Effects of weight change on HDL-cholesterol and its subfractions in over 28,000 men and women

BACKGROUND: Changes in body mass index (Delta BMI) have well-established relationships to changes in high-density lipoprotein (Delta HDL)-cholesterol concentrations; however, their relationships to Delta HDL subfractions are less well understood. OBJECTIVE: Assess the associations between Delta HDL and Delta BMI in a very large cohort. METHOD: Age and sex-adjusted Delta apo A1 concentrations were measured within 10 HDL subfractions in 14,121 women and 13,969 men using two-dimensional HDL-mapping. Significance was identified at .01 < P <=.05 (*), .001 < P <= .01 (dagger), .0001 < P <= .001 (double dagger), and P <= .0001 (<section>). RESULTS: Delta BMI was significantly associated with Delta alpha-1 (very large HDL, slope +/- SE, females: -0.39 +/- 0.07; males: -0.51 +/- 0.05), Delta alpha-3 (medium HDL, females: 0.18 +/- 0.04; males: 0.19 +/- 0.04), and Delta alpha-4 (small HDL, females: 0.14 +/- 0.03; males: 0.15 +/- 0.04 mg/dL per kg/m(2)). As a percent of baseline, the changes in alpha-1 per Delta BMI were nearly twice as great as the changes in HDL-cholesterol per Delta BMI in both males (-1.53% vs -0.77%) and females (-0.79% vs -0.42%). HDL-cholesterol decreased significantly in healthy-weight patients who became overweight, overweight patients who became class I or class II obese, class I obese patients who became class II obese, and class II obese patients who became class III. In contrast, HDL-cholesterol increased in class III obese patients who became class II or class I, class II obese patients who became class I or overweight, class I patients who became overweight or healthy weight, overweight patients who became healthy weight, and healthy weight patients who became underweight. CONCLUSIONS: Weight change significantly affects HDL-cholesterol concentrations throughout the obesity spectrum. Delta BMI's effect on Delta alpha-1 was nearly twice as great as its effect on HDL-cholesterol. (C) 2018 National Lipid Association. All rights reserved.