Proposed Framework for Research Case Definitions of Lipedema.

Background: Our aim is to propose a framework for the development of a research case definition of lipedema, based on current available literature and those observations that can be applied to future lipedema research with the intent to standardize and strengthen the scientific evidence base. Methods and Results: We conducted a narrative review of the literature, and identified consensus characteristics and disputed characteristics that could be included in a research case definition of lipedema. After considering the strength of the evidence and how each characteristic might be measured in a research study, we recommended an approach for the development of a research case definition of lipedema that would be based on consideration of five agreed-upon characteristics, and five disputed, or less substantiated, characteristics as additional evidence to enhance specificity. Conclusions: We present a case definition framework for lipedema drawn from the scientific literature that can be applied to future studies on lipedema. Utilizing this framework should help to increase the sensitivity and specificity of case definition and provide an opportunity for meta-analysis of clinical studies and facilitate future research intercomparisons.

Short-term hyper-caloric high-fat feeding on a ketogenic diet can lower low-density lipoprotein cholesterol: the cholesterol drop experiment.

PURPOSE OF REVIEW: Conventional knowledge holds that saturated fat is the primary dietary driver of increases in low-density lipoprotein-cholesterol (LDL-C), and that high LDL-C seen among some persons consuming low-carbohydrate, high-fat diets is driven by increased saturated fat intake. This simple paradigm cannot account for the lipid patterns, nor for the magnitude of effect, observed in 'lean mass hyper-responders' on low-carbohydrate diets. The Lipid Energy Model (LEM) provides an alternative explanation for LDL-C increases seen in persons without obesity who adopt ketogenic diets and makes testable predictions, including that acute overfeeding, including increased saturated fat consumption, would decrease LDL-C levels. RECENT FINDINGS: This study reports data from an n  = 1 experiment, performed in duplicate, in which the subject consumed three ketogenic diets for 5 days that varied in caloric content: weight-maintenance (2278 kcal/day), hypo-caloric (1135 kcal/day), and hyper-caloric (4116 kcal/day). Consistent with the LEM, LDL-C and apolipoprotein B increased following caloric restriction and decreased following overfeeding, despite increased saturated fat consumption. Data from a case series of 24 individuals who underwent similar protocols similarly found that overfeeding on a ketogenic diet decreased LDL-C. SUMMARY: This n = 1 study and associated case series provide data that short-term overfeeding can lower LDL-C in the context of carbohydrate restriction.