).
Conclusion: TRF supplementation improved lipid profiles in this study of maintenance hemodialysis patients. A multi-centered trial is warranted to confirm these observations.

Keyword: vitamin, tocotrienol-rich fraction, lipid profiles, hemodialysis, end-stage renal disease, nutrition intervention


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Effects of protein and omega-3 supplementation, provided during regular dialysis sessions, on nutritional and inflammatory indices in hemodialysis patients

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