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Diethylaminoethoxyhexestrol causes hypertriglyceridemia in guinea pigs.

Treatment of rats, monkeys and man with diethylaminoethoxyhexestrol causes phospholipid storage in liver and other tissues. However, this drug has not been reported to alter plasma lipoprotein levels. When guinea pigs were treated with diethylaminoethoxyhexestrol, the fasting plasma triacylglycerol levels increased dramatically, from 43 to 1281 mg/dl, after only five doses of 12.5 mg/kg. Diethylaminoethoxyhexestrol-treated guinea pigs had reduced postheparin lipase activity. In addition, in vitro assays showed that this agent inhibited guinea pig postheparin lipoprotein lipase. It is hypothesized that diethylaminoethoxyhexestrol causes hypertriglyceridemia in guinea pigs because these animals are known to have low levels of serum activator for lipoprotein lipase and may be unusually susceptible to agents that inhibit lipoprotein lipase activity. The ability to produce hypertriglyceridemia in guinea pigs provides an animal model in which the metabolic consequences of hypertriglyceridemia can be studied.

Animals↗

Hypertriglyceridemia and its relation to tissue lipoprotein lipase activity in endotoxemic, Escherichia coli bacteremic, and polymicrobial septic rats.

Hypertriglyceridemia, commonly observed in septic patients, may result from a decreased ability of tissues to remove plasma triacylglycerol due to depressed lipoprotein lipase activity. While endotoxin administration results in substantial decreases in muscle lipoprotein lipase activity, enzyme activity is increased in animals subjected to other forms of stress and trauma. The present study was initiated to compare changes in plasma triacylglycerol concentrations and tissue lipoprotein lipase activities in rats challenged with endotoxin or live Escherichia coli (iv or ip) or rats subjected to polymicrobial peritoneal sepsis. Sixteen hours post-treatment plasma triacylglycerol levels were increased 200 to 300% in endotoxin- and E. coli-treated rats but did not differ from control animals subjected to peritoneal sepsis. At the same time, endotoxin administration resulted in significant decreases in heart (71-80%), soleus muscle (52-74%), and adipose tissue (21-32%) lipoprotein lipase activity regardless of the route injected. Intravenous E. coli also lead to a decrease in the three tissues examined while ip administration of E. coli reduced muscle and adipose tissue but not heart lipoprotein lipase activity. In contrast to endotoxemic and E. coli bacteremic rats, polymicrobial peritonitis resulted in significant increases in heart (46-89%) and skeletal muscle (18-39%) lipoprotein lipase activity. Thus, hypertriglyceridemia is not necessarily a consequence of sepsis but occurred in endotoxemic and bacteremic states when muscle and adipose tissue lipoprotein lipase activities were reduced. These findings support the postulate that sepsis-induced hypertriglyceridemia is likely to be associated with a decreased ability of lipoprotein lipase-containing tissues to clear circulating triacylglycerol.

Animals↗

Myocardial infarction in the familial forms of hypertriglyceridemia.

Among 74 hypertriglyceridemic patients who were referred for study because of hypertriglyceridemia, family investigations detected 19 with familial hypertriglyceridemia and 24 with familial combined hyperlipidemia. The frequency of myocardial infarction among adult living hyperlipidemic relatives of patients with familial combined hyperlipidemia was 17.5% (10/57). Five of these relatives had their infarct between the ages of 40 and 50 yr of age, and five before the age of 40 yr. The frequency of myocardial infarction in living hyperlipedemic relatives with familial hypertriglyceridemia was 4.7% (2/43) and was similar to the frequency of myocardial infarction among normolipidemic relatives (4.5%) or among spouse controls (5.2%). Mortality data due to myocardial infarction among relatives of index patients failed to contribute meaningful information.

Adult↗

Mechanism of carbohydrate-induced hypertriglyceridemia: plasma lipid metabolism in mice.

