Cholesterol Absorption and Synthesis in Children With Type 1 Diabetes

Abstract

OBJECTIVE—The levels of the surrogate markers of cholesterol absorption (cholestanol and plant sterols) and synthesis (cholesterol precursors) in serum have suggested that in adult type 1 diabetes, cholesterol absorption is high and synthesis is low compared with type 2 diabetic or control subjects. Accordingly, these findings were further studied in children with type 1 diabetes. RESEARCH DESIGN AND METHODS—Forty-eight children with diabetes were compared with 79 age- and sex-matched control subjects. The serum ratios of cholesterol absorption and synthesis markers were measured with gas-liquid chromatography. The study population was divided into triads (combining the two lowest triads) by serum cholestanol ratios of the control subjects indicating low to high cholesterol absorption efficiency. RESULTS—The ratios of the absorption and synthesis markers were similar in case and control subjects, and they were negatively related to each other in control subjects, being less consistent in diabetic patients. Thus, high cholesterol absorption was associated with low synthesis. Plant sterol ratios increased significantly with increasing cholestanol triads in both groups, but the values in the lowest triads were higher in case versus control subjects. CONCLUSIONS—Homeostasis between cholesterol absorption and synthesis is maintained in control children and somewhat less consistently in those with diabetes. The higher plant sterol ratios in diabetic versus control subjects in the lowest cholestanol triads suggest that cholesterol absorption is higher in children with diabetes versus control subjects but only within the range of low cholesterol absorption.