Reversal of Small, Dense LDL Subclass Phenotype by Normalization of Adiposity

Excess adiposity and high‐carbohydrate diets have been associated with an atherogenic lipoprotein phenotype (ALP) characterized by increased concentrations of small, dense low‐density lipoprotein (LDL) particles (pattern B). We tested whether weight loss and normalization of adiposity could reverse ALP in overweight men with pattern B. After consuming a moderate‐carbohydrate, high‐fat diet for 3 weeks, pattern B and nonpattern B (pattern A) men were randomized to a weight loss (n = 60 and n = 36, respectively) or control weight‐stable arm (n = 20 and n = 17, respectively). Men in the weight loss arm consumed ∼1,000 fewer calories per day over 9 weeks to induce an average ∼9 kg weight loss. In the control group, weight stability was maintained for 4 weeks after randomization. Weight loss led to the conversion of pattern B to pattern A in 58% of baseline pattern B men. Among men who achieved BMIs of