A group of mice were fed on a basal diet for 2 wk and thereafter maintained on a fat free high sucrose or starch diet for 5-6 wk. Hypertriglyceridemia was induced in the mice on feeding the high carbohydrate diets. The triglyceride levels reached maximum in 12 and 14-18 days on high sucrose and starch diets, respectively. This was associated with increased pre-beta-lipoproteins in plasma. Though males had higher levels of triglycerides than females on both the diets, this attained statistical significance only in the sucrose-fed group. Cholesterol and phospholipids recorded a significant increase only towards the end of the experimental period. The plasma lipid levels correlated with their secretion rates from the liver following an injection of Triton WR 1339. Furthermore, the hypertriglyceridemia appeared to be due to defective plasma triglyceride removal as seen by the reduced postheparin lipolytic activity (PHLA) of plasma and decreased triglyceride removal (intravenous fat tolerance test) in these animals. The triglycerides returned to almost normal levels when feeding was continued on the diets. During this adaptation, PHLA and fat tolerance of animals increased significantly. Higher triglycerides in the sucrose group seem to be due to a higher rate of secretion as well as slower removal of triglycerides in this group. The sex difference noticed in the plasma triglycerides at peak hypertriglyceridemia appeared to be mainly due to sex difference in removal rates. Blood sugar raised significantly in the animals maintained on both the diets.

Animals↗

Ability of exercise to inhibit carbohydrate-induced hypertriglyceridemia in rats.

The ability of spontaneous running to prevent carbohydrate-induced hypertriglyceridemia was studied in young, nonobese rats. Exercise-trained and sedentary rats were fed a diet consisting of (as percent total calories) 12% fat, 22% protein, and 66% carbohydrate. The source of the carbohydrate was varied, and experiments were carried out with sucrose and glucose as the sole dietary carbohydrate. Plasma triglyceride (TG) levels rose in response to both forms of dietary carbohydrate in both sedentary and exercise-trained rats, but the magnitude of the elevation was greatly attenuated in the exercise-trained group. Plasma insulin concentrations were also significantly lower in exercise-trained rats. Measurements of hepatic very low density lipoprotein (VLDL)-TG secretion rate and adipose tissue lipoprotein lipase (LPL) activity were made in an effort to determine how exercise-training prevented the development of carbohydrate-induced hypertriglyceridemia. The results of these studies indicated that perfused livers of exercise-trained rats secreted significantly less VLDL-TG, whereas adipose tissue LPL activity of the two groups was similar. On the basis of these results, it is postulated that the ability of exercise-training to inhibit carbohydrate-induced hypertriglyceridemia is due to an increase in insulin sensitivity resulting from chronic exercise. As a result, the postprandial insulin responses to high carbohydrate diets would be relatively reduced in exercise-trained rats, leading to decreased hepatic VLD-TG secretion, and lower plasma triglyceride concentrations.

Adipose Tissue↗

Reduction of carbohydrate-induced hypertriglyceridemia in (fa,fa) "Zucker" rats by the alpha-glucosidase inhibitor acarbose (BAY g 5421).

Inhibition of carbohydrate digestion by the alpha-glucosidase inhibitor acarbose (BAY g 5421)reduces carbohydrate-induced postprandial blood glucose increase and insulin secretion. As a consequence, in feeding experiments sucrose-induced hyperinsulinemia and hypertriglyceridemia in genetically obese (fa,fa) "Zucker" rats were dose-dependently reduced by addition of acarbose to the diet (15-80 mg/100 g feed). The body weight gain was dose-dependently reduced. In short-term experiments with a fat-free diet acarbose not only prevented serum triglyceride and free fatty acid increase in spite of lowered insulin concentrations but also decreased their concentrations below the values obtained on standard feed. Under these conditions there were no significant effects on body weight. Hypertriglyceridemia induced by i.v. injection of the lipoprotein lipase inhibitor Triton WR 1339 was reduced without affecting body weight in "Zucker" rats after 3 days on a fat-free diet supplemented with acarbose. The triglyceride increase was even lower than in animals kept on standard feed. The data demonstrate that acarbose reduces sucrose-induced hypertriglyceridemia in (fa,fa) "Zucker" rats by diminishing VLDL production and/or secretion rather than by increasing VLDL removal from the blood.

Acarbose↗

Compositional and metabolic heterogeneity of alpha 2- and beta-very-low-density lipoproteins in subjects with broad beta disease and endogenous hypertriglyceridemia.

