ABSTRACT
BACKGROUND AND AIMS: A healthy diet is one of the pillars of familial hypercholesterolemia (FH) treatment. However, the best dietary pattern and indication for specific supplementation have not been established. Our aim is to conduct a pilot study to assess the effect of an adapted cardioprotective diet with or without phytosterol and/or krill oil supplement in participants with a probable or definitive diagnosis of FH, treated with moderate/high potency statins. METHODS: A national, multicenter, factorial, and parallel placebocontrolled randomized clinical trial with a superiority design and 1:1:1:1 allocation rate will be conducted. The participants will undergo whole exome sequencing and be allocated into four treatment groups: 1) a cardioprotective diet adapted for FH (DICAFH) þ phytosterol placebo þ krill oil placebo; 2) DICA-FH þ phytosterol 2 g/day þ krill oil placebo; 3) DICA-FH þ phytosterol placebo þ krill oil 2 g/day; or 4) DICA-FH þ phytosterol 2 g/day þ krill oil 2 g/day. The primary outcomes will be low-density lipoprotein (LDL)-cholesterol and lipoprotein (a) levels and adherence to treatment after a 120-day follow-up. LDL- and high-density lipoprotein (HDL)-cholesterol subclasses, untargeted lipidomics analysis, adverse events, and protocol implementation components will also be assessed. RESULTS: A total of 58 participants were enrolled between May e August 2023. After the end of the follow-up period, the efficacy and feasibility results of this pilot study will form the basis of the design of a large-scale randomized clinical trial. CONCLUSIONS: This study's overall goal is to recommend dietary treatment strategies in the context of FH.
Subject(s)
Hyperlipoproteinemia Type IIABSTRACT
While bird diversity in the Atlantic Forest can be considered well-known, how the communities have been affected by deforestation and habitat fragmentation is not. We studied birds in 10 forest fragments of distinct sizes (all originally within the Atlantic Forest) in southern Bahia. In 5,391 bird encounters, we found 251 species, with 46 endemics and eight considered globally vulnerable or endangered. We also compiled a list of the 380 species that should comprise the expected regional assemblage, and found that only 66% of these species were present in all the fragments combined. Only 9% of all observed species were found in all fragments. The largest fragment (700 ha) had the greatest number of endemic species (40), and seven threatened species. All fragments had some conservation-important species (some were found in one or a few fragments), but no fragment included them all. Fragments shared 10% of endemic species, but overall, the contingent of endemics was unique in each fragment. Finally, most functional traits of bird assemblages decreased with increasing fragment size. Neither species richness nor similarity correlated with fragment size or distance between fragments, and unknown, non-random factors probably influence the likelihood of species survival in each fragment. Thus, to ensure the persistence of threatened species, as well as maintain the most common species, conservation management decisions should include all fragments together because no single fragment is most representative of the local community.