The catabolism of alpha 2- and beta-very-low-density lipoproteins (VLDL) was studied in normolipidemic and hyperlipidemic subjects to determine whether differences in the catabolism of these subfractions are due to their composition. alpha 2-VLDL (cholesterol/triglyceride ratio, 00.18 +/- 0.06; and apoprotein E/C ratio, 0.27 +/- 0.22, n = 4) and beta-VLDL (cholesterol/triglyceride ratio, 0.67 +/- 0.13; and apoprotein E/C ratio, 1.05 +/- 0.52, n = 4) were isolated from subjects with broad beta disease, iodinated, and injected in five normolipidemic subjects, six with broad beta disease, and five with endogenous hypertriglyceridemia. VLDL, intermediate (IDL) and low-density lipoprotein (LDL) apoprotein (apo)-B radioactivity (tetramethylurea insoluble) following injection of 125I-labeled alpha 2- and beta-VLDL decayed biphasically in all subjects, and this decay in normolipidemic subjects was more rapid than in subjects with broad beta disease (P = 0.004) or endogenous hypertriglyceridemia (P = 0.004 for alpha 2- and P = 0.010 for beta-VLDL). The residence times, however, for the delipidation chain in alpha 2-VLDL were similar in all the subjects and varied from three to six hours. The decay of radioactivity in beta-VLDL in subjects with broad beta disease was much slower (residence time, 36.9 +/- 24.4 hr, n = 7) than in normolipidemic subjects (residence time, 7.56 +/- 4.6 hr, n = 5) or in subjects with endogenous hypertriglyceridemia (residence time, 10.6 +/- 4.65, n = 4). The residence time for alpha 2-VLDL was longer than for beta-VLDL in all subjects, suggesting that alpha 2-VLDL is a precursor to beta-VLDL. To test this directly, iodinated alpha 2-VLDL was injected into a subject with broad beta disease and the radioactivity in the subfractions was followed. The radioactivity from alpha 2-VLDL was transferred into beta-VLDL supporting, the notion that alpha 2-VLDL generated some beta-VLDL. Nicotinic acid treatment of a subject with broad beta disease accelerated the catabolism of alpha 2- and beta-VLDL without changing the VLDL composition.

Adult↗

Postchallenge plasma lipoprotein retinoids: chylomicron remnants in endogenous hypertriglyceridemia.

This study was conducted to determine whether chylomicron remnants accumulate in the plasma of patients with "endogenous" hypertriglyceridemia. Retinyl esters were used as markers of chylomicrons and chylomicron remnants since they are carried mainly if not exclusively by lipoproteins of intestinal origin. Seventy-six fasting normotriglyceridemic and hypertriglyceridemic patients were studied 12 to 15 hours after ingesting 25,000 IU of vitamin A. Plasma retinol and retinyl esters were measured by reversed-phase high-performance liquid chromatography. Chylomicronemia was assessed by flotation at unit gravity and by chylomicron flocculation in 3% polyvinylpyrrolidone. Plasma lipids, retinoids, lipoprotein cholesterol, and the electrophoretic mobility of very-low density lipoproteins were determined in a subset of 36 subjects. Progressively elevated plasma retinyl ester concentrations were observed among patients with mild, moderate, and severe hypertriglyceridemia. All subjects with fasting chylomicronemia had retinyl ester retention. The majority of subjects with mild or moderate hypertriglyceridemia (predominantly type IV hyperlipoproteinemia) also had elevated plasma concentrations of retinyl esters. Total plasma retinyl ester and plasma triglyceride concentrations correlated significantly (rs = 0.721, P less than 0.001) in nonchylomicronemic subjects. In addition, total plasma retinol concentrations were mildly elevated among hypertriglyceridemic subjects because retinol, as well as retinyl esters, is transported by triglyceride-rich lipoproteins. If lipoprotein remnants are atherogenic in man, then chylomicron remnant retention may accelerate atherogenesis in hypertriglyceridemic individuals.

Adult↗

Pathogenetic mechanisms of the endogenous hypertriglyceridemia in a nonobese rat model.

Male Sprague-Dawley IVA-SIV rats were compared to male Sprague-Dawley Charles River rats of the same age, body weight, and daily food intake. The IVA-SIV rats demonstrated hypertriglyceridemia (182 +/- 9.4 v 131 +/- 9.4 mg/dL, P less than 0.001), associated with increased fasting plasma glucose (115 +/- 3 v 84 +/- 2 mg/dL, P less than 0.001), and plasma insulin (35 +/- 5 v 19 +/- 2 microU/mL, P less than 0.001) levels. Furthermore, IVA-SIV rats responded to an oral glucose load with higher plasma glucose and insulin levels. Very-low-density lipoprotein (VLDL)-triglyceride (TG) turnover studies were performed, documenting a higher TG production rate, which correlated with the plasma TG concentrations, (r = 0.58, P less than 0.01) in the IVA-SIV rats. Since lipoprotein lipase activity in both adipose tissue and muscle was not significantly different in the two groups of rats, it appears that the hypertriglyceridemia in IVA-SIV rats is due to increased VLDL-TG secretion, associated with hyperglycemia, hyperinsulinemia, and increased plasma FFA levels. The IVA-SIV rats provide a model of endogenous hypertriglyceridemia, independent of obesity.

Adipose Tissue↗

Postprandial hemorrheology and apolipoprotein B metabolism in patients with familial hypertriglyceridemia.

Impaired postprandial lipoprotein metabolism has been found to be related to the extent of coronary artery disease. Moreover, since dyslipoproteinemias are associated with impaired hemorrheology, we investigated the effect of postprandial hypertriglyceridemia on hemorrheological parameters before and after triglyceride-lowering therapy. Triglyceride-rich lipoproteins (TRLs) separated by ultracentrifugation (d < 1.006 g/dL) and chylomicrons and chylomicron remnants (quantified by apolipoprotein [apo] B-48 determination) were determined after a fat load in 10 patients with familial hypertriglyceridemia before and after therapy with gemfibrozil (900 mg daily). Lipid and hemorrheological parameters (plasma and whole-blood viscosity [PV and BV], red cell aggregation [RCA], hematocrit, and fibrinogen) were determined at baseline and every hour up to 6 hours postprandially. Fasting total triglycerides and TRL triglycerides significantly decreased with gemfibrozil therapy (P < .01). Total triglycerides postprandially increased from 9.53 +/- 1.72 to 14.47 +/- 2.07 mmol/L (TRL triglycerides by 61%) before therapy (P < .05) and from 4.61 +/- 1.28 to 7.17 +/- 0.99 mmol/L (TRL triglycerides by 57%) after therapy (P < .05). The postprandial TRL apo B increase was reduced with gemfibrozil (from 11.6 +/- 2.8 to 20.7 +/- 5.0 mg/dL with therapy v 19.0 +/- 7.6 to 33.0 +/- 12.5 mg/dL before therapy, P < .05, respectively) with a proportionally greater increase in apo B-48 (119% and 169%, respectively) compared with apo B-100 (64% and 64%, respectively). Fasting RCA was improved with lipid-lowering therapy (P < .05), but PV, BV, RCA, and fibrinogen did not show any statistically significant postprandial changes either before or after lipid-lowering therapy. In summary, we did not find any statistically significant changes in hemorrheological parameters, despite a strong postprandial increase of triglycerides. In particular, these findings were independent of fasting triglyceride levels. We conclude that triglyceride-lowering therapy by gemfibrozil had no substantial beneficial effects with respect to hemorrheology in patients with familial hypertriglyceridemia.

Adult↗

Clinical significance of hypertriglyceridemia.

Available data suggest that elevated triglyceride levels in plasma, associated with increased VLDL or chylomicron remnants, are associated with premature coronary artery atherosclerosis. Whether this is a direct effect or as a result of the association of hypertriglyceridemia with decreased HDL as well as decreased LDL particle size remains to be determined. Many families with premature coronary disease have a genetic form of hypertriglyceridemia associated with decreased HDL, or with both decreased HDL and increased LDL cholesterol concentrations. In addition, subjects with severe hypertriglyceridemia in excess of 1000 mg/dl associated with elevation of plasma chylomicrons are at increased risk of developing recurrent pancreatitis. Therefore, triglycerides have been implicated in the pathogenesis of both atherosclerosis and pancreatitis.

Chylomicrons↗

Is the glucocorticoid-induced hypertriglyceridemia in uremic rats caused by decreased tissue lipoprotein lipase activity?

The glucocorticoid-induced hypertriglyceridemia in uremic rats is partly due to defective removal of triglyceride (Tg)-rich lipoproteins. To determine whether this was due to decreased lipoprotein lipase (LPL), the key enzyme involved in the hydrolysis of Tg-rich lipoproteins, the LPL activity in soleus, heart and adipose tissue and the triglyceride secretion rates (TgSR) of uremic rats treated with Triamcinolone or placebo were studied. Sprague-Dawley rats were made uremic by a 2-stage 5/6 nephrectomy and studied three weeks later. During the 3rd week, one group was treated with a five day course of Triamcinolone (0.5 mg/kg body weight i.m.) and the other given an equal volume of saline. Triamcinolone aggravated the hypertriglyceridemia in uremic rats. This was associated with an increase in soleus and heart LPL with no change in adipose tissue LPL. The TgSR was also increased in the Triamcinolone-treated rats. These data suggest that decreased LPL activity is not the cause of hypertriglyceridemia in these rats.

Adipose Tissue↗

Serum lipids in alcoholic patients with and without cirrhosis of the liver, with particular reference to endogenous familial hypertriglyceridemia.

The purpose of this study was to determine the frequency of hypertriglyceridemia in alcoholic patients with and without cirrhosis of the liver. It had been observed by others that subjects with endogenous familial hypertriglyceridemia (type IV hyperlipoproteinemia) showed an exaggerated lipidemic response to ingestion of alcohol, and, therefore, might be predisposed to hepatic cirrhosis. Comparison of 40 alcoholic cirrhotics with 40 noncirrhotic alcoholic patients showed no increased incidence of hypertriglyceridemia in either group. The findings suggest that the frequency of cirrhosis in the general population is not materially affected by subjects with this metabolic defect.

Adult↗

Metabolic regulation as a control for lipid disorders. II. Influence of (--)-hydroxycitrate on genetically and experimentally induced hypertriglyceridemia in the rat.

These studies were designed to determine whether genetically and experimentally induced hypertriglyceridemia were correlated with hyperlipogenesis, and whether inhibiting fatty acid synthesis would reduce serum triglyceride levels. Hypertrigylceridemia, resulting from genetic obesity in Zucker rats and fructose feeding or Triton administration to Charles River rats, was examined in relation to in vivo rates of heatic fatty acid synthesis, and the influence of (--)-hydroxycitrate (a potent competitive inhibitor of ATP citrate lyase) on serum triglyceride levels and lipogenesis was determined. Zucker obese rats demonstrated significantly increased rates of fatty acid synthesis and levels of serum triglycerides compared to their lean litter mates; lipogenic rates and circulating triglycerides were reduced markedly by the oral administration of (--)-hydroxycitrate. Fructose administered in the diet or drinking water induced a hypertriglyceridemia which was associated with a marked increase in hepatic lipogenesis, and (--)-hydroxycitrate reduced significantly both parameters. In contrast to the significant role that increased rates of lipogenesis apparently played in the development of hypertriglyceridemia in the Zucker rat and fructose-fed rat, Triton given intravenously produced a marked rise in serum triglycerides which could not be accounted for, to an appreciate extent, by increased rates of fatty acid synthesis. (--)-Hydroxycitrate reduced serum triglyceride levels and hepatic lipogenic rates equivalently in the Triton-treated and nontreated rats.

ATP Citrate (pro-S)-Lyase↗

A genetic model for control of hypertriglyceridemia and apolipoprotein B levels in the Johns Hopkins colony of St. Thomas Hospital rabbits.

The St. Thomas Hospital (STH) rabbit has been previously shown to have a Mendelian form of hypertriglyceridemia, accompanied by accelerated atherosclerosis, and these animals may serve as a useful model for human dyslipoproteinemia syndromes. Here we describe the establishment of a new colony of these STH animals, and present genetic analysis of triglyceride (TG) and apolipoprotein B (apoB) levels. Segregation analysis of TG in 39 STH animals and 24 controls gave evidence of Mendelian segregation for an allele leading to both elevated TG levels and increased variability in these levels. Predicted means from the most parsimonious model for the Johns Hopkins STH colony were quite similar to that seen in the original London colony, and this model accounted for 80% of the variation in TG seen in the sample. This hypertriglyceridemia locus indirectly influenced the mean apoB levels in these rabbits, and segregation analysis of mean apoB levels suggested a second locus controlling apoB levels. Analysis of residual apoB levels (adjusted for predicted effects of the hypertriglyceridemia locus) revealed clearer evidence for a second locus controlling mean apoB levels in this colony. Arguments for two distinct genetic mechanisms operating in these STH animals are presented.

Animals↗

Mechanisms for development of diabetic hypertriglyceridemia in streptozotocin-treated rats. Effect of diet and duration of insulin deficiency.

A combined ultrastructural and functional approach was employed to define the effects of duration of diabetes and of diet on various aspects of lipid metabolism in rats with severe streptozotocin (SZ)-induced insulin deficiency. Plasma triglyceride (TG) levels rose to a mean of 479 mg/100 ml 24 h after SZ administration in rats eating a fat-free, high carbohydrate diet as compared to a mean of 324 mg/100 ml in rats eating a high fat diet. These changes were associated with a commensurate increase in hepatocyte Golgi very low density lipoprotein (VLDL) content, but only a small increase in estimates of VLDL-TG secretion rate (post-Triton WR 1339 increment in plasma TG level). Although these findings are consistent with the thesis that VLDL-TG synthesis and secretion are increased 24 h after administration of SZ, it seemed unlikely that the observed increase in VLDL-TG secretion could entirely account for the severity of the hypertriglyceridemia. Thus, although lipoprotein removal rate was not measured directly, it was necessary to postulate that a defect in VLDL-TG removal was also present at this stage. Hypertriglyceridemia was still present 7 days later, only in this instance plasma TG levels were higher in rats eating the high fat diet (a mean of 589 mg/100 ml, as compared to 263 mg/100 ml). Rats with diabetes of 7-day duration had a 50% decrease in both TG entry rate and hepatocyte Golgi complex VLDL content, irrespective of diet. Thus, there was no evidence of increased VLDL-TG secretion in chronic insulin deficiency. In this instance, although not assessed directly, it was necessary to postulate that the hypertriglyceridemia in chronically insulin-deficient rats is due entirely to a defect in lipoprotein removal, involving both dietary and endogenous fat.

Animals↗

Transport of very low density lipoprotein triglycerides in varying degrees of obesity and hypertriglyceridemia.

Measurements of transport of triglycerides (TG) in very low density lipoproteins (VLDL) were carried out in 59 patients by injection of radioactive glycerol, determinations of specific activities of VLDL-TG for 48 h thereafter, and treatment of the data by multicompartmental analysis. The patients were divided into three groups: normal weight (89-120% ideal weight), mildly obese (120-135% ideal weight), and markedly obese (135% ideal weight). They had varying levels of VLDL-TG ranging from normal to markedly elevated. In many subjects, there was a positive correlation between concentrations and transport of VLDL indicating that overproduction of VLDL-TG contributed to hypertriglyceridemia. In others, and particularly in several markedly obese subjects, transport rates were greatly increased without significant hypertriglyceridemia, suggesting that they had enhanced capacity to clear TG. In all groups, however, there were patients whose degree of hypertriglyceridemia seemed out of proportion to their transport rates. This finding and the fact that many patients have increased secretion of VLDL-TG without elevated plasma TG suggests that both overproduction of VLDL-TG and insufficient enhancement of clearance contributed to the development of hypertriglyceridemia.The data showed a poor correlation between transport rates determined by our multicompartment analysis and single-exponential analysis used previously by other investigators (r = 0.46); this comparison was not improved by segregating patients according to their degree of obesity. Although two conversion pathways (fast and slow synthetic paths) were required to fit the data, there was no correlation between transport rates and the ratio of the two pathways. Also, despite the known pathway of conversion of VLDL to low density lipoprotein, no correlation was found between VLDL-TG transport rates and estimated low density lipoprotein-cholesterol concentrations.

Biological Transport↗

Interactions of obesity and glucose-stimulated insulin secretion in familial hypertriglyceridemia.

Plasma lipids and lipoproteins, glucose tolerance, plasma insulin response to glucose load, and liver function were examined in 81 relatives of 12 index cases with primary endogenous hypertriglyceridemia, hyperinsulinemia, and hepatic steatosis, as well as in 90 nonrelatives, including the spouses, as controls. Insulin hypersecretion (with or without glucose intolerance), endogenous hypertriglyceridemia, and abnormal liver function suggesting hepatic steatosis were shown to exist in the relatives mostly in combined fashion. Correlation analysis and stepwise multiple regression analysis revealed that the combined disorder developed on the basis of obesity. The incidence of diabetes mellitus was significantly high in the relatives (14.8 per cent) as compared with the normal Japanese population (3.5 per cent). Although the vertical transmission of the combined disorder was noted in almost all pedigrees, the frequency distribution analysis of insulin response, glucose tolerance, and plasma triglyceride showed the histograms of these variables similarly skewed to the right as compared with those of the controls, with no apparent bimodality. In view of the hitherto suggested role of insulin in triglyceride metabolism, it is concluded that hyperinsulinemia coupled with obesity seems to be the basic trait of this form of familial hypertriglyceridemia and hepatic steatosis, though the mode of transmission remains to be elucidated.

Adolescent↗